COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.: 3084-14
Bill No.: HCS for SCS for SB 712
Subject: Emergencies; Health Care; Health Care Professionals; Health, Public; Governor & Lt. Governor; Health Dept.; Medical Procedures and Personnel; Public Safety Dept.
Type: #Corrected
Date: May 1, 2002
#Corrected to include corrected responses from Department of Health and Senior Services and the Department of Mental Health
FISCAL SUMMARY
| FUND AFFECTED | FY 2003 | FY 2004 | FY 2005 |
| #General Revenue | $0 | $0 | $0 |
| Total Estimated
Net Effect on All State Funds |
$0 | $0 | $0 |
| FUND AFFECTED | FY 2003 | FY 2004 | FY 2005 |
| Total Estimated
Net Effect on All Federal Funds |
$0 | $0 | $0 |
| FUND AFFECTED | FY 2003 | FY 2004 | FY 2005 |
| Local Government | $0 | $0 | $0 |
Numbers within parentheses: ( ) indicate costs or losses.
This fiscal note contains 8 pages.
ASSUMPTION
Officials from the Missouri Senate stated the proposed legislation should have no fiscal impact on their organization. Any costs associated with it would be absorbed in current appropriations.
Officials from the Department of Social Services, Office of Administration - Division of Risk Management, Office of the Governor, Missouri Department of Conservation, Department of Agriculture, Department of Natural Resources, Department of Public Safety (DPS)- State Emergency Management Agency, DPS - Missouri Highway Patrol and DPS - Missouri State Water Patrol assume the proposed legislation will have not fiscal impact on their organizations.
Officials from the Office of the Secretary of State (SOS) state this bill creates the Joint Committee on Terrorism, Bioterrorism, and Homeland Security and modifies various provisions regarding declared states of emergencies. The Department of Health and Senior Services and the Department of Public Safety will promulgate rules to implement this bill. Based on experience with other divisions, the rules, regulations and forms issued by the Department of Health and Senior Services and the Department of Public Safety could require as many as 70 pages in the Code of State Regulations. For any given rule, roughly one-half again as many pages are published in the Missouri Register as are published in the Code because cost statements, fiscal notes and notices are not published in the Code. The estimated cost of a page in the Missouri Register is $23.00. The estimated cost of a page in the Code of State Regulations is $27.00. The actual costs could be more or less than the numbers given. The fiscal impact of this legislation in future years is unknown and depends upon the frequency and length of rules filed, amended, rescinded and withdrawn. The SOS estimates the cost of this legislation to be $4,305 [(70 pp x $27) + (105 pp x $23)].
Oversight assumes the SOS could absorb the costs of printing and distributing regulations related to this proposal. If multiple bills pass which require the printing and distribution of regulations at substantial costs, the SOS could request funding through the appropriation process. Any decisions to raise fees to defray costs would likely be made in subsequent fiscal years.
Officials from the Missouri House of Representatives assumes the cost the House Members would incur would be absorbed in a joint appropriation that reimburses for joint committee costs.
Officials from the Department of Highways and Transportation (DHT) stated the Manual on Uniform Traffic Control Devices (MUTCD) has a standard sign to be used when hazardous cargo is prohibited. The sign would be 2 feet by 2 feet in size and mounted on a wood post. The estimated cost to install one sign would be $250. Two signs would be installed on each side of the tunnel for a total cost of $500.
Signing for other routes where hazardous cargo is prohibited can not be estimated since there are no routes currently designated.
ASSUMPTION (continued)
Oversight assume the DHT can absorb the cost of the two signs within its current funding levels.
Officials from the Office of Attorney General assume costs related to the proposed legislation can be absorbed within existing resources.
Officials from the Department of Mental Health (DMH) stated the duties placed upon the Department of Mental Health, Public Affairs would cause minimal increases in expenditures. The cost of distributing the public statements and news releases would generally be covered in the regular operating expenses of the Department. However, substantial increases in cost are anticipated from the provision of increased mental health and substance abuse services. A recent draft report from experiences in Virginia (Virginia Terrorism-Related Mental Health Needs Assessment by the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services) based upon events and costs from the events in New York and Virginia on September 11, 2001 indicate a cost to Virginia of $50,144,503 in increased mental health and substance abuse costs. A simple comparison based on population of the two states (Missouri and Virginia), shows Missouri has a population which is 79% of Virginia's 7,078,515. Applying that to the projected costs in Virginia shows Missouri with a similar cost increase of $39,614,157 for increased mental health and substance abuse services. However, needs for such events as September 11 will differ from event to event. Therefore we do not show the
$39.6 million as the cost projection for Missouri for a terrorist/bio-chemical event but rather show it as an illustration of the enormous costs such an event might have in Missouri. This analysis is also based on the assumption that mental health facilities would not be utilized for any medical/quarantine purposes. Overtime pay for DMH staff would be a part of the "unknown" amount shown on the Summary of Fiscal Impact sheet.
