Sources of Revenue:

Special Fund

Legislation creates:

A New Program,A New 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 funding source and programs for persons with traumatic brain injury (TBI). The proposed legislation requires the Department to develop the eligibility requirements and the appropriate array of services for the program. The array of services may change annually dependent upon the amount of funding available for the program. The estimated cost to the Department for the proposed legislation is $4,243,630 the first year and $5,213,755 the second year. The TBI Fund would be a new special revenue fund to receive fees that would be dedicated to two Traumatic Brain Injury programs. Funding for the program is generated from (1) a portion of the fee set by the county commission of each county for obtaining certain reports and (2) specific fees set for those convicted of a DUI (Driving Under the Influence). Fifty percent of the moneys in this fund will be transferred to the state Medicaid agency for certification of the state match for the home and community based waiver program (TBI Waiver). The remaining fifty percent is to be used by the Bureau for Behavioral Health and Health Facilities (BBHHF) to provide services for those persons with TBI that are otherwise ineligible for the waiver services. In October 2010 the Bureau for Medical Services (the state Medicaid agency) submitted an application to CMS for a TBI Waiver (approval not yet received) based on an assumed state funding of $1 Million per year. The estimate of costs for this waiver was $2,960,775 for the first year ($805,923 State, $2,154,852 Federal) and $3,930,900 for the second year ($1,089,645 State, $2,841,255 Federal). The estimated cost to BBHHF is $282,855 to operate this program. This includes personnel costs and travel (significant amounts of travel will be required including attendance at national conferences), office supplies, and training materials. In addition, we anticipate the cost of grant related services to be approximately $2,000,000 of which the BBHHF is currently funding $1,000,000 per court order thru WVUCED. The estimated revenue from DUI fees (for conviction and for enrolling in the Safety and Treatment program) is estimated to be $600,000 ($50 x 6,000 x 2). Additionally, the Deputy Sheriff's Retirement Fund received approximately $547,000 in SFY2010 for miscellaneous reports. If the fee is raised from $10 to $20, the additional funds would equate to approximately $547,000. Therefore, total revenue is estimated at $1,147,000. These estimates do not include the fees charged for criminal cases before a circuit court upon appeal as the number of cases of this kind are uncertain.

Fiscal Note Detail

Effect of Proposal	Fiscal Year
Effect of Proposal	2011 Increase/Decrease (use"-")	2012 Increase/Decrease (use"-")	Fiscal Year (Upon Full Implementation)
1. Estmated Total Cost	0	4,243,630	5,213,755
Personal Services	0	101,855	101,855
Current Expenses	0	181,000	181,000
Repairs and Alterations	0	0	0
Assets	0	0	0
Other	0	3,960,775	4,930,900
2. Estimated Total Revenues	0	1,147,000	1,147,000

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

The total personnel services cost to the Bureau for Behavioral Health and Health Facilities of $101,855 is based upon the following: one HHR Program Manager I at $53,000 (1 FTE * $53,000); one Office Assistant 2 at $13,000 (0.5 FTE * $26,000); and one Accounting Tech 3 at $7,250 (0.25 FTE * $29,000) for a total of $73,250. Benefits were calculated as follows: admin. fees, OPEB and health insurance at $6,982 per FTE and FICA, retirement, and workers' compensation at 22.37% of personal services. Travel, office supplies, and training materials are estimated at $181,000. In October 2010 the Bureau for Medical Services (the state Medicaid agency) submitted an application to CMS for a TBI Waiver (approval not yet received) based on an assumed state funding of $1 Million per year. The estimate of costs for this waiver was $2,960,775 for the first year ($805,923 State, $2,154,852 Federal) and $3,930,900 for the second year ($1,089,645 State, $2,841,255 Federal). The above estimates reflect the cost of the services that were included in the waiver application submitted to CMS, assuming that Year 1 would be SFY 2012 (with 75 waiver slots available) and Year 2 would be SFY 2013 (with 100 waiver slots available). The FMAP for state portion was calculated at the estimated blended FMAP of 72.78% Federal/27.22% State for SFY 2012 and 72.28% Federal/27.72% State for SFY 2013.

Memorandum

Section 16-43-1 Traumatic Brain Injury Programs, subsection (a) includes the sentence: "The Bureau for Medical Services is hereby authorized to apply to the Centers for Medicare and Medicaid Services for a waiver to administer a home and community based services program for persons with traumatic brain injury who meet the eligibility requirements for those services." There is concern with how the last section regarding eligibility would be applied; would recommend modifying to: "The Bureau for Medical Services is hereby authorized to apply to the Centers for Medicare and Medicaid Services for a waiver to administer a home and community based services program for persons with traumatic brain injury who meet the applicable Medicaid eligibility requirements and standards for Medicaid and waiver services." The bill requires that the fees outlined in the legislation be committed to the special revenue fund and split 50/50 between Bureau for Medical Services Waiver and BHHF for a separate TBI program, and specifically indicates that the legislation does not mandate additional funding for the TBI programs or require additional appropriation by the Legislature. A variable funding stream would be problematic in administering the waiver, and would impact the waiver slots that could be funded. The legislation does not specify whether BMS would be required to limit the number of slots within the waiver to the number that could be funded at the 50% allocated to BMS or if BMS would alternatively be responsible to identify other sources for the state match in the event that the special revenue funding would fall short of the $1M state funding estimate used in the TBI waiver application. Either situation would require constant monitoring and potentially periodic amendment of the waiver with CMS in the event that the TBI Fund did not generate the amount needed to fund the number of slots approved by CMS (or alternatively the shortfall would have to come from the Medical Services appropriation, reducing the amount available for other Medicaid services). The Hartley court order requires the Department to apply for a TBI waiver. There are currently amendments to this version of the bill which alter the fiscal impact indicated above. The removal of the Bureau for Behavioral Health and Health Facilities would eliminate $1,282,855 of the above costs. Additionally, there was a redirection of DUI funding to the "West Virginia Traumatic Brain and Spinal Cord Injury rehabilitaion fund". Therefore, the Rehab Services should receive a fiscal note request.

Person submitting Fiscal Note: Michael J. Lewis, MD, PhD
Email Address: dhhrbudgetoffice@wv.gov