LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 76th Regular Session April 29, 1999 TO: Honorable Patricia Gray, Chair, House Committee on Public Health FROM: John Keel, Director, Legislative Budget Board IN RE: SB1340 by Carona (relating to the regulation of anesthesia in certain outpatient settings), Committee Report 2nd House, as amended ************************************************************************** * Estimated Two-year Net Impact to General Revenue Related Funds for * * SB1340, Committee Report 2nd House, as amended: positive impact * * of $92,000 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 $39,000 * * 2001 53,000 * * 2002 53,000 * * 2003 53,000 * * 2004 53,000 * **************************************************** All Funds, Five-Year Impact: *************************************************************************** *Fiscal Probable Revenue Gain/(Loss) Probable Savings/(Cost) from * * Year from General Revenue Fund General Revenue Fund * * 0001 0001 * * 2000 $72,750 $(33,750) * * 2001 134,000 (81,000) * * 2002 134,000 (81,000) * * 2003 135,000 (82,000) * * 2004 135,000 (82,000) * *************************************************************************** Fiscal Analysis The bill would amend the Medical Practice Act and the Nursing Practice Act to require the Board of Medical Examiners (BME) and the Board of Nurse Examiners (BNE) to adopt rules to regulate the provision of anesthesia services in outpatient surgical settings that are not a part of a licensed hospital or licensed ambulatory surgical center. The bill would require the BME and BNE to work together to reduce conflicts between the rules adopted by each board. The bill would also require physicians and nurse anesthetists to comply with rules adopted on or after August 31, 2000 so that physicians would register annually; nurse anesthetists would register biennially; and both would pay a registration fee. The bill would require the BME and the BNE to adopt rules necessary to implement the provisions of the bill by January 7, 2000, and would allow registrations to be staggered over a two year period so that all affected physicians and nurse anesthetists would be in compliance by September 1, 2002. In addition, the bill would authorize the BME and the BNE to inspect office sites, and related documents, as well as allowing physicians and nurse anesthetists to request an inspection from their respective board to receive an advisory opinion regarding their compliance with the provisions of the bill. The bill would also allow the BME and BNE to conduct requested compliance inspections and establish a fee for providing that service. The bill would take effect September 1, 1999. Methodology The BME estimates 530 physicians would be affected by the requirements of the bill and that a $100 registration fee will be assessed to those physicians. It is assumed that the BME would stagger and phase in registrations over a one-year period so that all affected physicians would be in compliance by September 1, 2001. Accordingly, the BME anticipates generating $39,000 in fee revenues by registering 390 affected physicians in fiscal year 2000, and $53,000 in fiscal year 2001 with all 530 affected physicians registering annually. In addition, the BME estimates that a total of $33,750 in operating and travel costs would be realized by the state for providing compliance inspections in fiscal year 2000, and that $45,000 would be realized in each following year. The BME estimates conducting 54 inspections in fiscal year 2000 and 72 inspections in each subsequent year with each inspections costing approximately $625 to cover the costs of providing the service. The BNE estimates that 1,454 registered nurse anesthetists would be affected by the requirements of the bill and that license renewal fees would be increased beginning September 1, 2000 by 50 cents per renewal to cover operating and travel costs required to conduct compliance inspections. The BNE estimates that the increase would generate approximately $36,000 in the first two years and $37,000 in the following two years in accordance with the anticipated growth in the number of licensees. Local Government Impact No significant fiscal implication to units of local government is anticipated. Source Agencies: 304 Comptroller of Public Accounts LBB Staff: JK, TP, MW