FISCAL NOTE
Date Requested: January 16, 2026
Time Requested: 03:41 PM |
| Agency: |
Corrections & Rehabilitation, Division of |
|---|
| CBD Number: |
Version: |
Bill Number: |
Resolution Number: |
| 2745 |
Introduced |
SB448 |
|
|---|
| CBD Subject: |
Health |
|---|
|
FUND(S):
0608 - 0450 - General Revenue and 0608 - Special Revenue 6678
Sources of Revenue:
General Fund This would increase cost to special revenue 0608 regional jail funds as well as general revenue 0608 0450
Legislation creates:
Creates New Expense
Fiscal Note Summary
Effect this measure will have on costs and revenues of state government.
Summarize in a clear and concise manner what impact this measure will have on costs and revenues of state government.
Summary
This measure is expected to create significant new expenses for the State associated
with the development and implementation of a comprehensive screening, neurology,
and neuropsychology testing program for the inmate population. The program will incur
a one-time start-up cost of $14,264,990 to clear the existing backlog and purchase
equipment, followed by ongoing annual costs of $12,765,171 to manage new intakes
and maintain the program.
Fiscal Note Detail
Breakdown by Fiscal Year Effect of Proposal
FY 2026 (Start-up)
FY 2027 (Recurring)
Upon Full
Implementation
1. Estimated Total
Cost $14,264,990 $12,765,171 $12,765,171
Personal Services $0 $0 $0
Current Expenses $14,241,230 $12,765,171 $12,765,171
Repairs and
Alterations $0 $0 $0
Assets $23,760 $0 $0
2. Estimated Total
Revenues $0 $0 $0
3. Explanation of above estimates:
Assumptions & Data Sources:
The costs are derived from a model based on the following key assumptions:
Average Prison Population: 4,541
Yearly Jail Intakes: 36,831
Program Participation Rate: 75%
Positive Screen Rate (for neurology/NS): 65%
Unit Costs: The model uses calculated per-visit costs, including staff time (RN,
LPN, CO-2) and the Neurology Visit Cost ($236.81 reimbursement) to determine:
Cost associated with neurology visit: $369.44
Cost associated with neuropsychology required visits: $2,718.07
FY 2026 (Initial Costs) - $14,264,990 (Start-up)
This one-time cost is for clearing the backlog of the current inmate population and
purchasing necessary equipment.
Category Cost Detail
Assets $23,760 Purchase of 22 Desktop Workstations at $1,080 each.
Current Expenses
$14,241,230
Represents the cost of the one-time screening, neurology visits, and subsequent
neuropsychology referrals for the existing inmate
population. This includes the cost of:
Catch Up Screening
$63,104 Prisons ($43,299) and Jails ($19,070).
Catch Up Neurology Visits
$1,178,047 Prisons ($817,843) and Jails ($360,204).
Catch Up NS Referrals
$13,000,07
6 Prisons ($9,025,638) and Jails ($3,975,176).
FY 2027 and Upon Full Implementation (Recurring Yearly Costs) - $12,765,171 (Ongoing)
This ongoing annual cost is for the screening and treatment of new yearly intakes into
the jail system. The cost is allocated to Current Expenses as service fees and staff
costs.
Category Cost Detail
Screening
Costs $351,191 Annual LPN time for screening all new yearly jail intakes.
Neurology
Visits $2,653,333 Annual cost for 7,182 recurring neurology visits.
NS Visits $9,760,648
Annual cost for neuropsychology testing, calculated
as 7,182 neurology visits $\times 0.5$ referral rate
$\times $2,718.07 unit cost.
Total Recurring Cost
$12,765,171
Memorandum Summary
[Please identify any areas of vagueness, technical defects, reasons a bill would not
have a fiscal impact, and/or any special issues not captured elsewhere on this form.]
The time and personnel required to administer a screening test for Traumatic Brain
Injury (TBI) varies by the specific test used. The VA uses a straightforward test,
sometimes referred to as TBI-4, which could easily be added to our intake screening
and yearly physicals. There are much more complicated screening tests, and the study
group referenced jointly determines which screening test to use. If the group chooses a
more complex screening tool, time and training will increase significantly. However, a
positive screening test should be followed by a confirmatory test.
The prevalence of TBI in the correctional system is estimated to be 46% per CDC. By
their nature, screening tests are designed to capture more potential cases, so the
estimated percent of positive screens is 65%. The main cost driver is not the screening
test itself, but the required follow-up and confirmation testing. We could perform the
initial screening test within the facilities at a relatively low cost, but it would be
unadvisable not to act on a positive screening test from a medicolegal standpoint.
