Joint Labor Committee Minutes for Meeting October 17, 2005

Committee Meeting Information

October 17-18, 2005

Univ. of Wyo. 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 Marty Martin

Representative Layton Morgan

Committee Members Absent

Representative Burke Jackson

Legislative Service Office Staff

Gerald W. Laska, 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 (Monday, October 17)

Co-Chairman Scott called the meeting to order at 7:00 a.m. The following sections summarize the Committee proceedings by topic. Please refer to Appendix 2 to review the Committee Meeting Agenda.

Healthcare Information Technology

Chris Muirhead, Carol Jenkins and Emily Genoff of the Wyoming Health Care Commission ("WHCC"), reported to the Committee on the Commission's study of a possible statewide healthcare information technology system. The Commission had formed an Information Technology Technical Management Subcommittee to conduct the study. The subcommittee in turn contracted with John Snow, Inc. to facilitate the study. WHCC had previously submitted its written report to the Committee. Michael Rodriguez and Michael Stelmach of John Snow, Inc., and Dr. Goeff Smith of the subcommittee also addressed the Committee.

Based on the study, WHCC recommended that legislation be drafted to create a "hub and spoke" system to share patient information electronically between a central database and participating health care providers. According to the panel, the system would be coordinated through a designated 'Wyoming Health Information Organization,' with initial funding through state appropriations, federal and private grants and user fees. The system would be intended to decrease medical errors, improve provider efficiency, facilitate disaster recovery, enable patient access to records, facilitate portability of records and allow electronic prescription and tracking of drugs. It could also include additional modules for vaccination records and a registry of patients' advance care directives.

The Committee generally discussed the recommendations, specifically the startup and continuing costs of the proposed system, security questions and participation incentives for smaller health care providers. WHCC estimated cost would be $77 Million for 12 hospitals and 250 doctors to participate. Estimated cost to include all providers in the state would be $150 Million to $170 Million.

The Committee authorized a work group of its members to work with WHCC to bring specific enabling legislation to the next meeting, in accord with the WHCC subcommittee recommendation. Senator Scott volunteered to spearhead the work group.

Assisted Living Facilities in Wyoming

Sarah Green and Brett Salmon reported to the Committee (PowerPoint presentation, Appendix 4) on assisted living facilities in Wyoming operated by SunWest Management, Inc. The company operates five facilities in Wyoming serving 350 clients. Most of the clients are on the Medicaid nursing home waiver program, however reimbursement rates under that program have not been increased since 2001, and there is a persistent waiting list for assisted living services of 35-40 persons, waiting an average of nine months. The Committee expressed agreement with the need for increased reimbursement for more clients, but felt the budget process is the appropriate way to address the need. Dan Lex, Quality Healthcare Foundation, expressed support for an increase in assisted living reimbursements and a regular re-basing of those rates so that rates remain current.

Reauthorization of Wyoming Healthcare Commission

Co-Chairman Scott suggested and the Committee agreed, given the number of agenda topics and bills remaining, that this topic be deferred until the November meeting.

Wyoming Healthcare Commission – Medical Errors Report

Fran Cadez, Department of Health Telehealth Manager, reported to the Committee on the medical errors reporting program created by Laws 2005 Chapter 243. The program has only been in effect since July, so results are preliminary. Ms. Cadez stated that compliance with reporting programs in other states has been low and suggested alternatives, including increased tort immunity for compliant providers, a tort-like system with expert juries or an administrative system of compensation for victims of medical injury. At the request of Chairman Osborn, Senator Scott, Senator Massie and Representative Iekel volunteered to review the Department of Health report to see if legislative changes to the medical errors reporting program are indicated before the 2007 general session.

Office of Rural Health / Community Services Block Grant

Lynne Weidel, Wyoming Office of Rural Health, reported to the Committee on the Department of Health's Community Services Program. It is a 40-year old program paid for entirely by federal funds. Ms. Weidel distributed a "program handout" of relevant statistics (Appendix 5). The block grants are administered through local boards, and have been used to support such programs as Boys and Girls Clubs, senior citizens centers, community resource centers, domestic violence shelters, food pantries and soup kitchens.

