File name: JACSupplementalBudget2011-2012_20110113_152438.dcr

Folder: C:\Documents and Settings\HAppropriations\Desktop\Recordings


      0 ~ 1/13/2011 3:37:46 PM ~ Thursday January 13..Department of Health,,Dr. Sherard, Director..

   1:03 ~ 1/13/2011 3:38:50 PM ~ SHerard  In Dec. Sheri and her staff put together a very good document on macaid.  Basically ..21% of the entire state budget.. about 2/3 or that is Medicaid..One of the important things is that 88% of the dept budget goes to direct providers.. Document:  Handout shows amount to each county, then second page shows top 10 providers of each county..will see top providers in your individual counties...peruse as I talk Medicaid is a roughly 50/50 partnership between federal govt and the state...lots of rules by federal govt..changes in medicaid program must go through the floor ..slow, system does nto move quickly.. We are going to look at this budget with a lot of concern...the growth is based upon increased enrollments in the Wyoming medicaid program..primarily related to the economy..increased unemployment rate..almost all states have seen this as well. Medicaid Facts: in the Wyoming program 58% of the expenditures are for the aged, blind and disabled; 15% of the eligibles are in that category..We cover a lot of children..63% but 28% of expenditures..  That is 86% of our budget for those two groups.  63% of all beds in nursing home are medicaid beds..liability shifted...45% of all Wyoming births are paid for by Medicaid.   That is not that unusual nationwide..staggering statistic..Texas is higher than that. Wyo physicians receive about 8.8% of their income from Wyoming, developementally disable providers receive almost 100% from Wyoming program...some general information

   8:31 ~ 1/13/2011 3:46:18 PM ~ Meier:  Was that 8.8%..

   8:43 ~ 1/13/2011 3:46:29 PM ~ Sherard:  8.8 %  of all physician income comes from Wyoming medicaid program

   9:09 ~ 1/13/2011 3:46:56 PM ~ Meier:  Assume obstetricians would be a large percent of that

   9:25 ~ 1/13/2011 3:47:11 PM ~ Sherard:  not sure...would imagine that.. We have watched this problem develop.  I have been director for six years ..have looked for ways to mitigate this problem.. Four things affect the Wyoming Medicaid budget: 1.  Administrative costs...ours is quite low.  That process has been streamlined....have to look 2.  Eligibility- one of the most conservative in the United States The legislature last year considered introducing a bill to change eligibility..the stimulus funds...if we would have changed eleigibility great likly hood we would not have been eligible for stimulus funds.. Ongoing discussion withs dept. of family services..bringing the eligibility into the Dept of health. The other area of eligibility...eligibility is good for one year when receive unemployment...should look at eligibility more often than once a year 3.  Optional services in Wyoming medicaid program:  Feds say mandatory and then over years the legislature has put options into effect.

  14:16 ~ 1/13/2011 3:52:03 PM ~ Meier:  Would optional services affect our federal .

  14:33 ~ 1/13/2011 3:52:19 PM ~ Sherard:  I think it would

  14:39 ~ 1/13/2011 3:52:25 PM ~ Terri Green:  99.9% no..if we change those it would not jeopordize our funding

  15:15 ~ 1/13/2011 3:53:01 PM ~ Berger:  Handout

  15:22 ~ 1/13/2011 3:53:08 PM ~ Terri:  Handouts are in the book given out previously

  15:42 ~ 1/13/2011 3:53:29 PM ~ Berger:  Committee has had a chance to look at that

  15:53 ~ 1/13/2011 3:53:39 PM ~ Sherard:  Fourth area is rate paid to providers..last year made cuts..cuts were successful..problem is the override of the enrollment negated the positive impacts of our cuts...discussed this with our providers at great lengths..  We do have a fragile provider service.. Two ways to reduce expenditures in the medicaid program

  18:00 ~ 1/13/2011 3:55:46 PM ~ Berger: Do you think it is more stagnant...?

