COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:2536H.01I Bill No.:HB 1133 Subject:Ambulances and Ambulance Districts; Taxation and Revenue - General Type:Original Date:February 17, 2025Bill Summary:This proposal modifies provisions relating to the ground ambulance service
reimbursement allowance tax.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2026FY 2027FY 2028GeneralUp to $60,000Up to $60,000Up to $60,000Total Estimated Net
Effect on General
RevenueUp to $60,000Up to $60,000Up to $60,000
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028University Of
Missouri Healthcare(Up to $60,000)(Up to $60,000)(Up to $60,000)
Total Estimated Net
Effect on Other State
Funds(Up to $60,000)(Up to $60,000)(Up to $60,000)
Numbers within parentheses: () indicate costs or losses. L.R. No. 2536H.01I
Bill No. HB 1133
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on All Federal
Funds $0$0$0
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2026FY 2027FY 2028Total 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 2026FY 2027FY 2028Local Government$0$0$0 L.R. No. 2536H.01I
Bill No. HB 1133
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FISCAL ANALYSIS
ASSUMPTION
§ 190.800 - Ground ambulance service reimbursement allowance tax
Officials from the University of Missouri Health Care (UMHC) state they have reviewed the
proposed legislation and have determined that, as written, using the State MMIS (Medicaid
Management Information System) data for CY2023 the impact would be $35,000 and using the
State MMIS data for CY2024 the impact would be $60,000.
Oversight does not have information to the contrary and therefore, Oversight will reflect the
estimates as provided by the UMHC as a cost of up to $60,000 annually.
Officials from the Department of Social Services (DSS) state the passage of the proposed
legislation would require a previously excluded ground ambulance provider to pay an ambulance
service reimbursement allowance tax. Currently, this proposal only affects the Board of Curators
of the University of Missouri.
Oversight does not have information to the contrary and therefore, Oversight will reflect the
estimates as provided by the UMHC as a savings to GR of up to $60,000 annually.
Officials from the Department of Health and Senior Services assume the proposal will have no
fiscal impact on their organization. Oversight does not have any information to the contrary.
Therefore, Oversight will reflect a zero impact in the fiscal note.
Oversight only reflects the responses received from state agencies and political subdivisions;
however, other hospitals and emergency medical services were requested to respond to this
proposed legislation but did not. A listing of political subdivisions included in the Missouri
Legislative Information System (MOLIS) database is available upon request. L.R. No. 2536H.01I
Bill No. HB 1133
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FISCAL IMPACT – State GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028GENERAL REVENUE FUND Savings - DSS (§190.800) Offset –
provider tax being paid by UMHC,
rather than GR p. 3Up to $60,000Up to $60,000Up to $60,000
ESTIMATED NET EFFECT ON
THE GENERAL REVENUE FUNDUp to $60,000Up to $60,000Up to $60,000
UNIVERSITY OF MISSOURI
HEALTHCARE
Cost - UMHC (§190.800) Payment of
ambulance provider tax p. 3(Up to $60,000)(Up to $60,000)(Up to $60,000)
ESTIMATED NET EFFECT ON
THE UNIVERSITY OF MISSOURI
HEALTHCARE
(Up to
$60,000)
(Up to
$60,000)
(Up to
$60,000)
FISCAL IMPACT – Local GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028$0$0$0
FISCAL IMPACT – Small Business
No direct fiscal impact to small businesses would be expected as a result of this proposal.
FISCAL DESCRIPTION
For the purposes of reimbursement allowance taxes, current law exempts ambulance services
that are owned and operated by an entity owned and operated by the state of Missouri from being
required to pay an ambulance service reimbursement allowance tax. This bill repeals that
exemption. (§ 190.800) L.R. No. 2536H.01I
Bill No. HB 1133
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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 Health and Senior Services
Department of Social Services
University of Missouri Health Care
Julie MorffJessica HarrisDirectorAssistant DirectorFebruary 17, 2025February 17, 2025