COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:1685H.01I Bill No.:HB 553 Subject:Health Care; Drugs and Controlled Substances; Department of Elementary and
Secondary Education; Nurses; Emergencies; Health Care Professionals
Type:Original Date:January 27, 2025Bill Summary:This proposal modifies provisions relating to epinephrine products.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2026FY 2027FY 2028General Revenue($14,400)$0 to ($14,400)$0 to ($14,400)Total Estimated Net
Effect on General
Revenue($14,400)$0 to ($14,400)$0 to ($14,400)
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. 1685H.01I
Bill No. HB 553
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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 to (Unknown)$0 to (Unknown)$0 to (Unknown) L.R. No. 1685H.01I
Bill No. HB 553
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FISCAL ANALYSIS
ASSUMPTION
Sections 167.630, 190.246, & 167.627 - Modifies provisions relating to epinephrine products
Officials from the Department of Social Services (DSS) assume the cost of Epinephrine nasal
spray devices has an average cost of $100 per device. It is anticipated that the Division of Youth
Services would need to purchase 144 Epinephrine devices to meet the needs of this legislation.
Therefore, the fiscal impact to DYS would be $14,400 in FY 2026 and an ongoing cost of $0 to
$14,400 for the fiscal years following.
Oversight does not have any information to the contrary. Therefore, Oversight will reflect the
cost estimated by DSS in the fiscal note.
Officials from the Office of Attorney General (AGO)
arising from this proposal can be absorbed with existing resources. The AGO may seek
additional appropriations if the proposal results in a significant increase in litigation or
investigation costs.
Oversight does not have any information to the contrary. Therefore, Oversight assumes the
AGO will be able to perform any additional duties required by this proposal with current staff
and resources and will reflect no fiscal impact to the AGO for fiscal note purposes.
Officials from the Department of Elementary and Secondary Education, Department of
Health and Senior Services, Department of Mental Health, Department of Public Safety -
Fire Safety, Missouri Highway Patrol, Office of the State Public DefenderOffice of the
State Treasurer 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 Audrain County Health Department assume the proposal will have a fiscal
impact.
Officials from the Newton County Health Department, Phelps County Sheriff’s Office
Kansas City Police DepartmentSt. Louis County Police Department each assume the
proposal will have no fiscal impact on their organizations.
Oversight notes the proposal authorizes each board of education in this state to grant permission
to pupils, as well as each school board in this state to grant permission to school nurses to use
this medication (single-use epinephrine nasal sprays). Oversight assumes there could be a
potential cost to schools to purchase these devices. Therefore, Oversight will reflect a $0 to
Unknown cost to schools in the fiscal note. L.R. No. 1685H.01I
Bill No. HB 553
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Oversight only reflects the responses that we have received from state agencies and political
subdivisions; however, other local agencies, schools, and associations were requested to respond
to this proposed legislation but did not. A general listing of political subdivisions included in our
database is available upon request.
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 2026
(10 Mo.)
FY 2027FY 2028GENERAL REVENUECost – DSS – to purchase epinephrine
nasal spray devices §§167.630, 190.246
& 167.627($14,400)$0 to ($14,400)$0 to ($14,400)
ESTIMATED NET EFFECT ON
THE GENERAL REVENUE FUND($14,400)$0 to ($14,400)$0 to ($14,400) L.R. No. 1685H.01I
Bill No. HB 553
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FISCAL IMPACT – Local GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028LOCAL POLITICAL
SUBDIVISIONS
Cost – School Districts - to purchase
epinephrine nasal spray devices
§§167.630, 190.246 & 167.627
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT ON
LOCAL POLITICAL
SUBDIVISIONS
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
FISCAL IMPACT – Small Business
No direct fiscal impact to small businesses would be expected as a result of this proposal.
FISCAL DESCRIPTION
This bill adds single-use epinephrine nasal spray to provisions of statute that permit the
possession and self-administration of the medication to treat a student's chronic health condition,
such as asthma or anaphylaxis.
The bill authorizes each board of education in this state to grant permission to pupils, as well as
each school board in this state to grant permission to school nurses to use this medication.
This bill additionally modifies existing provisions for epinephrine possession, use limitations,
and stock supply by adding single-use epinephrine nasal sprays as eligible products.
Current law authorizes qualified first responders, as defined in the bill, to administer epinephrine
auto-injectors to a person who is suffering from an apparent anaphylactic reaction. This bill
extends that authorization to single-use epinephrine nasal sprays. L.R. No. 1685H.01I
Bill No. HB 553
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SOURCES OF INFORMATION
Attorney General’s Office
Department of Elementary and Secondary Education
Department of Health and Senior Services
Department of Mental Health
Department of Public Safety - Fire Safety
Missouri Highway Patrol
Department of Social Services
Office of the Secretary of State Office of the State Public Defender
Office of the State Treasurer
Joint Committee on Administrative Rules
Audrain County Health Department
Newton County Health Department
Phelps County Sheriff’s Office
Kansas City Police Department
St. Louis County Police Department
Julie MorffJessica HarrisDirectorAssistant DirectorJanuary 27, 2025January 27, 2025