DRAFT ONLY - APPROVAL PENDING

Wyoming Legislature

Committee Meeting Summary of Proceedings

Select Committee on Mental Health and Substance Abuse Services

Committee Meeting Information

November 4, 2005

Room 302, State Capitol

Cheyenne, Wyoming

Committee Members Present

Senator John Schiffer, Co-chairman

Representative Colin Simpson, Co-chairman

Senator Pat Aullman

Senator Ken Decaria

Senator Rae Lynn Job

Senator Wayne Johnson

Senator Tony Ross

Representative Keith Gingery

Representative Patrick Goggles

Representative Jerry Iekel

Representative Doug Osborn

Representative Jane Warren

Legislative Service Office Staff

John Rivera, Senior Staff Attorney

Others Present at Meeting

Please refer to Appendix 1 to review the Committee Sign-in Sheet
for a list of other individuals who attended the meeting.

Call To Order

Chairman Simpson called the meeting to order at 8:05 a.m.  The following sections summarize the Committee proceedings by topic.  Please refer to Appendix 2 to review the Committee Meeting Agenda.

Approval of Minutes

Minutes from the September 14-15, 2005 Committee meeting were approved.

Proposed Draft Legislation

06LSO-0093.W1, DFS contract for residential services-juveniles.

Senator Ross explained that the Attorney General issued two opinions regarding whether the Department of Family Services may enter into residential services contracts for juveniles with nonprofit entities.  While the second opinion stated such contracts were legal, Senator Ross requested consideration of the draft bill to clarify the legality of such contracts. 

Senator Ross, seconded by Representative Osborn, moved for Committee sponsorship of the bill.  The motion carried unanimously with Senators Aullman, Decaria, Job, Johnson, Ross and Schiffer and Representatives Gingery, Iekel, Goggles, Osborn, Simpson and Warren voting aye.  Chairman Simpson advised that all draft legislation approved by the Committee for sponsorship, except 06LSO-0183, would be introduced as Senate Files.  06LSO-0183, if approved for sponsorship, would be introduced as a House Bill.

06LSO-0183.W2, Mental health and substance abuse appropriations.

The Department of Health distributed materials for Committee consideration on the bill. Appendix 3, distributed by the Mental Health Division, provided a description of the proposed plan for regionalization of the mental health system of care in the state, with costs for the plan.  Appendices 4 and 5, distributed by the Substance Abuse Division, contained alternative language for section 12 of the bill and provided explanations of changes to funding requests for substance abuse programs provided in the bill.

Representative Iekel moved the bill,  seconded by Senator Johnson, for purposes of considering changes to the bill. The bill was then considered section by section.

The following motions were made to the bill:

