LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 77th Regular Session
April 9, 2001
TO: Honorable Mike Moncrief, Chair, Senate Committee on
Health & Human Services
FROM: John Keel, Director, Legislative Budget Board
IN RE: SB1245 by Moncrief (Relating to reporting certain acts
of misconduct by and background checks of certain
employees and applicants for employment of certain
health care agencies and facilities.), Committee Report
1st House, Substituted
**************************************************************************
* Estimated Two-year Net Impact to General Revenue Related Fundsfor *
* SB1245, Committee Report 1st House, Substituted: positive impact *
* of $252,566 for an immediate effective date, and a positive impact *
* of $213,738 for a September 1, 2001 effective date, for 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. *
**************************************************************************
All Funds, Six-Year Impact:
***********************************************************************
*Fiscal Probable Probable Probable Probable Change in *
* Year Savings/ Savings/ Savings/ Savings/ Number of *
* (Cost) from (Cost) from (Cost) from (Cost) from State *
* General General Federal Federal Employees *
* Revenue Revenue Funds - Funds - from FY 2001 *
* Fund Fund Federal Federal *
* 0001 0001 0555 0555 *
* 2001 $(25,450) $111,249 $(12,366) $28,161 0.0 *
* 2002 (349,488) 444,955 (45,168) 112,683 1.0 *
* 2003 (373,655) 444,955 (50,210) 112,683 1.0 *
* 2004 (375,365) 444,955 (50,379) 112,683 1.0 *
* 2005 (376,505) 444,955 (50,491) 112,683 1.0 *
* 2006 (377,075) 444,955 (50,548) 112,683 1.0 *
***********************************************************************
The table above assumes an immediate effective date.
All Funds, Five-Year Impact:
The table below assumes a September 1, 2001, effective date.
***********************************************************************
*Fiscal Probable Probable Probable Probable Change in *
* Year Savings/ Savings/ Savings/ Savings/ Number of *
* (Cost) from (Cost) from (Cost) from (Cost) from State *
* General General Federal Federal Employees *
* Revenue Revenue Funds - Funds - from FY 2001 *
* Fund Fund Federal Federal *
* 0001 0001 0555 0555 *
* 2002 $(302,517) $444,955 $(46,825) $112,683 1.0 *
* 2003 (373,655) 444,955 (50,210) 112,683 1.0 *
* 2004 (375,365) 444,955 (50,379) 112,683 1.0 *
* 2005 (376,505) 444,955 (50,491) 112,683 1.0 *
* 2006 (377,075) 444,955 (50,548) 112,683 1.0 *
***********************************************************************
Fiscal Analysis
The bill would amend Chapter 48 of the Human Resources Code to require
the Department of Protective and Regulatory Services (PRS) to develop and
implement procedures for reporting misconduct by certain unlicensed
employees of home and community support services (home health) agencies.
Reportable conduct would include abuse or neglect that harms an
individual receiving agency services and financial exploitation ($25 or
more) of an individual receiving agency services. The procedures would
include but not be limited to providing written notice of findings to the
employee; offering the employee a formal administrative hearing; issuing
an order based on the hearings examiner's findings of fact, conclusions
of law and recommended decision; and providing for judicial appeal of the
order. The bill would also require PRS by rule to adopt procedures
governing informal proceedings and to forward findings of reportable
conduct to the Department of Human Services (DHS) for recording in the
Employee Misconduct Registry (EMR). Home and community support services
agencies would not be allowed to employ a person listed on the registry.
The bill would amend Chapter 250 of the Health and Safety Code to
authorize long-term care facilities, unlicensed attendant care agencies
that contract with DHS, adult foster care providers that contract with
DHS, local mental health and mental retardation authorities, and home and
community support services agencies to obtain criminal history record
information directly from the Texas Department of Public Safety (DPS).
It would prohibit these entities from employing a person in any position
(including a position that does not include direct contact with
consumers) based on adverse information obtained from inquiries made to
the DHS EMR or Nurse Aide Registry (NAR).
The bill would take effect immediately if it receives two-thirds vote in
each chamber, or on September 1, 2001. The amendments to Chapter 48 of
the Human Resources Code would only apply to reportable conduct that
occurs on or after the effective date of the act.
Methodology
It is assumed PRS would implement the new reporting requirement under
Chapter 48 of the Human Resources Code six months after the effective
date which is assumed to be December 1, 2001, for immediate effect and
March 1, 2002, for September 1, 2001 effective date. It is assumed DHS
would realize savings, as well as costs, based on the changes to Chapter
250 of the Health and Safety Code for either effective date.
PRS estimates the number of home and community support services agency
employees subject to the new reporting requirement ("confirmed
perpetrators") under Chapter 48 of the Human Resources Code would be 177
for 2002, 184 for 2003, 190 for 2004, 194 for 2005, and 196 for 2006.
PRS also estimates that 90% of these individuals would request a formal
or informal administrative review. It is assumed that 20% of those
requesting an administrative review would file an appeal. PRS would
require three additional FTE positions to handle the workload associated
with the new program including an attorney, a program specialist, and an
adult protective services specialist. The method-of-finance assumes 90%
General Revenue Funds and 10% federal matching funds from Medicaid. DHS
estimates there would be an annual telecommunications cost of
approximately $50,000 to handle an increased volume of calls from home
and community support services agency employers seeking information about
unlicensed direct care staff. DHS would require an additional FTE
position (Administrative Technician III) to manually enter information on
to the EMR, provide notification, and handle direct caller inquiries.
The method-of-finance would be 100% General Revenue Funds.
DHS assumes it would no longer process criminal history background checks
for the entities that could obtain criminal history record information
directly from DPS under Chapter 250 of the Health and Safety Code. This
would result in an annual savings of $557,638 and four FTE positions due
to the elimination of costs associated with conducting approximately
300,000 background checks per year. The method-of-finance for the
savings would be 80% General Revenue Funds and 20% Federal Funds. DHS
also assumes phone calls to the EMR and NAR would double because of the
requirement that entities check all employees. This would result in an
annual cost of approximately $83,000 plus $17,000 to upgrade the phone
system. The method-of-finance for the cost would be 67% General Revenue
Funds and 33% Federal Funds.
The Texas Department of Mental Health and Mental Retardation indicates
there would be a substantial (but not quantified) fiscal impact upon the
agency if the Chapter 250 bar on employment is absolute and retroactive
to include persons who committed minor offenses in the past, corrected
or not, due to the requirement that such persons be terminated and new
persons attracted, hired and trained.
Local Government Impact
No significant fiscal implication to units of local government is
anticipated.
Source Agencies: 405 Texas Department of Public Safety, 324 Texas
Department of Human Services
LBB Staff: JK, HD, NM