Committee Meeting Information

August 23-24, 2007

Wyoming Game & Fish Dept. Regional Office

Casper, Wyoming

 

Committee Members Present

Committee Members Present

Senator Charles K. Scott, Co-Chairman

Representative Jack Landon, Co-Chairman

Senator Pat Aullman

Senator John Hastert

Senator Bob Fecht

Senator William Landen

Representative Ken Esquibel

Representative Mary Hales

Representative Timothy Hallinan

Representative Elaine Harvey

Representative Jerry Iekel

Representative Tom Lubnau

Representative Lori Millin

Representative Jeb Steward

 

 

Committee Members Absent

None

 

Legislative Service Office Staff

Gerald W. Laska, Staff Attorney

Joy N. Hill, Associate Research Analyst

 

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.


Executive Summary

The Committee met for two days and received testimony and updates from Department of Health representatives concerning Medicaid, Aging Division programs, immunization, worksite wellness, cancer screening and terrorism/pandemic public health issues.  The Wyoming Primary Care Association made a presentation on community health networks.  The Wyoming Healthcare Commission advised on the status of pending studies.  A variety of interest groups addressed the Committee concerning the state of Wyoming hospitals and healthcare reform efforts.  The committee requested the following draft bills:

·         Statewide public smoking ban

·         Use of standard taxonomy for reporting of safety events by hospitals

·         Authority for regular recalculation of physician reimbursement rates under Medicaid

·         Immunity for inactive/retired health care workers who volunteer during a pandemic emergency

·         Creation of a health care trust fund

·         Health care access pilot projects

·         Physician recruitment incentives.

The next meeting was scheduled for November 1 and 2, to be focused primarily on workers' compensation and labor issues.

 

Call To Order (Thursday, August 23)

Co-Chairman Landon called the meeting to order at 8:30 a.m.  The following sections summarize the Committee proceedings by topic.  Please refer to Appendix 2 to review the Committee Meeting Agenda.

 

 

Wyoming Department of Health Reports

Medicaid

Dr. Brent Sherard, Director, Department of Health, distributed a 2007-2008 budget analysis of the Medicaid Program.  He reported that the program is under budget as a result of fiscal management initiatives and disease management efforts.  The Healthy Together Program is a pro-active disease management program that has increased home care and reduced emergency room visits.  He further reported that Medicaid enrollment is beginning to trend downward.  He expects current trends to continue for at least another year.

 

Bob Peck, Chief Operating Officer, Department of Health, added that, if present trends continue, the Department will have a $40 Million Medicaid surplus at the end of the biennium, which the Department would allow to revert to the budget reserve account.

 

Teri Green, Medicaid Economic Assistance Consultant, stated that there are increasing problems in getting approval of state plan changes from the federal Center for Medicare and Medicaid Services ("CMS").  For the first time, CMS is reviewing the entire state plan whenever a change approval is requested.  Dr. Sherard added that the new approach seems to be coming from the national office, and the regional CMS people have been very uncooperative.  Greg Gruman, Medicaid Program Director, added that the object seems to be to save federal dollars, especially in the areas of mental health/substance abuse, foster care services and rehabilitative services.  Committee members discussed in general what the state legislature might do to assist in negotiating with the federal government.

 

Immunization Program Update

Dr. Sherard, Molly Bruner and Robert Grenwelge reported that the new state-funded part of the child immunization program is working very well.  Dr. Sherard stated that the program is one of the best things that the Department is done and is well worth the investment, but it is too early to tell if the immunization rate is increasing.

 

Cancer Screening

Joe Grandpre and Kim Rogers distributed an update on the new colorectal screening program (Appendix 4).  Emergency rules have been promulgated and regular rules proposed.  A marketing campaign is beginning.  Dr. Sherard stated the program will probably be a cost saver over the long term, as colorectal cancer is probably the number two cancer killer in Wyoming.  Committee members discussed startup problems with the program and ideas to increase participation.

 

SCHIP Program

Kellie Grady  and Dr. Sherard reported that KidCare/CHIP was recently audited by the LSO and passed with flying colors.  The audit recommended additional promotional and prevention activities, which the Department will be proposing later this year.  Greg Gruman reported that there are two bills in Congress to continue the program, both of which the President has threatened to veto.  The program is currently funded only through September 30th.  Ms. Grady reported that she has been informed that the proposed expansion to cover parents will likely be denied by CMS.  She estimated the cost of a state-funded program could be as high as $300 Million.

