This Fiscal Note is not an official copy and should not be quoted or cited.
This Fiscal Note is not an official copy and should not be quoted or cited.
Fiscal Note - SB 0320 - Establishes programs to identify and assist the handicapped
COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. NO.: 1067-07
BILL NO.: HCS For SCS For SBs 320 & 445
SUBJECT: Education, Elementary and Secondary: Blind Student Literacy
TYPE: Original
DATE: April 22, 1999
FISCAL SUMMARY
|
ESTIMATED NET EFFECT ON STATE FUNDS | |||
| FUND AFFECTED | FY 2000 | FY 2001 | FY 2002 |
| Blindness Skills Specialist | $0 | $0 | $0 |
| General Revenue | ($164,144 to Unknown) | ($176,686 to Unknown) | ($403,590 to Unknown) |
| Insurance Dedicated | $14,450 to $28,900 | $0 | $0 |
| Highway | $0 | $0 | ($41,177) |
| Assistive Technology Loan Revolving | $0 | $0 | $0 |
| Total Estimated
Net Effect on All State Funds |
($149,694 to Unknown) | ($176,686 to Unknown) | ($444,767 to Unknown) |
|
ESTIMATED NET EFFECT ON FEDERAL FUNDS | |||
| FUND AFFECTED | FY 2000 | FY 2001 | FY 2002 |
| Federal | (Unknown) | (Unknown) | ($311,109) |
| Total Estimated
Net Effect on All Federal Funds |
(Unknown) | (Unknown) | ($311,109) |
|
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 11 pages.
FISCAL ANALYSIS
ASSUMPTION
Officials from the Department of Conservation, Department of Mental Health and University of Missouri assume the proposal would result in no fiscal impact to the agencies.
Officials from the Department of Labor and Industrial Relations, Missouri Assistive Technology Project, (DOL) stated that regarding the Assistive Technology Loan Program, Title III provides matching federal funds for states to establish no-interest or low-interest loans for the purchase of assistive technology. Each state has been allotted $500,000 for program start-up. They assume no new staff would be required, and existing positions, currently funded with federal Title Assistive Technology Act dollars, would be used to support program development in FY 2000. An FY 2001 decision item for state general revenue would be developed for staff time and internal operation costs (about $50,000 annually) and a one-time state appropriation of matching dollars (up to $500,000 if that is the federal allotment). Staff roles would include coordinating the financial aspect with a bank or banks (credit review, acceptance of non-traditional income, flexible payment options, etc.) and coordinating the disability organization activities (consumer support in identifying appropriate purchases, etc.). The Oversight Division assumes that since the banks would administer the loan program, the DOL could oversee the program with existing staff.
Officials from the State Treasurer's Office assume new accounting funds would be created in the state treasury for the Blind Skills Specialist Fund and Assistive Technology Loan Revolving Fund. The proposed legislation would slightly increase the number of accounting transactions processed through their accounting system and increase the available funds for investment. The STO would absorb the costs associated with increased accounting transactions and investments through their current appropriations.
Officials from the Department of Corrections assume the proposal would establish a visual acuity level as criteria for eligible students who would benefit from the legislation, if enacted. Reassessment of eligible offenders within DOC would be necessary. At present, it is unknown how many offenders could be granted service under the proposed standard. DOC assumes additional resources for staff and related expense (such as teacher assistants) would be required to meet the education provisions of the bill. Because the DOC does know the number of offenders who would be served under the bill, the fiscal impact as it relates to DOC is unknown, but estimated to be significant, or over $100,000 per year.
ASSUMPTION (continued)
Officials from the Department of Transportation (DHT) state that by requiring health insurance providers to cover the cost of the hearing loss screening, there would be a fiscal impact on the Highway and Patrol medical plan. Based on data from 1998, 164 infants were added to DHT's medical plan. According to Westport Benefits, costs for an auditory brainstem response screening are $340, and costs for an otoacoustic emissions screening are $41. Assuming that 50% of the newborns tested were using each type of screening, the estimated cost to the medical plan would be $28,118, including a 10% copayment. Assuming an effective date of January 1, 2002, this proposal would not impact DHT's medical plan until FY 2002.
