Sources of Revenue:

General Fund,Special Fund,Other Fund Federal

Legislation creates:

Neither Program nor Fund

Fiscal Note Summary

Effect this measure will have on costs and revenues of state government.

The purpose of this bill is to prohibit out-of-state placements unless the out-of-state treatment or service is in the best interest of the child or the needed treatment is not available in the state. The Department cannot accurately estimate the fiscal impact of the legislation. The Department of Health and Human Resources (DHHR) currently spends $24 million annually for out-of-state placements through the Bureau for Children and Families. These costs include room and board costs, education costs and ancillary costs. Currently, the Department only places children in out-of-state facilities when in-state facilities are not available, when the placement is the result of a court order or when the out-of-state placement is in the best interest of the child. This bill would not result in a change of policy by the Department, however, if facilities within the state became available that could provide the needed services, there could be some children returned to the state, as well some being placed in-state initially. In addition to the above costs, the DHHR's Bureau for Medical Services (Medicaid), for state fiscal year 2003, made an average payment per day for in-state placements of $308.33 versus an average payment per day for an out-of-state placement of $238.70. The cost impact to Medicaid for this bill would be, at best, cost neutral and could potentially result in a cost increase. Medicaid is unable to quantify the potential cost increase due to unknown variables such as: length of stay, unallowable costs identified through cost settlements, the number of court mandated orders resulting in out-of-state placements, and the limited resources available in-state to serve these children. Based on the assumption that children would be placed in in-state medicaid certified facilities, the Department would see a shift of some placement costs from the Department's Bureau for Children and Families to the Department's Bureau for Medical Services, which has a higher federal participation. Additionally, some of the in-state education costs would then become the obligation of the Department of Education rather than DHHR.

Fiscal Note Detail

Effect of Proposal	Fiscal Year
Effect of Proposal	2005 Increase/Decrease (use"-")	2006 Increase/Decrease (use"-")	Fiscal Year (Upon Full Implementation)
1. Estmated Total Cost	0	0	0
Personal Services	0	0	0
Current Expenses	0	0	0
Repairs and Alterations	0	0	0
Assets	0	0	0
Other	0	0	0
2. Estimated Total Revenues	0	0	0

Explanation of above estimates (including long-range effect):

For the above reasons the Department cannot accurately estimate the fiscal impact of the legislation.

Memorandum

Person submitting Fiscal Note: Martha Yeager Walker
Email Address: fnbudoff@wvdhhr.org