SSUUMMMMAARRYY ooff

PP RROOCCEEEEDDIINNGGSS JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE

COMMITTEE MEETING INFORMATION June 4-5, 2013 Conference Room, Oil and Gas Commission Building (June 4 a.m.) Casper College (June 4 p.m. and June 5) Casper, Wyoming

JOINT LABOR COMMITTEE MEMBERS PRESENT Senator Charlie Scott, Cochairman Representative , Cochairman Senator (SD28) (June 5) Senator Senator Ray Peterson (June 5) Senator Representative Representative Kathy Coleman Representative Representative Matthias Greene Representative Representative Representative

JOINT EDUCATION COMMITTEE MEMBERS PRESENT (June 4 a.m.) Senator Hank Coe, Cochairman Representative , Cochairman Senator Jim Anderson (SD02) Senator Paul Barnard Senator Senator Representative Representative John Freeman Representative Representative Representative John Patton Representative Representative

LEGISL ATIVE SERVICE OFFICE ST AF F Gerald W. Laska, Staff Attorney Ian Shaw, Staff Attorney Michael Swank, Research Analyst

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

2

SSUUMMMMAARRYY ooff

PP RROOCCEEEEDDIINNGGSS JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE

EXECUTIVE SUMMARY The Committee met jointly with the Joint Education Committee to receive various reports on preschool and early learning programs. The Committees then met separately at Casper College. The Wyoming Insurance Commissioner provided an update on Health Insurance Exchanges and the Affordable Care Act. The Department of Health reported on its Medicaid reform implementation, the Life Resource Center study and Title 25/Wyoming State Hospital issues. The Department of Workforce Services addressed the appeals process in Unemployment Insurance and Workers' Compensation. The Committee requested a draft bill based on the Arkansas bill for Medicaid expansion using private insurance premium subsidies. The next meeting will be in August in Lander, Wyoming.

CALL TO ORDER (JUNE 4, 2013, MORNING SESSION) The Committee met jointly in the morning with the Joint Education Committee. Education Committee Co-Chair Senator Coe called the meeting to order at 8:30 a.m... The following sections summarize the Committee proceedings by topic. Please refer to Appendix 2 to review the Committee Meeting Agenda.

EARLY CHILDHOOD EDUCATION DEPARTMENT OF HEALTH Mr. Tom Forslund, Director, Wyoming Department of Health (WDH), spoke to the Committee about programs provided to children ages birth through age five via the Individuals with Disabilities Act (IDEA) in accordance with Part B and C. [Appendices 12 and 13]. Ms. Chris Newman, Senior Administrator of the Behavioral Health Division, WDH, commented about the programs administered in accordance with the requirements of Parts B and C of IDEA. She explained the various child find activities conducted by the agency within the state and noted that the percentage of children identified in accordance with Part B and C is in excess of the national average in both instances.

Director Forslund suggested the transfer of the pre-school programs from the Department of Health to the WDE in an effort to stream-line programing and systems. Senator Nutting inquired about the growth rate in proficiency for the students receiving services and requested further explanation. Ms. Newman responded that the data collected is limited to the services provided during the preschool years and that there is no mechanism currently to collect data on a long term longitudinal basis related specifically to the children that receive services via the WDH for preschool related activities. Representative Kasperik requested additional information related to the Director's suggestion for transfer of programs from the WDH to the WDE. Ms. Newman responded that she would envision the entire unit, including existing personnel, transferring to the WDE to avoid the loss of institutional knowledge. Director Forslund followed up that the transfer would allow data to be gathered on a long term basis and ensure a more unified effort regarding services. Co-chairman Teeters requested additional information regarding the recommendation for transfer of the program to the WDE. He noted that TANF students receive WISER ID numbers and it would seem that would allow collection of longitudinal data. He requested the WDH provide additional information regarding this suggestion.

