COMMITTEE ON LEGISLATIVE RESEARCH

OVERSIGHT DIVISION

FISCAL NOTE

L.R. No.: 0368-04

Bill No.: Truly Agreed To And Finally Passed SCS for HCS for HBs 59 & 269

Subject: Boards, Commissions, Committees, Councils; Disabilities; Guardians; Health Care; Health Care Professionals; Health Dept.; Health, Public; Medical Procedures and Personnel; Mental Health; Mental Health Dept.; Physicians

Type: Original

Date: May 27, 2003

FISCAL SUMMARY

* Subject to appropriation.

Numbers within parentheses: ( ) indicate costs or losses.

This fiscal note contains 7 pages.

ASSUMPTION

Officials from the Department of Social Services, Missouri Senate, Department of Economic Development - Division of Professional Registration, Department of Elementary and Secondary Education, and Missouri House of Representatives assume the proposal will have no fiscal impact on their organizations.

Officials from the Office of Attorney General (AGO) state the AGO assumes that costs incurred in participating on the Advisory Council may be absorbed with existing resources.

In response to similar legislation from this session, officials from Missouri Southern State College (MSSC) believe the proposal would have no fiscal impact on their organization. MSSC officials state they have counselors on staff who can provide personal counseling on many issues including depression, suicide prevention and substance abuse. The MSSC is part of a state-wide coalition called Partner's In Prevention which is designed to reduce high risk drinking, participates in the National Depression Screening Day, and has online confidential screening for depression, alcohol abuse and eating disorders which students can use anytime.

In response to similar legislation from this session, officials from the University of Missouri assumed the proposal would have no fiscal impact on their organization.

ASSUMPTION (continued)

Officials from the Department of Mental Health (DMH) state Section 633.032 requiring the development of a plan to address the needs of persons on a waiting list for services would not create a

fiscal impact to the DMH. The cost of developing the plan would be absorbed by existing staff. However, while there is no fiscal impact for the development of the plan, it should be noted that implementation of the plan would result in a significant fiscal impact to the DMH.

Officials from the Department of Higher Education (DHE) state the DHE's expected involvement is not defined and therefore, the cost is unknown.

Oversight assumes since the Department of Mental Health is only required to develop a proposal for a state suicide prevention plan and submit it to the General Assembly, any costs incurred by the DHE's collaborative involvement would be minimal and, therefore, absorbable within current appropriations.

Officials from the Department of Corrections (DOC) state it is unknown what plans may be decided on for implementation. The DOC is unsure what potential fiscal impact could result due to possible programs for employees as well as incarcerated offenders. Program development, implementation and the monitoring thereof, could result in costs as well as the need for staff. Therefore, the potential cost to the DOC is unknown at this time.

Oversight assumes potential costs to the DOC would be minimal and could be absorbed within existing resources based on the Departments of Mental Health, Elementary and Secondary Education, Health and Senior Services, and Social Services responses.

Officials from the Department of Health and Senior Services (DOH) assume the DOH would furnish administrative support and staff as needed to carry out the mandates of the Council. The DOH currently does not have program or services related to the issues of this proposal. DOH states a Health Program Representative III would be needed on or about January 2004, just prior to the council member appointments. DOH estimates the salary and related expenses for this position to be $37,285 in FY 04; $68,440 in FY 05; and $70,212 in FY 06.

The DOH assumes that council members would not be reimbursed for expenses unless federal funds, donated funds, or grants from private foundations can be obtained to support those costs. DOH estimates that lodging, meals and mileage for the council would be $8,280 in FY 04 and $16,560 in years FY 05 and FY 06.

ASSUMPTION (continued)

Oversight assumes the DOH would be required to provide administrative support and staff as necessary with existing resources and the fiscal impact would be $0. Oversight further assumes DOH would pay the Council expenses unless other funds are available. For fiscal note purposes, these expenses are presented as General Revenue costs.

In response to similar legislation proposed this session, officials from Truman State University assumed the proposal would not fiscally impact their organization.

* Subject to appropriation.

FISCAL IMPACT - Small Business

No direct fiscal impact to small businesses would be expected as a result of this proposal.

DESCRIPTION

This bill requires the development of a state suicide prevention plan and certain preventive mental health plans. It also creates an advisory committee on pain and symptom management.

DESCRIPTION (continued)

SUICIDE PREVENTION

The bill requires the Director of the Department of Mental Health, in partnership with the Department of Health and Senior Services, to design and develop a state suicide prevention plan in collaboration with the departments of Social Services, Elementary and Secondary Education, Higher Education, and Corrections. The plan must: (1) Promote the use of employee assistance and workplace programs to support employees experiencing depression or other psychiatric illnesses; (2) Promote the use of student assistance and educational programs to support students with depression, other psychiatric illnesses, and substance abuse disorders; (3) Provide training and technical assistance to local public health and other community-based professionals on the best practices to prevent suicides; (4) Coordinate federal, state, and local agencies in order to collect and analyze data on suicides and suicidal behaviors in Missouri and annually issue a public report; (5) Establish a toll-free suicide prevention hotline; and (6) Recommend statutory changes and implementation and funding requirements to the General Assembly by December 31, 2004.

ADVISORY COUNCIL ON PAIN AND SYMPTOM MANAGEMENT

The bill establishes the Missouri State Advisory Council on Pain and Symptom Management. The council will consist of 19 members, who will be appointed by February 1, 2004. The council is required to: (1) Hold public hearings to gather information relating to pain management;(2) Make recommendations on acute and chronic pain management practices; (3) Analyze statutes, rules, and regulations relating to pain management; (4) Study the use of alternative therapies and any sanctions imposed; (5) Examine the needs of adults, children, the terminally ill, and minorities that have acute and chronic pain; (6) Review the pain management education materials provided by professional licensing boards; (7) Make recommendations to health care professionals for integrating pain management into their practices and regarding continuing education requirements for pain management; (8) Review guidelines issued by the United States Department of Health and Human Services; and (9) Prepare an annual report to deliver to the Speaker of the House of Representatives, President Pro Tem of the Senate, and Governor by February 1 of each year. Members of the council will serve without compensation but may be reimbursed for any expenses incurred, subject to appropriation. The Department of Health and Senior Services will provide existing personnel to staff the council and may receive any moneys that become available on behalf of the council.

DESCRIPTION (continued)

MENTAL HEALTH SERVICE PLAN

The bill requires the Department of Mental Health to develop a plan to address the needs of persons who are on a waiting list for services. The plan is required to emphasize the partnership between developmentally disabled individuals and their families, community providers, and state officials.

The plan is required to include: (1) A method for reducing the waiting period to 90 days; (2) A description of available services and an evaluation of the capacity to serve more individuals; (3) A method of adjusting support and service levels based on individual needs and a method for determining when out-of-home, 24-hour care is necessary; (4) A description of how the plan with be implemented; (5) Any recommendations for necessary changes to state law; and (6) An analysis of the monetary effects in providing services to all eligible individuals and their families.

The bill requires the plan to be completed no later than November 1, 2003. The director of the department is required to submit a copy of the plan to the Speaker of the House of Representatives, the President Pro Tem of the Senate, and the Governor.

This legislation is not federally mandated, would not duplicate any other program and would not require additional capital improvements or rental space.

SOURCES OF INFORMATION

Office of Attorney General

Department of Higher Education

Department of Economic Development

Department of Elementary and Secondary Education

Department of Mental Health

Department of Corrections

Department of Health and Senior Services

Department of Social Services

Missouri House of Representatives

Missouri Senate

Missouri Southern State College

University of Missouri

Mickey Wilson, CPA

Director

May 27, 2003