LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE
74th Regular Session
April 24, 1995
TO: Honorable Harvey Hilderbran, Chair IN RE: House Bill No. 3118
Committee on Human Services By: Coleman, Maxey
House of Representatives
Austin, Texas
FROM: John Keel, Director
In response to your request for a Fiscal Note on House Bill No.
3118 (Relating to the amendment of Subtitle B, Title 4, Health
and Safety Code, by adding Chapter 251 to read as follows:
Chapter 251. Intermediate Care Facilities for the Mentally
Retarded (ICF/MR)) this office has determined the following:
The bill would make no appropriation but could provide the legal
basis for an appropriation of funds to implement the provisions
of the bill.
This bill repeals parts of Chapter 242 of the Health and Safety
Code relating to the ICF/MR program and creates a new chapter
specifically to govern the licensing of ICF's/MR.
The bill would require all facilities to obtain a license, which
is an expansion of the current licensing requirement to include
state operated facilities and community MHMR center affiliated
facilities (which are currently exempted). Penalties associated
with administrative violations have been revised to exclude
active treatment penalties and penalties for QMRP supervisions of
the program. Penalties for threats to health or safety have been
retained. The bill develops an independent trust fund for ICF/MR
facilities; however, it does not provide a mechanism to establish
the revenue source for this new fund. Unencumbered funds over
$100,000 would be transferred from the trust fund to the general
revenue fund at the end of each fiscal year.
The most significant fiscal impact concerning this bill involves
the lack of a plan for limiting the number of licensed ICF/MR
facilities such as the Long-Term Care Plan. By implicitly
requiring the issuance of a license to any applicants that "meet
the requirements established under this chapter" without respect
to expansion limits set in the Plan on Long-Term Care for Persons
with Mental Retardation or Related Conditions places the state in
a precarious fiscal position regarding the cost controls of the
ICF/MR program. Growth under uncontrolled conditions could
preclude strategic program planning. The fiscal impact is based
on an estimated 50 new ICF's/MR per year, which has been the
historical growth rate.
The bill's requirement for all facilities to obtain a license
represents an increase in costs to the Department of Mental
Health and Mental Retardation (MHMR) and participating Community
Mental Health and Mental Retardation Centers.
A provision is made for the Texas Department of Human Services
(TDHS) to maintain a central registry of cases involving abuse
and neglect in ICF/MR facilities. This information is already
included in a larger database. Separating and separately
maintaining the information for ICF's/MR would result in
increased costs to TDHS.
The provision regarding two unannounced visits per licensing year
would increase cost to TDHS. Currently the number of ICF-MR
survey and certification visits is limited to two unannounced
visits per licensing cycle (average of one per year). The fiscal
implication of the bill is based on the cost of the required
second visit. The impact is based on a cost per survey of $2550
multiplied by an estimated 864 MR facilities. The cost of the
second visit must be paid for with 100% state funds, since it is
a state and not a federal requirement.
The development of an independent trust fund for ICF/MR
facilities provides no mechanism to support this trust fund
through license fees and penalties. The lessening of areas
subject to penalties would result in a reduction of revenue
related to penalties. Information necessary to predict the fiscal
impact of this is not available. It is assumed that TDHS would
absorb the cost of establishing the trust fund.
The probable fiscal implication of implementing the provisions of
the bill during each of the first five years following passage
is estimated as follows:
Fiscal Probable Cost Out Probable Cost Out
Year of General of Federal Funds
Revenue Fund 001 555
1996 $4,469,370 $3,798,600
1997 6,790,895 7,476,000
1998 9,152,620 11,113,200
1999 11,447,145 14,817,600
2000 13,741,670 18,522,000
Similar annual fiscal implications would continue as long as the
provisions of the bill are in effect.
The fiscal implication to units of local government cannot be
determined.
Source: Texas Department of Mental Health and Mental
Retardation,
Texas Department of Human Services,
Health and Human Services Commission
LBB Staff: JK, GT, DF