Joint Corporations Minutes

Draft Only

Approval Pending

S UMMARY of

P ROCEEDINGS JOINT LABOR, HEALTH & SOCIAL SERVICES

COMM ITTEE M EETING I NFORMATION August 25-26, 2016 Lovell Community Center 502 Hampshire Ave. Lovell, Wyoming

COMM ITTEE M EM BERS PRESENT Senator Charles Scott, Cochairman Representative Elaine Harvey, Cochairman Senator Brian Boner Senator Ogden Driskill Senator R. Ray Peterson Representative Fred Baldwin Representative Eric Barlow Representative JoAnn Dayton Representative Norine Kasperik Representative Lloyd Larsen Representative Andy Schwartz Representative Sue Wilson

COMM ITTEE M EM BERS NOT PRESENT Senator Bernadine Craft Representative Harlan Edmonds

LEGISLATIVE SERVICE OFFICE STAFF Ian Shaw, Legal Division Administrator Elizabeth Martineau, Associate Program Evaluator

OTHERS PRESENT AT M EETING Please refer to Appendix 1 to review the Committee Sign-in Sheet for a list of other individuals who attended the meeting.

The Committee Meeting Summary of Proceedings (meeting minutes) is prepared by the Legislative Service Office (LSO) and is the official record of the proceedings of a legislative committee meeting. This document does not represent a transcript of the meeting; it is a digest of the meeting and provides a record of official actions taken by the Committee. All meeting materials and handouts provided to the Committee by the Legislative Service Office, public officials, lobbyists, and the public are on file at the Legislative Service Office and are part of the official record of the meeting. An index of these materials is provided at the end of this document and these materials are on file at the Legislative Service Office. For more information or to review meeting materials, please contact the Legislative Service Office at (307) 777-7881 or by e-mail at [email protected] . The Summary of Proceedings for each legislative committee meeting can be found on the Wyoming Legislature’s website at www.wyoleg.gov. PAGE 2 OF 12

EXECUTIVE SUMMARY The Committee met for two days in Lovell. During the meeting, the Committee heard testimony from the Department of Health and others about the Joint Subcommittee on Title 25 Issues, the Department of Health Facilities Task Force, the multipayer claims database and state administered health insurance study, the UW Family Medicine Residency study, nursing home and assisted living rules and regulations, the new high-utilizer program, healthcare provider reimbursement rebasing, changes to the CHIP program, and community mental health and substance abuse center funding. The Committee heard testimony from the Department of Family Services about statutory cleanup requests and welfare program qualification requirements that affect participant wage increases. The Department of Insurance and others provided information on telehealth and the WHIP and WySEHRP programs. EMS representatives presented information about an interstate licensure compact.

CALL TO ORDER AND APPROVAL OF MINUTES (AUGUST 25, 2016) Cochair Harvey called the meeting to order at 8:00 a.m. The Committee voted to approve its April 28-29, 2016 meeting minutes. The following sections summarize the Committee proceedings by topic. Please refer to Appendix 2 to review the meeting agenda.

JOINT SUBCOMMITTEE ON TITLE 25 ISSUES [INCLUDING TITLE 7 SERVICES] Representative Barlow provided a summary of the Joint Subcommittee on Title 25 Issues' July 7, 2016 meeting and provided a preview of topics to be discussed during the August 30, 2016 meeting. These topics include the implementation of 2016 SF 58, involuntary hospitalization and treatment, and associated rules revisions, as well as the development of the gatekeeper pilot program, community mental health and substance abuse payment reform, and concerns associated with Title 7. Please refer to Appendix 3 for a Title 25 cost and demand summary and Appendix 4 for information about Title 7 forensic evaluations.

During discussion with the Committee, Director Tom Forslund of the Department of Health noted that the gatekeeper pilot program would be one way to address Title 25 costs and increased utilization. However, Director Forslund noted other concerns with the Title 25 and Title 7 processes including a limited budget to meet increasing demand, inadequate data, a lack of accountability within the current system for forensic evaluations, the complexities of coordinating with multiple stakeholders, the difficulties with managing court directed processes, and the lack of access to necessary information such as county level records.

DEPARTMENT OF FAMILY SERVICES STATUTORY CLEANUP REQUESTS Director Steve Corsi, Department of Family Services ("DFS"), introduced draft legislation 17 LSO 111.05- Department of family services – statutory amendments, Appendix 5. DFS presented the Committee with a revised version of the draft legislation, included as Appendix 6, and identified as 17 LSO-0111 Working Draft 0.3. DFS' explanation of the statutory change requests can be found in Appendix 7.