Public Comment

Brenda Moser, Wyoming HomeCare Alliance, addressed the Committee regarding Medicaid reimbursement rates for home health care providers. The reimbursement rate has been unchanged since 1989. She distributed a chart and table (Appendix 6) showing the number of Wyoming home health providers, clients and costs as a percentage of the Medicaid budget. The number of providers since 1989 has decreased from 65 to 37, while the number of clients has increased from 699 to 1200. The Committee suggested that this is also a matter for the department budget process.

Jan Drury, American Heart Association, advised the Committee that her association strongly supports a tobacco tax increase. She noted that the average annual cost of tobacco-related illness is $548 per family, and that the average tax nationally is one dollar per pack compared to Wyoming's forty cents per pack.

Meeting Recess

The Committee recessed at 5:00 p.m.

Call To Order (Tuesday, October 18)

Co-Chairman Osborn called the meeting to order at 7:00 a.m. The following sections summarize the Committee proceedings by topic.

Joint Dept. of Health Review Committee Report

Senator Scott and Brent Sherard, Department of Health Director, reported to the Committee on the activities of the Joint Executive/Legislative Department of Health Review Committee. The Committee collected very useful data and recommended studying the redesign of the Medicaid benefit structure, probably as an interim project of this Committee. Dr. Sherard added that the review was very constructive and that the Department of Health is already implementing many of the joint committee's recommendations. Senator Scott noted that the September 1^st deadline for a final report prevented a very in-depth analysis of the department's programs and budget, something the legislature should consider when assigning large study topics to select committees.

Children and Families Initiative – Department of Family Services

Early Childhood Programs

Rodger McDaniel, Marilyn Patton and Beverly Campbell, Department of Family Services, reported to the Committee on the Children and Families Initiative authorized by the 2005 Legislature. They distributed the published "Recommendations Synopsis" (Appendix 7) and made a PowerPoint presentation regarding Wyoming's early childhood development system (Appendix 8). The Department will be making proposals for legislation to implement the recommendations of the Initiative. One of the most significant will be a proposed system of rating the quality of early childhood facilities and providing incentive payments to improve quality.

Senator Massie distributed a handout entitled "Early Childhood Programs: The Best Bang for the Buck" (Appendix 9), summarizing research on the benefits of early childhood programs for society, the family and the individual. The Committee discussed the proposal generally, including estimated costs, whether the state should be promoting or paying for child care and whether the state could constitutionally provide aid to families and programs without a sliding income scale. The Committee will consider a proposed bill at its next meeting. Senator Massie and Representative Harvey volunteered to work with the Department of Family Services on a proposed bill.

Healthy Living/Healthy Learning Grants

Gerald Mass, Health and Safety Unit Director for the Department of Education, described the Department's pilot project to provide grants to school districts that adopt specified health promotion activities. He distributed the program's February newsletter, "Health Notes" (Appendix 10). Rodger McDaniel proposed expanding the pilot program and presented a draft of legislation that would expand the grant program from six to sixteen school districts at an estimated cost of $3.1 Million per biennium. The Committee discussed the proposal, including its costs, possible interference with parental prerogatives, whether the proposal should be before the education committee for inclusion in the recalibration formula and whether the program would evolve into an unfunded mandate. Upon Chairman Scott's recommendation, the Committee decided to postpone the consideration of any legislation to the next meeting.

Problem Solving Courts

Director McDaniel advised the Committee that another recommendation from the Children and Families Initiative is to expand the successful drug court program to include other intractable social issues such as anger management, parenting skills and job training. He distributed an excerpt from "Painting the Current Picture: A National Report Card on Drug Courts and Other Problem Solving Court Programs in the United States" (Appendix 11), and a Bureau of Justice Assistance Bulletin: "Drug Courts: An Effective Strategy for Communities Facing Methamphetamine" (Appendix 12). Senator Scott suggested that the matter would more appropriately be brought to the Judiciary Committee.

Richard Lavery, Evanston Municipal Court, and Kurt Zunker, Wyoming Drug Court Association, addressed the Committee. They stated that the drug courts have been very successful and should be expanded, but any expansion of jurisdiction should not be allowed to reduce the success of the drug programs. Mr. Zunker distributed copies of "White Paper – Painting the Current Picture: Wyoming Drug Court Programs" (Appendix 13).

