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Wyoming Legislature

Committee Meeting Summary of Proceedings

Joint labor, health and social services interim committee 

Committee Meeting Information

July 18 & 19, 2005

University of Wyoming Outreach Center

Casper, Wyoming

 

Committee Members Present

Senator Charles K. Scott, Co-Chairman

Representative Doug Osborn, Co-Chairman

Senator Pat Aullman

Senator John Barrasso

Senator Ken Decaria

Senator Mike Massie

Representative Bruce Barnard

Representative Bob Brechtel

Representative Elaine Harvey

Representative John Hastert

Representative Jerry Iekel

Representative Burke Jackson

Representative Marty Martin

Representative Layton Morgan

 

Legislative Service Office Staff

John H. Rivera, Senior Staff Attorney

 

Others Present at Meeting

Please refer to Appendix 1 to review the Committee Sign-in Sheet
for a list of other individuals who attended the meeting.

Call To Order (July 18, 2005)

Chairman Osborn called the meeting to order at 8:35 a.m.  The following sections summarize the Committee proceedings by topic.  Please refer to Appendix 2 to review the Committee Meeting Agenda.

 

Department of Employment

Ms. Cindy Pomeroy, Director, Department of Employment, introduced her administrative staff in attendance at the meeting. She discussed the impending retirement of senior staff in the Department, and the difficulty in recruiting staff, particularly for information technology and risk analysis positions.  She described the health wellness incentive program she has instituted in her agency which has resulted in improvement of employee morale and performance.

 

She provided statistics for each of the divisions within the Department of Employment.  The low unemployment in State has lowered costs for the Unemployment Insurance Compensation Division.  The Department was rated the quickest in the nation in resolving nonmonetary complaints.  One of the difficulties the Department has currently is trying to find COBOL programmers to maintain the current software until the system is upgraded with more modern software.  The tax collection functions for the workers' compensation and unemployment insurance compensation programs have been reorganized so each tax collection program remains within the parent program.  The workers' compensation reserve fund has increased to $567 million in FY2005.

 

Ms. Pomeroy made two requests for draft legislation that would affect the workers' compensation program.  The first request was to amend W.S. 27-14-301, 27-14-302 and 27-14-304 to eliminate the surety bond for nonresident employers and require those employers to obtain workers' compensation coverage for Wyoming employees working for the nonresident employer within the state.  Representatives Martin and Brechtel agreed to work with the Department to develop the legislation.  The second request was for an amendment to W.S. 27-14-203(c) to replace the 2% interest charge and replace that with a $50.00 penalty for failure to pay premiums.  Representatives Barnard and Iekel agreed to work with the Department to develop the legislation.  The draft legislation should be prepared for consideration at the October committee meeting.

 

Ms. Pomeroy advised that the proposed rules of the workers' compensation program affecting employer experience ratings have been withdrawn because employers have expressed opposition.  The Division will be working with employer groups to resolve the difference and resubmit proposed rules.  Chairman Osborn asked if the Department has promulgated rules to address the growing methamphetamine problem in the state.  Ms. Pomeroy replied that the Department is working to define "intoxication" and "under the influence".   Senator Scott asked for a chart reflecting the average hourly wage in workers' compensation cases to determine if some are using the program as a replacement for health insurance, as suggested in the study by Dr. Hank Gardner.  Ms. Pomeroy and Mr. Gary Child replied that the Department has no data to show if that is occurring, but there may be some overlap when a person transitions from one program to another.  Senator Scott also discussed an Attorney General's opinion that suggests that the workers' compensation program could better invest its funds if a statutory change is enacted.  Senators Scott and Jackson agreed to work with the Department to develop proposed legislation on this matter.  Senator Massie advised they speak with Mr. Dave Gruver at LSO who may have a different opinion on this issue.

 

Ms. Lynn Birleffi , Wyoming Lodging and Restaurant Association, stated the organization she represents and others were opposed to the experience modification review plan because smaller employers might lose their premium safety discount.