  18:12 ~ 1/13/2011 3:55:58 PM ~ Sherard:  I believe we are starting to see some concern on the reimbursement rate...we have been able to maintain access pretty well with most of our providers..right not not too badly with access

  18:48 ~ 1/13/2011 3:56:35 PM ~ Meier:  Followup - Altzheimer's in the nursing homes...requirement by health dept to have greater numbers of providers for those corresonding increase in the rate..not sure number of may lose 1/2 million per year..understands it is necessary..other problems residential treatment centers...out of business or close to it...wraparound payments.  Can you address those two things today?  will have more..will have to provide more services..suggestions for the future.

  20:46 ~ 1/13/2011 3:58:32 PM ~ Sherard:  We can...spent a lot of time on the Residential Centers..I will have Terri address Altzheimers.  If you have a high-end client there are codes that you can receive higher reimbursements for more complex patients..we try to help providers with coding Another issue brought up in Dec is issue of forecasting..need to be better at that...appreciate LSO suggestion on working closely with the department.  We need more actuarial data in the department.

  23:02 ~ 1/13/2011 4:00:48 PM ~ Edmunds:  Possible savings..front end gatekeeper, moving over to the dept of health and a more up to date verification..possibly real time.  Have you looked into that?

  23:38 ~ 1/13/2011 4:01:25 PM ~ Sherard:  We have..Tony Lewis

  23:51 ~ 1/13/2011 4:01:38 PM ~ Terri:  Over the last year we have worked with a consultant who helped us work with the Dept of Family Services..Family care act..federal money ..for a new system..  We have created a roadmap to look for a new system. We have partnered with the CIO.  The federal funding available to us is at 90%.

  25:21 ~ 1/13/2011 4:03:08 PM ~ Sherard:  90% Federal match 10% state for the syustem

  25:38 ~ 1/13/2011 4:03:25 PM ~ Berger:  What is the next step

  25:44 ~ 1/13/2011 4:03:31 PM ~ Green:  Next step is approval from the CIO office

  25:56 ~ 1/13/2011 4:03:42 PM ~ Green:  No idea of what a system would cost....a lot of options and opportunities

  26:23 ~ 1/13/2011 4:04:10 PM ~ Berger:  Have you an idea for installation timeframe after making decisions?

  26:38 ~ 1/13/2011 4:04:24 PM ~ Green:  We do not have an estimate..from experience upwards of 2 or 3 years.

  26:55 ~ 1/13/2011 4:04:41 PM ~ Berger:  How does DFS record and maintain elegibility?

  27:10 ~ 1/13/2011 4:04:57 PM ~ Green: ...manually entered ..12 months is for family and childfren care

  27:31 ~ 1/13/2011 4:05:17 PM ~ Steward:  In your Dec handout has graph 12.. shows the eligibility tracks fairly well with unemployment then unemployment drops off and eligibility continues to rise.

  28:22 ~ 1/13/2011 4:06:08 PM ~ Sherard:  Please repeat.

  28:39 ~ 1/13/2011 4:06:25 PM ~ Steward:  On graph, unemployment tracks....that would seem to be the low-hanging fruit to go after first in terms of ..once people get on the rolls then they stay on.  How can we better correlate those numbers?  Should not take 2 years

  29:38 ~ 1/13/2011 4:07:24 PM ~ Green:  Graph:  A large amount of Medicaid eligibles stay on for 12 months..graph is for six months.. would expect that in another six months the amount would drop..

  30:26 ~ 1/13/2011 4:08:12 PM ~ Edmunds:  I get the sense that part of the issue with the gatekeeping .your ability is hampered because you are not are paying..when you implement an electronic system that you will do that

  31:13 ~ 1/13/2011 4:08:59 PM ~ Sherard:  I agree..not a lot of control on who writes checks.  When people qualify we have to pay. I think there are two areas to discuss today.  One is the shortfall of 21 million for the 2009-2010 biennium.  We have looked in the dept and applied as much from GF as we could.  We have from the Federal govt that is owed to us. There is 9.7 million owed to the state of Wyoming owed by the feds.  We have sent letters, agressively pursuing those funds...we feel we will get those funds... Supplemental

  33:26 ~ 1/13/2011 4:11:12 PM ~ Berger:  Possible to get response or check while in session so we can do an amendment

  33:42 ~ 1/13/2011 4:11:29 PM ~ Sherard:  That is our hope

  33:51 ~ 1/13/2011 4:11:38 PM ~ were talking about 4 choices to reduce costs..chart..question of mine is how much are we responsible for this problem.  How much have we exceeded what is mandated by the Federal govt?..any pie chart for responsibility for cost overruns caused by the legislature

  34:52 ~ 1/13/2011 4:12:38 PM ~ Sherard:  I don't look at any one being responsible..probably a good reason why it was put in at the time...the legislature has the authority to put in optional services but they are not the majority..what the feds mandate is our bigger part. What we are seeing is a growth in enrollment.. I thank you for keeping the program conservative..we would be in more trouble..

