Joint Corporations Minutes

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PP RROOCCEEEEDDIINNGGSS JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE

COMM ITTEE M EETING I NFORM ATIO N August 26-27, 2013 Lovell Community Center Lovell, Wyoming

COMM ITTEE M EM BERS PRESENT Senator Charles Scott, Cochairman Representative Elaine Harvey, Cochairman Senator James Lee Anderson (SD 28) Senator Leslie Nutting Senator R. Ray Peterson Representative Eric Barlow Representative Kathy Coleman 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 Bernadine Craft Senator Leslie Nutting

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 in Lovell, Wyoming. The Department of Health presented updates on Title 25 discharge planning, the Affordable Care Act's impact on Wyoming Medicaid, the Medicaid enrollment system, the public health nursing program, Medicaid waiver redesign, the Life Resource Center and medical education programs. The Committee received a draft of a bill on premium assistance options under Medicaid. Several members of the public testified about the effect of cuts in the developmental disability waiver programs.

Brad Rodu testified about using smokeless tobacco as a method to reduce tobacco harm. The Department of Workforce Services presented updates on a proposal to define worker misconduct in unemployment insurance, anti-fraud initiatives and the safety discount programs. The University of Wyoming provided program status updates for all of its medical education programs.

Committee members requested bill drafts regarding: unemployment compensation misconduct; Medicaid expansion using the Arkansas model, the Department's "Medicaid Fit" concept and regarding tribal members only; and statute updates as requested by the Department of Health. The next meeting of the Committee is to be in November in Casper.

CALL TO ORDER (MONDAY, AUGUST 26) Co-Chairman Scott called the meeting to order at 8:00 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 June Committee meeting were approved on a unanimous voice vote.

DEPARTMENT OF HEALTH

Title 25 The Committee was addressed by a panel of Department of Health staff, including: Carol Day, Community Systems Unit Manager; Chris Newman, Administrator, Behavioral Health Division; Bill Sexton, Superintendent, Wyoming State Hospital; Alice Russler, Administrator, Mental Health and Substance Abuse Services Division.

Ms. Day explained that the Department in 2004 developed a standard of care for inclusion in memoranda of understanding ("MOU") between the department and community mental health centers for cases involving involuntary detentions and involuntary hospitalizations under Title 25. The standard has been updated with Wyoming State Hospital staff and emphasizes standards for timely communication with the centers upon admission, upon deciding on a course of treatment and medication and upon discharge. The State Hospital arranges for transportation back to the community and makes sure the patient knows where the community mental health center is located.

Committee members discussed with Ms. Day and Mr. Sexton how the MOU's might be changed if the Judiciary Committee's proposal is enacted, with would call for more diversion to community resources rather than the State Hospital. Mr. Sexton explained that the MOU is currently being revised, and that it would not come into play if the patient is not referred to State Hospital.

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

Co-chairman Scott stated that he was concerned about coordination among community intake entities, the State Hospital and community placement providers. Co-chairman Harvey was concerned about the costs of involuntary detention; Ms. Russler stated that the Department' response to the Judiciary Committee bill will address costs and will recommend putting medical personal back in the initial stage of the detention proceeding. She agreed to copy the members of the Committee with the Department's response to the Judiciary Committee bill.

Superintendent Sexton stated that the State Hospital has already implemented many reforms, resulting in decreased length of stay and decreased admissions.

Director Forslund stated that the Department's shortfall in funds for Title 25 cases had been $8 Million per biennium. Half of that shortfall has been appropriated, one-quarter has been saved through management changes and the remaining $2 Million will be in a supplemental budget request. Mr. Sexton noted that there were 249 Title 25 cases last year.

The Committee received copies of a letter from the Park County Title 25 Task Force [Appendix 3].

David Monhollen, President of the Wyoming Association of Mental Health and Substance Abuse Centers, advocated increased diversionary housing and crisis intervention centers.