The Missouri Consolidated Health Care Plan (HCP) did not respond to our fiscal impact request. However, in their response to a similar proposal, HCP stated that current HMO and POS contracts would require them to absorb the additional cost of the screenings. The plans may shift this cost to HCP through increased premiums under any contract renewal. Consequently, there would be some modest increase in cost, but that cannot be determined. HCP also stated that the indemnity plan also does not currently include this cost. However, since the indemnity plan covers very few HCP members, those enrolled in the indemnity contract would be minimally affected.
The Department of Social Services, Division of Medical Services (DMS) states the cost of a hearing screening is $34.21. The Department of Health assumes there will be 74,000 births in Missouri in FY2002, and 52.5% of these births will be for Medicaid eligibles. Based on this, DMS assumes a full year cost to Medicaid would be $1,329,059. Due to the effective date of this proposal and the expected lag in billing, DMS assumes only four months of billings would be received in FY2002 for a cost of $443,020.
DMS also assumes the cost of the hearing screening would be billed by a provider that is not employed by the hospital. If the hearing screening is done by the hospital, the cost would be included in the hospital's cost report, which would be passed onto Medicaid in future years through the cost settlement process. DMS notes that additional screenings would probably be done prior to the effective date of this proposal since these types of screenings are allowable by
Medicaid, but DMS is unable to estimate these costs.
Officials from the Department of Insurance (INS) state that approximately 259 health insurers and 30 HMO's have policies filed with INS. Each insurer may submit one or two policy form amendments (one for individual and one for group or one filing for both) to comply with the requirements of this proposal. Form filings are to be accompanied with a $50 filing fee. Based on the estimated range of new policy filings, INS estimates $14,450 to $28,900 in new revenue would be generated for the Insurance Dedicated Fund in the first fiscal year only. INS
ASSUMPTION (continued)
anticipates that current appropriations and staff would be able to absorb the work duties in this proposal. However, INS states that if additional proposals are approved, they may need to request an increase in appropriations due to the combined effect of multiple proposals.
The Department of Public Safety, Missouri State Highway Patrol (MSHP) states there were 93 infants born into MSHP's insurance plan last year. According to Westport Benefits, costs for an auditory brainstem response screening are $340, and costs for an otoacoustic emissions screening are $41. Assuming that 50% of the newborns tested are using each type of screening, the estimated cost to the medical plan would be $15,945, including a 10% copayment. This fiscal impact would begin in FY 2002 and would be split between General Revenue (8.44%), Highway Funds (81.9%), Air Pollution Control (.25%), Criminal Record System Fund (1.01%), Gaming Fund (5.04%) and Federal Fund (3.36%). Oversight will show costs to the Highway Fund and General Revenue, and will assume minimal costs on the other funds.
Officials from the Department of Elementary and Secondary Education (DESE) assume the proposal would result in the following fiscal impact:
Blindness Skills Specialist
FTE 4.00 Blindness Skills Specialist @ $47,388 (salary for a supervisor) to be located in 4 regional professional development centers (Kansas City, St. Louis, Springfield and Cape Girardeau).
FTE 0.25 Support staff per Blindness Skills Specialist: 2.25 FTE @ $29,136 (salary for secretary I)
Office Space =1.25 FTE X 200 sq.ft. X $15.00 per sq. ft. =$ 3,750 (St. Louis)
Office Space =3.00 FTE X 200 sq.ft. X $12.70 per sq. ft. =$ 9,525 (Kansas City, Cape Girardeau, Springfield)
Total for Office Space: $13,275
Cost to DESE to conduct annual survey of the Blind
$40,000 (assumes contractor cost of $100 per hour plus expenses)
Preferential Buying Requirement
Since the bill specifies that the cost shall be the same as for regular materials, it is assumed there will be no fiscal impact.
