COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. NO.: 4492-04
BILL NO.: Perfected SCS for SB 1027 and 815
SUBJECT: Children and Minors; Dentists; Medicaid; Health Care; Health Department; Health Care Professionals; Medical Procedures and Personnel
TYPE: Original
DATE: April 18, 2000
FISCAL SUMMARY
| FUND AFFECTED | FY 2001 | FY 2002 | FY 2003 |
| General Revenue | ($67,142 to Unknown) | ($79,311 to Unknown) | ($81,690 to Unknown) |
| Total Estimated
Net Effect on All State Funds* |
($67,142 TO UNKNOWN) | ($79,311 TO UNKNOWN) | ($81,690 TO UNKNOWN) |
*Expected to exceed $100,000 annually.
| FUND AFFECTED | FY 2001 | FY 2002 | FY 2003 |
| Federal | $0 | $0 | $0 |
| Total Estimated
Net Effect on All Federal Funds* |
$0 | $0 | $0 |
*Unknown revenues and expenditures annually and net to $0.
| FUND AFFECTED | FY 2001 | FY 2002 | FY 2003 |
| Local Government | $0 | $0 | $0 |
Numbers within parentheses: ( ) indicate costs or losses.
This fiscal note contains 5 pages.
ASSUMPTION
Officials from the Department of Public Safety - Missouri State Highway Patrol, the Missouri Consolidated Health Care Plan, the Department of Economic Development - Division of Professional Registration, the Department of Conservation, the Department of Transportation, the Department of Health, and the Department of Insurance assume this proposal would not fiscally impact their agencies.
Department of Social Services (DOS) officials state the proposal would allow a physician that is treating a child for immunizations to administer the appropriate fluoride treatment to the child. DOS states a licensed dental hygienist who is practicing in a public health setting may provide fluoride treatments, teeth cleaning, and sealants to Medicaid-eligible children without the supervision of a dentist. DOS states that Medicaid would reimburse any dental hygienist, dentist, or pediatrician who provides fluoride treatments, teeth cleaning, and sealants to Medicaid-eligible children at no less than 75% of the usual and customary cost. DOS assumes the fiscal impact is unknown but expects the fiscal impact to be greater than $100,000.
Amendment 2
Officials from the Department of Economic Development - Division of Professional Registration, the Department of Transportation, and the Department of Social Services 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.
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 ASSUMPTION (continued)
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 Social Services | |||
| Medical assistance payments | (Unknown) | (Unknown) | (Unknown) |
| Costs - Department of Health | |||
| Contracted professional services | ($67,142) | ($79,311) | ($81,690) |
| ESTIMATED NET EFFECT ON GENERAL REVENUE FUND* |
($67,142 TO UNKNOWN) |
($79,311 TO UNKNOWN) |
($81,690 TO UNKNOWN) |
| *Expected to exceed $100,000 annually. | |||
| FEDERAL FUNDS | |||
| Income - Department of Social Services | |||
| Medicaid reimbursements* | Unknown | Unknown | Unknown |
| Costs - Department of Social Services | |||
| Medical assistance payments* | (Unknown) | (Unknown) | (Unknown) |
| ESTIMATED NET EFFECT ON FEDERAL FUNDS |
$0 |
$0 |
$0 |
| *Expected to exceed $100,000 annually. | |||
| FISCAL IMPACT - Local Government | FY 2001
(10 Mo.) |
FY 2002 | FY 2003 |
| $0 | $0 | $0 |
FISCAL IMPACT - Small Business
Small dental offices would expect to be fiscally impacted to the extent they would incur additional revenue and costs as a result of the requirements of this proposal.
DESCRIPTION
This proposal would allow additional persons to provide certain dental treatments to children and establishes a dental hygienist advisory commission. Section 167.181 currently requires children to be immunized. New language states that when a child is receiving an immunization, the physician may also administer the appropriate fluoride treatment to the child. Currently, Section 192.070 requires the Bureau of Child Hygiene to issue educational literature. New language states that such literature should include the importance of routine dental care for children. Section 332.086 remains in the proposal, which would establishs 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.
DESCRIPTION (continued)
This proposal would also 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.
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 Social Services
Department of Economic Development
Division of Professional Registration
Missouri Consolidated Health Care Plan
Department of Transportation
Department of Conservation
Department of Public Safety
Missouri State Highway Patrol
Department of Insurance
Office of Secretary of State
Jeanne Jarrett, CPA
Director
April 18, 2000