Honorable James B. Frank, Chair, House Committee on Human Services
FROM:
John McGeady, Assistant Director Sarah Keyton, Assistant Director Legislative Budget Board
IN RE:
HB2134 by Klick (Relating to health care specialty consultations in certain child abuse or neglect investigations and assessments.), As Introduced
Estimated Two-year Net Impact to General Revenue Related Funds for HB2134, As Introduced: a negative impact of ($8,715,912) through the biennium ending August 31, 2021.
The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.
Fiscal Year
Probable Net Positive/(Negative) Impact to General Revenue Related Funds
2020
($4,361,307)
2021
($4,354,605)
2022
($4,354,605)
2023
($4,354,605)
2024
($4,354,605)
Fiscal Year
Probable Savings/(Cost) from General Revenue Fund 1
Probable Savings/(Cost) from GR Match For Medicaid 758
Probable Savings/(Cost) from Federal Funds 555
Change in Number of State Employees from FY 2019
2020
($4,338,425)
($22,882)
($215,091)
20.0
2021
($4,331,758)
($22,847)
($214,760)
20.0
2022
($4,331,758)
($22,847)
($214,760)
20.0
2023
($4,331,758)
($22,847)
($214,760)
20.0
2024
($4,331,758)
($22,847)
($214,760)
20.0
Fiscal Analysis
The bill would require the Department of Family and Protective Services (DFPS) to include provisions for medical consultations by orthopedist to the list of physicians that Forensic Assessment Center Network (FACN) or the Texas Medical Child Abuse Resources and Education System (MEDCARES) must make available for consultations.
The bill would also require DFPS or FACN to refer the case to MEDCARES for consultation, if recommended by the child's primary care physician, or other health care provider, the child's parent or legal guardian or the parent or legal guardian's attorney. MEDCARES would be required to accept consultation regardless of available capacity.
DFPS and FACN would be required to provide information and credentials of a specialist before making a referral to MEDCARES and be required to collaborate with the parent or legal guardian to identify a mutually acceptable specialist.
The bill would add additional terms and medical definitions for medical consults during investigations.
The bill would also prohibit a health care provider that reports abuse or neglect, regardless of whether the provider is a FACN or MEDCARES provider, from then serving as a consultant to DFPS on the case, and would instead require DFPS to refer the case to another health care provider for consultation and would require FACN and MEDCARES to select providers for DFPS consultations that are located outside the geographic area where the alleged abuse/neglect occurred and where the provider practices.
The bill would take effect September 1, 2019.
Methodology
DFPS indicated that providing medical expertise and making informed decisions on the qualification of medical specialists would be a new function of the agency. DFPS assumes that it would need 18 Nurse III full-time equivalents (FTEs) and 2 manager IV FTEs each fiscal year to implement the provisions of the bill. In addition to specifically managing the second opinion procedures and process, these staff will be used to develop and deliver training to field staff relating to the policy and practice changes required by this bill, and ensure the process supports the field in making critical child safety decisions.
The bill would prohibit a health care provider that reports abuse/neglect from then serving as a consultant to DFPS on the case. Since further consultation with the health care provider who made the report is prohibited, DFPS assumes FACN would be the primary source for a second opinion. DFPS assumes that the current FACN contract in the amount of $2,459,950 in All Funds would be doubled to meet the potential increase in demand for consultations, resulting in additional cost of $2,459,950 in All Funds. Historically, the most frequent reporter of child abuse and neglect are medical personnel. This amount would cover about 9,000 additional consultations which is approximately 10 percent of the caseload associated with physician referrals.
The Department of State Health Services and the University of Texas System Administration did not indicate significant fiscal impact to implement the provisions of the bill.
Technology
The analysis assumes that FTE related IT costs would be $214,920 in All Funds in fiscal year 2020 and $14,460 in All Funds in future fiscal years.
Local Government Impact
No significant fiscal implication to units of local government is anticipated.
Source Agencies:
530 Family and Protective Services, Department of, 537 State Health Services, Department of, 720 The University of Texas System Administration