COMMITTEE ON LEGISLATIVE RESEARCH

OVERSIGHT DIVISION



FISCAL NOTE



L.R. No.: 1155-09

Bill No.: HS for HCS for SCS for SB 266 w/ HA 1, HA 2, HA 3, HA 4, HA 5, HA 6, HA7, HA9, HA 10, and HA 11

Subject: Health Care; Health Care Professionals; Health Department; Health, Public; Medical Procedures

Type: Original

Date: May 16, 2001




FISCAL SUMMARY



ESTIMATED NET EFFECT ON STATE FUNDS
FUND AFFECTED FY 2002 FY 2003 FY 2004
All funds (Unknown) (Unknown) (Unknown)
General Revenue* (Could exceed $812,472) (Could exceed $851,712) (Could exceed $869,317)
Insurance Dedicated $10,000 $0 $0
Childhood Lead Testing $0 $0 $0
Highway ($90,852) $0 $0
Organ Donor Program** $121,712 $202,092 $0
Total Estimated

Net Effect on All

State Funds* **

(COULD EXCEED $771,612) (COULD EXCEED $649,620) (COULD EXCEED $869,317)

*Does not include unknown medical assistance payments and unknown medical/lab costs.

**Does not include unknown revenues from income tax return donations.













ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED FY 2002 FY 2003 FY 2004
Federal $0 $0 $0
Total Estimated

Net Effect on All

Federal Funds*

$0 $0 $0

*Unknown revenues and expenditures annually net to $0.

ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED FY 2002 FY 2003 FY 2004
Local Government $0 $0 $0

Numbers within parentheses: ( ) indicate costs or losses.

This fiscal note contains 33 pages.



FISCAL ANALYSIS



ASSUMPTION





Section 191.714



Officials from the Department of Elementary and Secondary Education, the Department of Mental Health, the Department of Public Safety - Capitol Police, the Department of Public Safety - Veterans' Commission, and the Department of Social Services assume this portion of the proposal would not fiscally impact their agencies.



Officials from the Department of Health (DOH) state that one Consultant Community Health Nurse (CCHN) would be required to establish the DOH program, to develop for adoption a blood-borne pathogen standard governing occupational exposure of public employees to blood and other potentially infectious materials, and to develop the department's written exposure control plan. The CCHN would be responsible for collecting and recording the required data on exposure incidents in the sharps injury log, assessing engineering, administrative, or work practice controls to prevent such incidents/injuries, to train department staff, and lead the evaluation committee. The CCHN would develop additional measures to prevent sharps injuries or exposure incidents, compile and maintain a list of needleless systems and sharps with engineered sharps injury protection, and prepare the annual report on the use of needle safety technology as a means of reducing needlestick injuries and to place the report on the Department's internet site.



ASSUMPTION (continued)



The Department of Corrections (DOC) officials did not respond to our fiscal impact request. However, in responding to a similar proposal from the current session DOC assumed no fiscal impact to their agencies.





Section 191.938



Officials from the Office of Administration assume this portion of the proposal would not fiscally impact their agency.



Department of Health (DOH) officials state there would be expenses for five committee

members meeting four times a year. DOH stated this would be $65 for lodging, $45 for meals, and $75 for travel per meeting per member. DOH assumes the administrative and technical support to the committee would be provided using existing resources with DOH's Bureau of Emergency Medical Services.





Section 192.729



Officials from the Department of Health (DOH) assume that at a minimum one additional staff person would be needed for this portion of the proposal. A Health Educator I ($30,204) would be responsible for planning, coordination of daily program operation, and integration of the lupus program in all seven Regional Arthritis Centers. In order to track and monitor the prevalence of lupus the existing surveillance system can be utilized, once modified. DOH anticipates that data collection and analysis would be conducted in-house. DOH states that regional arthritis centers would receive $5,000 each for educational efforts to include materials and related expenses. When initial surveillance activities are completed and if prevalence is found to be higher in the urban areas, contracts would be adjusted.



Oversight assumes that DOH could use the existing resources of the Office of Women's Health, the Office of Minority Health, and the State Arthritis Program to track and monitor the prevalence of lupus.





Section 191.940



Officials from the Department of Transportation, the Department of Health, the Department of Insurance, the Department of Conservation, the Department of Social Services, the Missouri Consolidated Health Care Plan, the Department of Public Safety - Missouri State Highway Patrol, and the Department of Revenue assume this portion of the ASSUMPTION (continued)



proposal would not fiscally impact their agencies.



Office of Administration - Division of Budget and Planning (BAP) officials state this portion of the proposal would create a Commission on Health Information Privacy to make recommendations to the General Assembly for additional legislative measures needed to protect the privacy of nonpublic health information. BAP states the members would be reimbursed for actual and reasonable expenses. Since the department responsible for paying these expenses is not specified, BAP assumes the following costs for the thirteen public members of the commission. BAP assumes the meetings would be held in Jefferson City and the two state officials on the Commission would be reimbursed through their respective offices/departments.

BAP states the section has an effective date of January 1, 2002 and the Commission must make recommendations within six months from the effective date. BAP assumes there would be two meetings per month for two days. BAP expenses assumes expenses of $48,797 for FY 2002. BAP assumes the Commission would no longer meet after its recommendations are presented to the General Assembly and there would be no cost in FY 2003 or FY 2004.



Officials from the Department of Economic Development - Division of Professional

Registration, did not respond to our fiscal impact request. However, in responding to a similar proposal they assumed this proposal would not fiscally impact their agencies.





Sections 199.170, 199.180, and 199.200



Officials from the Office of State Courts Administrator, the Department of Health, the Office of Prosecution Services, the State Public Defender, the City of Kansas City, the Department of Health, and the University of Missouri assume this portion of the proposal would not fiscally impact their agencies.



Officials from the Office of Attorney General, St. Louis County, City of St. Louis, Jackson County, and Springfield-Greene County Health Department did not respond to our fiscal impact request.





Section 376.1199



Officials from the Department of Conservation assume this portion of the proposal would not fiscally impact their agency.



Department of Insurance (INS) officials state that health insurers and HMOs would be required to amend policy forms in order to comply with this portion of the proposal. INS states that they anticipate that current appropriations and staff would be able to absorb the work for ASSUMPTION (continued)



implementation of this proposal. However, if additional proposals are approved during the legislative session, INS may need to request an increase in appropriations due to the combined effect of multiple proposals. INS states there are 171 health insurers and 29 HMOs that offer health insurance coverage. INS states that of the health insurers, many offer coverage through out-of-state trusts which are not typically subject to such mandates. INS estimates that 171 health insurers and 29 HMOs would each submit one policy form amendment resulting in revenues of $10,000 to the Insurance Dedicated Fund. If multiple proposals pass during the legislative session which would require form amendments to be filed, the insurers would probably file one amendment for all required mandates. INS states this would result in increased revenue of $10,000 for all proposals.



