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F I S C A L I M P A C T R E P O R T
SPONSOR Trujillo
DATE TYPED 1/25/05
HB 82
SHORT TITLE Case Management Services for Children
SB
ANALYST Collard
APPROPRIATION
Appropriation Contained Estimated Additional Impact Recurring
or Non-Rec
Fund
Affected
FY05
FY06
FY05
FY06
$300.0
Recurring General Fund
(Parenthesis ( ) Indicate Expenditure Decreases)
SOURCES OF INFORMATION
LFC Files
Responses Received From
Department of Health (DOH)
Health Policy Commission (669)
SUMMARY
Synopsis of Bill
House Bill 82 appropriates $300 thousand from the general fund to the Department of Health for
the purpose of maintaining case management services for medically fragile children in FY05 and
FY06. Any unexpended or unencumbered balance at the end of FY06 will revert to the general
fund. This bill contains an emergency clause.
Significant Issues
DOH notes the Long-Term Care Services Program currently administrators the Medicaid Medi-
cally Fragile Waiver program that serves individuals from birth to death who meet the medical
and financial criteria set forth by Medicaid. A part of the program service is to contract with case
management services to coordinate healthcare related services for the medically fragile waiver
clients statewide who have been approved for services. Currently, there are statewide case man-
agement services available.
pg_0002
House Bill 82 -- Page 2
The existing rate of reimbursement for case management services is based on a rate validation
study that was conducted beginning in September 1999 that resulted in reimbursement rate in-
creases by the program for the case management services for medically fragile waiver clients.
The department also notes the Long-Term Care Services Program will be conducting a rate study
specifically for case management services in spring 2005. DOH believes that the covered reim-
bursement rate is appropriate but is committed to further evaluation of the current medically
fragile waiver case management rate and service delivery model.
FISCAL IMPLICATIONS
The appropriation of $300 thousand contained in this bill is a recurring expense to the general
fund. Any unexpended or unencumbered balance remaining at the end of FY06 shall revert to the
general fund.
ADMINISTRATIVE IMPLICATIONS
DOH indicates staff time would be required to oversee the use of $300 thousand appropriated to
assure the appropriation is used to serve medically fragile children.
OTHER SUBSTANTIVE ISSUES
DOH indicates the department is required to maintain case management services for the Medi-
cally Fragile Waiver recipients by the Center for Medicare and Medicaid Services (CMS) as a
Home and Community Based Waiver Service (HCBWS).
Reimbursement for Medically Fragile Waiver case management is $394 per month. Currently,
152 individuals receive Medically Fragile Waiver services. DOH intends to serve additional in-
dividuals who meet criteria for services with the goal of serving up to 200 individuals. The de-
partment indicates, if the $300 thousand were appropriated, and this funding were used to sup-
plement the current case management reimbursement rate for 200 medically fragile waiver re-
cipients, the rate would be $519 per individual per month. This is calculated as follows: $300
thousand divided by 200 individuals equals $1,500. This, divided by 12 months, equals $125.
Therefore, the current rate of $394 would be added to the increased funding of $125 to equal
$519 per month per individual for Medically Fragile Waiver case management services.
DOH has committed to undertake a rate study this spring. The results of this rate study will assist
in determining if the current rate is appropriate or not.
HPC indicates the importance of case management for medically fragile children and all medi-
cally fragile individuals is to help keep them living in their own home as long as possible, delay-
ing hospitalization or institutionalized care. Case managers use a family centered approach to
care, and act as advocates, resource persons, facilitators, and paperwork coordinators for fami-
lies. Case managers also support parents as team leaders who address the day-to-day care of
their child and services in the community, as well provide support to families in their decision to
care for their medically fragile child in their home.
pg_0003
House Bill 82 -- Page 3
Case management is a service provided by trained professionals who assess needs and coordinate
service. Case managers meet with the individual and family members to conduct a thorough as-
sessment of the individual’s health and safety needs. Through this assessment, the case manager
can determine the strengths, weaknesses and specific needs of that individual. The case manager
can then pass along information on programs or services that may be available to the person to
help keep them safely in their own homes. Case managers also develop individualized care
plans, which detail the type of services needed, the frequency, and the payer source for each ser-
vice. Government programs, private insurance, family, friends, and public services are included
in the planning stages in developing a plan of care.
WHAT WILL BE THE CONSEQUENCES OF NOT ENACTING THIS BILL.
DOH notes, if the bill is not enacted, the case management reimbursement rate will remain at
$394 per month at least until the rate study is completed. At that time, based on the results of the
rate study, the DOH and the Human Services Department will have to consider if a rate change is
warranted.
HPC indicates no additional funding for case management services may adversely affect the
health of the vulnerable population of medically fragile children and the public’s health and
safety concerns.
KBC/lg