Senator Scott requested information related to identification of students and the process for delivery of services. Ms. Rebecca Walk, WDH, provided explanation regarding this issue. Senator Scott requested clarification of the identification process and explanation of the standard deviations with regard to assessments for identification. Ms. Walk responded that identification requires the child perform two standard deviations below proficient on certain assessments. She further stated that there are additional mechanisms for identification. Representative Connolly requested clarification regarding the proposed transfer for the pre-kindergarten activities to the WDE. She inquired about the possibility of overlap for services for certain children for other programs administered by WDH. Ms. Newman responded that there are certain services that would overlap for the same children. Representative Harvey explained the genesis of the program being placed in the WDH, noting the overlap of medical services under Part C of IDEA and the transition to activities more educationally related under Part B. Director Forslund noted that the pre-school programs under the WDH will experience a four percent budget reduction as a result of the reduction of state-level funds.

PROVIDER COMMENTS

Lori Morrow, Child Development Services for Wyoming/Child Development Services for Fremont County, spoke to the Committee about the organizational structure for developmental preschools. She noted the 14 regions, which include 46 developmental preschools. [Appendix 14] Ms. Morrow noted the services provided, including developmental screenings. She moved on to discussion of the staffing, noting that budget difficulties make hiring difficult, particularly in light of the increases in funding for the K-12 educational program and potential reductions in the area of preschool funding. Ms. Morrow discussed the partnership between public and private entities related to funding for these programs. Mr. Mitch Brauchie, Children's Resource Center, discouraged any reduction of funding for the developmental preschools and noted that in his opinion there is no over-identification of students. He noted the prior budget reductions and requested that additional reductions not take place. Co-chairman Teeters inquired about recommendations for budgets as the Legislature considers the issue. Mr. Brauchie responded that he would request that no additional reductions take place and that the four percent reduction be replaced.

DEPARTMENT OF FAMILY SERVICES

Director Steve Corsi, Department of Family Services (DFS), presented information to the Committee related to the activities conducted by the DFS in relation to pre-kindergarten students. [Appendices 15, 16, and 17] Ms. Jillian Balow, Family Assistance Division Administrator, DFS, gave a detailed description of the funds and the programs administered by DFS in relation to this particular population of children. The programs include protective services, child protection, SNAP (formerly food stamps), and numerous additional initiatives to improve the quality of life for children. Ms. Balow also discussed the various professional development activities required in relation to the programs administered by the DFS in relation to early childhood activities. She discussed the details of Child Care Development Fund and the Temporary Assistance for Needy Families (TANF). She also discussed the Instructional Foundation for Kindergarten assessment (IF-K) and the activities related to this activity. She stated, using 2011 data, 77% of pre-school student receiving TANF were proficient on the IF-K as compared to approximately 50% for all student's entering kindergarten. Representative Greene requested information related to the percentage of single-families that receive TANF assistance. Ms. Balow responded that 99% of the families are single parent families that receive this type of assistance.

Director Corsi provided comments on activities that could be utilized to stream-line activities related to pre-school services. Ms. Balow noted that the agency has issued an RFP for services which relates to the services currently provided by DFS in this area. Representative Throne inquired about the data available for the children and families that receive assistance outside of the TANF program by DFS. Ms. Balow

4 noted that there is no comprehensive data collection of the population served with regard to educational outcomes for populations served outside of TANF. Representative Connolly noted the data indicated approximately 51% of children are kindergarten ready in comparison to 77% for those served by TANF. In addition, she inquired about the nature of the RFP and the services sought by DFS. Ms. Balow responded that the RFP is seeking services to coordinate regional and community services.

DEPARTMENT OF EDUCATION

Dr. Rose introduced the activities performed by the WDE in relation to pre-kindergarten services and early childhood. [Appendix 18] Ms. Julie Magee, WDE, summarized the various budgets utilized to deploy services to the pre-kindergarten and early childhood populations. Ms. Tiffany Dobler, Director of Special Education WDE, discussed the various programs deployed by the Special Programs Unit and the WDE to the student population ages three to five in accordance with Part B of IDEA. Dr. Rose noted the complexity of the issue and the necessity to study the issue and ensure that a thoughtful and comprehensive approach is utilized in addressing the issue of pre-school and early learning opportunities. He suggested the Committee commission a study of the issue to align all agencies and the activities conducted for this population.

