FISCAL NOTE

Date Requested: January 28, 2022
Time Requested: 05:11 PM
Agency: Division of Regulatory and Fiscal Affairs, WV
CBD Number: Version: Bill Number: Resolution Number:
1585 Introduced SB289
CBD Subject: Legislature--Rule Making


FUND(S):

0407 - Central Office General Administrative Fund, 8802 - PUBLIC HEALTH-FEDERAL FUND

Sources of Revenue:

Other Fund Other Fund General & Federal

Legislation creates:

Increases Existing Expenses



Fiscal Note Summary


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


The purpose of Senate Bill 289 is to authorize 64 CSR 42, which makes changes to the guidelines of screening and testing for blood lead levels in children. This rule applies to all physicians, hospitals, health care facilities, and health care providers who conduct or oversee medical examinations of children under the age of six. Health care providers will be required to perform a blood lead screening on all children under the age of six years for risk of elevated blood lead levels. Under current code, a screening is already required, which is an assessment of a child’s environment and social conditions to determine risk of lead poisoning. If enacted, S.B. 289 would require a standard blood draw test or a finger prick test as part of a lead screening to detect blood lead levels. All children will be required to have a lead screening test done once at the age of one and once at the age of two, and children 36 to 72 months of age are required to get tested once if they have not done so previously. If a child’s results are confirmed as elevated, the Bureau of Public Health shall advise pregnant women residing at the same address to get tested as well. Children with blood lead levels of greater than or equal to five micrograms per deciliter shall be referred to appropriate programs based on age and concern offered by the Office of Maternal, Child and Family Health. Children with two consecutive blood lead levels of greater than or equal to eight micrograms per deciliter shall be referred to the Bureau of Public Health for an environmental investigation of the home to identify potential sources of lead within two days of confirmation. All children with elevated blood lead levels of greater than or equal to five micrograms per deciliter shall have a follow-up blood lead level screening test performed within three months. The Bureau of Public Health shall review this program at least every three years and make available to all interested parties a summary of the quarterly testing results beginning in July of the effective year of this rule. The Division of Regulatory and Fiscal Affairs (RAFA) has estimated the total cost of Senate Bill 289 to be $121,454.29. The cost comes from the additional tests required to be administered to children covered by PEIA (Public Employees Insurance Agency). From 2017 to 2021, PEIA covered a yearly average of 2,200 blood tests for children under the age of six. SB 289 is estimated to require 4,401.8 blood lead tests of children under the age of six, a 2,201.8 per-year test increase. Assuming the portion of traditional blood lead tests and finger prick tests proliferated under the current code are consummate to the portion under the passage of SB 289, an additional 611.5 traditional blood lead tests and 1,590.3 finger prick tests would be administered. This also assumes that one third of West Virginian under the age of six and covered by PEIA are either ages one or two. RAFA also requested information from the West Virginia Department of Health and Human Resources (DHHR) in order to determine whether a cost would be incurred to the state via Medicaid. DHHR in its responses stated, "During fiscal year 2020, 46,236 of 65,186 Medicaid-eligible children under the age of six are assumed to have received a lead risk screening questionnaire." This data suggests that universal blood lead testing does not currently occur for all Medicaid-eligible children in West Virginia. However, RAFA is unable to determine what, if any, additional costs would be incurred by the state via Medicaid.



Fiscal Note Detail


Effect of Proposal Fiscal Year
2022
Increase/Decrease
(use"-")
2023
Increase/Decrease
(use"-")
Fiscal Year
(Upon Full
Implementation)
1. Estmated Total Cost 0 121,454 121,454
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):


RAFA estimates SB 289 will generate a cost per fiscal year of $121,454.29. The fiscal cost of Senate Bill 289 which RAFA can calculate is derived from the additional tests that PEIA will be required to administer under this new rule. According to PEIA, from 2017 to 2021, a yearly average of 2,200 blood lead tests were given to children under the age of six who were covered under PEIA, 611 and 1,589 of which were traditional blood draw tests and finger prick tests, respectively. PEIA states that they covered approximately 13,000 children ages six and under every year during this period. Assuming one-third of children ages six and under are ages two and under, PEIA can expect to administer approximately ((13,000/3)-2,200)=2,133.33 additional blood lead tests. A traditional blood draw test costs the state $131 on average and a finger prick test costs the state $26 on average. 27.77 percent and 72.23 percent of blood lead tests for children under the age of six and covered by PEIA were traditional blood lead tests and finger prick test, respectively. Assuming that all additional blood lead tests will be administered at the same proportion of test types, an estimated ((13,000/3)*0.2777)=592.48 tradition blood draw tests will be required and an estimated ((13,000/3)*0.7223)=1,540.84 finger prick tests will be required. ((592.48 traditional blood tests*$131 cost per test)+(1,540.84 finger prick tests*$26 cost))=$117,677.58. A smaller cost will be derived from the additional tests required to children under the age of 6 who are covered by PEIA and who test for between 5 micrograms per deciliter and 10 micrograms per deciliter of lead in their blood. SB 289 lowers the standard for follow up testing within three months of an initial test from testing for 10 micrograms per deciliter to testing for 5 micrograms per deciliter. According to the Healthy Home and Lead Poisoning Surveillance Survey as submitted by the WV DHHR, 1.58 percent of children under the age of 6 who received blood lead testing from 2018 to 2020 in West Virginia tested for 5.1 to 10 micrograms per deciliter of lead in their blood. Assuming children who test in this range do not already receive follow-up testing, PEIA can expect an additional 68.46 blood lead tests. Since 72.23 percent of current tests administered under PEIA are finger prick tests, (68.46*0.7223)=49.45 of additional tests needed will be finger prick tests. Under PEIA, 27.77 percent of tests administered are finger prick tests, making the total number of additional traditional blood draw tests required, (68.46*0.2777)=19.01 additional traditional blood draw tests needed. Again, the average cost for a finger prick test is $26 and the average cost for a traditional blood draw is $131 according to PEIA. The total cost for additional lead blood testing needed due to the decrease in micrograms per deciliter under the new rule is ((19.01 traditional blood draws*$131)+(49.45 finger pricks*$26))=$3,776.71. This assumes that the children age six and under who are now tested as a requirement of this rule and were not required to before test for between 5 and 10 micrograms per deciliter at the same rate as children tested under the previous policy.



Memorandum


Based on information provided by DHHR, it does not appear that all children under the age of six that are Medicaid-eligible currently received blood lead testing. As a result, some additional testing is plausible. If all children on Medicaid in West Virginia currently receive universal blood lead testing at ages 12 and 24 months, then the only fiscal impact to the state will be derived from additional testing of children under the age of six who are covered by PEIA. If there were additional lead blood testing for children age six and under who are on Medicaid under the new rule, each test is estimated to cost the state $13.90 according to WV DHHR. WV DHHR states that West Virginia Medicaid does not cover home tests or lead abatement services. It is unclear whether PEIA covers home tests or lead abatement services. Additional costs could be incurred if PEIA does cover these services.



    Person submitting Fiscal Note: Peter Shirley
    Email Address: peter.shirley@wvlegislature.gov