Date Requested:February 09, 2005
Time Requested:08:44 AM
Agency: Health and Human Resources, Department of
CBD Number: Version: Bill Number: Resolution Number:
2005r247 intro SB72
CBD Subject: reduce early entry to nursing homes
FUND(S)
5084-Medical Services, 0407-Central Office General Administrative Fund, 5172-Health Facility Licensing 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.

    This bill would require a pilot project to divert low-income residents from early institionalization in nursing homes by providing services in licensed personal care homes in their communities. The Department believes it will cost $34 per day per individual for personal care services to Medicaid eligible individuals residing in assisted living facilities. This assigned cost is based on the cost per day per individual receiving homemaker and transportation services under the Aged/Disabled Waiver program. Assuming that 100 individuals will be eligible in the target area of Williamson, Wheeling and Moundsville, the estimated annual cost for this pilot program would be $1,241,000 including $ 330,044 in state funds.
    In addition, the Department would also incur costs and revenue to the Department's Bureau for Public Health, Office of Health Facility Licensure and Certification relating to the licensing of these facilities. The figures are as follows:
    In the first year, this bill requires an initial licensure survey for the two new facilities (Moundsville currently has a licesned facility), Personal Service costs for surveyors at $1,979; Current Expense costs at $1,080; for a total cost of $3,059, to complete the initial surveys.
    An initial inspection fee calculated by averaging the actual cost of performing an initial inspection on similar facility types preceding the new facility initial survey would be collected from each provider to cover the cost of the survey. The current average inspection fee collected is eight hundred seventy-eight (878) dollars per facility, for a total revenue of $1,756 for the two new facilities (Williamson, Wheeling).
    No additional revenue is collected following the initial inspection.
    

Fiscal Note Detail
Over-all effect
Effect of Proposal Fiscal Year
2005
Increase/Decrease
(use"-")
2006
Increase/Decrease
(use"-")
Fiscal Year
(Upon Full
Implementation)
1. Estmated Total Cost 0 1,244,059 1,244,059
Personal Services 0 1,979 1,979
Current Expenses 0 1,080 1,080
Repairs and Alterations 0 0 0
Assets 0 0 0
Other 0 1,241,000 1,241,000
2. Estimated Total Revenues 0 1,756 0
3. Explanation of above estimates (including long-range effect):
     The cost per day per individual was based on homemaker and transportation services currently provided under the Aged/Disabled Waiver program. The base services used to calculate this rate have historically increased 13-15% each year. It is expected that if passed, the service rates for this program would increase proportionately.
    Personal Service costs for surveyors at $1,979; Current Expense costs at $1,080; for a total cost of $3,059, to complete the initial surveys.
    Revenue for the first year consists of eight hundred seventy-eight (878) dollars per facility, the average cost of performing an inspection for the prior ten facilities, for a total revenue of $1,756 for the two new facilities (Williamson, Wheeling).
    
    


Memorandum
Person submitting Fiscal Note:
Martha Yeager Walker
Email Address:
fnbudoff@wvdhhr.org
    The effect of this legislation would add an additional layer of cost to the Medicaid program. It may also result in a duplication of services available to individuals who qualify for services under the Aged/Disabled Waiver program. While it would possibly be less expensive to provide these services in the noninstitutional setting, the cost savings would be negligible due to cost based reimbursement received by nursing facilities. The cost per patient day in a nursing facility would increase as a result of the decrease of the individuals being served. Although some variable costs for nursing facilities may be reduced, such as staffing, fixed costs per patient day would remain the same thus offsetting any potential savings.