DEPARTMENT OF WORKFORCE SERVICES

Ms. Lisa Osvold, Deputy Director of Wyoming Department of Workforce Services (DWS), discussed the role of Why Quality Counts in the context of the preschool discussion and the grants or scholarships provided by this entity in relation to head start licensed facilities. [Appendix 19] She noted that this program is the professional development component for Head Start and public awareness efforts for birth through age five. Ms. Sheila Ricley, Department of Workforce Service, oversees the Head Start Program and the allocation of funds to the Head Start Field Offices. [Appendix 20] She noted that as a result of sequestration her budget will be reduced by five percent. Representative Connolly inquired about the frequency of meetings which include the collective agencies to discuss the efforts of the various parties. Ms. Ricley responded that the Wyoming Early Childhood State Advisory Council meets regularly, which includes various stakeholders and state and local agencies. Co-chairman Teeters also inquired about the genesis of placement of Head Start within the DWS. Ms. Ricley responded that there was a study conducted when the position was moved and based upon a recommendation, supported by Governor Mead, the program was located within the DWS.

WYOMING EARLY CHILDHOOD STATE ADVISORY COUNCIL

Ms. Brittany Ashby, Executive Director of the Wyoming Early Childhood State Advisory Council (Council), and Ms. Kendra West, Director of the Evanston Child Development Center Wyoming, spoke to the Committee about the activities of the Council. [Appendix 21]. She noted members are appointed by Governor Mead and that the Council has a very diverse membership. Ms. West noted that the Council has completed developmental guidelines for ages birth through three and that the Council is currently working on preparing similar guidelines for ages three through five. She noted the second set of guidelines will likely be completed in the summer of 2013 for consideration by Governor Mead. Ms. West noted the Council meets every other month and when transferred to DFS, the Council will meet quarterly. Ms. Ashby noted that the Council has contracted with Wyoming Survey and Analysis Center at the University of Wyoming to streamline data collection and analysis. Senator Landen requested input from the presenters regarding suggested improvements related to delivery of services and data collection and tracking. Ms. West responded that the efforts are very decentralized and coordination of the multiple efforts is very difficult. Representative Connolly requested additional information of the funding for the Council and the nature of the members of the Council. Ms. West responded that the funding for the Council is via a grant award through the federal American Recovery and Reinvestment Act received in

5

2011 that will expire the summer of 2014. After July of 2014, the DFS will take over administration and funding for a very basic program; she noted that the meetings will be quarterly upon DFS taking over the Council. Ms. West noted that members of the Advisory Council are voluntary. Representative Kasperik noted the importance of addressing education and support of single parent families.

WYOMING KIDS FIRST Ms. Mary Garland, Ellbogen Foundation, spoke to the Committee about the activities of the Wyoming Kids First Program (Program), an initiative partially funded by the Ellbogen Foundation. [Appendix 22] She noted the importance of addressing the pre-school population and applauded the efforts of the Legislature via the Hathaway Scholarship Program and followed up that early childhood education and services is the other part of the equation to ensure success for Wyoming's youth. Ms. Becca Freeburn- Steinhoff continued discussion of the Program, outlining the history and philosophy of the program and the initiatives deployed. She explained the nature of developing programs via a collaborative, community based effort to improve the lives of children and families. Ms. Freeburn-Steinhoff summarized the Program's partnership with Hot Springs County School District to administer the Early Childhood Liaison Program that was implemented in the fall of 2009 because more than 50% of their incoming kindergarteners were not prepared for success according to readiness measures. She highlighted several additional initiatives and community based programs that are underway or are under consideration by the Program to improve early childhood readiness, including the programs deployed in Fremont County School District No. 6, Albany County School Readiness Initiative, and the Weston County Early Childhood Partnership. Ms. Freeburn-Steinhoff concluded her presentation by noting the interdependence of early childhood problems that are systemic and noted the importance of having shared vision for impact that includes a common understanding of the problem for young children and families. Ms. Rae Lynn Job spoke to the Committee about options that may be available to continue the efforts of the Program and leverage state and private resources for a common goal, including setting up an endowment to fund early childhood initiatives and the possibility of establishing a public and private partnership for early childhood initiatives, similar to the National Board Certified Program. Co-chairman Coe commended the work of the Ellbogen Foundation and the Program. Representative Connolly requested information on the budget for a public-private provision. Ms. Garland noted that to date the program has expended approximately $700,000 and the Ellbogen Foundation recently committed to an additional $500,000 to support future efforts initiated by the Program. Representative Patton inquired about the Ellbogen Foundation's interaction with the Advisory Council. Ms. Freeburn-Steinhoff stated she is a member of the Advisory Council and attempts to bring the district perspective to the table in those discussions.

