LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 76th Regular Session April 6, 1999 TO: Honorable Judith Zaffirini, Chair, Senate Committee on Human Services FROM: John Keel, Director, Legislative Budget Board IN RE: SB1587 by Zaffirini (Relating to the detection of fraud, waste, and abuse in the state Medicaid program), Committee Report 1st House, Substituted ************************************************************************** * Estimated Two-year Net Impact to General Revenue Related Funds for * * SB1587, Committee Report 1st House, Substituted: positive impact * * of $6,059,065 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 $(609,854) * * 2001 6,668,919 * * 2002 13,156,707 * * 2003 11,343,332 * * 2004 11,155,928 * **************************************************** All Funds, Five-Year Impact: *************************************************************************** *Fiscal Probable (Cost) Probable (Cost) Probable Probable * * Year from General from Federal Savings from Savings from * * Revenue Fund Funds General Revenue Federal Funds * * 0001 0555 Fund 0555 * * 0001 * * 2000 $(609,854) $(609,854) $0 $0 * * 2001 (1,779,562) (1,799,562) 8,448,481 13,416,119 * * 2002 (1,120,000) (1,120,000) 14,276,707 22,671,293 * * 2003 (1,120,000) (1,120,000) 12,463,332 19,791,668 * * 2004 (1,120,000) (1,120,000) 12,275,928 19,494,072 * *************************************************************************** Technology Impact The bill would require adaptations to the current System for Application, Verification, Eligibility, Referral and Reporting (SAVERR) at the Department of Human Services. Because this system is not Year 2000 compliant, it is anticipated that adaptations to the SAVERR system will begin in the last quarter of fiscal year 2000. The bill would require modifications to the current medical profile and tape matches, as well as require a redesign of the medical identification card. Total costs related to the system changes are estimated to be $1.8 million (50 percent state). Fiscal Analysis The bill would require certain program changes at several agencies, including the Department of Health (TDH), Department of Human Services (DHS), and Health and Human Services Commission (HHSC). The bill would require DHS to enhance its current efforts related to the periodic review of eligibility status of Medicaid recipients by verification of state and federal agencies' databases. DHS would also be required to redesign the Medicaid identification form. The interagency task force on electronic benefits would explore possible use of an electronic benefits card for Medicaid services. The bill would provide authority for HHSC to contact recipients by phone or visit individuals to confirm receipt of Medicaid services. The bill would also require TDH to contract for professional services to test Medicaid claims payment systems. Methodology Costs 1. Costs for information technology system changes will begin in the last quarter of fiscal year 2000; thus, savings from provisions of the bill would not begin until the mid-year in 2001. 2. Contracted services will be required for one-time programming of the SAVERR system and redesign of the Medicaid identification form by DHS ($1.8 million); phone and/or on-site verification of benefits by HHSC ($780,000 annually); and testing of claims payment systems by TDH ($1.5 million annually). 3. Administrative costs are estimated to be shared equally (50 percent state and 50 percent federal). Savings 1. Savings estimates provided by the Comptroller of Public Accounts have been adjusted to reflect the anticipated delay in automated system adjustments. Savings would begin in the middle of fiscal year 2001. Under current operations, if overpayments are identified by the National Heritage Insurance Company on behalf of the Department of Health, the State receives these refunds through premium credits and shares them with the federal government. 2. A number of activities are currently underway by the affected agencies which are anticipated to be operational prior to the new 2000-01 biennium. These include new claims payment systems (also referred to as COMPASS 21) for Medicaid programs including payments for hospital, physician, nursing homes, community care, and the ICF-MR program. The new systems are expected to prevent inappropriate payments and more readily access data for claims review and audit. 3. The Office of Investigation and Enforcement at HHSC continues to build new algorithms to detect fraudulent claiming activities in the Medicaid program. 4. The savings relate to client services payments which would be shared according to the Federal Medical Assistance Percentage (FMAP) with the federal government (39 percent state; 61 percent federal). The State currently accepts eligibility determination by the federal Social Security Administration for Supplemental Security Income (SSI) eligible individuals as conferring Medicaid eligibility in Texas. It may be necessary for the State to renegotiate or alter its current arrangement with SSA in order to implement the provisions of the bill. Local Government Impact No significant fiscal implication to units of local government is anticipated. Source Agencies: LBB Staff: JK, TP, AZ