ASSUMPTION (continued)
Task Force for Blind Student Literacy
$30,000 (assumes 10-15 person task force that meets quarterly)
Referral System for the Blind
$10,000 (estimated impact on portions of FTEs for establishing new procedures and oversight within the rehabilitation services for the blind and the division of special education). The Oversight Division assumes this cost could be absorbed by DESE.
In the original version of the proposal, DESE assumed they would need 9 FTE, one at each regional professional development center. DESE now assumes they could perform the duties with four FTE by giving each FTE a territory. Therefore, the Oversight Division has included the 4 FTE Blind Skills Specialists in the fiscal impact section. Oversight has excluded the support staff and the office space, assuming each regional professional development center (RPDC) could accommodate a portion of an additional FTE. Oversight assumes professional development grants (the funding source for the RPDCs) per section 160.530, RSMo, could be redirected to provide the blind skills specialists at the RPDCs. Therefore, Oversight has ranged DESE's costs from zero for each year.
DESE officials assume the incidence of children with hearing loss sufficient to be eligible who are not otherwise identified to be .02%. Assuming that there are 75,000 live births per year, there would be 150 births of children who are hearing impaired. Annual cost for evaluation are $500 per evaluation or $37,500, with a portion of these costs attributed to general revenue and federal funds. Assuming 40 of the children evaluated will require therapy, therapy costs are $2,500 per therapy or $100,000. DESE assumes an annual increase of infants of 50% and an inflation rate of 10%. DES also assumes there would be costs associated with developing and maintaining the reporting system described in the proposal. DESE estimates total costs related to this proposal at $93,750 in FY02, $233,125 in FY03, and $407,062 in FY04.
DESE officials assume the provisions related to the Assistive Technology Loan Revolving Fund would result in no fiscal impact to DESE or local public school districts.
The Department of Health (DOH) states that those facilities or persons who currently provide hearing screening to newborns prior to January 1, 2002, are to report the results to the Department of Health. In addition, this proposal requires DOH to provide audiological and administrative technical support to facilities implementing a hearing screening program. DOH will develop a training program for individuals administering screening procedures, and develop and distribute educational materials for families. There are approximately 90 hospitals in the
state that deliver and/or have a neonatal intensive care unit that would require training. Costs
ASSUMPTION (continued)
associated with training include materials, travel, lodging, and meals.
DOH assumes this proposal would require 4 FTE, including a Health Program Representative III, an Audiologist, a Clerk Typist III, and a Research Analyst III. The Health Program Representative and Audiologist would be responsible for developing and supplying educational material on universal newborn hearing screenings, obtaining hearing screen results data from the hospitals and agencies that rescreened the infants, providing audiological and administrative technical support to facilities in selecting screening equipment, and developing and training individuals administering tests. The Research Analyst would assist in the development of a surveillance system, collect and enter data, assist in the development of reporting forms, and write reports based on the data; and the Clerk Typist would provide support for the staff. Expenses related to these FTE include equipment, office furniture, personal computers, travel, rent, and office and communication expenses.
Oversight assumes a Clerk Typist would not be needed for the support of 3 FTE. Oversight further assumes additional staff could be located in existing office space, and rent expense would not be needed.
DOH also states they are required to establish a Newborn Hearing Screening Advisory Committee. This committee is required to meet at least four times a year. DOH assumes there would be costs associated with this committee, including travel, lodging, and meal expenses.
The committee would terminate on August 28, 2001; therefore, costs would not be included in FY 2002.
DOH assumes the additional FTE would need to be hired or contracted immediately to work with those hospitals that currently provide hearing screens, collect data, and develop and implement program requirements.