 

Roxanne Homar reported that the drug donation program has been very successful, with an overwhelming level of participation.  The program has received $111,000 in donated medications and distributed $27,000 worth so far.  The medications have helped with the "donut hole" in the Medicare Part D drug plan.

 

Ms. Homar explained that there is a new federal law imposing a "Federal Upper Limit" (Appendix 5) on generic drug prices.  The state limit has worked well and she intends to seek approval of the state plan so the federal FUL formula will not have to be implemented.

 

Ms. Homar advised that another new federal law, requiring tamper resistant prescription pads (Appendix 6), could increase costs and affect drug availability and Medicaid costs.

 

Greg Gruman also advised the CMS is implementing new claim verification systems that are filled with bugs and will increase administrative costs and impact all providers as legitimate claims are questions or payments withheld.

 

Aging

Bev Morrow, DoH Aging Division, distributed a list of programs offered through the Aging Division (Appendix 7).  She reported that funding and slot increases in the Home and Community Based Waiver and Assisted Living Waiver programs have been implemented and both programs now have waiting lists.  Consumer directed care has increased to 283 participants and the Division is applying for a Nursing Home Diversion Caregivers grant.  A study of adult daycare providers is being conducted by Public Knowledge Corporation.  The Division is concerned about the availability of continuing funding for the SF89 pilot projects, as the budget office has concluded that the appropriations were one-time only.

 

The Committee generally discussed the increase in the aged population, the adequacy of long term care in Wyoming, the decrease in nursing home population despite the increase in elderly population.  Dr. Sherard advocated the creation of a select committee on long term care.

 

Ms. Morrow described the pilot Aging and Disability Resource Centers in Natrona and Converse Counties.  The centers are a federal grant project to the University of Wyoming/WIND to provide a one-stop shop for elderly/disabled and their families to learn of available resources.  The federal pilot is likely to expire next year, so the Division is considering a budget request to create a statewide ADRC program through Medicaid and state funds.  Dr. Sherard added that the Department would request $964,000 to contract for ADRC services.

 

Public Health/Terrorism Legislation

Dr. Sherard introduced Dr. Tracy Murphy, the state epidemiologist.  They have assessed the state's preparedness for a pandemic flu outbreak (Appendix 13).  Dr. Sherard stated that the Attorney General's Office and the Office of Health and Safety of the CDC have advised that retired health workers probably could not volunteer in an emergency without an active license.  Dr. Sherard requested a bill to authorize retired, inactive or out-of-state health workers to volunteer to work in a public health emergency and be immunized from civil liability.

 

Community Healthcare Network – funding and expansion

Patrick Monihan addressed the Committee during a working lunch.  He distributed an “Introduction to the

Wyoming Primary Care Association (Appendix 14) and made a PowerPoint presentation entitled “Wyoming Health Center Primary Care ‘Safety Net’ Support Act” (Appendix 15).  He described possible means to expand the existing ADRC pilot program statewide with either federal and state funds or state funding alone.  Sharon Montagnino, CEO, Cheyenne Health & Wellness Center and President, WYPCA, described the two existing Community Health Center (CHC) locations in Cheyenne and Casper as providers of primary health care services, primarily to the uninsured, Medicaid and Medicare participants.  She asked that the Committee sponsor legislation to create look-alike state-funded clinics statewide.  She further explained that the CHC’s operate through a board of directors having 51% patient members, that the CHC hires direct care providers and that patients are charged a sliding scale nominal fee.  She stated that federally-qualified CHC’s and state look-alike CHS’s receive enhanced Medicaid and Medicare reimbursements.

 

Mr. Monihan included in his PowerPoint presentation estimated start up costs by county (Appendix 15, page 6, slide 1) and an estimated first year budget of $2,054,214 for creating CHC’s in Carbon and Sweetwater Counties (Appendix 15, page 6, slide 2).

 

Wyoming Healthcare Commission Reports

Dixie Roberts, Commission Chairman, Susie Scott-Mullen, Executive Director, Wyoming Healthcare Commission, distributed a summary of the Commission’s background, makeup and activities (Appendix 16).  Ms. Roberts, Ms. Scott-Mullen, Beth Worthen, Assistant Director, and Dr. Jack Glode, Commission member, described the commission’s activities.  The goal of the access and affordability subcommittee is to incrementally decrease the number of uninsured.  The commission recommends that the state fully fund coverage for the parents of CHIP children if CMS denies the plan amendment.

