SB 0689 - Fiscal Note

Fiscal Note - SB 0689 - Relates to blood tests for pregnant women

COMMITTEE ON LEGISLATIVE RESEARCH

OVERSIGHT DIVISION

FISCAL NOTE

L.R. NO. 3146-06

BILL NO. HCS for SB 689

SUBJECT: Health Care: Blood Test

TYPE: Original

DATE: April 28, 1998

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FISCAL SUMMARY

ESTIMATED NET EFFECT ON STATE FUNDS
FUND AFFECTED	FY 1999	FY 2000	FY 2001
General Revenue*	$0 to ($262,737)	$0 to ($281,557)	$0 to ($288,893)
Missouri Public Health Services	$3,500	$3,500	$3,500
Total Estimated Net Effect on All State Funds*	$3,500 to ($259,237)	$3,500 to ($278,057)	$3,500 to ($285,393)

*Subject to appropriation.

ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED	FY 1999	FY 2000	FY 2001
None
Total Estimated Net Effect on All Federal Funds	$0	$0	$0

ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED	FY 1999	FY 2000	FY 2001
Local Government	$3,500	$3,500	$3,500

Numbers within parentheses: ( ) indicate costs or losses

This fiscal note contains 6 pages.

FISCAL ANALYSIS

ASSUMPTION

Officials from the Department of Mental Health, the Department of Social Services, the Missouri Consolidated Health Care Plan, the Department of Agriculture, and the Department of Economic Development - Division of Professional Registration assume this proposal would not fiscally impact their agencies.

Department of Health (DOH) officials state there may be an impact on Environmental Public Health and local health agencies because of the demand for increased safe food handling practice training. DOH states that additional staff is necessary to develop a highly visible program to educate the public and health care providers on the risks and health impact of hepatitis C disease. This staff would take the leadership to coordinate efforts and activities to prevent the spread of this disease and reduce the impact of this disease on its victims. They would analyze and recruit the capacity of other state agencies, stakeholders, advisors, consumer and interest groups, support groups, and health care providers. DOH would promote education about this disease, screening of persons at risk, early treatment, and prevention of disability and death from this disease.

DOH would collect and analyze data on the incidence and prevalence of hepatitis C and utilize this data to reduce risk, promote effective treatment options, and to solicit public and private resources and funds to effectively prevent, reduce and manage this disease. DOH estimates the cost of an annual seminar to educate physicians and health care workers on epidemiology, new hepatitis C research projects, and treatment options would cost approximately $9000 based on the cost of a one day seminar that was held for 50 participants. The public information materials of approximately $15,000 for educational books, videos and media campaigns would be needed. If there were a mandate for DOH to perform screening, the cost to screen those at risk to acquire hepatitis C would be approximately $830,000 based on estimated group of 83,000 at $100 per test. Some of this funding could be acquired though federal grants and public/private donations.

One Program Coordinator ($43,272) would develop the hepatitis C program. The coordinator would direct a statewide screening program, hepatitis C data collection, and health education program. The coordinator would take the leadership to coordinate existing organizations and programs to utilize capacity of those agencies. The coordinator would direct application and implementation of NIH and National Liver Foundation grants, develop stakeholder and advisory groups, and patient support groups. The coordinator would develop and maintain the program through strategic planning and measure the effectiveness through quality assurance outcome measurements.

One Consultant Community Health Nurse ($41,448) would communicate with health care providers on screening, and treatment programs. The position would provide technical information on testing, and treatment options, maintain policies and procedures, develop

ASSUMPTION (continued)

questionnaires on risks of hepatitis C transmission. The position would manage the hepatitis C look back program.

One Public Information Specialist ($29,760) would develop media programs to make the hepatitis C program highly visible to impact the public's knowledge of the risk of hepatitis C disease. This position would develop brochures and educational information materials for hepatitis C victims, risk groups, and health care professionals. The position would develop an annual seminar to educate health care professionals, assess informational needs, and provide information for support groups and health fairs.

One Epidemiology Specialist ($34,296) would perform data management and analysis of hepatitis C prevalence and disease incidence.

One Clerk Typist II ($16,512) would manage hepatitis C morbidity reports, data entry, file, correspondence, copying literature and fact sheets, mass mailings, maintain policy and procedure manual.