 

Department of health

Dr. Brent Sherard, M.D., Director, Department of Health, distributed Appendix 3, consisting of a notebook binder with the Department's report to the Committee.  He described his history with the Department since being initially employed there in 2001, culminating in his recent appointment as director by Governor Freudenthal.  The Department has been in the process of centralizing the fiscal accountability for its programs.  Dr. Sherard introduced Dr. Greg Gruman, Ph.D., who has extensive experience with Medicaid.

 

During discussion of the reports the Department is required to submit to the Legislature, Senator Scott expressed concern with the recruitment and retention of clients in the public health nurse infant home visitation program. Ms. Beth Schober explained the difficulty in recruiting mothers who may be eligible for the program and described the efforts to recruit those mothers to the program. An incentive that had worked in the past was requiring the mother to attend a meeting as a condition of receiving her welfare check.  Dr. Sherard added that some public health nursing offices have difficulty with staffing also because of salaries paid and the aging workforce that may not relate as well to younger clients.  Representative Harvey and Jimm Murray, Department of Health, explained part of the salary disparity exists because some public health nurses are paid from both state and local funds, others are paid by block grant funds and there are contract nurses that are paid hourly, but work fewer hours.  Senator Scott recommended that no legislation is needed yet because the Department is attempting to resolve the problems in the program. Chairman Osborn asked Dr. Sherard to update the Committee in October on  this issue.

 

Dr. Sherard described efforts in the vaccine for children program.  In the past, the program has distributed the vaccine to providers, who provided the vaccine at no cost to the family.  After the funding agency, Centers for Disease Control (CDC), audited the program in various states, it found many, including Wyoming, were noncompliant because the vaccine was distributed universally, rather than only to the eligible populations.  Providers in Wyoming have expressed concern that they may not use the vaccine for children who are not eligible because the family's health insurance may not cover the vaccine, or the family is otherwise unable to pay for the vaccine.  Ms. Katelyn Wells-Fahling, Immunization Program manager, explained the issues further.  A family's health insurance premiums may increase to cover the cost of the vaccine, or the family may forego vaccination altogether.  Information in Appendix 3 was intended to illustrate the value of childhood vaccinations.  Nine states currently are "universal" state because the state pays for, and distributes, the vaccine for use by children who are not eligible under the  CDC program.  Dr. Sherard and Ms. Wells-Fahling requested the Committee to consider sponsoring legislation to make Wyoming a "universal" state to provide the vaccine to the 45% of the state's children who would not be eligible for free vaccine under the CDC program.  The State could purchase the vaccine for $5.1 million cheaper than if providers purchased the vaccine.  Currently the State has an 82% vaccination rate, with a goal of increasing the rate to 90% by 2010.  The rate of vaccination would probably drop if Wyoming does not become a "universal" state.  Senator Massie moved to request LSO staff to draft legislation necessary to make Wyoming a "universal" state, including an appropriation to implement the program.  The motion carried unanimously.

 

Ms. Erin Croughwell Luben, Epidemiology Manager, Community & Family Health Division, stated she would like all child fatality investigations transferred from the Department of Family Services (DFS) to the Department of Health.  Currently only deaths that involve suspected abuse or neglect are investigated. She would like all deaths of children investigated. Wyoming ranks in the top 5 states in the nation in preventable deaths to children, but abuse or neglect only constitute 5% of all child deaths in the State.  Additionally, it is necessary to expand the ability of agencies to share information during an investigation.  Representative Iekel agreed to work with the Department of Health to prepare draft legislation.  Senators Scott and Massie advised that DFS has been asked to review this issues also as part of the Children and Families Initiative.  Chairman Osborn nevertheless asked Representative Iekel to work with the Department of Health on this issue.

 

Dr. Greg Gruman, Ph.D., Office of Healthcare Financing, explained the effects of the federal Medicare Modernization Act (MMA), which will provide medication aid for persons dually eligible for Medicare and Medicaid.  The program will be mandatory for states and there will be costs associated with participation.  The State will have to payback to the federal government approximately $15-$18 million as part of its participation in the program.  The actual amounts to be paid back are difficult to estimate with any accuracy because the formula to be used is complex.  There should be some drop in enrollment in Medicaid because of MMA, which should offset the State's reimbursement rate to the federal government.

