FISCAL NOTE



FUND(S):

0407 (Central Office General Administrative Fund), 5172 (Health Facility Licensing Fund)

Sources of Revenue:

General Fund,Special Fund

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 establish a program to permit medicine aides who are certified to administer certain drugs in licensed nursing homes. The bill sets forth the qualifications of certified medicine aides, establishes training curricula and competency evaluations for certified medicine aides The bill requires a facility's records that authorizes certified medicine aides to be available for review. The bill also requires facilities that permit certified medicine aides to administer drugs to have an administrative monitoring system. The bill permits fees to be set and collected. Additionally, the bill authorizes rulemaking. The estimated cost to the Department of Health and Human Resources (Department) to establish this program to permit medicine aides who are certified to administer certain drugs in nursing homes is $162,364; and an on-going cost of $65,576. The Department's Bureau for Public Health's - Office of Health Facility Licensure and Certification (OHFLAC) must develop a 60 hour training curriculum for the Certified Medicine Aide (CMA); a written and skills competency evaluation test; a retraining course for the CMA to be recertified every two years; an on-line train-the-trainer course for training and supervising Registered Nurse's; and a database to track the CMA's. The Department's Bureau for Medical Services could potentially experience increased costs as well. See Memorandum section for more information.



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 0 162,364 65,576
Personal Services 0 162,364 65,576
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 33,541


Explanation of above estimates (including long-range effect):


EXPENDITURES: One-time: Salaries and benefits for a Program Manager II ($44,014) and a Program Manager I ($41,332) to establish and implement a program for the administration of medications in nursing homes. This would include establishing a council of nurses to represent the nursing homes and registered professional nurses; developing and approving training curricula and competency evaluation procedures for certified medicine aides who administer medication, and retraining participants every two years. Salary and benefits of $44,983 for a Programmer Analyst I to design a database to track the certified medicine aids to verify that they have met the requirements set forth in this article. On-going costs: salary and benefits of $12,515 (based on approximately 4 hours per each facility (107 facilities) for re-training the CMA's every two years; salaries and benefits of $21,026 for an Office Assistant to screen the CMA applicants and maintain the database. In addition investigations for nurse aid abuse, neglect, and misappropriation allegations are expected to increase by approximately 5%. These additional investigations are estimated to cost an additional $32,035 per year. WV Code 16-5O allows unlicensed personnel to administer medicines in certain facilities (not including nursing homes). The Department has an outside contractor (PHD) provide certification of unlicensed personnel. The contractor provides the training and certification and retains the fee, therefore there is no cost to the Department for the certification of unlicensed personnel. This bill allows nursing homes to have certified (unlicensed personnel) as other facilities do. Thus, the Department anticipates utilizing this contract for the certification. Therefore, the revenues for certification would remain with the contractor. REVENUE: The Department anticipates establishing a fee related to the annual review of facility compliance and for maintaining the database. The fee would be equivalent to the cost to the Department for implementing the review and maintaining the database. The one-time start-up costs and the investigation costs are not anticipated to be included in the ongoing fee.



Memorandum


For the Bureau for Medical Services, this would be a duplication of what is already available in nursing homes through the minimum staffing requirements mandating RN’s and LPN’s, both of whom administer medications. The legislation does not make any changes to the minimum staffing requirements. It is anticipated that there would potentially be significant costs associated with this mandate in that the CNA’s wages paid by the nursing homes would likely increase with the additional responsibility to complete additional training and administer medications, which would be passed on to Medicaid in the long term care cost reports filed semi-annually by nursing homes. Additional costs to the nursing home for the training would potentially increase the per diem rate paid to nursing homes for Medicaid members. It is not possible to quantify these costs as there are a number of variables affecting what they might be.



    Person submitting Fiscal Note: Martha Yeager Walker
    Email Address: dhhrbudgetoffice@wv.gov