Joint Corporations Minutes

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PP RROOCCEEEEDDIINNGGSS JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE

COMM ITTEE M EETING I NFORM ATIO N January 9-10, 2014 Room 302, Capitol Building Cheyenne, Wyoming

COMM ITTEE M EM BERS PRESENT Senator Charles Scott, Cochairman Representative Elaine Harvey, Cochairman Senator James Lee Anderson (SD 28) Senator Bernadine Craft Senator R. Ray Peterson Representative Eric Barlow Representative Lee Filer Representative Matt Greene Representative Norine Kasperik Representative Lloyd Larsen Representative Mary Throne Representative Sue Wilson

COMM ITTEE M EM BERS NOT PRESENT Senator Leslie Nutting Representative Kathy Coleman

LEGISL ATIVE SERVICE OFFICE ST AF F Gerald W. Laska, 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.

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 at the Capitol Building in Cheyenne. The Insurance Department presented an update on health insurance exchanges and the Affordable Care Act. The Committee considered four alternative bills on Medicaid expansion and three bills on licensed hospitals' acceptance of Medicaid/Medicare patients. The Department of Workforce Services reported results of its continuing back injury study and the definition of 'worker misconduct' for purposes of unemployment compensation. The Department of Health presented an update on its study of institutional facilities and on Title 25 mental health treatment options. The Committee agreed to sponsor bills regarding "Insurance-coverage of inherited enzymatic disorders," "Medicaid expansion—limited benefits," "Public health nursing," "Unemployment insurance—worker misconduct" and "Medicaid expansion—insurance pool."

CALL TO ORDER (THURSDAY, JANUARY 9) Co-Chairman Scott called the meeting to order at 8:15 a.m. The following sections summarize the Committee proceedings by topic. Please refer to Appendix 2 to review the Committee Meeting Agenda.

APPROV AL OF MINUTES Minutes from the November Committee meeting were approved without amendment. .

WYOMING INSURANCE COMMISSIONER

Update on Federal Health Insurance Exchange in Wyoming

Tom Hirsig, Jeff Rude and Jeri Melinkovich, from the Insurance Department, addressed the Committee.

Mr. Hirsig advised the Committee that approximately 5,000 persons enrolled through the health insurance exchange and that approximately 80% have paid their initial premium. However, the Department does not have data on how many were previously insured or how many were Medicaid eligible. He stated that it will take two years to determine if sufficient premiums are being charged by the companies.

Mr. Rude distributed a "Health Insurance Rate Comparison, 2009 to 2014, in the Wyoming Individual and Small Group Markets." [Appendix 3] The Committee discussed the causes for premium increases and the difficulty of comparing insurance products and prices before and after the Affordable Care Act because mandatory coverage is different, there is no longer a pre-existing exclusion and some companies have left the state.

Insurance-coverage of inherited enzymatic disorders

Senator Scott explained that last year's bill requiring insurance coverage for phenylketonuria and similar enzymatic disorders created an unintended consequence because the ADA requires states to pay for any coverage mandated after the essential benefits package for the state was approved. The alternatives are to repeal the requirement or to find a way to pay for it without violating the constitutional prohibition on appropriations in aid of private companies.

Ms. Melinkovich explained the bill [Appendix 4] as providing a tax credit for companies to the extent that they have to pay the new mandated coverage. She also suggested two amendments to the bill [Appendix 5].

JOINT LABOR, HEALTH AND 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

Representative Greene, seconded by Senator Anderson, moved the bill. The Committee amended the bill to clarify its effective date and to delete a reference to taxes due under the Wyoming Health Insurance Pool Act. The motion to sponsor was adopted on a vote of 12-0.

MEDICAID EXP ANSION – EXPLANATION OF PROPOS ALS

Senator Scott asked for an explanation of all of the Medicaid expansion bills before proceeding to a straw poll. He noted, however, that the Tribal Relations Committee had voted to sponsor a bill similar to 14LSO-140.C1, Medicaid waiver—tribal health programs [Appendix 6], so this Committee would not consider it further and the bill was laid back.