Officials from the Department of Transportation (DHT) state the Highway & Patrol Medical Plan currently does not limit direct access to obstetrical/gynecological services; therefore, this provision would have no impact on the Medical Plan. The provision of annually notifying enrollees of the cancer screenings would not impact the Medical Plan because Section 104.801 RSMo. 2000, does not require the Medical Plan to provide this notification. The Medical Plan

does not provide coverage for bone density testing unless it is medically necessary, therefore, this provision would have a fiscal impact to the Medical Plan. The Medical Plan does not cover contraceptives at 100 percent and this proposal would require the Medical Plan to do so, therefore, this provision would have a fiscal impact on the Medical Plan. DHT states that menopause occurs naturally in women between the ages of 58 and 52, but it can occur as early as their late 30s or as late as their mid 50s. The assumption for this fiscal note is that menopause occurs by age 50 and a woman would be considered postmenopausal at age 50 and over. The Medical Plan's third party administrator, indicated that currently there are 245 female participants between the age of 50 and 65. Females 65 years of age and older are usually participating in a Medicare supplement policy and the Medical Plan would have to cover these tests for individuals with a Medicare supplement policy. DHT's third party administrator provides the usual and customary rate for the bone density testing. The actual bone density test would cost $147.50 and the fee for the radiologist to interpret is $62.75. Assuming that the women between the ages of 50 and 65 have met their deductible and out-of-pocket maximums, the fiscal impact for coverage of bone density testing for postmenopausal women would be approximately $51,511 [($147.50 + $62.75) X 245 females]. In the 2000 calendar year, the Medical Plan paid $121,000 in claims for contraceptives. The Medical Plan currently pays 70 percent and the participant pays 30

percent for prescriptions. The fiscal impact for 100 percent coverage of contraceptives would be approximately $51,857 ($121,000/.70 = $172,857 - $121,000). The total fiscal impact to the Medical Plan due to this proposal would be approximately $103,386 ($51,511 + $51,857). There is 75 percent participation for MoDOT and 25 percent participation for the Patrol, therefore, there would be a $77,526 ($103,386 X .75) impact due to MoDOT and $25,842 ($103,386 X .25) impact due to the Patrol. Historically, the department and the plan members have shared in any premium increases necessary because of increases in benefits. The costs may be shared in the long run (meaning shared between three categories: absorbed by the plan, state appropriated ASSUMPTION (continued)



funds, and/or costs to individuals covered under the plan). However, the department (commission) must make a decision on what portion they would provide. Until the commission makes a decision, we can only provide the cost to the medical plan.



Department of Social Services (DOS) officials state this portion of the proposal would affect the Division of Medical Services. Currently, MC+ managed care does not provide enrollees with direct access to OB/GYN services. State law does mandate access on one annual visit. Many health plans require a referral from the enrollees primary care physician to obtain OB/GYN services. DOS states this would increase their capitated rate when the health plans re-bid their contracts. The MC+ managed care and the fee-for-service programs do not currently notify enrollees of cancer screenings. This requirement would increase administrative cost for both the

MC+ health plans and the fee-for-service program. DOS states the fiscal impact to the Division of Medical Services is unknown.



Officials from the Missouri Consolidated Health Care Plan (HCP) state this portion of the

proposal would allow members to directly access participating obstetricians or gynecologists without a referral from a primary care physician (PCP). HCP states the more "open" the access to providers, the higher the premium associated with the product. As evident in the HCP plans, the open access plans are considerably more costly than those requiring a PCP referral to a specialist. In some cases there could be a cost savings by not duplicating services. However, other members may inappropriately access OB/GYN providers, thereby increasing costs. One cannot predict how many would directly access these providers or for what services. HCP states this proposal has an unknown fiscal impact.



HCP states notifying members of available cancer screenings may be an additional cost to the plans. However, HCP assumes this cost would be minimal as most plans currently do mailings to their members. Providing coverage for bone density test for postmenopausal women and requiring 100% coverage for all contraceptives should have a minimal impact. Bone density testing is not a new procedure so the cost should reflect this. Also, the plans currently cover the bone density testing when medically necessary. HCP plans currently cover oral contraceptives at 100%. Covering the additional contraceptives at 100% would be more costly, however the impact should be minimal.



Department of Public Safety - Missouri State Highway Patrol officials did not respond to our fiscal impact request.





Amendment 3



Officials from the Department of Conservation and Office of the State Treasurer stated the proposed legislation would not appear to have a fiscal impact on the on their organizations.



ASSUMPTION (continued)



Officials from the Missouri Consolidated Health Care Plan (MCP) stated this bill is similar to SB 572 of this session. This bill requires medical plans to offer coverage for testing pregnant women for lead poisoning and for all testing for lead poisoning authorized in Chapter 710. Testing for lead is done through testing blood specimens. This type of test is not costly. Therefore, this bill should have a minimal, if any, impact on the MCP.



Officials from the Office of Secretary of State (SOS) stated this bill establishes a Childhood Lead Testing Program and Fund in the Department of Health. The DOH will promulgate rules to implement this bill. Based on experience with other divisions, the rules, regulations and forms issued by the DOH could require as many as 14 pages in the Code of State Regulations. For any

given rule, roughly half again as many pages are published in the Missouri Register as in the Code because cost statements, fiscal notes and the like are not repeated in the Code. These costs are estimated. The estimated cost of a page in the Missouri Register is $23.00. The estimated cost of a page in the Code of State Regulations is $27.00. The actual cost could be more or less than the numbers given. The impact of this legislation in future years is unknown and depends

upon the frequency and length of rules filed, amended, rescinded or withdrawn. The SOS estimates the cost of the proposed legislation to be $861 [(14 pgs. x $27) + ( 21 pgs. x $23)] in FY 02.



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.



Officials from the Department of Insurance (INS) stated Health Insurers and HMOs will be required to amend policy forms in order to comply with the legislation. It is anticipated that current appropriations and staff will be able to absorb the work for implementation of this single proposal. However, if additional proposals are approved during the legislative session the INS will need to request additional staff to handle the increase in workload. The INS estimates 171 health insurers and 29 HMOs will be required to file amendments to their policy form to comply with legislation resulting in revenue of $10,000. If multiple proposals pass during the legislative session which require policy for amendments to be filed, the insurers will probably file one amendment for all required mandates. This would result in increased revenue of $10,000 for all.



Officials from the Department of Public Safety - Missouri Highway Patrol (MHP) stated the Department of Highway and Transportation would respond for the MHP on this proposal.



Officials from the Department of Highway and Transportation (DHT) - Division of

Resource Management stated this legislation requires health carriers to provide coverage for lead poisoning testing for pregnant women and children less than six years of age. This benefit must be covered at the same level of coverage as other covered benefits. The Department of ASSUMPTION (continued)



Health in coordination with the Department of Social Services and Department of Elementary & Secondary Education is responsible for developing and providing questionnaires for every child to be assessed within six months of birth and annually until the child is six years of age to determine whether a child is at high risk for lead poisoning.

If the questionnaire indicates that a child is at high risk for lead poisoning the child shall be tested at least once every six months between the ages of six months and three years of age and then annually between the ages of three years and six years. In addition, any child to be considered at high risk and resides in housing currently undergoing renovations shall be tested at least once every three months during the renovation and once after the completion of the

renovation. Children that are not at high risk for lead poisoning shall be tested once at the age of twelve months and once at two years of age. Any child not tested by the age of five years shall be tested at least once before the age of six years. The tests for lead poisoning shall consist of a blood sample that shall be sent to a state-licensed laboratory for analysis.

