LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 88TH LEGISLATIVE REGULAR SESSION March 24, 2023 TO: Honorable Senfronia Thompson, Chair, House Committee on Youth Health & Safety, Select FROM: Jerry McGinty, Director, Legislative Budget Board IN RE: HB2404 by Johnson, Ann (Relating to Medicaid coverage and reimbursement for functional family therapy services.), As Introduced Estimated Two-year Net Impact to General Revenue Related Funds for HB2404, As Introduced : a positive impact of $259,468 through the biennium ending August 31, 2025. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill. General Revenue-Related Funds, Five- Year Impact: Fiscal Year Probable Net Positive/(Negative) Impact toGeneral Revenue Related Funds2024$39,7532025$219,7152026$298,0252027$297,3762028$301,347All Funds, Five-Year Impact: Fiscal Year Probable (Cost) fromGR Match For Medicaid758 Probable (Cost) fromFederal Funds555 Probable Savings fromGR Match For Medicaid758 Probable Savings fromFederal Funds5552024($139,967)($216,273)$180,937$279,5802025($773,482)($1,154,199)$999,777$1,491,8792026($1,033,986)($1,541,321)$1,336,406$1,992,1272027($1,047,597)($1,561,611)$1,353,873$2,018,1642028($1,061,208)($1,581,901)$1,371,574$3,416,124Fiscal Year Probable Revenue (Loss) fromGeneral Revenue Fund1 Probable Revenue (Loss) fromFoundation School Fund1932024($913)($304)2025($4,935)($1,645)2026($6,591)$2,1962027($6,675)($2,225)2028($6,764)($2,255) Fiscal AnalysisThe bill would require the Health and Human Services Commission (HHSC) to establish and provide Medicaid reimbursement for functional family therapy services for eligible clients. LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 88TH LEGISLATIVE REGULAR SESSION March 24, 2023 TO: Honorable Senfronia Thompson, Chair, House Committee on Youth Health & Safety, Select FROM: Jerry McGinty, Director, Legislative Budget Board IN RE: HB2404 by Johnson, Ann (Relating to Medicaid coverage and reimbursement for functional family therapy services.), As Introduced TO: Honorable Senfronia Thompson, Chair, House Committee on Youth Health & Safety, Select FROM: Jerry McGinty, Director, Legislative Budget Board IN RE: HB2404 by Johnson, Ann (Relating to Medicaid coverage and reimbursement for functional family therapy services.), As Introduced Honorable Senfronia Thompson, Chair, House Committee on Youth Health & Safety, Select Honorable Senfronia Thompson, Chair, House Committee on Youth Health & Safety, Select Jerry McGinty, Director, Legislative Budget Board Jerry McGinty, Director, Legislative Budget Board HB2404 by Johnson, Ann (Relating to Medicaid coverage and reimbursement for functional family therapy services.), As Introduced HB2404 by Johnson, Ann (Relating to Medicaid coverage and reimbursement for functional family therapy services.), As Introduced Estimated Two-year Net Impact to General Revenue Related Funds for HB2404, As Introduced : a positive impact of $259,468 through the biennium ending August 31, 2025. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill. Estimated Two-year Net Impact to General Revenue Related Funds for HB2404, As Introduced : a positive impact of $259,468 through the biennium ending August 31, 2025. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill. General Revenue-Related Funds, Five- Year Impact: 2024 $39,753 2025 $219,715 2026 $298,025 2027 $297,376 2028 $301,347 All Funds, Five-Year Impact: 2024 ($139,967) ($216,273) $180,937 $279,580 2025 ($773,482) ($1,154,199) $999,777 $1,491,879 2026 ($1,033,986) ($1,541,321) $1,336,406 $1,992,127 2027 ($1,047,597) ($1,561,611) $1,353,873 $2,018,164 2028 ($1,061,208) ($1,581,901) $1,371,574 $3,416,124 2024 ($913) ($304) 2025 ($4,935) ($1,645) 2026 ($6,591) $2,196 2027 ($6,675) ($2,225) 2028 ($6,764) ($2,255) Fiscal Analysis The bill would require the Health and Human Services Commission (HHSC) to establish and provide Medicaid reimbursement for functional family therapy services for eligible clients. Methodology Assuming a March 1, 2024 start date, with utilization ramping up in the first year, the additional average monthly caseload associated with adding functional family therapy as a new Medicaid benefit is estimated to be 610 in fiscal year 2024 and 1,649 in fiscal year 2025, increasing in each subsequent fiscal year to 2,261 in fiscal year 2028. The estimated cost is $0.4 million in All Funds, including $0.1 million in General Revenue, in fiscal year 2024, and $1.9 million in All Funds, including $0.8 million in General Revenue, in fiscal year 2025, increasing each subsequent fiscal year to $2.6 million in All Funds, including $1.1 million in General Revenue in fiscal year 2028.HHSC estimates that there will be cost savings related to adding functional family therapy for clients that would have accessed outpatient psychotherapy or experienced inpatient hospitalizations. The estimated Medicaid savings is $0.5 million in All Funds, including $0.2 million in General Revenue, in fiscal year 2024, increasing each subsequent fiscal year to $3.4 million in All Funds, including $1.4 million in General Revenue in fiscal year 2028.The net decrease in client services payments through managed care is assumed to result in a decrease to insurance premium tax revenue, estimated as 1.75 percent of the increased managed care expenditures. Revenue is adjusted for assumed timing of payments and prepayments resulting in decreased collections estimated to be less than $0.1 million in fiscal year 2024, less than $0.1 million in fiscal year 2025, less than $0.1 million in fiscal year 2026, less than $0.1 million in fiscal year 2027, less than $0.1 million in fiscal year 2028. Pursuant to Section 227.001(b), Insurance Code, 25 percent of the revenue is assumed to be be a reduction in the credit towards the Foundation School Program. Technology HHSC indicates that any technology costs associated with the bill could be absorbed using existing resources. Local Government Impact No significant fiscal implication to units of local government is anticipated. Source Agencies: b > td > 529 Health and Human Services Commission 529 Health and Human Services Commission LBB Staff: b > td > JMc, NPe, ER, CST, NV JMc, NPe, ER, CST, NV