LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE
75th Regular Session
April 8, 1997
TO: Honorable Judith Zaffirini, Chair IN RE: Senate Bill No. 1165
Committee on Health & Human Services By: Zaffirini
Senate
Austin, Texas
FROM: John Keel, Director
In response to your request for a Fiscal Note on SB1165 ( Relating
to managed care under the state Medicaid program for children
with special health care needs.) this office has detemined the
following:
Biennial Net Impact to General Revenue Funds by SB1165-As Introduced
Implementing the provisions of the bill would result in a net
negative impact of $(271,895) to General Revenue Related Funds
through the biennium ending August 31, 1999.
The bill would make no appropriation but could provide the legal
basis for an appropriation of funds to implement the provisions
of the bill.
Fiscal Analysis
The bill would prohibit the Health and Human Services Commission
from requiring a child with special health care needs who is
eligible for Medicaid to enroll in a Medicaid managed care plan.
The bill would also require HHSC in cooperation with the Department
of Health to monitor and assess health care services provided
under managed care plans to this population; to adopt specific
quality of care standards applicable to health care services
provided under managed care plans to child with special health
care needs; and to develop managed care pilot programs designed
for children with special health care needs. The bill would
require HHSC to promulgate a rule prescribing qualifications
of a child as a "child with special health care needs."
Methodolgy
It is assumed that HHSC would delegate some of the responsibilities
to the Department of Health but that the State Medicaid Office
would add a new full-time equivalent position to assist with
the development of the quality standard and rules required by
the provisions of the bill. In addition, the FTE would work
on the pilot development and monitoring requirements. The costs
associated with the additional FTE would be phased in the first
year ($42,806) and $56,204 for the remaining years of the pilot.
It is assumed that these costs will be matched equally with
federal funds and cease at the end of fiscal year 2001.
It
is assumed that modifications to existing systems will be required
in order for the systems to identify children with special health
care needs; to ensure that children are given the option to
choose between fee-for-service and managed care plans; and to
pay the health care claims according to the selected health
care delivery system.
Currently there is not a specific
definition for classifying a child as a child with special health
care needs. In the event that a significant number of children
with special health care needs choose not to participate in
a managed care plan, costs for this population may be greater
than for those enrolled in managed care.
Based on two recent
changes to the eligibility system which required modifications
to the existing eligibility determination system, it is estimated
that 6,300 programming hours would be required to make the management
information system changes. It is assumed that those hours
would be contracted at a rate of $70.60 per hour and that no
new FTEs would be added for this purpose. It is assumed that
the costs would be funded in part with Medicaid matching dollars
(50% federal : 50% state).
The probable fiscal implications of implementing the provisions
of the bill during each of the first five years following passage
is estimated as follows:
Five Year Impact:
Fiscal Year Probable (Cost) Probable (Cost) Change in Number
from General from Federal Funds of State
Revenue Fund Employees from
FY 1997
0001 0555
1998 ($243,793) ($243,793) 1.0
1998 (28,102) (28,102) 1.0
2000 (28,102) (28,102) 1.0
2001 (28,102) (28,102) 1.0
2002 0 0 0.0
Net Impact on General Revenue Related Funds:
The probable fiscal implication to General Revenue related funds
during each of the first five years is estimated as follows:
Fiscal Year Probable Net Postive/(Negative)
General Revenue Related Funds
Funds
1998 ($243,793)
1999 (28,102)
2000 (28,102)
2001 (28,102)
2002 0
No fiscal implication to units of local government is anticipated.
Source: Agencies: 529 Health and Human Services Commission
501 Department of Health
LBB Staff: JK ,BB ,AZ