The Committee discussed provisions related to the central registry for reports of child and adult abuse and neglect. The legislation proposes allowing unsubstantiated reports that are taken off the central registry after six months to be replaced if the reports are later substantiated. The Committee discussed extending the time limit for the removal of unsubstantiated reports from six to twelve months. The Committee also discussed allowing the removal deadline to be extended in three month increments, upon written approval. The Committee discussed the fee charged for requesting reports from the central registry, the statutory definition of "employer," and the obligation of DFS to notify licensing boards and current employers of changes in the status of a person described in a registry report. DFS agreed to study existing language in W.S. 42-2-103(b)(x) regarding the use of available maintenance of effort funds.

JOINT LABOR, HEALTH & SOCIAL SERVICES COMMITTEE Summary of Proceedings

WYOMING LEGISLATIVE SERVICE OFFICE • 213 State Capitol • Cheyenne, Wyoming 82002 TELEPHONE (307) 777-7881 • FAX 307-777-5466 • E-MAIL [email protected] • WEB SITE www.wyoleg.gov PAGE 3 OF 12

Upon a voice vote, the Committee passed a motion requiring LSO to revise 17 LSO 111 Working Draft 0.5 to be consistent with the draft prepared by DFS. LSO should work with DFS and provide options in the bill draft regarding: 1) time requirements for removing unsubstantiated reports from the registry, 2) the fee charged for obtaining a report from the central registry, 3) using the term "employer or entity" rather than "employer" where appropriate, 4) appropriate language when referring to legislative appropriations, and 5) notices to employers and licensing boards when a person who is the subject of a registry report has a change in status. Upon the Committee's request, DFS agreed to provide the Committee with a written summary of the statutory changes proposed in the legislation, as amended, including explanations for the provisions to be repealed. The summary should be delivered to the Committee as soon as possible.

TELEHEALTH AND INSURANCE P ARITY Representative Wilson provided a background and examples of current practices and uses of telehealth in Wyoming. Telehealth is not considered to be a different kind of health care and is simply a different delivery mechanism. Denise Burke, Department of Insurance, and Mary Walker, Board of Pharmacy, discussed ongoing efforts by various healthcare licensing boards and other stakeholders to define the scope of telehealth. These discussions have coalesced into a suggested uniform policy that the various licensing boards can choose to adopt, Appendix 8. Representative Wilson and Ms. Walker will provide the Committee with information regarding the ability of licensing boards to adopt the uniform policy.

Ms. Burke indicated that the Department of Insurance is neutral on the topic of telehealth insurance parity as local insurance providers have indicated that telehealth is currently covered.

Ms. Walker proposed several statutory changes related to telehealth's application to the practice of pharmacy. After discussion, the Committee passed a motion to have LSO draft legislation based on the pharmacy telehealth bill presented by the Board of Pharmacy, Appendix 9. The legislation should include an amendment to the language on page 2, subsection (d), indicating "the board shall require inspections of remote sites pursuant to rules adopted by the board."

The Committee also passed a motion to have LSO draft legislation based on a recent bill in front of the Colorado legislature, 2015 House Bill 15-1029. The Colorado legislation requires health insurance parity between telehealth and other means of healthcare delivery.

WELFARE PROGRAM QUALIFICATION REQUIREMENTS THAT DISCOURAGE/ENCOURAGE P ARTICIPANT WAGE INCREASES Director Steve Corsi, Brenda Lyttle, and Roxanne O’Connor, from the Department of Family Services (“DFS”), provide information about current assistance programs offered by DFS, Appendix 10. The discussion included looking at an example assistance package and the associated challenges and disincentives that impact a person’s ability to earn a self-sufficient wage. Director Corsi presented four options that could alleviate dependence on DFS assistance programs and lessen the fiscal cliff individuals encounter as they move towards financial independence, including 1) expansion of simplified reporting to all DFS assistance programs, 2) incentivize Employment and Training Programs for all DFS assistance programs, 3) require budgeting classes for all clients receiving assistance, and 4) provide cash incentives to clients who obtain and maintain self-sufficiency.

