Date Requested:March 23, 2009
Time Requested:11:36 AM
Agency: Health and Human Resources, Department of
CBD Number: Version: Bill Number: Resolution Number:
2009R2941 Introduced SB672
CBD Subject: MENTAL HEALTH MEDICAID BILL
FUND(S)
Sources of Revenue
Other Fund N/A
Legislation creates:
A New Program

Fiscal Note Summary

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

    The purpose of this bill is to create a special joint committee on mental health. The bill sets forth its composition and duties. The bill requires agencies to cooperate with the committee and requires the review of mental health rate increases. The bill also creates the Mental Health Stabilization Act of 2009, including making legislative findings, increases reimbursement rates in mental health service codes, requires periodic reports to Joint Committee on Government and Finance. The bill also provides an implementation date and a termination date.
     The fiscal impact cannot be determined at this time with the information provided (see "Explanation of above estimates" section below). Any increase in rates may cause an overall increase in expenditures; however, the fiscal impact cannot be calculated without the required rates. Additionally, there are concerns with the implementation of the mandated rate increases in Section 9-2-9a and other provisions of this legislation (see "Memorandum" section below).
    

Fiscal Note Detail
Over-all effect
Effect of Proposal Fiscal Year
2009
Increase/Decrease
(use"-")
2010
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
3. Explanation of above estimates (including long-range effect):
    


Memorandum
Person submitting Fiscal Note:
Martha Yeager Walker
Email Address:
dhhrbudgetoffice@wv.gov
    The following should be taken into consideration in regards to potential fiscal impacts: .
    1. These codes were last increased in 2007, and a subsequent analysis of these codes in 2008 indicates that per applicable wage indices, etc. for the positions providing the services they are already being reimbursed at an appropriate rate; additionally, there are different levels of education, training, credentialing and skill sets applicable to the professions/positions that provide these services which comes into consideration in any rate increase applicable to these services which may not justify the "across the board" methodology mandated. Without supporting research to document the reasonableness and appropriateness of the methodology such an increase would be difficult to justify and could cause problems with Centers for Medical Services (CMS), resulting in a risk to and potential loss of federal match for these services. .
    2. Concerns exist regarding the current existence of a Behavioral Health Commission that can deal with these matters and that the establishment of an additional committee appears to be duplicative of this effort. There are also concerns about the short turnaround times available related to data requests and reporting, as well as the prior authorization oversight responsibility given to the Committee (which is not clearly defined).
    3. Section 9-2-9a (b) refers to additional appropriations that would “increase proportionally across the board” reimbursement rates for certain listed behavioral health service codes. However, the legislation does not specify what the dollar amount of the additional state appropriation would be; this would be needed in order to calculate the cost impact (applying the FMAP to the available state appropriation to arrive at a total amount of the increase).
    4. There is no definition of how the "increase proportionally across the board" should be implemented. The bill does not speak to what proportionally should be used to calculate this increase. Utilization and members served can play a factor and impact the division of these funds (i.e. each of the 32 codes to receive an equal percentage of the funding, weighted based on units of service, weighted based on current rate, weighted based on payments by code for a given period of time, weighted based on members served for a given period of time, etc.). Given these issues it is not possible to calculate a cost at this time with the information available.