Fiscal Note - SB 0214 - Direct Access To Eye Care Providers
L.R. NO. 0996-01
BILL NO. SB 214
SUBJECT: Health Care, Health Care Professionals, Insurance-medical,
Optometry
TYPE: #Updated
DATE: March 5, 1997
#Updated to reflect new information.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON STATE FUNDS
FUND AFFECTED FY 1998 FY 1999 FY 2000
All Funds (Unknown)* (Unknown)* (Unknown)*
Insurance
Dedicated $14,250 to $28,500 $0 $0
Total Estimated
Net Effect on All (less than (less than (less than
State Funds $100,000) $100,000) $100,000)
*Expected to be less than $100,000 annually.
ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED FY 1998 FY 1999 FY 2000
None
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 Unknown Unknown Unknown
FISCAL ANALYSIS
ASSUMPTION
Officials from the Department of Corrections, the Department of
Transportation, the Department of Public Safety - Missouri State Highway
Patrol, the Office of Administration, the Department of Economic Development
- Division of Professional Registration, and the Department of Conservation
assume this proposal would not fiscally impact their agencies.
The Department of Insurance (INS) states that approximately 250 health
insurers and 35 HMOs have policies filed with INS. Each insurer may submit
one or two policy form amendments (one for individual and one for group or
one filing for both) to comply with the requirements of this proposal. The
result would be a range of 285 to 570 new policy filings needed to comply
with this proposal. Form filings are to be accompanied with a $50 filing
fee. Based on the estimated range of new policy filings, $14,250 to $28,500
in new revenue would be generated for the Insurance Dedicated Fund in the
first fiscal year only. INS further states that the passage of more than one
similar proposal could require the INS to request increased appropriations to
cover cumulative administrative costs.
Officials from the Missouri Consolidated Health Care Plan (HCP) state that a
1996 study by the Barents Group projected increased cost through self
referral for health services. HCP further states that when examining self
referral to emergency rooms, a technical expert panel of actuaries, assembled
by Barents, found an increase in costs for managed care companies of one to
three percent annually. HCP believes that this percentage increase could be
applied when considering the impact of self referral to specialist physicians
for these services. HCP assumes a two percent annual inflation factor. When
the state's contribution to employee benefits is applied to those HMOs
requiring primary care physician approval of referral, HCP estimates this
amount to be $1,398,160 annually. In addition, HCP estimates the fiscal
impact on public entities participating in HCP plans to be $275,400 annually.
#Oversight has received new information stating the assumption by HCP of a
one to three percent increase in premiums was based on a study of self
referral to emergency rooms not for self referral for vision care.
Oversight estimates the fiscal impact to be unknown but would be less than
$100,000 annually.
FISCAL IMPACT - State Government FY 1998 FY 1999 FY 2000
(10 Mo.)
#ALL FUNDS
Cost - State Government
Increased state contribution* (Unknown) (Unknown) (Unknown)
ESTIMATED NET EFFECT ON
ALL FUNDS (less than (less than (less than
$100,000) $100,000) $100,000)
*Expected to be less than $100,000 annually.
INSURANCE DEDICATED FUND
Income - Department of Insurance
Filings fees $14,250 to $28,500 $0 $0
ESTIMATED NET EFFECT ON
INSURANCE DEDICATED FUND $14,250 TO $28,500 $0 $0
FISCAL IMPACT - Local Government FY 1998 FY 1999 FY 2000
(10 Mo.)
#LOCAL GOVERNMENTS
Costs - Local Governments
Premium increases (Unknown) (Unknown) (Unknown)
ESTIMATED NET EFFECT ON
LOCAL GOVERNMENTS (Unknown) (Unknown) (Unknown)
FISCAL IMPACT - Small Business
Small businesses would be expected to be fiscally impacted to the extent that
they would incur additional costs for increases in premiums due to the
requirements of this proposal.
DESCRIPTION
This proposal contains several provisions related to insurance coverage for
eye care. The proposal would:
(1) Prohibit health care insurers from requiring a referral from the
insured's primary
care physician before seeing an ophthalmologist or optometrist (provider);
(2) Prohibit health care insurers from discriminating against a provider by
setting different reimbursement rates for the same services;
(3) Require health care insurers to have an adequate number of providers
available to provide services; and
(4) Prohibit health care insurers from requiring providers to have hospital
staff privileges.
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 Insurance
Department of Corrections
Office of Administration
Department of Transportation
Missouri Consolidated Health Care Plan
Department of Public Safety
Missouri State Highway Patrol
Department of Economic Development
Division of Professional Registration
This Fiscal Note is not an official copy and should not be quoted or cited.