#Officials from the Department of Mental Health state no fiscal impact as a result of this proposal.
Official from the Department of Health and Senior Services (DOH) stated the department currently has a decision item in the FY 03 budget request that includes enhanced virus and bacteria surveillance components, as well as other unrelated components. Costs are reflected in the decision item to expand the high alert biological, chemical and radiological surveillance system in the DOH for early detection and control of possible terrorism events over extended periods of time and multiple events. That request reflects the cost for additional staff and equipment needed to run the system efficiently and effectively and communicate threats to health care providers, the media, the public, and those other agencies and entities participating in the response. If funded, additional resources would become available that the DOH would hope to use regarding this legislation as well; however, the decision item is based on a need that the DOH currently has, and is not related to a specific outbreak.
In the case of a large outbreak, additional funds (amount unknown) would be requested to ASSUMPTION (continued)
address needs specific to that crisis. The impact of a public health emergency would depend on the type of emergency and the necessary response, which would be determined at that time.
#Officials from the Department of Health and Senior Services assume no fiscal impact as a result of this proposal.
Officials from the Office of State Courts Administrator stated the proposed legislation would create a number of new crimes and penalties relating to terrorism and establish the "Joint Committee on Terrorism, Bioterrorism, and Homeland Security" in the general assembly.
While there may be some additional cases, there should not be a significant impact on the workload of the judiciary.
Officials from the Department of Economic Development (DED) - Division of Professional Registration (PR) stated PR is assuming a zero fiscal impact as they are hopeful that their current appropriations/funds can support the impact of a state emergency. The PR is also assuming no charge to the temporary license holder. However, due to many unknown factors, such as the number of temporary licenses that will have to be issued, it may be necessary to secure additional appropriation authority and to charge the temporary licensee a respective fee.
Officials from the DED - Public Service Commission stated having reviewed the proposed legislation and having sought the conclusion of the appropriate board(s), they are of the opinion that this fiscal note in its present form has no fiscal impact to our division.
Officials from the Department of Corrections (DOC) did not respond to our request for a statement of fiscal impact. However, in response to a similar piece of legislation the DOC officials stated the DOC cannot predict the number of new commitments which may result from the creation of the offense(s) outlined in this proposal. An increase in commitments depends on the utilization by prosecutors and the actual sentences imposed by the court.
If additional persons are sentenced to the custody of the DOC due to the provisions of this legislation, the DOC will incur a corresponding increase in operational cost either through incarceration (FY 01 average of $35.78 per inmate per day, or an annual cost of $13,060 per inmate) or through supervision provided by the Board of Probation and Parole (FY 01 average of $3.34 per offender per day, or an annual cost of $1,219 per offender).
The following factors contribute to the DOC's minimal assumption:
ASSUMPTION (continued)
Supervision by the DOC through probation or incarceration would result in some additional costs, but it is assumed the impact would be $0 or a minimal amount that could be absorbed
within existing resources.
| FISCAL IMPACT - State Government | FY 2003 | FY 2004 | FY 2005 |
| GENERAL REVENUE FUND | |||
| Costs - Department of Mental Health | |||
| # Public Health Emergency Costs | $0 | $0 | $0 |
| #Total Costs - Department of Mental Health | $0 | $0 | $0 |
| Costs - Department of Health and Senior Services | |||
| # Public Health Emergency Costs | $0 | $0 | $0 |
| #Total Costs - Department of Health and Senior Services |
$0 |
$0 |
$0 |
| #ESTIMATED NET EFFECT ON GENERAL REVENUE FUND | $0 | $0 | $0 |
| FISCAL IMPACT - Local Government | FY 2003 | FY 2004 | FY 2005 |
| $0 | $0 | $0 |
FISCAL IMPACT - Small Business
No direct fiscal impact to small businesses would be expected as a result of this proposal.
DESCRIPTION
This act increases state emergency health powers.
The Joint Committee on Terrorism, Bioterrorism, and Homeland Security is created, to be composed of seven members of the House and seven members of the Senate. A new Section 38.050 provides for appointments to continue during the member's term of office. No party may DESCRIPTION (continued)
be represented by more than four members from either chamber. The Committee must analyze current efforts, devise a standard reporting system, determine changes needed, and make other
recommendations. The Committee must meet within thirty days after its creation and must meet at least quarterly thereafter. A report is due by January 15th of each year. This portion of the act will expire December 31, 2007.