Ken Blackburn, Big Horn County Sheriff, stated that law enforcement is necessarily involved in many Title 25 cases but law enforcement personnel are not appropriately trained for mental health care and do not have appropriate facilities or budget. He said the biggest problems are recidivism and follow-up care. He advocated that local treatment programs be expanded, not consolidated.

Darwin Irvine, Director of Big Horn Basin Counseling Services, stated that mental health and substance abuse counselors are not paid very well. He noted that the Wyoming Retirement Center deals with a lot of former mental health patients and advocated creation of transition and group homes all over the state.

Rick Schroeder, CEO of Big Horn Hospital in Lovell, advised that the hospital cooperates with law enforcement to treat mental health patients as patients, not prisoners. Sheriff Blackburn added that reduction in local treatment would lead to an increase in law enforcement involvement in mental health cases.

Dee Cozzens, Administrator of the Worland Healthcare and Rehabilitation Center, told the Committee she sees problems with continuation of overmedication into se4nior years and inadequate staff for existing beds.

Senator Scott asked if the Department had any statutory requests. Ms. Newman replied that they are doing a complete system review and redesign right now, including mental health homes and increasing use of Medicaid, but are still in the assessment and problem identification stage. The department is not sure yet if they will look for more statewide standardization or more local control, noting that the last big infusion of funding was not uniformly applied.

Senator Scott stated that it appears there is need for long-term housing for chronic patients and a continuing need for transitional housing, both for up front diversion and for community reintegration after in-patient treatment. Ms. Newman stated that they should have specific recommendations in time for the Committee's November meeting.

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

Medicaid Enrollment System Director Forslund, Teri Green, Jan Stahl and Jesse Springer addressed the Committee and distributed a 2013 Impact Update entitled "Affordable Care Act and Wyoming Medicaid [Appendix 4] and an information on the "Wyoming Eligibility System" [Appendix 5]. The Department has received 90% federal funding for a new Medicaid eligibility and enrollment system, and has chosen Northrup Grumman as the vendor.

Ms. Stahl described the Wyoming Eligibility System. It will cover Medicaid and the Children's Health Insurance Program to start, with improved security and accuracy of eligibility determinations. It can be expanded later to cover other entitlement programs, and will work together with the insurance marketplace.

Committee members discussed how the system will handle continuity of coverage with changes in client eligibility and whether the system will allow non-citizen mothers to receive pre-natal care. Director Forslund stated that there are no anticipated expansion modules for workforce services programs.

Public Health Nursing Program Ron Harvey, Vice President of the Wyoming County Commissioners Association, addressed the Committee to advise that the Association is working with the Department of Health to come up with solutions to the jurisdictional and inconsistency problems in public health nursing, but that they have no recommendations yet.

Co-Chairman Scott noted that three counties do not participate at all in the state's public health nursing program, that the Committee has tried for several years to address the problem of dual county-state responsibility, and that the public health nursing program does not appear to be working. The program will therefore be a target if additional budget savings are required.

Commissioner Harvey stated that his county works very well with the state, and that there are no issues. He doesn't want to fix what is not broken.

Jerry Hewitt, Big Horn County Commissioner, said that there have been problems regarding county employees supervised by a state employed public health nurse and that the commissioners recently voted not to renew any arrangement where county employees are supervised by person outside of the county's control.

Director Forslund stated that the Department recognizes there are issues. The current model is for the state to pay 65% and counties to pay 35% of costs. Both Sweetwater and Natrona Counties have asked to come back but that couldn't be done after the nurses were laid off. The model needs discussion; it invariably creates occasional conflicts, usually when there are personnel changes. The Department has considered contracting for all services and getting the state out of the direct provision of services, but that doesn't solve all of the problems either.

