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"Draft Only – Approval Pending"
Long Term Care Subcommittee
of the
Joint Labor, Health and
October 4 and 5, 2001
Room 302
Capitol Building
Cheyenne, Wyoming
PRESENT: Senator Tex Boggs, Chairman;
Senator Mike Massie;
Representatives Larry Meuli (Friday only) and Ann Robinson.
Legislative Service Office: John H. Rivera, Senior Staff Attorney.
ABSENT: Representative Jerry Iekel and Larry Meuli (Thursday only).
OTHERS: See Appendix A.
AGENDA: See Appendix B.
* * * * * * * * * *
Thursday
The meeting was called to order at 10:05 a.m. on Thursday, October 4, 2001, by Chairman Boggs.
1. Department of Health
Mr. Jerry Bronnenberg advised the subcommittee that presentations would be made by Mr. Bob Clabby on medication aides at the Wyoming State Training School and on a Department of Health nurse education program. Mr. Dan Stackis would be presenting on reimbursement for extraordinary nursing home care.
a. Medication Aides at the Wyoming State Training School.
Mr. Clabby, Administrator of the Developmental Disabilities Division, distributed Appendices C, D and E.
Mr. Clabby explained that Appendix C contained a new proposed statutory provision which would authorize medication aides at the Wyoming State Training School to administer medications in basic resident care situations. He explained that last year such authority for medication aides at the training school had been provided under a budget footnote, but the statutory authorization for medication aides would be a more permanent solution to the problem. In response to a question from Senator Massie, Mr. Clabby explained that the term "basic residential care situations" does have a specific meaning and provides a limitation on when medication aides could and would be used and when licensed nurses would be required to administer medications.
b. State Health Professional Training Enhancement Program
Mr. Clabby explained the second proposal, contained in Appendix D, would appropriate $416,000.00 to the Department of Health to implement the state health professional training enhancement program created by W.S. 35‑23‑107. The proposal would also authorize 13 full-time positions to allow the department to hire staff to fill in, on a half-time basis, for people who are engaged in the training enhancement program. The people engaged in the training would also receive up to one-half salary while participating in the program.
Mr. Clabby explained that Appendix E contains the language of W.S. 35‑23‑107, the state health professional training enhancement program. For that program to work, the proposal for funding and positions contained in Appendix D is necessary. The experience of the program is that it builds a nursing cadre not only for state government, but also for the state. Many of the individuals who utilize the program move to the private sector but stay within the state since their roots are within Wyoming.
Senator Massie asked the department to provide the statistics to support that assertion. Senator Massie asked why the department is requesting full-time equivalent positions if the funds are to fund half-time staff. Mr. Clabby explained the department would be using a full-time equivalent substitute part-time/half-time salary for the person in the training program. He advised that he would get a better answer for the subcommittee after he researches the question.
c. Reimbursement for extraordinary nursing home care.
Mr. Dan Stackis, Administrator of the Division on Aging, distributed Appendix F. He explained the Department of Health rules and regulations that address ventilator assistance. State Medicaid rules define extraordinary care as ventilator care that is necessary for Medicaid recipients. He explained the process and reimbursement rates provided under a single contract provide extraordinary care for ventilator services. Since 1992 there have been 9 cases of extraordinary care recipients with reimbursement rates that ranged from $175.00 to $400.00 per day. The division has been looking at other conditions that may require extraordinary care and appropriate reimbursement by Medicaid. The division wants to look at legitimate and valid needs before requesting funding for additional extraordinary care services.
Mr. Dan Lex, Quality Health Care Foundation, expressed his support for the approach proposed by Mr. Stackis. He asked that the process for determining reimbursement rates for extraordinary care should be kept simple. Mr. Tom Jones, Wyoming Health Care Association, stated that he agreed with Mr. Lex.
Mr. Stackis advised that the department would have to change the state Medicaid plan and its rules and regulations to accommodate changes if the Legislature provides the necessary funding for additional extraordinary care services. He would like the Legislature to give directions in terms of what conditions should be added to those extraordinary care services.
Mr. Bronnenberg introduced Ms. Iris Oleske, Office of Medicaid. Ms. Oleske distributed Appendix G containing her research on speech assistive devices. In order for speech assistive devices to be covered under Medicaid, it would have to serve a medical purpose and be medically necessary. She has researched other states to find out how those states provide speech assistive devices. It appears those speech assistive devices are provided only under a waiver to the state's Medicaid plan.