 

In response to questioning by Senator Scott, Ms. Scott-Mullen agreed that the cost to cover all uninsured in Wyoming would be $500 Million/year.  She stated that a report containing specific proposals from a consulting economist, Dr. Jonathan Gruber, is due within a month.

 

Ms. Roberts stated that the Commission recommends maintaining a stable supply of healthcare professionals by reviving the UDOC program for high school students, expanding loan repayment programs, funding an additional healthcare professor at UW and increasing residency slots in the family practice residency program.

 

The Commission recommended facilitation of integrated, patient-centered care (Appendix 17), mainly by having a personal primary care physician where most of a patient’s care takes place and records are kept.

 

The Commission further recommended that the state start keeping database records regarding hospitals, including in-migration, out-migration, in-patient vs. out-patient care, diagnoses, payment source, acuity level and patient charges.  Ms. Roberts estimated the cost of a state-run database at $50,000/year/hospital.

 

The Commission also recommended

·         a sliding scale on co-payments for health care to encourage personal responsibility in managing care;

·         statewide non-smoking initiatives;

·         a new system for medical error reporting (Appendix 18) that uses a standard taxonomy, state-funded training of hospital employees and creation of a Wyoming safety event reporting center

 

Representative Landon stated that he will be requesting all Committee members to list their legislative priorities for health related legislation before the end of the meeting on Friday.

 

Amendment of Committee Rules

Representative Landon explained a proposed amendment to the Committee’s rules of operation that would require a majority vote of Senate members and House members to approve a bill for sponsorship by the Committee.  Following discussion of the proposal, Representative Lubnau, seconded by Senator Fecht, moved adoption of the rule change (Appendix 19).  The motion carried on a voice vote.

 

 

Meeting Recess

The Committee recessed at 4:30 p.m..

 

Call To Order (Friday, August 24)

Co-Chairman Scott called the meeting to order at 8:00 a.m.

 

The State of Wyoming Hospitals

Dan Perdue, Steve Perry, Charles harms and Mike McCafferty addressed the Commiteee.  They distributed “The State of Wyoming Hospitals” (Appendix 20).  They reported on the current environment, suggested changes, workforce challenges, and changes to State Loan and Investment Board rules that make it more difficult for county memorial and special district hospitals to access capital for replacement or remodeling of hospital facilities.  The Committee generally discussed the status of negotiations with the Board of Nursing regarding a nurse licensure interstate compact.

 

Mr. Harms requested Committee support for a bill to help fund unreimbursed trauma care.

 

Mr. McCafferty distributed a PowerPoint presentation regarding safety event reporting (Appendix 21) and some of the various reporting and quality initiatives throughout the country.  He stated that compliance with existing reporting requirements requires six full-time employees at Sheridan Memorial Hospital.  The committee generally discussed and the presenters agreed that a uniform system of reporting would be helpful and would save money without decreasing patient safety.  He also distributed information on CMS’s quality data reporting initiative (Appendix 22), CMA Core Measures reportable events (Appendix 23) and the Wyoming Department of Health’s list of reportable diseases and conditions (Appendix 24).

 

Wyoming Medical Society

Susie Polliot reported to the Committee that physician recruitment is a pressing concern of WMS.  In addition, Medicaid should have a method of regularly reviewing physician reimbursement schedules, tied to consumer or medical price indices, with a bonus for higher Medicaid patient loads and local adjustment factors.

 

The Committee discussed the adequacy of Medicaid reimbursements.  Bob Peck, COO, Department of Health, advised that Medicaid is prohibited from paying more than Medicare and pays on average 94% of the Medicare reimbursement.  Dr. Sherard agreed that Medicaid reimbursements should be higher, and that he would like to see something like the periodic re-basing that occurs for nursing home rates .

 

Smoke Free Wyoming

Jan Drury, American Heart Association, and Loretta Wolf, Wyoming Cancer Society, advocated a statewide smoking ban.  They testified that there is no safe level of second-hand smoke and that there is accumulating evidence of the effect of second-hand smoke’s association with asthma and breast cancer.  Ms. Wolf stated that tobacco taxes generate approximately $24 Million/year for the state, but that tobacco illnesses cost an estimated $37 Million in Medicaid funds alone.

 

Ms. Wolf further advocated a bill to require health insurance coverage for participation in clinical trials and an increase in the Medicaid reimbursement for medically-required travel.

