FISCAL NOTE

Date Requested: March 07, 2017
Time Requested: 01:46 PM
Agency: Health and Human Resources, WV Department of
CBD Number: Version: Bill Number: Resolution Number:
2898 Introduced SB526
CBD Subject: Insurance


FUND(S):

0403 - DIV OF HUMAN SERVICES GENERAL ADMINISTRATION FUND, 8722 - CONS FEDERAL FUNDS DIV HUMAN SERVICES GEN ADMN FD, 0407 - CENTRAL OFFICE GENERAL ADMINISTRATIVE FUND, 8750 - FED BLOCK GRANTS MATERNAL/CHILD HEALTH PROG FUND

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.


    The purpose of this bill is to provide for mandatory insurance coverage for inherited enzymatic disorders.
    The Department has multiple programs that provide coverage of these types of disorders (Medicaid, Children's Health Insurance Program, Children with Special Health Care Needs). Coverage exists for all listed types of inherited conditions, with the exception of histidinemia; eosinophilic disorders as evidenced by the results of a biopsy; and impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length and motility of the gastrointestinal tract.
    Coverage of medical foods for these disorders is currently covered by the Department's Medicaid program for children that are 100% tube fed. Coverage is also provided by the Department's Children with Special Health Care Needs for those children that are not 100% tube fed, excluding those above 200% of FPL.
    The bill does not limit coverage for these disorders by age. Currently nutritional supplements for adults is not a covered benefit under the Medicaid program and would require approval from the Centers for Medicare and Medicaid Services (CMS) or coverage with 100% state dollars. The estimated cost for adults is $1,028,568.
    Children with Special Health Care Needs currently covers approximately $700,000 per year in food costs for Medicaid children and $32,000 per year in food costs for the CHIP program. These costs could be shifted to either program, potentially causing a shift in state funding used to support.
    Currently there is not enough information to project the costs that may be attributable to adding coverage for the three disorders not currently covered.



Fiscal Note Detail


Effect of Proposal Fiscal Year
2017
Increase/Decrease
(use"-")
2018
Increase/Decrease
(use"-")
Fiscal Year
(Upon Full
Implementation)
1. Estmated Total Cost 0 1,028,568 1,028,568
Personal Services 0 0 0
Current Expenses 0 1,028,568 1,028,568
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):


    Estimates indicated were calculated by comparing the number of Medicaid individuals currently receiving services through Children with Special Healthcare Needs (which is approximately 0.06% of the population). Applying this percentage to the approximate 340,000 would equate to approximately 204 adults with the potential to need food supplements. Total average cost for food of approximately $5,042 x 204 adults = $1,028,568.
    



Memorandum


    The Children with Special Health Care Needs currently controls costs through highly specialized nutrition clinics which include feeding and swallowing specialists. Without this check and balance, physicians (through their own admission) tend to prescribe more product than the families actually need which drives cost up. The process of utilizing nutrition clinics would continue and include adults.
    



    Person submitting Fiscal Note: Bill J. Crouch
    Email Address: dhhrbudgetoffice@wv.gov