Senator Scott stated that he has been judging the public health nursing program in part on the basis of the mother/child home visitation program. The most recent department report shows that 52% of the recipients of that program's services were not Medicaid eligible. The underlying research for the program showed the most benefit was when services were for young, poor and unmarried mothers, yet 48% of the services are going to the wrong target group. He stated that that is mismanagement of resources , and it is working so poorly that there is no solution except to cut out the people.

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

Mike Nickel, Sheridan County Commissioner, stated that many people in his county benefit from the public health nursing program and that they should be the focus.

Wendy Braund, State Health Officer, noted that the program is under review, with the participation of the County Commissioners Association. She made the following points regarding the program:  The home visitation program is just one of eight components of the public health nursing program;  The program is the only direct public care health system in the state, and eliminating it would be very damaging to the people served by the other seven components;  The same contract form is used in each county, with any changes that the county attorney requests and is approved by the Department's attorneys  Since 2012, interview teams for nurse managers have included a county representative, and new hires are required to waive confidentiality under the personnel rules to allow a county representative's participation in any personnel actions;  In a Department survey, public health nurses, county commissioners and boards of health all reported overall satisfaction with the program, with the highest level of dissatisfaction in regard to supervision.

Co-Chairman Scott stated that statutory changes will probably be needed, as there have been chronic management problems for years, and that the Committee looks forward to the Department's recommendations.

Draft Legislation 14-LSO-0110.W2 Co-Chairman Harvey noted that the Legislation has not shown the political will for expanding Medicaid under the Affordable Care Act ("ACA"), and that one alternative that might be more palatable is the Arkansas model, which would authorize a Medicaid waiver program that would provide medical services through support for private insurance premiums. She stated that Arkansas takes the existing and newly eligible Medicaid population, except for the highest cost cases, and provides coverage through subsidizing the purchase of insurance on the marketplace. She advised that the draft bill [Appendix 6] is based closely on the Arkansas legislation, but that the Committee will not work the bill until the November meeting and not take a final vote until the January meeting.

Co-Chairman Scott stated that there will be a lot of amendments and distributed some that he would request [Appendix 7].

Committee members generally discussed how the Arkansas waiver plan would work, including whether it would take the place of the Children's Health Insurance Program, whether co-pays would be included and whether the Center for Medicare and Medicaid Services will be willing to accept this much state flexibility in Medicaid.

Representative Filer requested a side-by-side comparison of traditional Medicaid expansion under the ACA and expansion under the Arkansas plan.

Representative Throne asked for another bill draft, expanding Medicaid per the Department's "Medicaid Fit" proposal as circulated in the Department's paper entitled "The Wyoming Approach For Medicaid Expansion – Alternate Benefits Plan Options." [Appendix 8].

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

Retaining and Recruiting Medical Professionals Dr. Wendy Braund, State Health Officer, summarized the physician and health care professional recruiting programs. One program offers student loan subsidies of $30,000 per physician and $10,000 per allied health professional per year for three years. 72% of the first cohort is still practicing in Wyoming after completion of the required service. Another program offers physician recruitment grants of up to $80,000. She noted that 22 of Wyoming's 23 counties are considered critical physician shortage areas for purposes of the National Health Service Corps, which Wyoming supports and which was expanded under the ACA. The budgets for all of the recruitment programs were cut along with the Department's overall budget cuts.

Proposed Statutory Changes Meredith Asay, Department of Health Administrator of the Director's Unit for Policy, Research and Evaluation, distributed a list of proposed statutory cleanup items [Appendix 9]. She stated that it is a short list of noncontroversial clean-up items. Co-Chairmen Harvey and Scott agreed that the items would be put into bill format and considered at the November meeting.

Medicaid Waiver Redesign Director Forslund updated the Committee regarding the waiver redesign called for by 2013 Senate File 60. He distributed a handout entitled "Medicaid Reform/Waiver Redesign: Summary of Framework" [Appendix 10. He noted the current system serves 2442 people, costing $51 Million/year with a 50-50 federal match. As of July 31, there were 584 people on the waiting list, which would require $24 Million/year to completely eliminate. The waiver redesign is intended to serve all of those on the waiting list without any increase in funding. The waiver redesign has gone through many drafts and is ready to be submitted to the Center for Medicare and Medicaid Services for approval.