Senator Massie stated that many of these speech assistive devices are covered under Medicare which raises the issue of states providing the same service under Medicaid. It is a worthwhile service but for a limited number of cases. He suggested the department engage the public in dialogue to determine if those services are needed under a Medicaid waiver.
Chairman Boggs asked if this could be considered an extraordinary care issue. Ms. Oleske replied that in some cases it might be. She explained a problem exists because the assistive device needs to be personalized for the individual so the item would not become a hand-me-down to other persons requiring a similar device.
Dr. Garry McKee, Director, Department of Health, provided the subcommittee an update on the bioterrorism subcommittee the governor had appointed recently. The governor appointed 3 members to the committee including Director McKee from the Department of Health, a representative from the Adjutant General and from the Department of Transportation. This subcommittee will be working with the Wyoming Emergency Management Agency and the Federal Bureau of Investigation. He explained over $700,000.00 per year had been provided over the years to develop the necessary infrastructure to deal with bioterrorism. The subcommittee on bioterrorism is on a computer system that issues an alert when the Centers for Disease Control (CDC) believes a bioterrorism threat exists. He explained the governor will be asking for state funding to expand efforts to deal with the threat of bioterrorism. He believes surveillance is the best weapon and a rapid response capability is the next most important.
In response to a question from Representative Robinson, Director McKee explained the state would be establishing a toll free hotline for reporting any perceived threats.
Mr. Stackis provided an update on rebasing. He discussed the various options for the year to use as the new base for determining Medicaid reimbursement rates. He reminded the subcommittee that Medicaid does not allow a greater reimbursement rate for a facility than the private pay rate for that facility. But there are options to eliminate the artificial barrier. Director McKee added that using the most current year's data is the preferred year to use as the base rate year.
In response to a question from Senator Massie, Mr. Stackis advised that "pass through" is a more effective way to increase nursing staff salaries than rebasing would be because rebasing has an inherent time lag between the time the facility gets a new reimbursement rate and the time that the staff of the facility would actually see the benefits of that increased reimbursement rate. Director McKee suggested that the Joint Labor, Health and Social Services Interim Committee propose any wage pass through provisions rather than add those provisions to the Department of Health's budget requests which are already quite large.
Senator Massie requested the department to provide complete information to the full Joint Labor, Health and Social Services Interim Committee's next meeting on the need for salary increases in nursing homes.
Mr. Lex advised that 68% of costs in a nursing care facility are labor related.
2. Senior Project
Mr. Bill Michie, Carbon County Senior Center, distributed a hard copy of his power point presentation (Appendix H). He also distributed Appendix I, a pamphlet describing a proposed Wyoming Older Americans' Trust Fund. The trust fund, he explained, would be used to provide additional funding to senior centers around the state.
Mr. Stackis advised that senior centers are now providing services they did not provide a decade ago. Although senior centers are being more cost effective in providing these additional services, they are dealing with significant funding restraints. The federal Older Americans Act provides funding which is not keeping pace with costs and with added services that are being provided. He expressed his support for Mr. Michie's efforts to establish a Wyoming Older Americans' Trust Fund. Mr. Stackis is aware that there are some senior centers in the state that are marginally funded. In the last year the division had to provide help for 4 centers that were on the verge of closing their doors.
Ms. Hazel Chapin, Wheatland, explained that Platte County has recently created a senior citizen special district. Both Niobrara County and Big Horn County also have senior citizen special districts to provide funding for the senior centers in those counties. She expressed concern because funding from the special districts may not be sufficient and it is unknown whether the voters in the counties will reapprove the special districts as required every 2 years. The maximum mill levy allowable by statute for these special districts is 2 mills.
Mr. Michie explained that the trust fund would provide supplemental funds to the special district funding, but not all of the details of the proposed trust fund have been worked out.
3. American Association of Retired Persons (AARP)
Ms. Bess Arnold distributed Appendix J, containing her testimony before the subcommittee. She advised that AARP has been working with the Department of Health and representatives from the University of Wyoming to develop a single point of entry system in Wyoming and to provide a centralized state information and assistance program. She explained how the web site would work to allow senior citizens to receive information about services available in the state. She explained that continuing efforts will be reported to the Joint Labor, Health and Social Services Interim Committee.
