OFFICE OF FISCAL ANALYSIS

Legislative Office Building, Room 5200

Hartford, CT 06106 (860) 240-0200

http: //www.cga.ct.gov/ofa

sHB-6618

AN ACT CONCERNING VARIOUS REVISIONS TO PUBLIC HEALTH RELATED STATUTES.

AMENDMENT

LCO No.: 8357

File Copy No.: 544

House Calendar No.: 343

OFA Fiscal Note

State Impact: See Below

Municipal Impact: None

Explanation

The amendment results in a revenue loss of $2, 530 in FY 12 and FY 13, along with various other fiscal impacts that are detailed below.

It results in a revenue loss of $2, 530 in FY 12 and FY 13 by reducing a fee established in the underlying bill from $20 to $15. This fee is to accompany approval application forms for individuals to act as an assistant or substitute staff member to a person, or entity, maintaining a family day care home. Currently, the Department of Public Health (DPH) receives 266 initial applications and 240 renewal applications for approval each year.

Section 501 expands the lists of privileged relationships associated with private records and does not result in a fiscal impact.

Section 502 expands confidentiality of certain records obtained by DPH and does not result in a fiscal impact.

Section 503 allows the Commissioner of Public Health's designee to participate in the Stem Cell Research Advisory Committee and does not result in a fiscal impact to DPH.

Section 504 makes a clarifying change to a technologist-related statute and does not result in a fiscal impact.

Section 505 adds Quinnipiac University to a list of universities that may be the recipient of unclaimed deceased persons and does not result in a fiscal impact.

Section 506, and Sections 517 to 518 revise certain acupuncture-related statutes and do not result in a fiscal impact.

Section 507 permits the use of an oral swab drug screening at facilities that are licensed by DPH and is not anticipated to result in a fiscal impact.

Section 508 changes the composition of the school-based health center advisory committee and places administrative responsibilities for it under the Connecticut Association of School-Based Health Centers.

Section 509 codifies current practice related to physicians and the use of fluoroscopy and does not result in a fiscal impact.

Section 510 allows DPH to take action against an assistant or substitute staff member in a family day care home and is not anticipated to result in a fiscal impact to DPH.

Sections 511 to 513 and Section 537 make technical changes to funeral service business statutes and do not result in a fiscal impact.

Section 514, which allows the Commissioner of Consumer Protection (DCP) , in consultation with DPH, to establish a pilot program to permit a hospital that operates a hospital pharmacy to use electronic technology, or telepharmacy at the hospital's satellite, or remote locations to enable a clinical pharmacist to supervise pharmacy technicians in the preparation of IV admixtures, does not result in a fiscal impact. DCP has expertise in pharmacy regulation.

Section 515, which adds the Department of Mental Health and Addiction Services to a list of entities exempted from certain requirements related to the acquisition, construction, developing, or leasing of real estate, does not result in a fiscal impact.

Section 516 allows a nursing home resident, whose facility has been closed, to bypass the waiting list of the facility such resident is being transferred to, and does not result in a fiscal impact.

Section 519 requires the Departments of Public Health, Developmental Services, Social Services, Children and Families, and Mental Health and Addiction Services to consult with the Nonprofit Liaison to the Governor on a feasibility study regarding the establishment of a uniform state licensing process for community-based providers and does not result in a fiscal impact.

Section 520 makes changes to residential care home requirements and does not result in a fiscal impact.

Section 521 revises certain disclosure of information requirements of the Department of Children and Families and DPH and does not result in a fiscal impact to either agency.

Sections 522 to 536 make changes to statutes concerning DPH's certified water treatment, water distribution, and water system operator program. Specifically, it establishes the following fees:

● An initial water treatment, water distribution system, or small water system operator certificates fee of $224 each,

● A renewal water treatment, water distribution system, or small water system operator certificates fee of $98 each,

● An initial backflow prevention device tester and cross-connection survey inspector certificates fee of $154, and

● A renewal backflow prevention device tester and cross-connection survey inspector certificates fee of $98.

These fees will generate annual General Fund revenue of $129, 770. This assumes an annual average of:

● 280 initial water treatment, water distribution system, or small water system operator certificates (resulting in $62, 720 in revenue) and 382 renewals (resulting in $37, 436 in revenue) , for a total of $100, 156.

● 100 initial backflow prevention device tester and cross-connection survey inspector certificates (resulting in $15, 400 in revenue) and 206 renewals (resulting in $14, 214 in revenue) , for a total of $29, 614.