Committee members generally discussed the need for the redesign. Director Forslund responded that the Department was directed several years ago to study Medicaid, its cost drivers, and to come up with recommendations. The Department produced three reports with reform options and the Legislature directed implementation of some of those options. The Joint Appropriations Committee indicated it would not approve funding any more positions off of the waiting list, so the Department suggested and the Legislature approved the idea of a dual waiver system, to include a capped supportive services waiver and a comprehensive waiver. Chris Newman added that the Department worked with a stakeholders group in drafting the redesign, that the waiver application was posted online for three weeks for comments and that it will be posted for an additional two weeks for final comments.

Joe Simpson, Deputy Administrator for Development Disabilities at the Department of Health, explained that the Department will still do annual plans of care for every person on the waivers, and that there will be six levels of service on the comprehensive waiver. Some clients will not need higher levels of service and can be stepped down to lower levels, resulting in savings that can be used for other clients.

Regarding reimbursement rates, Ms. Newman explained that there was a 4% budget cut on July 1, 2012 due to the across-the-board cuts from the 2012 budget session, but that, due to other efficiencies, the Department was able to limit the actual reimbursement reduction to 1%. The waiver redesign, which is anticipated to be approved in February or March, is an entirely different matter from the budget cuts

Committee members expressed concern about the Department's plan to rely more heavily on natural supports from the relationships that form naturally in everyday life such as relationships with family members, friends, neighbors and coworkers.

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

Members also expressed concern about cutting the respite care rate. Ms. Newman explained that part of the 2013 fiscal year cuts were done by implementing a daily rate of $167. Before that, an hourly rate for 24 hours could add up to $335, which was out of line with skilled care and therefore an appropriate place to cut. Director Forslund added that the Department was required to cut $19 Million out of its budget. Cuts were made to public health nursing, preschools, developmental disabilities and adult day care. Now that the cuts have been felt, there is pushback, but those cuts have nothing to do with waiver redesign.

Life Resource Center Meredith Asay reviewed the study required by 2013 Senate File 81, referring to a handout [Appendix 11]. She noted that the Department has contracted with HDR, an architectural firm, and the Buckley Group, an expert on intermediate care facilities for persons with intellectual disabilities. The study is proceeding, with a final report to be made by November 1.

QUALITY REPORTING SYSTEM – WYOMING HOSPIT AL ASSOCIATION Dan Perdue, President, Wyoming Hospital Association, and Anne Ladd, CEO, Wyoming Business Coalition on Health, addressed the Committee. They advised that the two groups have been working together on the best way to achieve price transparency for hospitals via a uniform reporting system and accessible website. They will hold a third stakeholders meeting in September and will make a final report before the legislative session.

PUBLIC COMMENT Allison Sage spoke in favor of an exception to the Medicaid expansion prohibition to allow a demonstration waiver for Medicaid expansion for Native Americans. She stated it would be a 100% pass through program without cost to the state.

Paula Morris said she is a pastor at a Methodist Church, but had to rely on charity care to pay for her medical expenses

Chelsea Lee, Wyoming Association of Churches, advocated expansion of Medicaid.

Gary Collins, Arapahoe Tribe tribal liaison, spoke in favor of the Indian health waiver.

Buck Gwen, Protection and Advocacy, reviewed the history of litigation over the de-institutionalization of persons with disabilities and cautioned against violating the court orders in the waiver redesign.

Heather Sawaya spoke about her son Jeff who has a developmental disability. She distributed a handout [Appendix 12]. She spoke in support of full funding for a waiver program that will provide all of the necessary services.

Katherine and Wade Brown distributed a handout and photos [Appendix 13] about their son who is dependent on a gastronomy tube for feeding and is on the waiting list for services.

