Subject: Health Care; Health Care Professionals; Health Department; Hospitals; Physicians

Bill Summary: This legislation modifies the designation of hospitals as trauma, heart attack, or stroke centers to implement a time critical diagnosis system.

ESTIMATED NET EFFECT ON GENERAL REVENUE FUND
FUND AFFECTED	FY 2009	FY 2010	FY 2011


Total Estimated Net Effect on General Revenue Fund	$0	$0	$0

ESTIMATED NET EFFECT ON OTHER STATE FUNDS
FUND AFFECTED	FY 2009	FY 2010	FY 2011


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

ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED	FY 2009	FY 2010	FY 2011


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

ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)
FUND AFFECTED	FY 2009	FY 2010	FY 2011


Total Estimated Net Effect on FTE	0	0	0

☐ Estimated Total Net Effect on All funds expected to exceed $100,000 savings or (cost).

☐ Estimated Net Effect on General Revenue Fund expected to exceed $100,000 (cost).

ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED	FY 2009	FY 2010	FY 2011
Local Government	$0	$0	$0

Officials from the Department of Health and Senior Services (DHSS) state section 190.241 requires the DHSS to designate a hospital as a heart attack or stroke center if they meet the necessary criteria and complete the application and review process. An on-site review would be completed every five years. The legislation would also allow the DHSS to establish an appropriate fee for the review.

It is difficult to estimate the number of hospitals that would participate as heart attack and/or stroke centers. There are currently 29 hospitals designated as trauma centers. DHSS believes that most of the 29 trauma centers would also participate as a stroke center and that about two-thirds or 19 of these hospitals would participate as heart attack centers. DHSS further believes there will be other hospitals that are not trauma centers that would participate in one or both programs.

DHSS believes that existing resources, including grant funding from the Centers for Disease Control and Prevention, can be utilized to implement this program. No additional funding would be required.

Officials from the Department of Social Services states the Institutional Reimbursement Unit (IRU) of the MO HealthNet Division (MHD) determines a per diem reimbursement rate for each hospital based on the cost reports submitted by the hospital to the IRU. Payments are made to all hospitals based on their per diem rate for all inpatient care they provide regardless of the patient's injury or disease.

Currently, there are three levels of trauma designation assigned by DHSS. This legislation creates additional designations for heart attack or stroke centers. Though facilities' payments may be identified differently due to these designations their overall payments will not increase or decrease due to these designations. Some incidental costs may be incurred by the facilities due to licensing fees and paperwork associated with these designations but these costs are not significant. Therefore, there will be no fiscal impact to the MHD due to this legislation.

It could impact small ambulance services by mandating that a patient be transferred to a hospital that is not the closest facility. The cost for this should be reimbursed by private insurance companies, but there could be an issue with coverage from Medicare.

This legislation is not federally mandated, would not duplicate any other program and would not require additional capital improvements or rental space.

FISCAL IMPACT - State Government	FY 2009 (10 Mo.)	FY 2010	FY 2011

	$0	$0	$0