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

SPONSOR King

DATE

TYPED 02-20-05

HB 625

SHORT TITLE UNM Neurodevelopmental Diagnostic Center

SB

ANALYST Woods

APPROPRIATION

Appropriation Contained Estimated Additional Impact Recurring

or Non-Rec

Fund

Affected

FY05

FY06

FY05

FY06

$500.0

Recurring General Fund

(Parenthesis ( ) Indicate Expenditure Decreases)

Relates to the appropriation for the University of New Mexico in the General Appropriations

Act.

Relates to HJM32, SB124

SOURCES OF INFORMATION

LFC Files

Responses Received From

New Mexico Department of Health (DOH)

New Mexico Commission on Higher Education (CHE)

Developmental Disabilities Planning Council

SUMMARY

Synopsis of Bill

House Bill 625 – Making an Appropriation for the Neurodevelopmental Interdisciplinary Diag-

nostic Clinic at the University of New Mexico, Including its Programs in Autism Spectrum Dis-

order – appropriates $500,000 from the general fund to the Board of Regents of the University

of New Mexico for expenditure in FY06 for Neurodevelopmental Interdisciplinary Diagnostic

Clinic programs, including diagnostic evaluations for children with autism spectrum disorder and

telemedicine consultation for autism spectrum disorders. Any unexpended or unencumbered bal-

ance remaining at the end of FY06 shall revert to the general fund.

House Bill 625 -- Page 2

Significant Issues

DOH indicates that the number of children with autism spectrum disorders being identified and

needing evaluations has increased significantly both nationally and in New Mexico. The South-

west Autism Network in New Mexico serves 990 children ages 3-22 with Autism Spectrum Dis-

order with 67 percent of these clients between the ages of 3-8 years old. Diagnostic evaluations

should be timely and require a highly qualified inter-disciplinary team. The University of New

Mexico (UNM), Health Sciences Center, Center for Development and Disability (CDD) has such

expertise.

According to UNM-CDD the waiting list for children to receive an interdisciplinary evaluation

through the clinic is ten months. In 2004 the UNM-CDD conducted 74 evaluations on children

from across New Mexico. Thirty-three percent of the children evaluated were diagnosed with

Autism Spectrum Disorder and the remaining children were found to have other complex neuro-

developmental conditions. The Center for Telehealth at UNM has been working on developing a

telehealth consultation program to address health care capacity around specialty clinics. This ap-

propriation is to assist in meeting the increased need for diagnostic evaluations and consultation

for Autism Spectrum Disorders and other neurodevelopmental conditions across New Mexico.

The Developmental Disabilities Planning Council adds that:

•

autism is the fastest growing low-incidence disability, according to the U.S. De-

partment of Education;

•

between 3600-10,800 persons in New Mexico have Autism Spectrum Disorders;

•

the numbers of referrals for diagnostic and follow-up services continue to rise in

New Mexico; and

•

telemedicine is an effective way to share expertise and provide technical assis-

tance in rural or otherwise underserved areas.

The council does comment that, of the $500,000, the language does not specifically state “what

proportion would go toward the programs at UNM addressing autism spectrum disorders.”

CHE notes that this request was not in the list of priority projects submitted by the University of

New Mexico to the CHE for review. Accordingly, the request was not included in the commis-

sion’s funding recommendation for FY06.

PERFORMANCE IMPLICATIONS

DOH notes that this legislation in aligned with a number of the department’s strategic plan initia-

tives including:

•

Program Area 2: Health Care Delivery; Strategic Direction: Improve access to

health care services; and

House Bill 625 -- Page 3

•

Program Area 7: DD Community Services; Strategic Direction: To Promote in-

dependence, self-determination and inclusion in community life for persons with

developmental disabilities.

DOH adds that the legislation also aligns with the Governor’s Comprehensive Strategic Health

Plan to improve coverage and access to health care services for all New Mexicans.

FISCAL IMPLICATIONS

The appropriation of $500,000 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 gen-

eral fund.

ADMINISTRATIVE IMPLICATIONS

The University of New Mexico would retain oversight of this initiative.

CONFLICT, DUPLICATION, COMPANIONSHIP, RELATIONSHIP

Relates to the appropriation for the University of New Mexico in the General Appropriations

Act.

Relates to HJM32 in that HJM32 requires the legislative Health and Human Services Committee

to study the feasibility of establishing a system for determining the number of individuals with

Autism Spectrum Disorder (ASD) and how to deliver the necessary services to that population

and the feasibility of developing a “one-stop shop” approach ASD client evaluation.

Relates to SB124 in that SB124 seeks to appropriate $200,000 from the general fund to the Pub-

lic Education Department for the purpose of professional development for school personnel

working with students with Autism Spectrum Disorder.

TECHNICAL ISSUES

CHE notes that Autism Spectrum Disorder (ASD) is an increasingly popular term that refers to a

broad definition of autism including the classical form of the disorder as well as closely related

disabilities that share many of the core characteristics.