4. Criminal Background Check Report
Representative Robinson explained that she had met the previous week with the Division of Criminal Investigation and Board of Nursing staff to attempt to work out proposed draft legislation. She learned that federal law was enacted in 1998 to allow full criminal history record background reports on employees in nursing care facilities and home health care agencies. She believes it best to include both types of facilities to protect vulnerable adults in the proposed legislation. When she discussed the proposal with the Department of Health, Director McKee agreed with Representative Robinson that the Department of Health would be the best conduit for processing the criminal history record background reports. She decided to leave it open to the particular facility to decide the mechanism for payment of the fees for the criminal history record background check. To attract employees, the facility may be willing to pay that fee on behalf of the employee. The proposed legislation would only state that the facility submit the fee with the request for the background check. She explained that she did ask Ms. Cheryl Koski, Board of Nursing, to provide information with respect to the number of hits conducted under the background checks conducted by the board. Representative Robinson is concerned that, currently, a check by the board is done only once. If the proposed requirement for an employment check is enacted, a check could be done each time a person applies for work at a nursing care facility or home health care agency.
Ms. Koski advised the subcommittee that the person on staff who could generate the report requested by Representative Robinson had major surgery so she was not available to determine the number of checks that came back indicating a criminal history record existed. She also doesn't know the number of employees with criminal histories because the time to do the research didn't allow for a compilation of the results.
Director McKee added that it is necessary to define what is meant by "direct care givers" to know what actual costs will be.
Mr. Lex explained most nursing care facilities are already required to conduct background checks. He is concerned that for some persons, such as physicians who are still willing to accept new patients in nursing care facilities, a background check requirement may be the last straw and those physicians may refuse to become providers at nursing care facilities.
Ms. Koski advised that to get the legislative authority to conduct criminal history record background checks, the board had to promise not to hold up the licensure process. Therefore, the board does issue temporary certificates for licenses before the actual results from the background check are received. The results can take anywhere from 6 weeks to 6 months before they are received by the Board of Nursing.
Ms. Pat Fritz, Board of Nursing and Department of Health Institutional Manager, stated she is required to conduct background checks on employees. She advised the Division of Criminal Investigation is slower to respond than the FBI. The FBI is actually pretty good in providing reports. The average response from DCI is 2 months. She also stated that indirect care givers are even greater risks for mischief with residents of nursing care facilities.
Mr. Jim Wilson, DCI, explained there are 2 federal laws that address criminal history record background checks. Public Law 105-277 authorizes such checks for employees of nursing care facilities and home health care agencies. Public Law 92-544 authorizes criminal history record background checks for employees of governmental entities. He explained that state legislation to broaden the authority given by the federal law would not guarantee participation of the FBI. The broader state authority, if enacted into law, could result in additional reports being provided by the state Division of Criminal Investigation.
5. Public Testimony
Ms. Nancy Bigley, Heart to Heart Day Care Center, distributed Appendix K containing the cost and revenues in Wyoming nursing care facilities. Ms. Bigley also discussed problems with facilities operated by Encor.
Ms. Bigley asked the legislature to consider strengthening the long term care ombudsman program. She proposed several approaches to strengthen the program. First, the program could be placed within the Department of Family Services to keep it independent. Second, the program could work with AARP to both provide training and do public relations. Third, she suggested the ombudsman program should be empowered to pull funding from nursing care facilities for infractions substantiated. After explaining the third recommendation, Ms. Bigley indicated she did not mean to suggest that such drastic authority should be implemented.
Senator Massie suggested Ms. Bigley provide more concrete proposals for strengthening the ombudsman program because she stated on the one hand that the ombudsman had no power to act, yet families fear retribution if the ombudsman gets involved in problems at a facility.
Mr. Stackis advised that the Division on Aging can provide any info on the ombudsman program that the subcommittee may want.
Mr. Tom Jones expressed his hope that the subcommittee will follow up on the extraordinary care issue under Medicaid. He also hopes that the industry may participate in the process when the department considers rebasing. He stated that the department's proposal with respect to medication aides at the training school should apply equally to nursing homes and he hopes the bill won't be limited to medication aides at the state training school.
