FISCAL NOTE
Date Requested: February 03, 2023
Time Requested: 12:38 PM |
| Agency: |
Public Health, Bureau for |
|---|
| CBD Number: |
Version: |
Bill Number: |
Resolution Number: |
| 2272 |
Introduced |
HB2002 |
|
|---|
| CBD Subject: |
Taxation |
|---|
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FUND(S):
0407 - CENTRAL OFFICE GENERAL ADMINISTRATIVE FUND, 0525 - CONSOLIDATED MEDICAL SERVICES FUND, 8793 - SUBSTANCE ABUSE PREVENTION AND TREATMENT FUND, 8750 - FED BLOCK GRANTS MATERNAL/CHILD HEALTH PROG FUND
Sources of Revenue:
Other Fund General and Federal
Legislation creates:
Creates New Program
Fiscal Note Summary
Effect this measure will have on costs and revenues of state government.
The purpose of this bill is to increase support for families.
This Bill adds a new section to Chapter 16 of the WV Code, designated §16-5K-7, establishing categorical eligibility of adopted children for any early intervention services offered by the DHHR. The Bill stipulates that parents and their newly adopted children may be required to meet federally mandated eligibility requirements for participation in early intervention services offered by the DHHR, which include but are not limited to, Right From the Start, Drug Free Moms and Babies, and Birth to Three. See memorandum below.
Additionally this Bill adds a new article to Chapter 16 of the WV Code (designated §16-66-1, §16-66-2, and §16-66-3) establishing the West Virginia Mothers and Babies Pregnancy Support Program under the Bureau for Public Health.
The Bill tasks the Department with recruiting additional sites to expand the Drug Free Moms and Babies (DFMB) program and report back to the Legislature if additional funding becomes necessary to operate these sites.
The DFMB receives funding from the Department's Bureau for Behavioral Health (BBH), Bureau for Public Health - Office of Maternal, Child, and Family Health, and the Claude Worthington Benedum Foundation.
The Department's BBH currently provides grants to support 18 DFMB programs through multiple funding sources.
The Department estimates the fiscal impact related to this bill would be $1,137,551 the first year and $1,555,861 each year thereafter.
Funding sources and estimated revenues for the WV Mothers and Babies Pregnancy Support Program, cannot be determined at this time.
Fiscal Note Detail
| Effect of Proposal |
Fiscal Year |
2023
Increase/Decrease
(use"-") |
2024
Increase/Decrease
(use"-") |
Fiscal Year
(Upon Full
Implementation) |
| 1. Estmated Total Cost |
0 |
1,137,551 |
1,555,861 |
| Personal Services |
0 |
57,771 |
57,771 |
| Current Expenses |
0 |
1,079,780 |
1,498,090 |
| 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):
If the OMCFH was responsible for administering the West Virginia Mothers and Babies Pregnancy Support Program on behalf of the BPH, no less than one (1) FTE staff, a Health and Human Resources Specialist Senior, will be needed to carry out all necessary planning and operational aspects of the newly formed Program. Position responsibilities will include, but not be limited to, pre-award administration and monitoring the contract (likely subrecipient agreement) with the required “Management Agency.” Duties will include, but not be limited to, defining the subaward, identifying applicable programmatic and administrative requirements and determining whether those will be communicated with the solicitation, facilitating negotiation of the subaward(s), as well as ongoing administration. Estimated personal services include salary (DHHR average for the classification = $47,487) and fringe costs ($10,284).
The estimated annual contractual cost of the Management Agency ($279,780) matches the average annual contractual costs for one Right From the Start (RFTS) region. RFTS Regional Lead Agencies are tasked with accomplishing a comparable public purpose. The Bill requires the Management Agency to establish a fee per service arrangement with invoicing and reimbursement for Pregnancy Help Organizations - 501(c)(3) entities traditionally known as "crisis pregnancy organizations," maternity homes, adoption agencies, and social services agencies that provide material support and other assistance to individuals facing an unintended pregnancy with the intent to help those individuals give birth to their unborn child).
Section §16-5K-7(c) requires the DHHR recruit additional sites to expand the Drug Free Moms and Babies program and report back to the Legislature if additional funding becomes necessary to operate these sites. Both the total number of state birthing centers and the number of birthing centers providing Drug Free Moms and Babies programs has fluctuated in recent years; however, the Department currently funds 18 DFMB programs that work with 16 birthing centers in the state. Start up cost for a new DFMB program is $80,000 which does not include the cost of prevention, early intervention and referral to addiction and recovery support services for the women. It is believed that each of the State's 26 birthing centers could utilize a program allowing for an additional 10 programs tied to the 10 currently unserved birthing centers at $80,000 in start up for each.
