COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:1880S.01I Bill No.:SB 824 Subject:Department of Commerce and Insurance - Health; Medical Procedures and
Personnel; Health Care; Health, Public; Federal - State Relations
Type:Original Date:April 7, 2025Bill Summary:This proposal enacts provisions relating to insurance coverage of genetic
screenings for cancer risk.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND
AFFECTED
FY 2026FY 2027FY 2028General Revenue
Fund
(Could exceed
$113,000)
(Less than
$63,000)
(Less than
$63,000)
Total Estimated
Net Effect on
General
Revenue
(Could exceed
$113,000)
(Less than
$63,000)
(Less than
$63,000)
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND
AFFECTED
FY 2026FY 2027FY 2028
Other State(Less than $22,000)(Less than $22,000)(Less than $22,000)
State Road Fund
(0320) ($100,000)($100,000)($100,000)
Conservation
Commission Fund
(0609)*(Less than $250,000)(Less than $250,000)(Less than $250,000)
Total Estimated
Net Effect on
Other State
Funds(Less than $372,000)(Less than $372,000)(Less than $372,000)
* Unknown number of members utilizing new health benefit coverage.
Numbers within parentheses: () indicate costs or losses. L.R. No. 1880S.01I
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND
AFFECTED
FY 2026FY 2027FY 2028Federal Funds(Less than $15,000)(Less than $15,000)(Less than $15,000)Total Estimated
Net Effect on All
Federal Funds(Less than $15,000)(Less than $15,000)(Less than $15,000)
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)
* Unknown number of members utilizing new health benefit coverage. L.R. No. 1880S.01I
Bill No. SB 824
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FISCAL ANALYSIS
ASSUMPTION
§376.1260 – Heath Benefit Plan Coverage
Officials from the Missouri Consolidated Health Care Plan (MCHCP) assume this proposal
enacts provisions relating to insurance coverage of genetic screenings for cancer risk.
As MCHCP is not a health care plan under the definition of 376.1350, this legislation would not
apply to MCHCP using that definition. However, section 104.801 requires MCHCP to follow
any law which mandates coverage of specific health benefits, services, or providers. Since this
legislation does mandate benefits, services, or providers it would apply to MCHCP.
The potential fiscal impact of this proposal is less than $100,000.
MCHCP currently covers this testing in most instances. There may be a few instances that this
bill would mandate coverage that would not be covered today. However, based on the low
number of claims that they currently receive and the low-cost impact, they do not believe the
increase to be more than $100,000.
Oversight will reflect MCHCP’s estimated cost of less than $100,000 annual cost to the General
Revenue Fund, Other State Funds and Federal Funds.
General RevenueLess than $63,00063%Federal FundsLess than $22,00022%Other FundsLess than $15,00015%TotalLess than100%
*MCHCP Fund Split Percentages provided by Budget & Planning
Officials from the Missouri Department of Transportation (MoDOT) state the
MoDOT/MSHP health care plan estimates these provisions will cost $100,000 annually from the
State Road Fund based on unit costs and the current cost share at a minimal amount. This could
vary depending on increased utilization.
Oversight does not have any information to the contrary. Therefore, Oversight will reflect the
estimated cost provided by MoDOT to the State Road Fund (0320).
Officials from the Missouri Department of Conservation (MDC) assume the proposal have an
unknown fiscal impact of less than $250,000. L.R. No. 1880S.01I
Bill No. SB 824
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Oversight does not have any information to the contrary. Therefore, Oversight will reflect the
estimated cost provided by MDC to the Conservation Commission Fund (0690) as less than
$250,000.
Oversight assumes this provision could have a fiscal to other government health plans. Since it
is unknown if members of the health benefit plan will utilize the new coverage, Oversight will
reflect a $0 to Unknown fiscal impact to local political subdivisions.
Officials from the Department of Commerce and Insurance (DCI) state the Affordable Care
Act (ACA) requires all non-grandfathered individual and small group health plans to cover a
core set of healthcare services within 10 essential health benefit (EHB) categories. In 2012,
Missouri, like other states, adopted a benchmark plan that defined the core benefits these plans
must offer in the state. The benchmark plan was updated in 2017, based on a plan that was sold
in 2014. Missouri has not made any further updates to its EHB benchmark plan. The ACA also
requires that the cost of a new coverage mandate added by a state after adoption of its benchmark
plan that is above and beyond the EHB benchmark will be the responsibility of the state.
45 C.F.R 155.170 requires states to defray the cost of additional required benefits mandated by a
state on or after January 1, 2012. States may require qualified health plans to offer benefits in
addition to essential health benefits. States will identify which state-required benefits are in
addition to the EHB and must make payments to defray the cost of additional benefits either to
enrollees in qualified health plans or directly to the qualified health plans, on behalf of their
enrollees.
Documentation provided by the U. S. Department of Health and Human Services, Center for
Consumer Information & Insurance Oversight (CCIIO) in October 2018 instructed states as
follows:
Although it is the state’s responsibility to identify which state required benefits require defrayal,
states must make such determinations using the framework finalized at §155.170, which
specifies that benefits required by state action taking place on or before December 31, 2011, may
be considered EHB, whereas benefits required by state action taking place after December 31,
2011, other than for purposes of compliance with federal requirements, are in addition to EHB
and must be defrayed by the state. For example, a law requiring coverage of a benefit passed by a
state after December 31, 2011, is still a state mandated benefit requiring defrayal even if the text
of the law says otherwise.