Director McKee stated that he would be happy to facilitate a meeting involving the Department of Health, its accountant, Meyers and Stauffer, and industry representatives to develop a concrete rebasing proposal.
Chairman Boggs advised that the proposed draft legislation had been distributed to subcommittee members for their review in the evening, and copies of the proposed draft legislation is available for the public also. With no further business before it on the first day of the meeting, Chairman Boggs adjourned the meeting at 3:45 p.m., Thursday, October 4, 2001.
* * * * *
Friday
October 5, 2001
Chairman Boggs called the meeting to order on the second day of the meeting at 8:05 a.m. The following is a summary of the proceedings of the day:
6. Quality Health Care Foundation
Mr. Lex explained that 1999 Senate File 44 was a result of a pending crisis for long term care in the state. He expressed his appreciation of the efforts of the Joint Labor, Health and Social Services Interim Committee and the Department of Health.
He reiterated his testimony of the previous day that Medicare reimbursement rates have to be rebased because 56.7% of the nursing care facilities in the state do not receive the calculated rate. The average loss for nursing care facilities is $3.97 per day per patient. Rebasing would update recognized costs for nursing care facilities.
With respect to the case-mix concept, Mr. Lex indicated he had spoken with Mr. Stackis and Mr. Jones and they found the concept to be very complicated. Only 5 to 6% of patients in nursing care facilities would be affected. He doesn't believe that the entire system has to be restructured to meet the needs of those few patients. It may be better to address extraordinary care cost as proposed by Mr. Stackis.
Mr. Lex advised he would provide LSO with the summary of the staffing need survey. He stated the average facility bed size is 77 beds and the average facility shortage includes 4.3 full-time equivalent certified nursing assistants, 1.8 full-time equivalent licensed practical nurses and 1.6 full-time equivalent registered nurses. During the previous 3 months the survey reports 53 cases of denied admissions to facilities due to insufficient staffing even with beds available. This total could be extrapolated to 68 cases for all nursing care facilities in the state for the quarter, including those that did not respond to the survey. Projecting this quarterly sample out to one year would reflect approximately 274 citizens in the state would be unable to use an empty nursing home bed because of staffing shortages. Mr. Lex suggested that there is a need to evaluate a wage pass through on a biennial basis until the nursing shortage issues have been addressed.
Mr. Stackis added that if wage pass throughs are considered again, the legislature should specify the relationship of the pass through as it affects direct wages and related benefits.
Mr. Lex stated that wage pass throughs for direct care givers ignores other staff who have to wait for adjusted Medicaid reimbursement rates in order to receive salary increases.
Chairman Boggs asked what percentage of staff in a nursing care facility are considered direct care givers. Mr. Greg Neilson, Director of Western Manor in Newcastle, stated that in his facility approximately 48 of 62 employees are considered direct care givers. Mr. Rick Spilovoy of the Morning Star Adult Day Care Center on the Wind River Reservation stated his facility, unlike Western Manor, is a free standing facility not affiliated with a hospital. Nevertheless, approximately 70 to 75% of his staff are direct care givers.
7. Public Testimony on Nursing Shortage
Chairman Boggs explained that the subcommittee would be receiving public testimony on nursing shortage and requested that the public testimony not address the proposed bills which will be considered later.
Mr. Spilovoy explained the different culture he has to deal with in administering the Morning Star Day Care Center for the Eastern Shoshoni Nation. He explained some of the problems involve staff not working during pow wows and other Native American events which contributes to staffing shortages he deals with constantly. He stated the annual survey is also demoralizing, referring to the licensing surveys. He believes the regulatory environment is too burdensome for nursing care facilities. He has problems with staffing shortages even though the pay rate in his facility is among the highest in the state.
Mr. Neilson agreed with many of the comments made by Mr. Spilovoy. He stated the problem is multifaceted and needs a multi-prong approach involving state and federal policy makers, the Department of Health, educators and others. He expressed his appreciation that the legislature is attempting to address the issues affecting nursing care facilities and long term care in the state.
Mr. Bronnenberg provided some general information with respect to staff turnovers in nursing care facilities. He wanted to clarify that the regulatory surveys Mr. Spilovoy complained about were the federal surveys. He explained that federal surveys are generally conducted after a state survey has found few deficiencies in a facility. Generally the federal survey will find significantly more deficiencies than the state survey found. He explained that a similar process occurs throughout the Rocky Mountain Region where the federal survey finds more deficiencies than state surveys, indicating it is not a weakness of the Wyoming survey team that is the problem.
