On August 28, 2022, Senate Bill 710 became law, requiring the Department of Health and Senior Services (DHSS), Division of Regulation and Licensure (DRL), to monitor and collect data for registration of each supplemental health care services agency (SHCSA) that provides or procures temporary health care personnel in Missouri health care facilities. Any registered supplemental health care services agency that contracts with a health care facility that participates in Medicare or Medicaid is required to submit quarterly reports to the department that contain the following information:
- A detailed list of each health care facility participating in Medicare or Medicaid with whom the agency has contracted over the prior quarter;
- A detailed list of the average hourly amount charged by the agency to the health care facility over the prior quarter, broken down by health care facility and each individual health care personnel category within each job classification (including but not limited to nursing, therapy, dietary/nutrition, lab, and radiology); and
- A detailed list of the average hourly amount paid by the agency to health care personnel over the prior quarter, broken down by health care facility and each individual health care personnel category within each job classification, including but not limited to nursing, therapy, dietary/nutrition, lab, and radiology.
Section 198.640, RSMo, defines a health care facility as a licensed hospital as defined under section 197.020, RSMo, or as a licensed assisted living facility, intermediate care facility, residential care facility, or skilled nursing facility as defined under section 198.006, RSMo.
Section 198.640, RSMo, defines health care personnel as any individual licensed, accredited, or certified by the state of Missouri to perform specified health services consistent with state law. Health care personnel as defined in section 198.640, RSMo, include: Certified Medication Technician (CMT); Certified Nursing Aide (CNA); Dietitian; Emergency Medical Tech (EMT) (ER only); Hearing Instrument Specialist (HIS); Level One Medication Aide (LIMA); Licensed Practical Nurse (LPN); Occupational Therapist (OT); Occupational Therapist Assistant (OTA); Paramedic (ER only); Perfusionist; Pharmacy Technician (Pharm Tech); Physical Therapy Assistant (PTA); Registered Nurse (RN); and Speech Language Aide (SLA). As noted in the supplemental health care services agency definition, the term shall not include an individual who engages only on his or her own behalf, or to provide the individual’s services on a temporary basis to health care facilities or a home health agency licensed under section 197.415, RSMo, and shall not include a person, firm, corporation, partnership, or association engaged in the provision of contracted specialty services by a practitioner as defined under subdivision (4) of section 376.1575, RSMo, to a hospital as defined under section 197.020, RSMo, or to other individuals or entities providing health care that are not health care facilities.
Pursuant to section 198.644, RSMo, the department is required to prepare an annual report of aggregate data received from the agencies without including information specific to any one agency. This report summarizes data received by the department for 2025. It is important to note that data reflected within each quarter may not include all personnel defined, as some personnel may not have been reported by all agencies each quarter. Averages of data include personnel that may work in a specialty area (Emergency Department, Telemetry, Operating Room, Step-down, Pediatric, Oncology, Rehabilitation, etc.). Average hourly charges to health care facilities reported to the department may or may not include labor-related costs paid by agencies for health care personnel, such as payroll taxes, worker’s compensation insurance, professional liability coverage, credentialing, per diems, and other employee-related costs.
1st Quarter 2025 Report
At the time the 1st quarter 2025 reporting opened on April 1, 251 agencies were registered with DHSS. Two agency reports were not obtained by the department during the submission period due to registration expiration or voluntary closure of registration. 131 agencies reported personnel working in a Medicare/Medicaid certified hospital or long-term care facility in Missouri between Jan. 1 and March 31. Out of the 131 agencies that reported data, 112 agencies had personnel working in a certified hospital(s) and 43 agencies had personnel working in a certified long-term care facility(ies).
Averages of Healthcare Personnel Reported in Certified Long-Term Care Facilities
1st Quarter 2025
| Personnel Type | Hourly Charge to Facility | Hourly Pay to Personnel |
|---|---|---|
| CMT | $36.11 | $25.58 |
| CNA | $34.46 | $23.60 |
| LPN | $56.83 | $39.60 |
| OT | $79.00 | $42.70 |
| OTA | $55.07 | $21.47 |
| PTA | $58.25 | $25.71 |
| RN | $69.14 | $49.65 |
| SLA | $80.00 | $34.37 |
Averages of Healthcare Personnel Reported in Certified Hospitals
1st Quarter 2025
| Personnel Type | Hourly Charge to Facility | Hourly Pay to Personnel |
|---|---|---|
| CMT | $46.83 | $28.61 |
| CNA | $32.65 | $22.23 |
| Dietitian | $77.00 | $20.00 |
| LPN | $62.13 | $29.16 |
| OT | $84.50 | $22.52 |
| Paramedic (ER) | $90.72 | $65.41 |
| Perfusionist | $84.13 | $56.59 |
| Pharm Tech | $62.33 | $26.41 |
| PTA | $68.70 | $33.70 |
| RN | $83.50 | $40.32 |
2nd Quarter 2025 Report
At the time the 2nd quarter 2025 reporting opened on July 1, 247 agencies were registered with DHSS. Four agency reports were not obtained by the department during the submission period due to registration expiration or voluntary closure of registration. 137 agencies reported personnel working in a Medicare/Medicaid certified hospital or long-term care facility in Missouri between April 1 and June 30. Out of the 137 agencies that reported data, 117 agencies had personnel working in a certified hospital(s) and 53 agencies had personnel working in a certified long-term care facility(ies).
