COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:1390H.01I Bill No.:HB 398 Subject:Health Care; Physicians; Public Health; Physicians; Insurance - Health; Victims of
Crime
Type:Original Date:February 24, 2025Bill Summary:This proposal modifies provisions relating to health care.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2026FY 2027FY 2028General Revenue($16,106)($20,390)($21,414)Total Estimated Net
Effect on General
Revenue($16,106)($20,390)($21,414)
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on Other State
Funds $0$0$0
Numbers within parentheses: () indicate costs or losses. L.R. No. 1390H.01I
Bill No. HB 398
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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. 1390H.01I
Bill No. HB 398
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FISCAL ANALYSIS
ASSUMPTION
§ 192.2521 - Specialty hospital forensic examinations of victims of sexual offenses
Officials from the Department of Health and Senior Services (DHSS) state the proposed
legislation exempts a specialty hospital from the provisions of sections 192.2520 and 197.135 if
such hospital has a policy for transfer of a victim of a sexual assault to an appropriate hospital
with an emergency department. As used in this section, "specialty hospital" means a hospital that
has been designated by the Department of Health and Senior Services as something other than a
general acute care hospital.
As a result of the proposed legislation, the Division of Regulation and Licensure, Section for
Health Standards and Licensure may experience minor additional work in terms of receiving and
processing complaints related to the statute.
It is assumed that the Department can absorb the costs of this bill with current resources.
However, if the workload significantly increased or other legislation was enacted, additional
resources would be requested through the appropriation process.
Oversight does not have any information to the contrary. Therefore, Oversight will reflect a zero
impact in the fiscal note for DHSS for this section.
§ 210.030 - Provisions relating to blood tests of pregnant women
Officials from the Department of Health and Senior Services (DHSS) state § 210.030.1 of the
proposed legislation would increase the number of patient samples that the Missouri State Public
Health Laboratory would receive for HIV, syphilis, Hepatitis C, and Hepatitis B testing.
Approximately 4.5% of women are pregnant at any one time so this percentage was used on the
total number of female samples received for HIV and syphilis testing in 2023. An additional 500-
800 samples a year would be tested for all conditions if this legislation passed. The estimated
number of pregnant women was used in the calculations for HIV, syphilis, Hepatitis C, and
Hepatitis B expenses for both screening and confirmatory costs. Confirmatory numbers were
based on current trends that are seen for each test.
Expenses (BOC); Laboratory Supplies (190), $19,327
The cost estimates are based upon the expected number of samples and cost per test with an
applied algorithm for testing and confirmation.
HIV (765 samples * $6.90 per test + $216 confirmation testing = $5,495)
Syphilis (585 samples * $3.00 per test + $1,037.30 confirmation testing = $2,792) L.R. No. 1390H.01I
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Hepatitis B (500 samples * $7.52 per test = $3,760)
Hepatitis C (500 samples * $10.03 per test + $2,265 confirmation testing = $7,280)
Total: $19,327
FY27 5% Increase:
HIV (765 samples * $7.25 per test + $226 confirmation testing = $5,772)
Syphilis (585 samples * $3.31 per test + $1,089 confirmation testing = $3,025)
Hepatitis B (500 samples * $7.90 per test = $3,950)
Hepatitis C (500 samples * $10.53 per test + $2,378 confirmation testing = $7,643)
Total: $20,390
FY28 5% Increase:
HIV (765 samples * $7.61 per test + $237 confirmation testing = $6,058)
Syphilis (585 samples * $3.48 per test + $1,143 confirmation testing = $3,179)
Hepatitis B (500 samples * $8.30 per test = $4,150)
Hepatitis C (500 samples * $11.06 per test + $2,497 confirmation testing = $8,027)
Total: $21,414
The projected total per year would be $19,327 in additional reagents and kit costs. The cost of
reagents will go up each year with an inflation cost of 5% per year. The Missouri State Public
Health Laboratory cannot absorb this cost. The workload for performing the additional testing
can be absorbed by current staff.
Oversight does not have information to the contrary. Oversight notes this proposal does not have
an emergency clause. Therefore, Oversight will reflect the FY 2026 estimates as provided by the
DHSS as $16,106 (($19,327/12)*10).
Responses regarding the proposed legislation as a whole
Officials from the Department of Commerce and Insurance, the Department of Social
ServicesMissouri Consolidated Health Care Plan, the Missouri Department of
Conservation, the Missouri Department of Transportation, the Oversight Division, the City
of Kansas City and the Newton County Health Department each assume the proposal will
have no fiscal impact on their respective organizations. Oversight does not have any information
to the contrary. Therefore, Oversight will reflect a zero impact in the fiscal note for these
agencies.
Officials from the Department of Public Safety (DPS), Missouri Highway Patrol (MHP)
defer to the Missouri Department of Transportation (MODOT)/MSHP Healthcare Board for an
impact statement for the potential fiscal impact of this proposal.
Oversight notes DPS/MHP’s deferral to the MODOT/ MSHP Healthcare Board for a statement
of fiscal impact; for fiscal note purposes, Oversight assumes no fiscal impact for DPS/MHP. L.R. No. 1390H.01I
Bill No. HB 398
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Oversight only reflects the responses received from state agencies and political subdivisions;
however, other cities, local public health agencies and hospitals 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.
FISCAL IMPACT – State GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028GENERAL REVENUE FUNDCosts – DHSS/MSPHL (§210.030)
Additional testing supplies p. 3-4($16,106)($20,390)($21,414)
ESTIMATED NET EFFECT ON
THE GENERAL REVENUE FUND($16,106)($20,390)($21,414)
FISCAL IMPACT – Local GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028$0$0$0
FISCAL IMPACT – Small Business
Certain small medical and laboratory businesses would be impacted by this proposal. (§ 210.030)
FISCAL DESCRIPTION
Under this act, a specialty hospital, meaning a hospital other than a general acute care hospital,
shall not be required to comply with certain statutory provisions relating to forensic
examinations of victims of sexual assault if such hospital has in place a policy for the transfer of
such victims to an appropriate hospital with an emergency department. (§ 192.2521)
Currently, a physician or other health care provider shall draw and test a pregnant woman's blood
at or soon after her first prenatal examination, with her consent, for syphilis, hepatitis B, or other
similar diseases. Under this act, the testing of the pregnant woman's blood shall also occur at the
twenty-eighth week of her pregnancy. Additionally, the test shall include hepatitis C and HIV. If
a mother tests positive for syphilis, hepatitis B, hepatitis C, or HIV, the physician or other health
care provider shall treat the mother in accordance with the most recent accepted medical
practice. L.R. No. 1390H.01I
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Current law requires the Department of Health and Senior Services to work in consultation with
the Missouri Genetic Disease Advisory Committee to make rules pertaining to these blood tests.
This act repeals the requirement to work with the Committee and requires that the tests be
approved or accepted by the U.S. Food and Drug Administration. (§ 210.030)
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 Public Safety, Missouri Highway Patrol
Department of Social Services
Missouri Consolidated Health Care Plan
Missouri Department of Conservation
Missouri Department of Transportation
Oversight Division
Newton County Health Department
City of Kansas City
Julie MorffJessica HarrisDirectorAssistant DirectorFebruary 24, 2025February 24, 2025