In response to a question from Representative Meuli, Mr. Bronnenberg stated that the surveys are generally still outcome-based but the federal surveys do have some criteria that are not outcome-based. The state survey is conducted under contract with the federal government, in accordance with federal criteria. The problems with the surveys have to be addressed on a federal level since federal criteria are used.
Mr. Bronnenberg said of the 39 nursing care facilities in the state, 19 had a turnover of both the administrator and the director of nursing during the 2 year period studied. The average length of stay at a facility was 3.98 months. This average includes temporary administrators who fill in when a permanent administrator leaves a facility. He added that 11 facilities in the state had retained both administrator and director of nursing for that 2 year period. Most facilities with high turnover rates for administrators also have a high turnover rate for certified nursing assistants and registered nurses. The survey indicated that where there is high turnover there is also a substandard quality of care for patients. Of the 11 facilities where neither the administrator nor the director of nursing left the facility, no substandard quality of care was found.
Ms. Lorreta Wolf, Wyoming Nursing Association, expressed her support for the direction the subcommittee was going on issues it was considering. She suggested the state should look at best practices in nursing facilities to see if those best practices can be replicated in other facilities. To address the nursing shortage it is imperative that the working environment be studied.
8. Consideration of Proposed Draft Legislation
a. 02LSO-0162.W3, Office of technical assistance.
Mr. Bronnenberg explained that this bill was developed as a way to address the problem with the federal survey process, based on recommendations made at the June meeting of the subcommittee. The bill is also intended to improve quality of care.
Mr. Jones advised that the bill had been patterned after OSHA which has 2 units, the public survey unit and the confidential training technical assistance unit. As a result of OSHA efforts in both regards, worker's safety and worker's compensation rates in the state have improved. He suggested that the bill could contain a 4 year sunset in case the office of technical assistance does not work out as expected. This bill is a step toward developing a process that results in good facilities being surveyed less and bad facilities being surveyed more.
Mr. Lex expressed a concern that the process proposed by this bill may create just another survey. He questioned whether the money for the office of technical assistance couldn't just be used for wage pass throughs. If the subcommittee goes forward with the bill, Mr. Lex suggested that they start simple, using only one or two people to gather data to trend problems and propose solutions with an advisory group to provide input.
Senator Massie stated he found no provision in the bill that would require a survey. Mr. Bronnenberg added that there is no survey requirement in the bill. Consultants would only go to facilities and discuss problems and potential solutions upon the request of the facility, using survey data already compiled. Other states are already using this process. He stated that the states of Washington and Oregon have had good results with an office of technical assistance.
Mr. Spilovoy stated that Mr. Lex accurately represented the position of the Quality Health Care Foundation. He stated his is the only facility in the state to be a member of both the Quality Health Care Foundation and the Wyoming Health Care Association, so he acknowledged the two organizations have different positions on the bill. He expressed his concern with new medical privacy laws that may prevent the sharing of information.
Mr. Neilson stated that, as a provider, he wants to be able to ask the department what procedures to follow when there is an incident at his facility. For example, if abuse occurs in his facility he would like to know to whom he should report the abuse because he is not familiar with the requirements of the law in that regard. The proposed office of technical assistance could fulfill that role.
Ms. Arnold, AARP, stated that quality of care is the bottom line issue with this bill. She would support any efforts of the state to provide technical assistance to facilities. She suggested that maybe the technical assistance could be provided through a strengthened ombudsman program using trained volunteers and eliminating the 24 hour notice requirements.
Senator Massie moved for the subcommittee to consider 02LSO-0162.W3 for submission to the Joint Labor, Health and Social Services Interim Committee.
Senator Massie moved to change the title from "office of technical assistance" to "program of technical assistance". After discussion the motion failed on a voice vote.
Senator Massie moved to delete on page 4, lines 13 through 17 and renumber as necessary. The motion carried unanimously on a voice vote.
Senator Massie moved to amend page 5 by deleting lines 9 through 14. The motion carried unanimously on a voice vote.
Senator Massie moved to delete lines 5 through 7 on page 5. The motion failed for lack of a second.
