This Fiscal Note is not an official copy and should not be quoted or cited.
Fiscal Note - SB 0741 - Pregnancy Counseling Services
L.R. NO.  2689-01
BILL NO.  SB 741
SUBJECT:  Case Manager Bill
TYPE:     Original
DATE:     January 23, 1996

                              FISCAL SUMMARY

FUND AFFECTED              FY 1997             FY 1998           FY 1999
General Revenue          ($78,160)           ($88,746)         ($88,076)

Total Estimated
Net Effect on All
State Funds              ($78,160)           ($88,746)         ($88,076)


FUND AFFECTED              FY 1997             FY 1998           FY 1999

Total Estimated
Net Effect on All
Federal Funds                   $0                  $0                $0


FUND AFFECTED              FY 1997             FY 1998           FY 1999
Local Government                $0                  $0                $0

                              FISCAL ANALYSIS


The Attorney General's Office (AGO), the Department of Economic Development
(DED), Division of Professional Registration (DPR), the Coordinating Board
for Higher Education (CBE), the Department of Social Services (DOS), and the
Department of Mental Health (DMH) do not expect to be fiscally impacted.

The Office of State Courts Administrator (CTS) indicated it was unable to
provide an estimate of costs because it was unclear as to who was responsible
for funding case managers and to the amount of compensation to be paid.
Additionally, the CTS believe that the services proposed to be provided by
the family courts would extend to individuals who do not have cases pending
in Missouri courts and that are non-judicial in nature.  This raises the
question as to whether or not the provision of the services would be more
appropriately located in an executive branch agency.  Oversight assumes,
based on a similar proposal from last session (1127-19T), that the CTS would
not incur any costs.

Section 8 requires the Department of Elementary & Secondary Education (DES)
to develop and disseminate procedures for referral to case managers to public
and private schools.  DES assumes that this can be accomplished with existing

The Department of Health (DOH) expects to incur costs has a result of this
proposal.  DOH estimated costs for 2 FTE (i.e., Clerk Typist III and Health
Program Representative II).  The Health Program Representative II (HPR II)
would be responsible for developing a registration system for case managers;
informing local public health departments and relevant state agencies of
available case management services and how to refer clients; providing a list
of counties with no case managers available; investigating complaints and
taking necessary action to revoke a case manager's certification; and
supervising and operating the MCFH toll-free line TEL-LINK.  The Clerk Typist
II would establish and maintain record keeping of the verification process;
answer and respond to request for forms; provide support for the HPR II;
maintain the database for the TEL-LINK directory; and perform general
clerical duties.

DOH assumes that it would incur printing costs for the verification forms as
well as sample literature to be distributed to patients.  DOH expects to
print 30,000 forms at $.05 each, resulting in total costs of $1,500 annually.
Costs for printing sample literature was estimated at $600.  This was based
on providing literature to an estimated 20,000 health care providers.  Since
the proposal provides that the patient must present the verification form to
the abortion facility, DOH assumes general postage would only be $1,000.

DOH assumes that since section 487.207 (2) would require local public health
departments to make the registration list available, that under Hancock
provisions, DOH would actually incur the costs for printing and postage
related to the registration list.  DOH assumes that the registration list
would be 100 pages at a cost of $.03 per page and that 25,000 copies would be
printed.  It was also assumed that it would cost $3.00 per list to mail first
class.  Total costs related to this section would be $150,000.  Total costs
estimated by DOH would be $196,324 in FY97; $231,588 in FY98; and $238,283 in

Oversight assumes that if DOH only anticipates 100 case managers to be
registered, that the registration list could be condensed to approximately 20
pages printed front and back.  At $.03 per page for 25,000 copies the
printing costs would be reduced to $15,000.  Additionally, DOH currently
mails items at a bulk rate.  According to DOH mailroom personnel, a 20 page
document could be mailed at a bulk rate of $0.266 per piece, totalling $6,650
for 25,000 pieces.  As adjusted total costs would be $21,650.

Oversight adjusted personal services to reflect the Office of
Administration's guidelines and expense and equipment costs were adjusted
based on prior experience.  Rental costs were eliminated because it was
assumed that additional space would not be required, but the additional FTE
would be incorporated into existing space.  DOH could also realize income as
a result of charging a $10 registration fee.  DOH assumes that there would be
a minimum of 100 case managers registered at any given time for annual income
of $1,000.  The FY97 income amount was prorated to 10 months.

Oversight acknowledges the possibility of an increase in the number of
registered case managers in the second and third fiscal years.  If this
occurs, DOH would experience an increase in registration fee income, printing
costs and postage costs.

Lastly, DOH estimated costs for the local health departments.  It was assumed
that the local health departments would need a Clerk Typist II in each of the
114 counties.  The Clerk Typist II's would serve as the point of contact for
women and conduct follow-up to ensure that services were provided.  According
to DOH, the local health departments expect extensive phone time as a result
of this proposal.  The total for local health department contracts was
estimated at $3,073,440.  Oversight assumes that any increase in the local
health department's workload could be absorbed with existing personnel.
The only requirement of the proposal for the local health departments is to
maintain a registration list.  The registration list developed by DOH could
be sent to the local health departments, thus, allowing the local health
departments to fulfill the requirements of this proposal.  Furthermore, the
language does not provide for follow- up to be conducted in order ensure the
provision of services.