To determine the fiscal impact of providing the coverage for pregnant women, the DHT found that over the past three years the Medical Plan has had an average of 1,520 pregnancies per year and Westport Benefits, the DHT's third party administrator, provided the usual and customary rate (UCR) for the lead poisoning screening and specimen collection. The CPT codes the DHT used are 83645 for the screening and 36415 for the specimen collection. The average UCR, using the rates for Jefferson City and St. Louis, are $32 for the screening and $14 for the specimen collection. The DHT assumes that this test would be part of a woman's prenatal care and no office visit charge would be necessary. The DHT also assumes that the women have met their deductibles and maximum out of pocket benefits. Therefore, the total fiscal impact to the Medical Plan for the lead poisoning testing of pregnant women would be approximately $69,920 per year [1,520 pregnancies x ($32/screening + $14/specimen collection)].

To determine the fiscal impact of providing the coverage for children, the DHT had to determine how many of the children in DHT's plan would be at high risk for lead poisoning. The DOH provided information that they used in preparing their fiscal impact to this legislation. The DOH calculated this by five groups within the state. Those groups are St. Louis City, St. Louis County, Jackson County/Kansas City, Greene County/Springfield and Outstate (all other health

jurisdictions). The DOH then designated a high risk factor based on population density, old housing, poverty and current elevated blood lead (EBL) to each of these groups. The risk factors

for each group are: St. Louis City = 4, Jackson County/Kansas City = 2 and St. Louis County, Greene County/Springfield and Outstate = 1. The risk factors were then assigned a percentage rate where the percentage of total children in the group were determined as high risk. The risk

factors are 5 = 100%, 4 = 80%, 3 = 60%, 2 = 40% and 1 = 20%. The DOH also used 1990 census data, adjusted for 1999, to determine the number of children in each group.

The census data from DOH showed 38,034 children in St. Louis, 84,088 in St. Louis County, ASSUMPTION (continued)



58,427 in Jackson County/Kansas City, 16,111 in Greene County/Springfield and 251,233 in Outstate. Therefore, the total population of children under the age of six was 447,893.

For purposes of this fiscal note, the DHT is going to use the percentage of children in each group to the total number of children statewide provide by the DOH to determine the demographics of the Medical Plan's children. Following are those percentages: St. Louis City = 8.5% (38,304/447,893), St. Louis County = 18.8% (84,088/447,893), Jackson County/Kansas City = 13% (58,427/447,893), Greene County/Springfield = 3.6% (16,111/447,893), and Outstate = 56.1% (251,233/447,893). Westport Benefits provided the current number of children in the Medical Plan. Currently the medical plan has 255 children under the age of 1; 259 under the age

of 2; 276 under the age of 3; 268 under the age of 4; 258 under the age of 5; and, 260 under the age of 6. Based on this information, the following was determined:

# in # in # in Jack # in Greene/

Ages STL City STL Co. Co./K.C. Spgfld. # in OS Total

<1 22 48 33 9 143 255

<2 22 49 34 9 145 259

<3 23 52 36 10 155 276

<4 23 50 35 10 150 268

<5 22 49 34 8 145 258

<6 22 49 34 9 146 260

Total 134 297 206 55 884 1576



# Corrected table information for the number of children at high risk in each group is as follows:

# in # in # in Jack # in Greene/ Total #

Ages STL City STL Co. Co./KC Spgfld # in OS Total # of Tests of Tests

<1 22 0 0 0 16 38 1 38

<2 22 0 0 0 16 38 1 38

<3 23 0 0 0 17 40 1 40

<4 23 0 0 0 17 40 1 40

<5 22 0 0 0 16 38 1 38

<6 22 0 0 0 16 38 1 38

Total 134 0 0 0 98 232 232

















ASSUMPTION (continued)



The number of children not at high risk is as follows:

# in # in # in Jack # in Greene/ Total #

Ages STL.City STL Co. Co./KC Spgfld # in OS Total # of Tests of Tests

<1 0 48 33 9 127 217 1 217

<2 0 49 34 9 129 221 1 221

<3 0 52 36 10 138 236 0 0

<4 0 50 35 10 133 228 0 0

<5 0 49 34 8 129 220 0 0

<6 0 49 34 9 130 222 0 0

Total 0 297 206 55 786 1,344 438

The Department of Health also determined that 5% of children at high risk will be living in a home being renovated. The DHT assumed the renovation period would be one year. The legislation would require these children to be tested every three months during the renovation period. Depending on the age of the child at the time of the renovation they could have an

additional two or three tests per child. Taking the average, the DHT assumes this will result in 2.5 additional tests. The number of children at high risk and living in a home being renovated is approximately 22 (438 x .05), resulting in an additional 55 (22 x 2.5) tests. The total number of tests that the Medical Plan would be responsible for covering the first or second year is approximately 1,779 (586+1,138+55) tests while the third and subsequent years will be approximately 1,012 (586+371+55).



The number of tests required for children that are not high risk for lead poisoning in this legislation differs from what was stated in SB 572. Although the number of tests decreases, it also has provisions for catching up those children that are between the ages of two and six years of age and were not tested previously. In the first two years, all children under the age of five in the first year, will be tested a total of two times over the two year period while children over five, but under six, will only be tested once in the two year period. Therefore, after the first two years, all of the children from the first year will have their testing complete.

Westport Benefits, our third party administrator, provided the DHT the UCR for the lead poisoning screening and specimen collection. The CPT codes DHT used are 83645 for the screening and 36415 for the specimen collection. The average UCR, using the rates for Jefferson City and St. Louis, are $32 for the screening and $14 for the specimen collection. The DHT also assumed that there would be an office visit charge. The average office visit charge is $62.50 per visit and the Medical Plan has a $15 co-pay on PPO office visits. Assuming that the children have met their deductible, maximum out of pocket benefit, and are using a PPO physician, the total fiscal impact to the Medical Plan for the lead poisoning testing of children under the age of six years would be approximately $166,337 per year [1,779 tests x ($32/screening + $14/specimen collection + $62.50/office visit - $15 co-pay)] for the first two years and $94,622 per year [1,012 tests x ($32/screening + $14/specimen collection + $62.50/office visit - $15 co-ASSUMPTION (continued)



pay)] for all subsequent years.

The total fiscal impact to the Highway & Patrol Medical Plan is approximately $236,257 for the

first two years and $164,542 for all subsequent years. The DHT is responsible for 75% of the Medical Plan's participants and the Patrol is responsible for 25% of the participants. Based on this information, $177,193 of the cost in the first two years and $ 123,407 each subsequent year is due to the DHT participants and $59,064 of the costs in the first and second years and $41,135 each subsequent year is due to Patrol participants.



Historically, the DHT and the plan members have shared in any premium increases necessary because of increases in benefits. The costs may be shared in the long run (meaning shared between three categories: absorbed by the plan, state appropriated funds, and/or costs to individuals covered under the plan). However, the DHT Commission must make a decision on what portion they will provide. Until the Commission makes a decision, the DHT can only provide the cost to the medical plan.



Officials from the Department of Health (DOH) stated that when the legislation was originally read, it was interpreted that the bill intended for all children to be required to be tested for lead poisoning at 12 and 24 months, and only children in high risk areas would be tested at a more frequent rate. As a result of re-reading the legislation, the testing assumptions have been changed to reflect only identified high risk areas.



Officials from the DOH provided the following corrected assumptions for FN 2136-05/HCS for HB 964:



1. High Risk areas for lead poisoning (using 1990 housing data and lead testing data)

Local Public Health Agency (LPHA)Jurisdictions with 50% or more pre-1960 housing.

LPHA jurisdictions whose cities have known areas of high lead poisoning in all or part of them.