  36:32 ~ 1/13/2011 4:14:19 PM ~ Pederson:  There is a % that you can quantify that is for optional service.  Do you have that number?

  36:56 ~ 1/13/2011 4:14:42 PM ~ Green: We do not

  37:02 ~ 1/13/2011 4:14:48 PM ~ Berger: request it , markup around the 20th..we know there is substantial discussion about reorganization and transistion..What have you done to start looking at you will look at changing the face of medicaid in a new reorganization, if that occurs

  37:49 ~ 1/13/2011 4:15:35 PM ~ Sherard:  pros and cons of anything..The medicaid program has always been a challenge for the director of the Health dept..the avg. life expectency is 2...years.   Four components in our department Facilities-direct patient care Divisions - public health components Wyoming medicaid - 2/3 of our budget Regulatory component- licensing Hope to maintain integration of our health services dept..don't want Medicaid to be sitting out without incentives to use prevention and health promotion..tried to integrate that within the department Need to be sure not creating redundent systems Bill- a lot of statutory changes in other titles that need to be carefully looked at.. Point is I think it is worth looking at but be cautious about the statutory changes and with a lot of thought.

  41:55 ~ 1/13/2011 4:19:41 PM ~ Berger:  everyone having trouble with medicaid  They are looking at cutting those two different areas.   I think that the elegibility

  43:46 ~ 1/13/2011 4:21:32 PM ~ Esqabel  Referring to this handout here.  The age group from 20 - 29 is out of balance with the men   Just for the committees knowledge benefit, there is a program out there to help these women.  It makes more sense to have people have pre     costs rather than    The unborn child program

  46:18 ~ 1/13/2011 4:24:05 PM ~ Sherard   We do look at these programs  The costs are very large.  I don't know what the costs would be but worth looking into  Teri do you want to

  47:21 ~ 1/13/2011 4:25:08 PM ~ Patti  I'm the manager of the CHIP program.  I know it's available and is available.  U can cover the child from inception on.  Can you repeat

  48:36 ~ 1/13/2011 4:26:23 PM ~ Esquabel   It do go under the CH(P program   When I did talk to Ms. Goosman I got some figures of about 20 Mill. per years.

  50:03 ~ 1/13/2011 4:27:49 PM ~ Sherard  Most of these kids go to Denver, Salt Lake, Rapid City.

  50:35 ~ 1/13/2011 4:28:22 PM ~ Wallis   Is what Esquabel referring to an option in Medicaid that

  51:21 ~ 1/13/2011 4:29:08 PM ~ Patti   It is an option under CHIP  In Chip you can only cover the child.

  52:23 ~ 1/13/2011 4:30:09 PM ~ Wallis   45% covers the births but not the prenatel care.  They were not eligable for medicaid previoulsly.

  53:27 ~ 1/13/2011 4:31:14 PM ~ Patti  In covers people over 133% of the povery  level.

  54:18 ~ 1/13/2011 4:32:04 PM ~ Edmonds   Walk me through speaking of medicaid specifically.

  54:49 ~ 1/13/2011 4:32:35 PM ~ Sherard  We do have a syquence

  55:09 ~ 1/13/2011 4:32:55 PM ~ Peck  We do have a handout for this.  It indicates that we are not sitting here with our heads in the sand.  This is a short history.  When the unimployment was beginning ti rise, we met with the budget office and the governor's office.  We decided that to be safe, we projected an 8% growth in medicad..   When we looked at FS?? ended  Buy June of 2009 we had already exceded by 9%  If we continued on, our expenditure for 09/10  would be       510,000   If in fact our 2010 had been.     What happened in 2010 instead of decreasing acturally increased.  Basically the problem the actural cosst ended up being 8.1.....   That 60 Mill. increase the feds asorbed most of that.  Any time you change .   CMS approval to get that 10% approval  We are showing that went down over 12%.   When do you have to start making those changes.  It would have taken several months before you could implement those changes.  The bottom line is that it is still a very small percentage.