PUBLIC COMMENTS

Ms. Jill Bramlet, Interim Director of the P-16 Council, spoke to the Committee about the efforts of the P- 16 Council in relation to the Advisory Council. [Appendix 23] She noted importance of a system that coordinates efforts from preschool to college and supported the Committee's continued study of the issue. Ms. Lauren Nordeen, Wyoming Child and Family Development, spoke to the Committee about the activities of Head Start Programs, including serving children ages birth through five and families through this program. She noted that Head Start is present in every county in Wyoming except one and that Head Start Programs often partner with TANF and child development centers and that there is a strong partnership with providers. Ms. Jamie Stockwell, Executive Director of Absaroka, Inc., noted the center she oversees serves seven counties. [Appendix 24] She noted the importance of the State focusing on early childhood and investing in families to decrease educational and social costs. She encouraged the Committee to invest in early childhood education and initiatives.

Superintendent Diana Clapp, Fremont County School District No. 6 (FCSD #6), summarized the program administered in her school district to address the preschool population that may otherwise not receive

6 educational services. [Appendix 25] She explained that FCSD #6 partnered with the Wyoming Kids First Program to serve high-risk populations via a traveling classroom Ms. Michelle Carr, Teacher for FCSD #6, spoke to the Committee about the program and the partnership between the district and the community. She noted it was the goal of the program to serve children in need of additional services to enable the kids to succeed as students and then later as citizens. Ms. Carr gave the Committee a detailed example of her work as a teacher in a mobile classroom.

Mr. Bill Winney, private citizen, provided comments to the Committee regarding children of military and veteran families and supported the comments by Senator Anderson in reference to this issue.

LEGISLATIVE COMMENTS

Senator Scott commented that the general principles need to address the 30% of students that are not proficient on the PAWS in entering kindergarten. He suggested remedies that will address a uniform definition of kindergarten readiness that is easy to understand. The Senator commented that he is skeptical of the organizational modifications suggested, but that if reorganization does take place it would make the most sense to move the programs to DFS, given the demands on the other agencies. He also commented that he supported the idea of a matching program for state and private early learning initiatives. Representative Harvey suggested consolidation of the programs within the WDE to ensure a streamlined approach and goals and ensure the ability to track information. She also suggested funding for the programs via the school foundation program. She went on to support the notion of innovation and new ideas for pre-school and early childhood education programs and voiced support for public-private partnerships to continue in ways that are unique to serve community needs. Representative Throne inquired about the potential for overlap of services, and the population served and concluded that in her opinion there is no comprehensive early childhood program and supported the idea of requesting the executive branch coordinate to suggest a comprehensive early childhood program plan. Representative Kasperik voiced her support for the continued study of the issue. Senator Anderson supported the notion of retaining local control and innovation in the pre-school and early learning initiatives. He cited the example utilized in Hot Springs County. Representative Connolly suggested a motion be made to direct staff to draft legislation to create an endowment similar to that created for the library foundation to create a public and private matching partnership. Representative Patton suggested the Committee consider the suggestion by Dr. Rose to request the executive agencies collaborate to submit a comprehensive plan to address the needs of early childhood learning. Representative Harvey requested the Joint Education Committee copy the Joint Labor Committee with any reports or information submitted in accordance with any motions or actions taken.

