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May 13, 2003
Wyoming Girls' School
Sheridan, Wyoming
Senator Charles K. Scott, Cochairman;
Representative Doug Osborn, Cochairman;
Senators John Barrasso, Cale Case and Mike Massie;
Representatives Mary Meyer Gilmore, Elaine Harvey, John Hastert, Becket Hinckley, Jerry Iekel, David Miller and Ann Robinson.
John H. Rivera, Senior Staff Attorney, and Mike Causey, Staff Attorney.
Please refer to Appendix 1 to review the Committee Sign-in Sheet for a list of other individuals who attended the meeting.
Senator Tex Boggs;
Representative George B. McMurtrey.
All meeting materials and handouts provided to the Committee by the Legislative Service Office (LSO), public officials, lobbyists and the public are referenced in the Meeting Materials Index, attached to the minutes. These materials are on file at the LSO and are part of the official record of the meeting.
Cochairman Osborn called the meeting to order at 8:40 a.m. The following sections summarize the Committee proceedings by topic. Please refer to Appendix 2 to review the Committee Meeting Agenda.
Departmental Status Reports
Department of Family Services
Rodger McDaniel, Director of the Department of Family Services (DFS)—along with Rick Robb, Ginger Stout, and Donna Sheen—updated the Committee on the status of the Department. Mr. McDaniel first commented upon several recent changes to the staffing and structure of DFS (see Appendix 3). Mr. McDaniel also noted a recent emphasis upon improving "customer relations" and detailed positive feedback that DFS had received in the form of customer comment cards. Mr. McDaniel indicated that other major goals included advocacy on behalf of customers and collaboration with other agencies. Mr. McDaniel discussed family drug and treatment courts in other jurisdictions and described the successes of these programs (see Appendices 4 and 5). Mr. McDaniel emphasized that more modern approaches should be used to address problems with families, noting that the current approach in Wyoming is to "shoehorn" modern problems into nineteenth century solutions. Ms. Sheen described the work that the Select Committee on Juveniles had done and described work completed last year (see Appendix 6). Ms. Sheen also detailed the subcommittees of the Select Committee and described what steps each subcommittee had taken in completing its assigned tasks.
Ms. Stout informed the Committee about "institutional certification" for teachers at Wyoming institutions. Ms. Stout stated that having institutional certifications allows teachers to teach "outside of their areas," which makes for more effective and efficient use of institutional personnel. Ms. Stout also indicated that the lack of guidance on the "No Child Left Behind" program for institutions makes implementation of that program difficult. Mr. McDaniel added that DFS is working with the Department of Education to resolve such concerns.
Mr. McDaniel also indicated that the federal government reviews state children and family services programs and that DFS recently received Wyoming's report. Mr. McDaniel indicated that DFS must submit a detailed child services improvement plan by June 30, 2003, which must be implemented within two years to avoid federal sanctions. Mr. McDaniel stated that the preliminary plan will be sent to legislators in early June 2003; a statewide teleconference is scheduled June 20, 2003.
Mr. Robb commented upon several identified weaknesses within DFS—a lack of consistency, the focus solely on the target child, the insufficiency of worker contacts, the inadequate service array, the lack of permanency, and the lack of training—and noted steps to be taken to strengthen work in these areas. Mr. McDaniel then discussed several major DFS initiatives and further discussed the United States Department of Health and Human Services Report (see Appendices 7 and 8). Mr. McDaniel indicated that current caseload of DFS personnel is up to two times the national average and that additional funding and personnel may be needed. Mr. McDaniel also acknowledged the relationship of drug and substance abuse problems and poverty to family problems. Cochairman Scott indicated that a possible tax on beer and alcohol might be considered at the next Committee meeting.
Department of Health
Deb Fleming, Director of the Department of Health (DOH)—along with Brent Sherard, Iris Oleske, Roxanne Homar, and Patricia Guzman—updated the Committee on the status of the Department. Dr. Fleming detailed the work and organizational structure of DOH (see Appendix 9). Dr. Fleming stated that DOH must use an interdisciplinary approach to problem solving and that DOH must work to increase public knowledge of DOH's role and to increase cooperation between various state and federal agencies. Dr. Fleming also stated that the Governor has indicated a desire to decrease the number of at-will contract employees (AWECs).
