LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 77th Regular Session
March 15, 2001
TO: Honorable Mike Moncrief, Chair, Senate Committee on
Health & Human Services
FROM: John Keel, Director, Legislative Budget Board
IN RE: SB33 by Zaffirini (Relating to the provision of
prescribed medications and community and personal care
services under the medical assistance program.), As
Introduced
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* Estimated Two-year Net Impact to General Revenue Related Funds for *
* SB33, 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. *
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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:
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*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) *
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Technology Impact
It is assumed the Department of Human Services (DHS) would need 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