FISCAL NOTE
FUND(S):
Sources of Revenue:
Other Fund NA
Legislation creates:
Neither Program nor Fund
Fiscal Note Summary
Effect this measure will have on costs and revenues of state government.
The purpose of this bill is to expand the definition of court-ordered services for children for which the Department of Health and Human resources required to pay to include socially necessary services. The bill also addresses the payment for services rendered, and would prevent non-Medicaid approved providers from seeking payments above the Medicaid rate or the established rate set by the Department of Health and Human Resources.
The existing code section allows the Department to pay Medicaid rates, if any, or customary rates for medical services, however it does not address non-medical services. This modification will extend the legislation to enforce rate setting for non-medical services provided by the Department for cases in articles five and six of chapter 49 of the WV State Code. The bill has the potential to reduce costs to the Department or keep expenses contained. The Department is currently setting rates for all types of services to help maintain consistency and reasonableness, but is unable to legally enforce the use of these rates. The Department should incur no additional costs due to this proposed legislation.
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 |
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 |
Explanation of above estimates (including long-range effect):
Memorandum
The Department is currently using rates set by the Bureau for Children and Families (BCF) for all services being provided to a client or to a third party on behalf of a client. Currently, the Department is unable to enforce these rates resulting in higher rates when challenged by providers or ordered through court action.
This legislation will provide the Department with a means to control costs.
The Department looked at the difference in rates on two existing services. 1)Tutoring, the BCF established rate is $15 per hour versus a $39 per hour rate charged by a tutoring franchise. For 5,000 hours of service it would cost the Department an additional $120,000; and 2) Individualized parenting, BCF has a rate of $40 per hour and a provider rate of $45 per hour. The $5 difference would save the Department $102,250 for 20,450 hours of service provided. With a total of approximately 166 types of services being paid for, the financial impact could be significant.
There are concerns with the provision in section 49-7-33 Payment of Services, item (b) that states “shall be paid no more than the state’s share of the costs if the service qualifies as a Medicaid reimbursable service” which appears to indicate that only the state share would be paid and not the FMAP portion, thus reducing the rate to only the percentage consisting of state dollars. This can create access issues if the providers (particularly out-of-state providers) choose not to accept this reduced rate, limiting the availability of needed services which cannot be provided in-state.
Person submitting Fiscal Note: Martha Yeager Walker
Email Address: dhhrbudgetoffice@wv.gov