Definitions are provided for related terms, including "bioterrorism" (Section 44.010). Current law outlines the emergency powers of the Governor. This act adds that such powers are allowed when there is a major natural or man-made disaster, an act of biological terrorism, or there exists an imminent threat of a disaster (Section 44.100).
A new section exempts the state and its officers from liability when responding to a state emergency (Section 44.240).
A twelve-month temporary license is currently allowed for a health care practitioner licensed in another state who is acting under military orders and is enrolled in a trauma and disaster response training in this state. This act adds a third category to also allow temporary licensure of a health care practitioner licensed in another state and acting pursuant to a Governor's declaration of a state public health emergency. Temporary licensure for this category will be issued for a two-week period and, after verification of qualifications, may be reissued every two weeks. Licensure information for all three categories may be obtained by any means, including electronic mail. The term "health care professional" means as defined in Section 383.130, RSMo, which includes physicians, dentists, podiatrists, pharmacists, psychologists, or nurses.
A new section requires pharmacists to report unusual or increased prescription trends within 24 hours. Out-of-state laboratories which collect specimens within Missouri and in-state labs that send specimens out-of-state must report all cases of illness or health conditions. The Department will define this procedure by rule (Section 192.021).
Current law penalizes persons for leaving a quarantine without permission. This act modifies the language and imposes a Class A misdemeanor on those who: (1) Refuse to submit to medical exams or testing; (2) Refuse to perform medical exams or testing; (3) Refuse to comply with isolation or quarantine orders; (4) Knowingly put themselves in contact with an isolated or quarantined person; (5) Knowingly fail to report or conceal a dangerous disease; (6) Refuse to cooperate with investigations; (7) Remove quarantine notices. If anyone performs any of the above acts during a state health emergency, he or she will be guilty of a Class D felony (Section 192.320).
A new section allows the Department to waive the registration and record keeping requirements DESCRIPTION (continued)
regarding narcotic drugs (Section 195.041).
Current law allows probate to begin in certain circumstances when it relates to the estate of an
absent persons. New language adds an individual's exposure to a specific peril of death due to an actual or suspected terrorist event to the list of circumstances (Section 473.697). Current law also allows a presumption of death after five years and without proof otherwise. New language provides that it will be sufficient to presume a person dead at any time after that person was exposed to a specific peril of death, even if five years have not yet elapsed (Section 490.620).
This act adds an exemption to Sunshine Law, allowing closure of meetings and records regarding specific information on certain terrorism readiness issues. However, certain information regarding municipal utilities and information regarding costs of security measures shall not be considered closed.
No person shall transport hazardous materials in or through any highway tunnel in this state. Nor shall any person park a vehicle containing hazardous material within three hundred feet of a highway tunnel. Any person found guilty of a violation of this section is guilty of a class B misdemeanor and subsequent violation is a class A misdemeanor. (Section 304.370)
It is unlawful for any person to exercise unfair leverage when selling essential consumer merchandise. A person who is found guilty of violating this section may be liable for restitution and a civil penalty not to exceed three thousand dollars or two times the amount gained unlawfully. Only the attorney general has the authority to commence a civil action for a violation of this section.
A person commits the crime of water contamination if the person knowingly introduces any dangerous radiological, chemical, or biological agent into any public or private waters with the purpose of causing death or serious physical injury. Criminal water contamination is a class B felony. (Section 569.071)
A person commits the crime of making a terrorist threat if the person communicates a threat to cause an incident or condition involving danger to life, communicates a knowingly false report or condition involving danger to life or knowingly causes a false belief or fear that an incident has occurred. Supporting terrorism is a class C felony. (Section 576.080)
A new section requires the Department of Mental Health to provide information about mental health support to address the emergency. The Department of Health and Senior Services may assist (Section
630.807).
This act contains an emergency clause.
DESCRIPTION (continued)
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
Missouri Senate
Department of Social Services
Department of Public Safety
- State Emergency Management Agency
- Missouri Highway Patrol
- Missouri State Water Patrol
Missouri Department of Highways and Transportation
Missouri House of Representatives
Office of Administration - Division of Risk Management
Office of Secretary of State
Missouri Department of Conservation
Office of the Governor
Office of Attorney General
Department of Mental Health
Department of Health and Senior Services
Office of State Courts Administrator
Department of Economic Development
- Division of Professional Registration
- Public Service Commission
Department of Natural Resources
Department of Agriculture
NOT RESPONDING: Department of Corrections
Mickey Wilson, CPA
Acting Director
May 9, 2002