Fiscal Note & Local Impact Statement

126 th General Assembly of Ohio

Ohio Legislative Service Commission

77 South High Street, 9th Floor, Columbus, OH 43215-6136 Phone: (614) 466-3615

Internet Web Site: http://www.lsc.state.oh.us/

BILL:

Sub. S.B. 87

DATE:

September 7, 2005

STATUS:

As Passed by the Senate

SPONSOR:

Sen. Wachtmann

LOCAL IMPACT STATEMENT REQUIRED:

No

No local cost

 


CONTENTS:

Amends the law regarding the provision of hospice care in residential care facilities

 

State Fiscal Highlights

 

STATE FUND

FY 2006

FY 2007

FUTURE YEARS

General Revenue Fund

Revenues

Potential gain or loss

in federal Medicaid reimbursement as a result of an increase or decrease in Medicaid costs

Potential gain or loss

in federal Medicaid reimbursement as a result of an increase or decrease in Medicaid costs

Potential gain or loss

in federal Medicaid reimbursement as a result of an increase or decrease in Medicaid costs

Expenditures

Potential increase or decrease

Potential increase or decrease

Potential increase or decrease

 

        If a person whose need for hospice care and services extends beyond the 120-day limit and were to be transferred to a nursing home or intermediate care facility for the mentally retarded, the bill, by allowing an individual to remain in a residential care facility and receive hospice care and services without a time limit, is likely to save Medicaid costs to the state. On the other hand, if a person would choose to discontinue hospice services because they do not wish to be transferred or discharged, then the provisions of the bill allowing them to continue services would increase state Medicaid costs. However, it seems that while the provisions of the bill may increase or decrease Medicaid costs, any impact would be minimal since the length of most hospice care is less than 120 days. The state will receive reimbursement of approximately 60% of the Medicaid costs from the federal government.

Local Fiscal Highlights

 

        No direct fiscal effect on political subdivisions.

 


 


 

Detailed Fiscal Analysis

 

Background

 

A residential care facility is permitted to provide a limited amount of skilled nursing care to its residents.  Specifically, a residential care facility may provide skilled nursing care as follows:

 

(1) Supervision of special diets;
(2) Application of dressings;
(3) Medication administration;

(4) Other skilled nursing care, but only if the care will be provided to a resident on a part-time intermittent basis for not more than 120 days in any 12-month period.  The care may be provided by a home health agency, hospice care program, or qualified member of the facility's staff.

 

Therefore, a person residing in a residential care facility who is in need of hospice care and services can, under current law, receive those services but not for more than 120 days in any 12-month period. If a person requires or desires hospice services beyond the 120-day limit, the residential care facility would have to transfer or discharge the resident. If the person does not wish to leave the residential care facility, the hospice care and services may be discontinued.

 

The Bill

 

The bill allows a residential care facility to admit and retain an individual who requires hospice care and services and includes hospice care and services among the skilled nursing care that a residential care facility can provide without the 120-day time limitation.

 

Therefore, a person residing in a residential care facility who is in need of hospice care and services can, under the bill, receive those services for as long as needed without being discharged, transferred to another facility, such as a nursing home, or having the services discontinued after 120 days.

 

Fiscal Impact

 

A person whose need for hospice care and services extends beyond the 120-day limit may be transferred to a nursing home or intermediate care facility for the mentally retarded (ICF/MR). If the person is a Medicaid recipient, the cost of providing hospice care and services in a nursing home or ICF/MR is greater than providing the care and services in a residential care facility because Medicaid pays for not only the hospice care and services in a nursing home or ICF/MR but also the cost of room and board. In this scenario, allowing an individual to remain in a residential care facility and receive hospice care and services without a time limit is likely to save Medicaid costs to the state. If a person would choose to discontinue hospice services because they do not wish to be transferred or discharged, then the provisions of the bill allowing them to continue services would increase state Medicaid costs.

 

However, according to an analysis of services delivered under the Medicaid hospice program prepared by the Auditor of State, the length of stay in the Medicaid hospice program average 52.7 days, with a median of 18 days, and ranged from 1 to 973 days. Therefore, it seems that while the provisions of the bill may increase or decrease Medicaid costs, any impact would be minimal since the length of most hospice care is less than 120 days.

 

 

 

LSC fiscal staff: Ivy Chen, Economist

 

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