TO:	Honorable Lois W. Kolkhorst, Chair, Senate Committee on Health & Human Services
FROM:	Jerry McGinty, Director, Legislative Budget Board
IN RE:	HB1998 by Johnson, Julie (Relating to the regulation of physicians and the disciplinary authority of the Texas Medical Board; increasing a criminal penalty; imposing a surcharge.), Committee Report 2nd House, Substituted

General Revenue-Related Funds, Five- Year Impact:

All Funds, Five-Year Impact:

Fiscal Analysis

The bill would amend the Occupations Code to require the Texas Medical Board (TMB) to annually subscribe each licensee to the National Practitioner Data Bank's (NPDB) continuous query feature. The bill would require TMB to maintain publicly available physician profiles that would be updated with the information found in these queries regarding disciplinary action against the physician and the history of a physician's license in other states. The bill would also require TMB to submit a set of fingerprints of all licensees who do not have fingerprints on file to the Department of Public Safety for the purposes of a criminal background check. Additionally, the bill would increase the penalty for making a false statement in a license application or under oath to obtain a medical license from a Class A misdemeanor to a felony if the intent is to defraud or harm another. 

Note: This legislation would do one or more of the following: create or recreate a dedicated account in the General Revenue Fund, create or recreate a special or trust fund either in, with, or outside of the Treasury, or create a dedicated revenue source. Legislative policy, implemented as Government Code 403.095, consolidated special funds (except those affected by constitutional, federal, or other restrictions) into the General Revenue Fund as of August 31, 1993 and eliminated all applicable statutory revenue dedications as of August 31, 1995. Each subsequent Legislature has reviewed bills that affect funds consolidation. The fund, account, or revenue dedication included in this bill would be subject to funds consolidation review by the current Legislature.

The bill would take effect September 1, 2023. 

Methodology

Based on information provided by the Texas Medical Board, this estimate assumes that at a cost of $2.50 per licensee for an annual continuous query, implementing the provision of the bill to subscribe each licensee would cost $500,000 each fiscal year. If the continuous query results in new information, it costs an additional $2.50 to access the new report, this estimate assumes costs associated with new information discovery would be $250,000. In total, the continuous queries with the NPDB would cost $750,000 each year. 

In addition, this estimate assumes TMB will require additional staffing to implement the provisions of the bill relating to the NPDB. TMB would require the 5.0 additional full-time equivalent (FTE) positions: 2.0 License and Permit Specialists FTEs (annual salary of $48,024 with estimated benefits of $15,286) to conduct a daily review of the system, 2.0 Administrative Assistant FTEs (annual salary of $32,320 with estimate benefits of $10,287) to update the physician profiles, and a Program Supervisor FTE (annual salary of $62,817 with estimated benefits of $19,994) to be the point of contact for all NPDB matters. These FTEs have an annual cost of $341,960 with a one-time cost of $32,600 in fiscal year 2024.

Based on information provided by TMB, there are approximately 73,500 physicians that would need to be re-fingerprinted. This estimate assumes that implementing the fingerprinting requirements of the bill would require 2.0 additional License and Permit Specialist FTEs (annual salary of $55,096 with estimate benefits of $15,537) to review any background checks that produces any findings. These FTEs would have combined annual cost of $164,192 with a one-time cost of $8,900 in fiscal year 2024.

This analysis assumes that any increased cost to TMB above would be offset by an increase in fee-generated revenue because they are statutorily required to generate sufficient revenue to cover the costs of operation. Additionally, the bill authorizes TMB to set an additional surcharge to cover the cost of administering the continuous queries with the National Practitioner Data Bank to be deposited to the credit of General Revenue Dedicated Account No. 5105, Public Assurance. According to the Comptroller of Public Accounts, this new surcharge fee is estimated to provide $1,000,000 each fiscal year in additional revenue to the Public Assurance account.

Based on the analysis of the Office of Court Administration and the Department of Public Safety, duties and responsibilities associated with implementing the provisions of the bill could be accomplished by utilizing existing resources. 

Relating to the escalation of a Class A misdemeanor to a felony for false statements to obtain a license with harmful intent, it is assumed that any impact on state correctional populations or on the demand for state correctional resources would not be significant.

Technology

Technology costs include desktop computer costs totaling $5,500 in fiscal year 2024 associated with the new positions. 

Local Government Impact