LEGISLATIVE BUDGET BOARD
                              Austin, Texas
                                     
                    FISCAL NOTE, 76th Regular Session
                                Revision 1
  
                              April 23, 1999
  
  
          TO:  Honorable Judith Zaffirini, Chair, Senate Committee on
               Human Services
  
        FROM:  John Keel, Director, Legislative Budget Board
  
       IN RE:  SB369  by Zaffirini (Relating to the continuation and
               functions of the Texas Department of Human Services),
               Committee Report 1st House, Substituted
  
**************************************************************************
*  Estimated Two-year Net Impact to General Revenue Related Funds for    *
*  SB369, Committee Report 1st House, Substituted:  negative impact      *
*  of $(4,360,043) 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                         $(2,007,964)  *
          *       2001                          (2,352,079)  *
          *       2002                          (2,494,194)  *
          *       2003                          (2,644,835)  *
          *       2004                          (2,804,515)  *
          ****************************************************
  
All Funds, Five-Year Impact:
  
***************************************************************************
*Fiscal      Probable    Probable (Cost) Probable (Cost) Probable (Cost)  *
* Year   Revenue Gain to    to General      to General      to Federal    *
*        General Revenue   Revenue Fund    Revenue Fund       Funds       *
*              Fund            0001         (Medicaid       (Medicaid)    *
*              0001                           Match)           0555       *
*                                              0001                       *
*  2000           $16,500       $(86,527)    $(1,937,937)    $(3,031,133) *
*  2001            16,500       (101,235)     (2,267,344)     (3,546,359) *
*  2002            16,500       (107,309)     (2,403,385)     (3,759,140) *
*  2003            16,500       (113,747)     (2,547,588)     (3,984,689) *
*  2004            16,500       (120,572)     (2,700,443)     (4,223,770) *
***************************************************************************
  
Technology Impact
  
The bill would require programming changes to information systems at the
Department of Human Services (DHS).  It is assumed these costs could be
absorbed within existing resources.
  
  
Fiscal Analysis
  
The bill would continue the existence of DHS until August 31, 2011, make
numerous changes in agency operations, and transfer contested case
hearings to the State Office of Administrative Hearings.  All changes,
including funding and FTE position transfers, are assumed to have no net
fiscal impact unless otherwise noted below.

Section 10 of the bill would require DHS to assist a recipient of
financial assistance to assess the needs of the recipient and those of
the recipient's family that, if addressed, would help the recipient and
the recipient's family attain and retain independence, and to refer the
recipient and the recipient's family to appropriate preventative and
support services.  It is assumed that assistance and referral services
provided by DHS would be limited in scope and duration.  Consequently,
the department could comply with the provision without requiring
additional resources.

Section 13 would require DHS to perform presumptive eligibility for
certain community care programs, resulting in increased enrollment in the
Frail Elderly program.  Most of the increased cost would be paid with
Medicaid funding.  However, a portion of the additional clients would be
determined (subsequent to enrollment) to be ineligible for Medicaid.  It
is assumed the department would continue to provide benefits for these
clients using General Revenue alone.  Increased enrollment in the Frail
Elderly program would require additional expenditures for acute care at
the Department of Health.  These costs have been included in this fiscal
estimate.

Sections 25 and 27 would increase licensing fees, resulting in increased
revenue of $16,500 per year.
  
  
Methodology
  
It is estimated implementation of presumptive eligibility (Section 12)
would increase enrollment in the Frail Elderly program by 2.6 percent
over the otherwise anticipated caseload.  Therefore, enrollment would
increase by 721 clients in fiscal year 2000, 844 in 2001, 894 in 2002,
948 in 2003, and 1,005 in 2001. The average annual cost per client is
estimated to be $6,000.  Ninety-eight percent of additional clients would
qualify for Medicaid benefits (paid with approximately 39 percent
General Revenue, and 61 percent matching Federal Funds).  It is estimated
the remaining 2 percent of additional clients would not qualify for
Medicaid; their benefits would be paid with unmatched General Revenue.

The additional number of Medicaid Frail Elderly clients would require
increased expenditures for acute care costs at the Department of Health
(TDH).  The average monthly cost to TDH (including premium and
transportation) per client would total $86, resulting in an annual cost
of $729,249 in fiscal year 2000, $853,206 in 2001, $904,398 in 2002,
$958,662 in 2003, and $1,016,181 in 2004.  Benefits would be paid with
approximately 39 percent General Revenue, and 61 percent matching Federal
Funds.

Section 25 and 27:  Change in License Renewal Fees for Nursing Facility
Administrators
The bill would increase fees for approximately 112 administrators who
renew their licenses within 90 days after expiration by $50 resulting in
an increased revenue of $5,600 per year.  The bill would increase fees
for approximately 109 administrators who renew their licenses after more
than 90 days, but not longer than 1 year after expiration, by
$100--resulting in an increased revenue of $10,900 per year.
  
  
Local Government Impact
  
No significant fiscal implication to units of local government is
anticipated.
  
  
Source Agencies:   324   Department of Human Services
LBB Staff:         JK, TP, PP