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Funding Subcommittee
of the Select Committee on Mental Health and Substance Abuse Services
Funding Subcommittee
of the
Select Committee on Mental Health and Substance Abuse Services
June 2, 2005
Room H10, State Capitol
Cheyenne, Wyoming
Representative Colin Simpson, Chairman
Senator Rae Lynn Job
Representative Jane Warren
John Rivera, Senior Staff Attorney
Nicole Novotny, Associate Research Analyst
Please refer to
Appendix 1 to review the Committee Sign-in Sheet
for a list of other individuals who attended the meeting.
Chairman Simpson called the meeting to order at 9:05 a.m. Chairman Simpson explained the meeting was intended to be an informal meeting to discuss the objectives of the subcommittee, to consider the reports received to date by Subcommittee members and to request any additional information the Subcommittee may need to study issues assigned to it. Due to the informal nature of the meeting, no agenda had been prepared.
Dr. Brent Sherard, M.D., Director of the Department of Health (WDH), distributed a flowchart illustrating the structure of the major offices and programs within WDH. He stated WDH's fiscal management is being centralized to improve accountability. The WDH is in the process of hiring a chief information officer to manage information the WDH produces.
Mr. Chuck Hayes, Administrator of the Mental Health Division, added that data collection is key to managing and understanding the allocation of funds. Mr. Dean Jessup, Deputy Administrator of the Substance Abuse Division, stated that data on the number and nature of clients served is critical.
Senator Job asked for projections on future needs that may be created in the State with respect to substance abuse. Mr. Jessup replied that the information is contained within the DATACORP report dated January 10, 2005 entitled Social Indicator and Gap Analysis Study,which was provided to LSO the previous day. Chairman Simpson advised that the report has not been provided to Subcommittee members yet because the Cochairmen of the Select Committee are reviewing all information provided to LSO to determine which information will be further distributed to Committee members in an effort to avoid inundating members with volumes of materials that may be of limited value.
Mr. Hayes advised the Mental Health Division is getting the same type of data, but has a different approach to compiling the data. Under the current system which is performance based, the contracting providers receive an allocation of funds based on specified criteria. The providers are allowed to maintain their allocations until a provider under performs, at which time the program's funding is reduced and reallocated among the remaining programs that are not under performing. The Division works with providers who are under performing to avoid a reduction in the provider's allocation, to the extent possible.
Mr. Jessup stated that the Substance Abuse Division is moving toward the system used by the Mental Health Division for monitoring client data. Ms. Marla Smith, Mental Health Division Information Systems Manager, explained there are two ways of tracking client services. First, the units of service by service category is used. Client services are also tracked by the number of persons served with those units of services. The methods can be aggregated to arrive at some numbers, but the methods can't be used to analyze specific client services by individual.
Chairman Simpson stated the mental health center in his county might not count emergency services provided to its clients for purposes of reporting to the WDH and asked why that is happening. Mr. Hayes responded that the State doesn't pay for emergency services so the community mental health centers do not count those persons served in the data provided to the WDH. Ms. Marian Schulz, Wyoming Association of Mental Health and Substance Abuse Centers (WAMHSAC), agreed that since the programs she represents are not being paid by the State, the programs do not provide the information for those services. Some of those emergency services are paid for by local funds or by the individual, e.g., DUI assessments are paid by the person ordered to undergo the assessment.
Chairman Simpson asked then if the WDH is only tracking information relative to the performance based contracts with WAMHSAC providers. Mr. Hayes responded in the affirmative, but said he would continue talking with WAMHSAC providers to improve data reporting.
Senator Job is concerned that the Legislature has studied for numerous years the same issues that this Select Committee is now studying. The results of the prior studies indicated a need for outcome measures to be tracked, but that has yet to happen. She asked why outcome measures aren't being comprehensively tracked in light of the long-standing recognition that it is necessary. Ms. Smith indicated that the WDH is headed in that direction, but the need for additional staff and system enhancements limit the ability to move quickly. Senator Job asked for an estimate of the costs for software, equipment and staff necessary to develop a comprehensive system to measure outcomes. Ms. Smith said she would try to develop cost estimates on the local and state levels necessary to develop the system and added that she distributed a document at the initial meeting of the Select Committee that may contain some of the nationally-based outcome measures that Senator Job is requesting. Mr. Hayes stated that there are some best practices that work in rural and frontier settings and other practices that have potential. Both Divisions are monitoring national development of best practices that may work in Wyoming. In January, 2006, the WDH will send a request for proposal (RFP) for development of software to improve tracking of client outcomes. The delay in distributing the RFP is because time is necessary to work with providers and both Divisions to determine what type of information will be sought in the development of the software.
