| TO: | Honorable Leticia Van de Putte, Chair, Senate Committee on Veteran Affairs & Military Installations |
| FROM: | John S. O'Brien, Director, Legislative Budget Board |
| IN RE: | SB1030 by Shapleigh (Relating to providing certain health care services for certain military servicemembers.), As Introduced |
| Fiscal Year | Probable Net Positive/(Negative) Impact to General Revenue Related Funds |
|---|---|
| 2010 | ($13,207,632) |
| 2011 | ($27,314,706) |
| 2012 | ($18,132,636) |
| 2013 | ($18,135,096) |
| 2014 | ($18,137,638) |
| Fiscal Year | Probable (Cost) from General Revenue Fund 1 |
Change in Number of State Employees from FY 2009 |
|---|---|---|
| 2010 | ($13,207,632) | 23.3 |
| 2011 | ($27,314,706) | 20.5 |
| 2012 | ($18,132,636) | 20.5 |
| 2013 | ($18,135,096) | 20.5 |
| 2014 | ($18,137,638) | 20.5 |
The bill requires the adjutant general to require each member of the Texas National Guard who served during Operation Enduring Freedom or Operation Iraqi Freedom to be screened for traumatic brain injury; it also requires the adjutant general to assist any member who tests positive in obtaining appropriate medical care.
The bill would require the Department of State Health Services (DSHS) to establish the Texas Servicemembers Assistance Program. The program would include: a 24-hour toll-free telephone hotline; traumatic brain injury (TBI) screening; additional diagnostic review, and treatment for post-traumatic stress disorder (PTSD) or TBI, including peer-based counseling, psychotherapy, prescriptions for behavior health pharmaceuticals, intensive outpatient services, and physical, speech, and occupational therapy services; referrals to local mental health authorities (LMHAs); and referrals to the Texas Veterans Commission.
The bill would require an LMHA to provide treatment for TBI or other mental health conditions of any servicemember referred to the authority by DSHS. The bill sets forth conditions for eligibility for services provided under the program and requires that servicemembers who do not meet the eligibility requirements for services under the program be referred to an appropriate service provider for follow-up care.
The bill would require that an eligible servicemember enroll in the program to receive services under the program, and that following expiration of the term of enrollment, the servicemember may reenroll for services under the program if DSHS determines that the servicemember continues to qualify for treatment for PTSD or TBI.
The bill would authorize a family member of an enrollee to receive counseling services, appropriate training, and other appropriate services under the program.
The bill would require the executive commissioner of the Health and Human Services Commission to adopt rules relating to the program not later than January 1, 2010.
The adjutant general assumes no cost for screening and related assistance because screening is currently required at demobilization.
DSHS assumes that they will enter into contracts with LMHAs and the Department of Assistive and Rehabilitative Services to provide services required by the bill.
The agency estimates a one-time cost of $0.5 million in fiscal year 2010 for the establishment of a 24-hour toll-free hotline, and an annual cost of $0.1 million for each subsequent year. The agency estimates an additional one-time cost of $0.5 million for integrating training relating to treatment protocols for PTSD into the existing resiliency disease management mental health service delivery model used by DSHS. The agency estimates that one peer-to-peer service coordinator would be needed at each of the 37 LMHAs and NorthSTAR for the provision of peer-to-peer counseling at an annual cost of $2.4 million.
It is assumed that it would take six months to develop and implement the program and that client services would be provided beginning in March 2010.
DSHS estimates that there are 230,000 veterans in
The agency estimates that the average cost to serve an adult mental health patient in an LMHA is $415 per month with an additional monthly cost of $52.05 for medications. An average length of service of six months is assumed. It is assumed that the 4,255 servicemembers meeting the criteria would be phased into the program over its first 12 months (355 clients entering per month) and that an additional 177 clients would present each month thereafter as more servicemembers return to Texas or present with symptoms. The total estimated cost to provide services to these clients is $3.4 million in fiscal year 2010, $10.0 million in fiscal year 2011, and $5.8 million in fiscal year 2012 and subsequent years.
The agency estimates that approximately 50 percent or 2,217 servicemembers would have family members that are eligible and likely to request services available to them through the program. The agency estimates 11 sessions per family at the standard rate for family therapy of $60.14 per session. The resulting cost for family services offered through the program is estimated to be $0.7 million in fiscal year 2010 and $1.4 million in fiscal year 2011 and subsequent years.
It is assumed that DSHS would contract with the Department of Assistive and Rehabilitative Services (DARS) for treatment of servicemembers with TBI through the comprehensive rehabilitation services program; DSHS notes that while the bill requires that individuals needing further treatment for TBI be referred to LMHAs, the authorities do not currently provide treatment for TBI. DARS currently operates a waiting list for comprehensive rehabilitation services, but it is assumed that the contract for services would not require clients to be placed on the waiting list. An average monthly cost of $3,803.08 is assumed with an average length of service of six months. It is assumed that the 628 servicemembers meeting the criteria would be phased into the program over its first 12 months (52 clients entering per month) and that an additional 26 clients would present each month thereafter as more servicemembers return to Texas or present with symptoms. The total estimated cost to provide services to these clients is $4.2 million in fiscal year 2010, $12.2 million in fiscal year 2011, and $7.1 million in fiscal year 2012 and subsequent years.
DSHS estimates that 15 full-time-equivalent positions (FTEs) would be necessary for administration of the program. It is estimated that DARS would require an additional 12 FTEs in fiscal year 2010 and 5.5 FTEs in fiscal year 2011 and beyond to serve the additional clients in the comprehensive rehabilitation services program. The total estimated staffing costs are $1.5 million in fiscal year 2010 and $1.2 million in fiscal year 2011 and subsequent years.
The total cost of the bill is estimated to be $13.2 million in fiscal year 2010, $27.3 million in fiscal year 2011, and $18.1 million in fiscal year 2012 and beyond.
The bill requires LMHAs to provide treatment for TBI or other mental health conditions. The cost of contracted services provided through the Texas Servicemembers Assistance Program are assumed to be covered by DSHS, however the cost of extended services provided by LMHAs upon referral from the program could be substantial and are not part of the estimated cost of the program. Although the bill requires LMHAs to provide treatment for TBI or other mental health conditions, they are not currently equipped to provide such services and establishing capacity to do so, if possible, could also have a substantial cost.
| Source Agencies: | 401 Adjutant General's Department, 537 State Health Services, Department of, 538 Assistive and Rehabilitative Services, Department of
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| LBB Staff: | JOB, KK, LR, SDO, JJ
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