Averages of Healthcare Personnel Reported in Certified Long-Term Care Facilities
2nd Quarter 2025
| Personnel Type | Hourly Charge to Facility | Hourly Pay to Personnel |
|---|---|---|
| CMT | $35.10 | $26.05 |
| CNA | $33.71 | $23.90 |
| LPN | $55.08 | $38.88 |
| OT | $79.46 | $35.66 |
| OTA | $57.47 | $22.80 |
| PTA | $61.89 | $32.81 |
| RN | $68.83 | $49.37 |
| SLA | $80.12 | $40.82 |
Averages of Healthcare Personnel Reported in Certified Hospitals
2nd Quarter 2025
| Personnel Type | Hourly Charge to Facility | Hourly Pay to Personnel |
|---|---|---|
| CMT | $45.28 | $28.44 |
| CNA | $31.74 | $21.78 |
| Dietitian | $77.00 | $20.00 |
| LPN | $59.68 | $27.48 |
| OT | $83.45 | $24.68 |
| OTA | $60.18 | $17.97 |
| Paramedic (ER) | $90.72 | $65.41 |
| Perfusionist | $250.00 | $112.50 |
| Pharm Tech | $68.32 | $43.35 |
| PTA | $71.00 | $26.31 |
| RN | $83.25 | $39.53 |
3rd Quarter 2025 Report
At the time the 3rd quarter 2025 reporting opened on Oct. 1, 244 agencies were registered with DHSS. Two agency reports were not obtained by the department during the submission period due to registration revocation or voluntary closure of registration. 129 agencies reported personnel working in a Medicare/Medicaid certified hospital or long-term care facility in Missouri between July 1 and Sept. 30. Out of the 129 agencies that reported data, 109 agencies had personnel working in a certified hospital(s) and 44 agencies had personnel working in a certified long-term care facility(ies).
Averages of Healthcare Personnel Reported in Certified Long-Term Care Facilities
3rd Quarter 2025
| Personnel Type | Hourly Charge to Facility | Hourly Pay to Personnel |
|---|---|---|
| CMT | $36.47 | $26.48 |
| CNA | $33.78 | $24.12 |
| Dietitian | $28.00 | $22.40 |
| LPN | $55.46 | $40.04 |
| OT | $83.49 | $34.69 |
| OTA | $55.57 | $31.49 |
| Perfusionist | $250.00 | $112.50 |
| PTA | $62.50 | $27.65 |
| RN | $70.45 | $50.87 |
| SLA | $80.00 | $63.93 |
Averages of Healthcare Personnel Reported in Certified Hospitals
3rd Quarter 2025
| Personnel Type | Hourly Charge to Facility | Hourly Pay to Personnel |
|---|---|---|
| CMT | $56.58 | $32.98 |
| CNA | $35.09 | $23.56 |
| Dietician | $77.00 | $20.75 |
| LPN | $58.84 | $29.87 |
| OT | $86.86 | $35.31 |
| OTA | $60.12 | $17.88 |
| Paramedic (ER) | $90.72 | $65.41 |
| Perfusionist | $193.75 | $150.00 |
| Pharm Tech | $72.15 | $43.94 |
| PTA | $76.02 | $34.42 |
| RN | $84.14 | $38.91 |
| SLA | $84.45 | $33.47 |
3th Quarter 2025 Report
At the time the 4th quarter 2025 reporting opened on Jan. 1, 2026, 246 agencies were registered with DHSS. Three agency reports were not obtained by the department during the submission period due to registration expiration. 114 agencies reported personnel working in a Medicare/Medicaid certified hospital or long-term care facility in Missouri between Oct. 1 and Dec. 31. Out of the 114 agencies that reported data, 97 agencies had personnel working in a certified hospital(s) and 38 agencies had personnel working in a certified long-term care facility(ies).
Averages of Healthcare Personnel Reported in Certified Long-Term Care Facilities
4th Quarter 2025
| Personnel Type | Hourly Charge to Facility | Hourly Pay to Personnel |
|---|---|---|
| CMT | $35.95 | $26.20 |
| CNA | $34.06 | $24.02 |
| LPN | $54.97 | $40.02 |
| OT | $84.00 | $24.50 |
| OTA | $57.00 | $30.58 |
| PTA | $64.35 | $35.24 |
| RN | $70.66 | $49.94 |
| SLA | $82.50 | $34.57 |
Averages of Healthcare Personnel Reported in Certified Hospitals
4th Quarter 2025
| Personnel Type | Hourly Charge to Facility | Hourly Pay to Personnel |
|---|---|---|
| CMT | $35.91 | $26.00 |
| CNA | $35.99 | $23.23 |
| LPN | $60.89 | $32.79 |
| OT | $87.49 | $32.04 |
| OTA | $71.49 | $32.40 |
| Paramedic (ER) | $90.72 | $65.41 |
| Perfusionist | $295.00 | $85.00 |
| Pharm Tech | $66.38 | $35.26 |
| PTA | $72.00 | $44.89 |
| RN | $83.01 | $40.04 |
Comparison of 2024-2025 Data
Data submitted to the department between 2024 and 2025 indicates that CMTs, CNAs, LPNs, and RNs are the most frequently reported personnel in certified hospitals and long-term care facilities. The following graphs illustrate the quarterly hourly averages for each of these roles during this period.
CMT Average Hourly Data in Hospitals and LTC Facilities: 2024-2025
CNA Average Hourly Data in Hospitals and LTC Facilities: 2024-2025
LPN Average Hourly Data in Hospitals
RN Average Hourly Data in Hospitals