Senator Rothfuss moved that staff, in consultation with relevant agencies, develop a chart synthesizing activities described today, including agency/entity, program, funds, source of the funds (with breakdown state/federal), target of the funds (e.g. low income), and any restrictions on the use of the funds. The motion was seconded by Senator Anderson. The motion was adopted.

Senator Rothfuss moved that staff draft a memo to the Governor requesting he assemble representatives from each of the agencies overseeing early childhood development programs to prepare a list of policy recommendations to facilitate better coordination and more efficient use of available funds towards a cohesive early childhood development program and report back to the Joint Education Committee and the Joint Labor Committee. He further clarified the report should include suggestions of methods to promote better collaboration among existing projects and programs, and any reorganization necessary to facilitate better overall performance. The motion was seconded by Senator Anderson. The motion was adopted.

Senator Rothfuss moved that staff draft legislation to expand the use of IF-K to all relevant state funded programs as appropriate, and encourage the continued development of the IF-K assessment, to include

7 articulating what it means to be kindergarten ready in a way that families can understand and providing guidelines for families. The motion was seconded by Senator Anderson. Representative Freeman noted he was concerned with the proposed motion and would not support it. He stated he thought it was premature given the status of the programming. Representative Connolly noted that the IF-K is an assessment that is customized for Wyoming and that it has been utilized for the prior five years. Representative Patton and Co-chairman Teeters noted concern in voting for the motion as well, agreeing that the motion is premature. The motion was adopted.

Representative Connolly moved that staff draft legislation to establish a matching endowment fund for counties for early childhood learning and systems building modeled after the library endowment challenge program. The motion was seconded by Senator Rothfuss. The motion was adopted.

Representative Connolly moved that staff draft legislation establishing a public-private partnership for early childhood learning and systems building modeled after the national board certification program. The motion was seconded by Senator Rothfuss. The motion was adopted.

MEETING ADJOURNMENT There being no further business, Co-Chairman Teeters adjourned the joint meeting of the Education and Labor Committees at 12:50 pm.

CALL TO ORDER (AFTERNOON SESSION, TUESDAY, JUNE 4) Co-Chairman Scott called the meeting of the Labor Committee to order at 2:00 p.m.

HEALTH INSURANCE EXCHANGE

Department of Insurance Tom Hirsig, Director, Department of Insurance, addressed the Committee regarding the status of the Health Insurance Exchange under the Affordable Care Act. He distributed copies of department information sheets, including "Health Care Reform for Individuals" [Appendix 17], and "Health Care Reform Information for Employers" [Appendix 18]. He proceeded with a PowerPoint presentation entitled "The Affordable Care Act: A Summary on Healthcare Reform" [Appendix 19] in which he explained common misunderstandings about the Affordable Care Act, market reforms, insurance rating guidelines and the individual mandate. He also explained the premium subsidies through premium tax credits and the general operation of the health insurance marketplaces. He explained the applicability of the employer mandate on large employers and the small business tax credit. He also distributed a "Health Reform Quiz" [Appendix 20].

DEPARTMENT OF HEALTH Medicaid Reform Study Director Forslund addressed the Committee and distributed a copy of the 2013 Medicaid reform legislation, Senate File 60, [Appendix 21] and three handouts providing project update information on waiver redesign [Appendix 22], the managed care study [Appendix 23], long-term care services [Appendix 24] and health care services [Appendix 25].

Senator Barnard expressed concern that the Department is proceeding too quickly with the waiver program reforms. Co-Chairman Harvey noted that the reform started with a select committee in 2005. Chris Newman, Senior Administrator of the Behavioral Health Division, pointed out that the Department has had many stakeholder meetings throughout the state and that the legislation requires creation of a comprehensive waiver and a support services waiver. Director Forslund also noted that most other states

8 have already implemented the two-waiver reform and that the Department had hired an experience consultant.

Meredith Asay, Administrator, WDH Director's Unit for Policy, Research and Evaluation, described the status of the Department's work on manage care, referring to Appendix 23.