After considering the options outlined by DFS, the Committee passed a motion requiring LSO to draft legislation authorizing DFS to enter into negotiations with the federal government as necessary to allow

JOINT LABOR, HEALTH & SOCIAL SERVICES COMMITTEE Summary of Proceedings

Wyoming to create pilot programs like the four options proposed in the DFS materials. The pilot programs would be aimed at reducing or eliminating the financial cliff effect within Wyoming's assistance programs. Any new programs would be required to be funded with federal monies, or within existing funding streams, with no additional funding from the State.

IDENTIFICATION OF POPULATIONS WHO CANNOT AFFORD HEALTHCARE/HEALTH INSURANCE Department of Health Director Forslund and Denise Burke, Department of Insurance, presented information about those individuals who may not be able to afford health insurance, including county level estimates using 2013 data, Appendix 11, health care coverage and cost sharing details, Appendix 12, and examples of unaffordable health services for indigent populations, Appendix 13. Ms. Burke provided information about insurance marketplace statistics for Wyoming and associated data limitations, Appendix 14.

Ms. Burke then provided information regarding the Centers for Medicare and Medicaid Service's (“CMS”) guidance on using a state high-risk insurance pool to meet minimum essential coverage under the Affordable Care Act. Ms. Burke also discussed ongoing changes within Wyoming's high risk pool plans, Appendix 15.

MULTIPAYER CLAIMS DATABASE/STATE ADMINISTERED HEALTH INSURANCE Director Forslund, Stefan Johannsson, and Franz Fuchs, Department of Health, provided an update about results from the first phase of studying state administered health insurance and a multipayer claims database, Appendix 16, which included an interim report, Appendix 17. Mr. Johansson explained that two studies were combined because adequate claims data is essential to state administered insurance.

According to Mr. Fuchs, a common problem, nationally and in Wyoming, is that healthcare costs are too expensive, which is then reflected in higher insurance premiums. Mr. Fuchs explained that detailed data combined with thorough analysis can help to identify information necessary for controlling these costs. With regard to state administered health insurance, the Department of Health is continuing to study several outstanding considerations, such as the impact on other insurers and existing legal parameters, including recent Employee Retirement Income Security Act of 1974 (“ERISA”) rulings.

The topic was opened for public comment. Anne Ladd, Wyoming Business Coalition on Health, clarified that individuals cannot opt out of plan reporting to a claims database. Instead, a plan administrator must make that decision for the entire plan, provided the plan is not protected by ERISA. Ms. Ladd also noted that if the state developed a claims database, other stakeholders would be interested because the information would be useful. Charles Katebi, Wyoming Liberty Group, testified that although patients typically ignore the costs associated with healthcare, encouraging price transparency and incentivizing patient use of cost data is important. Eric Boley, Wyoming Hospital Association, noted that bundled payment pilot programs are already being implemented in Wyoming and he believes that the higher healthcare costs are likely the result of being a rural state. Sheila Bush, Wyoming Medical Society, encouraged the State to move cautiously because, in addition to already having a fragile provider community, healthcare data taken out of context can be damaging. Ms. Bush asked that the Wyoming Medical Society be involved in any ongoing work.

RESPONSES TO FEDERAL ACTIONS Denise Burke, Department of Insurance, introduced and discussed draft legislation 17 LSO 112.03-Small employer health reinsurance program amendments, Appendix 18. This bill makes changes to the

JOINT LABOR, HEALTH & SOCIAL SERVICES COMMITTEE Summary of Proceedings

Wyoming Small Employer Health Reinsurance Program (“WySEHRP”), discussed at the Committee's April meeting. For a program update and a preliminary estimate of the fiscal impact of 17 LSO 112, please refer to Appendix 19. There has been a significant loss in covered lives within WySEHRP as a result of the Affordable Care Act. Currently, the Program insures only 50 lives and all Program liabilities will end by 2019. The draft legislation reduces the size of the Program's board, amends various statutes in order to allow the WySEHRP to go dormant, and allows the Program to restart, if needed in the future.

After discussion, Cochair Scott moved for the Committee to sponsor 17 LSO 112.03. The motion was seconded by Representative Schwartz and passed on a roll call vote, all present members voting in favor of the motion. The following amendments were adopted by the Committee:

Page 1-line 2 After "program;" insert "repealing unnecessary provisions;".

Page 13-line 3 Strike "(iii)" insert "(v)".