Representative Meuli moved to amend page 5 line 5 before "have" by inserting "to the extent allowed by state or federal law,". The motion carried unanimously on a voice vote.
Representative Robinson moved to amend page 5 line 6 after "information" by inserting "when the facility believes the access is necessary". The motion died for lack of a second.
Representative Robinson moved to amend page 6 line 2, by deleting "which are". The motion carried unanimously.
Senator Massie moved to insert a 4 year sunset for the program so that it would sunset June 30, 2006. The motion carried unanimously.
Senator Massie moved to insert a new subsection on page 6 after line 16 to read "beginning October 1, 2003, the department shall report annually to the joint labor, health and social services interim committee the outcomes and results of the office of technical assistance." The motion carried unanimously on a voice vote.
Chairman Boggs recommended that the department of health provide the fiscal note with respect to the appropriation and the full-time employee equivalent employees that would be needed in section 2 of the bill.
Returning to Senator Massie's motion to work the bill for introduction for submission to the Joint Labor, Health and Social Services Interim Committee, the motion to submit the bill as amended carried on a roll call vote 3 ayes, 1 no, 1 excused with Senators Boggs and Massie and Representative Robinson voting aye and Representative Meuli voting no, with Representative Iekel excused.
b. 02LSO-0171.W1, Limits on construction nursing care beds.
Senator Massie moved, seconded by Representative Meuli to consider the bill for submission to the Joint Labor, Health and Social Services Interim Committee.
Representative Robinson moved to amend page 2 line 2 by reinserting the stricken "facility". The motion carried unanimously on a voice vote.
Ms. Loretta Wolf stated she believes the changes proposed in this bill would increase competition and make for new opportunities for nurses.
Returning to the motion by Representative Meuli to submit the full bill as amended to the Joint Labor, Health and Social Services Interim Committee, the motion carried unanimously with Senators Boggs and Massie and Representative Meuli and Robinson voting aye, Representative Iekel was excused.
c. 02LSO-0129.W1, Criminal background checks-nursing facilities.
Representative Robinson moved, seconded by Senator Massie to consider the bill for submission to the Joint Labor, Health and Social Services Interim Committee.
Representative Robinson moved to delete the introductory paragraph in subsection (a) and to insert "Any applicant for employment who is offered employment in a nursing care facility or home health care agency who may be involved in direct patient care, including employees who may provide direct care for a resident or patient without the presence or supervision of another staff member shall provide:". After discussion the motion died for lack of a second.
Senator Massie asked if the language on page 2 lines 17 and 18 could include providing DNA samples. Representative Robinson stated that the practice is not excluded, but it is not part of the current practice when identifying information is obtained for criminal history record information checks.
Representative Robinson moved to amend page 2 lines 1 through 3 by deleting the introductory paragraph and inserting "No person shall accept employment at a nursing care facility or a home health care agency where that employment may involve direct patient care, unless the person provides the facility or agency:". The motion carried on a voice vote.
Mr. Jim Wilson, Division of Criminal Investigation, stated the criminal history record information check can take from 2 weeks to 30 days depending on the time of year but on the average it takes 3 to 4 weeks for results to be returned. Approximately 2% of the checks can take longer.
Mr. Lex stated that certified nursing assistants, licensed practical nurses and registered nurses all provide direct patient care, but there are other people in nursing care facilities who do have direct patient contact. He stated that if a potential employee has to wait the variable period of 3 to 6 weeks, the employee will not be available for employment when the results of the criminal history record information check are completed and received.
Mr. Jones suggested imposing a penalty for false statement on the application when a person states that they have no felony conviction when in fact they do have one. He also questioned whether adult day care facilities would be included in the bill. Representative Robinson stated she prefers not to include them in the bill at this time because the federal legislation only allows checks for employees of nursing care facilities and home health agencies.
Representative Robinson moved to amend the bill on page 5 line 2 by deleting "his" inserting "the person's"; on page 2 line 7 by deleting "him" and inserting "the person"; and on page 2 line 12 by deleting "such" and inserting "the". The motion carried unanimously on a voice vote.
Senator Massie moved to amend the bill on page 2 line 17 by deleting "identifying". The motion carried unanimously.
Representative Robinson asked that Mr. Wilson get any information he can with respect to federal intent for the term "direct patient care".
