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Joint Corporations Minutes D r a f t O n l y A p p r o v a l P e n d i n g SS UUMMMMAARRYY ooff 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 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 4 OF 12 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
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