Representative Throne explained 14LSO-0139.C1 Medicaid expansion—limited benefits, [Appendix 7]. She stated that this would be the least objectionable alternative to simple Medicaid expansion. The basic concept in the bill is the same as in the WDH August report, namely, to give the department flexibility in designing a plan to cover the expansion group within the existing Medicaid framework while saving on benefits at the same time.

WDH Director Forslund explained further that the Affordable Care Act allows a state to implement different cost-sharing requirements for the Medicaid expansion population, and to provide different benefit packages for different expansion groups. One example of cost saving, he noted, would be that the federal match would pick up 100% of mental health care for the expansion population, which the state is currently paying for. He reminded the Committee that the Department studied Medicaid expansion alternatives last year and that, if the state were to expand Medicaid, this was the Department's recommended method of expansion. He thought the bill could be implemented in six to nine months..

Meredith Asay, WDH Administrator, circulated the federal poverty level guidelines for 2013 [Appendix 8]. Committee members discussed various potential cost savings, the uncertainty of all cost projections and the uncertainty that the federal matching amount will remain at 90% as provided in the Affordable Care Act.

MEDICAID EXP ANSION – PUBLIC COMMENT Co-Chairman Scott suggested that the Committee hear public comment on Medicaid expansion before the lunch break.

Duane Keown, UW science professor, presented written remarks in favor of Medicaid expansion [Appendix 9].

Elizabeth Hoy, Cheyenne Health and Wellness Center, distributed a PowerPoint presentation [Appendix 10] on the benefits to the Center, which is a federally qualified community health center, from addition revenue it would receive under Medicaid expansion.

Edna Ramsey, Laurie Heath (Komen Foundation), Kerry Drake, Gene Halpern, Michael Selmer, Evelyn Maguire, Bonnie Saltman and Tim Locca (AARP) all spoke in favor of Medicaid expansion.

Sara Robinson, tribal liaison for the Eastern Shoshone Business Council, spoke in favor of Medicaid expansion and distributed a handout entitled "Health Disparities on the Native American Population in Wyoming" [Appendix 11].

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

MEDICAID EXP ANSION – EXPLANATION OF PROPOS ALS

Co-Chairman Harvey continued with an explanation of 14LSO-0110.C1 Medicaid—premium assistance options [Appendix 12]. She explained that it is based on the Arkansas model, which is a Medicaid waiver program allowing the state Medicaid program to purchase private health insurance for the expansion population instead of providing traditional Medicaid coverage. She stated that she preferred this alternative because it includes private insurance, because providers would be paid better, because it includes a self-sufficiency provision through premium contributions, and because it would group families together for coverage no matter which health program they were on before. It would also remove a barrier to upward income mobility by allowing people to keep the same policy as long as they want, even if their income increases.

Senator Scott explained 14LSO-0262.C1 Medicaid expansion—insurance pool [Appendix 13] as a modification of the Arkansas model. Two of the major differences are that the bill would add a provision similar to a health savings account and a work requirement for participants.

MEDICAID EXP ANSION – COMMITTEE DISCUSSION

The Committee generally discussed their preferred Medicaid expansion or non-expansion alternatives. Co-Chairman Scott conducted a straw poll, with a majority of the members present preferring that the Committee proceed with one of the expansion bills, but without a strong preference for any one of the bills. Co-Chairman Scott stated that there did not appear to be a consensus and suggested the Committee return to the topic later.

HOSPITAL LICENSURE

Co-Chairman Scott stated that there are several proposals to deal with the problem discussed at the prior meeting involving the refusal of some hospitals to accept Medicaid and Medicare patients.

Co-Chairman Harvey described 14LSO-0141.C1 Hospital licensure [Appendix 14] as a simple bill that would require licensed hospitals to treat Medicaid and Medicare patients. Senator Scott stated that the simple bill would be very complicated to administer, especially under the Affordable Care Act.

Co-Chairman Harvey explained 14LSO-0142.C1 Hospitals—charity care equalization [Appendix 15], as an formula approach to leveling the playing field by imposing a sliding scale fee on hospitals based on the percentage of Medicaid and Medicare patients they serve.

