LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 76th Regular Session
April 29, 1999
TO: Honorable Jane Nelson, Chair, Senate Committee on Health
Services
FROM: John Keel, Director, Legislative Budget Board
IN RE: HB2085 by McCall (relating to the continuation and
functions of the Texas Board of Health and Texas
Department of Health, including the operation of certain
boards and councils administratively attached to the
department; providing penalties), Committee Report 2nd
House, Substituted
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* Estimated Two-year Net Impact to General Revenue Related Funds for *
* HB2085, Committee Report 2nd House, Substituted: positive impact *
* of $1,630,604 through the biennium ending August 31, 2001. *
* *
* The bill would make no appropriation but could provide the legal *
* basis for an appropriation of funds to implement the provisions of *
* the bill. *
* *
* The bill would provide for the continuation of the Texas Department *
* of Health and certain boards and councils administratively *
* attached to the department until September 1, 2011. *
**************************************************************************
General Revenue-Related Funds, Five-Year Impact:
****************************************************
* Fiscal Year Probable Net Positive/(Negative) *
* Impact to General Revenue Related *
* Funds *
* 2000 $350,026 *
* 2001 1,280,578 *
* 2002 1,280,578 *
* 2003 1,280,578 *
* 2004 1,280,578 *
****************************************************
All Funds, Five-Year Impact:
***********************************************************************
*Fiscal Probable Probable Probable Probable Change in *
* Year Savings (Cost) from Savings Revenue Number of *
* from General from Gain/(Loss) State *
* General Revenue Federal from Bureau Employees *
* Revenue Fund Funds of from FY 1999 *
* Fund 0001 0555 Emergency *
* 0001 Management *
* Account/ *
* GR- *
* Dedicated *
* 0512 *
* 2000 $650,000 $(299,974) $0 $225,000 4.0 *
* 2001 1,725,000 (444,422) 1,075,000 225,000 6.0 *
* 2002 1,725,000 (444,422) 1,075,000 225,000 6.0 *
* 2003 1,725,000 (444,422) 1,075,000 225,000 6.0 *
* 2004 1,725,000 (444,422) 1,075,000 225,000 6.0 *
***********************************************************************
*****************************************************
* Fiscal Year Probable Savings/(Cost) from *
* Bureau of Emergency Management *
* Account/ GR-Dedicated *
* 0512 *
* 2000 $(177,789) *
* 2001 (225,000) *
* 2002 (225,000) *
* 2003 (225,000) *
* 2004 (225,000) *
*****************************************************
Fiscal Analysis
Sections of the bill that would result in a fiscal impact include a
provision requiring electronic funds transfer of Medicaid payments and a
provision requiring the department to integrate health care delivery
programs. A provision in the bill that would transfer responsibility for
administrative hearings in contested cases under Chapter 2001,
Government Code, to the State Office of Administrative Hearings is not
projected to result in increased overall costs to the state. It is
assumed that the provision of the bill requiring an annual external audit
of the Medicaid fiscal agent could be accomplished within existing
resources. It is assumed that provisions relating to a comprehensive
strategic and operational plan and requiring the department to
comprehensively study the impact that the state's Medicaid managed care
program has had on populations served by the department and on providers,
clinics, and hospitals can be accomplished within existing resources.
Other provisions in the bill are not anticipated to have a significant
fiscal impact.
The bill would also create the Emergency Medical Services Advisory
Council, a 15 member council appointed by the governor. It is assumed
that members of the council would receive reimbursement for travel and
related costs. Reimbursement for travel and other expenses for the
council would require authorization through the General Appropriations
Act.
The bill would also create the Council on Cardiovascular Disease and
Stroke. The Council would be composed of 12 members appointed by the
Board of Health. The Council would be required to develop a plan to
reduce the burden of cardiovascular disease in Texas and implement
various activities to accomplish this goal, including health education
programs, assisting communities in developing plans, and others. The
Council would be required to develop a database of recommendations for
appropriate care and treatment of patients with cardiovascular disease or
who have suffered from or who are at risk for stroke. The Council would
be authorized to appoint consultants to the council or advisory
committees. Reimbursement for travel and other expenses for advisory
committees would require authorization through the General Appropriations
Act.
The bill would also amend Section 773.041 of the Health and Safety Code
to require that a person receiving remuneration for transporting a
person required to be in a recumbent or near fully recumbent position be
licensed as an emergency medical provider, regardless of whether the
person is in need of emergency medical services during transport.
Methodology
The estimates included in the tables above relating to savings in General
Revenue and Federal are based on analysis submitted by the Sunset
Advisory Commission. The provision in the bill that requires electronic
funds transfer of Medicaid payments is estimated to save approximately
$650,000 per fiscal year due to savings in contract costs from
administrative efficiencies due to paying Medicaid providers through
electronic funds transfer rather than by mailing paper checks, offset by
reduced interest earnings from the quicker payment of claims.
The provision in the bill that requires the department to integrate
health care delivery programs is estimated to save approximately $2
million in General Revenue and Federal funds per year, beginning in
fiscal year 2001. Savings are estimated to be 10 percent of the amounts
currently expended by the department for administration of health care
delivery programs.
Two of the full-time equivalent positions noted in the table above, as
well as the associated costs noted as General Revenue costs, would be an
Epidemiologist and an Information Specialist to manage public awareness
and database activities in association with the provisions relating to
the Council on Cardiovascular Disease and Stroke. It is assumed that the
first year activities of the Council will be phased-in. It is assumed
that the campaign to promote public awareness of cardiovascular disease
would be a contracted service.
The Department of Health assumes that the amendments to Section 773.041
will result in 1500 new emergency medical services providers needing
licensure. The providers would be licensed for a period of two years
and each provider is assumed to have two vehicles. The license fee is
$150 per vehicle. The resulting revenue, shown in the table above under
revenue gain to Bureau of Emergency Management Account-GR Dedicated
Account 512, would be $225,000 per year. Costs to regulate the
providers are assumed to equal the revenues and come from General
Revenue Dedicated Account 512 and would include an increase of 4 Full
Time Equivalent Positions. First year costs have been reduced for a
start-up period.
Local Government Impact
No significant fiscal implication to units of local government is
anticipated.
Source Agencies: 501 Department of Health
LBB Staff: JK, TP, KF