8722 - Cons Federal Funds Div Human Services Gen Admn Fund; 0403 - Division of Human Services Gen Admin Fund

Sources of Revenue:

General 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.

    The purpose of the amended bill is to require health insurance coverage for eosinophilic disorders.
    The amended bill added the following language to the original proposed bill: "including coverage for enteral nutrition supplements necessary to preserve the life of the insured". The Department of Health and Human Resources Medicaid program would see an increase in costs associated with this additional coverage, as it is not currently a covered service. Without knowing the expected utilization of these services the Department is unable to provide an estimate of the cost. (see "Memorandum" section below).

Fiscal Note Detail

Effect of Proposal Fiscal Year
Fiscal Year
(Upon Full
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):



    The enteral formulae required by the proposed amendment to the legislation is not a covered service by the Medicaid program. This would be new services and anticipated to result in additional costs, however since we cannot anticipate the utilization of these services if they were to be covered, we cannot provide an accurate estimate of the cost. The Health Care Procedure Coding System (HCPCS) codes for enteral formulae are based on 1 unit equals 100 calories, and the amount per individual is based on the individual's caloric needs. Per unit costs for these codes range from $0.55 to $1.89 per unit (based on Medicare intermediary's fee schedule for the West Virginia area). For SFY2011, there were 2,200 Medicaid members with a diagnosis that would make them eligible for the enteral formulae as specified in the amendment. Of these members, approximately 150 were under age 21, and would potentially be able to obtain these services under Early Periodic Screening, Diagnosis, and Treatment (EPSDT). An example for an adult with a 2,000 per day caloric requirement would be, 2,000 units divided by 100 calories would be 20 units per day, multiplied by $1.89 per unit would be $37.80 per day, multiplied by 365 days per year would be $13,797 per adult per year; multiplied by 2,050 adults per year would be approximately $28.3M per year. Using the $0.55 per unit and the same assumptions would be approximately $8.2M per year.

    Person submitting Fiscal Note: Michael J. Lewis, M.D., Ph.D.
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