Committee members stressed that the Department should seek to maximize provider and client involvement in the waiver redesign process, including ample opportunity for feedback before any waiver application is filed with the Center for Medicare and Medicaid Services ("CMS").

MEETING RECESS The Committee recessed for the day at 5:20 p.m.

CALL TO ORDER (WEDNESDAY, JUNE 5) Co-Chairman Harvey called the meeting of the Labor Committee to order at 8:00 a.m.

DEPARTMENT OF HEALTH (CONTINUED)

Medicaid Reform Study (continued) Director Forslund advised that, based on the Committee's feedback, the Department will slow down the waiver application until it has been posted on the Department's website for several weeks before filing with CMS.

Teri Green, WDH Senior Administrator and State Medicaid Agent, explained the status of the statutorily required changes to Medicaid long-term care services. She noted that Senate File 60 required replacement of the LT-101 assessment form, redesign of nursing facility reimbursement to reflect patient acuity and elimination of participant caps. The Department is currently in the process of hiring consultants and conducting targeted surveys and discussions with stakeholders, toward implementation of changes during fiscal year 2014. Chairman Scott discussed the effect of unduly restrictive regulations on care provided at assisted living facilities.

Jesse Springer, WDH Policy Analyst/Special Projects Manager, referring to Appendix 25, explained miscellaneous additional reforms required by Senate File 60.

Director Forslund advised that the Department, working with a number of other states and Northrup Grumman Corporation, has developed a new Medicaid eligibility system which will be rolled out later this year. He called it a very robust system, and stated that WDH intends to request additional funding to purchase add-on components for other benefit programs. 90% of the cost is paid by federal funds.

Life Resource Center Study Meredith Asay provided an update on the Life Resource Center study, referring to Appendix 26.. The Department has surveyed client families, will shortly issue a provider survey and is in the process of hiring a contractor to do the technical review work. She stated that the Department is especially focusing on acuity level s of clients using Inventory for Client and Agency Planning ("ICAP") scores. She stated that the Department will combine the results of the master facilities study from a few years ago with this study, then make recommendations to the Legislature. Committee members generally discussed with Director Forslund the nature of the physical plant facility at WLRC, the expense of facility maintenance, the patient acuity level at WLRC versus community providers.

9

Wyoming State Hospital Bill Sexton, Superintendent of the Wyoming State Hospital, Chris Newman and Carol Day, Community Systems Unit Manager, addressed the Committee on the status of the Wyoming State Hospital. They referred to an information handout [Appendix 27] in explaining hospital costs, waiting lists, census figures, length of stay and total involuntary admissions. Senator Scott noted improvements in management at the hospital, including the convalescent leave policy and improved coordination between the hospital and community mental health centers.

Co-Chairman Harvey noted that both the Labor Committee and the Judiciary Committee were tasked with looking at Title 25 issues. Senator Schiffer, attending on behalf of the Judiciary Committee, explained that that Committee is looking primarily at the intake process and cost cutting. He noted that there is great variation among the counties, and that the Judiciary Committee will probably try to implement a more clinical and less legal approach to involuntary commitments, with the goals of beginning treatment immediately and diverting to community services as much as possible.

Medicaid Expansion Committee members generally discussed Medicaid expansion options in light of the Affordable Care Act. Co-Chairman Scott distributed a paper entitled "Medicaid Expansion – Flexibility Needed" [Appendix 28]. He noted that both chambers voted overwhelmingly against Medicaid expansion, but that the sentiment in the Senate was that the subject could be reconsidered if CMS allowed sufficient flexibility for the state to control the details of the expansion services. He stated that a health savings account, wellness incentives and a work requirement would be important factors.

Representative Throne disputed any assumption that the federal government will have to renege on its increased matching share under the Affordable Care Act.

