COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. NO.: 4233-04
BILL NO.: HCS for SB 974
SUBJECT: Dentists; Health Care; Health Care Professionals; Health Department; Elderly; Disabilities; Public Assistance
TYPE: Original
DATE: May 4, 2000
FISCAL SUMMARY
| FUND AFFECTED | FY 2001 | FY 2002 | FY 2003 |
| General Revenue | ($67,142 to $2,856,942) | ($79,311 to $2,869,111) | ($81,690 to $2,871,490) |
| Dental Board | ($8,352) | ($13,439) | ($13,736) |
| Total Estimated
Net Effect on All State Funds |
($75,494 TO $2,865,297) | ($92,750 TO $2,882,550) | ($95,426 TO $2,885,226) |
| FUND AFFECTED | FY 2001 | FY 2002 | FY 2003 |
| None | |||
| Total Estimated
Net Effect on All Federal Funds |
$0 | $0 | $0 |
| FUND AFFECTED | FY 2001 | FY 2002 | FY 2003 |
| Local Government | $0 | $0 TO $24,666,000 | $0 TO $24,666,000 |
Numbers within parentheses: ( ) indicate costs or losses.
This fiscal note contains 7 pages.
ASSUMPTION
Section 92.031
The Kansas City debt service levy is $.14 per $100 assessed valuation, the Kansas City health levy is $.49, the Kansas City museum levy is $.02, and the total Kansas City property tax levy is $1.32. The total statutory levy ceiling is $1.50. If Kansas City elected to do so, it could impose, under the proposed section 92.031, an annual debt service levy and an annual levy for capital improvements and operating expenses for hospital, public health, recreation grounds and museum purposes independent of the taxes for capital improvements, public health, hospital, recreation and museum purposes authorized in 92.030. If Kansas City made this election then the limits on individual and total annual tax rate levies in subdivisions (1), (2) and (3) of subdivision 92.030.2 would not apply. Kansas City could, with voter approval, raise the tax levy for capital improvements and operating expenses for hospital, public health, recreation grounds and museum purposes from current rates to a rate not to exceed $1.00 per $100 assessed value. Currently, the tax levies for the purposes specified is $.51. An increase to $1.00 for these purposes would raise about $24,666,000. However, the increase would not have to be for the full amount and any increase in the levy would have to be approved by the voters of Kansas City.
Section 191.211, 191.213, and 191.411
Officials from the Department of Health (DOH) state the proposal allows but does not require the use of general revenue to support the Primary Care resource Initiative for Missouri (PRIMO). DOH assumes there would be no cost associated with the passage of this proposal. DOH states any funds available through this statutory change would have to be appropriated by the General Assembly and approved by the Governor.
Oversight assumes a range of $0 to ($2,789,800) from the General Revenue Fund. This amount reflects the amount of new funding requested from General Revenue in the FY2001 DOH budget request. Oversight assumes that any funding is subject to appropriation.
Section 192.070, 332.086, 332.311, and 332.324
Officials from the Department of Public Safety - Missouri State Highway Patrol, the Missouri Consolidated Health Care Plan, the Department of Conservation, the Department of Transportation, the Department of Social Services, and the Department of Insurance ASSUMPTION (continued)
assume this proposal would not fiscally impact their agencies.
Department of Health (DOH) officials state that data from other state donated dental service programs was used to determine the fiscal impact of this proposal. DOH assumes that they would contract for professional services to administer this program. DOH states that the costs would include administrative services, laboratory services, and office expenses. DOH anticipates costs of $79,311 annually.
Officials from the Department of Economic Development (DED)-Professional Registration (DPR) assume the proposed legislation would result in increased costs related to the establishment of the Advisory Commission for Dental Hygienists. The DPR assumes annual meeting expenses of $9,598 would be incurred for the Advisory Commission to meet quarterly, for two days each.
The DPR assumes a .5 Licensure Technician II (.5 FTE at $23,472 per year) would be needed to provide technical support directly to the Principal Assistant. This individual would be responsible for coordinating advisory board meetings, including, but not limited to, agenda preparation, minutes, etc.
Office and communication expenses and equipment are based on estimated existing costs within the Division and follow OA guidelines.
The DPR also assumes the Office of the Attorney General would provide approximately 60 hours of assistance per year with rules, opinions and meetings at a cost of $59.22 per hour, resulting in annual costs of $3,553.
NOTE: The DPR assumes a license fee increase for dental hygienists may be necessary to cover the costs associated with this proposal.
Oversight assumes workload associated with the licensing of dental hygienists is currently occurring. Thus, the proposal should not create additional workload associated with licensees. Any additional workload would be associated with quarterly meetings for the newly created Advisory Commission. Therefore, it is assumed any additional workload associated with quarterly meetings could be absorbed with existing resources. However, if the additional workload should be significant, then the DPR could request additional resources through the normal budget process.
For purposes of this fiscal note, Oversight has included costs associated with quarterly meeting ASSUMPTION (continued)
expenses for the Advisory Commission and costs for the Attorney General to assist the Advisory Commission. Oversight assumes the Commission would only meet two times in FY 01, since the members would be required to be appointed by January 1, 2001, and therefore, has adjusted meeting expenses accordingly for FY 01.
