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May 13, 2004
Wyoming Oil and Gas Conservation Commission Building
Casper, Wyoming
Senator Charles K. Scott, Chairman
Representative Doug Osborn, Chairman
Senator John Barrasso
Senator Tex Boggs
Senator Cale Case
Senator Mike Massie
Representative Mary Gilmore
Representative Elaine Harvey
Representative John Hastert
Representative Jerry Iekel
Representative David Miller
Representative Ann Robinson
Representative Becket Hinckley
Representative George McMurtrey
Gerald W. Laska, Staff Attorney
Please refer to
Appendix 1 to review the Committee Sign-in Sheet
for a list of other individuals who attended the meeting.
Chairman Doug Osborn called the meeting to order at 7:55 a.m.. The following sections summarize the Committee proceedings by topic. Please refer to Appendix 2 to review the Committee Meeting Agenda.
Cindy Pomeroy (Director, Department of Employment), Gary Child (Administrator, Workers' Safety and Compensation Division) and Glenn Evans (Pacific Actuarial Consultants) reviewed the actuarial status of the workers' compensation fund. Ms. Pomeroy explained that the Workers' Compensation Act establishes a separate fund within the trust and agency account, and requires that account to be "fully funded" by 2008, a phrase which is not defined but which the department has assumed to mean that available assets equal undiscounted liabilities.
Glenn Evans, the division's contract actuary, explained with a Powerpoint presentation (Appendix 3) the current fiscal status of the fund. The fund has a balance of approximately $430 Million. Undiscounted reserves for injuries that have already occurred are approximately $634 Million, creating a shortage or under-reserved position of $204 Million. Projections for 2008 are that the shortage will be $50 Million.
Mr. Evans explained that the reserves are estimated on an undiscounted basis. The three main reasons he has changed his projection about meeting the 2008 deadline are that investment income has been less than previously assumed, that medical expenses have increased beyond projections, and that case costs were underestimated by $15 Million.
Mr. Evans explained four possible funding targets to be considered "fully reserved", from least to most risky:
1) Undiscounted reserves plus a surplus;
2) Undiscounted reserves with a surplus;
3) Discounted reserves plus a surplus;
4) Discounted reserves without a surplus.
Ms. Pomeroy and Mr. Child explained that the department would appreciate legislative direction on whether the 2008 target should be maintained, what actuarial method the fund should use and what discount rate, if any, should be applied to the calculated reserves. They acknowledged that the staff's preferred choice would be discounted reserves plus a defined level of surplus.
The committee generally discussed the history of the workers' compensation fund, the funds impressive progress in the last 15 years, and the pros and cons of the various funding scenarios.
Carol Jenkins (Wyoming Healthcare Commission) explained the current status of the health care information technology study authorized by 2004 Senate Enrolled Act 31. The study is to address issues and techniques for a modern health data exchange network. Eleven members of the oversight committee have been appointed and Dr. Geoffrey Smith appointed chairman. (Appendix 4) Their first meeting will be around June 1st, .when they will review a request for proposals and appoint an 8-member technical management subcommittee.
The Commission has endorsed a pilot project with Duke University to survey consumer and user expectations for the system. Brian Baum of Duke University's "Health Data Exchange" project, addressed the committee on speakerphone. He reviewed generally the concept and debate over healthcare IT over the last forty years and presented a vision of how such a system could improve patient care while decreasing healthcare costs. The largest difficulty would be creating a market demand for the system, but he believes that Wyoming could be the pilot for the rest of the country. He anticipates that Duke University could assist in developing a non-profit entity using public domain systems, that there would be 24/7 access to the information, that access rights would be controlled by the patient but that there would be no cost to the patient.
Deb Fleming (Director, Department of Health) addressed the committee and presented a Wyoming Department of Health Issue Paper (Appendix 5). She presented statistical information on the prevalence and health effects of overweight and obesity in Wyoming, especially among school aged children based upon the Wyoming Youth Risk Behavior Survey. The department's Healthy People 2010 objective is to reduce the incidence of obesity among high school students from the current 7.2% to below 5% by 2010.
Sunny Kaste (Coordinator, School Health Programs, Department of Health) made a Powerpoint presentation (Appendix 6) on the department's Healthy Living/Healthy Learning program. Jan Drury (American Heart Association, Wyoming Chapter) presented information on avoidable health risk factors (Appendix 7), and emphasized that overweight and obesity have surpassed tobacco as the leading preventable causes of illness in Wyoming and the United States.
The committee discussed the associated problem of distorted body image, especially among young women, whether bariatric surgery should be compensable under Medicaid, and concerns about unhealthy food choices in school vending machines. Lisa Skiles Parady (Chief of Staff, Department of Education) indicated that she will report the committee's concerns to the Superintendent and school districts and report back to the committee if any legislation is indicated.
Marilyn Patton (Assistant Department of Family Services) addressed the committee with a Powerpoint presentation (Appendix 8) regarding the status of the study authorized by 2004 HEA 28. The project plan prepared by Department Director Rodger McDaniel has been approved by the governor, and calls for a 28-member steering committee. Handouts included the organizational structure of the survey, a timeline for the study and survey materials prepared to date. Surveys regarding the needs of children and families have been prepared and are being distributed throughout the state and are available on-line. Statewide town meetings will also be conducted.
The committee discussed the fact that the survey is apparently not using a scientifically valid statistical sampling. Ms. Patton stated that a scientifically valid telephone survey is being considered to validate the other survey results.
The Committee recessed at 12:00 noon and reconvened at 1:15 p.m.
