Sources of Revenue:

General 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 the proposed legislation is to require providers of Medicaid services to send the recipients an itemized statement of services rendered. If the statement is accurate, the recipient verifies it by signing. If the statement is incorrect, the discrepancy is to be reported to DHHR, which shall investigate. The Department of Health and Human Resources (Department) estimates the fiscal impact to be minimal to the Department. The proposed legislation requires the provider to send the itemized statement. The Department's only responsibilities are to prescribe the form and investigate any noted discrepancies. The estimated cost for drafting/prescribing the form can be absorbed within the Department's existing budget. The proposed legislation also requires the recipient to notify the Department of any discrepancies between the actual services rendered and the itemized statement. The legislation requires the Department to investigate any discrepancies brought to its attention. Investigation of discrepancies will result in the need for three additional investigators in the Department's Bureau for Medical Services, Quality and Program Integrity unit. The Department believes that recipients' inquiries about the forms can be handled by the Department's contract with Unisys as part of their customer services responsibilities.

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	121,763	121,763
Personal Services	0	121,763	121,763
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):

Personal Services: 3 DHHR Specialists @ $29,157 ($87,471), Employee Benefits: Administrative Fees @ $240 per FTE ($720), FICA @ 7.65% ($6,692), Retirement @ 10.5% ($9,185), Workers' Comp @ 1.01% ($883), PEIA Health Insurance @ $467 per month per FTE ($16,812). Total Employee Benefits $34,292. Total Personal Services and Employee Benefits $121,763, including $60,881.50 in state funds.

Memorandum

As indicated in the note portion of the legislation, the Department's response to this fiscal note assumes the providers of service will be furnishing the itemized statements. Section 9-5-11d states "All recipients of medical services under the medicaid program shall be furnished an itemized statement of the services or assistance they receive from each provider of medical services or medical assistance and any other services or assistance authorized by this chapter." This statement is vague in regards to the determination of who is responsible for supplying the itemized statements. Should the Department be responsible for the distribution of statements, the cost would be significantly greater. In reviewing the proposed legislation, the Department was unclear as to the provision requiring the recipient to verify the accuracy of the statement. This provision requires the recipient to sign the statement, if accurate, but it does not indicate what, if any, other action the recipient is to take. While the proposed legislation would have a minimal direct fiscal impact on the Department, there is the issue of the possible reduction in access to health services. This legislation would place an additional administrative burden on the provider community, in regards to time and money. Some providers may decide not to accept Medicaid if they are mandated to issue these statements. Currently Medicaid providers voice concern about the low reimbursement and the amount of administrative time devoted to Medicaid recipients.

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