1:04:52 ~ 1/13/2011 4:42:39 PM ~ Meier   You have some provideers going bankrupt.  We have some very serious discussion that we have made.  We are going to make some very deep cuts.  How can we make the jig saw puzzle pieces meet.

1:06:49 ~ 1/13/2011 4:44:36 PM ~ Harshman   Most of that was provider reinbursments.  What about the optional cuts  Are there other states

1:07:55 ~ 1/13/2011 4:45:42 PM ~ Terri  Arizona cut trnsplants out of our eligibility.  But that is very small percentage in Wyoming.  There are sstates that cutting out physical thereapy.  Do states give that authority over

1:09:37 ~ 1/13/2011 4:47:24 PM ~ Berger  What can of power can be given

1:09:55 ~ 1/13/2011 4:47:41 PM ~ Peck   Some states have full time legislatures, hence they can change the regulations right of way.

1:10:53 ~ 1/13/2011 4:48:40 PM ~ Sherard  When we did our budgedt cuts.

1:11:19 ~ 1/13/2011 4:49:06 PM ~ Harshman  We are one of the few part time legislatures

1:11:46 ~ 1/13/2011 4:49:32 PM ~ Edmonds   Can you Mr. Peck,  tell my how you treat

1:12:37 ~ 1/13/2011 4:50:23 PM ~ Peck  We have met monthly to go over the actual medicaid expenditures  or the actual payments

1:13:14 ~ 1/13/2011 4:51:00 PM ~ Terri  There are two seperate systems.  THey interface with each other.  We turn around 98 or 99 % within a week.

1:14:11 ~ 1/13/2011 4:51:57 PM ~ Meier  Are those located on page 7

1:14:33 ~ 1/13/2011 4:52:20 PM ~ Teri  That just speaks to the percentage of expeditures in the program.

1:15:13 ~ 1/13/2011 4:53:00 PM ~ Meier   Do we have a pie chart

1:15:27 ~ 1/13/2011 4:53:13 PM ~ Teri  That was requested and we will proved that   4%

1:16:00 ~ 1/13/2011 4:53:47 PM ~ Sherard

1:17:06 ~ 1/13/2011 4:54:52 PM ~ Peck  We are almost thru with the 2010 application programs.  There was a slight increase in apllicants but less than we anticipated  Page 13  SChip  Mental Health parity  Medical necesary othodonics.  The actural request is 1.6 mill.  The gov recomended approval.  Page 14  Request recommended by Gov  Page 17  I actually met with LSO on how we wanted to to.  OUr best guess in 1112.  We went through this request.  We only had data through June.  We started in September of 2009 and projected them for 24 months.  By the time the gov.reviewed them we had data through September of 2010.  THe gov. reduced the amount.  A 10 mill. savings.  WE do have them through December at this time.  If I see four more months

1:24:43 ~ 1/13/2011 5:02:30 PM ~ Von Flatern  Do the Fed funds go down the same.

1:25:09 ~ 1/13/2011 5:02:55 PM ~ Peck  The fed funds would go down but not the ARROW funds.  That is based on an extension of those funds.  You can check thosw funds at the bottom of the handout.

1:26:20 ~ 1/13/2011 5:04:06 PM ~ Von Flatern  Is is moved somewhere else.

1:26:38 ~ 1/13/2011 5:04:24 PM ~ Peck  We have to move expeditures to 101 to Arror and then expend the funds  We have 25 million in the account. mindful that we should get around 90 million of ARRA funds..may want to put a placeholder there as you work up your goldenrod so we are not in a bind when those funds go away.

1:28:58 ~ 1/13/2011 5:06:44 PM ~ Meier:  If less drawdown on Medicaid and have a balance is that a reversion back to the General Fund?

