COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.: 3574-01
Bill No.: SB 1004
Subject: Health Care; Licenses - Professional; Physicians; Nurses; Health Care Professionals
Type: Original
Date: February 25, 2004
FISCAL SUMMARY
| FUND AFFECTED | FY 2005 | FY 2006 | FY 2007 |
| Total Estimated
Net Effect on General Revenue Fund |
$0 | $0 | $0 |
| FUND AFFECTED | FY 2005 | FY 2006 | FY 2007 |
| Total Estimated
Net Effect on All State Funds |
$0 | $0 | $0 |
Numbers within parentheses: ( ) indicate costs or losses.
This fiscal note contains 5 pages.
| FUND AFFECTED | FY 2005 | FY 2006 | FY 2007 |
| Total Estimated
Net Effect on All Federal Funds |
$0 | $0 | $0 |
| FUND AFFECTED | FY 2005 | FY 2006 | FY 2007 |
| Local Government | (Unknown exceeding $615,313) | (Unknown exceeding $738,376) | (Unknown exceeding $738,376) |
ASSUMPTION
Officials from the Department of Economic Development - Division of Professional Registration, Missouri Consolidated Health Care Plan, Department of Insurance, Missouri Department of Conservation and Department of Public Safety - Missouri State Highway Patrol assume the proposal would have no fiscal impact on their organizations.
Officials from the Department of Mental Health (DMH) state the provisions of the proposal are already followed in DMH facilities for injection of such drugs/medications. It is further protocol/intent of the DMH that such procedures be followed in the community setting as well. For purposes of this fiscal note, it is assumed that all community providers of services already utilize persons currently licensed by the state board of nursing or the state board of registration for the healing arts for any injections of drugs/medications for which a fee is received.
Officials from the Department of Health and Senior Services (DOH) state the proposal would not be expected to fiscally impact the operations of the DOH. If a fiscal impact were to result, funds to support the program would be sought through the appropriations process.
Officials from the Department of Social Services - Division of Medical Services (DMS) state the proposal will have no fiscal impact on their organization. Under Missouri's Medicaid policy, ASSUMPTION (continued)
injections are only covered if administered by a physician or a nurse under the physician's direct personal supervision. The physician and nurse would be responsible for working within their scope of practice.
Officials from the Missouri Department of Transportation (DOT) state this proposal prohibits any drug or medication injection for a fee unless administered by a licensed person with exceptions for self-administration and for other persons if no monetary remuneration is received. The DOT's medical plan policy specifically states providers must possess a valid license to render covered services. The plan also allows, under the prescription drug card program, self-administration of drugs if the member is properly instructed on how to administer the medication.
As a result, the proposal will have no fiscal impact on MHTC/DOT or the Highway and Patrol Medical Plan.
Officials from the University of Missouri (UM) state the proposal appears to have an effect on its financial operations. All persons providing or administering drugs should be licensed or under the supervision of a licensed professional. However, the proposal does not allow for medical or nursing students to administer drugs while they are in a training program (they are generally not licensed yet). UM is not able to quantify the fiscal impact of this proposal.
Officials from Cooper County Memorial Hospital (Cooper Co.) state the proposal would affect its ability to offer services, especially in the rural area. The proposal would not allow Radiology Technicians or Paramedics to give injections. Cooper Co. estimates the loss to their facility related to Radiology Technicians and Paramedics no longer being able to give injections for a fee, at approximately $380,000 per year.
Officials from the Valle Ambulance District (Valle) state the proposal affects Paramedics in Missouri in that it only allows individuals licensed by the Board of Nursing or the Board of Healing Arts to inject medications. Unless it refers to Paramedics currently licensed by the Bureau of Emergency Medical Services, Department of Health and Senior Services by authority of RSMo 190, Valle will no longer be able to inject medications since ambulance services in Missouri take payment for those services. Also, paramedics in hospitals would no longer be able to inject medications. Valle estimates losses associated with this proposal to be well over $100,000 annually.
Officials from the St. Charles County Ambulance (St. Charles) state the proposal would result in an increase in pre-hospital care. A minimal increase of 10% to place one (1) nurse per ambulance would cost taxpayers approximately $258,376 for FY 04.
ASSUMPTION (continued)
Officials from Pemiscot Memorial Hospital, Eureka Fire Protection District, Mehville Fire District, and Taney County Ambulance District did not respond to our request for a statement of fiscal impact.
| FISCAL IMPACT - State Government | FY 2005
(10 Mo.) |
FY 2006 | FY 2007 |
| $0 | $0 | $0 |
| FISCAL IMPACT - Local Government | FY 2005
(10 Mo.) |
FY 2006 | FY 2007 |
| HOSPITALS, FIRE PROTECTION DISTRICTS AND AMBULANCE DISTRICTS | |||
| Loss - Hospitals, Fire Protection Districts and Ambulance Districts | |||
| Reduction in revenue collected for injections |
(Unknown exceeding $615,313) |
(Unknown exceeding $738,376) |
(Unknown exceeding $738,376) |
| ESTIMATED NET EFFECT ON HOSPITALS, FIRE PROTECTION DISTRICTS AND AMBULANCE DISTRICTS |
(Unknown exceeding $615,313) |
(Unknown exceeding $738,376) |
(Unknown exceeding $738,376) |
FISCAL IMPACT - Small Business
This proposal would be expected to impact small business physicians offices and other small businesses that rely on individuals other than physicians to administer injections.
DESCRIPTION
This proposal provides that only persons licensed by the Board of Healing Art and the Board of Nursing may administer a drug by injection for a fee. Such persons' scope of practice must include the administration of drugs by injection. Nothing in this proposal shall prevent the self-administration of drugs by injection or the administration of drugs by injection by family or friends if no fee is received.
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 Economic Development -
Division of Professional Registration
Department of Mental Health
Department of Health and Senior Services
Department of Social Services
Missouri Department of Transportation
Department of Public Safety -
Missouri State Highway Patrol
Missouri Consolidated Health Care Plan
Department of Insurance
Missouri Department of Conservation
Cooper County Memorial Hospital
University of Missouri
St. Charles County Ambulance
Valle Ambulance District
NOT RESPONDING: Pemiscot Memorial Hospital, Eureka Fire Protection District, Mehville Fire District, and Taney County Ambulance District
Mickey Wilson, CPA
Director
February 25, 2004