The Committee decided to review any proposed legislation at the committee's next meeting, then refer any sponsored bills to the Judiciary Committee for possible co-sponsorship.

Workers' Safety and Compensation Division

Gary Child, Workers Compensation Administrator, Mike Todd, Department of Employment Business Systems Specialist and Bill Cole, Manager of Accounts Receivable, addressed the committee regarding the following bills which the department is requesting.

Non-resident employer coverage 06LSO-0205.W1 (Appendix 14) Mr. Child explained the bill as a response to the Supreme Court's Kunkel decision in which it was determined an injured employee was covered by Wyoming workers' compensation even though the employer had never registered with the program. The bill would clarify that coverage is determined by the location of the work and remove the conflicting requirement that the employer also be principally located in Wyoming.

Representative Brechtel, seconded by Representative Martin, moved that the Committee sponsor the bill. The motion passed on a vote of 13-0, with Senators Aullman, Barrasso, Decaria, Massie and Scott and Representatives Barnard, Brechtel, Harvey, Hastert, Iekel, Martin, Morgan and Osborn voting aye.

Delinquent employer penalties 06LSO-0206.W1 (Appendix 15) Mr. Child explained the purpose of the bill is to clarify employer delinquency provisions by requiring the division to send a notice of delinquency when an employer report is fifteen days late, by assessing a uniform $100 penalty on each report that is delinquent more than thirty days and by charging a uniform 2% per month on all delinquent accounts.

Investment of reserves 06LSO-0204.C1 (Appendix 16) Mr. Child explained the purpose of the bill is to resolve ambiguity about whether the workers' compensation fund reserves could constitutionally be invested in common stocks. An Attorney General's opinion stated that a statutory change would be sufficient; LSO staff concluded that a constitutional amendment would be necessary. Chairman Scott suggested that the Committee proceed with the statutory change.

Representative Brechtel, seconded by Senator Massie, moved that the Committee sponsor 06LSO-0204.C1. The committee amended the bill be deleting the sentence: "The authority under this section to invest in common stock shall not be subject to the provisions of title 9 of the Wyoming statutes governing investment of state funds."

The motion to sponsor passed on a vote of 13-0, with Senators Aullman, Barrasso, Decaria, Massie and Scott and Representatives Barnard, Brechtel, Harvey, Hastert, Iekel, Martin, Morgan and Osborn voting aye.

Drug and alcohol testing 06LSO-0203.W1 (Appendix 17) Mr. Child presented the bill, which would authorize an additional premium discount of 5% for employers implementing an approved drug and alcohol testing program. Senator Massie pointed out that the existing 10% safety discount already rewards drug-free workplace programs. Mr. Child replied that the additional incentive would compensate for the cost of testing. Barry Johnson, Barry Johnson Consulting, and Marion Loomis, Wyoming Mining Association, spoke in favor of the bill.

Representative Osborn, seconded by Representative Brechtel, moved that the Committee sponsor the bill. The motion passed on a vote of 10-3, with Senators Aullman, Barrasso, and Scott and Representatives Barnard, Brechtel, Harvey, Iekel, Martin, Morgan and Osborn voting aye, and Senators Decaria and Massie and Representative Hastert voting no.

On Chairman Scott's suggestion, the Committee agreed to combine the bills on non-resident employer coverage and delinquent employer penalties into one bill.

Regulation of Medical Specialty Centers

Dan Perdue, Wyoming Hospital Association, and Pam Fulks, Wyoming Medical Center, reported to the Committee on the impact of small, physician-owned specialty surgery centers on healthcare delivery. He distributed a list of study issues and possible public policy solutions (Appendix 18). Mr. Perdue stated that the Board of his association requests the Committee to sponsor legislation imposing a moratorium on licensing of new specialty medical centers pending a more in-depth study.

Jeffrey Fowler, M.D. Casper, spoke against the moratorium but welcomed a study. He distributed copies of an article entitled "Improving Health Care: A Dose of Competition" (Appendix 19).

Committee members generally discussed whether competition would help or hurt patient care, whether specialty centers "cherry pick" the best paying patients and whether fair competition is possible in health care. Susie Polliot, Wyoming Medical Society, spoke against a moratorium.