LPHA jurisdictions where testing has demonstrated high prevalence.

31 public health jurisdictions were selected based on 50% or more pre-1960 housing, population size and/or testing results to date. 100%: Atchison, Barton, Buchanan, Caldwell, Carroll, Chariton, Clark, Cooper, Dade, Gentry, Grundy, Harrison, Holt Howard, Knox, Linn, Livingston, Madison, Marion, Newton, Nodaway, Pettis, Schuyler, Scotland, Shelby, St. Francois, St. Louis City, and Worth. Partially: Jasper, Kansas City and St. Louis County.



In the high risk eligible areas, such as St. Louis City and Kansas City, many of the children are Medicaid-eligible, and lead testing would already be included in their global fee.





ASSUMPTION (continued)



2. Determination of numbers of children which would equal tests (because one test would be required per year between 0-6 years).

Determined numbers of children and tests in each area.

Subtracted from each area the amount of testing that had been done in FY2000.

Total number of new tests would be 100,592.

This figure does not include additional required tests for children with elevations.



3. Determine number of additional data entry FTEs both for state and in Local Public Health Agencies:

Currently DOH enters the data for approximately 1/3 of the 80,000 annual tests, i.e. 26,666 by approximately 1.2 FTEs. This translates into 22,222 per 1FTE.

The total increased test numbers and data entry need by regional groups:

Area Data Entry Total Test # FTE Additional needed

St. Louis City self 15,935 0.7

St. Louis County self 8,364 0.4

KC/Jackson County self KC only 30,212 1.4

Outstate DOH 46,081 2.1



Total 100,592 4.6.



Therefore, 100,592 additional tests per year would require approximately 4.6 additional FTEs 2.1 at DOH (rounded to 2.0) and 2.5 at the LPHAs.



B. Additional Assumptions

Personnel Needs:

2 DOH Clerk Typist II will be required for the increased data entry and follow-up of lead test results.

1 Management Analyst Specialist II will be required to search and apply for every federal and state lead grant that becomes available. Requirements for an FTE capable of searching and preparing grant applications for lead programs requires a person able to function at a higher level. Many of the grant programs require collaboration with local agencies.

Other:

There are currently 13,400 medical providers licensed to practice in the state of Missouri. Preparation and mailing of an educational mailing would cost approximately $10,000 based on the costs of the mailing of the testing guidelines in FY 2000.

It is difficult to determine what the costs of conducting audits of provider records would be in order to determine physician compliance. An estimate is that we could contract with an agency to conduct a random sample audit for $20,000.



Assumptions: for FN 2136-05A HCS for HB 964 State Public Health Laboratory (SPHL)



ASSUMPTION (continued)



A. Number of additional laboratory tests that would be done annually at the SPHL



. Routine screening would produce an increase of 100,592 tests statewide. Of the total new tests done annually, it is assumed the SPHL would perform approximately 20% of the total. Previously, the assumption was higher, based on an estimate of the immunizations performed in local health departments. After further research, the DOH feels the 20% is a more accurate projection. This would be 20,118 tests. Follow up testing by the SPHL of those children found to have initial elevated lead level (11%) would add an additional 2,213 tests. Total increased testing for the SPHL is estimated to be 22,331 (20,118 + 2,213). The SPHL would perform lead testing for those children who receive lead testing services from local health departments throughout the State who are not Medicaid clients.



B. Number and expense of adding additional laboratory staffing to perform 22,331 lead tests



. The SPHL presently performs approximately 14,000 lead tests annually. Based upon current staffing the following additional staff will be required.



Public Health Lab Scientist 2

. Perform laboratory analysis of blood samples for lead



Clerk II 1

.Prepare testing kits for mailing to providers



Clerk Typist II 1

.Perform data entry of client information and

test results plus client billing



C. Assumptions and cost of E&E required to perform additional SPHL testing



. Laboratory equipment leasing - lead testing requires specialized laboratory testing equipment. Based upon existing workload, one additional testing setup will be required. Each testing system can be leased for approximately $25,000 per year.



. Laboratory reagents - the chemicals and other materials to perform a lead test cost approximately $3.00 per sample tested.



. Blood collection kits - samples must be collected in special lead-free test tubes and packaged in

unbreakable shipping containers. These collection kits cost $2 per kit.

. Transportation costs - The SPHL employs a statewide courier to pickup and deliver laboratory ASSUMPTION (continued)



samples. This is much less expensive than using mail services because of Federal laboratory specimen mailing regulations. The increased cost to extend the statewide courier contract to all local health departments, will average $3 per sample collected.



D. Assumptions regarding fees



Authority currently exists for DOH to charge fees now for lead testing, but the department does not do so. It has been a struggle to get children tested for lead. Charging a fee will put up yet another barrier, which will prevent children from being tested. The language is permissive regarding fees, not mandatory.



Oversight assumes that the DOH would implement a fee to help cover the cost of the lead tests. The estimated revenue to the Childhood Lead Fund is unknown.





Amendment 4



Officials from the Department of Health (DOH) assume the proposed legislation would not

fiscally impact their agency.



Officials from the Department of Mental Health (DMH) assume this proposal would fiscally impact their agency because the bill requires reporting on certain procedures to the DMH. The bill states that failure to send such reports to the DMH is a misdemeanor and requires the DMH to analyze, audit, and monitor such procedures using the information in the reports. Because of numerous "unknown or unclear" aspects of this bill it is not possible to arrive at a clear determination of costs.



The DMH officials state if the purpose of the bill is to obtain purely statistical information for the purpose of tracking the prevalence of such procedures (which according to the DOH Client Abstract System exceeded 1,000 procedures in 1999), the Department would require 1 FTE clerk typist to handle the required quarterly hospital and physician survey mailings, the receipt and filing of the surveys, the entry of the required data into a database, and follow-up (written and phone) on surveys not returned.

"If the intent is to do the above and to perform detailed statistical/analytical and qualitative examination of the data two FTE research analysts would be needed. This estimate is based upon the amount of data required under this bill, which requires significantly more information on these procedures than what is currently captured by the DOH Patient Abstract System (which currently requires the use of 2 FTE Research Analysts by the DOH for system and data maintenance). The DMH analysts would be reviewing over 1000 cases for qualitative as well as quantitative data and handling phone follow-ups on reports raising questions. This would greatly ASSUMPTION (continued)



increase the projected cost of the bill."

"However, if the intent of the bill is to have a qualified ""peer"" review of the data for indications of improper use and results of such procedures at least one additional FTE, a physician, would be required. The information required under this bill is not only statistical in nature but qualitative as well. This data does not lend itself to entry into an electronic system. The potential requirements of this bill, if a peer review of the procedures is intended, would significantly increase the cost of the note.



If the intent of the bill is the gathering and analysis of the data as written above plus field visits to monitor and audit the hospitals and physicians which use these procedures the cost and FTEs required would be significantly increased. There is currently no means available to calculate this cost."



This bill not only does not give any indication what the specific purpose is for such analysis, auditing and monitoring, it does not specify what the DMH is to do if something "out of the ordinary" where to be found from the information in the reports (which could require the hiring of attorneys to handle such legal actions). Therefore, DMH officials assume the work to receive these reports, and process them according to the bill would be strictly of a "desk" audit, analysis, and monitoring in nature rather than "field" audit, and monitoring. For this reason the cost of the note is limited to 1 FTE clerk typist position. If, however, the DMH were to report violations of this bill for prosecution by the Attorney General this might necessitate additional costs.