• Page 1-line 15, delete "general fund" insert "budget reserve account".
• Page 2-line 14, after "committee" insert "select committee on mental health and substance abuse services".
• Page 3-line 6, after "plan" insert ",to be coordinated with the mental health division of the department of health,".
• Page 3-line 24, after "involuntary" insert "residential".
• Page 3-After line 24, insert "(vi)  Other programs of care as may be determined to be appropriate to the institution.".
• Page 4-line 7 through Page 5-line 20, leave as drafted, pending completion of negotiations between the Attorney General and Protection & Advocacy Systems, Inc.
• Page 6-line 6, delete "three million two hundred five thousand ninety-eight dollars ($3,205,098.00)" insert "three million one hundred ninety-five thousand one hundred dollars ($3,195,100.00)".
• Page 6-After line 19, insert  a new subsection (b)  to appropriate $3,670,697.00 to the Mental Health Division for clinical services enhancements. Staff is to work with Ms. Carol Day to develop the appropriate language for the new subsection.
• Page 8-line 20 through Page 9-line 3, Senator Schiffer suggested waiting to amend the appropriations to section 6 of the bill until department staff can advise as to the potential effect on the budgets of the Departments of Health, Family Services and Education with respect to calculation of state matching funds, if a Medicaid waiver is approved.
• Page 9-line 17,  after "bereavement" insert "counseling".
• Page 9-line 21,  after "." insert a new sentence containing a definition for "emergency responders", using language Senator Aullman will develop with staff.
• Page 11-line 1 through Page 12-line 20, delete the first alternative language entirely.
• Page 12-line 23 through Page 14-line 9, the second alternative language was adopted, with amendments.
• Page 12-line 23, Delete ", mental health division,".
• Page 13-line 2, delete "care".
• Page 13-line 3, after "." insert "The department of health, in consultation with the mental health division and the substance abuse division, shall designate the regions of the state.".
• Page 13-line 13, delete "care" insert "services".
• Page 15-line 15 through Page 16-line 4, delete entirely.
• Page 15-line 5, delete the line through "section," insert "(a)", and find out if earmarking the funds affects the state match for Medicaid purposes.
• Page 16-line 15, after "request" insert "that is consistent with the patient's discharge plan".
• Page 16-line 19, after "." delete balance of line.
• Page 16-lines 20 through 24, delete entirely (earmarking of funds).
• Page 17-line 8, delete "five hundred thousand".
• Page 17-line 9, delete the line through "($500,000.00)" insert "eight hundred sixty-eight thousand dollars ($868,000.00)".
• Page 17-line 11, delete "a" insert "providers of".
• Page 17-line 12, delete "agency" insert "services".
• Page 18-lines 7 through 12, delete entirely and insert Appendix 6.
• Page 18-line 16, delete "nurse practitioners" insert "practice registered nurses with specialties in psychiatric care"; delete "with" insert "who are supervised by psychiatrists;".
• Page 18-line 17, delete entirely.
• Page 18-line 20, delete "crisis" insert "emergency ".
• Page 18-line 21, delete "response and triage" insert "clinical services to establish uniformity in local emergency mental health response services. Provider contracts shall include requirements that emergency responses will take not longer than:  (i)  Fifteen (15) minutes for a telephone response by an appropriate licensed professional;   (ii)  One (1) hour on-site response time by an appropriate licensed professional within a community; and,  (iii)  Two (2) hours on-site response time by an appropriate licensed professional within a county.".
• Page 18-lines 19 through 21, delete entirely and move, as amended above, to Page 6-Before line 20, as a new subsection (c), with language as necessary to make the new subsection read properly.
• Page 18-lines 23 and 24, delete entirely.
• Page 19-lines 1 and 2, delete entirely and renumber as necessary.
• Page 19-lines 10 through 13, delete entirely.
• Page 20-line 3, delete "one".
• Page 20-lines 4 through 9, delete entirely and insert "seven (7) full-time equivalent employees who shall be employees of the mental health division and who shall work jointly with the substance abuse division for purposes of data research, analysis, performance measurement and quality improvement of services provided by community mental health and substance abuse centers under contract with the department of health;".
• Page 20-line 23, delete "one (1)" insert "seven (7)".
• Page 21-line 1, delete "position" insert "positions".
• Page 22-line 1, delete "one million fifty thousand".
• Page 22-line 2, delete "dollars ($1,050,000.00)" insert "six million two hundred ten thousand six hundred twenty-four dollars ($6,210,624.00)".
• Page 22-line 21,  delete "six million dollars".
• Page 22-line 22, delete "($6,000,000.00)" insert "eight million dollars ($8,000,000.00)".
• Page 23-lines 3 through 6, after "to" on line 3, delete entirely and insert "expand residential and outpatient services and increase all reimbursable unit-of-service rates by approximately fifteen  percent (15%);".
• Page 23-line 15, delete "and medical"; after "services" insert ", medications and other medical needs related to detoxification services;".
• Page 23-After line 16, insert "(b)  There is appropriated seven million five hundred eighty-three thousand three hundred thirty dollars ($7,583,330.00), or as much thereof as is necessary, from the tobacco settlement income account to the department of health, substance abuse division, for the biennium beginning July 1, 2006, to continue, restructure and build programs as follows:".
• Page 23-line 17, delete "(v)" insert "(i)".
• Page 23-line 19, after "the" insert "Wyoming quit".
• Page 23-line 20, delete "quitline" insert "program".
• Page 23-line 22, delete "(vi)" insert "(ii)".
• Page 23-line 24, delete "; and" insert ".".
• Page 24-lines 2 through 6, delete entirely.
• Renumber and adjust totals as necessary.