 

Wyoming Assisted Living Coalition

Lynn Birleffi and Sarah Green addressed the Committee and distributed a statement in support of a select long term care committee (Appendix 25).  They described the seven assisted living facilities in Wyoming and advocated: continuing pro-active work on elder care issues the a select committee or subcommittee of the Labor, Health and Social Services Committee; regular review of Medicaid reimbursement rates; and establishment of a different reimbursement rate for memory care facilities.

 

Senior Center Project Directors

Jeri Bottenfield, Margaret Myers and Jeanine Cox addressed the Committee regarding senior centers, which they described as the first point of contact for most people needing elder care.  They distributed a pamphlet describing the WDH Aging Division (Appendix 26) and a Wyoming Senior Centers fact sheet (Appendix 27).  According to Ms. Bottenfield, the main problems facing the centers is the patchwork nature of their funding and low wages/labor competition.

 

Stroke prevention/treatment Pilot Project

Jan Drury, American Heart Association and Wyoming Stroke Enhancement Project, and Richard Leslie, Wyoming Epilepsy Association, addressed the Committee.  They distributed a press release regarding the Stroke Enhancement Project (Appendix 28).  The project is a partnership of the American Stroke Association, the Wyoming Hospital Association and the Wyoming Medical Society which promotes a resource network and best practices in all frontline stroke treatment facilities.  They also distributed a list of facilities receiving an initial performance award (Appendix 29) and a sample poster entitled “What Took You A Lifetime to Learn Can Be Lost in Minutes” (Appendix 30).

 

Other states’ healthcare/long term care reform efforts

Tim Summers, Wyoming AARP, and JoAnn Lamphere, AARP State Health and Long Term Care Team Coordinator, addressed the Committee with a PowerPoint presentation (Appendix 31).  They expressed support for a select long term care committee and advocated increasing access to health insurance as the key to long term care affordability and access.  They recommended an incremental approach rather than a Massachusetts-style universal care system, with smaller elements being health care IT and quality control/reporting as severable and doable components.  The Committee discussed generally the pros and cons of universal health care versus private insurance and a state-run, low-income health plan, the high cost of insuring Wyoming’s estimated 14% uninsured population and the likely legal challenge under ERISA law to any “play-or-pay” plan.

 

Public Comment

Dr. Anne Maguire addressed the committee to advocate: stronger DUI suspensions; a motorcycle helmet law; a stronger seatbelt law; confiscation of car and license until age 21 for any juvenile convicted of DUI.

 

Tom Jones, Wyoming Healthcare Association, advocated a system like Minnesota’s, using a computer software program to more accurately predict long term care needs and impact on facilities.

 

Mary Hein, Alzheimer’s of Wyoming, thanked the Committee for its work on SF89 and stated that a continuing gap in facilities is for violent dementia patients.  She recommended restoration of tobacco settlement funds exclusively for health care.

 

Matt Graham, Wyoming Mining Association, addressed the Committee to describe the very good safety record of the industry in Wyoming and to rebut the claim that a Utah-type of mining accident is inevitable.

 

Dan Lex, Quality Healthcare Foundation, advocated enhanced use of CNA’s in long term care and review of all nurse licensing categories.  A training “spinout” program for CNA’s to become employed with the possibility of continuing later to become LPN certified would be very helpful, according to Mr. Lex.

 

Dan Neal, Equality State Policy Center, advocated state-supported health insurance for the currently uninsured.  He advocated giving the Insurance Department more teeth to require all insurers to report and post actual costs and negotiated rates of care.  He also expressed support for the Healthcare Commission recommendation that Wyoming not wait for Congress to expand KidCare.

 

Committee Discussion/Requests for Draft Legislation

The Committee polled each member for priorities in requesting draft legislation for presentation at the next meeting and consideration at the December meeting.  The Committee agreed by voice vote to request bills on the following topics:

 

Meeting Adjournment

There being no further business, Co-Chairman Scott adjourned the meeting at 4:45 p.m.