The clerk typist would be responsible for developing and maintaining the database on the required procedures, handle the distribution and receipt of the required quarterly reports from the hospitals and doctors, and spending a large portion of their time on the anticipated follow-up calls with hospitals and doctors who fail to return reports. The data required to be reported goes above simple entry of statistical information and as such will be labor intensive. This position will also be responsible for the development and distribution of quarterly reports on the data received and statutory compliance levels.





Amendment 5



Officials from the Office of State Courts Administrator and Office of Administration (COA) - Accounting and COA - Administrative Hearing Commission stated the proposed legislation would have no fiscal impact on their organizations.



Officials from the Office of Secretary of State (SOS) stated this bill requires the Division of Maternal, Child and Family Health to promulgate rules to implement the Adoption Awareness Law. Based on experience with other divisions, the rules, regulations and forms issued by the ASSUMPTION (continued)



Department of Elementary and Secondary Education could require as many as approximately 22 pages in the Code of State Regulations. For any given rule, roughly half again as many pages are published in the Missouri Register as in the Code because cost statements, fiscal notes and the like are not repeated in the Code. These costs are estimated. The estimated cost of a page in the Missouri Register is $23.00. The estimated cost of a page in the Code of State Regulations is $27.00. The actual costs could be more or less than the numbers given. The impact of this legislation in future years is unknown and depends upon the frequency and length of rules filed, amended, rescinded and withdrawn. Therefore, the officials from the SOS estimated the fiscal impact for FY 2002 to be $1,353 [(22 pgs. X $27) + (33 pgs. X $23)].



Oversight assumes the SOS could absorb the cost of printing and distributing the 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.



Officials from the Department of Social Services (DOS) stated the proposed legislation, which includes costs for the DOS to, through a contracted source, establish and promote education

materials for adoption awareness. DOS would provide this information and referral sources through the toll-free TEL-LINK telephone number. DOS would make materials available through the clinics and family planning programs, and privately-funded adoption agencies, and abortion facilities. DOS may make the education material available for the public through the DOS Internet website. Depending on the size of the campaign, costs would range from $39,723 - $197,506 in General Revenue for year one.



Based on fiscal note responses from the Department of Social Services (DOS) and the Department of Health (DOH) for similar legislation proposed in 2000, Oversight assumes the DOS could prepare a pamphlet that addresses adoption and foster care as an alternative to abortion.



Oversight assumes, based on the DMCH FY 2001 response, there would be approximately 25,500 mailings to include private adoption agencies, DOH physicians, family planning clinics, DOH clinics, abortion clinics, and any other person or entity that requests such materials. If 50 pamphlets were provided to the 25,500 entities per year, on a black and white tri-fold brochure, the cost for printing would be approximately $39,398. No new employees were expected to be

needed and the costs would be charged to the General Revenue Fund. Printing costs would be approximately $40,580 and $41,797 for FY 03 and FY 04, respectively.



Oversight assumes the DOH estimated costs of postage for an initial mailing to all doctors, family planning clinics, prenatal clinics, privately funded adoption agencies, Title X agencies,

abortion facilities, and any other person or entity who requests such material at $47,940. Subsequent mailing to the estimated 25,500 entities would result in postage expense of $54,106 ASSUMPTION (continued)



and $55,729 for fiscal years 2003 and 2004, respectively.





Amendment 7



Oversight assumes there will be a fiscal impact resulting from passage of this proposal due to the loss of fees collected and the savings generated by not completing inspections. Due to the effective date of July 1, 2005, of the proposal, no fiscal impact would be realized until FY 2006 and therefore Oversight reflects no impact for fiscal years 2002 - 2004.





Amendment 10



Officials from the Department of Social Services, Office of the State Public Defender, Department of Health, Office of Prosecution Services, Department of Public Safety -- Capitol Police, -- Division of Fire Safety, State Highway Patrol, and the -- State Water Patrol assume the proposed legislation would have no fiscal impact on their agencies.



Officials from the Office of State Courts Administrator assume that most health care, emergency, and law enforcement workers take significant precautions to protect themselves from bodily fluids. Therefore, they do not anticipate a significant impact on the workload of the courts.



Officials from the Department of Corrections (DOC) assume the DOC currently performs mandatory testing on offenders when staff has had a significant exposure to blood. The proposed legislation does not specify who is responsible for going to the court for the order when a staff member wants an offender tested after an exposure to bodily fluids and the DOC does not deem the exposure significant. The proposal also is silent regarding several other issues: (1) Whether the DOC would have to go to court every time it wanted a mandatory test, or whether the current practice of mandatory testing without a court order for significant exposures be permitted. (2) Who would be responsible for the cost of the test ordered by the court. (3) In order to compel an offender to be tested, sometimes it is necessary to physically restrain the offender and this can lead to significant exposure to blood for more staff. It is unclear whether the DOC would be responsible for compelling an offender to comply with the court ordered testing when the DOC does not consider the exposure significant.



The DOC currently tests offenders for detection of infectious disease when, according to departmental policy, testing is deemed reasonable due to an employee's exposure to bodily fluids. It is unclear who is responsible for enforcing that individuals comply with this proposal once directed. The potential for exposure to pathogens is exacerbated when testing is performed on a person who has initially refused testing. It is also unclear who perform the testing and who ASSUMPTION (continued)



pays for testing after a directive is ordered and authorized.



Due to the wide variance of unknown variables, the fiscal impact as it relates to the DOC is unknown.



Oversight assumes that the fiscal impact of the proposed legislation to the DOC would be less than $100,000 annually.





Amendment 11



Officials from the Department of Economic Development - Division of Professional Registration, the Department of Elementary and Secondary Education, the Department of Public Safety - Missouri State Highway Patrol, and the Office of Attorney General assume this proposal would not fiscally impact their agencies.



Department of Health (DOH) officials state the costs of the feasibility study and subsequent report would be less than $10,000 and would be absorbed by the existing organ donor program budget. Therefore, DOH assume this proposal would have no additional fiscal impact on their agency.



Officials from the Department of Revenue (DOR) assume the following administrative and fiscal impacts:



DIVISION OF MOTOR VEHICLES AND DRIVER LICENSING

Driver and Vehicle Services Bureau



Collection of Organ Donation Information and Increased Donation Amount

This proposal would require the Division of Motor Vehicle and Drivers Licensing to modify the driver's license and identification card application process and renewal system to: 1) Obtain information from individuals over the age of eighteen regarding consent to anatomical donation and 2) Allow persons under the age of eighteen to register as donors with parental consent.



The inquiry on the application and renewal form shall read "Do you wish to have the organ donor designation printed on your driver's license? If yes is answered to this question, the words "Organ Donor" would be printed on the front of the license.



In addition the application process must be modified in order to collect a $2 donation. Currently, the Driver and Vehicle Services Bureau can only collect a $1 donation from each applicant.



The Driver and Vehicle Services Bureau would incur programming expenses in the amount of ASSUMPTION (continued)



$42,000 to the Over-the-Counter system to accommodate each of the aforementioned changes to the system.





STATE DATA CENTER



The State Data Center would require an implementation cost of $5,129 in FY02 to make modifications to the current Missouri Drivers License System (MODL).



