COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.: 0446-01
Bill No.: SB 86
Subject: Insurance - Medical; Health Care; Licenses - Driver's
Type: #Corrected
Date: January 30, 2003
# Corrected bill number.
FISCAL SUMMARY
| FUND AFFECTED | FY 2004 | FY 2005 | FY 2006 |
| General Revenue | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
| Total Estimated
Net Effect on General Revenue Fund |
(Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
| FUND AFFECTED | FY 2004 | FY 2005 | FY 2006 |
| Insurance Dedicated | $8,000 | $0 | $0 |
| Highway | (Unknown) | (Unknown) | (Unknown) |
| Conservation Commission | (Unknown) | (Unknown) | (Unknown) |
| Other Funds | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
| Total Estimated
Net Effect on All State Funds |
(Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
Numbers within parentheses: ( ) indicate costs or losses.
This fiscal note contains 8 pages.
| FUND AFFECTED | FY 2004 | FY 2005 | FY 2006 |
| Federal Funds | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
| Total Estimated
Net Effect on All Federal Funds |
(Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
| FUND AFFECTED | FY 2004 | FY 2005 | FY 2006 |
| Local
Government |
(Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
ASSUMPTION
Officials from Department of Social Services - Division of Medical Services assume the proposal will have no fiscal impact on their organization. Currently, the Medicaid program covers the screening techniques for nonsymptomatic men with above normal prostate specific antigen.
Officials from the Department of Health and Senior Services (DOH) assume this proposal would not significantly impact the operations of the DOH. If the proposal were to substantially impact the DOH programs, then the Department would request funding through the legislative process.
Officials from the Department of Public Safety - Missouri Highway Patrol (MHP) defer to the Department of Transportation for response regarding the fiscal impact of this proposal on the MHP.
Officials from the Department of Transportation stated the first item, pertaining to anatomical donations for minors at least 16 years of age, is only a language clarification and will have no fiscal
ASSUMPTION (continued)
impact on the Missouri Highway and Transportation Commission (MHTC) or the Highway & Patrol Medical Plan. The third item which requires coverage of bone scans and prostate antibody imaging (PSA) for any otherwise nonsymptomatic man covered under such policy or contract for which there is an earlier diagnosis or reoccurrence, and as a guide for appropriate therapy in patients who have an above normal, or rising PSA is currently covered and therefore, will have no fiscal impact to MHTC or the Highway & Patrol Medical Plan. The second item, which requires coverage of Phase I and II of clinical trials for cancer will have fiscal impact to the Highway & Patrol Medical Plan. Currently the Medical Plan does not provide coverage for these phases of a clinical trial for cancer. The anticipated impact of this section of the proposal is unknown.
Officials from Missouri Consolidated Health Care Plan sated this proposal requires health insurance companies to provide coverage for routine patient care costs incurred as the result of phase I or II clinical trials to treat cancer. Currently, Section 376.429, RSMo, requires coverage for phases III or IV only. Mandating coverage for all phases of cancer clinical trials has the potential to add cost. Studies vary as to the cost for clinical trials versus the cost for standard care. According to the American Cancer Society website Journal of Clinical Oncology (Vol. 19, No. 23: 4330-4339), the "overall costs for patients in clinical trials ranged from 10% less to 23% more than those being treated outside of the trials."
This proposal also modifies the mandated prostate examination provision of the law by requiring coverage for bone scans and prostrate antibody imaging for a nonsymptomatic man for whom there was an earlier diagnosis and as a guide for appropriate therapy for patients who have an above normal prostate specific antigen. This additional mandated coverage will have a cost impact. It is extremely difficult to project the costs and how many members would receive these services. However, every 1% increase in premium would result in an increase of $284,962 a month for the total premium. The state's share of this additional premium is $216,571 and the employees would absorb an additional $68,391 per month.
Oversight assumes unknown costs would be expected to exceed $100,000 annually.
Officials from the Department of Insurance stated the department estimates 160 insurers and HMOs would be required to submit amendments to their policies to comply with this proposal. Policy amendments must be submitted to the department for review along with a $50 filing fee. One-time additional revenues to the Insurance Dedicated Fund are estimated to be $8,000.
ASSUMPTION (continued)
Additional staff and expenses are not being requested with this single proposal, but if multiple proposals pass during the legislative session which require policy form amendments and review, the department will need to request additional staff to handle the increase in workload.
