COMMITTEE ON LEGISLATIVE RESEARCH

OVERSIGHT DIVISION

FISCAL NOTE

L.R. No.:         5189-01

Bill No.:          SB 1169

Subject:           Children and Minors; Health, Public; Health Department

Type:              Original

Date:               March 10, 2008

Bill Summary:            This legislation establishes a school-based influenza vaccination pilot program.

FISCAL SUMMARY

Numbers within parentheses: ( ) indicate costs or losses.

This fiscal note contains 6 pages.

☐ 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).

FISCAL ANALYSIS

ASSUMPTION

Officials from the Missouri Senate assume the proposal would have no fiscal impact on their agency.

Officials from the Office of the Secretary of State (SOS) state many bills considered by the General Assembly include provisions allowing or requiring agencies to submit rules and regulations to implement the act. The SOS is provided with core funding to handle a certain amount of normal activity resulting from each year’s legislative session. The fiscal impact for this fiscal note to the SOS for Administrative Rules is less than $2,500. The SOS recognizes that this is a small amount and does not expect that additional funding would be required to meet these costs. However, the SOS also recognizes that many such bills may be passed by the General Assembly in a given year and that collectively the costs may be in excess of what the office can sustain with the core budget. Therefore, the SOS reserves the right to request funding for the cost of supporting administrative rules requirements should the need arise based on a review of the finally approved bills signed by the governor.

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 Social Services (DSS) assume the proposal requires the Department of Health and Senior Services to develop this program. It is assumed that MO HealthNet participant children would continue to receive their immunizations through the Vaccine for Children program and that the pilot project would provide immunizations for non MO HealthNet participant children. Therefore, it is assumed that the DSS will not be directly affected and there will be no additional costs to the DSS.

Officials from the Department of Elementary and Secondary Education assume the proposal would have no fiscal impact on their agency. Local school districts will incur unknown administrative costs to track and record the vaccinations.

Oversight, assumes the local school districts could absorb the costs to track and record the vaccinations.

ASSUMPTION (continued)

Officials from the Department of Health and Senior Services (DHSS) assume requires the Department to establish a school-based influenza vaccination program. The Department consulted with Dr. Robert Steele's medical group for assistance on developing assumptions to administer the program, since his group already operates a similar program in the Southwest part of the state. The medical group has encountered issues in dealing with Family Education Rights and Privacy Act, such as not being allowed to determine insurance status of individual students. Thus, their practice sends consent forms for the vaccines (via the school nurse) to the student's parents, who make the decision whether or not their child will receive the immunization. The parents complete the consent form and return it to the school, along with a dollar amount to pay for the vaccine. The school nurse facilitates receipt of the consent forms and money. Dr. Steele's group purchases the vaccine from a private source, and the school reimburses the practice for the cost of the vaccine with dollars collected from the students.

The pilot will run in three separate schools to represent three different school sizes. The costs are based on cost of vaccine given to 50 percent of the school's population, or 250 for the small school, 1,500 for the medium school, and 2,500 for the large school. The summary below provides the costs for each school participating in the pilot:

Note: Vaccine cost is the actual cost of delivering a dose of vaccine. Dose administration costs include gloves, tissues, and Epi-pens. Printed materials include consent forms, vaccine information sheets, and informational sheets for parents.

ASSUMPTION (continued)

To administer the program, the Department is requesting a total of 1.5 FTE, including 0.3 FTE for a Public Health Nurse, 0.75 FTE for a Health Program Rep. II, and 0.45 FTE for a Senior Office Support Assistant. The staff will coordinate ordering the vaccine through the Centers for Disease Control and Prevention, provide nurse consultation to advise and coordinate with school nurses; and personnel time to gather data and analyze the findings of how effectiveness the pilot program was. Standard expense and equipment would be needed for these staff.

Since it is assumed one year will be enough time to gauge the effectiveness of the pilot program, funding is requested only for one year to allow the pilot to run only during the 2009-2010 school year. Since DHSS will be required to promulgate rules prior to implementing the program, it is assumed funding would be needed for the pilot program during FY 2010.

Oversight assumes the DHSS could absorb a 0.3 Public Health Nurse FTE, a 0.75 Health Program Rep. II FTE and a 0.45 Senior Office Support Assistant FTE for the one year project. Oversight assumes any significant increase in the workload of the DHSS would be reflected in future budget request.

FISCAL IMPACT - Small Business

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

FISCAL DESCRIPTION

The proposed legislation provides that by July 1, 2009, the Department of Health and Senior Services shall establish a school-based influenza vaccination pilot program. When creating the program, the Department shall use a vaccine that will minimize discomfort to those vaccinated, consume the fewest medical supplies, speed administration by health officials and contain the least potential adverse events. The Department shall also take into account the cost and benefits, fiscal impact, and any barriers to implementing such a program.

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 Elementary and Secondary Education

Department of Health and Senior Services

Department of Social Services

Missouri Senate

Office of the Secretary of State

                                                                                                Mickey Wilson, CPA

                                                                                                Director

                                                                                                March 10, 2008