REVENUE IMPACT



Organ Donor Program Fund



The Driver and Vehicle Services Bureau estimates increased revenue collected for the organ donor program fund. The following estimates are based on fiscal years 2002 and 2003 only as these are the final two years of a three year transition to a six year driver license renewal system. The Driver and Vehicle Services Bureau estimates that half of the renewal license applicants would be able to donate $2 through this transitional period as these are the only applicants eligible to donate $2. Beginning fiscal year 2004, this proposal would be revenue neutral as license renewal volumes and the increased donation amount would offset each other.



Estimates are based on current donation levels of $33,682 per month.





FY02



$33,682 Current Donations Monthly

/ 2 Half of All Applicants Will Be Eligible for a $2 Donation

16,841 Six Year Applicants Who Will Donate an Additional $1

x $1 Increased Donations

$16,841 Increased Donation Per Month

x 10 Number of Months in Fiscal year 2002

$168,841 Increased Funding in FY02



FY03



$16,841 Increased Donations Monthly

x 12 Number of Months in Fiscal Year 2003

$202,092 Increased Funding for FY03





ASSUMPTION (continued)



Oversight assumes that hospitals could experience some administrative tasks relating to this proposal. However, we believe that the functions could be absorbed with existing resources and therefore have shown no fiscal impact to hospitals.



Officials from the Department of Public Safety (DPS) did not respond to our fiscal impact request. However, in responding to a similar proposal last session DPS assumed no fiscal impact.



This proposal would result in a increase in Total State Revenues.





FISCAL IMPACT - State Government FY 2002

(10 Mo.)

FY 2003 FY 2004
ALL FUNDS
Costs - All Funds
Increased state contributions* (Unknown) (Unknown) (Unknown)
ESTIMATED NET EFFECT ON ALL FUNDS



(UNKNOWN)


(UNKNOWN)


(UNKNOWN)
*Expected to exceed $100,000 annually.
GENERAL REVENUE FUND
Costs - Department of Health (section 191.714)
Personal services (1 FTE) ($41,974) ($51,628) ($52,918)
Fringe benefits ($13,990) ($17,208) ($17,638)
Expense and equipment ($13,055) ($10,630) ($10,949)
Total Costs - Department of Health ($69,019) ($79,466) ($81,505)
Costs - Department of Health (section 191.938)
Board meeting expenses ($3,700) ($3,700) $0
Costs - Office of Administration - Division of Budget and Planning (section 191.940)
Commission expenses ($48,797) $0 $0
Costs - Department of Health (section 192.729)
Expense and equipment ($35,000) ($35,000) ($35,000)
Costs - Department of Social Services (section 376.1199)
Medical assistance payments (Unknown) (Unknown) (Unknown)
Costs - Department of Health (amendment 3)
Personal Services (7 FTE) ($170,376) ($209,562) ($214,801)
Fringe Benefits ($56,786) ($69,847) ($71,593)
Equipment and Expenses ($266,891) ($289,768) ($298,462)
Total Costs - Department of Health ($494,053) ($569,177) ($584,856)
Costs - Department of Social Services -
Division of Medical Services (amendment 3)
Medical Assistance Payments (Unknown over (Unknown over (Unknown over
$40,000) $40,000) $40,000)
Costs - Department of Mental Health (amendment 4)
Personal Service (1 FTE) ($17,487) ($21,508) ($22,046)
Fringe Benefits ($5,828) ($7,169) ($7,348)
Expenses and Equipment ($9,250) ($1,006) ($1,037)
Total Costs - Department of Mental
Health ($32,565) ($29,683) ($30,431)
Costs - Department of Social Services (amendment 5)
Printing Pamphlets ($39,398) ($40,580) ($41,796)
Postage and Supplies ($49,940) ($54,106) ($55,729)
Total Costs - Department of Health ($89,338) ($94,686) ($97,525)
Costs - Department of Corrections (amendment 10)
Medical/Lab costs** (Unknown) (Unknown) (Unknown)
ESTIMATED NET EFFECT ON GENERAL REVENUE FUND*

(COULD EXCEED

$812,472)



(COULD EXCEED

$851,712)



(COULD EXCEED

$869,317)

*Does not include unknown medical assistance payments and unknown medical/lab costs.
**Costs will likely be less than $100,000 in any given year.
INSURANCE DEDICATED FUND
Income - Department of Insurance
Form filing fees $10,000 $0 $0
ESTIMATED NET EFFECT ON INSURANCE DEDICATED FUND



$10,000


$0


$0
CHILDHOOD LEAD TESTING FUND
Income - Department of Health (amendment 3)
Fees to Defray Testing Costs Unknown Unknown Unknown
Costs - Department of Health (amendment 3)
Additional lead testing costs (Unknown) (Unknown) (Unknown)
ESTIMATED NET EFFECT ON CHILDHOOD LEAD TESTING FUND



$0




$0




$0
HIGHWAY FUND
Transfer In - Organ Tissue Donor Awareness Board
Organ Donor Program Fund $47,129 $0 $0
Costs - Department of Revenue
OTC programming - Driver's license ($47,129) $0 $0
ESTIMATED NET EFFECT ON HIGHWAY FUND

$0


$0


$0
ORGAN DONOR PROGRAM FUND
Income - Department of Revenue
Donations on the state income tax return

Unknown


Unknown


Unknown
Income - Department of Health
Additional donation from license $168,841 $202,092 $0
Costs - Organ and Tissue Donor Awareness Board
Program costs (Unknown) (Unknown) (Unknown)
Transfer - Out
Transfer to Highway Fund for DOR development and implementation costs

($47,129)


$0


$0
ESTIMATED NET EFFECT ON ORGAN DONOR PROGRAM FUND*

$121,712


$202,092


$0
*Does not include unknown revenues from income tax return donations.
FEDERAL FUNDS
Income - Department of Social Services
Medicaid reimbursements Unknown Unknown Unknown
Costs - Department of Social Services
Medical assistance payments (Unknown) (Unknown) (Unknown)
Income - Department of Social Services -
Division of Medical Services (amendment 3)
Medical Assistance Payments Unknown over Unknown over Unknown over
$60,000 $60,000 $60,000
Costs - Department of Social Services -
Division of Medical Services (amendment 3)
Medical Assistance Payments (Unknown over (Unknown over (Unknown over
$60,000) $60,000) $60,000)
ESTIMATED NET EFFECT ON FEDERAL FUNDS

$0


$0


$0


FISCAL IMPACT - Local Government FY 2002

(10 Mo.)

FY 2003 FY 2004
$0 $0 $0



FISCAL IMPACT - Small Business



Small businesses would expect to be fiscally impacted to the extent that they could have an increase in health insurance premiums as a result of the requirements of this proposal.



Amendment 3



Increased screening would potentially lead to the identification of more children with elevated blood lead levels, which could lead to the abatement of more lead hazards. This may increase business for small lead abatement contractors and possible also affect medical providers. Estimated fiscal impact is unknown.



FISCAL IMPACT - Small Business (continued)



Amendment 7



In reference to the component addressing the revisions in inspection provisions for beverage manufacturers and distributors, small businesses would expect to be fiscally impacted to the extent they would incur a reduction in licensing and inspection fees as a result of the requirements of this proposal.



Amendment 10



A direct fiscal impact to small businesses that are considered hay ride enterprises would be expected as a result of this proposal, since they must now possess a $1 million general liability insurance policy, a $1 million bond, or cash or other surety acceptable to the Department of Public Safety to obtain a permit to operate their hay ride business in Missouri.



