Relating to the establishment of state intensive psychiatric units at the state mental health institutes

Description

Senate File 2216 requires the Department of Human Services (DHS) to establish intensive psychiatric units for adults and children at the State mental health institutes (MHIs) at Cherokee and Independence.

The Bill requires each intensive psychiatric unit to have a minimum of 12 residential service beds to be used by adults and children with the highest acuity level of needs, but the MHIs may use the beds for persons with lower-level acuity needs if beds are otherwise available within an intensive psychiatric unit.

The Bill requires the DHS to collect data necessary to determine the effectiveness of each intensive psychiatric unit. Four years after the DHS determines an intensive psychiatric unit is operational, the DHS is required to provide a report to the chairpersons and ranking members of the Health and Human Services Appropriations Subcommittee with details on the effectiveness of the intensive psychiatric units and recommendations for such units. No later than one year from the date the DHS submits its report, the Legislature is to determine whether to continue operations of the intensive psychiatric units based on the efficacy and feasibility for continued use of such units.

Assumptions

The DHS will open a 12-bed adult psychiatric unit at the Cherokee MHI and a 12- to 15-bed psychiatric medical institution for children (PMIC) at the Independence MHI. Due to required capital improvements, the estimated start date for admitting patients is January 1, 2023.

Capital Costs

One-time capital upgrades will be required to update previously used areas at both MHIs to bring them into compliance with current federal and State health and safety requirements. Full-Time Equivalent (FTE) Positions

• It is assumed that FTE positions will be filled beginning December 1, 2022.
• Due to the health care workforce shortage, particularly in rural areas, midpoint salary and benefits pay scale costs are assumed for all FTE positions.
• The 12-bed adult psychiatric unit at the Cherokee MHI will require 32.5 FTE positions ranging from Residential Treatment Workers (RTWs) to a Physician Assistant.
• The 12- to 15-bed PMIC at the Independence MHI will require 30.5 FTE positions ranging from RTWs to a Child Psychiatrist.

Support Costs

• Additional support costs for food, pharmacy and medical services, miscellaneous supplies, and transportation will be required at each of the two MHIs with six months of costs assumed in FY 2023 due to the January 1 start date.
• Inflation of 2.3% is for support costs in FY 2024.

Information Technology (IT) Infrastructure

• There will be approximately $22,000 in one-time costs to the Bureau of Enterprise Infrastructure Services for IT upgrades necessary for each MHI. In addition, the Independence MHI will require additional one-time IT infrastructure costs of $30,000.
• The data warehouse will need to be updated to collect, store, and produce information specified in the reporting requirements of the Bill. The updates are estimated to have a one-time cost of $195,000.
• The 32.5 FTE positions at Cherokee and the 30.5 FTE positions at Independence will require a computer and software license totaling $2,900 in FY 2023 and $1,000 in FY 2024 and beyond.

Revenue Offset

The MHIs will bill Medicare and Medicaid for patient services; however, revenues are returned to the Medicaid Program as a revenue offset or to the General Fund and are not retained by the MHIs.

Fiscal Impact

Senate File 2216 is estimated to cost the General Fund $2.8 million in FY 2023 and $2.7 million in FY 2024. This includes revenues received from billing both Medicaid and Medicare, which the two MHIs must revert to Medicaid and the General Fund. To open the two units, it is estimated the DHS will need an appropriation of $4.2 million in FY 2023 and $5.5 million in FY 2024. Details for FY 2023 and FY 2024 are in the table below.

Net Fiscal Impact Estimate for SF 2216FY 2023 FY 2024

Capital Costs

Cherokee 331,000$ 0$ Independence 300,000 0 Total Capital Costs 631,000$ 0$

FTE Positions

Cherokee 1,591,000$ 2,710,000$ Independence 1,417,000 2,408,000 Total FTE Positions 3,008,000$ 5,118,000$

Support Costs

Cherokee 111,000$ 227,000$ Independence 30,000 61,000 Total Support Costs 141,000$ 288,000$

IT Costs

Cherokee 118,000$ 34,000$ Independence 142,000 32,000 Data Warehouse Updates 195,000 0 Total IT Costs 455,000$ 66,000$ Total DHS Cost 4,235,000$ 5,472,000$

Medicaid and Medicare Revenue

Reversion to Medicaid -400,000$ -801,000$ Reversion to General Fund -998,000 -1,996,000 Total Medicaid and Medicare Revenue -1,398,000$ -2,797,000$ Net Cost to the State 2,837,000$ 2,675,000$

Sources

• Department of Human Services
• LSA analysis