Co-Chairman Harvey suggested the Arkansas idea of expansion via private premium-subsidy under a Section 1115 waiver, and explained the authorizing Arkansas legislation [Appendix 29]. The Committee generally discussed the advantages of supporting the private provider network, the possibility of using the expansion population as a pilot for further reforms and the fact that the federal administration may be very motivated to allow experimentation among the states due to the political climate on health care reform.

DEPARTMENT OF WORKFORCE SERVICES Appeals process in Unemployment Compensation and Workers' Compensation

Senator Scott stated that the Committee had some testimony at its interim study topics meeting about the appeals process in Unemployment Insurance being tilted too far toward the employees, and employers are continuing to complain.

Director Joan Evans and Assistant Direct Lisa Osvold addressed the Committee. Ms. Evans reviewed general appeals process, which can include redetermination, an appeal hearing, review by the Unemployment Insurance Commission, review by the district court and appeal to the Supreme Court. She reviewed recommendations received from the LSO Management Audit report several years ago and added that the hearing unit's procedures have been revamped.

Senator Scott stated that the Committed would eventually like an explanation of eligibility criteria, with an indication of which are federally required. Jim Reed, Unemployment Insurance Chief Hearing Officer,

10 generally explained separation-related issues and non-separation issues that are common in appeal hearings. He added that the state program is regularly audited for compliance with federal requirements.

Mr. Reed proceeded to explain monetary qualification criteria and read the Supreme Court's definition of misconduct connected to work as a disqualifying factor. Committee members generally discussed the definition of misconduct. George Parks, Wyoming Association of Municipalities, stated that WAM is working on a definition which it hopes to have in a bill for the upcoming session. Director Evans said she will bring any recommendation to the Committee. Co-Chairman Scott added that the complaints involve the number of cases going to the Supreme Court, and that the district courts are being cut out of the process. In the area of workers' compensation, it appears from some statistics that the program is being used as a substitute for health insurance.

John Ysebaert, Workforce Standards and Compliance Administrator, advised that there was no formal anti-fraud program in place at the time of the departmental merger but that one has now been implemented. The Department has also instituted an internal review process that has substantially cut down on the number of cases going to hearing. The Department has also added new claims advocate and employers' representative positions to help claimants and employers understand the system better.

PUBLIC COMMENT Dan Perdue, Wyoming Hospital Association, and Phyllis Sherard, Cheyenne Regional Medical Center, advised that Medicaid expansion continues to be their number one legislative priority this year. Mr. Perdue noted that the American Hospital Association agreed to $150 Billion in future reimbursement reductions when it endorsed the Affordable Care Act, upon the assumption that Medicaid would be expanded to deal with the uncompensated care problem. The Association of course was not given the opportunity to revisit the issue after the Supreme Court made Medicaid expansion optional.

Ms. Sherard provided a status update on Cheyenne Regional Medical Center's managed care efforts, including the Program for All-Inclusive Care for the Elderly and the Wyoming Integrated Care Network. She noted that uncompensated care has increased by 35% over the last five years, to $950 Million per year in Wyoming. Ms. Sherard also distributed a packet of information on CRMC's managed care and community health initiatives. [Appendix 30].

COMMITTEE BUSINESS Representative Harvey indicated that she may have a bill prepared for the next meeting that would follow the Arkansas model for Medicaid expansion through private premium supports.

Senator Scott requested that staff prepare a printout of the Medicaid waivers section 1115 with the cross- referenced sections of the statute identified.

Representative Harvey stated that she would like to hear more on the assisted living issue from the working group at the next meeting.

Committee members generally discussed funding levels for developmental pre-schools, particularly whether the state is out of compliance with the statutory funding formula and therefore not complying with federal maintenance-of-effort requirements. Co-chairman Harvey also explained that many providers are unable to comply with the federal requirement that they 15% of their funds through local fundraising.

11

MEETING ADJOURNMENT There being no further business, Co-Chairman Harvey adjourned the meeting at 4:40 p.m.

