SB 0173 - Fiscal Note

Fiscal Note - SB 0173 - Establishes a public education program about hepatitis C

COMMITTEE ON LEGISLATIVE RESEARCH

OVERSIGHT DIVISION

FISCAL NOTE

L.R. NO.: 0012-01

BILL NO.: SB 173

SUBJECT: Health

TYPE: Original

DATE: February 1, 1999

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FISCAL SUMMARY

ESTIMATED NET EFFECT ON STATE FUNDS
FUND AFFECTED	FY 2000	FY 2001	FY 2002
General Revenue	($174,147 to Unknown)	($207,720 to Unknown)	($213,667 to Unknown)
Total Estimated Net Effect on All State Funds	($174,147 to Unknown)	($207,720 to Unknown)	($213,667 to Unknown)

ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED	FY 2000	FY 2001	FY 2002
None
Total Estimated Net Effect on All Federal Funds	$0	$0	$0

ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED	FY 2000	FY 2001	FY 2002
Local Government	$0	$0	$0

Numbers within parentheses: ( ) indicate costs or losses

This fiscal note contains 5 pages.

FISCAL ANALYSIS

ASSUMPTION

The Department of Elementary and Secondary Education and the Office of Administration assume this proposal would not fiscally impact their agencies.

The Department of Mental Health (DMH) assumes the entire forensic population will be tested for Hepatitis C, as will all forensic patients being admitted. In FY97, there were 725 forensic clients and approximately 19 new admissions. For the first year, all current clients and admissions would be tested (744 people). The cost per test for Hepatitis A, B, & C is $135, making total costs $100,440. A confirmation test is then given for the estimated 19% that indicate the presence of hepatitis C. Estimated costs for the confirmation test would be $12,690 (141 clients @ $90 per test). Clients with positive confirmation tests are also given a liver function test. Estimated costs for the liver function test are $2,009 (141 clients @ $14.25 per test). DMH assumes total costs associated with testing would be $115,139. Assuming the responsibility for treating these individuals is imposed on the department, the cost would escalate tremendously.

The Department of Health (DOH) states that this proposal enables them to establish a Hepatitis C Prevention and Control Program. DOH assumes this program would require one FTE, a Consultant Community Health Nurse ($41,868), who will be responsible for planning and implementing education programs on hepatitis C prevention and control. The employee would also try to obtain additional resources for education, screening, and treatment of hepatitis C illness. Oversight assumes this additional FTE would be located using existing space and this proposal would not result in additional rental space.

DOH further assumes this program would require additional costs for radio and television advertisements, public information displays, literature printing, and mailings. DOH notes that because this is a new program, it is difficult to determine the entire expense for the informational displays, literature printings, and mailings. For fiscal note purposes, DOH assumes radio spots would be run on Friday and Saturday nights at an annual cost of $57,200 (11 spots @ $100 each for 52 weeks), and television spots would be run Friday through Sunday at an annual cost of $24,000 (50 thirty-second spots a month @ $40 each for 12 months). DOH also estimates annual billboard advertisement costs at $38,400 (40 billboards @ $80 for 12 months), annual bus poster costs at $12,060 (30 bus sides @ $370 per year plus 60 interior cards @ $16 per year), and annual literature costs at $4,838 (based on the expense of all Bureau of Communicable Disease literature, pamphlets, and brochures printed during FY98). DOH estimates total costs associated with this proposal to be $176,034 in FY00, $210,053 in FY01, and $216,070 in FY02.

ASSUMPTION (continued)

The Department of Corrections (DOC) states that this proposal mandates the Department of

Health to use the National Institutes of Health's strategies, protocols, and guidelines for education purposes relating to the detection, diagnosis, and treatment of Hepatitis C. DOC notes they cannot predict the specific protocol that DOH may stress for treatment of Hepatitis C in the prison population. One recent study completed by DOH's Bureau of Communicable Disease Control demonstrated that 19% of inmates entering the Diagnostic Center tested positive for Hepatitis C. If applied to the FY97 intake of 13,574 inmates, DOC estimates there would be 2,579 inmates requiring follow-up testing and treatment. DOC assumes this estimate to be low since the screenings were accomplished only on inmates who consented to be tested.

Based on information supplied by Correctional Medical Systems, if the NIH protocol were utilized, DOC estimates total costs of screening inmates at $773,718 (13,574 inmates at $57 per test), excluding the cost of staff time. Of that number, DOC assumes 2,579 inmates would have been re-screened at a cost of $197 each, which includes the cost of a liver function test, and that 85% of those inmates (2,192) would require additional testing and long-term treatment. DOC estimates total costs for screening, testing, and treating inmates in a prison setting at $9,000,000 over a two-year period. However, given the permissive language regarding the areas targeted for outreach and treatment, and since the duties described in this proposal are subject to appropriation, DOC assumes the actual fiscal impact of this proposal cannot be estimated.

Oversight assumes this proposal allows the Department of Health some flexibility in establishing education programs and identifying resources for screening and treatment. If the Department of Health chooses to screen, test, and treat the inmate population, costs would be substantial. Due to the uncertainty of the extent of the DOH's education, screening, and treatment programs, Oversight will range the costs associated with this proposal from DOH's estimates to unknown.

FISCAL IMPACT - State Government	FY 2000	FY 2001	FY 2002
	(10 Mo.)
GENERAL REVENUE
Costs - Department of Health
Personal Service (1 FTE)	($35,748)	($43,988)	($45,088)
Fringe Benefits	($10,685)	($13,148)	($13,477)
Expense and Equipment	($127,714)	($150,584)	($155,102)
Total Costs - DOH	($174,147)	($207,720)	($213,667)
FISCAL IMPACT - State Government	FY 2000	FY 2001	FY 2002
	(10 Mo.)
Costs - Department of Corrections
Screening, testing, and treatment	$0 to	$0 to	$0 to
of the prison population	(Unknown)	(Unknown)	(Unknown)
Costs - Department of Mental Health
Screening, testing, and treatment	$0 to	$0 to	$0 to
of the forensic population	(Unknown)	(Unknown)	(Unknown)
ESTIMATED NET EFFECT	($174,147	($207,720	($213,667
ON GENERAL REVENUE	to Unknown)	to Unknown)	to Unknown)
FISCAL IMPACT - Local Government	FY 2000	FY 2001	FY 2002
	(10 Mo.)
	$0	$0	$0
FISCAL IMPACT - Small Business
No direct fiscal impact to small businesses would be expected as a result of this proposal.

DESCRIPTION

This proposal authorizes the Department of Health to establish a public education program about hepatitis C and allows for the use of outreach campaigns and educational materials to raise public awareness about the disease. It also requires the Department of Health to use guidelines adopted by the National Institutes of Health for educating and training physicians, health professionals, and providers about hepatitis C detection. The guidelines may include tracking and reporting of

hepatitis C cases, screening of prison populations, and developing protocols to be used by the Department of Corrections, health care workers, and the public in treating hepatitis C cases.

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 Corrections

Office of Administration

Department of Elementary and Secondary Education

Jeanne Jarrett, CPA

Director

February 1, 1999