COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.: 3198-01
Bill No.: SB 951
Subject: Allows parents to refuse to immunize their children without providing certain justifications.
Type: Original
Date: February 4, 2002
FISCAL SUMMARY
| FUND AFFECTED | FY 2003 | FY 2004 | FY 2005 |
| 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 4 pages.
ASSUMPTION
Officials from the Department of Elementary and Secondary Education, Department of Insurance and Missouri Department of Conservation assume the proposed legislation would not fiscally impact their agencies.
Officials from the Missouri Department of Health and Senior Services (DOH) stated the primary responsibility for implementing this law would fall on public and private school nurses. It would have no fiscal impact on the DOH.
For similar legislation proposed this session, the DOH stated it does not expect this proposal to have a significant impact statewide.
Officials from the Missouri Consolidated Health Care Plan (HCP) stated this bill removes the "religious beliefs" exemption but still allows the reasons of medical contraindications as substantiated by a licensed physician. This bill will slightly increase cost as previously exempted individuals are now required to receive immunizations. But the overall effect is expected to be a minimal fiscal impact.
Officials from the Office of the Secretary of State (SOS) state this bill would require the Department of Health and Senior Services and the Department of Social Services, Family Services to promulgate rules and regulations as they pertain to allowing parents to refuse to immunize their children without providing certain justifications. Based on prior rulemakings for these agencies, rules and forms for these agencies could require as many as 29 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 $ 1,487 [(29 pp x $27) + ( 43.5 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 Department of Highways and Transportation (DHT) also responded for the Missouri Highway Patrol (MHP). The DHT stated that because this legislation does not mandate ASSUMPTION (continued)
any health insurance benefit coverage, there would be no fiscal impact to the DHT or the MHP medical plans.
Officials from the Department of Social Services (DOS) stated that although this bill could result in fewer vaccinations being administered to children, the savings to Medicaid is not expected to be significant. In addition, it is difficult to attach a cost to increased Medicaid payments for illnesses resulting from unvaccinated children.
| FISCAL IMPACT - State Government | FY 2003
(10 Mo.) |
FY 2004 | FY 2005 |
| $0 | $0 | $0 |
| FISCAL IMPACT - Local Government | FY 2003
(10 Mo.) |
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 allows parents to refuse to immunize their children without limitation. This act removes the limitation of religious objection and, thus, allows a parent to exempt a child through a written objection only. It retains the medical contraindication objection.
Currently, Section 210.003, RSMo, allows a parent to exempt his or her day care age child from immunization by providing a written objection citing either medical contraindications or reasons as determined by the Department of Health and Senior Services. This act removes the provision for reasons to be determined by the Department of Health, thus allowing a parent to exempt a child through a written objection only. The medical contraindication objection is retained.
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 Department of Health and Senior Services
Missouri Consolidated Health Care Plan
Missouri Department of Conservation
Department of Elementary and Secondary Education
Department of Insurance
Office of Secretary of State
Department of Highways and Transportation
Missouri Highway Patrol
Department of Social Services
Mickey Wilson, CPA
Acting Director
February 4, 2002