DOH indicates this legislation could affect small businesses operating as retail food establishments as the proposal would require the businesses to provide immune globulin at a cost of up to $1,000 per incident to prevent and/or control illness to employees or customers of a retail food establishment. DOH stated that in FY97 there were seven public announcements and immune globulin clinics. DOH stated that the Missouri Public Health Services Fund received $7,000. DOH stated it is not possible to estimate how many public announcements and clinics may occur in the future. The reimbursement would be waived if the establishment had an effectively implemented and monitored food safety program approved by the DOH. A retail food establishment will also incur extra costs to train employees on safe food handling practices. The following is the maximum cost assumption to a small business that has made a decision to provide the highest quality safe food handling training program to the employees. A private group would charge $70 for each employee attending the class. The retail food establishment would have to pay each employee for the eight hours of training. DOH used the minimum wage of $5.15. The retail food industry has approximately a 300 % turnover rate each year. It is also estimated that less than 20% of food handlers have completed a safe food handling course. Therefore the costs of training would be:

50 employees X $70 = $3,500 for training

50 employees x $41.20 (8 hours x $5.15 min. wage) = $2,060 employee wages to attend training

Total training costs = $5,560.

In addition, assuming a 300 % turnover rate of employees, the total training would cost $16,680 per year. The DOH could not provide Oversight with a cost of a DOH sponsored employee ASSUMPTION (continued)

training program.

DOH also assumes the proposal would save the state $1,000 per incident for immune globulin as

the DOH funds the cost of the immune globulin when a public announcement is made. The local

health agency of the county where the establishment is located is charged with the administrative costs for a public clinic. The DOH did not provide Oversight with a cost estimate for the administrative costs.

Oversight assumes an unknown amount of training costs and health clinic costs for the small businesses that are retail food establishments. Oversight also assumes that there would be seven public announcements and clinics in each of the fiscal periods of the fiscal note. In addition, Oversight assumes that DOH and local health agencies would share any reimbursements on a fifty-fifty breakdown.

Oversight assumes that no additional rental space would be needed due to the new building that DOH is located in.

Missouri Consolidated Health Care Plan and the Department of Corrections did not respond to our fiscal impact request.

FISCAL IMPACT - State Government	FY 1999	FY 2000	FY 2001
	(10 Mo.)
GENERAL REVENUE FUND
Cost - Department of Health
Personal services (5 FTE)	$0 to	$0 to	$0 to
	($141,127)	($173,656)	($177,999)
Fringe benefits	$0 to	$0 to	$0 to
	($39,558)	($48,676)	($49,893)
Expense and equipment	$0 to	$0 to	$0 to
	($82,052)	($59,225)	($61,001)
Total Costs - Department of Health	$0 to	$0 to	$0 to
	($262,737)	($281,557)	($288,893)
ESTIMATED NET EFFECT ON
GENERAL REVENUE FUND*	$0 to	$0 to	$0 to
	($262,737)	($281,557)	($288,893)
*Subject to appropriation.
FISCAL IMPACT - State Government	FY 1999	FY 2000	FY 2001
(continued)	(10 Mo.)
MISSOURI PUBLIC HEALTH
SERVICES FUND
Revenue - Department of Health
Reimbursements for Clinic Costs	$3,500	$3,500	$3,500
NET EFFECT ON MISSOURI PUBLIC
HEALTH SERVICES FUND	$3,500	$3,500	$3,500
FISCAL IMPACT - Local Government	FY 1999	FY 2000	FY 2001
	(10 Mo.)
LOCAL HEALTH AGENCY FUNDS
Revenue
Reimbursements for Administering Clinics	$3,500	$3,500	$3,500
ESTIMATED EFFECT ON LOCAL
HEALTH AGENCY FUNDS	$3,500	$3,500	$3,500
FISCAL IMPACT - Small Business

Small businesses would be expected to be fiscally impacted to the extent that they would incur additional administrative costs due to the requirements of this proposal

DESCRIPTION

This proposal would require pregnant women to be screened for hepatitis B. Mothers who test positively or those whose results are unknown within 12 hours would be vaccinated. No one would be denied testing because of inability to pay.

The proposal would authorize the Department of Health to do an assessment under emergency conditions when necessary to inform the public and to publicly use immune globulin to prevent the spread of foodborne diseases to employees and customers of retail food establishments. The establishment would reimburse state and local health agencies for the cost of the clinic including the cost of immune globulin per dose and administrative costs per person not to exceed the lesser of one-half of the total cost of the clinic or $1,000. When the retail food establishments DESCRIPTION (continued)

implement a Department of Health approved program to ensure that food practices are safe, and that food handlers do not handle food when they are sick, they may be exempt from paying the cost of reimbursement.

The proposal would also require the Department of Health to notify peace officers if there is a reason to believe they have been exposed to a communicable disease in transporting a patient to a medical treatment facility. It also require a facility to notify a peace officer upon the peace officer's written request of any exposure to a communicable disease. Public health officials would be required to track and report acute and chronic cases of hepatitis C. The prison population would be screened with protocols developed for the correction workers who come into contact with hepatitis C patients.

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 Health

Department of Mental Health

Department of Social Services

Department of Agriculture

Department of Economic Development

Division of Professional Registration

NOT RESPONDING: Missouri Consolidated Health Care Plan and Department of Corrections

Jeanne Jarrett, CPA

Director

April 28, 1998