Returning to the motion by Representative Robinson to submit 02LSO-0192.W1 as amended to the Joint Labor, Health and Social Services Interim Committee, the motion carried on a vote of 3 ayes, 1 no, 1 excused. Senator Boggs and Representatives Meuli and Robinson voted aye, Senator Massie voted no. Representative Iekel was excused.
d. 02LSO-0183.W1, Wyoming investment in nursing program.
Senator Massie moved, seconded by Representative Meuli to consider the bill for submission to the Joint Labor, Health and Social Services Interim Committee.
Mr. Rick Miller, University of Wyoming, suggested amending the bill on page 2 lines 12 and 13 by deleting "approved by the Wyoming higher education assistance authority" and inserting "at a Wyoming community college, the University of Wyoming, or in the case of a doctoral degree, a WICHE approved university". Representative Meuli moved to amend the bill as suggested by Mr. Miller. The motion carried unanimously on a voice vote.
Senator Massie moved to amend page 2 lines 11 and 12 by deleting "training or education program for nursing staff" and inserting "nurse aide training or nurse education program"; and page 2 line 17 by deleting "a nursing education program" and inserting "an approved nurse aide training or nurse education program". The motion carried unanimously on a voice vote.
Representative Robinson moved to amend W.S. 9‑2‑123(d) by deleting, where it appears, the term "in good standing with the board" and inserting "who holds an unencumbered certification or an unencumbered license as appropriate"; page 3 line 17 after "nurse" inserting "or registered nursing education"; page 4 lines 2 and 3 deleting "an associates degree in nursing" and inserting "a registered nursing degree"; page 4 line 18 before "degree" inserting "or masters"; page 5 line 5 before "degree" inserting "or PhD". The motion carried unanimously.
Senator Massie moved to amend page 3 line 16 after "Wyoming" by inserting "immediately before". After discussion the motion was withdrawn.
Senator Massie moved to eliminate the prior work requirement before being eligible to apply for a loan at the next level if the person has not previously received a grant or loan under the WYIN program. The motion carried on a voice vote.
Representative Meuli moved to amend page 4 line 9 by deleting "or" and lines 10 and 11 deleting through "Wyoming". The motion carried unanimously on a voice vote.
Mr. Miller discussed problems he had with page 4 lines 13 through 21 and advised the subcommittee he is willing to help develop proposed language for a 4 year student who does not have an associates degree as a registered nurse. Chairman Boggs, with the concurrence of the subcommittee, requested Mr. Miller work with Chairman Boggs and Mr. Rivera to develop the proposed language.
Senator Massie moved to amend page 5 line 4 by deleting the first "a" and inserting "the university of". The motion carried unanimously on a voice vote.
Mr. Miller advised on page 5 line 14 after "program" inserting "a WICHE participating university". Senator Massie moved the recommendation made by Mr. Miller. The motion carried unanimously on a voice vote.
Senator Massie moved to amend page 5 line 23 after "a" by inserting "Wyoming". The motion carried unanimously on a voice vote.
Senator Massie moved to amend page 6 line 15 by deleting "six (6)" and inserting "eight (8)". The motion carried unanimously.
Representative Meuli moved to amend page 6 line 13 by deleting "graduate" insert "doctoral". The motion carried unanimously on a voice vote.
Mr. Miller questioned on page 7 lines 11 through 13 if the repayment schedule specified also included the interest rates that would be charged, if proration would be allowed for work experience and other administrative functions that possibly should be addressed. He also recommended the language on page 9 line 15 with respect to "mitigating circumstances" may need more specific criteria. He proposed providing the subcommittee with language to address those issues. Chairman Boggs, with the concurrence of the subcommittee, requested Mr. Miller work with Chairman Boggs and Mr. Rivera to develop the proposed language.
Returning to the motion by Senator Massie to submit 02LSO-0183.W1 as amended to the Joint Labor, Health and Social Services Interim Committee, the motion carried unanimously with Senators Boggs and Massie and Representatives Meuli and Robinson voting aye with Representative Iekel excused.
e. 02LSO-0185.W1, Nursing education programs.
Senator Massie moved, seconded by Representative Robinson to consider 02LSO-0185.W1 for submission to the Joint Labor, Health and Social Services Interim Committee.
