COMMITTEE ON LEGISLATIVE RESEARCH

OVERSIGHT DIVISION

FISCAL NOTE

L.R. No.: 1593-01

Bill No.: SB 453

Subject: Education, Higher; Guardians; Health Care; Health Dept.; Health, Public.

Type: Original

Date: March 4, 2003

FISCAL SUMMARY

ESTIMATED NET EFFECT ON GENERAL REVENUE FUND
FUND AFFECTED	FY 2004	FY 2005	FY 2006
General Revenue *	($69,641 to Unknown)	($71,792 to Unknown)	($73,668 to Unknown)

Total Estimated Net Effect on General Revenue Fund *	($69,641 to Unknown)	($71,792 to Unknown)	($73,668 to Unknown)

* expected to exceed $100,000 per year.

ESTIMATED NET EFFECT ON OTHER STATE FUNDS
FUND AFFECTED	FY 2004	FY 2005	FY 2006


Total Estimated Net Effect on Other State Funds	$0	$0	$0

Numbers within parentheses: ( ) indicate costs or losses.

This fiscal note contains 8 pages.

ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED	FY 2004	FY 2005	FY 2006


Total Estimated Net Effect on All Federal Funds	$0	$0	$0

ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED	FY 2004	FY 2005	FY 2006
Local Government	(Unknown)	(Unknown)	(Unknown)

FISCAL ANALYSIS

ASSUMPTION

Officials from North Central Community College assume this proposal would cost their organization approximately $20,000 per year for reporting and tracking.

Officials from the University of Missouri assume this proposal would cost their organization approximately $36,000 per year for materials, mailing, and staff time.

Officials from the St. Louis Community College System and the Metropolitan Community Colleges assume this proposal would have no impact on their organizations.

Officials from the Department of Higher Education (DHE) assume this proposal would have no direct fiscal impact on the DHE. However, it would impact the higher education institutions with on-campus housing, including 2-year and 4-year public and private institutions. Even if students paid a fee to cover the cost of the vaccination, institutions would incur additional costs associated with tracking on-campus students for meningitis vaccinations or exemptions. In addition, costs could be incurred to provide literature as required in the proposal.

ASSUMPTION (continued)

Oversight assumes there would be a significant but unknown cost to the institutions of higher education which operate on-campus student housing, and has shown this cost in the General Revenue Fund.

Officials from the Office of the Secretary of State (SOS) assume this proposal would require students enrolled in institutions of higher education to receive the meningitis vaccine. The department of health and senior services could promulgate rules to enact this legislation. Based on experience with other divisions, the rules, regulations, and forms issued by the department of health and senior services could require as many as 8 pages in the Code of State Regulations and half again as many pages in the Missouri Register because cost statements, fiscal notes and the like are not repeated in Code. These costs are estimated. The estimated cost of a page in the Register is $23 and the estimated cost of a page in the Code is $27. The actual cost could be more or less than the numbers given. The impact of the legislation in future years is unknown and depends upon the frequency and length of rules filed, amended, rescinded or withdrawn. ((8 x $27) + ($12 x $23) = $492)

Oversight assumes the SOS could absorb the costs of printing and distributing regulations related to this proposal. If multiple bills pass which require the printing and distribution of regulations at substantial costs, the SOS could request funding through the appropriation process. Any decisions to raise fees to defray costs would likely be made in subsequent fiscal years.

Officials from the Department of Health and Senior Services (DHSS) assume this proposal would require DHSS to promulgate rules related to a requirement that students in institutions of higher learning, who reside in on-campus housing, be vaccinated against meningococcal disease. DHSS estimates no added cost to promulgate the rule. However, if there is an expectation that the sentence "The Department of Health shall supervise and secure the enforcement of the required vaccination program" requires actual monitoring of the activity, then DHSS would have to hire staff to meet the supervision and enforcement requirement of the bill. It is assumed the supervision and enforcement would involve at least one on-site audit conducted annually for approximately 50 institutions of higher learning.

For every case of meningococcal disease that is prevented, DHSS could eliminate approximately three days of hospitalization for the patient and possible death, three to five days of investigation by public health staff, and several days of treatment with rifampin medication for contacts to the case.

ASSUMPTION (continued)

DHSS assumes that the proposed legislation requires us to establish an enforcement program for the vaccination requirement. Also, it is assumed that the supervision and enforcement of this legislation requires annual audits of the vaccination programs at the institutions of higher learning.

Staff -

Health Program Representative III (1.0 FTE)- This position serves as the coordinator for the supervision and enforcement of the required vaccination program. The duties & responsibilities of this position include drafting rules and regulations related to the legislation, developing procedures for conducting the annual on-site program review, conducting approximately 50 annual on-site reviews of vaccination programs, preparing routine and special reports for the visited institutions, DHSS administration, and legislators, monitoring changes required as a result of exceptions noted during on-site reviews, and supervising a .5 FTE support staff.

Office Support Assistant (.5 FTE)- The duties & responsibilities of this position include providing general clerical support to the HPR III, scheduling the on-site reviews, and creating and maintaining an electronic database for the program reviews.