DEPARTMENT OF HEALTH FACILITIES TASK FORCE Representative Larsen provided the Committee with an update on the progress of the Department of Health Facilities Task Force. The Task Force is moving forward with Level III Design at the Wyoming Life Resource Center (“WLRC”) and State Hospital and has selected the architectural firm HOK, from St. Louis, Missouri, as the design contractor. The firm MOCA has been retained as the State's owner representative. The Governor has approved contracting with both entities and the State Building Commission has been informed of the project's progress. HOK and MOCA are anticipated to begin their work with visits to both the State Hospital in Evanston and the WLRC in Lander.

The Committee then discussed a recent complaint against the Canyons Intermediate Care Facility at the WLRC, which led to a CMS investigation. CMS determined that WLRC was non-compliant with several participation standards, including client protection and supervision. After reviewing the CMS response, the WLRC developed, submitted, and implemented a corrective action plan to address the outstanding concerns. As of August 5, 2016, CMS stated that the WLRC is back in compliance.

Director Forslund testified that ongoing issues with hiring high level staff contributed to the CMS investigation, but the Department of Health is currently working to hire necessary, qualified permanent staff. When asked by the Committee, Director Forslund testified that no legislation or statutory adjustments are necessary to address the issues that were raised by the CMS investigation.

The topic was opened for public comment. Shawn Humberson, Friends of the Wyoming Life Resource Center, commended the Department of Health's response to the CMS complaint. She is pleased with the newly hired administration.

UW FAMILY MEDICINE RESIDENCY PROGRAM Representative Wilson described the importance of residency programs for medical school graduates seeking to become physicians. Currently, Wyoming has only two family medicine residency program sites, both of which are operated by the UW Family Medicine Residency Program. One site is in Casper and one is in Cheyenne. Representative Wilson noted that the Residency Program does not receive federal funds like most other residency programs, which has presented a number of unique challenges.

Meredith Asay and Dr. Kevin Murray, University of Wyoming Family Medicine Residency Program, explained that the UW Family Medicine Residency Program is separate from the WWAMI Regional

JOINT LABOR, HEALTH & SOCIAL SERVICES COMMITTEE Summary of Proceedings

Medical Education Program. Although WWAMI students may participate in the Residency Program, typically they choose to go elsewhere. Ms. Asay explained that the Residency Program has historically struggled with funding. Current efforts are ongoing to generate more clinic revenue and in 2014 the Program did receive a Federally Qualified Health Center designation so they are eligible to receive Medicaid/Medicare reimbursements.

Pursuant to a requirement to study the Residency Program in the 2016 Budget Bill, the Program has solicited the Department of Health to conduct a study. Since January, the Department of Health and Residency Program staff have worked to understand the revenue and funding situation at each of the Program's sites. Stefan Johansson, Department of Health, provided a summary of the scope of the study which will focus on the Program's background, operations, and possible funding alternatives. Appendix 20.

MEETING RECESS The Committee recessed at 5:15 p.m.

CALL TO ORDER (AUGUST 26, 2016) Cochair Scott called the meeting to order at 8:10 a.m.

NURSING HOME / ASSISTED LIVING RULES AND REGULATIONS Rick Schroeder, representing the North Big Horn Hospital District, New Horizons Care Center and North Big Horn Hospital Clinic, described the capabilities his facility has to accommodate spouses who require different levels of professional heath care. Mr. Schroeder discussed the health related benefits for couples who stay together. During discussion with the Committee, Mr. Schroeder explained that one challenge in accommodating patients who each need different levels of health care is the necessity for the facility to maintain two separate licenses and participate in two, separate licensing surveys.

Mr. Schroeder noted that over the past year, communication with the Office of Healthcare Licensing and Survey has improved.

Director Forslund testified that he is supportive of keeping spouses together, but it is a complex issue. Laura Hudspeth, Department of Health, testified that the Department is working on the challenges associated with keeping spouses together and is trying to address the health and safety needs that arise when one spouse has significantly greater health care needs. Ms. Hudspeth noted that current rules do permit patients to contract with outside providers who can supplement existing services and provide a higher level of care. In this way, patients can avoid having to move to a higher care facility. However, Ms. Hudspeth noted that most of the healthcare facilities involved are private entities and the State does not mandate that they provide services to a broader range of patients. The State's role is limited to assuring that licensing requirements and CMS standards are met.