It should be noted that the certified water treatment, water distribution, and water system operator program, is currently administered by two positions under DPH that are supported by a federal Environmental Protection Agency (EPA) Expense Reimbursement Grant. This grant is projected to end in March 2012. This program is required for Connecticut to meet the EPA's Final Guidelines for the Certification and Recertification of Operators of Community and Non-Transient Non-Community Public Water Systems. If Connecticut does not meet these guidelines, EPA could withhold 20% of the Drinking Water State Revolving Fund grant, which would result in a potential loss of approximately $1.6 million in federal revenue annually.

Costs associated with these positions in FY 12 include a half-year Sanitary Engineer III salary of $38, 650, a half-year Office Assistant salary of $24, 554, and other related expenditures of $2, 500, for a total to DPH of $65, 704. Costs in FY 13 include full-time salaries of $126, 408 and other related costs of $500, for a total cost to DPH of $126, 908. Fringe benefit costs would be $15, 017 in FY 12 and $30, 035 in FY 13.

Section 538 creates an advisory committee on patient privacy and security within the Health Information and Technology Exchange of Connecticut's board of directors and does not result in a fiscal impact.

Section 539 makes a technical change to the requirements for a dentistry license and does not result in a fiscal impact.

Section 540 expands DPH's authority related to investigations of child day care centers, group day care homes, and family day care homes and does not result in a fiscal impact to the agency.

Section 541 alters the requirement that individuals must hold a master's degree in nursing, or a related field, to requiring that individuals hold a "graduate" degree in nursing, or a related field to be eligible for an advanced practice registered nurse (APRN) license. This allows individuals holding nursing doctorates to be eligible to be an APRN. This results in a General Fund revenue gain to the extent that such individuals obtain APRN licenses, paying the initial fee and renewal fees. DPH collected $54, 500 in initial APRN license fees and $363, 906 in renewal APRN license fees in FY 10.

Section 542 changes the effective date of Section 1 of PA 11-2 from 10/1/11 to 7/1/11, and does not result in a fiscal impact.

Section 543 requires DPH to adopt regulations related to the release of medical test results by clinical laboratories, and does not result in a fiscal impact.

Section 544 results in a potential General Fund revenue gain of $2, 500 in FY 12 and $3, 000 in FY 13. It requires any hospital seeking to terminate inpatient or outpatient services currently offered to file a certificate of need (CON) application with the Office of Health Care Access (OHCA) , a division of DPH1. It is unknown how many terminations of such services will be sought in FY 12 and FY 13. Based on the number of applications received in FY 09 (two) and FY 10 (three) , it is estimated that five applications may be received in FY 12 (resulting in a potential revenue gain of up to $2, 500) and six may be received in FY 13 (resulting in a potential revenue gain of up to $3, 000) . CGS Sec. 19a-639a establishes a $500 CON application fee for termination of certain hospital services.

Section 545 creates a pilot program in Bridgeport, New Haven, and Hartford related to vaccine-manufacture-choice for health care providers that administer vaccines to children under the Federal Vaccine for Children immunization program and does not result in a fiscal impact.

Section 546 removes the ceiling on the health and welfare fee aggregate assessment, which does not result in a fiscal impact to the state, as assessments are structured to cover the actual costs of DPH's immunization program. Therefore, this provision is not anticipated to result in a net revenue gain to the state.

Sections 547 to 548 require the Department of Social Services (DSS) to develop a strategic plan to rebalance Medicaid long-term supports and services, which has no fiscal impact. It allows DSS to 1) enter into contracts to carry-out the plan 2) adjust rates to effectuate the plan, and 3) use federal resources to fund such plan. It further allows DPH to waive certain requirements for purposes of effectuating this plan. It does not result in a fiscal impact to DSS, or to DPH.

Section 549 allows DPH to impose a directed plan of correction after a finding of substantial failure to comply with certain requirements and does not result in a fiscal impact.

Section 550 increases the fee associated with failure to pay the Office of Health Care Access assessment when due, and will result in a General Fund revenue gain to the extent that payments are remitted after they are due.

Sections 551 to 553 concern the electronic transfer of payments related to the assessment discussed above and do not result in a fiscal impact.