Officials from the Department of Revenue - Division of Motor Vehicles and Drivers Licensing (MV/DL) provided the following assumptions for this proposal:
ADMINISTRATIVE IMPACT
Division of Motor Vehicle and Drivers Licensing
Contracted Programming
This proposal will require 80 hours of contracted programming in order to make the appropriate program modifications to the over-the counter driver licensing system in order to comply with the parent/guardian signature requirement on the back of the license.
80 Hours of contracted programming
x $100 Contracted programming rate
$8,000 Total contracted programming
Cost Avoidance
The MV/DL FY04 budget recommendations contain a decision item necessary to provide program modifications to the over-the-counter driver licensing system in order to comply with SB 1026 (2002). The requirements of the current proposal would eliminate the need for the pending decision item.
$10,000 Contracted Programming for SB1026 (2002)
$14,960 Overtime Programming for Internal Systems (SB 1026, 2002)
$24,960 Cost Avoidance
NOTE: This decision item is pending and has not received final approval.
Officials from the Missouri Department of Conservation (MDC) state this proposal could have a fiscal impact on MDC funds. The amount of the impact is unknown.
| FISCAL IMPACT - State Government | FY 2004
(10 Mo.) |
FY 2005 | FY 2006 |
| GENERAL REVENUE FUND | |||
| Costs - Missouri Consolidated Health Care Plan | |||
|
Increase in state contributions |
(Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
| ESTIMATED NET
EFFECT ON GENERAL REVENUE FUND |
(Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
| INSURANCE DEDICATED FUND | |||
| Income - Department of Insurance | |||
| Policy form filing fees | $8,000 | $0 | $0 |
| ESTIMATED NET EFFECT ON INSURANCE DEDICATED FUND |
$8,000 |
$0 |
$0 |
| HIGHWAY FUND | |||
| Savings - Department of Revenue | |||
| Programming costs | $16,960* | $0 | $0 |
| Costs - Department of Transportation | |||
| Increase in contributions | (Unknown) | (Unknown) | (Unknown) |
| ESTIMATED NET EFFECT ON HIGHWAY FUND |
(Unknown) |
(Unknown) |
(Unknown) |
| * Cost avoidance/savings dependant on FY 04 decision item. | |||
| FISCAL IMPACT - State Government | FY 2004
(10 Mo.) |
FY 2005 | FY 2006 |
| CONSERVATION COMMISSION | |||
| Costs - Missouri Department of Conservation | |||
| Increase in contributions | (Unknown) | (Unknown) | (Unknown) |
| ESTIMATED NET EFFECT ON CONSERVATION COMMISSION |
(Unknown) |
(Unknown) |
(Unknown) |
| OTHER FUNDS | |||
| Costs - Missouri Consolidated Health Care Plan | |||
|
Increase in state contributions |
(Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
| ESTIMATED NET
EFFECT ON OTHER FUNDS |
(Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
| FEDERAL FUNDS | |||
| Costs - Missouri Consolidated Health Care Plan | |||
|
Increase in state contributions |
(Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
| ESTIMATED NET
EFFECT ON FEDERAL FUNDS |
(Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
| FISCAL IMPACT - Local Government | FY 2004
(10 Mo.) |
FY 2005 | FY 2006 |
| ALL POLITICAL SUBDIVISIONS | |||
| Costs - All Political Subdivisions | |||
|
Increase in local contributions |
(Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
| ESTIMATED NET
EFFECT ON ALL POLITICAL SUBDIVISIONS |
(Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) | (Unknown expected to exceed $100,000) |
FISCAL IMPACT - Small Business
Small businesses could be expected to be fiscally impacted to the extent they incur increased health insurance premiums as a result of the requirements of this proposal. The estimated impact is unknown.
DESCRIPTION
This proposal requires health insurance companies to provide coverage for routine patient care costs incurred as the result of phase I or II clinical trials undertaken to treat cancer. Currently, Section
376.429, RSMo, requires coverage for phases III or IV only.
This proposal modifies the mandated prostate examination provision of the law by requiring coverage for bone scans and prostrate antibody imaging for a nonsymptomatic man for whom there was an earlier diagnosis and as a guide for appropriate therapy for patients who have an above normal prostrate specific antigen.
This proposal changes the procedure in which parental or guardian consent is noted for the organ donation process of minors. Under current law, parental or guardian consent must be noted on the minor's donor card, application for the donor's instruction permit or driver's license, or other document of gift.
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 Transportation
Department of Revenue
Department of Social Services
Department of Public Safety -
Missouri Highway Patrol
Missouri Consolidated Health Care Plan
Department of Insurance
Missouri Department of Conservation
Department of Health and Senior Services
Mickey Wilson, CPA
Director
January 30, 2003