FISCAL NOTE
FUND(S):
2180
Sources of Revenue:
Special 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 bill is to expand newborn testing to include testing for illegal drugs in newborns.
The testing requirement for illegal drugs is universal and is to become part of every newborn testing. Based upon the Report on the Blueprint to Improve West Virginia Perinatal Health, December 2007, approximately 1 in 10 nenates is exposed to one or more mood alterning drugs during pregnancy. The Report concluded that newborn illegal drug testing should be performed only with evidence of newborn and/or maternal risk indicators recieved during the assessment that will include a specialized assesment and a follow-up screening questionnaire. Only after this should a urine or blood test for illegal drugs be performed. Universal screening of women and newborns for substance abuse using biologicial specimens is not recommended. Further, the newborn drug testing should be done only for the purpose of determing appropriate medical treatment.
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 |
342,000 |
376,000 |
414,000 |
| 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 |
342,000 |
376,000 |
414,000 |
Explanation of above estimates (including long-range effect):
In Fiscal Year 2008, PEIA members with primary coverage had 1850 live births.
Used Drug screen code = 80101 x 9 = $20.20 x 9 = $181.80 per newborn
Approximate cost to PEIA for meconium drug screen $181.80 billed individually, for 1850 newborns is $336,330.
If repeat or confirmatory tests are required, this will be an additional cost to PEIA. The following costs are associated with the drug-specific confirmatory tests:
82542 $26.49
82520 $22.23
82205 $12.82
83840 $9.01
83992 $21.57
83925 $23.72 (this code may be used for 2 different drugs and would be billed for each)
80154 $27.13
If 1 out of 10 newborns is exposed to illicit drugs, then the maximum exposure to PEIA for the most expensive confirmatory test for one drug would be 185 x $27.13 = $5019.05.
Some of these confirmatory tests may require tandem mass spectrometry which WV did not have as of Feb 2008. Tandem Mass Spectrometry machine costs $300,000 to $500,000. Additional costs for hiring and training staff.
Increased costs in the subsequent years is due to an expected medical tread of 10%. Cost estimate for a three year period is
$1,132,000.00
Memorandum
No uniform policy or state law exist regarding consent for newborn drug testing.
Universal drug testing is presently not recommended by medical groups most likelty because there are no stardard accepted drug tests that can be applied for a universal testing model as set forth in this bill. A survey of WV OB hospital nurse managers revealed meconium testing is the primary test of choice, with urine testing close behind. A 2007 article from "Advances in Neonatal Care" noted that the science behind meconium screening at present is not strong enough to warrant widespread implementation of screening.
Indiana, Iowa, Washting and other states have developed laws and/or specific criteria around standardized testing of drug impaired newborns based on symptoms exhibited and risk assessment, with a protocol to be used in all clinical settings.
PEIA does not support universal newborn drug screening at this time due to the concerns cited in the studies we have reviewed and the concerns about an acceptable universal drug test. However, PEIA does support covering newborn drug screening based on a standardized protocol for assessment of the newborn; testing performed based on evidence of maternal/newborn risk indicators (similar to Guidelines for Testing and Reporting Drug Exposed Newborns in Washington State) and final decision resting with physician.
Person submitting Fiscal Note: J. Michael Adkins, Deputy Director
Email Address: michael.adkins@wv.gov