It is estimated that the cost of DFMB services per woman/participant is $1,706.67.
Assuming each of the 10 new program locations would be funded at the average of the 18 current programs ($2,192,958 /18 = $121,831) the addition of those programs would require ongoing funding of $1,218,310.
The Federal Funds to administer the current programs are discretionary grants. Any change/reduction to those grants could shift all or portions of the current funding amounts of $2,192,958 to state general revenue dollars to remain compliant with this bills requirements.
Memorandum
The Bill does not define "early intervention services."
The Bill directs the Bureau for Medical Services to seek approval of and implement a Medicaid state plan amendment to meet the requirements of this new section (§16-5K-7) if the program is offered through or funded by the state Medicaid program and a state Medicaid plan amendment would be necessary to effectuate the purposes of this section. WV's State Medicaid Plan specifically identifies "early intervention" as Medicaid rehabilitation services provided to EPSDT-eligible children who are eligible for Individuals with Disabilities Education Act Part C services to correct or ameliorate defects and conditions identified by EPSDT screening. Consequently, 16-5K-7 would not necessitate an amendment to the State Medicaid Plan for early intervention services provided by Birth to Three.
Right From the Start (RFTS) is a Medicaid-funded in-home care coordination initiative provided by a community-based network of registered nurses and licensed social workers that visit eligible clients, i.e. obstetrical populations and children up to age one, in their homes to assess educational, social, nutritional, and medical needs and to facilitate access to appropriate service providers (WV Code §9-5-12). All Medicaid members ages 0-1 are eligible. This Bill relates to the provision of "early intervention services" which the WV Code (§16-5K-1 et seq.) and federal education law (Public Law 94-142, Public Law 99-457, Public Law 110-476 - Individuals with Disabilities Education Act) makes applicable to individuals from birth to no less than 36 months of age. A determination will need to be made as to whether RFTS eligibility will have to be expanded to include Medicaid-eligible members ages 0-36 months.
Birth to Three, i.e. Part C of the Individuals with Disabilities Education Act, allows states to establish eligibility. Said eligibility is determined by each state's definition of an infant or toddler with a disability, which must include an infant or toddler with a developmental delay and an infant or toddler with a diagnosed physical or mental condition with a high probability of resulting in developmental delay. States may establish "at-risk" criteria for eligibility with approval from the U.S. Department of Education. Acknowledging the purpose of this Bill is to establish categorical eligibility of adopted children for any early intervention services offered by the DHHR, a determination will need to be made as to whether DHHR (WV's designated lead agency for IDEA Part C) would need to initiate a request to the U.S. Department of Education to modify its current eligibility to include "adopted children" under 36 months of age?
If the U.S. Department of Education approved a change to WV's eligibility to include "adopted children" the ensuing methodology for estimating costs would be appropriate. According to the U.S. Department of Health and Human Services' Adoption and Foster Care Analysis and Reporting System (AFCARS), there were 1,683 WV adoptions in 2020, of which 28.8% involved children ages zero to three years (approximately 485 children). Historically, approximately 50% of Birth to Three referrals proceed with early intervention services. The average annual cost per WV Birth to Three client is $4,500. Assuming that 50% of all adoptive families (243) each year receive early intervention services, the estimated annual increase in costs could be as much as $1,093,500.
Section §16-5K-7(a) allows that any child or children adopted as a newborn on and after that date whose adoptive parent or parents are residents of West Virginia shall be eligible for the Drug Free Moms and Babies program. The DFMB program is targeted to Pregnant and Postpartum women and provides prevention, early intervention and referral to addiction and recovery support services. With the focus of the program being Mothers with substance use disorders and providing referrals to other available resources there would be no additional costs to the state for the referrals for the adopted children to those same resources.
West Virginia was awarded a three-year Federal grant that will invest $2.7 million combined in services supporting pregnant and postpartum women with substance use disorder in West Virginia. This grant runs from 09/30/2022 – 09/29/2024 and will increase the statewide coordinated continuum of care with a focus on collaborative family-centered approaches and evidence-based service delivery. The grant will also enable expansion of the state’s Drug Free Moms and Babies (DFMB) program, an integrated comprehensive medical and behavioral health program for pregnant and postpartum women with substance use disorder.
Person submitting Fiscal Note: Jeffrey H. Coben
Email Address: dhhrsecretary@wv.gov