Dr. Gruman distributed Appendix 4, the New Medicare Prescription Drug Benefit Cheat Sheet, and Appendix 5, MMA Guide for State Legislators.

 

Ms. Roxanne Homar, R.Ph., State Pharmacist, expressed a concern that eligible clients may have to be switched with respect to medications they use.  Those persons will have to chose a plan between November 15 and December 31, 2005, or they will automatically be enrolled in a specific formulary not of their choosing.  There may also be a problem with access if pharmacists decide not to dispense for low reimbursement drugs.  She proceeded to guide the Committee through  the checklist beginning on page 3, Appendix 5. 

 

Dr. Sherard added MMA may negate the Legislature's efforts over the last few years to facilitate prescription assistance.  The new program will impact patients, providers and state government.  Chairman Osborn suggested continuing this discussion at the October meeting.

 

Department of Family Services

Mr. Tony Lewis, DFS Deputy Director,  distributed Appendix 6, DFS directory; Appendix  7, a list of 2005 laws affecting DFS programs; and, Appendix 8, a DFS general status report.  He introduced Ms. Marilyn Patton, Deputy Assistant, Children and Families Initiative, and Mr. J. Terry Williams, Administrator of the Economic Assistance Division.  Mr. Lewis described the new, federally funded IRIS/FAMIS system that is being implemented to determine eligibility for a variety of programs.

 

The Children and Families Initiative is developing recommendations to present to the Legislature, including early intervention initiatives, enhanced health care options and development of systems of care that empower clients to chose a suitable plan for the client.  A draft of the recommendations should be ready by the middle of August.

 

Dr. Philip DeVol, what Legislators need to know about poverty

Ms. Patton introduced Dr. Philip DeVol, author of Bridges Out of Poverty: Strategies for Professionals and Communities.  Dr. DeVol distributed Appendix 9, a copy of his PowerPoint presentation, and Appendix 10, mental model of poverty and other indices.  He explained the differences that exist in the mental outlooks, language and "hidden rules" of people who live in generational poverty, the middle class and wealthy individuals. 

 

Meeting Recess

The Committee recessed at 4:45 p.m.

 

 

Call To Order (July 19, 2005)

Chairman Scott called the meeting to order at 8:10 a.m.  The following sections summarize the Committee proceedings by topic.  Please refer to Appendix 2 to review the Committee Meeting Agenda.

 

Health Care Cost Containment

Ms. Anne Ladd, Executive Director, Wyoming Healthcare Commission, and Mr. George Bryce, Commission member, distributed Appendix 11, The Significance of Cost Shifting, and Appendix 12, The Wyoming Healthcare Commission's Toolbox of Ideas.  Mr. Bryce stated he has served on 3 different commissions over the years that have looked at the issues affecting health care access. Although much of the study reports have been placed on the shelve, 80% of the recommendations have been implemented.  He opined that the single most limiting factor in the cost of healthcare delivery is that the consumer is not involved in the cost of care.  Most healthcare is paid for by a third party payor, whether the government or private insurance.  Because government programs buy 50% of healthcare services at less than wholesale cost, cost-shifting occurs because the private insurance market (35%) is required to pay more to offset the losses that occur as a result of government programs.  He proposed increasing reimbursement from the government programs to reduce the level of cost-shifting and the creation of  WyoCare Accounts whereby individuals and families could contribute to a healthcare savings account, including monies from government-funded programs. Chairman Scott said smarter consumers would help, but most healthcare costs are a result of catastrophic needs, so savings accounts can be wiped out with a single episode and will not resolve the bigger problem.

