Fiscal Note - SB 0283 - Abortion-Licensing of Facilities & Physician and Penalties and Alternatives to Abortion
L.R. NO. 0970-01
BILL NO. SB 283
SUBJECT: Abortion
TYPE: Original
DATE: February 10, 1997
FISCAL SUMMARY
ESTIMATED NET EFFECT ON STATE FUNDS
FUND AFFECTED FY 1998 FY 1999 FY 2000
Total Estimated
Net Effect on All
State Funds $0 $0 $0
ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED FY 1998 FY 1999 FY 2000
Total Estimated
Net Effect on All
Federal Funds $0 $0 $0
ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED FY 1998 FY 1999 FY 2000
Local Government $0 $0 $0
FISCAL ANALYSIS
ASSUMPTION
The Office of Prosecution Services (OPS), State Public Defender (SPD), Office
of State Courts Administrator (CTS), and Department of Social Services (DOS)
do not expect to be fiscally impacted.
The Department of Insurance (INS) does not expect this proposal to have a
significant fiscal impact in its current form and any costs could be absorbed
with existing resources. However, if more than one such proposal is enacted
the INS may need an increase in its appropriation due to the combined effect
of multiple proposals.
The Department of Health (DOH) indicates costs of $323,173 to $3.7 million in
FY98; $331,579 to $4.2 million in FY99; and $341,526 to $4.3 million in FY00.
DOH assumes that over the past five years there has been an average of 16,000
resident abortions each year. There are approximately 75,000 live births per
year, with an unintended pregnancy rate of 51% or 38,250 unintended
pregnancies. Combining these categories, DOH assumes a potential client pool
of 54,250. In a similar proposal from the 1996 legislative session, DOH had
requested two FTE (Health Educator III and Clerk Typist II) to provide
services to these individuals. The FTE were received in the FY97 budget so
no costs were included by DOH for any additional FTE.
The DOH assumes that it would receive 54,250 calls at a cost of $1.00 per
call. According to DOH, it received FTE and expense and equipment in its
FY97 budget related to the expansion of the Tel-Link system. Oversight
assumes no new costs would be incurred.
DOH assumes that the definition of abortion facility would require it to
inspect physicians offices and other abortion facilities, resulting in a
potential 100 to 1,500 facilities which would have to be inspected. In order
to conduct a comprehensive review of these facilities, DOH assumes that a
survey team comprised of, at a minimum, 2 Health Facility Nursing Consultants
and a Health Facility Consultant I, would be required. The Health Facility
Nursing Consultants would evaluate the care provided while the Health
Facility Consultant I would evaluate the construction, fire safety
requirements and infection control. In addition, a Health Facility
Consultant II would be needed to manage the program and develop rules and
regulations. Clerical support would be needed as well. This would be the
minimum needed to inspect 100 facilities. Therefore, DOH has ranged the
costs for the staff from the 100 to 1,500 facilities.
Section 192.038 requires any abortion facilities as defined in section
188.015, which advertises and holds itself out to the public as providing
abortions and which is not required to be licensed as an ambulatory surgical
center, to be inspected, at least annually, by the DOH. Similar language has
previously been contested and per a decision by the Oversight Subcommittee on
April 10, 1996, any costs related to licensure and inspection have been
eliminated. Furthermore, the proposal does not require the DOH to contract
with the local health departments for the provision of services. Based on
the previous Oversight Subcommittee ruling, interpretation of the language in
this proposal, and the fact that DOH already inspects and licenses certain
abortion facilities by regulation, Oversight assumes there would be no fiscal
impact related to this provision.
FISCAL IMPACT - State Government FY 1998 FY 1999 FY 2000
(6 Mo.)
$0 $0 $0
FISCAL IMPACT - Local Government FY 1998 FY 1999 FY 2000
(6 Mo.)
$0 $0 $0
FISCAL IMPACT - Small Business
This proposal would not have a direct fiscal impact on small businesses.
DESCRIPTION
The proposal would prohibit abortions from being performed except in a
physician's office, outpatient clinic, licensed ambulatory surgical center or
licensed hospital.
Physicians would be prohibited from leaving a facility after an abortion
until the patient has been discharged or unless another physician is present.
Physicians would be required to maintain medical malpractice insurance of at
least $500,000 for personal injury, death or failure to render health care
services. Physicians would be prohibited from performing abortions at a
hospital unless the physician has clinical privileges, including obstetrical
or gynecological care at a hospital in this state. Failure to have clinical
privileges at a hospital which offers obstetrical or gynecological care would
be a class A misdemeanor.
An abortion facility as defined under chapter 188.015 (i.e., clinic,
physician's office or any other place or facility in which abortions are
performed other than a hospital) would not be required to be licensed as an
ambulatory surgical center, but would be inspected at least annually, or any
time for good cause, by the Department of Health (DOH). DOH would promulgate
rules and regulations deemed in order to establish standards of service and
care. No rule or regulation would restrict or interfere with operations or
programs concerning the physical health and safety of patients. Twenty day
written notice would be given to the facility when the DOH finds that a
facility is substantially failing to comply with any provision of this
proposal or the health, safety or record keeping provisions of chapter 188,
RSMo. Failure on the part of the facility to correct the violation could
result in DOH seeking whatever relief necessary to enforce this proposal and
the health, safety or record keeping provisions of chapter 188, RSMo. The
DOH could seek other relief available under the law as well.
The DOH would be required to provide a program of information and referral
regarding alternatives to abortion services, including a computerized listing
of available services, a referral program and/or a statewide toll-free
telephone number in connection with the Tel-Link program. When the DOH
publicizes the Tel-Link program, it would include information concerning the
alternatives available through Tel-Link.
This proposal would become effective January 1, 1998.
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 Social Services
Department of Health
Department of Insurance
Office of State Courts Administrator
State Public Defender
Office of Prosecution Services
NOT RESPONDING: Attorney General
This Fiscal Note is not an official copy and should not be quoted or cited.