FISCAL NOTE
Date Requested: March 03, 2025
Time Requested: 03:34 PM |
| Agency: |
Human Services, WV Department of |
|---|
| CBD Number: |
Version: |
Bill Number: |
Resolution Number: |
| 1079 |
Introduced |
SB128 |
|
|---|
| CBD Subject: |
Health |
|---|
|
FUND(S):
0484 - Bureau for Medical Services-Policy and Programming, 8722 - Cons Federal Funds Div Human Services Gen Admn Fd. 0487 - Bureau for Social Services - Children's Services, 0488 - Bureau for Social Services-Adoption, Bureau for Social Services, - Foster
Sources of Revenue:
Other Fund General and 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 remove the option for courts to order services at a higher rate than Medicaid.
This could result in a cost savings to the Department, however the amount is difficult to calculate as the number or types of services the courts might order within a given fiscal year is unknown. Additionally, to evaluate court ordered rates in comparison to Medicaid rates is not easy to calculate quickly.
The Department pulled a report for court ordered services at an aggregate level. To get detailed information for types of services and rates paid to compare to Medicaid rates, a manual effort is required to pull individual orders.
For purposes of providing an estimate, the Department pulled several categories with high volume/spend data and compared them to the Medicaid rates. The categories pulled were Out of State Placements, Drug Testing, and Psychological Services. The estimated cost savings from this calculation is $9,007,806.
Fiscal Note Detail
| Effect of Proposal |
Fiscal Year |
2025
Increase/Decrease
(use"-") |
2026
Increase/Decrease
(use"-") |
Fiscal Year
(Upon Full
Implementation) |
| 1. Estmated Total Cost |
0 |
-9,007,806 |
-9,007,806 |
| Personal Services |
0 |
0 |
0 |
| Current Expenses |
0 |
-9,007,806 |
-9,007,806 |
| 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):
The Department pulled a report for court ordered services at an aggregate level. To get detailed information for types of services and amounts to compare to Medicaid rates, a manual effort is required to pull individual information.
For purposes of providing an estimate, the Department pulled high level date for the below and compared them to the Medicaid rates.
Out of State Placements - Overall cost increased 40% from 2022 to 2024. Number of children increased by 36% (from 541 to 736) and the rates increased 34%. In 2022, per diem rates ranged from $538-$541 per day. In 2024, the range increased from $692-$723 per day. NOTE: WV does not have the ability to mandate a rate for out-of-state providers, unless the provider enrolls as a Medicaid Psychiatric Residential treatment Provider (PRTF). The average rate for Medicaid enrolled PRTF's is $700. It is unlikely that DoHS would realize a significant cost savings by using the Medicaid rate in this category.
Drug Testing - Costs increased 29% from SFY2022 to SFY2024, although the contract rate did not change. Contract rate is $29.33 and represented only $127,685 of the cost in 2024. For drug tests ordered outside of the contract, the current average rate is $158 with a range of $45 to $475 per drug test. The Medicaid average rate for drug testing is $97.96 with a range of $11.34 (for dipstick style testing) to $223.23 (a test capable of identifying individual drugs). If DoHS, BSS paid the average Medicaid rate for testing, a cost of $7,024,680 could potentially be realized. (Average BSS rate $158 - Average Medicaid rate $97.96 = $60.04 x 117,000 tests = $7,024,680).
Psychological Services - Overall cost increased 337%. Costs include a mix of psychological evaluations at an average of $1,191 per evaluation. Psychological evaluations represent 87% of the total costs in this category. Remaining costs include therapeutic services for children and adults at the provider's customary rate. The average Medicaid rate for a bundled psychological evaluation is approximately $500. If DoHS, BSS paid the average Medicaid rate for psychological evaluations, a cost savings of $1,983,126 could potentially be realized. (Average BSS rate $1,191 - Average Medicaid rate $500 = $691 x 2,870 evaluations = $1,983,126).
Memorandum
The Department's Bureau for Social services has historically been ordered by the courts to provide services at rates above the standard Medicaid rates. Examples of typical services ordered to pay include treatment, therapy, counseling, evaluation, report preparation, consultation, drug testing and preparation of expert testimony.
Person submitting Fiscal Note: Alex J. Mayer
Email Address: osafiscalnotes@wv.gov