DEPARTMENT OF HEALTH

BUDGET CUTS Director Forslund provided an overview of the considerations that led to the $90 million budget reduction in the Department of Health's 2017-2018 biennium budget. He provided details regarding the impact of specific cuts, Appendix 21. The Department is currently working to mitigate federal match reductions.

JOINT LABOR, HEALTH & SOCIAL SERVICES COMMITTEE Summary of Proceedings

The meeting was open to public comment. Gregg Bennet, Northwest Wyoming Treatment Center, testified that money needs to continue to be invested in mental health. He feels that his facility has been negatively impacted by existing Department of Health processes and procedures.

WYOMING SUPER-UTILIZER PROGRAM Director Forslund, Stefan Johansson, Franz Fuchs, and Jesse Springer, Department of Health, provided an update for the Committee on the Wyoming Super-Utilizers Program ("WySUP"), which was a legislatively required Medicaid option study to consider managed care, Appendix 22. After the initial study was completed, it was determined that, due to the medical infrastructure in Wyoming, broad spectrum managed care was not a good solution. Therefore, the Department determined that a pilot program focused on a selected group of volunteer super utilizers would be the best approach. The pilot program has been established and is expected to track the treatment and control group over the next year.

DEVELOPMENTAL DISABILITIES REBASING UPDATE Joe Simpson and Shirley Pratt, Department of Health, provided an update to the Committee on the Developmental Disabilities (“DD”) services rate rebasing for the 2017-2018 biennium. They summarized a letter from the Department of Workforce Services which discloses the appropriate home, health, and personal care aid wages which will be used in the rebasing, Appendix 23. During the discussion, Mr. Simpson explained several elements in the prior Navigant rebasing effort that will be addressed in the new rebasing.

CHILD HEALTH INSURANCE PROGRAM – MANAGED-CARE Teri Green, Jan Stall, Jesse Springer, and Jerry Laska, Department of Health, provided information regarding recent federal changes that create new parameters for the Children's Health Insurance Program ("CHIP"), Appendix 24. Ms. Green reviewed proposed changes to Wyoming law made necessary by the federal changes, Appendix 25. Importantly, the proposed new language will require the provision of all services through risk-based managed care to the same extent required by Medicaid.

The Committee passed a motion to have LSO draft legislation identical to that proposed by the Department of Health, Appendix 25. The Department will work with LSO to confirm that changes to federal law require this legislation. Any necessary changes to the proposed legislation should be coordinated through LSO and the Department.

EMS LICENSURE COMPACT Andy Gienapp, Emergency Health Services Administrator, Eric Boley, Wyoming Hospital Association, and Scott Murphy, North Big Horn Hospital District, provided information for the Committee regarding the Recognition of EMS Personnel Licensure Interstate Compact (“REPLICA”). Mr. Murphy provided the Committee with his perspective about EMS licensure, and explained that REPLICA could help with the coordination of EMS activities across state lines, Appendix 26. Mr. Murphy cautioned that REPLICA also could lead to some unintended consequences, such as changing the dynamic in the current system, which is composed mostly of volunteers and smaller private businesses. Mr. Gienapp provided additional explanation about REPLICA and noted that it was developed to be similar to the nursing compacts recently passed by the Legislature, Appendix 27. Mr. Gienapp reviewed several benefits of REPLICA including an observation that the quality of licensure testing would improve and that more EMS professionals and services would be available in Wyoming. Mr. Gienapp and Mr. Boley provided the REPLICA model language, Appendix 28. They also provided examples of adopted REPLIC language from Colorado, Appendix 29, Idaho, Appendix 30, and Utah, Appendix 31.

JOINT LABOR, HEALTH & SOCIAL SERVICES COMMITTEE Summary of Proceedings

During discussion, the Committee expressed concern that communities and other stakeholders across the State had not been contacted regarding REPLICA and suggested that this work be done prior to taking substantial action. The Committee recalled that implementation of the nursing compacts took years of collaborative work. Cochair Scott asked Mr. Boley whether provisions in the proposed model language constitute an unlawful delegation of legislative power. Ian Shaw, LSO Attorney, stated that the proposed language may be problematic to the extent it allows an EMT Compact Commission to pass rules which then have the force of statutory law in Wyoming. Mr. Shaw also expressed some concern with other language in the model legislation.