Diane Badget spoke on behalf of her grandchild who has spina bifida and autism, and who cannot walk or talk, but is number 500-something on the waiver waiting list.

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

Yvonne Bryant described how the proposed waiver changes would impact her family and her 24-year old son who has the mental capacity of a 6-year old and has seizures every day. She stated the case manager change would take away her right to choose what is best for her son. She distributed a handout about her son's condition and advocating for increased funding [Appendix 14].

Rose French stated that her two sons who are on the waiver will lose essential services under the waiver redesign.

Donna Capellen expressed concerns about changes in case management for their son and fear that it will not meet his and the family's needs [Appendix 15].

Nicole Hendershot stated that she is a service provider in Lovell and that the proposed new service levels would result in a server drop in service reimbursement, to a level below minimum wage.

Sean Griffin, Community Entry Services, stated that it is impossible to add more services for more people at the same funding level without taking something away from others. It is simply a funding priority issue.

Shirley Pratt, ARC Regional Services in Laramie, agreed with Mr. Griffin.

Kim Schweikert, Easter Seals of Wyoming, testified that Montana is doing away with its comprehensive waiver. Easter Seals is lucky to have other funding, but other small community providers have no safety net.

Kirstin Akin, read and distributed a handout [Appendix 16] in support of independent case managers.

Anne Bennett spoke in favor of independent case managers.

MEETING RECESS The Committee recessed at 6:43 p.m.

CALL TO ORDER (TUESDAY, AUGUST 27) Co-Chairman Harvey called the meeting to order at 8:00 a.m.

TOBACCO HARM Dr. Brad Rodu, an oral pathologist and professor at the University of Kentucky, spoke in favor of public policies that favor electronic cigarettes as a more healthy alternative to traditional smoking and a more effective tobacco cessation device. He distributed a booklet, "Helping Smokers Quit" [Appendix 17] and a PowerPoint presentation on "Tobacco Harm Reduction" [Appendix 18]. He stated that smokeless nicotine delivery systems are 98% safer than smoking.

DEPARTMENT OF WORKFORCE SERVICES

Workers' Compensation and Unemployment Insurance Appeals Processes A panel from the Department of Workforce Services addressed the Committee, including: Joan Evans, Director; Jim Reed, Chief Hearing Officer; Brian Jacobson, Special Investigations Unit Manager; and Tobi Wickham, Workforce Programs Administrator. They distributed a copy of 2013 HB 237, Unemployment Insurance—Worker Misconduct [Appendix 19], along with proposed changed to that bill [Appendix 20].

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

Director Evans explained the proposed language, which would define worker misconduct as an 'intentional disregard of the employer's interests or the commonly accepted duties.' It would exclude ordinary negligence or good faith errors in judgment or discretion."

Committee members generally discussed the need for the bill if it is consistent with a Supreme Court decision on the subject, and whether it would solve the employers' perceived problem of losing too many appeals and the length of time involved in an appeal.

Director Evans replied that her intent is to have the same definition applied by everyone at all levels. She stated that the determination system has already been improved, and that the Department is in the middle of a modernization program that bill be finished in 2016 and vastly change the business.

Representative Throne stated that the proposed bill does not exactly mirror the language of the Supreme Court decision, and eliminates an entire category of exception to the misconduct definition.

Representative Larsen moved that the Department's suggestions be prepared as an LSO draft for the next meeting. Representative Throne asked that the Supreme Court's language regarding employee inefficiency be included in the draft.

Co-employee Lawsuits John Ysebaert, Workforce Standards and Compliance Administrator, addressed the Committee regarding co-employee lawsuits. He provided statistics on co-employee lawsuits gathered by the attorney general's office. There were two suits filed this year, five last year, and 35 over last 10 years. Of those, there were 9 verdicts, including 6 split decisions. Nineteen cases were settled and seven are pending decision at district or supreme court. Over $2.7 million recovered has been recovered for the fund from the proceeds of those lawsuits.

