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F I S C A L I M P A C T R E P O R T

SPONSOR Sandoval

ORIGINAL DATE

LAST UPDATED

02/17/07

03/13/07 HB 1283/aHAFC/aSFC

SHORT TITLE Driver Contributions to Children’s Sight Fund

SB

ANALYST Hanika Ortiz

REVENUE (dollars in thousands)

Estimated Revenue

Recurring

or Non-Rec

Fund

Affected

FY07

FY08

FY09

$0.1

see narrative Children’s Sight

Fund

(Parenthesis ( ) Indicate Revenue Decreases)

ESTIMATED ADDITIONAL OPERATING BUDGET IMPACT (dollars in thousands)

FY07

FY08

FY09 3 Year

Total Cost

Recurring

or Non-Rec

Fund

Affected

Total

$15.2

$7.5

Recurring General

fund

(Parenthesis ( ) Indicate Expenditure Decreases)

SOURCES OF INFORMATION

LFC Files

Responses Received From

Public Education Department (PED)

Department of Health (DOH)

SUMMARY

Synopsis of SFC Amendment

The Senate Finance Committee Amendment removes the requirement that the vision testing

occur annually.

Synopsis of HAFC Amendment

The House Appropriations and Finance Committee Amendment allows a school nurse or the

nurse’s designee, a primary care health provider or a lay eye screener to conduct vision

screenings; provides a vision test only for students enrolled in PK, K 1

st

and 3

rd

grades; removes

House Bill 1283/aHAFC/aSFC – Page

2

the requirement that any parent notification be only by mail; allows eyeglasses purchased from

the fund to not necessarily be the least expensive; disallows using monies from the fund to

provide replacement insurance for ruined contact lenses; and, includes the appointment of a

school administrator to the advisory committee.

Synopsis of Original Bill

House Bill 1283 amends the public school code and adds new sections to Chapters 24 and 66-

Article 6 NMSA 1978 to require an elementary school nurse administer an annual vision screen

for enrolled students unless the parent refuses the screening. In addition, it will establish a “save

our children’s sight fund" in the state treasury administratively attached to the DOH. The fund

will be used for the purpose of developing and implementing a vision screening program with

follow-up comprehensive examinations for children regardless of family income. A temporary

provision will require the Secretary of Health to appoint an advisory committee to establish the

standards for an appropriate vision screen. The DOH will also be required to promulgate rules

for appropriate vision screening test standards.

SIGNIFICANT ISSUES

The bill is unclear if a “lay eye screener" needs specific training or prior qualifications to

conduct vision screenings on children.

AMENDMENTS

Pg 2, line 8, insert “developmentally appropriate" between “annual" and “vision screening test"

to help address the needs of PK; non-verbal children with disabilities; and, children with hearing

impairments.

FISCAL IMPLICATIONS

Children’s Medical Services within the DOH pays for diagnostic evaluations for children, but

only those children diagnosed with severe problems receive continued vision services. Children

found to have only mild visual acuity are not covered. In those cases, families must pay out-of-

pocket for glasses and follow-up care.

The bill establishes a non-reverting “Save Our Children’s Sight Fund" administered by DOH for

development and implementation of a vision screening program to be administered annually in

the state’s elementary schools. The fund will support the costs associated with follow-up exams

as needed, contact lenses or polycarbonate lenses and replacement insurance for lost or broken

lenses or ruined contact lenses. Funds will come from voluntary contributions from drivers who

have checked-off an option to contribute to the fund for a $1.00 or $5.00 fee. Other funds may

come from grants, appropriations, contributions and statutory revenues directed to the fund.

Expenditures will be by warrants of the secretary of finance and administration pursuant to

vouchers signed by the secretary of health or the secretary’s authorized representative

.

This bill creates a new fund and provides for continuing appropriations. The LFC has concerns

with including continuing appropriation language in the statutory provisions for newly created

funds, as earmarking reduces the ability of the legislature to establish spending priorities.