Dr. Sherard next discussed several health issues in Wyoming, including West Nile virus, Severe Acute Respiratory Syndrome (SARS), and bioterrorism (see Appendix 9). Dr. Sherard indicated that mosquito spraying is occurring in larger counties. Dr. Sherard stated that SARS seems to be a threat equal to the 1918 influenza outbreak. Dr. Sherard indicated that roughly 400 primary health responders have been inoculated against smallpox, which should be sufficient given the geographic distribution of these personnel. Dr. Sherard stated that four persons have experienced health troubles after inoculation. However, Dr. Sherard also indicated that DOH was unsure whether the incidents were directly related to the vaccination and that worker's compensation policies are being reviewed to determine if these circumstances could be covered under the worker’s compensation program if related to the inoculations.
Ms. Oleske discussed Medicaid and related programs in the State. Ms. Oleske indicated that Wyoming has one of the smallest programs and that Wyoming will not be reducing services as are other states. Ms. Oleske also detailed some of the benefits to Wyoming employers participating in the deductible program. Finally, Ms. Oleske described several pieces of legislation that passed during last session and the impact that the legislation has had thus far.
Ms. Homar discussed several matters relating to prescription drugs. Ms. Homar described the use of preferred drug lists in Wyoming's Medicaid program and related some details of an Oregon study that will serve as a model for a Wyoming study to be started by the fall of this year (see Appendix 9). Ms. Homar also stated that a "sister project" remains the Prescription Drug Effectiveness Review Project, a program that encourages states to work together in developing preferred drug lists. The Project will receive funding from the federal government's Medicaid program but will also require approximately $36,000.00 of Wyoming funds; however, Ms. Homar indicated that current budgetary authorizations should be sufficient. Ms. Homar also detailed recent legislation on the subject of prescription drugs, including changes affecting the School of Pharmacy and the Pharmacy Plus Waiver Program.
Ms. Guzman gave an accounting of the Wyoming Kidcare program and described the impact of and DOH responses to recent statutory changes. Ms. Guzman indicated that the State plan for Kidcare was sent to the Centers for Medicare and Medicaid Services (CMS) March 31, 2003. CMS has 90 days to approve the new plan. Ms. Guzman stated that the CMS review has so far been positive. Ms. Guzman also stated that Requests for Proposal were sent to insurance companies April 18, 2003, and insurance companies have 60 days to respond.
Department of Workforce Services
Kathy Emmons, Director of the Department of Workforce Services (DWS)—along with Dave Teubner, Jim Elias, and Jonathan Downing—updated the Committee on the status of the Department. Ms. Emmons detailed the current make-up of DWS and stated that DWS would like more local control over and involvement with decisions (see Appendix 10). Ms. Emmons indicated that the transfer of functions from other agencies to DWS has been completed ahead of schedule and provided an update on recent DWS news (see Appendix 11). Ms. Emmons indicated that one problem encountered by DWS is the lack of adequate office space to accommodate the "one-stop shopping" that DWS would like to offer. Ms. Emmons stated that the Workforce Development Council is working on a "State of the State" report that will address Wyoming's workforce issues. Ms. Emmons stated while the federal government largely funds DWS, more State funds need to be invested in improving Wyoming's workforce. For example, Ms. Emmons stated that there might need to be an approximate $200,000.00 appropriation to DWS because of a change in a federal fund matching formula.
Mr. Teubner stated that DWS has developed a new logo and new strategies to work with other agencies, including the Wyoming Business Council. Mr. Teubner also indicated that DWS has been working with many Wyoming businesses to train thousands of workers around the State.
Department of Employment
Cindy Pomeroy, Director of the Department of Employment (DOE)—along with Gary Child, Ellen Schreiner, and Wendy Tyson—updated the Committee on the status of the Department. Ms. Pomeroy detailed the current DOE administration and staffing. Ms. Pomeroy indicated that the Information Technology section in Casper has 13 new projects underway and has identified 26 additional projects to be completed to improve DOE operations. Ms. Pomeroy stated that DOE would be making a special budget request of $200,000.00 to purchase the State's Call Center building. Ms. Pomeroy indicated that she was concerned with a Medical Commission backlog of 214 cases with hearings scheduled into 2004. To resolve the cases, DOE has been using mediation and medical consultants. Ms. Pomeroy indicated that a statutory change might be needed to address a problem with the worker's safety rules. Ms. Pomeroy also stated that the worker's compensation deductible program (HB 154) that passed without a request for funding is being examined (see Appendix 12). Ms. Pomeroy also detailed other changes made during the last legislative session as well as other legislative changes that DOE would like to see in upcoming sessions, including encouraging light duty work and allowing for collection of overpayments (see Appendix 13).
In response to Committee questions, Ms. Pomeroy indicated that DOE would like to make current AWECs into full-time State employees and that she will examine possible overstaffing at certain DOE offices. Ms. Pomeroy also indicated that DOE is looking into DOE's "image" from the perspectives of care providers, employees, and employers. Mr. Child indicated that he had become aware of Wyoming's high number of worker fatalities but was not sure how many of these fatalities were automobile-related. Mr. Child was asked to provide information on the numbers of automobile fatalities at the Committee's August meeting.