| FISCAL IMPACT - State Government | FY 2000 | FY 2001 | FY 2002 |
| (10 Mo.) | |||
| BLINDNESS SKILLS SPECIALIST FUND | |||
| Income-DESE | |||
| Appropriation from General Revenue Fund | $40,000 | $41,200 | $42,436 |
| Cost-DESE | |||
| Annual Survey | ($40,000) | ($41,200) | ($42,436) |
| FISCAL IMPACT - State Government | FY 2000 | FY 2001 | FY 2002 |
| (Continued) | (10 Mo.) | ||
|
ESTIMATED NET EFFECT ON BLINDNESS | |||
| SKILLS SPECIALIST FUND | $0 | $0 | $0 |
| GENERAL REVENUE FUND | |||
| Costs - Department of Health | |||
| Personal Service | ($68,051) | ($83,736) | ($85,829) |
| Fringe Benefits | ($20,340) | ($25,029) | ($25,654) |
| Expense and Equipment | ($75,753) | ($69,921) | ($65,100) |
| Total Costs - DOH | ($164,144) | ($178,686) | ($176,583) |
| Cost-Department of Elementary | |||
| and Secondary Education (DESE) | |||
| Personal Service (4 FTE) | ($161,844) | ($199,148) | ($204,127) |
| Fringe Benefits | (55,811) | (68,675) | (70,392) |
| Expense and Equipment | (45,247) | (25,132) | (25,886) |
| Annual Survey-Appropriation to | |||
| Blindness Skills Specialist Fund | (40,000) | (41,200) | (42,436) |
| Task Force | (30,000) | (30,900) | (31,827) |
| Total Cost-DESE | ($0 to | ($0 to | ($0 to |
| $332,902) | $365,055) | $374,668) | |
| Costs - Department of Elementary | |||
| and Secondary Education | |||
| Testing, therapy, and costs for | |||
| developing and maintaining reporting system | |||
| of newborn screening | $0 | $0 | ($50,712) |
| Costs - Missouri State Highway Patrol | |||
| Increased premiums | $0 | $0 | ($1,346) |
| Costs - Department of Social Services | |||
| Division of Medical Services | |||
| Increased Medicaid costs | (Unknown) | (Unknown) | ($174,949) |
| Costs- Department of Corrections | |||
| Education of Offenders | (Unknown) | (Unknown) | (Unknown) |
| FISCAL IMPACT - State Government | FY 2000 | FY 2001 | FY 2002 |
| (Continued) | (10 Mo.) | ||
| Costs-Department of Labor and Industrial Relations | |||
| Appropriation to Assistive Technology | |||
| Loan Revolving Fund | 0 | (0 to | 0 |
| 500,000) | |||
|
ESTIMATED NET EFFECT |
($164,144 to | ($178,686 to | ($403,590 to |
| ON GENERAL REVENUE FUND | Unknown) | Unknown) | Unknown) |
| INSURANCE DEDICATED FUND | |||
| Income - Department of Insurance | |||
| Filing fees | $14,450 | $0 | $0 |
| to $28,900 | |||
|
ESTIMATED NET EFFECT ON |
$14,450 | ||
| INSURANCE DEDICATED FUND | to $28,900 | $0 | $0 |
| HIGHWAY FUND | |||
| Costs - Department of Transportation | |||
| Increased premiums | $0 | $0 | ($28,118) |
| Costs - Missouri State Highway Patrol | |||
| Increased premiums | $0 | $0 | ($13,059) |
|
ESTIMATED NET EFFECT | |||
| ON HIGHWAY FUND | $0 | $0 | ($41,177) |
| FEDERAL FUNDS | |||
| Costs - Department of Social Services | |||
| Division of Medical Services | |||
| Increased Medicaid costs | (Unknown) | (Unknown) | ($268,071) |
| Costs - Department of Elementary | |||
| and Secondary Education | |||
| Testing, therapy, and costs for | |||
| developing and maintaining reporting system | $0 | $0 | ($43,038) |
| FISCAL IMPACT - State Government | FY 2000 | FY 2001 | FY 2002 |
| (Continued) | (10 Mo.) | ||
| Income-Department of Labor and Industrial Relations | |||
| Federal Matching Grant | 0 | 0 to | 0 |
| 500,000 | |||
| Cost-Department of Labor and Industrial Relations | |||
| Assistive Technology Loans | 0 | (0 to | 0 |
| 500,000) | |||
|
ESTIMATED NET EFFECT | |||
| ON FEDERAL FUNDS | (Unknown) | (Unknown) | ($311,109) |
| ASSISTIVE TECHNOLOGY LOAN | |||
| REVOLVING FUND | |||
| Income-Department of Labor and Industrial Relations | |||
| Appropriation from General Revenue Fund | $0 | $0 to | $0 |
| $500,000 | |||
| Loan Repayments | 0 | 0 | $0 to |
| Unknown | |||
| Cost-Department of Labor and Industrial Relations | |||
| Assistive Technology Loans | 0 | (0 to | (0 to |
| 500,000) | Unknown) | ||
|
ESTIMATED NET EFFECT ON |
|||
| ASSISTIVE TECHNOLOGY LOAN | |||
| REVOLVING FUND | $0 | $0 | $0 |
| FISCAL IMPACT - Local Government | FY 2000 | FY 2001 | FY 2002 |
| (10 Mo.) | |||
| 0 | 0 | 0 | |
| FISCAL IMPACT - Small Business | |||
| This proposal may fiscally impact small businesses as it may result in increased medical insurance costs. | |||
DESCRIPTION
The Division of Special Education within the Department of Elementary and Secondary Education would develop and coordinate a program to provide a vision specialist, available at DESCRIPTION (Continued)
each professional development center.