After further discussion, the Committee passed a motion on a voice vote requiring LSO to work with Mr. Boley to draft legislation which will accomplish the purposes of the model act, but which also addresses any legal concerns identified by LSO.

COMMUNITY MENTAL HEALTH AND SUBSTANCE ABUSE CENTERS Senator Boner provided background about Wyoming's community mental health and substance abuse centers, including a funding history and synopsis of other states' approaches. Representative Baldwin and Senator Boner have spoken with community mental health and substance abuse centers in Casper. Representative Baldwin believes that community mental health and substance abuse center payment reform will help assist with existing problems in the Title 25 system.

Director Forslund and Stefan Johansson, Department of Health, provided a summary of the topics to be discussed at the next Joint Subcommittee on Title 25 Issues meeting. Mr. Johansson provided a brief summary of the latest payment reform model, which has been separated into two phases and incorporates additions made as a result of ongoing, collaborative talks with stakeholders, Appendix 32. Phase I of the new model, anticipated to be implemented in FY2018, would continue base payments to centers, implement enhanced payments for special, high risk patients, and would be focused on gathering needed data. Phase II, with no set implementation date, would adjust payments to centers according to the utilization and cost data gathered during Phase I. Director Forslund noted that the new phased model is intended to provide a transitional period for centers and the Department, and allow for adjustments in the model. Mr. Johansson indicated that the purpose of payment reform is to address the demand side of Title 25 issues, rather than the supply side. Payment reform focuses on community mental health and substance abuse centers because they represent an annual, multi-million dollar investment in local services throughout the state that could provide a community-based solution to assist in addressing Title 25 concerns.

Mr. Johansson introduced draft legislation which would provide statutory authority for the proposed payment reform, Appendix 33. The draft legislation is intentionally broad and only contains authorizing language without mandating specific reforms. The draft was completed in response to a request by the Joint Subcommittee on Title 25 Issues. Mr. Johansson explained that the draft is not intended to finalize the elements of payment reform and made clear that the Department is still working with stakeholders to formulate the final payment reform model.

The Committee expressed concerns about payment reform and the possibility of transforming the focus of community mental health and substance abuse centers toward Title 25 patients when the system was originally intended to provide general access to mental health and substance abuse services.

The meeting was opened to public comment. Erin Johnson, Wyoming Association of Mental Health and Substance Abuse Centers (“WAMSAC”), testified that the proposed Department of Health legislation is incomplete and contains unaddressed issues. Ms. Johnson stated that all stakeholders should be consulted

JOINT LABOR, HEALTH & SOCIAL SERVICES COMMITTEE Summary of Proceedings

and their input taken into consideration before legislation moves forward. Additionally, the State should look at the needs of each community and let them work on implementing the requirements of 2016 SF 58 before initiating a payment reform. Mark Russler, Yellowstone Behavioral Health Center and Cloud Peak, also testified that communities should be allowed to work on implementing 2016 SF 58 before proceeding with payment reform. Mr. Russler described the work that his facilities are currently engaged in to address Title 25 concerns. He believes that some of these changes will have a notable impact. Mr. Russler noted that, while payment reform may be a good idea, he does not believe that it will have the impact on Title 25 that the State expects because the system is underfunded. Brandon Wordel, Central Wyoming Counseling, testified that centers do not receive additional funding for crisis intervention or for acting as a community gatekeeper. Mr. Wordel noted that payment reform would force providers to change their business models. Mr. Wordel provided a description of the work his facility is engaged in to address ongoing Title 25 concerns.

The Committee engaged in a discussion about the availability and benefit of convalescent leave in the Title 25 system. Mr. Russler affirmed that the procedures for convalesce leave include the Attorney General's Office and the county prosecutor who ordered the original involuntary hospitalization. Mr. Russler testified that the process should be streamlined and that planning for convalescent leave should begin earlier in the process. Mr. Russler believes that planning for convalescent leave and patient discharge in advance would have a significant and positive impact on Title 25 treatment and results.

GENERAL PUBLIC COMMENT There was no further public comment.

NEXT MEETING DATE The next Committee meeting will be held December 12-13, 2016 in Cheyenne, Wyoming.

MEETING ADJOURNMENT There being no further business, Cochair Scott adjourned the meeting at 3:20 p.m.