Co-Chairman Scott explained 14LSO-0261 Hospital construction moratorium [Appendix 16], stating that it would put a moratorium on new hospital licenses for a year while the committee reviewed standards for licensure and worked on any new ideas legislation during the 2015 session.

The Committee generally discussed the three bills. Dan Perdue, Wyoming Hospital Association, advised the Committee to study the issue further and impose a temporary moratorium. Phyllis Sherard, Cheyenne Regional Medical Center, spoke in favor of leveling the playing field and distributed written information in support [Appendix 17].

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

Senator Scott, seconded by Senator Craft, moved that the Committee sponsor the moratorium bill, 14LSO-0261. The Committee amended the bill to add a new subsection (b) on page 2 at line 2 as follows:

(b) The attorney general shall conduct a review of federal law and regulations to determine whether and under what conditions new hospitals can be certified to treat... The AG may seek a formal opinion on this issue from an appropriate federal agency. The AG shall report this opinion to the JLHSS by September 1, 2014.

The motion to sponsor the bill failed on a 6-6 vote, with Senator Peterson and Representatives Barlow, Greene, Harvey Kasperik and Larsen voting no. Co-Chairman Scott stated that there did not appear to be any interest in pursuing the other hospital licensing bill so, without objection, they would be laid back.

The Committee recessed for the day at 5:53 p.m.

CALL TO ORDER (FRIDAY, JANUARY 10) Co-Chairman Harvey called the meeting to order at 8:00 a.m.

Representative Throne moved to suspend the Committee rule, adopted by the Committee for the Sixty- Second Legislature, that requires a majority of committee members from each chamber to adopt a motion to sponsor a bill. Following discussion, the motion to suspend the rule was adopted on a voice vote.

HOSPITAL LICENSURE (CONTINUED)

Co-Chairman Harvey, being on the prevailing side of the vote on 14LSO-0261.C1, Hospital construction moratorium, moved to reconsider the vote. Senator Craft seconded the motion. The motion to reconsider carried on a voice vote.

On reconsideration, the motion to sponsor again failed on a 6-6 vote, with Senators Anderson and Peterson and Representatives Barlow, Greene, Kasperik and Larsen voting no.

MEDICAID EXP ANSION – COMMITTEE DISCUSSION (CONTINUED)

Committee members continued to discuss the three Medicaid expansion bills before the Committee. Co- Co-Chairman Scott suggested tabling all three bills, as Medicaid expansion failed to pass the Senate last session by a vote of 8-12. Co-chairman Harvey suggested moving forward the two bills that call for expansion through waivers and private insurance, so the entire body could decide the important Medicaid expansion question. Co-Chairman Scott, without objection, conducted a verbal straw poll of the Committee, which chose to proceed with consideration of two bills, not including 14LSO-0110, Medicaid—premium assistance options.

Representative Barlow, seconded by Senator Craft, moved that the Committee sponsor 14LSO-0139.C1, Medicaid expansion—limited benefits. The motion was adopted on a vote of 7-5, with Senators Peterson and Scott and Representatives Harvey, Kasperik and Larsen voting no.

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

Representative Barlow, seconded by Representative Filer, moved that the Committee sponsor 14LSO- 0262.C1, Medicaid expansion—insurance pool. The motion was adopted on a vote of 8-4, with Senators Peterson and Scott and Representatives Kasperik and Larsen voting no.

DEPARTMENT OF HEALTH – STATUTORY CLE ANUP

Director Forslund reminded the members that the Department at the previous meeting had requested several items of statutory cleanup. 14LSO-0173.C1, Department of health programs—updates [Appendix 18], was drafted in response. However, Director Forslund indicated that the Department, in light of the number of other bills before the Committee and questions about some of the cleanup items, would withdraw its request for a bill. Co-Chairman Scott announced that, without objection, the bill would be laid back.

DEPARTMENT OF WORKFORCE SERVICES

Back study report

The Department of Workforce Services reported on a study of back injuries commissioned by the Legislature in the 2012 and 2013 budget bills. Drs. Karen Nelson and Julia Nelson presented the report [Appendix 19]. They described the prevalence and cost of back injuries; the design, objectives and methods of the study; and the primary results of the study.

