COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:3517S.01I Bill No.:SB 809 Subject:Contracts and Contractors; Health Care; Health Care Professionals; Medical
Procedures and Personnel; Nurses; Physicians; Professional Registration and
Licensing
Type:Original Date:January 15, 2024Bill Summary:This proposal modifies provisions relating to advanced practice registered
nurses.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2025FY 2026FY 2027General Revenue($28,350)$0$0Total Estimated Net
Effect on General
Revenue($28,350)$0$0
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2025FY 2026FY 2027Total Estimated Net
Effect on Other State
Funds $0$0$0
Numbers within parentheses: () indicate costs or losses. L.R. No. 3517S.01I
Bill No. SB 809
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2025FY 2026FY 2027Total Estimated Net
Effect on All Federal
Funds $0$0$0
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2025FY 2026FY 2027Total Estimated Net
Effect on FTE 000
☐ Estimated Net Effect (expenditures or reduced revenues) expected to exceed $250,000 in any
of the three fiscal years after implementation of the act or at full implementation of the act.
☐ Estimated Net Effect (savings or increased revenues) expected to exceed $250,000 in any of
the three fiscal years after implementation of the act or at full implementation of the act.
ESTIMATED NET EFFECT ON LOCAL FUNDSFUND AFFECTEDFY 2025FY 2026FY 2027Local Government$0$0$0 L.R. No. 3517S.01I
Bill No. SB 809
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FISCAL ANALYSIS
ASSUMPTION
Section 334.104.13 – Advance Practice Registered Nurses
Officials from the Department of Health and Senior Services (DHSS) state this proposal
allows advanced practice registered nurses who have been in a collaborative practice
arrangement for a cumulative 2,000-documented hours with a collaborating physician and whose
license is in good standing to be exempt from entering into or remaining in a collaborative
arrangement in order to practice in the state.
Currently, when an advanced practice registered nurse applies for certification through the
Bureau of Narcotics and Dangerous Drugs (BNDD), they are required to submit the name and
license number of their collaborating physician. The system will not issue without that data
completed. BNDD will need to have ITSD amend the current database to allow nurse
practitioners to be “exempted” and not be required to complete that information. The estimated
cost is $28,350.
IT Consultants – one-time costs in FY 2028
• Requirements Gathering = 25 hours at a rate of $105 = $2,625
• Analysis = 20 hours at a rate of $105 = $2,100
• Design = 40 hours at a rate of $105 = $4,200
• Development = 125 hours at a rate of $105 = $13,125
• Test = 20 hours at a rate of $105 = $2,100
• Implementation = 20 hours at a rate of $105 = $2,100
• Project Management = 20 hours at a rate of $105 = $2,100
• On-going Support = None required
• Section Total IT Consultants = 270 hours at a rate of $105 = $28,350
Total General Revenue Expenditures
$28,350
Oversight does not have any information to the contrary. Therefore, Oversight will reflect the
estimated ITSD provided by DHSS to the General Revenue Fund in the fiscal note.
Officials from the Department of Commerce and Insurance and the Department of Social
Services
Oversight does not have any information to the contrary. Therefore, Oversight will reflect a zero
impact in the fiscal note for these agencies. L.R. No. 3517S.01I
Bill No. SB 809
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Rule Promulgation
Officials from the Joint Committee on Administrative Rules assume this proposal is not
anticipated to cause a fiscal impact beyond its current appropriation.
Officials from the Office of the Secretary of State (SOS) note many bills considered by the
General Assembly include provisions allowing or requiring agencies to submit rules and
regulations to implement the act. The SOS is provided with core funding to handle a certain
amount of normal activity resulting from each year's legislative session. The fiscal impact for
this fiscal note to the SOS for Administrative Rules is less than $5,000. The SOS recognizes that
this is a small amount and does not expect that additional funding would be required to meet
these costs. However, the SOS also recognizes that many such bills may be passed by the
General Assembly in a given year and that collectively the costs may be in excess of what the
office can sustain with its core budget. Therefore, the SOS reserves the right to request funding
for the cost of supporting administrative rules requirements should the need arise based on a
review of the finally approved bills signed by the governor.
FISCAL IMPACT – State GovernmentFY 2025
(10 Mo.)
FY 2026FY 2027GENERAL REVENUE FUNDCost – DHSS/ITSD
Amending current database
($28,350)$0$0ESTIMATED NET EFFECT TO
THE GENERAL REVENUE FUND($28,350)$0$0
FISCAL IMPACT – Local GovernmentFY 2025
(10 Mo.)
FY 2026FY 2027$0$0$0
FISCAL IMPACT – Small Business
Certain small medical businesses could be impacted by this proposal.
FISCAL DESCRIPTION
This act modifies provisions relating to the practice of advanced practice nursing. Under current
law, collaborative practice arrangements between physicians and registered professional nurses
may delegate to an advanced practice registered nurses ("APRNs") the authority to administer, L.R. No. 3517S.01I
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dispense, or prescribe certain controlled substances. This act provides that the section of law
providing for such agreements shall not apply to APRNs, excluding certified registered nurse
anesthetists ("CRNAs"), who have been in a collaborative practice arrangement for a cumulative
of 2000 documented hours with a collaborating physician and whose license is in good standing.
APRNs applying for licensure by endorsement may demonstrate to the Missouri State Board of
Nursing completion of such hours. Additionally, any such APRN shall not be required to enter
into or remain in such arrangement to practice in this state.
This act further modifies the definition of "practice of advanced practice nursing" by providing
that in addition to the practice of professional nursing and within the advanced practice
registered nurse role and population focus, the term shall include certain actions and measures.
This act also provides that an APRN's prescriptive authority shall include authority to prescribe,
dispense, and administer controlled substances as provided in current law. Furthermore, the
provision on prescriptive authority shall also apply to good-standing APRNs who have been in
collaborative practice arrangements for a cumulative of 2,000 documented hours with
collaborating physicians and who are no longer required to hold collaborative practice
arrangements.
This legislation is not federally mandated, would not duplicate any other program and would not
require additional capital improvements or rental space.
SOURCES OF INFORMATION
Department of Commerce and Insurance
Department of Health and Senior Services
Department of Social Services
Office of the Secretary of State
Joint Committee on Administrative Rules
Julie MorffRoss StropeDirectorAssistant DirectorJanuary 15, 2024January 15, 2024