LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 77th Regular Session
March 29, 2001
TO: Honorable Mike Moncrief, Chair, Senate Committee on
Health & Human Services
FROM: John Keel, Director, Legislative Budget Board
IN RE: SB1082 by Harris (Relating to licensing, inspecting,
surveying, and investigating certain nursing
institutions.), As Introduced
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* Estimated Two-year Net Impact to General Revenue Related Funds for *
* SB1082, As Introduced: negative impact of $(2,778,906) 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 $(1,439,453) *
* 2003 (1,339,453) *
* 2004 (1,339,453) *
* 2005 (1,339,453) *
* 2006 (1,339,453) *
****************************************************
All Funds, Five-Year Impact:
***********************************************************************
*Fiscal Probable Probable Probable Probable Change in *
* Year Savings/ Savings/ Savings/ Revenue Number of *
* (Cost) from (Cost) from (Cost) from Gain/(Loss) State *
* General GR Match Federal from Employees *
* Revenue for Funds - General from FY 2001 *
* Fund Medicaid Federal Revenue *
* 0001 0758 0555 Fund *
* 0001 *
* 2002 $(11,972) $(35,917) $(277,298) 20.0 *
* $(1,150,183) *
* 2003 (1,050,183) (11,972) (35,917) (277,298) 20.0 *
* 2004 (1,050,183) (11,972) (35,917) (277,298) 20.0 *
* 2005 (1,050,183) (11,972) (35,917) (277,298) 20.0 *
* 2006 (1,050,183) (11,972) (35,917) (277,298) 20.0 *
***********************************************************************
Technology Impact
Changes necessary to implement the bill could be reasonably absorbed
within existing resources.
Fiscal Analysis
I. The bill would move all informal dispute resolutions (IDR) from the
Texas Department of Health (TDH) to the Health and Human Services
Commission (HHSC), effective January 1, 2002.
II. The bill would require an attorney to require evidence of a violation
to ensure that such evidence sufficiently establishes a prima facie care
of failure to comply with the law. The bill would require the HHSC to
establish a program integrity office to ensure an employee's consistent,
competent, and faithful performance of survey, investigation, and related
duties and to establish an internal affairs office within the program
integrity office to handle complaints related to an employee who performs
such duties.
III. The bill would amend Chapter 242, Health and Safety Code, and
require the Department of Human Services (DHS) to identify in its rules
each violation of a rule for which a licensure or a Medicaid penalty may
be assessed and identify the specific reason, under 242.0665 (b), a
facility was denied a "right to correct." DHS would be required to leave
an "official notice" of violations with the facility at the time of the
exit conference. This notice would have to contain a list of violations
and recommendations for the facility's plan to correct the violations.
DHS would not be able to impose a penalty or remedy unless the violation
was included in the "official list." DHS could impose only one
administrative penalty per violation. The department could not assess
more than one monetary penalty under this chapter for a violation arising
out of the same act or failure to act, except as provided by Section
242.0665 (c). The bill would further allow DHS to consider the cash flow
and financial condition of the facility when determining the amount of a
penalty. The department could not assess a monetary penalty under this
chapter and a monetary penalty under Chapter 32, Human Resources Code,
for the same act or failure to act.
Provisions of bill other than the transfer of IDRs would be effective
September 1, 2001.
Methodology
I. It is assumed that the transfer of IDR functions would have no cost.
II. Four (4.0) additional FTEs would perform the additional legal
functions and staff the program integrity office.
III. a) The estimate assumes a workload increase of 2.5 percent pursuant
to provisions of the bill related to inspections, violation reporting,
and exit interviews. Additional staffing, totaling 15.0 full-time
equivalent positions per year, would be related to the licensing,
inspecting, surveying, and investigating of institutions. The estimate
also includes increases for travel and other operating costs associated
with the staffing adjustment. Annual costs associated with the
additional employees totaled $558,909.
b) Since the proposal would allow considerations of a facility's cash
flow and financial condition in determining the amount of a penalty, it
is assumed that an additional FTE (1.0) could perform the additional
workload. It is also assumed that the audit-related functions could be
funded through the federal Survey and Certification program.
c) Based upon the provisions of the bill which would limit administrative
penalties, DHS estimated the decrease in administrative penalties by
examining the FY 2000 data on penalties and removing the per day costs
beyond one day. Based on the FY 2000 data, DHS estimated a decrease of
$277,298 per year in General Revenue.
Local Government Impact
No significant fiscal implication to units of local government is
anticipated.
Source Agencies: 529 Health and Human Services Commission, 324
Texas Department of Human Services
LBB Staff: JK, HD, AJ, KF