The study concluded that encouraging the use of experience based treatment guidelines could lead to fewer surgeries, lower cost and more successful outcomes. Projected savings to workers' compensation would amount to $7.7 Million per year in medical costs and $2 Million per year in indemnity costs.

The Committee generally discussed the importance of the study findings and encouraged the Department to proceed with application of the study results to all or a larger group of back injury workers compensation claimants.

Unemployment Insurance—worker misconduct.

Senator Scott introduced 14LSO-0138.C, Unemployment insurance—worker misconduct, as a revision of a bill that was vetoed last session. He reminded the Committee that the bill was originally requested by the Wyoming Association of Municipalities and understands that they are supporting this draft.

James Reed, chief hearing examiner for unemployment insurance, stated that the bill accurately reflects the Supreme Court's case law definition of worker misconduct.

Senator Anderson, seconded by Representative Larsen, moved that the Committee sponsor the bill. The motion was adopted on a vote of 9-3, with Senator Craft and Representatives Filer and Throne voting no.

PUBLIC HEALTH NURSING

Co-Chairman Scott advised that the Committee had been looking at the issue of public health nursing for several years. Problems arise because there are many different service delivery models, with some state- funded public health nurses working side-by-side with and sometimes supervising county-funded nurses. There have been complaints about supervision and pay discrepancies between state and county

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

employees. The county commissioners and department created a task force which came up with some good ideas that were incorporated into a bill draft, 14LSO-0263.C1, Public health nursing. [Appendix 21]. The bill would allow the Department of Health to negotiate difference service delivery models for public health with the various counties. The bill would also give counties an opportunity under agreement with the Department to transition their public health nurses from county employee status to state at-will employee contract status. Finally, the bill would require the county commissioners and develop a task force to further study the issues and report back to the committee.

Speaking in favor of the bill were Mike Nichols, Sheridan County Commissioner, Bill McDowell, Natrona County Commissioner, Korin Schmidt, WDH Deputy Administrator for Public Health and Wendy Braund, State Health Officer.

Representative Barlow, seconded by Representative Larsen, moved that the Committee sponsor the bill. The Committee amended the bill in Section 2 to change the mandated task force to a request that the County Commissioners Association form a task force to make further recommendations.

The motion to sponsor the bill was adopted on a vote of 12-0.

WYOMING LIFE RESOURCE CENTER

WDH Director Forslund reviewed the recent history. He stated that the legislature directed a study of the Wyoming Life Resource Center ("WLRC") and whether some or all residents could be transferred to community facilities and whether any efficiencies could be accomplished. The study was completed and presented last year. The Department determined that all the clients could be transferred over time but the department recommended against a quick transfer. The Department also determined that there could be efficiencies through changes in operations, and is proceeding to eliminate some positions through attrition.

Director Forslund stated that there was also a study commissioned by the Department of Health, through the Department of Administration and Information, of all of the Department's institutional facilities. The Governor has recommended $60 Million for renovations to WLRC, and an appropriation to be saved and used for renovations when the study is complete . The preliminary determination is that the State Hospital, WLRC and Veterans Home need significant capital updating -- $159 Million -- but that a needs/mission analysis should be done first. The Governor’s plan is to set aside as much money as we can afford, while a task force works on strategic planning.

The Committee generally discussed the advantages and disadvantages of proceeding with more study of the facilities. Co-Chairman Harvey stated that the time has come to totally replace the WLRC with newly built facility in the same part of the state.

Representative Larsen distributed a map and aerial photograph of the WLRC facility, showing the extensive land holdings that the State has as part of an original land grant at the time of Wyoming's admission to the United States. [Appendix 22] He recommended proceeding with study and planning review of all of the facilities.

Co-Chairman Harvey introduced for the Committee a bill draft, 14LSO-0233.C1 Facility for individuals with intellectual disability. The bill would call for the state to proceed with Level I and Level II study

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

and plans for the replacement of the WLRC, and require the current facility to be sold off as a way of funding its replacement. Co-Chairman Harvey moved that the Committee sponsor the bill, but the motion died for lack of a second.

