0588, 2154 (Children's Operating Fund), 8838

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.

    This bill provides technical corrections to HB 2693 passed during the 2011 Legislative session. Specifically, HB 4260 makes the following changes: 1) specifies that the $30,000 annual services limit is applied to Applied Behavioral Therapy services only for three consecutive years, reducing to $2,000 per month to age 18; and, 2) removes requirement that coverage be in accordance with treatment plan developed by a certified behavior analyst and instead requires only progress reports for continued coverage.
    WVCHIP projects total costs for covering services as defined in this bill to be $3,333,364 ($2,694,358 federal and $639,006 state) for 121 children in SFY 2012; $4,277,818 ($3,440,649 federal and $837,169 state) for 141 children in SFY 2013; and $5,377,828 ($4,325,387 federal and $1,052,441 state) for 161 children in SFY 2014, during the "ramp-up" period in which members are made aware of the benefit and providers are establishing networks. Costs are estimated to be approximately $17,014,955 ($13,685,128 federal and $3,329,827 state) for 312 children in SFY 2017 when services are fully implemented. Costs assume the Federal Fiscal Year 2012 federal match rate of 80.83%, and the Federal Fiscal Year 2013 federal match rate of 80.43% in 2013 and future years.
    Costs reflected in the Fiscal Note Detail in the following section represent the differences in costs between HB 2693 passed in the 2011 Legislative session and HB 4260 as noted above.

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 141,971 199,308 797,399
2. Estimated Total Revenues 0 0 0

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

    The difference between HB 2693 and HB 4260 results in total cost increases as follows: SFY 2012 - $740,591; SFY 2013 - $950,426; SFY 2014 - $1,194,821; SFY 2017 (at full implementation) - $3,831,586.
    Projections of costs for HB 4260 were developed with the same assumptions as projections for costs under HB 2693, except projections for HB 4260 assume the $30,000 cap (reducing to $2,000 per month after 3 years) applies only to applied behavioral analysis services only (projections for HB 2693 assumed the caps applied to all autism services).


    One other change noted in HB 4260, appears to be the removal of the requirement of a treatment plan developed by certified behavior analyst necessary for coverage of services. Since many of these autistic services are also provided in school settings, removal of this requirement makes the program susceptible to make duplicate payments for services rendered that are funded by other sources. WVCHIP is likely to retain this requirement both to assure medical necessity, and since without a treatment plan, members are susceptible to receive duplicative services with no coordination among providers which may be detrimental to the care and expected progress of the member. The current bill requires progress notes for Applied Behavioral Analysis services, but these may be meaningless in the absence of a required treatment plan based on current, up-to-date assessments.

    Person submitting Fiscal Note: Stacey L. Shamblin
    Email Address: