LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 77th Regular Session
April 2, 2001
TO: Honorable Mike Moncrief, Chair, Senate Committee on
Health & Human Services
FROM: John Keel, Director, Legislative Budget Board
IN RE: SB367 by Zaffirini (Relating to ensuring an appropriate
care setting for a person with a disability.), As
Introduced
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* Estimated Two-year Net Impact to General Revenue Related Funds for *
* SB367, As Introduced: negative impact of $(88,568,999) 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 $(24,126,271) *
* 2003 (64,442,728) *
* 2004 (96,725,016) *
* 2005 (97,942,354) *
* 2006 (94,176,063) *
****************************************************
All Funds, Five-Year Impact:
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*Fiscal Probable Probable Probable Change in *
* Year Savings/(Cost) Savings/(Cost) Savings/(Cost) Number of State *
* from General from GR Match from Federal Employees from *
* Revenue Fund for Medicaid Funds - Federal FY 2001 *
* 0001 0758 0555 *
* 2002 $(6,245,516) $(17,880,755) $(25,618,169) 99.8 *
* 2003 (6,732,357) (57,710,371) (85,444,600) 104.2 *
* 2004 (8,427,185) (88,297,831) (130,883,912) 155.9 *
* 2005 (8,598,188) (89,344,166) (132,363,982) 168.3 *
* 2006 (8,752,450) (85,423,613) (126,370,318) 177.5 *
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Fiscal Analysis
Section 1 of the bill would require the Health and Human Services
Commission (HHSC) and appropriate health and human services agencies to
implement a plan that provides a system of services and support that
fosters independence and productivity and provides meaningful
opportunities for persons with disabilities to live in the community. It
would also establish an interagency work group and a 12-member advisory
committee on ensuring appropriate care settings for persons with
disabilities. Reimbursement for travel and related expenses for members
of the work group and the advisory committee would have to be authorized
in the General Appropriations Act.
Section 2 would require each health and human services agency to provide
each client of the agency information regarding all care and support
options available to the client before allowing the client to be placed
in a care setting. The agency providing the information would also be
required to assist the client in taking advantage of an option selected.
Section 3 would establish a voucher program for transitional living
assistance for persons with disabilities. HHSC would be required to
coordinate with other agencies to develop the program which would be
implemented and administered by the Department of Human Services (DHS).
Section 4 would establish a pilot program for community-based
alternatives for persons with disabilities. DHS would be required to
develop and implement the pilot program in at least five sites. It would
also require DHS and the Department of Mental Health and Mental
Retardation (MHMR) by rule to adopt a memorandum of understanding to
implement the pilot program.
The Commissioner of Health and Human Services would be required to
establish the interagency work group and advisory committee and adopt
rules not later than December 1, 2001. Each health and human services
agency would be required to provide each client and the client's
guardian, the information required by Section 2 not later than March 1,
2002. The pilot program would be required to be implemented not later
than September 1, 2003. The effective date of the bill is September 1,
2001.
Methodology
According to DHS, the cost of providing long-term care services and
support for nursing facility residents who decide to move to the
community would be offset by savings achieved from no longer making
nursing facility payments on their behalf. Funding would need to be
realigned between strategies to accomplish the transition. DHS reports
it would begin informing nursing facility residents and applicants about
all care and support options at the beginning of FY 2002. According to
the agency, 35 new FTEs would be required to support this activity in FY
2002 and 8.9 positions would be required on a continuing basis
thereafter.
It is assumed MHMR would assist 425 state school residents who choose to
move to a Home and Community-based Services (HCS) placement in FYs 2002,
2003 and 2004 to make the transition in equal monthly increments (e.g.,
1/12th of 225 state school residents moving in FY 2002 would move during
the first month of the year and 1/12th each month thereafter). The
average monthly cost for these placements would be $5,791 which includes
$847 for Medicaid acute care coverage paid by the Department of Health.
1,296 residents of community intermediate care facilities for the
mentally retarded (ICFs/MR) would move to an HCS placement during this
time period (also in equal monthly increments) at an average monthly cost
of $4,475 per placement. 2,840 persons on waiting lists would move to
an HCS placement in FYs 2002 and 2003 at an average monthly cost of
$3,509 per placement plus $847 for Medicaid acute care coverage for those
without previously established Medicaid eligibility. 400 persons would
move to a new mid-range waiver program in FY 2003 at an average monthly
cost of $2,083 per placement plus $847 for Medicaid acute care coverage
as necessary. The total cost for these services would rise from $38
million in FY 2002 to $197 million in FY 2006, 60% of which could be paid
for using federal funds. According to MHMR, 28 new FTEs would be
required through FY 2006 for administration and oversight activities.
DHS reports it would provide $2,500 in one-time transitional assistance
for 961 persons each year as well as monthly housing subsidies ranging
from $207 to $407 for 79 persons in FY 2002 rising to 194 persons in FY
2006. According to the agency, 44 new FTEs would be required to support
relocation activities in FY 2002 rising to 106 positions in FY 2006.
It is assumed the annual costs of the pilot program for community-based
alternatives, including permanency planning, presumptive eligibility and
pre-admission screening, would be slightly more than $9 million from FY
2003 to FY 2006. According to DHS, 35 new FTEs would be required to
support the activities.
Local Government Impact
No fiscal implication to units of local government is anticipated.
Source Agencies: 529 Health and Human Services Commission, 332
Texas Department of Housing and Community Affairs,
655 TX Dept. of Mental Health & Mental
Retardation, 324 Texas Department of Human
Services, 501 Texas Department of Health
LBB Staff: JK, HD, NM