LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 77th Regular Session March 18, 2001 TO: Honorable Patricia Gray, Chair, House Committee on Public Health FROM: John Keel, Director, Legislative Budget Board IN RE: HB1152 by Raymond (Relating to the provision of prescribed medications and community and personal care services under the medical assistance program.), As Introduced ************************************************************************** * Estimated Two-year Net Impact to General Revenue Related Funds for * * HB1152, As Introduced: negative impact of $(80,686,994) through * * the biennium ending August 31, 2003. * * * * 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 * * 2002 $(25,827,405) * * 2003 (54,859,589) * * 2004 (58,242,909) * * 2005 (61,814,837) * * 2006 (65,605,320) * **************************************************** All Funds, Five-Year Impact: *************************************************************************** *Fiscal Probable Savings/(Cost) from GR Probable Savings/(Cost) from * * Year Match for Medicaid Federal Funds - Federal * * 0758 0555 * * 2002 $(25,827,405) $(39,031,743) * * 2003 (54,859,589) (82,564,231) * * 2004 (58,242,909) (87,619,623) * * 2005 (61,814,837) (92,993,169) * * 2006 (65,605,320) (98,695,506) * *************************************************************************** Technology Impact It is assumed the Department of Human Services (DHS) would need to modify automation systems related to client eligibility. A total of 1,200 hours--for all policy changes--at a cost of $110 per hour is assumed for FY 2002. The federal share of expenses would total 50%. Fiscal Analysis The bill would amend three areas of the Human Resources Code, making three changes in Medicaid services. Section 1 would require the provision of three prescribed medications each month for a recipient of services under the DHS Frail Elderly program. It is assumed the expense would be paid through the Department of Health's (TDH) Medicaid Vendor Drug program. Section 2 would require DHS to provide for the determination and certification of presumptive eligibility for a person who appears to meet the financial and other program eligibility criteria for the receipt of services under the Primary Home Care program or Community-based Alternatives program. Section 3 would require DHS by rule to permit a registered nurse to delegate to an unlicensed attendant the performance of appropriate nursing tasks under the nurse's supervision in accordance with rules adopted by the Board of Nurse Examiners for the Primary Home Care program. Methodology It is assumed that any necessary federal approvals and programming changes would allow for a March 2002 implementation for all three policy changes. Cost estimates below are adjusted accordingly. Three Prescriptions per Month for Frail Elderly Clients It is assumed that program clients would receive three prescriptions per month per year. The number of average monthly clients is assumed to be 30,731 in FY 2002, 33,192 in FY 2003, 35,850 in FY 2004, 38,721 in FY 2005, and 41,822 in FY 2006. The average monthly cost for one prescription for this population is estimated to be $66.13 per month in FY 2002. No cost growth is assumed for subsequent years. The federal share of client services expenses are assumed to be 60.20% in FY 2002, 60.08% in FY 2003, and 60.07% in each subsequent year. It is assumed the expense would be paid through the Department of Health's (TDH) Medicaid Vendor Drug program. Presumptive Eligibility for the Primary Home Care program or Community-based Alternatives Program DHS estimates implementation would result in the following increase in average monthly clients: 2,502 in FY 2002, 2,585 in FY 2003, 2,668 in FY 2004, 2,668 in FY 2005, and 2,834 in FY 2006. The client cost for long-term care services provided by DHS is assumed to average $761 per month per client. The client cost for acute care services provided by TDH for the same clients is assumed to average $223.93 per month per client. The federal share of client services expenses are assumed to be 60.20% in FY 2002, 60.08% in FY 2003, and 60.07% in each subsequent year. Nurse Delegation DHS estimates the number of average monthly clients to be affected would total 74,228 in FY 2002, 77,366 in FY 200, 80,504 in FY 2004, 83,642 in FY 2005, and 86,780 in FY 2006. An incremental cost increase per client per month is assumed to total $30. Assumptions related to increased expenditures include: an increase in the level of service, higher wages for attendants, and oversight by nurses. The federal share of client services expenses are assumed to be 60.20% in FY 2002, 60.08% in FY 2003, and 60.07% in each subsequent year. Local Government Impact No fiscal implication to units of local government is anticipated. Source Agencies: 324 Texas Department of Human Services, 529 Health and Human Services Commission, 501 Texas Department of Health LBB Staff: JK, HD, PP, ML