DESCRIPTION



Exposure control for blood-borne pathogens



This portion of the proposal would require the Department of Health to adopt a blood-borne pathogen standard governing the occupational exposure of public employees to blood and other potentially infectious materials. The portion of the proposal would:



(1) require the department to develop a standard that would meet the standard developed by the Occupational Safety and Health Administration (OSHA). The standard would be adopted no later than February of 2002;



(2) exempt the use of a drug or biologic that is pre-packaged or used in a pre-filled syringe from the blood-borne pathogen standard. This exemption would expire on June 1, 2004;



(3) require the establishment of an evaluation committee and would specify the members, qualifications, and duties of the committee;



(4) require the department to compile and maintain a list of needleless systems and sharps with engineered sharps injury protection;



(5) require the department to issue an annual report on the use of needle safety technology to the Governor, State Auditor, President Pro Tem of the Senate, Speaker of the House of Representatives, and the Technical Advisory Committee on the Quality of Patient Care and Nursing Practices by February 1 of each year. The report would be available to the public on the

department's web site by February 15 of each year;



DESCRIPTION (continued)



(6) require persons to report a suspected violation; and



(7) subject an employer to a reduction or loss in state funding for violating provisions of this portion of the proposal.





Automated External Defibrillator Advisory Committee



This portion of the proposal would establish an Automated External Defibrillator Advisory Committee within the Department of Health, subject to appropriations. The committee would advise the department, Office of Administration, and the General Assembly on the feasibility of placing automated external defibrillators in public buildings. The committee would issue a final report by December 31, 2002, and the committee would terminate on June 1, 2003.





Statewide Lupus Program



This portion of the proposal would establish a statewide Systemic Lupus Erythematosus Program in the Department of Health. Subject to appropriations, the program would be required to:



(1) track and monitor the prevalence of lupus;



(2) identify medical professionals and providers who specialize in the treatment of lupus and related diseases; and



(3) promote lupus research and public awareness through collaboration with academic researchers, local boards, and the Missouri Chapter of the Lupus Foundation.



The department can utilize or expand existing programs such as the state Arthritis Program, Office of Minority Health, and the Office of Women's Health to meet the requirements of this portion of the proposal.





Tuberculosis



This proposal would revise the definition of a local board and provisions concerning a local board of health's filing for a petition to commit persons with active tuberculosis or persons who are potential transmitters by adding provisions concerning emergency temporary commitment. If a person with active tuberculosis or who would be a potential transmitter conducts himself or herself in a manner which exposes others to the immediate danger of infection, the board

can file an ex parte petition with a circuit court for emergency temporary commitment. After the DESCRIPTION (continued)



petition has been filed, the circuit court would be required to hear the matter within 96 hours. The local board would have the authority to detain the person named in the petition pending the

circuit court's decision on the petition. Currently, a non-emergency petition filed with the circuit court would be heard in 5 days or no later than 15 days after the non-emergency petition has been filed. If the ex parte petition is granted, the person named in the petition would be committed to the Missouri Rehabilitation Center until a full hearing is held.





Health Information Privacy



This proposal would prohibit the selling of personal health information to a third party or the disclosure of information to a third party for the purpose of: (1) marketing a product or service; (2) employment decisions; or (3) credit worthiness. The proposal does not apply in cases where the person cannot be identified from the information or when the person provides written authorization. The proposal does not prohibit disclosure of information that is necessary in the providing of health care or to comply with any other state or federal law. Insurance entities would be deemed to be in compliance with the proposal upon either: (1) demonstrating a good

faith effort to comply with federal privacy rules; or (2) complying with model legislation adopted by the National Association of Insurance Commissioners. The Department of Insurance would enforce the proposal regarding insurance entities, who may be sued for unfair trade practices. Any other person in violation may be fined up to $500 for each violation and may be civilly liable for damages or equitable relief. The proposal would also establish the Commission on Health Information Privacy, to be comprised of 15 people from various health care industry, governmental, and consumer groups. The commission would make recommendations to the General Assembly by January 1, 2003, regarding any additional legislation needed to protect the privacy of personal health information. The proposal would become effective January 1, 2002.





Obstetrical/Gynecological Benefits



This proposal would require each health carrier that offers or issues benefit plans that provide obstetrical, gynecological, and pharmaceutical coverage which would be issued, continued, or renewed in Missouri on or after January 1, 2002, to provide enrollees with direct access to the services of a participating obstetrician, gynecologist, or participating obstetrician/gynecologist of her choice within the provider network. This requirement would be consistent with Subsection 4 of Section 354.618, RSMo, pertaining to open referrals for covered obstetrical and gynecological care within a provider network. The services covered by this provision would be limited to

services defined by published recommendations of the Accreditation Council for Graduate Medical Education for Training Obstetricians, Gynecologists and Obstetricians/Gynecologists. A health carrier would be prohibited from imposing a surcharge or additional co-payments or deductibles upon enrollees who seek obstetrical or gynecological services covered by the DESCRIPTION (continued)



proposal unless similar charges would be imposed for other types of health care services received within the provider network. Enrollees would be required to be notified of cancer screenings at intervals consistent with current American Cancer Society guidelines. The cancer screenings would be covered by the enrollee's health benefit plans. Health carriers would be required to provide coverage for diagnosis, treatment, and appropriate management of osteoporosis for individuals with a condition or medical history for which bone mass measurement is medically indicated for such individual. If a health benefit plan would also provide coverage for pharmaceutical benefits, the plan would be required to provide coverage for contraceptives either at no charge or at the same level of deductible or co-payment as any other drug on the health benefits plan's formulary. Coverage for contraceptives would include drugs, devices, or methods that prevent conception. The provisions of the proposal would not apply to supplemental insurance policies, life care contracts, accident only policies, specified disease policies, Medicare supplement policies, or long-term care policies. The coverage for contraceptives would not require any person or entity to provide contraceptive coverage if the coverage would be contrary to moral or religious beliefs sincerely held by a person who stands in a direct relationship with an entity. Entities would required to document sincerely held moral or religious beliefs but would not be able disclose the information.



Amendment 3



This act requires insurance companies to offer coverage for testing pregnant women and for children under the age of 6 for lead poisoning. This act requires the Director of the Department of Health to inform local boards of health when a case of lead poisoning is reported to the director. Health care professionals and health care organizations are required to report positive lead poisoning cases.



Beginning January 1, 2002, the Department of Health must implement a childhood lead testing program to test children under the age of 6 for lead poisoning. The test shall consist of a blood sample which must be sent to a state-licensed laboratory for analysis. Children less than six years of age who are not deemed high risk are to be tested once at the age of twelve months and once at two years of age. Any child that is not tested at twelve and twenty-four months of age shall be tested at least twice before the child's sixth birthday and any child at least five years of age but less than six who has not been tested, shall be tested once before the child's sixth birthday.



The Department of Health shall identify geographic areas in the state that are at high risk for lead poisoning. All children six months of age through six years who reside or spend more than 10

hours a week in an area identified as high risk shall be tested annually for lead poisoning. Any child who tests positive for lead poisoning shall receive follow-up testing, in accordance with guidelines and criteria established by the American Academy of Pediatrics, at the priority intervals and using the methods specified in such guidelines.