1

ASD includes the following diagnoses

and classifications:

•

Pervasive Developmental Disorder—Not Otherwise Specified (PDD-NOS),

which refers to a collection of features that resemble autism but may not be as

severe or extensive;

1

CHE indicates that the principal source for diagnosing autism is the Diagnostic and Statistical Manual of the

American Psychiatric Association, Fourth Edition (DSM-IV, 1994). Although children affected by autism are being

identified at earlier ages than was the case previously, the diagnosis usually does not occur until sometime between

two and three years of age. Diagnosticians are often reluctant to issue a formal diagnosis before the age at which

complex language is expected to emerge. However, early intervention services can still be provided on the basis of

developmental delay, even without a formal diagnosis of autism.

House Bill 625 -- Page 4

•

Rett's syndrome, which affects girls and is a genetic disorder with hard neuro-

logical signs, including seizures, that become more apparent with age;

•

Asperger syndrome, which refers to individuals with autistic characteristics but

relatively intact language abilities, and;

•

Childhood Disintegrative Disorder, which refers to children whose development

appears normal for the first few years, but then regresses with the loss of speech

and other skills until the characteristics of autism are conspicuous.

Although the classical form of autism can be readily distinguished from other forms of ASD, the

terms autism and ASD are often used interchangeably. Individuals with autism and ASD vary

widely in ability and personality. Individuals can exhibit severe mental retardation or be ex-

tremely gifted in their intellectual and academic accomplishments. While many individuals pre-

fer isolation and tend to withdraw from social contact, others show high levels of affection and

enjoyment in social situations. Some people with autism appear lethargic and slow to respond,

but others are very active and seem to interact constantly with preferred aspects of their envi-

ronment.

OTHER SUBSTANTIVE ISSUES

As general background to this initiative, DOH offers the following observations:

•

Both nationally and in New Mexico there has been a significant growth in the

number of children diagnosed with Autism Spectrum Disorders (ASD). Accord-

ing to a study by the University of Missouri-Columbia (Baker, D. L., 2004,

March 16. Public Policy and the Shaping of Disability: Incidence Growth in

Educational Autism) the average growth rate nationwide for ASD between 1995

and 2002 has been 307 percent, compared with just 15 percent for all other dis-

abilities.

•

According the Centers for Disease Control (CDC) studies done in Europe and

Asia since 1985 have found that as many as 6 of every 1,000 children have ASD.

CDC studies in the United States have shown a prevalence of between 3-6 per

1,000 children. Given these statistics it is estimated that there may be approxi-

mately 7,200 to 10,800 children and adults with Autism Spectrum Disorders in

New Mexico, with an estimated 540 - 810 children under the age of five.

•

Identification of children with Autism Spectrum Disorders typically occurs be-

tween the age of 2 – 4 years old. Due to the specific recommended interventions

for children with Autism Spectrum Disorders, it is important that they are accu-

rately diagnosed early in order to receive appropriate early intervention or pre-

school special education services.

•

The Department of Health currently contracts with the University of New Mex-

ico – Center for Development and Disability (UNM-CDD) to conduct compre-

hensive diagnostic evaluations for children birth the age three, which includes

young children where there is a concern regarding a diagnosis of Autism Spec-

House Bill 625 -- Page 5

trum Disorders. The UNM-CDD is able to bill Medicaid for children under age

three for these evaluations.

•

Experts in Autism at the UNM-CDD, who work as part of the Southwest Autism

Network and Project SET (Specialized Early Teaching), along with the Early

Childhood Evaluation Program collaborate in conducting diagnostic evaluations

of children with autism spectrum disorders. The UNM-CDD operates an autism

clinic at their Albuquerque location and also conducts diagnostic evaluation in

local communities. The clinical team consists of a developmental pediatrician, a

neuropsychologist, speech-language pathologists, a family specialist and staff

from other disciplines, including speech-language pathology, medicine, social

work, psychology and nutrition. Efforts have begun by the UNM-CDD to pro-

vide consultation services to local providers through telehealth conferencing thus

minimizing the need for families to often travel long distances to Albuquerque to

receive follow-up.

CHE observes that higher education institutions receive indirect cost revenues from federal con-

tracts and grants. This money is unrestricted in the sense that the governing board of the institu-

tion has the flexibility to choose which projects are supported with these funds. A great deal of

this money is used as seed money to develop new research and public services projects at institu-

tions. A portion of the indirect cost revenue, and earned overhead, is used to support items such

as the salaries of the accountants responsible for monitoring the contract and grants, or for pay-

ing utilities and other expenses required to maintain the space where the contract and grant ac-

tivities are housed. Further, that the higher education funding formula allows institutions to re-

tain 100 percent of this indirect cost revenue. One of the purposes of retaining these funds is to

provide seed money and matching funds for projects such as the one proposed in this bill.

CHE further suggests – assuming that funding will continue beyond FY06 – that consideration

might be given to requiring University of New Mexico to submit a plan for program evaluation,

including specific program goals and criteria for assessing program effectiveness to the Legisla-

tive Finance Committee and the Commission on Higher Education by October 1, 2005. Further

that the university should also submit a program evaluation to the Legislative Finance Commit-

tee and the Commission on Higher Education by June 30, 2008 detailing the benefits to the State

of New Mexico from having this program implemented for a three-year period.

BFW/njw