LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 77th Regular Session
February 19, 2001
TO: Honorable Elliott Naishtat, Chair, House Committee on
Human Services
FROM: John Keel, Director, Legislative Budget Board
IN RE: HB1213 by Maxey (Relating to creation and implementation
by the Health and Human Services Commission of
family-based alternatives to the institutionalization of
children.), As Introduced
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* Estimated Two-year Net Impact to General Revenue Related Funds for *
* HB1213, As Introduced: negative impact of $(25,252,507) 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 Net Impact:
****************************************************
* Fiscal Year Probable Net Positive/(Negative) *
* Impact to General Revenue Related *
* Funds *
* 2002 $(5,828,917) *
* 2003 (19,423,590) *
* 2004 (27,063,184) *
* 2005 (34,053,099) *
* 2006 (34,852,427) *
****************************************************
All Funds, Five-Year Impact:
***********************************************************************
*Fiscal Probable Probable Probable Probable Change in *
* Year Savings/ Savings/ Savings/ Savings/ Number of *
* (Cost) from (Cost) from (Cost) from (Cost) from State *
* General General Federal Federal Employees *
* Revenue Revenue Funds - Funds - from FY 2001 *
* Fund Fund Federal Federal *
* 0001 0001 0555 0555 *
* 2002 $143,197 $216,594 13.5 *
* $(5,972,114) $(4,241,011) *
* 2003 574,514 864,649 27.0 *
* (19,998,104) (15,392,306) *
* 2004 861,987 1,296,758 27.0 *
* (27,925,171) (22,379,518) *
* 2005 1,149,316 1,729,011 27.0 *
* (35,202,415) (29,368,511) *
* 2006 1,200,077 1,805,375 27.0 *
* (36,052,504) (30,417,338) *
***********************************************************************
Fiscal Analysis
The bill would require the Health and Human Services Commission to
contract with community organizations for the development and
implementation of a system under which a child may receive necessary
services in a family-based alternative instead of an institution. Among
other responsibilities, the commission would be required to: (1) begin
implementation of the system in areas of the state with high numbers of
children who reside in institutions, (2) ensure that waiver services are
available immediately to each eligible child and (3) ensure that
definitions applicable to waiver services are modified as necessary to
permit family-based service delivery. The commission would also be
required to report to the legislature on implementation of the system
not later than January 1 of each year.
Methodology
General Assumptions
1. Savings shown in the table above result from no longer making a
nursing facility payment for children moving to family-based community
services.
2. Costs shown in the table above reflect increased costs for waiver
services, foster care payments and development of the system. Increased
costs are assumed for the Home and Community-based Services (HCS) waiver
at the Department of Mental Health and Mental Retardation and for the
Community Living and Support Services (CLASS) and Medically Dependent
Children's Program (MDCP) waivers at the Department of Human Services.
Additional caseworkers (13 in the first year and 25 in each subsequent
year) and related operating costs are also provided due to the increase
in waiver clients.
3. First year administrative costs are reduced by fifty percent to allow
for rulemaking and other start-up demands.
Other Assumptions
1. It is assumed that there are 1,253 children in institutions. Of this
number, 302 are in state schools, 240 are in nursing facilities and the
remainder are in private Intermediate Care Facilities for the Mentally
Retarded (ICFs-MR).
2. It is assumed that the system would be implemented first in an area
with 300 children in institutions. An additional 300 children would be
served each year thereafter until 2006 when all children currently in
institutions will be served.
3. It is assumed that the children provided waiver services each year
would be equally distributed between the HCS, CLASS and MDCP waiver
programs.
4. It is assumed that the state would not make payments for these
children to nursing facilities, state schools and ICF-MR facilities once
the child is placed in a community setting. It is assumed that there
would be no savings to the state from freeing up a state school or ICF-MR
bed because another client would enter the system and require services.
5. It is assumed that the Health and Human Services Commission would
contract to develop the system. The approximate amount of the contract
would be $1.3 million in 2002, $2.7 million in 2003, $3.1 million in
2004, $2.8 million in 2005 and $2.5 million in 2006. Additional amounts
would be needed at the commission for administrative costs related to the
contract, including two new full-time equivalent positions (FTEs).
6. It is assumed that 90 percent of the children residing in nursing
facilities would require residential placement at a rate equivalent to
the current Department of Protective and Regulatory Services' Level of
Care 6 at a cost of $200.98 per day. Ten percent of the children would
return to their families of origin and not require a residential
payment.
Local Government Impact
No significant fiscal implication to units of local government is
anticipated.
Source Agencies: 340 Texas Department on Aging, 324 Texas
Department of Human Services, 655 TX Dept. of
Mental Health & Mental Retardation, 529 Health and
Human Services Commission, 530 Department of
Protective and Regulatory Services
LBB Staff: JK, HD, NM, KF