House Bill 1283/aHAFC/aSFC – Page

3

The bill is not part of the FY08 Governor’s Executive Budget request for the DOH. The budget

impact to DOH is reported at 0.25 FTE at an estimated cost of $15,250 for salary, benefits, and

start-up costs for the first year. There is no provision within the bill for a percentage of the

revenue from the fund be set aside for administrative costs.

SIGNIFICANT ISSUES

Pre-kindergarten public school students are required to have a vision screening. The current

practice in New Mexico is that vision screening occurs in kindergarten, first grade, third grade

and fifth grade. Early screening requires screening for vision problems such as amblyopia, which

needs treatment as early as possible for the best possible outcome.

The bill presents an innovative financing mechanism to help cover the cost of vision diagnosis

and treatment for student who do not have insurance coverage. It is not clear if this mechanism

of the vehicle registration check-off box will adequately fund such an effort. The bill will require

the parents to be notified by mail if a child’s vision screen indicates the need for follow-up.

Information regarding the availability of funds from the Save Our Children’s Sight Fund must be

enclosed.

PERFORMANCE IMPLICATIONS

Vision screening is recommended by the American Academies of Pediatrics, Family Physicians

and Ophthalmologists.

PED comments that providing early vision screening and possible funds to support follow-up

costs and treatment can lead to improved vision. As there is a link between health and academic

success, this can assist in closing the achievement gap and lead to improved reading and math

scores. However, there is currently no requirement for annual vision screening for all elementary

students; and, as there are 177,419 students enrolled in New Mexico in grades pre-K through 6

an annual screening may be difficult for the current number of elementary school nurses to

accomplish.

ADMINISTRATIVE IMPLICATIONS

DOH notes that the bill creates a new revenue stream to support specialty medical needs for

children without insurance coverage; and, until the revenue stream can be determined it is

impossible to identify the extent to which services will be provided. DOH further notes the need

to develop rules and establish a mechanism to disburse these funds to eligible families and to

evaluate efficiency and effectiveness of vision screening, follow-up referral and treatment

.

CONFLICT, DUPLICATION, COMPANIONSHIP, RELATIONSHIP

Duplicates SB 1149

TECHNICAL ISSUES

Vision screening protocols are already established and used in New Mexico public schools, so

that the recommendation for an “advisory committee to establish the standard for appropriate

vision screening" may be a duplication of efforts.

House Bill 1283/aHAFC/aSFC – Page

4

OTHER SUBSTANTIVE ISSUES

DOH has the following comments:

Not all children in New Mexico are receiving the vision care that they need. A recent national

report from the Centers for Disease Control highlights the lack of appropriate screening for

children 0-6 years of age who are from poor and or minority families. The report goes on to state

that for many children, their visual impairment only becomes obvious when they enter school. A

significant proportion of children with visual impairments do improve with appropriate treatment

if it is provided early.

School nurses in New Mexico public schools perform vision screening on elementary age

students, however there is no requirement or established standard for when a child should be

screened and or how often a screen is necessary. Even if these children are screened in school,

uninsured or underinsured children may not receive needed vision services or glasses. They may

attend school, yet not achieve up to their potential due to vision problems.

POSSIBLE QUESTIONS

The earlier vision impairment is identified and treated, the better the outcome for the child.

Is their a reason why the bill does not specifically include pre-school.

AMENDMENTS

The Departments suggest the following:

•

On page 2, line 7, strike “An elementary" and insert in lieu thereof of “A".

•

On page 2, line 8 after the word “nurse", insert “or their designee".

•

On page 2, line 8 after the word administer, strike the words “an annual" and insert the

word “a"

•

On page 2, line 9 after the word “students", insert “in grades pre-kindergarten,

kindergarten, first grade, third grade and fifth grade".

•

On page 2, line 10 after students, insert “in identified grades".

•

On page 2, line 19 after parent, strike “by mail and enclose" and insert in lieu thereof “of

that need and provide"

•

On page 3, line 21 after “a practicing school nurse," insert “a school administrator,"

AHO/nt