Ms. Ginny Mahoney, WDH Chief of Staff, stated that all the divisions of the WDH have submitted their strategic plans which have been compiled and submitted to the Governor's Office on May 29. Chairman Simpson asked that the LSO be provided a copy of the strategic plans for distribution to the Subcommittee. He also asked if there were any other reports that may show outcomes. Mr. Jessup stated that the Drug Court Evaluation report provided to LSO would be helpful and an adolescent treatment study will soon be issued that may also be helpful. The report required under 05HB0308 from the WDH to the Joint Labor, Health and Social Services Interim Committee and the Joint Appropriations Interim Committee by October 30, 2005 may contain some outcome measures. A collaborative study of the WDH and the Department of Corrections will be submitted soon. As these reports become available, the WDH will provide them to the Select Committee on Mental Health and Substance Abuse Services.
Representative Warren advised that outcome measures for mental health clients are difficult to assess. Mr. Hayes said he will provide some of the best practices that are available for mental health services.
Chairman Simpson asked what the effect of a 20% decrease in federal funding would be on 2004-2005 Substance Abuse Division resources. Mr. Jessup will provide that information as soon as he can assess that effect.
Senator Job asked what the outcomes would be for this subcommittee in terms of its report to the full committee. Chairman Simpson suggested the subcommittee would look at the current state of mental health and substance abuse services and what could be the costs of improving those services to an acceptable level. He believes the subcommittee is not ready to begin discussing what it may cost to improve services. The Mental Health and Substance Abuse Divisions were asked to develop costs for improved outcome measures. Mr. Hayes said he may be able to make projections for pilot projects, but he couldn't project what the costs would be for a long-term ideal model for Wyoming. Chairman Simpson requested a projection for the costs of regionalization of services and movement from a process-based system to an outcome-based system. Senator Job added that a 3-5 year plan may be necessary to get longer-term planning started since the outcomes issue has been discussed for 30 years now, with no changes. Mr. Hayes believes it may be necessary to hire an outside consultant to develop a good long-term plan for system and process development. A plan can be developed based on the number of persons in need and what services are needed to serve those persons. Senator Job said the subcommittee needs that plan to make its recommendations to the full committee. Representative Warren asked if the providers can provide projections of costs based on outcomes. Senator Job agreed with Ms. Schulz that the centers are already doing this. Ms. Schulz will ask the centers to provide their outcomes data. Mr. Hayes added that the WDH does have some outcomes data, but not all of it would be helpful to the subcommittee. He can provide some ball park figures. Mr. Jessup suggested that both divisions should collaborate on developing the plan for the subcommittee. Mr. Hayes said they could have the plan ready for the subcommittee in about 30 days.
Chairman Simpson asked Ms Smith what she would need to develop the data for a plan to make the projections. He suggested she speak with Larry Biggio for technical assistance in developing the information. Dr. Sherard advised the WDH will be interviewing the following week for a chief information officer, who will be doing that type of work.
Chairman Simpson said the Substance Abuse Division has about 30% of the funding that the Mental Health Division has and asked if this balance is appropriate. Mr. Hayes responded that the balance may not be appropriate. The Mental Health Division deals with many emergency detentions that involve primarily substance abuse issues, but are counted as mental health cases because of the emergency detention. The Mental Health Division thus spends more for treatment, but the Substance Abuse Division uses its money more effectively on prevention issues. Senator Job asked what the balance of dollars spent on mental health versus substance abuse issues is nationally. Mr. Hayes said he will try to get those numbers.
Ms. Lisa Brockman, Mental Health Division Medicaid Officer, stated that it is difficult to determine whether a person has a substance abuse problem, a mental health problem, or both because no single, universal assessment tool is available to detect all potential symptoms. Medicaid services for mental health problems are low co-pay or no co-pay, depending on the client. At the request of Chairman Simpson, she said she could provide the number of Medicaid clients served by provider and a one page explanation of eligibility criteria for Medicaid. Chairman Simpson also asked Ms. Brockman to explain problems that may exist with Medicaid funding of mental health services, with respect to parental relinquishments of children to obtain services, nonpayment by the Department of Family Services for court-ordered out-of-state placements and other barriers to services. She explained that Medicaid waivers are used for cost-containment, e.g. the children's mental health waiver that is being applied for by the WDH. Chairman Simpson asked that she provide an explanation in writing.
Ms. Smith advised she is working on a county by county profile to present to the Access Subcommittee which would help the Funding Subcommittee also. She will provide that information when it is available.
Chairman Simpson asked Ms. Schulz to poll WAMHSAC members to define unreimbursed care and what costs each center incurs. Ms. Novotny said she has polled counties and may follow up with hospitals to determine what unreimbursed costs they are incurring. When that data is completed, she will provide it to the subcommittee.
Chairman Simpson asked Mr. Hayes, Mr. Jessup and Ms. Smith to get their reports for the subcommittee as quickly as possible. He asked Ms. Smith to get the national outcome measures for the subcommittee and Ms. Brockman and her counterpart in the Substance Abuse Division to provide their Medicaid summaries as soon as possible. He wants the materials requested so he can set the next meeting of the subcommittee, hopefully for early July.
Dr. Sherard distributed Appendix 3, consisting of the WDH's Quality of Life Result Performance Measures.
There being no further business, Chairman Simpson adjourned the meeting at 12:40 p.m.
Respectfully submitted,
Representative Colin Simpson, Chairman