Travel -

-$72 average CONUS rate for lodging x 2 trips per month x 12 = $1,728

-$38 average CONUS rate for meals x 2 trips per month x 12 = $912

-50 annual visits x 200 miles/trip x .33 (new rate July 1)/mile x 12 = $3,300

Other expenditures -

In addition to the normal E&E request for new staff the following extraordinary expense would also be required: one laptop computer for the HPR III since the position would require considerable field work; special travel expenses detailed above.

ASSUMPTION (continued)

DHSS estimated costs as follows:

FY2004 FY2005 FY2006

Salaries (1.5 FTE) $45,074 $55,441 $56,828

Benefits $16,529 $20,330 $20,839

Equipment $12,360 $0 $0

Phone relocation $900 $0 $0

Travel - Professional $4,950 $6,118 $6,302

Rent $4,500 $5,562 $5,729

Janitorial $867 $1,071 $1,103

Office Communications $1,750 $2,163 $2,228

DP Network Charges $3,333 $4,120 $4,244

Software $500 $618 $637

Supplies $733 $906 $934

Travel - subsistence $2,200 $2,719 $2,801

Mileage $33,000 $40,788 $42,012

Total $126,696 $139,836 $143,657

Oversight assumes the proposal would require DHSS to develop, monitor, supervise, and enforce the program. However, Oversight has, for fiscal note purposes only, changed the starting salary for the HPR III and the Office Support Assistant to correspond to the second step above minimum for comparable positions in the state's merit system pay grid. This decision reflects a study of actual starting salaries for new state employees for a six month period and the policy of the Oversight Subcommittee of the Joint Committee on Legislative Research. Oversight has also reduced the estimated costs for equipment and operations to correspond with Office of Administration - Division of Budget and Planning guidelines. Oversight further assumes that the small number of additional employees requested to implement this proposal could be housed in existing space.

Officials from Truman State University, Southwest Missouri State University, Southeast Missouri State University, Missouri Southern State College, State Fair Community College, and Three Rivers Community College did not respond to our request for information on this proposal.

FISCAL IMPACT - State Government	FY 2004 (10 Mo.)	FY 2005	FY 2006
GENERAL REVENUE FUND

Cost - Higher Education Institutions
Program Administration *	(Unknown)	(Unknown)	(Unknown)

Cost - Department of Health and Senior Services
Program Administration
Personal Service (1.5 FTE)	($34,475)	($42,404)	($43,464)
Fringe Benefits	($12,642)	($15,520)	($15,938)
Equipment	($9,708)	$0	$0
Expense	($12,816)	($13,868)	($14,266)
Total	($69,641)	($71,792)	($73,668)

ESTIMATED NET EFFECT ON GENERAL REVENUE FUND	($69,641 to Unknown)	($71,792 to Unknown)	($73,668 to Unknown)
* expected to exceed $100,000 per year.

FISCAL IMPACT - Local Government	FY 2004 (10 Mo.)	FY 2005	FY 2006
COMMUNITY COLLEGE DISTRICTS

Cost - Higher Education Institutions
Program Administration *	(Unknown)	(Unknown)	(Unknown)

ESTIMATED NET EFFECT ON COMMUNITY COLLEGE DISTRICTS *	(Unknown)	(Unknown)	(Unknown)
* expected to exceed $100,000 per year.

FISCAL IMPACT - Small Business

No direct fiscal impact to small businesses would be expected as a result of this proposal.

DESCRIPTION

This proposal would require students enrolled in institutions of higher education to receive meningitis vaccine:

The department of health, after consultation with the department of higher education, would promulgate rules and regulations governing the vaccination program. The department of health would also supervise and secure the enforcement of the required vaccination program.

A vaccination program would be implemented at each institution of higher education with students in on-campus housing. The vaccinations required and the manner and frequency of their administration would be required to conform to recognized standards of medical practice.

Except as provided below, a student enrolled in an institution of higher education who resides in on-campus student housing would be required to receive a vaccination against meningoccal disease.

A student could be exempted from the vaccination requirement if the institution of higher education provides detailed information on the risks associated with meningococcal disease and the effectiveness of meningitis vaccine to the student or to the student's parent or guardian if the student is a minor; and the student or the student's parent or guardian if the student is a minor, has received and reviewed the information provided, and has chosen not to have the vaccination against meningococcal disease.

Any student, or parent or guardian, if the student is a minor, choosing not to receive a vaccination must notify, in writing, the student health office of the institution of higher education of a decision not to be vaccinated.

The proposal would not require any institution of higher education to provide or pay for vaccinations.

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

North Central Missouri College

University of Missouri

St. Louis Community Colleges

Metropolitan Community Colleges

Secretary of State

Department of Higher Education

Department of Health and Senior Services

NOT RESPONDING

Truman State University

Southwest Missouri State University

Southeast Missouri State University

Missouri Southern State College

State Fair Community College

Three Rivers Community College

Mickey Wilson, CPA

Director

March 4, 2003