1:29:30 ~ 1/13/2011 5:07:16 PM ~ Peck:  If we fund as is and actual expenditures are less then .budget , the goes back into General Fund Placeholder:  2010 DFS would not pay if child ordered to a certain facility so risk is must of court orders specified the place...the risk was we would no longer get the federal match for those children Gov. denied request..use budget reserves to cover it..six months in we have only paid out $40,000..may be some children paid for through medicaid and may have court order.  DFS controls the court orders..will let you know if that is a real risk..

1:32:05 ~ 1/13/2011 5:09:52 PM ~ Berger:  Before next Thursday or during the session

1:32:18 ~ 1/13/2011 5:10:04 PM ~ Peck:..during session Page 24:  Adult Comprehensive Waiver services..  a bill was passed that we would pay a fee ..expected increase in actual units of service. Chris Newman director..

1:33:13 ~ 1/13/2011 5:10:59 PM ~ Berger:  Typically at committee we have an extensive conversation..just an overview to understand ...

1:33:38 ~ 1/13/2011 5:11:25 PM ~ Newman:  July 1, 2008, implemented a new standardized rate for our two ....until that time..every person had an individual there was not a standard rate for those two services..needed a standardized rate..worked with select committee and consultant and provider  We looked at claims data..not aware that some providers who could negotiate the rate..provider does not get paid for days client is not in facility..provider may put less days but a higher rate to cover my costs.  When we implemented the new rates, not aware of how much that was happening...providers informed us they needed more units.  The allocation or appropriation did not factor that in..we were not aware of that so we have not been able to fund those additional services..Services now being provided but compensate those providers for days not paid for

1:37:33 ~ 1/13/2011 5:15:20 PM ~ Peck:  Gov did recommend this request.  We surveyed so have a good number Page &- same request for the ABI program..units served without being funded

1:38:11 ~ 1/13/2011 5:15:57 PM ~ Berger:  Handout that is more detailed, please

1:38:22 ~ 1/13/2011 5:16:08 PM ~ Peck:  Gov did recommend and it was only for 153,000 dollars. Page 31:  Request for medical services travel, educational materials for training around the state.. reason is that we lost federal funding..important function for our state.

1:39:28 ~ 1/13/2011 5:17:14 PM ~ Steward:  Some things have come to light about some funding issues Director of EMs step up to MIke

1:40:12 ~ 1/13/2011 5:17:59 PM ~ Andy:  Director - introduction of others..funding issue  776,000 dollars appropriated for four areas to support EMT classes to provide offer grants and supports to conferences.  In the tranisition between my predecessor, the request that the appropriation be extended did not get made.  We relied heavily on those expenditures and request that we get the money for next year.

1:42:24 ~ 1/13/2011 5:20:10 PM ~ Steward:  Handout in yoru boxes..doesn't seem fair to ask for the whole appropriations, will ask for half of the initial appropriation during the mark up session.. will come in during the normal process to request money for the remainder of the biennium.  It just fell through the cracks, an exception request was not made,

1:43:36 ~ 1/13/2011 5:21:22 PM ~ Sherard:  That was our oversight...legislature was very generous in the EMS program...volunteers...definitely improve the overall status of the programs

1:44:10 ~ 1/13/2011 5:21:57 PM ~ Nicholas:  Before we provided the appropriaton who provided it before and how is it handled now?

1:44:34 ~ 1/13/2011 5:22:21 PM ~ Andy:  ...large portion for training..

1:44:48 ~ 1/13/2011 5:22:34 PM ~ Nicholas:  Were the counties paying for those services?  Has training stopped?

1:45:07 ~ 1/13/2011 5:22:54 PM ~ Andy:  Suspect training was being provided..ramped up number of classes being done..from money in 2008.

1:45:44 ~ 1/13/2011 5:23:31 PM ~ Sherard:  Medical director appropriation--problem incentivizing medical directors to be part of the programs...

1:46:13 ~ 1/13/2011 5:23:59 PM ~ Berger:  Was there an incident ..?

1:46:27 ~ 1/13/2011 5:24:14 PM ~ Sherard:  What we were seeing at the time was physicians leaving the community or the position ..leaving the position with no director.  Rationale is to improve physician oversight and patient care on ambulance rides...well trained, properly licensed.. has been very helpful.

