SB 0138 - Fiscal Note

Fiscal Note - SB 0138 - Requires physicians to inform breast implantation patients of the risks and advantages of the surgery

COMMITTEE ON LEGISLATIVE RESEARCH

OVERSIGHT DIVISION

FISCAL NOTE

L.R. NO. 0064-01

BILL NO. SB 138

SUBJECT: Health Care

TYPE: Original

DATE: January 4, 1999

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FISCAL SUMMARY

ESTIMATED NET EFFECT ON STATE FUNDS
FUND AFFECTED	FY 2000	FY 2001	FY 2002
Insurance Dedicated Fund	($25,000 to $50,000)	($15,000 to $25,000)	($15,000 to $25,000)
Total Estimated Net Effect on All State Funds	($25,000 to $50,000)	($15,000 to $25,000)	($15,000 to $25,000)

ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED	FY 2000	FY 2001	FY 2002
None
Total Estimated Net Effect on All Federal Funds	$0	$0	$0

ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED	FY 2000	FY 2001	FY 2002
Local Government	$0	$0	$0

Numbers within parentheses: ( ) indicate costs or losses

This fiscal note contains 3 pages.

FISCAL ANALYSIS

ASSUMPTION

The Department of Corrections, Department of Conservation, Department of Transportation, Missouri Consolidated Health Care Plan, and Department of Public Safety, Missouri State Highway Patrol assume this proposal would not fiscally impact their agency.

The Department of Social Services state that physicians are already required to obtain a patient's informed consent before surgery, and the burden for this additional information would be minimal and should not increase Medicaid costs.

The Department of Insurance (INS) states that they do not have the medical expertise to develop a standardized summary nor do they have the network for distribution of the required information to all hospitals, clinics, physicians' offices that perform breast implantation. INS further states that they regulate insurers and agents and have no authority or existing programs that are in contact with the health care providers that could implement this legislation. INS assumes they would have to contract with an outside entity to develop the summary and patient signature statement as well as update and distribute the materials. There were approximately 2,200 breast cancer patients and 1,558 breast implant operations performed in Missouri Hospitals and Ambulatory Surgical Centers during 1997. It is not known how many physicians, clinics, hospitals, and other health care entities provide breast implant surgeries. INS estimates that initial development, printing, and distribution of the materials would cost $25,000 to $50,000, and updating and distributing material in subsequent years would cost $15,000 to $25,000 per year. INS states that actual costs could be more or less depending on the bids on the contract.

FISCAL IMPACT - State Government	FY 2000	FY 2001	FY 2002
	(10 Mo.)
INSURANCE DEDICATED FUND
Cost - Preparing and distributing materials	($25,000	($15,000	($15,000
	to $50,000)	to $25,000)	to $25,000)
ESTIMATED NET EFFECT ON	($25,000	($15,000	($15,000
INSURANCE DEDICATED FUND	to $50,000)	to $25,000)	to $25,000)
FISCAL IMPACT - Local Government	FY 2000	FY 2001	FY 2002
	(10 Mo.)
	$0	$0	$0
FISCAL IMPACT - Small Business
No direct fiscal impact to small businesses would be expected as a result of this proposal.

DESCRIPTION

This proposal requires physicians to inform patients of the advantages, disadvantages, and risks associated with breast implantation before operating on a patient to insert breast implants. It also requires the Department of Insurance to provide a standardized written summary that contains all general information on breast implantation, including the dangers and side effects of the operation, to all hospitals, clinics, and physicians' offices that perform breast implantation. Physicians satisfy the requirements of this proposal if they provide breast implantation patients with the standardized written summary and the patient signs a statement acknowledging receipt of the summary.

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 Insurance

Missouri Consolidated Health Care Plan

Department of Transportation

Department of Corrections

Department of Conservation

Department of Public Safety

Missouri State Highway Patrol

Jeanne Jarrett, CPA

Director

January 4, 1999