FISCAL NOTE
FUND(S):
0407 Central Office General Administrative Fund; 5163 Laboratory Services; 0403 Div of Human Services General Admin Fund; 8722 Cons Federal Funds Div Human Services Gen Admn Fund
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 expand newborn testing to include testing for illegal drugs in newborns.
This proposed legislation would impact both the Bureau for Medical Service (BMS) and Bureau for Public Health (BPH) within the Department of Health and Human Resources (Department).
Although it is anticipated that costs to the Bureau for Medical Service would increase, the fiscal impact of this proposed legislation cannot be determined at this time.
The Bureau for Public Health, Office of Laboratory Services (OLS) does not have the infrastructure to provide toxicology services required for the testing of illegal substances. The OLS currently tests for 28 metabolic disorders using dried blood spots collected from newborns. Positive results are reported to the Office of Maternal, Child and Family Health for follow up. There is no FDA approved method for testing for illegal drugs in newborns using dried blood spots. The sample of choice for drug testing in newborns is testing of meconium (stool). The OLS does not have capacity to do such testing. In order to provide testing of newborns for illegal drugs, the OLS would need testing supplies and storage, additional laboratory space, modifications to the electronic reporting system and three additional lab staff to process these specimens.
The estimated cost to the Department for the testing is $679,330 the first year and $399,330 each year thereafter.
Fiscal Note Detail
| Effect of Proposal |
Fiscal Year |
2009
Increase/Decrease
(use"-") |
2010
Increase/Decrease
(use"-") |
Fiscal Year
(Upon Full
Implementation) |
| 1. Estmated Total Cost |
0 |
679,330 |
399,330 |
| Personal Services |
0 |
212,250 |
212,250 |
| Current Expenses |
0 |
302,080 |
187,080 |
| Repairs and Alterations |
0 |
0 |
0 |
| Assets |
0 |
165,000 |
0 |
| Other |
0 |
0 |
0 |
| 2. Estimated Total Revenues |
0 |
0 |
0 |
Explanation of above estimates (including long-range effect):
Bureau for Public Health: Personal Services: 1 Forensic Analyst V @ $59,133, 1 Forensic Analyst III @ $51,420 and 1 Forensic Analyst II @ $48,849 = $159,402 X 21.12% ( FICA, Retirement, Workers Comp.) = $33,666 + $19,182 (Admin. Fees, Health Insurance at $6,394 per FTE * 3) Total Personal Services $159,402 + Fringes $52,848 = $212,250. Current Expense: One time costs: Lab space renovation $100,000, modification to electronic reporting system $15,000; Ongoing costs: Reagents $107,080. testing supplies and specimen containers $25,000, allocated overhead $50,000, staff training and continuing education $5,000; Equipment $160,000; storage units $5,000 (one time only).
One time costs: The equipment required consists of $10,000 for plate reader and $150,000 for Gas Chromatograph/Mass Spectrometer). Additional space will be needed to accommodate the new equipment and additional staff. The space is estimated to cost $100,000 based on recent similar renovation costs. There could be additional costs for additional required equipment not identified at this time. Current electronic reporting systems do not have capacity for reporting drug testing results.
Bureau for Medical Services: Currently the costs to BMS for the existing newborn screenings are determined based on the costs to the BPH to perform those tests; until a rate is determined by BPH and it is incorporated into the BMS rate structure for payment for births, no cost impact can be determined.
Memorandum
In calculating the cost of this proposed legislation, the Department has made the following assumptions: According to Vital Statistics, the number of live births in West Virginia in 2008 was 21,416 and that number was used to calculate the estimated costs; no specific tests were identified so estimates are based on a 5 panel test that includes marijuana, amphetamines, methamphetamines, opiates and cocaine.
The proposed legislation does not address several areas of concern to the Department. Metabolic screening services, tracking and subsequent treatment are accepted among the medical community and families. Screening for illegal drugs would not receive favorable response from families. There are legal implications of testing and the need for maternal consent for such testing. Follow up to any positive test results is vague. Testing for illegal drugs is currently ordered by physicians as circumstances for each pregnant woman warrant. The required testing for all infants will increase costs to the health care system. Based on test results, there may also be increased costs that cannot be estimated at this time.
The American College of OB/Gyns (ACOG) is a national organization comprised of board certified OB/Gyns. ACOG does not support the practice of universal testing for illegal substances. ACOG policy recommends proper pregnancy screening, good history taking and thorough physical examinations to alert the clinician to potential substance abuse. Once substance abuse is identified in the pregnant woman, ACOG recommends the development of a treatment plan for the pregnant patient and a detoxification plan for the infant.
Current legislation allows for newborn screening to be considered a covered benefit reimbursed to the birthing facilities by Public Employees Insurance Agency, the State Children's Health Insurance Program, the Medicaid Program and all health insurers whose benefit package includes pregnancy coverage and who are licensed under Chapter 33 of the WV Code. It is assumed that the Department will calculate a rate to provide these services and bill all birthing facilities as is the current practice for newborn metabolic screening. Once there is a rate established, it is anticipated the this program will generate revenue sufficient to cover program costs, excluding the costs to Medicaid. No revenue above the actual cost of the program is anticipated.
Person submitting Fiscal Note: Martha Yeager Walker
Email Address: dhhrbudgetoffice@wv.gov