The proposal would establish a task force on blind student literacy to develop goals and objectives to guide the improvement of special education, related services, vocational training, transition from school to work, rehabilitation services, independent living and employment outcomes for eligible students.
DESE would conduct an annual study of the educational status of blind children and report the findings no later than December 1 of each year. The report would contain required information.
DESE would develop a system of joint referral with rehabilitation services for the blind.
The Blindness Skills Specialist Fund would be created and administered by DESE. The fund would be used to establish and maintain the blindness skills specialist program pursuant to section 162.1136 (annual study).
All public elementary, secondary and post-secondary schools would preferentially procure educational materials from vendors who would make the materials available in either Braille or electronic format at no greater cost than for regular materials.
This proposal would require hearing screenings for infants. After January 1, 2002, every infant born in a Missouri ambulatory surgical center or hospital, before being released, would be given a screening for hearing loss. If an infant would be born in any other location, a hearing screening should be given within 3 months of birth. Test results would be reported to parents and the Department of Health. Anyone providing a hearing screening before January 1, 2002 should also report the results to the Department. This requirement would not apply to persons citing religious reasons.
The physician should provide educational materials to the parents of infants with hearing loss, and the Department should provide equipment and technical support to all facilities implementing this program.
The Department should monitor and refer infants found to have hearing loss to the contact person with the First Steps Program within the Department of Elementary and Secondary Education. Such information will be confidential, with exceptions. This proposal also establishes the "Newborn Hearing Screening Advisory Committee". All insurance companies specified in the proposal will be required to provide coverage for newborn hearing screening. Coverage should also be provided for newborns who are eligible for medical assistance or the children's health program. The Newborn Hearing Screening Advisory Committee would be terminated August 28, 2001.
DESCRIPTION (Continued)
The proposal would delete the expiration date of December 31, 2003 for the sections of law pertaining to the Advisory Assistive Technology Council (Disabilities Assistance).
The proposal would require the Missouri Assistive Technology Advisory Council to establish an assistive technology loan program to provide loans for the purchase of assistive technology devices and services as defined in section 191.850, RSMo. After July 1, 2000, upon appropriation and upon the state's receipt of any federal matching grant moneys, the loan program would provide loans. The proposal would create the Assistive Technology Loan Revolving Fund to be administered by the Missouri Assistive Technology Advisory Council and the State Treasurer. Moneys in the fund would be used to establish and maintain the assistive technology loan program.
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 Elementary and Secondary Education
State Treasurer's Office
Department of Social Services
Department of Health
Department of Insurance
Department of Conservation
Department of Transportation
Department of Public Safety - Highway Patrol
Department of Corrections
Consolidated Health Care Plan
University of Missouri
Department of Labor and Industrial Relations-Missouri Assistive Technology Project
Department of Mental Health
Jeanne Jarrett, CPA
Director
April 22, 1999