LEGISLATIVE FISCAL OFFICE
Fiscal Note
Fiscal Note On: HB 939 HLS 24RS 2113
Bill Text Version: ENGROSSED
Opp. Chamb. Action:
Proposed Amd.:
Sub. Bill For.:
Date: May 1, 2024 8:43 AM Author: FISHER
Dept./Agy.: LDH
Subject: at home care Analyst: Shawn Hotstream
HEALTH/SICKLE CELL ANEM EG INCREASE GF EX See Note Page 1 of 1
Provides relative to healthcare services provided to patients with sickle cell disease
Proposed law provides Medicaid coverage for digital monitoring of vital signs and 24-hour at home care for Medicaid eligibles
diagnosed with sickle cell disease. Services may include hydration and oxygenation at the direction of a healthcare
professional.
EXPENDITURES 2024-25 2025-26 2026-27 2027-28 2028-29 5 -YEAR TOTAL
State Gen. Fd. INCREASE INCREASE INCREASE INCREASE INCREASE
Agy. Self-Gen. $0 $0 $0 $0 $0 $0
Ded./Other INCREASE INCREASE INCREASE INCREASE INCREASE
Federal Funds INCREASE INCREASE INCREASE INCREASE INCREASE
Local Funds $0 $0 $0 $0 $0 $0
Annual Total
REVENUES 2024-25 2025-26 2026-27 2027-28 2028-29 5 -YEAR TOTAL
State Gen. Fd. $0 $0 $0 $0 $0 $0
Agy. Self-Gen. $0 $0 $0 $0 $0 $0
Ded./Other SEE BELOW SEE BELOW SEE BELOW SEE BELOW SEE BELOW
Federal Funds $0 $0 $0 $0 $0 $0
Local Funds $0 $0 $0 $0 $0 $0
Annual Total
EXPENDITURE EXPLANATION
Providing Medicaid coverage for digital monitoring and 24-hour at-home care for Medicaid enrollees diagnosed with sickle
cell disease is anticipated to result in significant Medicaid expenditure in FY 25 and future fiscal years. Based on the number
of projected eligibles and specific at-home services referenced in the proposed legislation, Medicaid expenditures are
anticipated to increase by a minimum of $1 M annually ($257,724 SGF, 712,525 federal match in FY 25). This estimate is
understated based on excluding the cost of the at-home monitoring technology. The estimate is based on the following
assumptions.
1). 3,223 number of Medicaid enrollees diagnosed with sickle cell
2). Members with a diagnosis of sickle cell during FY 22-23
3). Remote patient monitoring program calculated using procedure codes 99453, 99454, 99458, and 99091
4). Total cost estimated per sickle cell recipient is $1,911.36 annually
5). In-home care costs calculated for 12 months with a 15% initial uptake (utilization), and 5% year over year
To the extent utilization increases, cost will increase proportionately. The overall cost per individual is understated, as the
estimate does not consider the cost of monitoring devices, as specific types of devices would vary on a case-by-case basis,
depending on patient needs.
Note: The LFO is researching the additional cost associated with the purchase and maintenance of the technology.
REVENUE EXPLANATION
Any additional payments in managed care under this measure will result in additional tax revenues based on the 5.5%
managed care premium tax.
Senate Dual Referral Rules House
x 13.5.1 >= $100,000 Annual Fiscal Cost {S & H} x 6.8(F)(1) >= $100,000 SGF Fiscal Cost {H & S}
13.5.2 >= $500,000 Annual Tax or Fee Patrice Thomas
6.8(G) >= $500,000 Tax or Fee Increase
Change {S & H} or a Net Fee Decrease {S} Deputy Fiscal Officer