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F I S C A L I M P A C T R E P O R T
SPONSOR King
ORIGINAL DATE
LAST UPDATED
02/02/07
02/23/07 HB 375
SHORT TITLE Programs for Children With Certain Disorders
SB
ANALYST Geisler
APPROPRIATION (dollars in thousands)
Appropriation
Recurring
or Non-Rec
Fund
Affected
FY07
FY08
$7,750.0
Recurring
General Fund
(Parenthesis ( ) Indicate Expenditure Decreases)
REVENUE (dollars in thousands)
Estimated Revenue
Recurring
or Non-Rec
Fund
Affected
FY07
FY08
FY09
$14,876.8
$14,876.8 Recurring
Federal
Medicaid
(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
Significant,
see narrative
Significant,
see
narrative
Recurring General
(Parenthesis ( ) Indicate Expenditure Decreases)
Duplicates: SB 164
Relates to: SB 197
SOURCES OF INFORMATION
LFC Files
Responses Received From
Human Services Department (HSD)
Department of Health (DOH)
Public Education Department (PED)
pg_0002
House Bill 375 – Page
2
SUMMARY
Synopsis of Bill
House Bill 175, for the Legislative Health And Human Services Committee, appropriates $7.75
million in recurring general fund to establish and operate programs to benefit children with
neurodevelopmental disorders, including autism, as follows:
$6 million for the Department of Health (DOH) to match Medicaid funds to provide services
for adaptive skill building to children with an autism spectrum disorder.
$1 million for DOH to develop and deliver comprehensive training for professionals and
parents on adaptive skill building for children with autism spectrum disorders and for a
statewide family support network specific to autism spectrum disorders.
$750 thousand for the Center for Development and Disability (CDD) for a multidisciplinary
evaluation clinic for children with neurodevelopmental disorders, including autism spectrum
disorders.
The bill specifies that any unexpended or unencumbered funds remaining at the end of a fiscal
year shall not revert to the general fund
FISCAL IMPLICATIONS
This legislation duplicates the DOH budget request for 2 of the 3 items. In the FY08 operating
budget request, DOH requested $1 million for parent and healthcare provider training on children
diagnosed with autism spectrum disorders and $750 thousand for multidisciplinary evaluation
and diagnosis of autism spectrum disorders. The House Appropriations Committee Substitute
for House Bill 2 includes total funding of $1,050.0 for these two items.
HSD notes that the proposed general fund appropriation of $6,000,000 will draw an additional
$14,876,000 in federal matching funds through Medicaid, for a total amount of $20,876,000
available for services. To maintain the increased level of payment for future years, additional
funding will need included in the Medicaid budget request. In order to provide the “adaptive
skill-building services," HSD/MAD would have to amend its state plan, make file changes to the
Medicaid Management Information Systems (MMIS) and seek CMS approval for this benefit. If
approved under the Medicaid state plan, the new service would be an entitlement to everyone
that met the diagnosis criteria, including children currently on the DD waiver and the DD Central
Registry.
The $6,000.0 as proposed in the bill would provide these services to approximately 800
Medicaid eligible children, estimated to be only 1/3 of the children that have ASD in New
Mexico. The cost per person of $25 thousand general fund is slightly higher than the general
fund cost per person of the DD waiver, currently estimated at $23 thousand.
HB 375 could create a program that would not have sufficient funding to provide the services.
HSD is researching options for structuring this program to provide the maximum level of
services for the funding level provided.
In addition, HSD also notes that there is not sufficient funding for case management services that
would be provided with adaptive skills building. This cost is estimated to be at $1,000,000 total.
pg_0003
House Bill 375 – Page
3
SIGNIFICANT ISSUES
DOH notes that Autism Spectrum Disorders are lifelong neurodevelopmental, neurobiological
conditions. Autism is the fastest growing low incidence disability (US Department of Education
1999). Prevalence rate in New Mexico is estimated to be 3.6 per 1,000 (National Survey of
Children’s Health 2003-04), or approximately 1,813 children under the age of 18 with autism in
New Mexico (NM Treatment Service Data 2004). Estimates of individuals of all ages with the
disorder range from 3,600 to 10,800 persons (SWAN 2004). The Southwest Autism Network
(SWAN) database shows individuals with autism in every county but two in New Mexico. It is a
challenge for rural communities to provide services and trained individuals to provide services to
these clients.
HB 375 would provide autism specific services that are not currently available in our state and
are outside of the usual therapy and educational services provided through the Department of
Education and DOH’s Family Infant and Toddler program. This bill will build capacity and
infrastructure to serve people with autism spectrum disorders throughout the state by developing
a cadre of trained professionals who will be able to provide these services. It will provide
training for parents that-l will complement the professional services. It will create a center at the
CDD to provide a state of art, evidence based, best practice services for the state that will
contribute to positive outcomes for children and individuals and families with Autism Spectrum
Disorder.
Evidence-based research is clear that early and intensive intervention and treatment is important
to the overall prognosis of children with Autism Spectrum Disorders (SWAN, Centers for
Disease Control and Prevention, 2004). Currently, in New Mexico there is a three-year waiting
list for diagnostic evaluations for children over the age of 3. This waiting list limits access to
appropriate services and treatment, which may negatively affect prognosis.
The CDD currently has a variety of professionals with training in autism spectrum disorders, but
these may not be enough to meet the current and growing need in the state. HB 375 will allow
more individuals to access necessary services to improve their prognosis, improve independence,
treat co-existing medical and genetic conditions, reduce the need for special education services
and custodial care, and reduce the need for life-long interventions. (SWAN 2004, CDC). The
funding would pay for the training of 200 professionals and 120 families. Approximately 350
children a year could receive diagnostic services. HB 375 would provide intensive skill building
services to almost 800 children and youth in New Mexico. It will also reduce the financial
burden on families both directly and indirectly. Indirect costs of lost productivity for families and
individuals are estimated to range from $39,000 to $130,000 (Ganz 2006).
ADMINISTRATIVE IMPLICATIONS
DOH notes an additional FTE would be needed to administer these funds, manage the contracts,
provide monitoring and quality assurance of the services provided, and coordinate efforts with
HSD &CMS to include skill building services in the Medicaid State Plan. HSD notes that the
Medical Assistance Division would need to amend the Medicaid state plan which may require
several months to obtain federal approval, if approved, issue program regulations for public
comment.
pg_0004
House Bill 375 – Page
4
RELATIONSHIP
HB 375 is duplicated by SB 164.
DOH notes that SB 375 relates to SB 197, which would amend Chapter 59 of the New Mexico
State Statutes to prevent specific health insurance policies, health care plans, or contracts
delivered or issued for delivery in New Mexico from excluding coverage for the diagnosis and
treatment of Autism Spectrum Disorder.
GG/nt