LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 77th Regular Session
May 26, 2001
TO: Honorable Bill Ratliff, Lieutenant Governor
Honorable James E. "Pete" Laney, Speaker of the House
FROM: John Keel, Director, Legislative Budget Board
IN RE: HB3507 by Maxey (Relating to the regulation of dentistry
and the provision of dental services.), Conference
Committee Report
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* Estimated Two-year Net Impact to General Revenue Related Funds for *
* HB3507, Conference Committee Report: negative impact of *
* $(2,023,698) 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 $(1,106,741) *
* 2003 (916,957) *
* 2004 (899,750) *
* 2005 (899,750) *
* 2006 (899,750) *
****************************************************
All Funds, Five-Year Impact:
***********************************************************************
*Fiscal Probable Probable Probable Probable Change in *
* Year Savings/ Revenue Savings/ Savings/ Number of *
* (Cost) from Gain/(Loss) (Cost) from (Cost) from State *
* General from GR Match Federal Employees *
* Revenue General for Funds - from FY 2001 *
* Fund Revenue Medicaid Federal *
* 0001 Fund 0758 0555 *
* 0001 *
* 2002 $(115,641) $115,641 3.0 *
* $(1,106,741)$(1,611,706) *
* 2003 (56,324) 56,324 (916,957) (1,371,225) 2.5 *
* 2004 (56,324) 56,324 (899,750) (1,353,568) 2.0 *
* 2005 (56,324) 56,324 (899,750) (1,353,568) 2.0 *
* 2006 (56,324) 56,324 (899,750) (1,353,568) 2.0 *
***********************************************************************
Technology Impact
Automation costs are detailed under Methodology--Article IV.
Fiscal Analysis
The bill would make a number of changes regarding the regulation of
dentistry and the provision of dental services.
Article I would revise dental fees paid by the Medicaid program. The
bill would reduce the hospitalization fee, eliminate the behavior
management fee (except for patients diagnosed with a mental or physical
disability), and eliminate the nutritional consultation fee. No fiscal
impact is assumed for these changes since the bill directs that freed-up
funding should be redistributed to other commonly billed dental services
for which adequate accountability measures exist.
Article II would direct the Commissioner of Health and Human Services to
appoint a program administrator to administer a Medicaid pilot program
that uses teledentistry and other methods of dental services to provide
dental services to students in one public school district in the state.
The program administrator would establish a control group not to exceed
1,000 students to provide a benchmark for measuring performance of the
pilot program. Not later than December 31, 2002, the program
administrator would submit a report to the legislature regarding the
pilot. The bill would also direct the commissioner to appoint an advisory
committee related to the teledentistry pilot program. The article would
expire December 31, 2002, with the advisory committee abolished on the
same date. Client benefit costs and administrative costs are assumed for
this article. Travel reimbursement for advisory committee members would
have to be specifically authorized by the General Appropriations Act.
It is assumed that the provision of teledentistry dental services is
intended to apply only to participants in the pilot program. A broader
provision of teledentistry dental services to Medicaid clients would
result in additional costs.
Article III would direct the State Board of Dental Examiners (SBDE) to
establish an alternative dental hygiene training program and to appoint
an advisory committee to advise the board in developing the hygiene
training equivalency program. One FTE and travel costs are assumed for
this article. Travel reimbursement for advisory committee members would
have to be specifically authorized by the General Appropriations Act.
Article IV would allow dentists to delegate certain duties to dental
hygienists under certain conditions. The bill would allow for delegation
of the application of a pit and fissure sealant to a dental assistant,
provided the assistant had achieved a pit and fissure sealant
certificate. Costs to the Medicaid program are assumed. Additionally,
one FTE and automation costs are assumed for SBDE.
Article V would establish temporary reciprocal licensure for dentists who
practice in medically underserved areas. Potentially, this provision
could result in new revenue and new costs. However, these impacts have
not been estimated.
Article VI would remove the in-state institution limit on educational
repayment assistance provided by SBDE for dentists. The bill would also
repeal the time limit concerning payment assistant grants to dentists.
No fiscal impact is assumed.
Methodology
Article II
It is assumed the pilot would begin September 1, 2001, and end one year
later. It is assumed that 1,000 school children would receive pilot
program services at a cost of $222 per child. The federal share of
client benefits services would total 60.20%.
It is assumed the provision regarding a program administrator would
require one additional FTE position in FY 2002 (and .5 of an FTE position
in FY 2003). It is also assumed the eight members of the advisory
committee would travel four times in FY 2002, and one time in FY 2003, at
a cost per trip per member of $400. Administrative expenses would be
divided equally between Federal Funds and General Revenue Match for
Medicaid.
Article III
It is assumed the SBDE would require one additional FTE. One-time costs
related to advisory committee travel and related expenses would total
$28,340 in FY 2002. Costs would be paid with General Revenue, however,
it is anticipated the SBDE would increase fees to offset costs.
Article IV
TDH estimates allowing dental assistants to perform the application of a
pit and fissure sealant would result in 77,836 additional services per
year at a cost of $24.38 per service. TDH estimates allowing hygienists
to act independently would result in 7,025 additional services per year
at a cost of $50.63 per service. The federal share of client services
expenses would total 60.20% in FY 2002, 60.08% in FY 2003, and 60.07% in
each subsequent year.
TDH also estimates a one-time automation cost to establish hygienists as
a new provider type and to accomplish related claims processing changes,
totaling $167,000 in FY 2002. This administrative expense would be
divided equally between Federal Funds and General Revenue Match for
Medicaid.
It is assumed the SBDE would require one additional FTE. It is estimated
that one-time automation costs would total $23,575 in FY 2002. Annual
maintenance costs, beginning in FY 2003, would total $1,800. Costs
would be paid with General Revenue, however, it is anticipated the SBDE
would increase fees to offset costs.
Local Government Impact
No fiscal implication to units of local government is anticipated.
Source Agencies: 529 Health and Human Services Commission, 324
Texas Department of Human Services, 504 State Board
of Dental Examiners, 501 Texas Department of
Health
LBB Staff: JK, HD, PP