Sections 554 to 559 require DPH to establish a program, on or before 7/1/12, to ensure that individuals that would have direct access to patients or residents at long-term care facilities undergo criminal history background checks prior to employment. This results in a General Fund revenue gain of $562, 500 in FY 13 from the collection of state criminal background check fees by the Department of Public Safety (DPS) . The fee for a federal criminal background check is currently $19.25 and the fee for a state criminal background check is $50.002. Only the state criminal background check fees remain as General Fund revenue. Revenue from fees collected for federal criminal background checks are passed on to the Federal Bureau of Investigations.

An estimated 11, 250 long-term care position applicants will require state and federal criminal background checks from 10/1/12 to the end of FY 13. It is anticipated that the cost of state and federal background checks for direct access employees of long-term care facilities and providers performed prior to 10/1/12 will be covered by DPH federal funds, as this is a requirement of a grant described below.

The bill also results in one of three additional fiscal impacts under the following possible scenarios:

1. Scenario “A”: Results in a cost to DPH of $60, 000 in FY 13 for Information Technology (IT) maintenance and customer support,

2. Scenario “B”: Results in a total state cost of $316, 442 in FY 13 to support positions in DPH (at a cost of $200, 911) , DPS (at a cost of $55, 038) , and fringe benefits for those positions ($60, 493) , or

3. Scenario “C”: Both IT maintenance and customer support and agency position costs are incurred, but at an amount less than $60, 000 for IT maintenance and customer support and less than $316, 442 for agency positions.

Which scenario is likely to result will depend upon the outcome of a discretionary grant awarded to DPH from the Centers for Medicare and Medicaid Services for a “Connecticut Background Check Program for Direct Access Employees of Long-Term Care Facilities and Providers.” Further information is provided in the following sections.

GRANT OVERVIEW

DPH was awarded $1.9 million on 9/30/10 under the aforementioned grant in order to, by 9/30/12, establish a background check program system that includes:

● Utilization of fingerprints to check existing state and federal criminal records of long-term care employment applicants, and

● A framework through which the system that will report back to the users (the long-term care facilities/providers) if their employees, who have previously had a background check and were determined fit for hire, subsequently get arrested for an offense that would alter their fitness determination,  according to a set criteria.

To date, this system has not been developed. It is unknown whether it will be implemented by DPH before the grant terminates, or, if it is implemented, how comprehensive this system will be.

FISCAL IMPACT SCENARIOS

Scenario “A”

Should a criminal background check IT system funded under the Connecticut Background Check Program for Direct Access Employees of Long-Term Care Facilities and Providers grant be established and fully operational by 9/30/12, DPH would incur a cost of $60, 000 in FY 13, starting 10/1/12, to fund on-going IT maintenance and customer service support.

Scenario “B”

Should a criminal background check IT system not be established by 9/30/12, starting 10/1/12, DPH will incur costs of $200, 911 for 2.5 positions and associated expenses. DPS will incur costs of $55, 038 for 1.5 positions and associated expenses. There will also be fringe benefit costs of $60, 493 to support these positions. The positions will be needed to process the estimated 15, 000 annual criminal background checks (15, 000 state and 15, 000 federal) required under the bill. Costs are detailed in the table below. It should be noted that these costs are for nine months of FY 13, as federal funds support a DPH background check initiative through 9/30/12.

Item

FY 13 $

DPH

 

1.0 Health Program Supervisor

57, 951

1.0 Health Program Associate

48, 138

3.0 Office Assistants

93, 697

Office Supplies

1, 125

DPH TOTAL

200, 911

DPS

 

1.5 Processing Technicians

54, 813

Office Supplies

225

DPS TOTAL

55, 038

Office of the State Comptroller

 

Fringe Benefits

60, 493

TOTAL STATE COST

316, 442

Scenario “C”

Should a partial criminal background check IT system be implemented, it is anticipated that less staff support would be needed to the extent that the system facilitates processing tasks that would otherwise be performed by staff. A partially implemented criminal background check IT system would result in costs to DPH for maintenance and customer support, anticipated to be less than the $60, 000 cost for a fully implemented system for nine months in FY 13.

Section 560 makes changes to disciplinary actions against chiropractors and does not result in a fiscal impact.

The preceding Fiscal Impact statement is prepared for the benefit of the members of the General Assembly, solely for the purposes of information, summarization and explanation and does not represent the intent of the General Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of informational sources, including the analyst's professional knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

1 This requirement existed in previous years. PA 10-179 eliminated it from the OCHA statutes.

2 DPS is given authority to set these fees under CGS Sec. 29-17a.