Assuming the Department of Social Services and DOHSS will be working together to process claims, monitoring compliance of professional offices to ensuring that proper equipment is maintained and that it is in working order, and that DOHSS will be assisting the Department of Elementary and Secondary Education in compiling and maintaining a referral list, the following FTE will be necessary:

            Health Program Representative II - 100% FTE - assist with the compilation and                 maintenance of a referral list; assist in the determination of eligibility requirements, and             to assist with the compliance of equipment requirements in optometrists,                            ophthalmologist, physician, and doctor of osteopathy conducting offices comprehensive             vision examinations if necessary. 

            Planner II - 0% FTE - utilize existing position to work with Department of Elementary             and Secondary Education to create promulgate rules establishing enrollment criteria,             policies and procedures, determine eligibility requirements, assist Department of social             Services establish provider agreements (contracts) for each participating eye care provider             statewide, oversee Department responsibility and fund, and to supervise the Health             Program Representative.

            Standard expense and equipment is used. Additional funds are needed for other program             expenses that may range from paper copies and manual processing. Mailing of forms and             eligibility requirements will also be incurred.

             5,000 forms printed and mailed at $.10 printing ($500) and $.39 mailing cost per form             ($1,950) for a total cost of $2,450.

Oversight assumes the proposed legislation does not require additional duties of DOHSS other than assisting DESE with the compilation of a list of sources for treatment on a free or reduced cost basis. If other duties result from this proposal, resources could be requested through the appropriation process. (§ 167.195)

Declining contributions to the Blindness Education, Screening and Treatment Fund and ASSUMPTION (continued)

expenditures, if authorized, up to $99,000 per year, may deplete the fund completely within a few years. Income for the past three years has been: FY04 - $89,998, FY05 - $89,659, and FY06 - $65,746 (38% decline in donations since FY03). The Blindness Education, Screening and

Treatment Fund may not be able to sustain the proposed legislation for the entire possible term as outlined by the sunset clauses. (§192.935)

Oversight assumes other sources will be available to provide eye exams to groups at no cost which would decrease the amount needed from the Blindness Education, Screening and Treatment Program Fund.

The proposed legislation states "subject to appropriation". The cost to the Department of Health and Senior Services is dependent on how the funds will be appropriated. If it is determined that the fund will not be used for vision examinations of kindergarten or first grade students, there will be no impact to the Department.

According to officials from the Department of Social Services - Division of Medical Services (DOS-DMS), as of August 2006, there were 86,030 Missouri Medicaid eligibles ages five, six, and seven. Of this total, 34,978 were Fee-For-Service (FFS) Medicaid eligibles and 51,052 were MC+ Medicaid eligibles. For the FFS Medicaid eligibles, Missouri Medicaid currently reimburses for 5,057 eye examinations at an average cost of $42.32. If a comprehensive vision examination is mandated, there would be 29,921 (34,978-5,057) FFS Medicaid eligibles required to receive an exam. For state fiscal year (SFY) 2009, the DMS estimates the fiscal impact for the FFS Medicaid eligibles to be $1,323,238 (29,921 X $42.32 X 4.5%). The increase of 4.5% is for inflation.

As of August 2006, there were 30,283 Missouri Medicaid eligibles at the age of four. Of this total, 12,366 were Fee-For-Service (FFS) Medicaid eligibles and 17,917 were MC+ Medicaid eligibles. For the FFS Medicaid eligibles, Missouri Medicaid currently reimburses for 1,656 eye examinations. If a comprehensive vision examination is mandated, there would be 10,710 (12,366-1,656) FFS Medicaid eligibles required to receive an exam. For SFY 2010, the DMS estimates the fiscal impact for the FFS Medicaid eligibles to be $494,957 ((10,710 X $42.32 X 4.5%) X 4.5%). The inflation increase of 4.5% is applied to year one and year two costs.

For the MC+ Medicaid eligibles, the DOS-DMS contracts with managed care health plans to provide medical assistance to individuals eligible under Section 208.151. The managed care health plans are reimbursed by a monthly capitated rate. DOS-DMS is unable to determine the number of MC+ Medicaid eligibles who have received an eye exam. However, the increased utilization of a currently covered benefit would result in additional costs to the managed care ASSUMPTION (continued)

health plans. Therefore, the fiscal impact to the DOS-DMS, for the increase in the managed care capitated rates due to the increased utilization and for the cost of the actuarial consultant for DMS to re-negotiate the current contracts with the managed care health plans, would be

unknown greater than $100,000 for the MC+ Medicaid eligibles. (§ 167.195)

DOS-DMS notes that if an optometrist or an ophthalmologist were to provide a service on a free cost basis, the provider would not be able to bill Medicaid for these services. Section 1902(a)(17)(B) of the Social Security Act prohibits payment for services to a recipient for which the recipient bears no liability to pay. However, services provided by an optometrist or an ophthalmologist on a reduced cost basis would still be covered by Medicaid.

FISCAL IMPACT - Small Business

There is a potential increase in revenue for eye care specialists and vision services businesses.

FISCAL DESCRIPTION

§ 167.195

Beginning July 1, 2008, every child enrolling in kindergarten or first grade shall receive one comprehensive vision examination performed by a state licensed optometrist, ophthalmologist, physician or doctor of osteopathy.

The proposal requires the Department of Elementary and Secondary Education and the Department of Health and Senior Services to compile and maintain a list of sources to which children who may need vision examinations or children who have been found to need further DESCRIPTION (continued)

examination or vision correction may be referred for treatment on a free or reduced cost basis. A child may be excused from taking a vision examination based on religious beliefs by submitting a written request to the appropriate school administrator.

§ 192.935

The proposed legislation alters the statutorily-allowed uses for the "Blindness Education, Screening and Treatment Program Fund". The fund shall cover additional costs for vision examinations under this proposal that are not covered by existing public health insurance. Subject to appropriations, moneys from the fund shall be used to pay for those additional costs, provided that the costs from the fund not exceed ninety-nine thousand dollars a year. Payment from the fund for vision examinations under this act shall not exceed the allowable state medicaid reimbursement amount for vision examinations.

This act shall automatically sunset on June 12, 2012.

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

Department of Elementary and Secondary Education

Department of Insurance, Finance, and Professional Regulation

Department of Health and Senior Services

Department of Social Services

Office of State Treasurer

Office of Secretary of State

            Administrative Rules Division

                                                                                                Mickey Wilson, CPA

                                                                                                Director

                                                                                                February 5, 2007