Sources of Revenue:

General Fund

Legislation creates:

Neither Program nor Fund

Fiscal Note Summary

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

This bill would authorize modified mental hygiene procedures to be initially implemented in four to six judicial circuits for a period of three years and then expanded if successful. The procedures are: (1) To allow less restrictive judicial measures to address the failure or refusal by individuals to take prescribed medication and treatment which causes the individuals to be repeatedly hospitalized or commit crimes; (2) to reduce the mandatory use of an initial full adversarial hearing process to temporarily hospitalize and stabilize patients who are likely to cause serious harm as a result of their mental illness or addiction. This bill impacts the Department of Health and Human Resources in the following manner: 1) The bill addresses the failure or refusal by individuals to take prescribed medication and treatment that causes these individuals to be repeatedly hospitalized or commit crimes. The clients eligible for this medication and treatment order will receive "oversight" for treatment compliance on an out-patient basis which costs less than the individual receiving medication in a hospital setting. The oversight aspect of the medication and treatment order would increase the cost to the Department through the funding to comprehensive Behavioral Health Centers for case management staff and travel in up to 6 judicial circuits. The Department estimates this cost at $135,000 per year. 2) The bill's 96 hour hold component will have a fiscal impact on the Department, however, it is not possible to predict the expected increased cost or revenues. The level of patient acuity, which we are not able to forecast, will determine how many of the patients admitted for 96 hours would be eligible for discharge after 4 days versus requiring further hospital treatment at a higher cost. 3) This legislation could potentially increase Medicaid's expenditures due to the number of diversions of Medicaid eligible patients from State ran facilities to meet court mandates. Medicaid is unable to quantify the potential cost savings or the potential cost increases due to unknown variables such as the number of Medicaid eligibles this bill targets nor the expected increase/decrease in the number of detainees that would cause patients to be diverted from state ran facilities.

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	135,000
Personal Services	0	0	0
Current Expenses	0	0	135,000
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):

The Department estimates known costs associated with the proposed legislation would be $135,000 annually beginning in FY 2007. The $135,000 is to fund a case manager (.5 FTE) at 6 comprehensive centers: 3 FTE's x $45,000 ($35,000 average salary and benefits, and $10,000 travel).

Memorandum

The clients eligible for the medication and treatment order portion of these pilot programs may receive monitoring and oversight for treatment compliance on an out patient basis which is far less costly than receiving medication in a hospital setting at a per diem rate of approximately $610 per day. It is not possible to predict how many patients after 96 hours might be ready for discharge or need further hospital treatment, which would affect costs. Medicaid is unable to quantify the potential cost savings or the potential cost increases due to unknown variables such as the number of Medicaid eligibles this bill targets nor the expected increase/decrease in the number of detainees that would cause patients to be diverted from state ran facilities. Page 10, line 1 states "proceedings under this article, probable pause hearings may be held"… The Department assumes the word pause in the above sentence should be "cause".

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