Motions that failed or were withdrawn include:

• Page 19-lines 10 through 13, reinsert deleted subsection (b) and further amend by deleting  "six (6)" and inserting "three (3)".
• Page 20-line 3, delete "one".

• Page 20-lines 4 through 9, delete entirely and provide for 6 FTE's who will be employees of the Mental Health Division.
• Page 20-lines 11 through 13, delete entirely.

Mr. Rick Miller, University of Wyoming Vice-President for Governmental, Community and Legal Affairs, explained that Section 13 of the bill, relating to psychiatric residency rotations, was a new concept that is very complex, so a planning process has to occur before implementation could be considered.

Chairman Simpson advised the bill would be amended to incorporate the changes made by Committee and would be considered again at a later date.

06LSO-0216.W3, Advanced practice registered nurses in psychiatry

Mr. Miller introduced Dr. Susan McCabe and explained that the University was already starting a new program to increase nursing graduate students.  Dr. McCabe described the program the University is implementing.  There have been over 200 inquiries for the program, about ½ of them from Wyoming residents.  Tuition for the graduate students will be $11,000/ year. The biggest obstacle for students is a need to replace lost income.  The stipends the proposed legislation would provide would be a big help in overcoming that obstacle.  Mr. Miller distributed Appendix 7, containing amendments to clear up archaic language used in the bill.  Senator Schiffer moved the amendments proposed. The motion carried unanimously.

Senator Ross, seconded by Representative Osborn, moved for Committee sponsorship of the bill, as amended.  The motion carried unanimously with Senators Aullman, Decaria, Job, Johnson, Ross and Schiffer and Representatives Gingery, Iekel, Goggles, Osborn, Simpson and Warren voting aye. 

06LSO-0220.W2, Wyoming state hospital psychiatrists-recruitment.

Chairman Simpson explained the purpose of the bill.  After discussion about the number of psychiatrists currently employed and the need for additional psychiatrists, Senator Schiffer moved to amend the bill on page 2-lines 11 and 12, to delete ", in consultation with the office of rural health,".  The motion carried unanimously.  Senator Johnson moved to table the bill.  The motion failed on a hand vote with 5 ayes and 7 nays.

Senator Schiffer, seconded by Senator Ross, moved for Committee sponsorship of the bill, as amended.  The motion carried unanimously with Senators Aullman, Decaria, Job, Ross and Schiffer and Representatives Gingery, Iekel, Goggles, Osborn, Simpson and Warren voting aye.  Senator Johnson was excused.

06LSO-0178.W2, Mental health insurance parity.

After discussion, Representative Iekel, seconded by Representative Osborn, moved for Committee sponsorship of the bill.  The motion carried unanimously with Senators Aullman, Decaria, Job, Ross and Schiffer and Representatives Gingery, Iekel, Goggles, Osborn, Simpson and Warren voting aye.  Senator Johnson was excused.

06LSO-0179.W2, Substance abuse insurance parity.

Chairman Simpson expressed concern with the definition of "substance abuse" contained in the bill.  After discussion, the Committee directed staff to work with Dr. Ann Reyes, Substance Abuse Division, to prepare an amended definition for the Committee's consideration.  The bill was tabled for further consideration until receipt of the amended definition.

Substance Abuse Division Report-Treatment Beds Shortage

Due to the length of the meeting, the report by Dr. Reyes was postponed.

Meeting Adjournment

There being no further business, Chairman Simpson adjourned the meeting at 5:40 p.m.

Respectfully submitted,

Senator John Schiffer, Co-chairman                            Representative Colin Simpson, Co-chairman