1:47:27 ~ 1/13/2011 5:25:14 PM ~ Peck:  Page 35  New worksight wellness..09/10 biennium request was approved..when standard budget was approved for 11/12 the amount did not include the second year

1:48:16 ~ 1/13/2011 5:26:03 PM ~ Sherard:  Basically this is one of our wellness initiatives..outside contractors meet with businesses interested in establishing a work site wellness site.  One of our strategies to get people healthier is to make people healthier.  For every dollar put into prevention, get 3 dollars back.

1:49:24 ~ 1/13/2011 5:27:10 PM ~ Meier:  Settlement funds..downward glide path...are we at risk of overspending that fund

1:49:48 ~ 1/13/2011 5:27:35 PM ~ PeckL  Tobacco settlement funds..payment a little over 1v million less than the previous year...permanent fund has increased which has offset a little bit of that... The settlement agreement entered into 1999.  Manufacturers who agreed to be part of that settlement pay into fund...were given process to protest the payment.  Last year, protested a larger portion of the not know what we will get in our next payment...estimate about 40 million dollars of tobacco money settlement..projecting 48 or 50 million .  Not all the monies are spent ...Probation services for the DFS are paid from that fund..a portion of funds from vacancies can revert and so cover us...I think the fund can handle the $200,000.  I plan on giving you an acct of the settlement funds and my best projections

1:52:57 ~ 1/13/2011 5:30:43 PM ~ Meier:  100 series they revert to the General Fund?  Statue:  reverts to the permanent fund...began with 40 million is now over 60 million

1:53:38 ~ 1/13/2011 5:31:25 PM ~ Nicholas: question?

1:53:47 ~ 1/13/2011 5:31:34 PM ~ Peck:  If approved and included standard budget would be increased...

1:54:08 ~ 1/13/2011 5:31:55 PM ~ Nicholas:  ONe time put in 903 one time and 901 is standard.

1:54:23 ~ 1/13/2011 5:32:09 PM ~ Peck:  Gov approved this request pg 40:  First request is to make a correction in the fund account.  When approved, LSO sent the wrong fund identifier, this request changes the fund additional expense pg 41:  bring this request every session related to the child care ...count every year and calculate the adjustment to the appropriation. count would result in 8743 for each child..  I can reduce this request..we received a correction so head count was 3902 children so request can be reduced... Gov approved request.

1:56:57 ~ 1/13/2011 5:34:43 PM ~ Nicholas:  Back to the eligibility for these services, dramatic number increases, describe the eligibility and the volumes go up

1:57:32 ~ 1/13/2011 5:35:18 PM ~ Newman:  The preschool program has an extensive child find requirement,..actively assessing and getting kids in services quickly to get kids upt to age appropriate...reduced due to accounting error.,,,level off in upcoming years.  ..identify delays in speech..etc. that addressed early on

1:59:09 ~ 1/13/2011 5:36:56 PM ~ Nicholas:  If the legislature wants to make it more restrictive, can we do that?

1:59:30 ~ 1/13/2011 5:37:16 PM ~ Newman:  There is some flexability in the birth to 3.  IN the 3 to 18 or 21 which is special ed for schools, it is more limited

2:00:01 ~ 1/13/2011 5:37:48 PM ~ Nicholas:  would like to see the data..Does our statute specify we will give the full range of services?

2:00:26 ~ 1/13/2011 5:38:13 PM ~ Newman:  In Wyoming, once assessed, individualized, child is to get service recommended...not a specific array for each child..individualized

2:01:04 ~ 1/13/2011 5:38:50 PM ~ Nicholas:  Opted in, have authority to limit services , have not

2:01:18 ~ 1/13/2011 5:39:05 PM ~ Newman:  would not say that..would prefer to bring the information back to you

2:01:33 ~ 1/13/2011 5:39:20 PM ~ Nicholas:  scope of services provided by we know how we got here

2:01:52 ~ 1/13/2011 5:39:38 PM ~ Meier:  right numbers:

2:02:05 ~ 1/13/2011 5:39:51 PM ~ Peck:  Adjusted number

2:02:17 ~ 1/13/2011 5:40:03 PM ~ Meier:  pg 43?  I have different number

2:02:47 ~ 1/13/2011 5:40:33 PM ~ Berger:  It is a correction so will make amendment