To limit the cost, the proposal routes positively screened individuals to first see a
neurologist, which has a much lower unit cost ($369.44). The neurologist then refers
individuals for additional, high-cost neuropsychology testing as deemed necessary
(estimated at $2,718.07 per required visit).
Fiscal Note Detail
| Effect of Proposal |
Fiscal Year |
2026
Increase/Decrease
(use"-") |
2027
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.
Summary
This measure is expected to create significant new expenses for the State associated
with the development and implementation of a comprehensive screening, neurology,
and neuropsychology testing program for the inmate population. The program will incur
a one-time start-up cost of $14,264,990 to clear the existing backlog and purchase
equipment, followed by ongoing annual costs of $12,765,171 to manage new intakes
and maintain the program.
Fiscal Note Detail
Breakdown by Fiscal Year Effect of Proposal
FY 2026 (Start-up)
FY 2027 (Recurring)
Upon Full
Implementation
1. Estimated Total
Cost $14,264,990 $12,765,171 $12,765,171
Personal Services $0 $0 $0
Current Expenses $14,241,230 $12,765,171 $12,765,171
Repairs and
Alterations $0 $0 $0
Assets $23,760 $0 $0
2. Estimated Total
Revenues $0 $0 $0
3. Explanation of above estimates:
Assumptions & Data Sources:
The costs are derived from a model based on the following key assumptions:
Average Prison Population: 4,541
Yearly Jail Intakes: 36,831
Program Participation Rate: 75%
Positive Screen Rate (for neurology/NS): 65%
Unit Costs: The model uses calculated per-visit costs, including staff time (RN,
LPN, CO-2) and the Neurology Visit Cost ($236.81 reimbursement) to determine:
Cost associated with neurology visit: $369.44
Cost associated with neuropsychology required visits: $2,718.07
FY 2026 (Initial Costs) - $14,264,990 (Start-up)
This one-time cost is for clearing the backlog of the current inmate population and
purchasing necessary equipment.
Category Cost Detail
Assets $23,760 Purchase of 22 Desktop Workstations at $1,080 each.
Current Expenses
$14,241,230
Represents the cost of the one-time screening, neurology visits, and subsequent
neuropsychology referrals for the existing inmate
population. This includes the cost of:
Catch Up Screening
$63,104 Prisons ($43,299) and Jails ($19,070).
Catch Up Neurology Visits
$1,178,047 Prisons ($817,843) and Jails ($360,204).
Catch Up NS Referrals
$13,000,07
6 Prisons ($9,025,638) and Jails ($3,975,176).
FY 2027 and Upon Full Implementation (Recurring Yearly Costs) - $12,765,171 (Ongoing)
This ongoing annual cost is for the screening and treatment of new yearly intakes into
the jail system. The cost is allocated to Current Expenses as service fees and staff
costs.
Category Cost Detail
Screening
Costs $351,191 Annual LPN time for screening all new yearly jail intakes.
Neurology
Visits $2,653,333 Annual cost for 7,182 recurring neurology visits.
NS Visits $9,760,648
Annual cost for neuropsychology testing, calculated
as 7,182 neurology visits $\times 0.5$ referral rate
$\times $2,718.07 unit cost.
Total Recurring Cost
$12,765,171
Memorandum Summary
[Please identify any areas of vagueness, technical defects, reasons a bill would not
have a fiscal impact, and/or any special issues not captured elsewhere on this form.]
The time and personnel required to administer a screening test for Traumatic Brain
Injury (TBI) varies by the specific test used. The VA uses a straightforward test,
sometimes referred to as TBI-4, which could easily be added to our intake screening
and yearly physicals. There are much more complicated screening tests, and the study
group referenced jointly determines which screening test to use. If the group chooses a
more complex screening tool, time and training will increase significantly. However, a
positive screening test should be followed by a confirmatory test.
The prevalence of TBI in the correctional system is estimated to be 46% per CDC. By
their nature, screening tests are designed to capture more potential cases, so the
estimated percent of positive screens is 65%. The main cost driver is not the screening
test itself, but the required follow-up and confirmation testing. We could perform the
initial screening test within the facilities at a relatively low cost, but it would be
unadvisable not to act on a positive screening test from a medicolegal standpoint.
To limit the cost, the proposal routes positively screened individuals to first see a
neurologist, which has a much lower unit cost ($369.44). The neurologist then refers
individuals for additional, high-cost neuropsychology testing as deemed necessary
(estimated at $2,718.07 per required visit).
Memorandum
Please identify any areas of vagueness, technical defects, reasons a bill would not have a fiscal impact, and/or any special issues not captured elsewhere on this form.
Person submitting Fiscal Note: Lori Lynch, Chief of Staff, WVDCR
Email Address: lori.a.lynch@wv.gov