Gary Child reviewed the Workers' Safety and Compensation Division's cost control efforts, including fraud detection software, a pilot PPO contract, prescription drug plan, subrogation notices, contested case mediation, in-house programming to avoid mainframe computer costs, and a Deloitte management/ systems audit that made 34 recommendations.
The committee discussed the level of benefits generally, and death benefits in particular. Ms. Pomeroy stated that she would report to the committee on the specific levels of death benefits, the death benefits levels compared to surrounding states, and the cost to the fund if the benefits were doubled.
Senator Scott moved that the a bill be drafted including the following features: extending the reserve deadline by five years; defining "fully funded" to mean reserves discounted at a rate chosen by the division plus a surplus (and alternatively undiscounted plus a surplus); defining "surplus" to include provision for a catastrophe and for actuarial adjustments to liability estimates; annual evaluation of the fund's reserve/surplus/liability position with deficiency corrections to be amortized over a 10-year period. The motion passed on a voice vote.
In response to public comment regarding problems with drug and alcohol use in the workplace and the inadequacy of the current statutory injury exclusion for injuries caused by intoxication or drug use, Senator Scott moved for a bill to be drafted authorizing the division to define "under the influence of drugs or alcohol." The motion passed on a voice vote.
Tiernan McIlwaine (Early Childhood Coordinator, Department of Family Services) reported preliminarily to the committee on the distribution of TANF funds to preschools for at-risk children. The final report is required, pursuant to a budget footnote, by October 1, 2004. Mr. McIlwaine distributed a packet including preliminary recommendations, RFP and TANF Preschools Applications for Funding (Appendix 9). Senator Massie explained further that the budget footnote was added because providers were competing for TANF funds, and the department was instructed to improve the grant process with a view to reducing competition and increasing awareness of the funds' availability. Mr. McIlwaine reported that there has been an intensive review of the award process with the stakeholders, and that the department will also be reporting to the Joint Education Interim Committee on June 28th.
Representative Elaine Harvey reported to the committee on the activities to date of the subcommittee on long-term care issues. The committee toured the Wyoming Retirement Center, a private assisted living facility in Cody and a county assisted living facility in Lovell. The Retirement Center reported staff shortages evidenced by mandatory overtime, excessive use of contract nurses, morale problems and difficulty hiring replacement in a timely fashion because of delays at the Department of Administration and Information.
Senator Scott requested the Department of Health to develop a plan to remedy the problems at the Wyoming Retirement Center and report to the subcommittee at its next meeting. He further requested that the committee co-chairs be authorized to send a letter to the Department of Administration and Information, requesting the department to develop a plan to exempt state institutions from personnel and payscale rules applicable to other executive branch agencies.
Representative Harvey summarized the bills that the subcommittee has requested (Appendix 11):
1. Authorization and licensure guidelines for units within assisted living facilities for the care of memory-impaired patients;
2. Authorization and licensure guidelines for medication aides;
3. Authorization, training and licensure guidelines for certified geriatric aides;
4. Uniform health care decisions (after AARP receives feedback from stakeholders);
5. Authorization for waiver of the asset test for Medicaid eligibility for those persons eligible for long-term care who have had LTC insurance for the time period and in such amounts required by the state;
6. Correction to 42-4-104(c) regarding minimum/maximum time periods for rebasing of nursing home reimbursement rates: "...at least every five (5) years but not more than once in a three (3) year period…."
The committee heard a discussion on possible legislation, similar to failed 2004 SF 65, to require school districts to apply to Medicaid as a provider for reimbursement of eligible special education expenses. The committee heard from Iris Oleske (State Medicaid Agent, Department of Health), Dan Espeland (President-elect, Wyo. School Superintendents Association) and Tammy Cox (Deputy Superintendent, Department of Education).
The committee and panel discussed the benefit of having federal Medicaid funds pay for most of the special education services, but the administrative burden on the school districts of having to qualify as a provider and submit substantial paperwork to Medicaid for claims.
Senator Scott moved that the 2004 bill be resurrected and that the Departments of Health and Education and the school districts and school boards associations come forward at the committee's next meeting with any proposed amendments or improvements to the 2004 bill. The motion passed on a voice vote.
Mike Huston distributed a report (Appendix 12) and informed the committee of the status of the Comprehensive Substance Abuse Center program. Two programs (Cheyenne, Casper) were established and funded in 2001 in Tier 1 of the program. Four additional centers (Sheridan, Rock Springs, Big Horn Basin and Lander) were added in 2002 in Tier 2 of the program. Funding for each program comes through the Department of Health's Substance Abuse Division and ranges from $200,000 to $350,000 according to the size of the program. The CSACs have been very successful in expanding substance abuse services, coordinating existing services, and developing strategic plans for future needs.
Mike Moser, Wyoming Restaurant and Lodging Association, reported to the committee on the members' healthy lifestyle initiative and pamphlet (Appendix 13).
Wendy Curran, (Wyoming Medical Society) distributed information (Appendix 14) to the committee regarding the medical malpractice insurance situation in the state, including a list of doctors who are leaving the state or curtailing their practice, a chart of malpractice insurance rates by company and specialty, and a letter from the Texas Commissioner of Insurance about premium reductions in that state following tort reform legislation.
Diane Harrop (Wyoming Healthcare Commission) reported to the committee briefly on the four major studies the commission is conducting.
Senator Scott presented three pieces of draft legislation to the committee: medical errors commission; English rule for attorneys fees in medical malpractice litigation; and state-provided emergency medical malpractice insurance. He explained that the bills were drafted by him for the committee's consideration in the event of a special legislative session or for possible committee sponsorship in the 2005 general session.
There being no further business, Chairman Osborn adjourned the meeting at 5:05 p.m..
Respectfully submitted,
Charles K. Scott, Chairman
Doug Osborn, Chairman