Senator Scott observed that it does not sound as if there is any problem, perhaps beyond one case that was reported to him. Representative Throne noted that the statistics are interesting, but not related to any of the Committee's interim topics.

Anti-fraud initiatives Brian Jacobsen provided information on the Departments fraud investigation efforts which were begun two years ago. The unit's efforts resulted in one fraud conviction in Sublette County with a 4-6 year sentence. The Hot Springs County Attorney is seeking $35,000 restitution in a civil case. Committee members discussed the amount of potential fraud. Mr. Jacobsen stated that he suspects up to 5% of cases may involve some fraud or overuse, but that it is difficult to gather data and the program is too new to have reliable numbers.

Safety Discount Programs Director Evans distributed a spreadsheet [Appendix 21] on grants made under the Division's new safety program authorized during the 2012 session. She explained that the handout shows the identity of the employer receiving the grant, the number of affected employees, the amount of the grant and a brief description of the safety improvement.

UNIVERSITY OF WYOMING

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

WWAMI, WICHE, WYDENT – Status Report Mike Massie, Joe Steina and Beth Robitaille reported on the status of the Family Practice Residency Program [Appendix 22, 23] and the medical professional educational support programs [Appendix 24]. Committee members generally discussed the percentage of students who remain in Wyoming in each program, accreditation issues and outreach efforts.

COMMITTEE BUSINES Committee members requested bill drafts for the next meeting regarding: unemployment compensation misconduct; Medicaid expansion using the Arkansas model, the Department's "Medicaid Fit" concept and regarding tribal members only; and statute updates as requested by the Department of Health.

MEETING ADJOURNMENT There being no further business, Co-Chairman Harvey adjourned the meeting at 3:30 p.m..

Respectfully submitted,

Senator Charles K. Scott, Co-Chairman

Representative Elaine Harvey

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 Department of Health – Letter to Co-Chairs and Members Park County Title 25 Task Title 25 Force

4 Department of Health – 2013 Impact Update: Affordable Care Act WDH Affordable Care Act & Wyoming Medicaid

5 Department of Health 2013 Major Project Update: Wyoming Dept. of Health Eligibility System

6 Department of Health 14LSO-0110.W2 Medicaid—premium LSO assistance options.

7 Department of Health Medicaid—premium assistance options: Senator Scott suggested amendments

8 Department of Health The Wyoming Approach for Medicaid WDH Eligibility

9 Department of Health- Statutory Clean-Up Request WDH proposed statutory changes

10 Department of Health— Medicaid Reform | Waiver Redesign WDH Medicaid waiver redesign

11 Department of Health – 2013 Study Update: Wyoming Life WDH Life Resource Center Resource Center

12 Public Comment Written remarks Heather Sawaya

13 Public Comment Written remarks Katherine and Wade Brown

14 Public Comment Written remarks Yvonne Bryant

15 Public Comment Written remarks Donna K. Capellen

JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings

16 Public Comment Written remarks Kirsten Akin

17 Tobacco Harm Helping Smokers Quit: the Science Behind Brad Rodu Tobacco Harm Reduction

18 Tobacco Harm PowerPoint: Tobacco Harm Reduction Brad Rodu

19 Dept. of Workforce 13LSO-0608.E1 Unemployment DWS Services insurance—worker misconduct.

20 Dept. of Workforce Proposed Amendments to HB0237 DWS Services

21 Dept. of Workforce Spreadsheet: Safety Improvement Fund DWS Services—Safety discount program

22 University of Wyoming Report to the Governor on the Univ. of UW Wyo. Family Practice Residency Programs

23 University of Wyoming Task Force Statement on Univ. of Wyo. UW Family Medicine Residency Programs

24 University of Wyoming PowerPoint: College of Health Sciences UW Medical Education

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