This proposal requires, in pertinent part, that “Any health benefit plan delivered, issued for
delivery, continued, or renewed in this state on or after January 1, 2026, shall provide coverage
for prostheses and expenses for scalp hair prostheses worn for hair loss suffered as a result of
cancer treatment.” This provision appears to create a new mandate for which the state must
defray payments, as required under federal law. As a result, the state may be required to defray
the actuarial cost of new coverage requirement and make payments to either issuers or
beneficiaries to negate potential premium increases. DCI does not know the increased utilization L.R. No. 1880S.01I
Bill No. SB 824
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that may be created by the provisions of this proposal. As a result, there is a zero to unknown
negative impact to General Revenue.
In 2011, the Missouri General Assembly enacted section 376.1190, which states that “any health
care benefit mandate proposed after August 28, 2011, shall be subject to review by the oversight
division of the joint committee on legislative research. The oversight division shall perform an
actuarial analysis of the cost impact to private and public payers of any new or revised mandated
health care benefit proposed by the general assembly after August 28, 2011, and a
recommendation shall be delivered to the speaker and the president pro tem prior to mandate
being enacted.
Oversight notes, in 2011, the Missouri General Assembly enacted section 376.1190, which
states, “any health care benefit mandate proposed after August 28, 2011, shall be subject to
review by the Oversight Division of the Joint Committee on Legislative Research. The Oversight
Division shall perform an actuarial analysis of the cost impact to private and public payers of any
new or revised mandated health care benefit proposed by the general assembly after August 28,
2011, and a recommendation shall be delivered to the speaker and the president pro tem prior to
mandate being enacted.”
The customary process for an actuarial analysis involves Oversight contracting with an outside
firm who will request experience data from the largest insurance carries in the State of Missouri.
Since current law (§376.1190) requires any “proposed” mandate receive an actuarial analysis, the
timing may not allow for such in-depth reviews. In 2013 Oversight contracted with a company to
perform an actuarial analysis for Senate Bill 262, Senate Bill 159, and Senate Bill 161. Due to
the timing of the analysis, the company noted requesting outside data was not possible. This
limited analysis in 2013 cost almost $25,000. Given the cost increases over the last ten years, the
varying degree of available information to the outside firm and the potential for more in-depth
analysis if the information and timing allow, Oversight can easily assume that a current analysis
“could exceed $50,000”.
The Oversight Division does not currently have the appropriation to cover the costs of an
actuarial analysis and would need to request such additional funding through the budget process.
Oversight will reflect a onetime cost of “Could Exceed $50,000” to the General Revenue Fund in
FY 2026.
Officials from the Department of Public Safety - Missouri Highway Patrol defer to the
MoDOT/MHP Health Care Board for response relating to the fiscal impact of this proposal on
their organization.
Officials from the Department of Health and Senior Services 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. 1880S.01I
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Oversight only reflects the responses received from state agencies and political subdivisions;
however, other city officials 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
Government
FY 2026
(10 Mo.)
FY 2027FY 2028GENERAL REVEUE
FUND
Cost – Oversight Division
Actuarial Analysis
§376.1260 p.5
(Could exceed
$50,000)$0$0
Cost – MCHCP
Genetic Screening
§376.1260 p.3(Less than $63,000)(Less than $63,000)(Less than $63,000)
ESTIMATED NET
EFFECT TO THE
GENERAL REVENUE
FUND
(Could exceed
$113,000)
(Less than
$63,000)
(Less than
$63,000)
OTHER STATE FUNDSCost – MCHCP
Genetic Screening
§376.1260 p.3
(Less than
$22,000)
(Less than
$22,000)
(Less than
$22,000)
ESTIMATED NET
EFFECT TO OTHER
FUNDS
(Less than
$22,000)
(Less than
$22,000)
(Less than
$22,000) L.R. No. 1880S.01I
Bill No. SB 824
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STATE ROAD FUNDCost – MoDOT
Genetic Screening
§376.1260 p.4($100,000)($100,000)($100,000)
ESTIMATED NET
EFFECT TO THE
STATE ROAD FUND
(0320)($100,000)($100,000)($100,000)
CONSERVATION
COMMISSION FUND
Cost – MDC
Genetic Screening
§376.1260 p. 4$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
ESTIMATED NET
EFFECT TO THE
CONSERVATION
COMMISSION FUND
(0609)$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
FEDERAL FUNDSCost – MCHCP
Genetic Screening
§376.1260 p. 3
(Less than
$15,000)
(Less than
$15,000)
(Less than
$15,000)
ESTIMATED NET
EFFECT TO FEDERAL
FUNDS
(Less than
$15,000)
(Less than
$15,000)
(Less than
$15,000) L.R. No. 1880S.01I
Bill No. SB 824
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FISCAL IMPACT – Local
Government
FY 2026
(10 Mo.)
FY 2027FY 2028LOCAL POLITICAL
SUBDIVISIONS
*Cost – Local Political
Subdivisions
Genetic Screening
§376.1260 p. 4$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
ESTIMATED NET
EFFECT TO LOCAL
POLITICAL
SUDBVISIONS$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
* Unknown number of members utilizing new health benefit coverage.
FISCAL IMPACT – Small Business
No direct fiscal impact to small businesses would be expected as a result of this proposal.
FISCAL DESCRIPTION
This act requires health benefit plans to provide coverage for genetic testing and genetic
counseling, as defined in the act, of individuals who are at increased risk of potentially harmful
mutations to the BRCA gene due to a personal or family history of certain cancers.
The act prohibits insurers from using these tests and counseling in underwriting decisions such as
calculating premiums or determining coverage, and prohibits insurers from imposing cost-
sharing with regard to the required coverage.
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 Public Safety – Missouri Highway Patrol
Department of Social Services
Missouri Department of Conservation L.R. No. 1880S.01I
Bill No. SB 824
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Missouri Department of Transportation
Missouri Consolidated Health Care Plan
Oversight Division
Julie MorffJessica HarrisDirectorAssistant DirectorApril 7, 2025April 7, 2025