DEPARTMENT OF HEALTH

Departmental Facility Master Plan – report Director Forslund, accompanied by Tom Whetstone of HDR Architecture, reported to the Committee on the status of the facilities master review requested by the Department of Health and contracted by the Department of Administration and Information to HDR Architecture.

Mr. Whetstone distributed and reviewed a packet of maps showing the five institutions. He reviewed each facility as it exists today, the continued usefulness of some of the buildings and how each facility might be reconfigured after a general, preliminary review.

Director Forslund stated that the Department will continue its planning work with all deliberate speed, and that no further legislation is necessary at this time.

Report on Title 25 discharge planning

WDH representatives Chris Newman, Bill Sexton and Alice Russler addressed the Committee. They distributed a handout entitled "2013-2014 Update: Mental Health and Substance Abuse Modernization" [Appendix 25]. They reviewed patient census trends for the most recent four-year period and cost-saving initiatives already undertaken. The project has created subcommittees on maximizing Medicaid, impacts of the Affordable Care Act, coverage gaps, mental health best practices and data/technical issues. The project will be completed in July 2014 with any recommendations for legislation at that time.

PUBLIC COMMENT Jan Johnson and Tom Johnson testified to the Committee regarding ongoing problems they have with nursing home placement for Mrs. Johnson, who stated that she suffers from three incurable diseases, and eligibility for Medicaid placement in a nursing home and in the Green House Living facility in Sheridan. They played an audio recording for the Committee.

Co-Chairman Harvey clarified that Mrs. Johnson had been on the Medicaid long term waiver program at home, but then was admitted first to a nursing home in Gillette and then the Green House facility in Sheridan. However, Medicaid has a rule that a person loses their eligibility for nursing home care if the person is out of the facility for more than 14 nights, and Mrs. Johnson's slot was lost as a result. Co- Chairman Harvey also clarified that the Johnsons believe that Mrs. Johnson's condition was incorrectly assessed by Medicaid using the LT-101 assessment tool. Mr. Johnson insisted that the assessment was fraudulent.

Teri Green, State Medicaid Agent, explained that a person can lose a slot in a nursing facility if the person is gone from the facility for more than 14 days, but it is not correct that the person therefore loses eligibility for Medicaid. She stated the purpose of the rule is so the program is not paying for an empty bed and the facility does not have to maintain an empty bed for an absent person.

Committee members generally discussed the working of the 14-day rule. Ms. Green explained that the implications of the rule vary depending on nursing home availability and that sometimes private nursing

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

homes would rather have a private pay patient than a Medicaid patient because the facility can charge more to the private pay patient.

Representative Barlow related that he has followed this process for 16 months with the Johnsons and wants to make sure that we’re clear there are two issues: the 14 day issue and the LT-101. He believes the assessment process is troubled, and has learned that we do not have a cohesive patient bill of rights that covers all types of facilities. He suggested an interim study for a consolidated patient bill of rights applicable to all facilities. Second, he believes the level of advocacy when people are reliant on the nursing care system is inadequate; the ombudsman system is of limited effectiveness. We need a much more robust and engaged advocate system.

Co-Chairman Harvey requested that the state health officer look into the Johnsons' situation, with particular attention to due process issues.

Annie McLaughlin testified on her behalf as the mother of a dual-diagnosis child and also distributed a handout on behalf of another parent of a developmentally disabled child. [Appendix 26]. She advocated taking the money that is currently spent on the Wyoming Life Resource Center and putting it into community care. Chris Newman stated that the WDH study indicated at least a three-year transition would be necessary to put all WLRC residents with community providers.

SENATOR SCOTT – EXPLANATION OF OBAMACARE RELIEF BILL Senator Scott explained a private bill that he has had drafted, called the "Obamacare Relief Bill." He stated that he has identified three different groups that are adversely affected by Obamacare: people in the vicinity of 400% federal poverty level who can’t afford premium increases; persons who are hurt by temporary provisions under the Affordable Care Act and could be helped by stopgap provisions; and persons who are in the 'Medicaid gap', making too much for Medicaid but not enough for subsidies, especially persons in larger families.

