LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 77th Regular Session
May 1, 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.), Committee
Report 1st House, Substituted
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* Estimated Two-year Net Impact to General Revenue Related Funds for *
* SB367, Committee Report 1st House, Substituted: negative impact *
* of $(86,787,131) 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 $(22,410,297) *
* 2003 (64,376,834) *
* 2004 (92,734,625) *
* 2005 (93,938,689) *
* 2006 (90,095,669) *
****************************************************
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 $(4,813,210) $(17,597,087) $(25,335,900) 88.0 *
* 2003 (4,621,840) (59,754,994) (89,548,135) 115.0 *
* 2004 (4,904,073) (87,830,552) (131,623,107) 137.0 *
* 2005 (5,047,033) (88,891,656) (133,117,779) 147.0 *
* 2006 (5,165,881) (84,929,788) (127,087,619) 154.0 *
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Fiscal Analysis
The bill would require the Health and Human Services Commission (HHSC)
and health and human services agencies to implement a plan that provides
meaningful opportunities for persons with disabilities to live in the
community. It would establish an interagency task force on ensuring
appropriate care settings for persons with disabilities. Reimbursement
for travel and related expenses for members would have to be authorized
in the General Appropriations Act.
The bill would require the Department of Mental Health and Mental
Retardation (MHMR) to implement a process that informs persons with
mental retardation living in facilities operated by MHMR or intermediate
care facilities for the mentally retarded (ICFs/MR) about alternative
community living options. The process must include referral to a local
mental retardation authority for placement in the selected option or on a
waiting list for that option.
The bill would require health and human services agencies to inform each
client about all available care and support options before allowing the
client to be placed in a care setting. It would also require health and
human services agencies to assist their clients in taking advantage of an
option or getting on the waiting list for that option.
The bill would establish a voucher program for transitional living
assistance for persons with disabilities. It would require HHSC to
coordinate with other agencies to develop the program which would be
administered by the Department of Human Services (DHS).
The bill would establish a pilot program for community-based alternatives
for persons with disabilities. It would require DHS to implement the
program in three sites. It would also require DHS, MHMR and the
Department of Protective and Regulatory Services to adopt a memorandum of
understanding to implement the program.
The bill would require the Commissioner of Health and Human Services to
establish the interagency task force and adopt rules by December 1,
2001. It would require health and human services agencies to inform
their clients about available options and require MHMR to implement the
alternative community living options process by March 1, 2002. It would
also require DHS to implement the pilot program for community-based
alternatives by December 1, 2002 (nine months earlier than in the bill
as introduced) and require health and human services agencies to adopt
the memorandum of understanding by September 1, 2002 (three months
earlier than in the bill as introduced). The effective date of the bill
would be September 1, 2001.
Methodology
The cost estimate is based on the following assumptions which include
updated information from DHS and the Department of Protective and
Regulatory Services (PRS):
The number of persons moving to Home and Community-based Services (HCS)
and mid-range waiver placements was provided by MHMR.
1) 425 state school residents would move to an HCS waiver placement by
the end of FY 2004, with 225 residents moving in FY 2002, 100 residents
moving in FY 2003, and 100 residents moving in FY 2004. The residents
would move in equal monthly increments each year. The average monthly
cost per placement would be $5,791 which includes $847 for Medicaid acute
care coverage paid by the Texas Department of Health.
2) 1,296 residents of community intermediate care facilities for the
mentally retarded (ICFs/MR) would move to an HCS waiver placement by the
end of FY 2004, with 432 residents moving in equal monthly increments
each year. The average monthly cost per placement would be $4,475.
3) 2,840 persons on waiting lists would move to an HCS waiver placement
by the end of FY 2003, with 910 persons moving in 2002, and 1,930 persons
moving in FY 2003 (also in equal monthly increments). The average
monthly cost per placement would be $3,509 plus $847 for Medicaid acute
care coverage for those without previously established Medicaid
eligibility.
4) 400 persons would move to the new mid-range waiver program in equal
monthly increments during FY 2003. The average monthly cost per
placement would be $2,083 plus $847 for Medicaid acute care coverage as
necessary.
6) The total cost for MHMR services would rise from $38 million in FY
2002, to $197 million in FY 2006. The method-of-finance would include
40% in General Revenue funds and 60% in federal matching funds from the
Medicaid program. According to the agency, 28 FTEs would be required to
provide administration and oversight for the program.
7) The new alternative community living options process would not create
a significant fiscal impact for MHMR (the agency did not provide an
updated cost estimate for this bill).
8) According to DHS, the cost of providing services and support for
nursing facility residents who move to the community would be offset by
savings achieved from no longer making nursing facility payments on their
behalf. Funding would have to be realigned between strategies to
accomplish this transition.
9) DHS would begin informing nursing facility residents and applicants
about all available options at the beginning of FY 2002. According to
the agency, 35 FTEs would be required in FY 2002, and 9 FTEs would be
required in each subsequent year to support this activity.
10) DHS would provide $2,500 in one-time transitional assistance for 961
persons each year. It would also use Federal Funds to provide monthly
housing subsidies averaging $254 for 334 persons in FY 2002 rising to 355
persons each year thereafter. According to the agency, 32 FTEs would be
required in FY 2002 rising to 89 FTEs in FY 2006 to support relocation
activities.
11) The cost of the pilot program for community-based alternatives
(including permanency planning, presumptive eligibility and pre-admission
screening) would be about $6 million for FY 2003 and $8.2 million for
each subsequent year. According to the agency, 20 FTEs would be required
in FY 2003 rising to 26 FTEs in each subsequent year for the pilot
program.
12) According to PRS, 3 FTEs would be required by FY 2003 to handle
participation in the pilot program for community-based alternatives for
persons with disabilities which will operate at three sites.
Local Government Impact
No significant fiscal implication to units of local government is
anticipated.
Source Agencies: 324 Texas Department of Human Services, 332 Texas
Department of Housing and Community Affairs, 529
Health and Human Services Commission, 530
Department of Protective and Regulatory Services,
655 TX Dept. of Mental Health & Mental Retardation
LBB Staff: JK, HD, NM