2:02:56 ~ 1/13/2011 5:40:42 PM ~ Peck:  Pg 44:  another fund change..changin from permanent   fund..funding put in wrong permanent fund account  Pg 49: Last request, VA Home,  VA center will have to provide primary care to their veterans going forward..according to the feds we should always have been providing this care.  Feds will increase the monthly per diem.  ..provided care in VA at Sheridan...shoudl be able to provide for $90000.  Veterans home is funded in budget 1005 general fund ..we collect up to 75% of the cost from the VA or the only 25% of actual cost..We collect the funds and put back into the General Funds.  We will collect the 90000 from the VA and will put it back into the General Fund

2:05:46 ~ 1/13/2011 5:43:32 PM ~ Nicholas:  6.8 in form of reversions or factored into the goldenrod before?

2:06:05 ~ 1/13/2011 5:43:51 PM ~ Peck:  The 6.8, I am not sure where that shows up on the Goldenrod

2:06:23 ~ 1/13/2011 5:44:09 PM ~ Bill Mai:  sorry...

2:06:40 ~ 1/13/2011 5:44:27 PM ~ Berger: pg 52 Nicholas:  show up actually or reversions

2:06:55 ~ 1/13/2011 5:44:41 PM ~ Mai:  It gets reimbursed into the General Fund

2:07:09 ~ 1/13/2011 5:44:55 PM ~ Nicholas: so it gets factored into the Golden rod

2:07:23 ~ 1/13/2011 5:45:09 PM ~ Berger:  Any other questions

2:07:33 ~ 1/13/2011 5:45:20 PM ~ Hastert:  Can the dept of health pick up the pieces I missed..very interested in the drug prevention program...what would we do to enhance the program

2:08:15 ~ 1/13/2011 5:46:02 PM ~ Sherard:  Roxanne will address Roxanne Homar..amazing program

2:08:37 ~ 1/13/2011 5:46:23 PM ~ Homar:  Medication donation program - exciting and positive program..updated programs..1378 pounds of medications donated..most come from institutions..bubble packed...once donated in 2008, filled 2110 prescriptions for clients without insurance or underinsured. Value 258, 000        In 2010, almost 500 lbs, 8439 prescriptions, retail value it was 790000 dollars.  so a good return on investment for that program.

2:10:34 ~ 1/13/2011 5:48:21 PM ~ Berger:  Who are you reaching with that program?

2:10:43 ~ 1/13/2011 5:48:30 PM ~ Homar:  Most of that is being provided in Laramie County..Hospital provided free space...funding and grants.  We provided the staff.  In the last year, the community partners came back and say they could fund the pharmacist position.  We need to serve the entire state. space, county funding.. Our staff is acting as the warehousere..moving into their space at the end of this month.  Focus of our pharmacist and tech will be focus to get more donations out across the free clinics

2:12:31 ~ 1/13/2011 5:50:17 PM ~ Hastert:  Thank you.  Are we spending like 177,000?  What would it take to add an additional site?

2:12:59 ~ 1/13/2011 5:50:46 PM ~ Homar:  It would probably come down to which community would be ready.  177000 cost per year for salary, benefits, IT and rent, mostly staff costs.  Most places will tell you the difficulty is to hire a pharmacist.

2:14:08 ~ 1/13/2011 5:51:54 PM ~ Meier:  Any laws prohibit a private pharmacist from accepting drugs and redispensing them?

2:14:28 ~ 1/13/2011 5:52:14 PM ~ Homar:  No laws, space issue.  Hard time to put them in adequate space.  Most pharmacies do not have excess and must keep inventory seperate.

2:15:03 ~ 1/13/2011 5:52:49 PM ~ Berger:  Can you give us a hnadout on that?

2:15:14 ~ 1/13/2011 5:53:01 PM ~ Homar: absolutely

2:15:21 ~ 1/13/2011 5:53:08 PM ~ Hastert:  Can you give us some rough numbers if some communities are ready and some cost comparisions if you have some hard facts on what it will save the state...keep people away from ER..

2:16:03 ~ 1/13/2011 5:53:49 PM ~ Sherard:  Savings to the state are difficult to quantify.

2:16:18 ~ 1/13/2011 5:54:04 PM ~ Berger:  Thank you .  Committee back tomorrow morning at 8 oclock.