 

Senator Massie provided the Committee with a letter he had received from a constituent (Appendix 13), who expressed concern about the effect of a significant increase in health insurance premiums from $685 to over $900 a month, with a increase in the deductible to $2,000 and various co-pay requirements, despite the insured being a very healthy individual.  Senator Massie stated that Idaho is among the states that have extended their KidCare program to include family coverage.  Mr. Bryce responded that more government coverage might only exacerbate the cost-shifting that already occurs.  Dr. Gruman advised that Senator Massie's idea would require a Section 1115 waiver, which the Department of Health is considering and the Department may propose a plan.

 

Ms. Ladd stated she would provide the number of uninsured persons in Wyoming, in response to a request from Chairman Scott.  She discussed the Toolbox of Ideas formulated by the Healthcare Commission (see Appendix 12).  Thirty percent of healthcare services provided is unnecessary and 50%  of healthcare provided is not evidence based.  The goal should be to provide the right services at the right price.  It is imperative that a long-term solution is not sacrificed for a short-term goal.  The Commission has prepared 18 recommendations, with 3 recommendations worth pursuing immediately because those are achievable.  Those recommendations include:

 

Senator Decaria asked if legislation is necessary, or would it be better to work with the plan administrator.  Mr. Bryce advised the Commission would be meeting with the plan administrator August 11 to present these ideas.  Ms. Wendy Curran, Director, Wyoming Medical Society (WMS), said both the state plan and Medicaid are already moving down this path.

 

Ms. Ladd presented other recommendations that have been approved, but have not yet been fully developed, by the Commission, including:

 

Senator Massie asked for an update on the magnet hospital efforts.  United Medical Center (UMC) in Cheyenne and Wyoming Medical Center (WMC)  in Casper are pursuing designation as magnet hospitals.  The legislation that would have provided incentives for those efforts failed, but the Commission is promoting funding for other hospitals to seek magnet hospital status.  Ms. Mary Lynne Shickich, Wyoming Medical Center, advised that the facility is pursuing designation as the first magnet hospital in Wyoming.

 

Chairman Scott asked if any proposal from the Commission is ripe for, and requires legislation, before the Committee's October meeting, the proposal should be presented by then or it will have to wait until the next general session of the Legislature.  Representative Iekel was requested to  check with the University of Wyoming on the status of the WYAMI Program.  Ms. Ladd stated that if the program expands too quickly, it would be difficult to fill the additional positions.

 

Public Comment¾ Health Care Cost Containment

Mr. Robert Harrington, Director, Natrona County Department of Health, described the barriers to recruiting clients for the maternal health clinic program.  Coordination between the Department of Health and the Department of Education is needed.  It takes a special nurse to work with difficult clients and there is a high turnover of public health nurses because of the emotional involvement with client needs, resulting in burn-out.  The burn-out is a bigger factor in the high turnover than salary is.  He supports establishing a universal child vaccination program in the State and appreciates any help the Committee can provide.

 

Ms. Susie Pouliot, WMS, stated the WMS supports a balance between cost cutting and patient safety/quality of care. She believes the Medicaid APS is a good program for managing resources.  When asked what APS means, several members of the audience stated that it is an acronym that has become the name of the program for managing resources.  The WMS supports the pharmacy program as good system change that will foster better communication between physicians and pharmacists.  Telemedicine is another good program the WMS supports.  The WMS is developing policies for recruitment and retention of physicians, particularly for local recruitment of specialty practices.  Other issues of interest to the WMS include collaboration among regional localities and ensuring that family practice centers are adequately equipped and staffed.

 

Ms. Curran added that there are continuing issues that impact health care costs, including low reimbursement rates for Medicare and Medicaid, and medical liability premium costs and defensive medicine practices.  She asked for reauthorization for the loan program for tail coverage on medical malpractice insurance and would like to see continued discussion on options to address legal reform to lower liability costs.  She distributed Appendix 14, entitled Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment, and Appendix 15, entitled Impact of Malpractice Reforms on the Supply of Physician Services, in support of her requests.

