Sources of Revenue:

General Fund

Legislation creates:

A New Program

Fiscal Note Summary

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

The purpose of this article is to create a new commission for the service to veterans and others suffering from traumatic brain injuries. The Department of Health and Human Resources (Department) shall report annually to the commission and to the Legislature on the status of services for West Virginians with traumatic brain injuries. It is unclear under which agency the Commission will reside, however, this section of the code falls under Veteran's Affairs. The bill states the Department will be responsible for all costs associated with compiling data on costs and actuarial information requested by the Commission. Costs of compiling this data cannot be determined at this time due to the uncertainty of the type of data to be requested, however, the current reporting rate with the Bureau for Medical Services' (BMS) vendor is $137.54 per hour. The costs associated with provision of requested data would be dependent upon what is requested by the TBI Commission and the length of time it would take the vendor to develop and produce those reports. At this time, BMS cannot provide actuarial information as there is not currently an existing contract for actuarial services. The commission will consist of representatives from multiple state agencies and outside parties as defined in the legislation. The Department anticipates a cost of approximately $10,300 in miscellaneous expenditures for travel, etc. for those non-state employed individuals appointed to the Commission.

Fiscal Note Detail

Effect of Proposal	Fiscal Year
Effect of Proposal	2013 Increase/Decrease (use"-")	2014 Increase/Decrease (use"-")	Fiscal Year (Upon Full Implementation)
1. Estmated Total Cost	0	10,300	10,300
Personal Services	0	0	0
Current Expenses	0	10,300	10,300
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 anticipates that there may be approximately $10,300 in expenses (travel, printing) for members of this commission that are not state employees and do not have a mechanism to be reimbursed for their expenses. This estimate is based on approximately nine (9) non-state employed commission members with a maximum of four (4) meetings per year @ approximately $250 per meeting for a total of $9,000 per year for travel. Additionally, an estimated cost of $1,300 for printing and binding of annual report is included in the estimated expenditures.

Memorandum

Without specifics of the types of data and actuarial information the TBI Commission will request, the total costs to provide data and actuarial information cannot be determined. An additional option for actuarial costs is to hire an actuary. There is a DOP classification for an actuarial analyst with a salary range of ($37,140-$68,712), however it is uncertain that a full-time position would be needed. Section 9A-5-4 (1) states that the Commission shall establish outreach efforts. The Bureau for Behavioral Health and Health Facilities has contracted with the Center on Excellence in Disabilities at WVU (CED-WVU) to develop a statewide infrastructure for persons who have a TBI as defined in WV Code 18-10k-1. Therefore, this appears to be a duplication. Section 9A-5-4 (3) states "The commission shall determine the costs of establishing a Medicaid waiver and a trust fund to provide services for individuals with traumatic brain injuries." The Department's Bureau for Medical Services submitted an application to the Centers for Medicare and Medicaid Services for a TBI Waiver in October 2010. The waiver was approved with an effective date of February 1, 2012. The estimate for the services in the TBI Waiver is $2,608,475 for the first year ($747,915 State, $1,860,560 Federal) and $3,563,120 for the second year ($1,043,460 State, $2,519,660 Federal) based on 100 approved waiver slots and based on blended FMAPs both years. At full capacity, the SFY13 General Revenue appropriation of $800,000 does not fully fund the TBI Waiver (as of January 2013, there were 7 members served YTD). Estimated costs for the current year of the existing TBI Waiver average approximately $41,000 per person per year. Therefore, this section appears unnecessary as it has already been accomplished. Section 9A-5-4 (B) states: “All costs of compiling data and responding to the commission’s requests shall be borne by the Department of Health and Human Resources. However, the commission may not be limited to data from the Department in determining the costs of establishing a Medicaid waiver and a trust fund to provide services for individuals with traumatic brain injuries.” Does this mean that DHHR must pay any costs for the provision of data, even from other entities? For example, if the commission asks for data from Veterans Administration and they want to charge a fee for it, does DHHR have to pay for that? Section 9A-5-5(2) states: "A gross receipts tax of one percent on all Limited Video Lottery Terminals shall be used to fund the operations of the commission to match federal funds from a Medicaid waiver or other services and to establish a trust fund to provide services for individuals with traumatic brain injuries." This sentence could be more clear if a comma was inserted after "commission", to appropriately indicate the lottery proceeds would fund the administrative costs of the commission, along with the federal match for the Medicaid waiver and establishment of a trust fund. The Department is not able to determine the gross tax receipts of one percent on all limited Video Lottery Terminals, therefore also unable to determine funding that will be available.

Person submitting Fiscal Note: Rocco Fucillo
Email Address: dhhrbudgetoffice@wv.gov