COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.: 1383-01
Bill No.: SB 336
Subject: Education, Elementary and Secondary; Elementary and Secondary Education Department; Disabilities; Health Department; Health, Public; Children and Minors
Type: Original
Date: February 13, 2001
FISCAL SUMMARY
| FUND AFFECTED | FY 2002 | FY 2003 | FY 2004 |
| Blindness Education, Screening and Treatment Program | $0 | ($642,793) | ($645,466) |
| General Revenue | $0 | (Unknown to $809,983) | (Unknown to $809,983) |
| Total Estimated
Net Effect on All State Funds |
$0 | ($642,793 to $1,452,776) | ($645,466 to $1,455,449) |
| FUND AFFECTED | FY 2002 | FY 2003 | FY 2004 |
| Title XIX | $0 | $0 | $0 |
| Total Estimated
Net Effect on All Federal Funds* |
$0 | $0 | $0 |
*Net of up to $1,270,097 per year expenditures and reimbursements.
| FUND AFFECTED | FY 2002 | FY 2003 | FY 2004 |
| Local Government | $0 | $0 | $0 |
Numbers within parentheses: ( ) indicate costs or losses.
This fiscal note contains 6 pages.
ASSUMPTION
Officials from the Secretary of State's Office (SOS) assume the rules, regulations and forms issued by the State Board of Education could require as many as 8 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. The estimated cost of a page in the Code of State Regulations is $27. The actual costs could be more or less the SOS's estimated cost of $492 for FY 2002. The impact of this legislation in future years is unknown and depends upon the frequency and length of rules, filed, amended, rescinded or withdrawn.
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 Elementary and Secondary Education stated that they would not expect administrative costs to their agency due to this proposal to exceed $100,000 in any given fiscal year; however, they do anticipate significant program costs for eye exams.
Enrollment Numbers
Head Start 15,520
Kindergarten 67,412
First Grade 72,624
Total 155,556
Medicaid Eligible (51,360)
Insured (92,231)
Program Eligible 11,982 x $57 per exam = $682,974
Officials of the Department of Social Services - Division of Medical Services (DOS - DMS) estimated additional Medicaid costs due to this proposal.
DMS officials note that vision exams for children are covered by Medicaid, but not all children use the service. All children are given an Early Periodic Screening Diagnosis and Testing
(EPSDT) and the ten percent (10%) whose EPSDT shows problems get vision exams.
Medicaid Eligible 51,360
Now Vision Tested (5,136)
To Be Tested 46,224 x $45 per exam = $2,080,080
The $2,080,080 is a maximum cost because it includes the population in managed care. The proposal could affect managed care capitation rates because rates for services are determined by use. The proposal would increase use for vision exams by one class of clients to 100%. Costs would be divided between federal (61.06%) and general revenue (38.94%) funds.
Officials of the Department of Health - Division of Maternal, Child and Family Health would request a Health Program Representative III and an Account Clerk II to carry out provisions of the proposal.
The Health Program Representative would compile and maintain lists of optometrists and ophthalmologists who would provide eye examinations and of providers who would accept referrals for children needing further examinations, vision correction or treatment on a free or reduced cost basis; develop and distribute information and enrollment materials; promote the program among schools and parents; and coordinate services with the Department of Elementary and Secondary Education and Department of Social Services's Division of Rehabilitation Services for the Blind.
The Account Clerk would process claims for eye examinations. Processing would include reviewing claims to verify that they are from approved providers, checking for Medicaid eligibility or insurance coverage, entering children's names into a database (to avoid duplicate payment of claims, enter payments into the Department of Health claims payment system, and answer inquiries from schools and providers about processing claims and invoices.
Department of Health officials would also request $21,000 (300 man hours at $70 per hour) to update the DOH claims payment system.
Oversight assumed that FTE would be located in existing facilities and has made equipment costs concur with Office of Administration guidelines. Oversight has used Department of Elementary and Secondary Education estimates of number of eye examinations of children not covered by government or private insurance, but has assumed costs of $45 per exam.
Oversight also notes that costs for the proposal would be charged to the Blindness Education,
Screening and Treatment Program Fund. The law which established that Fund had an effective date of January 1, 2001. Officials of the Department of Health estimated annual receipts of $127,000 per year to the Fund.
Officials from the Department of Public Safety - Missouri State Highway Patrol and Office of Secretary of State did not respond to our fiscal impact request.
| FISCAL IMPACT - State Government | FY 2002
(10 Mo.) |
FY 2003 | FY 2004 |
| BLINDNESS EDUCATION, SCREENING AND TREATMENT PROGRAM FUND | |||
| Cost - Department of Health | |||
| Personal Service (2 FTE) | $0 | ($65,382) | ($67,017) |
| Fringe Benefits | $0 | ($21,792) | ($22,337) |
| Expense and Equipment | $0 | ($16,429) | ($16,922) |
| Eye Examinations | $0 | ($539,190) | ($539,190) |
| Total Costs - Department of Health | ($642,793) | ($645,466) | |
| ESTIMATED NET EFFECT ON BLINDNESS EDUCATION, SCREENING AND TREATMENT PROGRAM FUND |
$0 |
($642,793) |
($645,466) |
| GENERAL REVENUE FUND | |||
| Costs - Department of Social Services | |||
| Medicaid Payments for Eye Exams | $0 | (Unknown to $809,983) | (Unknown to $809,983) |
| ESTIMATED NET EFFECT ON GENERAL REVENUE FUND | $0 | (Unknown to $809,983) | (Unknown to $809,983) |
| FEDERAL FUNDS | |||
| Income - Department of Social Services | |||
| Matching Funds | $0 | Unknown to $1,270,097 | Unknown to $1,270,097 |
| Costs - Department of Social Services | |||
| Payments for Eye Exams | $0 | (Unknown to $1,270,097) | (Unknown to $1,270,097) |
| 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
No direct fiscal impact to small businesses would be expected as a result of this proposal.
DESCRIPTION
This proposal pertains to vision exams for kindergarten and first grade students. Beginning with the 2002-2003 school year, every pupil in kindergarten or first grade in a public elementary school or in a Head Start program would receive a comprehensive vision examination performed by a state licensed optometrist or ophthalmologist. The examination findings would be submitted to the school or Head Start program no later than January first of the school year. The State Board of Education would promulgate criteria for forms or other proof of such examination, a maximum number of years before a new examination would be required and other necessary rules. The Department of Elementary and Secondary Education would, in conjunction with the Department of Health, compile and maintain a list of sources providing vision
examinations, further examination or vision correction on a free or reduced cost basis. The Department of Elementary and Secondary Education would ensure that the superintendent, the principal of each elementary school, the school nurse, and the parent organization for each district elementary school receive an updated copy of the list each year prior to school opening.
This legislation is not federally mandated, would not duplicate any other program and would not require additional capital improvements or rental space.
SOURCES OF INFORMATION
Department of Elementary and Secondary Education
Department of Health
Department of Social Services
Department of Conservation
Missouri Consolidated Health Care Plan
NOT RESPONDING: Department of Public Safety - Missouri State Highway Patrol and Office of Secretary of State
Jeanne Jarrett, CPA
Director
February 13, 2001