Subcommittee Plans
State Employees' Compensation
Senator Cale Case updated the Committee on the status of the Subcommittee. Senator Case indicated that the Subcommittee intends to interview prospective consultants May 22, 2003, and expects to receive the work product of the selected consultant in September 2003 (see Appendix 14). While Senator Case did indicate that there is a potential for a problem because the consultants are not licensed by the State, he also indicated that Wyoming’s licensure statutes might not be applicable because the consultants are not offering "products" in addition to their consultations. Senator Case also indicated that the Governor's Office has also been working on similar issues and that both the Governor's Office and the Subcommittee would work together.
Health Care Commission
Representative Jerry Iekel updated the Committee on the status of the Subcommittee. Representative Iekel indicated that the Subcommittee has not met yet because only one-half of the Commission members have been appointed. Representative Iekel did indicate that the remaining members should be appointed within the next several weeks.
Worker's Compensation
Representative Becket Hinckley updated the Committee on the status of the Subcommittee. Representative Hinckley indicated that the Subcommittee had not met yet but also stated that he would like to meet soon to set schedules. It was suggested that the Subcommittee more closely examine the fiscal impact of the employer deductible passed during last session, and Representative Hinckley indicated that the Subcommittee would look into the issue.
Medicaid Cost Control/Content
Representative David Miller updated that Committee on the status of the Subcommittee. Representative Miller indicated that he would be contacting Chairman Phillip Nicholas of the Joint Interim Appropriations Committee to determine if the House would like to have a representative on the Subcommittee. In addition, Representative Miller indicated that he had received information from legislative staff and that Ms. Oleske's presentation had been useful.
Senator Massie discussed a study last year by the Department of Health particularly addressing the issues of why workers in Wyoming were not receiving health care coverage and indicated that he had served on a subcommittee of the committee put together to analyze the issue (see Appendix 15). Senator Massie indicated that the committee has met four times and has developed good information about the demographics of health insurance in the State. Senator Massie stated that an amendment to the Health Care Commission bill last session indicated that the work of the committee should be included in the Commission. Senator Massie reported that there were four areas of committee concentration: low-income employees, community health care centers, employers, and development of a catastrophic health insurance policy.
When asked whether the committee would incorporate its work into the Health Care Commission's work, both Representative Iekel and Dr. Fleming indicated their understanding that the new committee was to incorporate the work of the earlier committee.
Health Care Workforce Issues
Department of Health
Dr. Fleming indicated that health care workforce issues was an area that overlapped into the areas of several agencies but that she was unsure whether any single agency had taken the lead in addressing these problems. Dr. Fleming indicated that a "big picture" view was needed to solve these problems and that the solution could not be limited to one or two issues; instead, all of the problems with training, salary and benefits, retention, and job satisfaction would need to be addressed simultaneously. It was suggested that first changing the pay bands for these personnel and then requesting additional funding might better solve the pay-related problems with public health nurses.
Industry Representatives
Dan Perdue, Wyoming Hospital Association, discussed magnet and other special hospitals. Mr. Perdue indicated that financial incentives might be necessary to introduce these types of programs in Wyoming. Members of the Committee indicated that they would like hospital groups and State officials to come forward to discuss implementing such programs in the state, and Senators Massie and Boggs and Representative Iekel were recommended to meet with the groups and personnel from DOH.
Dan Lex, Quality Health Care Foundation, indicated that the amounts of paperwork required by both state and federal governments added to the problems faced by health care personnel. The Committee discussed the possibility of obtaining waivers from the federal government if federal law mandated the paperwork. The issue was assigned to be studied by the Subcommittee on Medicaid Cost Control/Content.
Wendy Curran, Wyoming Medical Society, commented upon issues regarding other health care professionals (especially dentists and nurses), licensure, and malpractice insurance and tort reforms (see Appendix 16). Ms. Curran mentioned that some parts of Wyoming are already experiencing difficulties. The Committee mentioned that the issue of licensure had been addressed in a similar profession—that of occupational therapists—and suggested examining these provisions as a starting point to address the issue for health care professionals. The Committee discussed discrimination in the amounts of dollars received for rural health care from Medicaid. Ms. Curran agreed that the problem has many different faces.
There being no further business, Cochairman Osborn adjourned the meeting at 4:30 p.m., Tuesday, May 13, 2003.
Respectfully submitted,
Representative Doug Osborn
Cochairman