SB 0738 - Fiscal Note

Fiscal Note - SB 0738 - Assures Direct Access to Eye Care Providers in Health Plans

L.R. NO.  2851-01
BILL NO.  SB 738 w/ SCA 1
SUBJECT:  Insurance, Insurance-Medical, Health, Optometry
TYPE:     Original
DATE:     February 19, 1996



                              FISCAL SUMMARY
                    ESTIMATED NET EFFECT ON STATE FUNDS


FUND AFFECTED              FY 1997             FY 1998           FY 1999
Insurance
Dedicated Fund             $40,500                  $0                $0

General Revenue                 $0           (UNKNOWN)         (UNKNOWN)

Total Estimated
Net Effect on All
State Funds                $40,500          *(UNKNOWN)        *(UNKNOWN)
   *  not expected to exceed ($100,000) per fiscal year.


                   ESTIMATED NET EFFECT ON FEDERAL FUNDS


FUND AFFECTED              FY 1997             FY 1998           FY 1999
Federal                         $0           (UNKNOWN)         (UNKNOWN)

Total Estimated
Net Effect on All
Federal Funds                   $0          *(UNKNOWN)        *(UNKNOWN)
   *  not expected to exceed ($100,000) per fiscal year.


                    ESTIMATED NET EFFECT ON LOCAL FUNDS


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


                              FISCAL ANALYSIS

ASSUMPTION

The Department of Insurance (INS) states it will need .5 FTE, an Insurance
Product Analyst II, and related expense to review all new life and health
form filings caused by changes to insurance policies and plans generated by
this and all other legislation enacted during this session.  This FTE would
work full-time for six months a year.  INS states that approximately 245
insurers and 25 HMOs are currently writing medical plans.  On average each
company offers three plans.  The result would be 810 new policy filings
needed to comply with this legislation.  A policy filing fee of $50 is
required and based on  810 filings, $40,500 in revenue to the Insurance
Dedicated Fund would be generated in the first fiscal year only.

Oversight assumes the passage of this proposal would not increase cost to
INS; however,  revenue of $40,500 in the first fiscal year only would be
realized.  In addition, passage of  more than one similar proposal could
require the INS to request increased appropriations to cover cumulative
administrative costs.

Officials from the Consolidated Health Care Plan stated that this proposal
would increase costs to the Plan in an unknown amount.

Officials from the Office of Administration stated that this proposal
mandates vision care benefits with all health care plans.  By mandating
vision coverage this proposal would increase the cost of medical care
coverage in an unknown amount to the state.

Oversight assumes the passage of this proposal would not mandate additional
vision care benefits on all health plans.  This proposal would only require
that for existing benefits the insured or enrollee need not receive a
referral from their primary care physician prior to receiving services from
the optometrist or ophthalmologist of their choice.  Oversight assumes that
this proposal would have no fiscal impact on the Office of Administration or
the Missouri Consolidated Health Care Plan.

Officials from the Department of Social Services stated that medicaid
currently pays for eye care for children.  This proposal would increase the
cost of these services an unknown amount.  This increase in cost would apply
beginning in fiscal year 1998.

Officials from the Department of Highway and Transportation, the Department
of Health, the Department of Corrections, the Missouri State Highway Patrol,
and the Department of Conservation stated that passage of this legislation
will have no fiscal impact on their agencies.


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

  Income - Department of Insurance

  Policy Filing Fees                   $40,500         $0          $0

  Estimated Net Effect on Insurance    $40,500         $0          $0
  Dedicated Fund


GENERAL REVENUE FUND

Cost - Department of Social Services

Increased Medicaid Payments                 $0  (UNKNOWN)   (UNKNOWN)

Estimated Net Effect on General
Revenue Fund                                $0 *(UNKNOWN)  *(UNKNOWN)
                         * not expected to exceed ($100,000) per fiscal year.

FEDERAL FUNDS

Cost-Department of Social Services

Increased Medicaid Payments                 $0  (UNKNOWN)   (UNKNOWN)

Estimated Net Effect on Federal
Funds                                       $0 *(UNKNOWN)  *(UNKNOWN)

                        *  not expected to exceed ($100,000) per fiscal year.


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

                                            $0         $0          $0


DESCRIPTION

This proposal would require any health care plan that provides eye care to
assure direct access to primary eye care providers without any referral.  The
primary eye care providers need not be on the list of preferred providers,
although the health care plan may charge a "reasonable" higher
copayment for out-of-plan care (under regulations issued by the Dept. of
Insurance).  Several other protections for the patient and eye care providers
are included.  Both ophthalmologists and optometrists are included as eye
care providers.

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

SOURCES OF INFORMATION

Department of Insurance
Department of Health
Department of Highway and Transportation
Department of Corrections
Department of Conservation
Missouri State Highway Patrol
Office of Administration
Department of Social Services
Consolidated Health Care Plan