 

Mr. Dan Perdue, Wyoming Hospital Association (WHA), said there was an increase from $65 million to $75 million in uncompensated care at hospitals in the State.  The rate of reimbursement for Medicaid is within the control of the Legislature and the State Health Care Review Team could recommend an increase in that reimbursement rate.  Mr. Perdue recommended establishment of a health care endowment challenge account. He advised that U.S. Senator Grassley proposed ending the tax exempt status for hospitals and at least one Wyoming hospital administrator agreed at a recent meeting  because hospitals would then not be required to treat indigent patients.  Chairman Scott added that such action would also mean that the hospitals could lose their Medicare and Medicaid reimbursements.

 

Ms. Sherlyn Kaiser, WMC,  distributed Appendix 16, a folder containing materials in support of her recommendation that the Committee consider the Healthcare Commission's recommendation to review specialty hospital licensure requirements.

 

Senator Massie suggested the Committee should begin thinking outside the box and possibly consider establishing a hospital commission with rate-making authority similar to the Public Service Commission.  Chairman Scott recommended Senator Massie may want to look at Maryland, which has set hospital rates for 25 years, before pursuing the idea further.  Mr. Perdue said the WHA would oppose setting rates since hospitals are already over-regulated and each hospital is a unique entity with its unique costs and expenses.

 

Mr. Tom Jones,  representing the National Federation of Independent Businesses, reminded the Committee of Senator Ross' bill last year that replaced the 2% penalty in the Unemployment Insurance Compensation program with discretion by the Department of Employment to assess a monetary penalty.  He requested that the 2% penalty for delinquencies in the Workers' Compensation program also be replaced with a penalty imposed at the discretion of the Department.  Ms. Wendy Tyson, Department of

Employment, said she believes the Department would be receptive to adding that provision to the bill request made on the first day of the meeting.

 

Mr. Jones, representing the Wyoming Health Care Association, stated that Iowa has a pay-for-performance program that provides a bonus of up to 3% over the base rate for average daily charges for meeting specified service standards.  This could establish a transformational change by pushing responsibility down the chain of command.  He expressed concern with the rate of reimbursement for nursing homes.  The reimbursement rate has created a nationwide deficit of $12.58 per bed per day for Medicaid patients in nursing homes.  He provided Appendix 17, entitled A Report on Shortfalls in Medicaid Funding For Nursing Home Care, in support of his concern.  Chairman Scott requested staff to make copies of the document and send the copies to Committee members.

 

Ms. Loretta Wolf, American Cancer Society, asked the Committee to consider policies to reduce tobacco usage, including using tobacco taxes to pay for health care costs related to tobacco use.  The Colorado Legislature appears receptive to the concept of dedicating tobacco taxes to pay for related health care costs.

 

Ms. Lynn Whalen, Natrona County Medical Society and Casper City Councilwoman, is concerned with high health insurance costs that are adversely affecting municipal budgets. She advised that U.S. Senators Bill Frist and Hillary Clinton have been considering information technology to help contain health care costs and the possibility of importing drugs from Canada, the latter of which Ms. Whalen does not support.  The National League of Cities has in the past supported creation of a single payor health care system, but has recently shifted away from that position.  She is concerned that health insurance coverage is not mandatory, because she believes everyone can afford it.

 

Dr. Sherard stated that, as state health officer, the county health officers are his local eyes and ears.  At least 3 of those county health officers have expressed concern that they have to purchase liability insurance out of their own funds for that position.  The reimbursement for county health officers does not pay for such coverage.  He asked the Committee to find a solution to the problem.  He reminded the Committee that the Legislature last session enacted a law to cover emergency medical personnel under the coverage of the Governmental Claims Act.  Some county health officers are covered under the Local Government Self-Insurance Act, but other counties do not belong so their county health officers may be vulnerable for actions they may take in the performance of their duties.  Representative Hastert volunteered to work with the Department of Health and the Attorney General to develop legislation for the October meeting.

