0525 - Consolidated Medical Services Fund, 0403 - Div of Human Services General Administration Fund, 8722 - Cons Federal Funds - Div of Human Services Gen Adm Fd

Sources of Revenue:

General Fund,Other Fund Federal

Legislation creates:

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 of Health and Human Resources (Department) to develop the eligibility requirements and the appropriate array of services for the program. The array of services may change annually, depending upon the amount of funding available. The estimated cost to the Department for the proposed legislation is $3,909,871 the first year and $4,864,516 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 Department's 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 the Centers for Medicare and Medicaid Services (CMS) for a TBI Waiver. The waiver was approved with an effective date of February 1, 2012. Based on the cost of services included in that waiver request, the Department's Bureau for Medical Services expects to incur costs of $2,608,475 for SFY14 ($1,860,560 Federal, $747,915 State) and $3,563,120 ($2,519,660 Federal, $1,043,460 State) the following year, based on 100 approved waiver slots and based on blended FMAPs both years.
    The Department's Bureau for Behavioral Health and Health Facilities estimates an increased cost of $301,396 to administer the TBI program.

Fiscal Note Detail

Effect of Proposal Fiscal Year
Fiscal Year
(Upon Full
1. Estmated Total Cost 0 3,909,871 4,864,516
Personal Services 0 120,396 120,396
Current Expenses 0 3,789,475 4,744,120
Repairs and Alterations 0 0 0
Assets 0 0 0
Other 0 0 0
2. Estimated Total Revenues 0 1,147,000 1,147,000

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

    The estimated increased costs to the Department's Bureau for Behavioral Health and Health Facilities is $301,396 to administer the TBI program. This would include increased personnel costs and travel (significant amounts of travel will be required including attendance at national conferences), office supplies, and training materials. The total personnel services cost to the Bureau for Behavioral Health and Health Facilities of $120,396 as based upon the following: one HHR Program Manger I at $53,000 (1 FTE * $53,000); one Office Assistant 2 at $13,000 (0.5 FTE * $26,000); and one Accounting Tech IV at $15,000 (0.5 FTE * $30,000) for a total of $81,000. Benefits were calculated as follows: admin. fees, OPEB and health insurance at $9,994 per FTE is $19,988 and FICA, retirement and workers' compensation at 23.96% of personal services is $19,408. Travel, office supplies, and training materials are estimated at $181,000. Currently, the BBHHF is funding $1,000,000 as a result of a court order thru the West Virginia University Center for Excellence in Disabilities with an expected increase in costs of $1,000,000, bringing the total cost for grant related services to $2,000,000.
    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.
    The Bureau for Medical Services (the state Medicaid agency) estimates costs as follows: $2,608,475 for SFY14 ($1,860,560 Federal, $747,915 State), and $3,563,120 ($2,519,660 Federal, $1,043,460 State) the following year based on 100 approved waiver slots and based on blended FMAPs both years. The above estimates reflect the cost of the services that were included in the waiver application submitted to CMS. Based on program enrollment at the time of fiscal note preparation, it is anticipated that the bulk of the Year 1 costs calculated for the waiver would be incurred in SFY 2014.


    Section 16-45-1 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." The Department is concerned with the wording regarding eligibility and how it would be applied. The Department recommends the language be removed as the Bureau for Medical Services has already received approval from CMS for the waiver, effective February 1, 2012.
    The bill requires that fees outlined in the legislation be committed to the TBI special revenue fund and split 50/50 between the Bureau for Medical Services Waiver Program and the Bureau for Behavioral Health and Health Facilities, 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).

    Person submitting Fiscal Note: Rocco S. Fucillo
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