Respectfully submitted,

Senator Charles K. Scott, Co-Chairman

Representative Elaine Harvey, Co-Chairman

12

Committee Meeting Committee Meeting

MMaatteerriiaallss IInnddeexx

Appendix Agenda Item Appendix Description Appendix Provider

1 Committee Sign-In Sheet Lists meeting attendees Legislative Service Office

2 Committee Meeting Provides an outline of the topics the Legislative Service Office Agenda Committee planned to address at meeting

3 Early Childhood Education October 1, 2012 Memo; To: Joint Wyo. Dept. of Health, Education Committee and Joint Labor Director Tom Forslund Committee; From: Tom Forslund, Director; Subject: Legislative Report: Developmental Disabilities Preschool Program

4 Early Childhood Education Survey Response: Wyo. Dept. of Health, Wyo. Dept. of Health, Behavioral Health Division Director Tom Forslund

5 Early Childhood Education Power point: Update Wyoming Child Development Developmental Preschools 2013-2014; Services of Wyoming Wyoming's Approach to Successfully Launching Children into K-12 and Beyond

6 Early Childhood Education Report: Early Care and Education Wyo. Dept. of Family Programs; June, 4, 2103 Services, Dir. Steve Corsi

7 Early Childhood Education Survey Responses Wyo. Dept. of Family Services, Dir. Steve Corsi

8 Early Childhood Education Chart and Statistics: 2013 State of Child Wyo. Dept. of Family Care Centers in Wyoming Services, Dir. Steve Corsi

9 Early Childhood Education Report: Early Childhood Education; June, Wyo. Dept. of Ed., 4, 2103 Interim Director Jim Rose

10 Early Childhood Education Survey Responses: Wyoming Quality Wyo. Dept. of Workforce Counts Services, Dir. Joan Evans

11 Early Childhood Education Survey Responses: Head Start Wyo. Dept. of Workforce Collaboration Office Services, Dir. Joan Evans

12 Early Childhood Education Report: Wyoming Early Childhood State Wyoming Early Advisory Council, June 4, 2013 Childhood State Advisory Council, Brittany Ashby

13 Early Childhood Education Presentation: Wyoming Kids First: An Ellbogen Foundation and Initiative of the Wyoming Early Childhood Wyoming Kids First, Partnership, June 4, 2013 Mary Garland

13

14 Early Childhood Education News Article: Babes on the Bus – Wind Fremont Cty Sch. Dist. River takes Preschool to Students No. 6, Superintendent Dianna Clapp

15 Early Childhood Education Report: Park County School District #1: Wyoming Child and Preschool Transitions Program Family Development, Lauren Nordeen

16 Early Childhood Education Report: Wyoming Education Coordinating Wyo Education Council: "Linking Education in Wyoming." Coordination Council, Jill Bramlet

17 Health Insurance Exchange Health Care Reform Information for Dept. of Ins. – Hirsig Individuals

18 Health Insurance Exchange Health Care Reform Information for Dept. of Ins. – Hirsig Employers

19 Health Insurance Exchange The Affordable Care Act: A Summary on Dept. of Ins. – Hirsig Healthcare Reform

20 Health Insurance Exchange Health Reform Quiz Dept. of Ins. – Hirsig

21 Medicaid Reform Study 2013 Senate File 60 Dept. of Health

22 Medicaid Reform Study 2013 Project Update: Medicaid Dept. of Health Reform/Waiver Redesign

23 Medicaid Reform Study 2013 Study Update: Medicaid Dept. of Health Reform/Managed Care Study

24 Medicaid Reform Study 2013 Project Update: Medicaid Dept. of Health Reform/Long-Term Care Services

25 Medicaid Reform Study 2013 Project Update: Medicaid Dept. of Health Reform/Health Care Services

26 Life Resource Center study 2013 Study Update: Wyoming Life Dept. of Health Resource Center

27 Wyoming State Hospital 2013 Update: Wyoming State Hospital Dept. of Health

28 Medicaid Expansion "Medicaid Expansion – Flexibility Needed" Senator Scott

29 Medicaid Expansion Arkansas premium subsidy legislation LSO Staff

30 Public Comment Packet: Wyoming Institute of Population Chey. Regional Medical Health Center - Sherard

14