LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 76th Regular Session
April 24, 1999
TO: Honorable Elliott Naishtat, Chair, House Committee on
Human Services
FROM: John Keel, Director, Legislative Budget Board
IN RE: HB3636 by Naishtat (Relating to providing dental
services to certain recipients of medical assistance),
Committee Report 1st House, Substituted
**************************************************************************
* Estimated Two-year Net Impact to General Revenue Related Funds for *
* HB3636, Committee Report 1st House, Substituted: negative impact *
* of $(2,340,449) 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. *
**************************************************************************
General Revenue-Related Funds, Five-Year Impact:
****************************************************
* Fiscal Year Probable Net Positive/(Negative) *
* Impact to General Revenue Related *
* Funds *
* 2000 $(615,086) *
* 2001 (1,725,363) *
* 2002 (1,726,590) *
* 2003 (1,727,817) *
* 2004 (1,729,071) *
****************************************************
All Funds, Five-Year Impact:
***************************************************************************
*Fiscal Probable (Cost) from: Medicaid Probable (Cost) from: Medicaid *
* Year Match General Revenue Fund Match Federal Funds *
* 0001 0555 *
* 2000 $(615,086) $(980,468) *
* 2001 (1,725,363) (2,739,861) *
* 2002 (1,726,590) (2,741,810) *
* 2003 (1,727,817) (2,743,759) *
* 2004 (1,729,071) (2,745,751) *
***************************************************************************
Fiscal Analysis
The bill would amend Chapter 32 of the Human Resources Code by adding a
requirement that the Department of Human Services (DHS) provide dental
services annually to a resident of a nursing facility who is a Medicaid
recipient. The bill would require the dental services to include a
routine dental exam by a licensed dentist, prophylaxis (cleaning) if
practical, as well as diagnostic dental x-rays.
DHS, in cooperation with the Health and Human Services Commission (HHSC),
would be required to develop a fee schedule for these dental services.
HHSC would be required to conduct a study regarding the need for and
cost of providing dental services to nursing home residents.
Methodology
Overall it is assumed that the delivery of dental services would be based
upon a fee-for-service reimbursement to providers in office-based
settings and that adequate dental care providers would be available to
serve the dental needs of the Medicaid nursing home population. Costs
related to transporting nursing home residents to dental offices are
included in the estimates. The following assumptions were used to derive
the cost estimates to implement the provisions of the bill:
1. It is assumed that DHS and HHSC would develop and submit required
state plan changes to the federal Health Care Financing Administration
for the Texas Medicaid Program to include dental services for the nursing
home population. Currently Medicaid eligible adults are only provided
dental services in emergency situations and through the Department of
Mental Health and Mental Retardation for those clients in intermediate
care facilities for the mentally retarded (ICF-MRs) and served in the
Home and Community-Based (HCS) Waiver.
2. It is assumed that federal approval would be granted and other
necessary state rule changes would be in place by April 1, 2000. It is
assumed that state efforts to submit federal changes, establish a dental
fee schedule for this population, adjust payment and eligibility systems,
and prepare the required report to the Governor and Legislature would be
absorbed within existing agency resources.
3. It is assumed that the nursing caseload projections include a 30
percent client turnover rate based upon DHS estimates of the average
monthly caseload: 64,569 in 2000; 64,667 in 2001; 64,713 in 2002; 64,759
in 2003; and 64,806 in 2004.
4. It is assumed that dental services would begin in April of 2000 and
that participation would reach 60 percent in year two and in each
subsequent year.
5. Dental services are assumed to include at a minimum, a dental exam
($15.25), routine adult prophylaxis ($28.00) and diagnostic x-rays(up to
$31.75). Fees for these services are based upon the current Texas
Medicaid reimbursement for dental services. In the event that HHSC and
DHS develop a reimbursement schedule that exceeds current Medicaid rates,
the fiscal implications to implement the provisions of the bill would be
understated.
6. It is assumed that 40 percent of the nursing home population would
not access dental services due to medical fragility or other reasons and
that 30 percent of the population seeking services are edentulous
(without teeth) and would not require a dental cleaning but would need
oral examination and partial or full denture repair or other related
services.
7. Cost estimates assume that approximately1,500 nursing home residents
annually would require partial denture or full denture repair ($50) and
approximately 500 nursing home clients would be provided a full set of
dentures annually ($750).
8. Cost estimates assume that approximately 7,500 individuals would
require dental restorative services with an estimated annual average cost
of $100.
9. Transportation costs assume $0.30 per mile with an average trip of 10
miles.
Local Government Impact
No significant fiscal implication to units of local government is
anticipated.
Source Agencies:
LBB Staff: JK, TP, AZ