The draft bill would use income flows to the Wyoming Health Insurance Pool as a funding mechanism because of an exception in Obamacare regulations, in order to provide three forms of relief for the three identified groups.

Commissioner Hirsig stated that the Insurance Department is projecting some issues in those areas. He agreed that we don’t want to jeopardize the insurance companies with adverse selection or compete with them and that he will be working with Senator Scott on those goals as the bill is revised.

COMMITTEE BUSINESS; ASSIGNMENT OF BILLS

Co-Chairman Harvey distributed for the members' benefit a PowerPoint presentation she had received at the fall forum of the National Conference of State Legislators entitled "State Legislative Considerations for Reforming the Long Term Services and Supports Systems." [Appendix 27]

Co-chairmen Scott and Harvey, without objection from the Committee, agreed to assign to the House of Representatives bills entitled "Insurance-coverage of inherited enzymatic disorders" and "Medicaid expansion—limited benefits" and to the Senate bills entitled "Public health nursing," "Unemployment insurance—worker misconduct" and "Medicaid expansion—insurance pool."

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

MEETING ADJOURNMENT There being no further business, Co-Chairman Harvey adjourned the meeting at 4:30 p.m.

Respectfully submitted,

Charles K. Scott, Co-Chairman

Elaine D. Harvey, Co-Chairman

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

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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 Wyoming Insurance Insurance rate comparison Insurance Dept./Rude Commissioner

4 Wyoming Insurance 14LSO-0277.C1 Insurance-coverage of LSO staff Commissioner inherited enzymatic disorders

5 Wyoming Insurance 14LSO-0277.C1 Proposed amendments Insurance Commissioner Dept./Melinkovich

6 Medicaid Expansion 14LSO-140.C1 Medicaid waiver—tribal LSO Staff health programs.

7 Medicaid Expansion 14LSO-0139.C1 Medicaid expansion— LSO Staff limited benefits.

8 Medicaid Expansion 2013 Federal Poverty Level Table Dept. of Health

9 Medicaid Expansion "Wyoming, what are your values" Duane Keown statement

10 Medicaid Expansion Cheyenne Health and Wellness Center – Elizabeth Hoy PowerPoint

11 Medicaid Expansion Health Disparities on the Native American Sara Robinson Population in Wyoming

12 Medicaid Expansion 14LSO-0110.C1 Medicaid—premium LSO staff assistance options. (Arkansas model)

13 Medicaid Expansion 14LSO-0262.C1 Medicaid expansion— LSO staff insurance pool. (Arkansas model with modifications)

14 Hospital Licensure 14LSO-0141.C1 Hospital licensure. LSO staff

15 Hospital Licensure 14LSO-0142.C1 Hospitals—charity care LSO staff equalization.

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

16 Hospital Licensure 14LSO-0261.C1 Hospital construction LSO Staff moratorium

17 Hospital Licensure Hospital Licensure—Importance of a Level CRMC / Sherard Playing Field

18 Department of Health – 14LSO-0173.C1 Department of health LSO Staff Statutory Cleanup programs--updates.

19 Department of Workforce Wyoming Initiative for Medical Evaluation DWS / Karen Nelson, Services – back study and Treatment M.D. reports

20 Department of Workforce 14LSO-0138.C1 Unemployment LSO Staff Services Insurance—worker misconduct.

21 Public Health Nursing 14LSO-0263.C1 Public Health Nursing LSO Staff

22 Department of Health— WLRC plat and aerial photo Representative Larsen Facility Master Plan report

23 Department of Health— 14LSO-0233.C1 Facility for individuals LSO Staff Facility Master Plan report with intellectual disability.

24 Department of Health— Facility Master Plan January 10, 2014 A&I Construction Facility Master Plan report Management / HDR / Whetstone

25 Department of Health— 2013-2014 Update: Mental Health and WDH / Forslund Report on Title 25 Substance Abuse Modernization Discharge planning

26 Public Comment Information Packet on behalf of Sydney Gale Roberts / Annie Roberts McLaughlin

27 Committee Business NCSL Fall Forum handout: Considerations Representative Harvey for Reforming the LTSS Systems

JOINT LABOR, HEALTH AND 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