Chairman Scott called for a bill to be drafted for discussion at the next meeting that includes a study by the Healthcare Commission, a moratorium and authority in the Department of Health director to waive the moratorium for good cause.

Child Vaccination – Universal Program 06LSO-0209.W1

Brent Sherard, Department of Health Director, described the federal Vaccine for Children Program. Until recently, the department had used discount vaccine from the program for all children in the state, but a federal audit determined that it could be used only for the 55% of children covered by the federal program. The draft bill (Appendix 19) would provide state funding to purchase vaccine for the other 45% of children.

Representative Osborn, seconded by Representative Iekel, moved that the Committee sponsor the bill. The committee directed that the bill be amended to make the program part of the codified statutes and to insert the phrase "or subsequent similar federal enactment" after the federal statutory reference. The motion to sponsor passed on a vote of 13-0, with Senators Aullman, Barrasso, Decaria, Massie and Scott and Representatives Barnard, Brechtel, Harvey, Hastert, Iekel, Martin, Morgan and Osborn voting aye.

Child Fatality Investigations – jurisdiction

Dr. Sherard reported to the committee that there is an existing program with the Department of Family Services which gathers a multi-disciplinary board to investigate avoidable child deaths. The proposal is to transfer the program to the Department of Health. Chairman Scott suggested that the Committee was accumulating too many bills and that a private sponsor may carry that bill. Representative Iekel and Senator Aullman offered to work on an individual bill.

WWAMI Program Status

Representative Iekel told the Committee he was informed by the University that of the six WWAMI medical students completing their residencies in 2004, five have returned to work in Wyoming.

County Health Officer Immunity

Representative Hastert reported that he is working with the Department of Health on this issue, and, if legislation is necessary, will have a draft for the Committee's next meeting.

Advance Health Care Directives Registry

Anne Ladd, Wyoming Healthcare Commission, stated that this topic is still under study by the Commission and could easily be added later to the healthcare information technology system hub-and-spoke network.

Health Benefits for the Uninsured

Senator Massie explained that the KidCare program could be expanded to cover the working parents of eligible poor children. The expansion could either pay for insurance through the parent's employer, augment the employer insurance or admit the parents directly to KidCare. With a program capped at 3720 participants, the cost would be approximately $10 Million per year. Senator Massie, Senator Decaria and Representative Iekel volunteered to work with the Healthcare Commission and Department of Health to draft a bill for the November meeting.

Physician Loan Repayment Program

Senator Massie reported that the "Stroock" plan to reimburse physicians and allied health practitioners for their student loans has been a huge success. The program pays up to $30,000/year for a physician and $10,000/year for allied health practitioners for each year that they work in an underserved area of Wyoming. Program cost for 2004 was $990,000. Senator Massie distributed a "Fact Sheet" concerning the program (Appendix 21) and proposed minor amendments to the loan repayment statutes (Appendix 22). The Committee directed Senator Massie to work with LSO to prepare a bill for the November meeting.

Magnet Hospitals

Senator Massie briefly described the Magnet Hospital program of the American Nurses Association. The Association audits hospitals and awards Magnet Hospital designation to those that meet strict criteria for quality working conditions and patient care. The Healthcare Commission has recommended that the state provide grants to assist hospitals in achieving the designation. The Committee directed Senator Massie to work with LSO to prepare a bill for the November meeting.

Health Insurance – Small Employer Carrier Reinsurance Amendments

Chairman Scott deferred this topic to the next meeting.

Tobacco Tax Revenues

Representative Hastert informed the Committee that he is working on a bill to raise the tobacco tax. He noted that 41 other states have increased their taxes since Wyoming last raised its tax in 2002, and that studies show a 10% increase in price produces a 7% decrease in consumption. The Committee will consider the bill at its November meeting. Loretta Wolf, American Cancer Society, spoke in favor of the increase and distributed a handout, "Cancer Facts & Figures 2005" (Appendix

Meeting Adjournment

There being no further business, Co-Chairman Osborn adjourned the meeting at 5:06 pm.

Respectfully submitted,

Senator Charles K. Scott, Co-Chairman

Representative Doug Osborn, Co-Chairman