Office of Secretary of State (SOS) officials state the proposal would create a donated dental services program for certain eligible persons. SOS states that based on experience with other divisions, the rules, regulations, and forms issued by the Department of Health could require as many as approximately six pages in the "Code of State Regulations". SOS states that for any given rule roughly half again as many pages would be published in the "Missouri Register" as in the "Code" because cost statements, fiscal notes, and the like are not repeated in the "Code". SOS states these costs are estimated. SOS estimates the cost of a page in the "Missouri Register" to be $22.50. SOS estimates the cost of a page in the "Code" to be $26.50. SOS states the actual costs could be more or less than the numbers given. SOS states the impact of this proposal in future years in unknown and depends upon the frequency and length of rules, filed, amended, rescinded, or withdrawn. SOS states the proposal alone does not require additional personnel but the cumulative effect of other proposals that require rulemaking activity may, in the aggregate, necessitate additional staff.
Oversight assumes the SOS could absorb the costs of printing and distributing regulations related to this proposal. If multiple bills pass which require the printing and distribution of regulations at substantial costs, the SOS could request funding through the appropriation process. Any decisions to raise fees to defray costs would likely be made in subsequent fiscal years.
| FISCAL IMPACT - State Government | FY 2001
(10 Mo.) |
FY 2002 | FY 2003 |
| GENERAL REVENUE FUND | |||
| Costs - Department of Health | |||
| Program expansion - Section 191.211* | $0 to ($2,789,800) | $0 to ($2,789,800) | $0 to ($2,789,800) |
| Costs - Department of Health | |||
| Contracted professional services - 332.324 | ($67,142) | ($79,311) | ($81,690) |
| ESTIMATED NET EFFECT ON GENERAL REVENUE FUND |
($67,142 TO $2,856,942) |
($79,311 TO $2,869,111) |
($81,690 TO $2,871,490) |
| *Subject to appropriation. | |||
| DENTAL BOARD FUND | |||
| Costs - Department of Economic Development - Division of Professional Registration | |||
| Meeting expenses | ($4,799) | ($9,886) | ($10,183) |
| Office of Attorney General expenses | ($3,553) | ($3,553) | ($3,553) |
| Total Costs - Professional Registration | ($8,352) | ($13,439) | ($13,736) |
| ESTIMATED NET EFFECT ON DENTAL BOARD FUND |
($8,352) |
($13,439) |
($13,736) |
| FISCAL IMPACT - Local Government | FY 2001
(10 Mo.) |
FY 2002 | FY 2003 |
| LOCAL POLITICAL SUBDIVISIONS | |||
| Income to Kansas City - Increased Levies - Section 92.031 |
$0 |
$0 to $24,666,000 |
$0 to $24,666,000 |
| ESTIMATED NET EFFECT ON LOCAL POLITICAL SUBDIVISIONS |
$0 |
$0 TO $24,666,000 |
$0 TO $24,666,000 |
FISCAL IMPACT - Small Business
Small businesses located in Clay and Buchanan counties and Kansas City which pay property taxes could be affected by this proposal.
DESCRIPTION
The provision of the proposal would allow the voters of Kansas City to approve a levy for capital improvements and operating expenses for hospital, public health, recreation grounds and museum purposes of up to $1.00;
The provision of the proposal would remove language prohibiting the use of general revenue funds for certain health care programs and initiatives. The provision would allow any other funds to be used for these health care programs and initiatives. The provision would also require the Director of the Department of Health to include dentists in the development and implementation of a plan to provide a system of coordinated health care services accessible to all persons in designated health resource shortage areas. Currently, dentists are not included in the plan to attract health care practitioners to these areas.
Currently, Section 192.070 requires the Bureau of Child Hygiene to issue educational literature. The provision of the proposal would include new language that states that such literature should include the importance of routine dental care for children. Section 332.086 remains in the proposal, which would establish the five member advisory commission. It would include the dental hygienist currently serving on the Missouri Dental Board. The Commission would review educational requirements and would make recommendations to the Dental Board regarding the practice of dental hygiene. All members would be appointed by April 1, 2001. The Dental Board would provide all necessary staff and support for the Commission. Section 332.311 currently prohibits dental hygienists from practicing without the supervision of a dentist. New language would create an exception to this rule by allowing a dental hygienist who is practicing in a public health setting to provide fluoride treatments, teeth cleaning, and sealants, if appropriate, to children who are eligible for Medicaid. These procedures would be done without the supervision of a dentist. Medicaid would reimburse all dentists, dental hygienists, and pediatricians who provide the above services at seventy-five percent of the usual and customary cost, which would be determined by the Division of Medical Services by rule. This provision would expire on August 28, 2005.
This provision of the proposal would allow the establishment of a donated dental services program for certain eligible persons. The Department of Health may contract with the Missouri Dental Board or other qualified organizations to provide free dental services, with the exception of any dental lab costs, to eligible needy, disabled, elderly, and medically-compromised individuals. The contract may describe the program, the network of volunteer dentists, referral systems, and the development of public awareness campaigns. The administering organization would submit an annual report to the Department and the Department would develop rules to implement the program and establish eligibility criteria.
DESCRIPTION (continued)
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 Economic Development
Division of Professional Registration
Department of Social Services
Department of Transportation
Office of Secretary of State
City of Kansas City
Missouri Consolidated Health Care Plan
Department of Insurance
Department of Conservation
Department of Public Safety
Missouri State Highway Patrol
Jeanne Jarrett, CPA
Director
May 4, 2000