 

Respectfully submitted,

 

 

 

Senator Charles Scott, Co-Chairman

 

 

 

Representative Jack Landon, Co-Chairman

 


 

 

 

 

 

 

 

 


Appendix

 

Appendix Topic

 

Appendix Description

 

Appendix Provider

1

 

Committee Sign-In Sheet

 

Lists meeting attendees

 

Legislative Service Office

2

 

Committee Meeting Agenda

 

Provides an outline of the topics the Committee planned to address at meeting

 

Legislative Service Office

3

 

Dept. of Health Reports - Medicaid

 

2007-2008 Budget Analysis

 

Office of Healthcare Financing

4

 

Dept. of Health Reports – Colorectal cancer screening

 

Program progress and highlights

 

Dept. of Health

5

 

Dept. of Health Reports – Medicaid

 

Medicaid Reimbursement: New FUL Calculation

 

DoH/Medicaid

6

 

Dept. of Health Reports – Medicaid

 

Tamper Resistant Pads

 

DoH/Medicaid

7

 

Dept. of Health Reports – Aging

 

Programs for Older and Disabled Persons

 

DoH/Aging Division

8

 

Dept. of Health Reports – Aging

 

Aging and Disability Resource Center (ADRC)

 

Wyo. Independent Living Rehabilitation, Inc.

9

 

Dept. of Health Reports – Aging

 

Pamphlet:  "The Resource Center"

 

DoH/Aging Division

10

 

Dept. of Health Reports – Aging

 

ADRC Statewide Proposal

 

DoH/Aging Division

11

 

Dept. of Health Reports – Aging

 

ADRC:  Statewide Budget and Budget Narrative Proposal

 

DoH/Aging Division

12

 

Community Healthcare Network Expansion

 

"Wyoming Health Center Primary Care 'Safety Net' Support Act"

 

Wyoming Primary Care Association

13

 

Dept. of Health

 

Letter, Dr. Brent Sherard to Rep. Landon, with attached Model State Emergency Health Powers Act

 

Dept. of Health

14

 

Community Healthcare Network Expansion

 

Introduction to the Wyo. Primary Care Association  (WYPCA)

 

WYPCA

15

 

Community Healthcare Network Expansion

 

PowerPoint: "Wyoming Health Center Primary Care 'Safety Net' Support Act"

 

WYPCA

16

 

Wyoming Healthcare Commission Reports

 

Folder:  Who We Are; Focus Areas; Key Accomplishments

 

Wyo. Healthcare Commission (WHCC)

17

 

Wyoming Healthcare Commission Reports

 

Recommendations for an Integrated Approach to Health Care

 

WHCC

18

 

Wyoming Healthcare Commission Reports

 

Patient Safety Event Reporting

 

WHCC

19

 

Committee Business: Adoption of Committee Rules

 

Proposed Rule Requiring Majority Vote of House and Senate Members for Bill Sponsorship

 

LSO

20

 

The State of Wyoming Hospitals

 

"The State of Wyoming Hospitals"

 

Wyo. Hospital Assn.

21

 

The State of Wyoming Hospitals

 

PowerPoint:  Public Reporting – Patient Safety – Quality Initiatives

 

Sheridan Memorial Hospital/ Mike McCafferty

22

 

The State of Wyoming Hospitals

 

CMS Website printout:  Hospital Quality Initiatives: Reporting Hospital Quality Data for Annual Payment Update

 

Sheridan Memorial Hospital/ Mike McCafferty

23

 

Public  Comment

 

Publicly Reported Data – Process of Care Measures

 

Sheridan Memorial Hospital/ Mike McCafferty

24

 

Public Comment

 

Wyoming Department of Health Reportable Diseases and Conditions

 

Sheridan Memorial Hospital/ Mike McCafferty

25

 

Assisted Living – Long Term Care

 

"Please support the establishment of a Select Committee on Long Term Care"

 

Wyo. Assisted Living Coalition

26

 

Senior Center Project Directors

 

Pamphlet:  "Wyoming Department of Health Aging Division"

 

Wyo. Assn. of  Senior Project Directors

27

 

Senior Center Project Directors

 

Wyoming's Senior Centers:  Fact Sheet – July 2007

 

Wyo. Assn. of  Senior Project Directors

28

 

Stroke Prevention/ Treatment Project

 

Press Release:  On a mission to reduce stroke: Wyoming launches Stroke Enhancement Project

 

American Heart Association/ American Stroke Association

29

 

Stroke Prevention/ Treatment Project

 

List of hospitals earning 2007 award for meeting treatment guidelines

 

American Heart Association/ American Stroke Association

30

 

Stroke Prevention/ Treatment Project

 

"What Took You a Livfetime to Learn Can Be Lost In Minutes"

 

American Heart Association/ American Stroke Association

31

 

Other states healthcare/long term care reform efforts

 

"Health Care Reform Across the States: Implications for Wyoming"

 

AARP/ JoAnn Lamphere

 


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