DESCRIPTION (continued)



The Department of Health, in coordination with the Department of Social Services and the Department of Elementary and Secondary Education, shall develop and provide questionnaires for every child not identified as high risk to be assessed within six months of birth and at least once a year thereafter until the child is six years of age. The questionnaire shall follow the recommendations of the Centers for Disease Control and Prevention.



The Department of Health is to promulgate rules to identify pregnant women who may be at high risk for exposure to lead poisoning. The Department of Health is required to develop an educational mailing list to be sent to physicians informing them of the childhood lead testing program.



The Department of Health is required to convene a task force to investigate the imposition of a fee on manufacturers of products containing lead. Fees collected from such manufacturers shall be deposited in the Childhood Lead Testing Fund.



Beginning January 1, 2003, and every year thereafter, the Department of Health is required to submit a report evaluating physician compliance with the act to the General Assembly.



The act requires child care facilities to require a child's parent to provide evidence of lead poisoning testing. If the parent fails to submit evidence of lead poisoning testing, the facility is required to inform the parent of the issue and where the parent can obtain testing for the child.



This act creates the Childhood Lead Fund. The fund is to be used to fund the administration of the childhood lead programs.



Amendment 4



This proposal would require mental health hospitals or facilities to submit a quarterly report to the Department of Mental Health if such facilities and physicians (on an outpatient basis) administer electroconvulsive therapy, psychosurgery, or other specified therapies for the treatment of mental illness. The proposal specifies the components which would be included in the quarterly reports. Mental hospitals, facilities, or physicians who violate provisions of the proposal would be committing a misdemeanor and would be subject to a specific fine, confinement in jail, or both. The penalties contained in the proposal would apply to violations committed on or after August 28, 2001. For violations committed before August 28, 2001, current law would apply.



The department would be required to use the submitted information for the purposes of auditing, analyzing, and monitoring the use of such therapies.







DESCRIPTION (continued)



Amendment 5



This act promotes adoption awareness and expedites the process of adopting foster children by waiving or shortening waiting periods.



The act outlines the adoption education and promotion duties of the Department of Social Services in conjunction with the Department of Health. The Department of Social Services must create a toll- free telephone number and make a variety of other materials available with specific information about adoption and related topics. This information will be available through all Department clinics and family planning programs, privately funded adoption agencies, abortion facilities, and through private physicians upon their patients' request.



Currently, the duties of the Division of Family Services (DFS) are outlined in Section 207.020, RSMo. Language is added to allow DFS to extend its custody of a child beyond his or her 18th birthday when a court deems it is necessary. DFS must also diligently seek adoptive homes that reflect racial and ethnic diversity. Current language requiring consideration to be given to a child's cultural, racial, or ethnic background is removed. Thus, the placement of a child should not be hindered on the basis of race, color, or national origin. (Section 453.005).



Current law outlines procedures for petitioning to adopt a child and states that the court shall not deny or delay the placement of a child when an approved family is available. New language adds a provision to expedite the placement of a child for adoption in cases in which the child is already under court custody. (Section 453.010).



Current law also gives permission to foster parents to apply for adoption if they have cared for a child for twelve months or longer. The adoption agency and court must give preference and first consideration to foster parents. New language changes the twelve-month period to nine months. (Section 453.070).



The court is currently required to conduct a hearing during the adoption of a child and to ascertain, among other things, that the child has been in custody of the petitioning adoptive parent for at least six months prior to entry of the decree. New language waives the six-month waiting period for children in court custody when the petitioner is a foster parent. (Section 453.080).



Amendment 7



This proposal would revise inspection provisions for beverage manufacturers and distributors. A new section 196.367 would be created to exempt any manufacturer or distributor from the inspection provisions in Sections 196.365 - 196.445, RSMo, if it has received approval after federal food safety inspection and if it satisfies all applicable Food and Drug Administration DESCRIPTION (continued)



regulations.



Amendment 10





The proposed legislation permits court-ordered infectious disease testing of persons whose bodily fluids have come in contact with a corrections officer, emergency services employee, health care provider, law enforcement employee, or juvenile correctional facility employee, while performing duties within the scope of such employee's duties as an employee.



Amendment 11



This proposal would make several changes to the Anatomical Gift Act. In its main provisions, the proposal would: (1) add definitions for "anatomical donations," "federally certified organ procurement organizations," and "organ donor program fund"; (2) allow persons who are 16 years of age to effect anatomical gifts with parental or guardian consent; (3) allow an attending physician or hospital designee to contact an organ procurement organization in Missouri to determine the suitability or non-suitability of an organ, tissue, or eye donation of any patient who is near death or who dies while an inpatient at a hospital and specifies the procedures for the

determination; (4) allow a hospital to develop and implement a protocol for referring potential anatomical donors; (5) establish procedures for conducting death medical record reviews for the purpose of determining the anatomical donor potential at a hospital; (6) allow the Division of Motor Vehicle and Drivers Licensing to modify the driver's license and identification card application process and renewal system for the purposes of obtaining information on anatomical donations from persons over 18 years of age and allowing persons under 18 years of age to register as donors with parental consent and further permits organ procurement organizations in

Missouri to have 24-hour access to the donor information; (7) allow applicants for a driver's

license to make voluntary contributions of $2 to the Organ Donor Program Fund; (8) specify procedures which would allow the Department of Revenue to provide space on the face of the individual income tax return form for persons voluntarily contributing to the Organ Donor Program Fund, effective for tax year 2000 and thereafter; (9) specify persons who can conduct reasonable, administrative, and physical searches in order to verify the approval or non-approval of an organ donation; (10) specify the use of the Organ Donor Program Fund; (11) adds the following members to the Organ Donation Advisory Committee: one representative from the Department of Revenue; one representative from the Missouri Hospital Association; and one representative from an eye bank. The proposal would also specify that 4 advisory committee representatives would be required to be current members of the organ procurement organizations in Missouri; and (12) allow the Director of Revenue to specify the rules and procedures for allowing an applicant to designate an anatomical gift on the back of a non-driver's license.



This legislation is not federally mandated, would not duplicate any other program and would DESCRIPTION (continued)



require additional capital improvements or rental space.



SOURCES OF INFORMATION



Department of Health

Department of Insurance

Missouri Consolidated Health Care Plan

Department of Transportation

Department of Social Services

Department of Conservation

Department of Public Safety

Missouri State Highway Patrol

Office of Secretary of State

Department of Mental Health

Department of Elementary and Secondary Education

Department of Public Safety - Capitol Police

Department of Public Safety - Veterans' Commission

Office of Administration

Division of Budget and Planning

Office of State Courts Administrator

Office of Prosecution Services

State Public Defender

City of Kansas City

University of Missouri

Department of Corrections

Office of the Secretary of State

Office of the State Treasurer

Cooper County Memorial Hospital





























SOURCES OF INFORMATION (continued)



NOT RESPONDING: Office of Attorney General, St. Louis County, City of St. Louis, Jackson County, and Springfield-Greene County Health Department, and Department of Economic Development - Division of Professional Registration, Department of Elementary and Secondary Education, Barton County Memorial Hospital, Cass Medical Center, Excelsior Springs Medical Center, Lincoln County Memorial Hospital, Pemiscot Memorial Hospital, Phelps County Regional Medical Center, Ray County Memorial Hospital, Samaritan Memorial Hospital, Ste. Genevieve County Memorial Hospital

















Jeanne Jarrett, CPA

Director



May 16, 2001