FISCAL NOTE

Date Requested: February 23, 2024
Time Requested: 09:26 AM

3928	Comm. Sub.	SB805
Agency:	Human Services, WV Department of
CBD Number:	Version:	Bill Number:	Resolution Number:
CBD Subject:	Health

FUND(S):

0403 - DIV OF HUMAN SERVICES GENERAL ADMINISTRATION FUND; 8722 - CONS FEDERAL FUNDS DIV HUMAN SERVICES GEN ADMN FD

Sources of Revenue:

General Fund Federal

Legislation creates:

Fiscal Note Summary

Effect this measure will have on costs and revenues of state government.

The purpose of this bill is to prohibit payment for Medicaid services rendered at certain facilities which do not meet minimum standards. The Department estimates the potential for savings to the Medicaid program if all current residential substance use disorder treatment facilities in West Virginia are not accredited by January 1, 2026. Assuming all facilities receive accreditation by January 1, 2026, there would be no fiscal impact to the Medicaid program. If facilities do not receive accreditation, there would be a cost savings to the Bureau for Medical Services. Based on current data there are 179 of the 1300 beds (or 14%) accredited. SFY2023 Medicaid Substance Use Disorder Waiver residential services spend was $61,566,128. If the current number of accredited facilities remains constant (and no additional facilities are accredited), then the potential exists for $52,946,870 of cost savings to the Medicaid program (86% of SFY2023 expenditures). The Department's Bureau for Behavioral Health (BBH) currently awards both state and federal funding for qualifying uninsured/underinsured individuals for substance use disorder treatment. The Department assumes the BBH would not be picking up any of these unreimbursed costs.

Fiscal Note Detail

Effect of Proposal	Fiscal Year
Effect of Proposal	2024 Increase/Decrease (use"-")	2025 Increase/Decrease (use"-")	Fiscal Year (Upon Full Implementation)
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):

Please explain increases and decreases in personal services, current expenses, repairs and alterations, assets, other costs and revenues, including assumptions and data sources and delineation between start-up and ongoing costs. Please also include a long-range schedule of costs and revenues if fiscal impact is expected to vary in future years.

Memorandum

During the 2017 Regular Session, the legislature approved the creation of the Ryan Brown fund for the development of treatment services statewide. Roughly 24 million in special revenue from drug settlements was appropriated through that funding and was sub awarded to grantees to develop the states SUD treatment infrastructure. While it can be assumed that all of those state funded providers as well as many other organizations who have invested in the development of SUD Treatment services would seek CARF accreditation, the inability of any of those organizations to timely achieve the accreditation would severely impact those organizations ability to exist. While the Committee Substitute for this bill allows additional time to complete the accreditation, it doesn't ensure that all providers can comply or that the level of resources exist to meet the requirements. West Virginia is experiencing a workforce shortage which could be a barrier for the changes prescribed by this bill for treatment of substance use disorder (SUD). The implementation of CARF accreditation for all statewide providers at the same time could be jeopardized by the current lack of available staffing, resulting in the closing of facilities for circumstances not directly under their control. The potential exists that if West Virginia cannot provide enough CARF certified beds that individuals who require substance use disorder treatment services may need to seek treatment outside of the state.

Person submitting Fiscal Note: Cynthia Persily, PhD.
Email Address: dhhrbudgetoffice@wv.gov