Representative Robinson moved to amend the bill on page 2 line 9 after "students" by inserting "." and deleting the balance of the line; page 2 line 10 deleting "that" and page 2 line 22 deleting "such". The motion carried unanimously on a voice vote.
Senator Massie moved to have LSO draft a new section 3 providing an appropriation to the University of Wyoming with conditions as provided in W.S. 21‑18‑202(c) and (d)(ii) of the proposed bill and to amend page 2 lines 5 through 10 accordingly. The motion carried unanimously on a voice vote.
Representative Robinson moved to amend page 3 line 12 by striking "education"; page 3 line 13 striking "such" inserting "the"; page 3 line 21 deleting "such" inserting "the"; and page 3 line 24 striking "any such" inserting "the". The motion carried unanimously.
Senator Massie moved to amend page 2 line 7 after "teaching" by inserting "faculty". The motion carried unanimously on a voice vote.
Returning to the motion by Senator Massie to submit 02LSO-0185.W1 as amended to the Joint Labor, Health and Social Services Interim Committee, the motion carried unanimously with Senators Boggs and Massie and Representatives Meuli and Robinson voting aye with Representative Iekel excused.
f. 02LSO-0186.W1, Mobile licensed practical nurse education program.
Senator Massie moved, seconded by Representative Robinson to consider 02LSO-0186.W1 for submission to the Joint Labor, Health and Social Services Interim Committee.
Chairman Boggs advised that the bill will require an appropriation and 2 full-time equivalent positions to implement, which staff was directed to incorporate into the bill.
The motion by Senator Massie to submit 02LSO-0186.W1 as amended to the Joint Labor, Health and Social Services Interim Committee carried on a vote of 3 ayes, 1 no with Senators Boggs and Massie and Representative Robinson voting aye. Representative Meuli voted no. Representative Iekel was excused.
g. Other proposed legislation.
Mr. Clabby advised the subcommittee that he had made changes in the proposed legislation he had provided on the previous day to the subcommittee with respect to medication aides and the state health professional training enhancement program (see Appendix L). Mr. Clabby explained the changes had been made after consultation with Ms. Koski.
After discussion of the proposal with respect to medication aides at the state training school, Senator Massie moved, seconded by Representative Robinson to direct staff to draft a bill consistent with the proposal from Mr. Clabby to authorize the use of medication aides at the Wyoming State Training School. The proposed draft legislation will be submitted to the Joint Labor, Health and Social Services Interim Committee. The motion carried unanimously with Senators Boggs and Massie and Representatives Meuli and Robinson voting aye. Representative Iekel was excused.
Mr. Clabby explained that the proposal with respect to an appropriation for the state health professional training enhancement program had been amended after discussion with Mr. Darald Dykeman, Department of Administration and Information. The amended language would allow for multiple fill positions rather than specify 13 full-time equivalent positions.
Senator Massie moved, seconded by Representative Meuli to direct staff to draft a bill consistent with amended language presented by Mr. Clabby. The motion carried unanimously on a roll call vote with Senators Boggs and Massie and Representatives Meuli and Robinson voting aye. Representative Iekel was excused.
9. Other business.
In response to a question from the subcommittee, Mr. Bronnenberg explained that there are various central registries operated by the Department of Family Services, Board of Nursing and others. Mr. Rivera added that the Joint Judiciary Interim Committee is participating in a Title 14 revision subcommittee. That subcommittee has recently met and one of the issues to be considered by the subcommittee is possible coordination or consolidation of the various central registries that exist in the state.
Representative Meuli expressed his concerns with the unknown costs and effect of a budget footnote in the last session that provided an appropriation for an adult acquired brain injury program. He has been working with LSO to draft a bill to place limitations on the program.
Director McKee said the department would be glad to provide the necessary information. He advised the acquired brain injury program is patterned after the adult DD waiver.
Senator Massie suggested a bill be drafted and patterned similarly to the adult DD waiver.
With no further business before the subcommittee, Chairman Boggs adjourned the meeting at 3:40 p.m., Friday, October 5, 2001.
Respectfully submitted,
Senator Tex Boggs
Chairman
Please Note: Due to the length and complexity of the appendices, the appendices are not being distributed with the summary of proceedings. A copy of the appendices is on file at the Legislative Service Office for anyone wishing to view them.