Respectfully submitted,

Representative Elaine Harvey, Cochair

JOINT LABOR, HEALTH & SOCIAL SERVICES COMMITTEE Summary of Proceedings

Committee Meeting

Materials Index

Appendix Agenda Item Appendix Description Appendix Provider

1 Committee Sign-In Sheet List of meeting attendees LSO

2 Committee Meeting Agenda Provides an outline of the topics the LSO Committee plans to address at meeting

3 Joint Subcommittee on Title Title 25 Cost and Demand Summary Dept. of Health 25 Issues / Title 7

4 Joint Subcommittee on Title Title 7 Memorandum Dept. of Health 25 Issues / Title 7

5 Dept. of Family Services 17 LSO 111 Working Draft 0.5 – Dept. of LSO Family Services statutory amendments

6 Dept. of Family Services 17 LSO 111 Working Draft 0.3 – Dept. of Dept. of Family Family Services revised version Services

7 Dept. of Family Services Dept. of Family Services statute cleanup Dept. of Family recommendations and explanations Services

8 Telehealth Wyoming Healthcare Licensing Board’s Dept. of Family Uniform Policy for Use of Telehealth Services Technologies

9 Telehealth Telepharmacy statute amendments Board of Pharmacy

10 Welfare Program Dept. of Family Services Assistance Dept. of Family Qualification Requirements Division Program Summaries – Fiscal Services Cliff Effect

11 Populations Who Cannot County-Level Insurance Estimates (using Dept. of Health Afford Healthcare 2013 data)

12 Populations Who Cannot Health Care Coverage and Cost Sharing Dept. of Health Afford Healthcare

13 Populations Who Cannot Examples of ‘Unaffordable’ Healthcare Dept. of Health Afford Healthcare Services for Indigent Populations

JOINT LABOR, HEALTH & SOCIAL SERVICES COMMITTEE Summary of Proceedings

14 Populations Who Cannot State Marketplace Statistics – November Dept. of Insurance Afford Healthcare 1, 2015 – February 1, 2016

15 Populations Who Cannot Summary of CMS guidance on use of Dept. of Insurance Afford Healthcare state high-risk pool plans to satisfy insurance mandates

16 Multipayer Claims Database / Dept. of Health presentation Dept. of Health State Administered Health Insurance

17 Multipayer Claims Database / State options for increasing value in Dept. of Health State Administered Health healthcare, July 2016 report Insurance

18 Response to Federal Actions 17 LSO 112 Working Draft 0.3 Small LSO employer health reinsurance program amendments

19 Response to Federal Actions 17 LSO 112 Working Draft 0.3 Dept. of Insurance Preliminary fiscal impact estimate

20 UW Family Medicine Dept. of Health presentation Dept. of Health Residency Program 21 Dept. of Health Updates Budget reduction summary Dept. of Health

22 Dept. of Health Updates Wyoming Super-Utilizer Program Dept. of Health (“WySUP”) presentation

23 Dept. of Health Updates Wyoming developmental disabilities Dept. of Health service rate rebasing update, including a letter from the Dept. of Workforce Services regarding wages

24 Dept. of Health Updates Children’s Health Insurance Program Dept. of Health (“CHIP”) funding and program changes

25 Dept. of Health Updates Proposed CHIP statutory amendments Dept. of Health

26 EMS Licensure Compact REPLICA summary Office of Emergency Medical Services

27 EMS Licensure Compact REPLICA pros and cons for Northern Big Scott Murphy Horn Hospital Ambulance

28 EMS Licensure Compact Recognition of EMS Personnel Licensure Wyo. Hospital Interstate Compact model language Association

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29 EMS Licensure Compact Colorado EMS personnel licensure Wyo. Hospital interstate compact Association

30 EMS Licensure Compact Idaho EMS personnel licensure interstate Wyo. Hospital compact Association

31 EMS Licensure Compact Utah EMS personnel licensure interstate Wyo. Hospital compact Association

32 Community MHSA Funding Community MHSA Collaborative Dept. of Health Approach to Payment Reform Phase I & II

33 Community MHSA Funding Proposed bill draft for Community Dept. of Health MHSA Payment Reform

JOINT LABOR, HEALTH & SOCIAL SERVICES COMMITTEE Summary of Proceedings

WYOMING LEGISLATIVE SERVICE OFFICE • 213 State Capitol • Cheyenne, Wyoming 82002 TELEPHONE (307) 777-7881 • FAX 307-777-5466 • E-MAIL [email protected] • WEB SITE www.wyoleg.gov