FISCAL IMPACT - State Government    FY 1997   FY 1998   FY 1999
                                   (10 Mo.)


Income-Department of Health (DOH)
Case Manager Registration Fee          $833    $1,000    $1,000

Costs-Department of Health (DOH)
  Personal Service (2 FTE)        ($33,914) ($41,731) ($42,774)
  Fringe Benefits                 ($10,425) ($12,828) ($13,149)
  Expense and Equipment           ($34,654) ($32,188) ($33,153)
Total Costs-DOH                   ($78,993) ($86,746) ($89,076)

GENERAL REVENUE                   ($78,160) ($85,746) ($88,076)

FISCAL IMPACT  - Local Government   FY 1997   FY 1998   FY 1999
                                   (10 Mo.)

                                         $0        $0        $0


The proposal would require that case management services, as defined in the
proposal, be provided to a client at no cost and that the acceptance of such
services would be on a voluntary basis.  A written verification form must
immediately be given to the client upon request.  It would be grounds for
revocation of the case manager's certification if a case manager refuses to
verify access to such services because the client did not choose to
participate.  The verification would conform to the language provided for in
the proposal and require that the case manager  sign the verification.  If
the case manager refuses to sign the verification form, the client could
swear under oath and attest before a notary public that the case manager
refused to sign and give the verification form to the client.  The swore
statement would be used in place of the verification form.

The Department of Health (DOH) would be responsible for defining minimum
standards for case management training consistent with this proposal, but
would not have any other duty not expressly mandated.  Any accredited public
or private post-secondary educational institutions could offer training
programs, with the applicant paying a fee not to exceed $70.  The school
would certify all applicants, with the training certification expiring after
three years.  Upon certification, the case managers would be required to
register with DOH.  The local public health department would be responsible
for maintaining a registration list of all case managers in the county or
city.  The list would be available to pregnant women at no charge, with other
persons being charged enough to cover the cost of copying.

DOH would be required to maintain a registration list of all case managers
including the case manager's date of birth.  A $10 registration fee would be
paid by the case managers at the time of registration.  The registration list
would be available, by county, to any person for public inspection without
charge and a copy would be provided at a charge not to exceed the actual
costs of copying.

Nothing in this proposal would require the department to compensate any
person for the performance of case manager services.

It would be unlawful for anyone to issue or purport to issue a verification
form without having completed the required training.  DOH, on its own
initiative or upon a complaint by any citizen, could revoke the training
certification of any case manager who consistently fails to comply with the
provisions of this proposal.  Any person who believes a case manager has not
complied with the provisions of this proposal could also make a complaint,
orally or in writing, to DOH or the family court.

The circuit court, by local rule, would be required to develop and implement
procedures within the family court to refer clients to case managers; DOH
would inform all local public health departments and relevant state agencies
of case manager services and how to refer clients; DOS would be required to
develop and implement procedures for social workers and other personnel
serving clients; DES would be required to develop and disseminate
implementation procedures to teachers, counselors and administrators for
referral purposes; and DMH would be required to develop and implement
procedures for counselors, treatment personnel and others for referral
purposes.  If a social worker, teacher, counselor, administrator, person
providing treatment or other person knows a client in need of prenatal care,
contemplating an abortion or otherwise needing case management services, the
client should be encouraged to seek services.  Any city, county or state
public health department could provide a place for case managers and clients
to meet.

The case manager would be required to use a system of identification codes
for record keeping which would protect the anonymity of the client.  All
information pertaining to an individual's need for case management services
and records would be strictly confidential.  All records would be delivered,
at any time, to the client upon demand.  If no demand were made by the
client, the records would be delivered to the client or destroyed within
thirty days after a case manager completes services.  Disclosure of client
records without written consent or failure to destroy records could subject a
public employee or any other person to civil actions and would be grounds for
revocation of any state license or certificate.

Beginning January 1, 1997, before a facility could perform an abortion, it
must receive a written verification from the client indicating that case
management services were offered.

Procedures would be developed when it would be necessary for a pregnant woman
to have a verification form prior to an induced abortion.  A list of case
managers would be available at the facilities for the clients.  If a
pregnancy results from rape or incest, as reported to a law enforcement
agency, no written verification would be necessary prior to an induced

It would be unlawful for a person to act as a case manager who has an
economic interest in an abortion facility or an organization which promotes a
purpose contrary to this proposal including, but not limited to employment,
investment or contractual relationships.   It would also be unlawful for a
person to act as a case manager who advocates violence or who has been
convicted of a misdemeanor, other than a traffic offense, or felony.  The
policy of the state would be to reduce out-of-wedlock conception, inadequate
prenatal care, infant mortality and abortion and to support childbirth and
effective family planning.

This legislation is not federally mandated, would not duplicate any other
program and would not require additional capital improvements or rental


Office of State Courts Administrator
Coordinating Board for Higher Education
Attorney General
Department of Economic Development
  Division of Professional Registration
Department of Social Services
Department of Mental Health
Department of Health
Department of Elementary & Secondary Education