 

Committee Discussion

Chairman Scott asked Committee members to present their ideas with respect to proposals for draft legislation.  In addition to proposals for draft legislation considered earlier in the meeting, the following proposals were presented and assigned for further action as follows:

  1. Representative Osborn, with Senators Massie and Aullman, will work on legislation with Carol Jenkins and Anne Ladd to develop proposals on the advance care directives registry;
  2. Representative Osborn suggested extending the sunset date of the Wyoming Healthcare Commission, which is currently June 30, 2006.  Ms. Ladd advised she has recommended to Governor Freudenthal that the Commission be allowed to expire and be replaced by a new entity with more information gathering authority, perhaps in the vein of the federal reserve board.  Chairman Scott suggested it would be worthwhile to review the Commission's originally assigned tasks, clean up those duties with more general language and possibly create a research unit within the Commission.  Senator Massie cautioned not to crowd the Commission's agenda in a way that would prevent it from proceeding creatively when it finds a worthwhile issue.  Representative Osborn and Senator Massie will work with the Commission on this topic;
  3. Senator Massie, with Senator Decaria and Representative Iekel, will work with the Department of Health and the Healthcare Commission to present recommendations to extend benefits to the uninsured in a manner that can quickly be drafted as legislation.  Dr. Gruman volunteered to assist in the effort on behalf of the Department of Health;
  4. Senator Massie suggested legislation to put more money into the physician loan repayment program and requested the Office of Rural Health be invited to the October meeting to report on the use of past monies appropriated to the program.  He also suggested including in the proposed legislation a provision to assistant physicians in the program with their medical malpractice insurance, which Chairman Scott suggested may be a violation of Article 16, Section 6 of the Wyoming Constitution and, if included in the proposed legislation, should be drafted in a way that will allow the provision to be amended in or amended out of the bill;
  5. Senator Massie, with Representative Harvey, will work in the magnet hospital recommendations heard earlier.  The legislators will work with Mr. Perdue, Ms. Kaiser and Dr. Gruman;
  6. Representative Brechtel, with help from Senator Decaria, will work with the Department of Education, Natrona County School District No. 1 and Senator Anderson, to determine if legislation is necessary to implement the Healthy Living/Healthy Learning program statewide.  Senator Decaria said this proposal should also be considered by the Select Committee on School Finance Recalibration. Representative Harvey added there is a similar need for the School Facilities Commission to consider adding facility space in the basket of goods for school nurses who currently aren't mandated by law;
  7. Chairman Scott distributed a copy of 2005 Senate File 0104, Health insurance-small employer carrier reinsurance. Chairman Scott will work with the Healthcare Commission to consider amendments to the bill and will bring a bill to the October meeting for further consideration. Senator Decaria asked that a fiscal impact statement be included with the bill draft;
  8. Representative Harvey asked for a bill to require a drug testing policy for state employees. Chairman Scott  suggested Representative Harvey speak first with the Governor on this issue, and if he agrees, she should speak with the Departments of Health and Family Services.  If all their responses are positive, then the issue should be presented to Management Council for assignment of the topic to the appropriate committee.  Dr. Sherard advised that Mr. Leland Clabots is already working on this issue. Chairman Scott asked Representative Harvey to discuss this with Mr. Clabots;
  9. Representative Hastert will research where tobacco tax revenues are being spent and possible uses for those revenues, with a report to the Committee at the next meeting;
  10. Representative Brechtel suggested reviewing the Uniform Health Care Decisions Act to determine if the term "comfort and care" includes the giving of food and hydration. Chairman Scott recommended Representative Brechtel can look into the matter, but it may infringe on an individual's right to chose and, therefore,  may be too controversial for the Committee to consider without extensive deliberation and public comment and which is not on the list of approved topics for this interim.

 

Chairman Scott asked staff to prepare a list of the assigned duties for the Committee and to distribute them to the Committee members.  The next meeting of the Committee is scheduled for October 17 and 18, 2005.

 

Meeting Adjournment

There being no further business, Chairman Scott adjourned the meeting at 4:40 p.m.

 

Respectfully submitted,

 

 

 

Senator Charles K. Scott, Cochairman                            Representative Doug Osborn, Cochairman

 

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