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Wyoming Legislature

Committee Meeting Summary of Proceedings

Select Committee on Developmental Programs

 

September 12, 2007

Park County Courthouse

Cody, Wyoming

 

 

Meeting Attendance (Present)

 

Committee Members

Senator Hank Coe, Cochairman

Representative Elaine Harvey, Cochairman

Senator Pat Aullman

Representative Rosie Berger

Representative Dan Dockstader

 

Legislative Service Office

Gerald W. Laska, Staff Attorney

Alex Kean, Associate Research Analyst

 

Others Present

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

 

Meeting Attendance (Absent)

 

Committee Members

Senator Mike Massie

Representative Bernadine Craft

 

Written Meeting Materials and Handouts

All meeting materials and handouts provided to the Committee by the Legislative Service Office (LSO), public officials, lobbyists, and the public are referenced in the Meeting Materials Index, attached to the minutes.  These materials are on file at the LSO and are part of the official record of the meeting. 

 

Meeting summary

The Committee met at 10:30 a.m. on Wednesday, September 12, 2007 at the Park County Courthouse in Cody, Wyoming.  The Committee introduced for discussion, but did not move or consider amendments to, a draft bill for the revision of statutes governing and renaming the Wyoming State Training School.  Department of Health representatives presented updates on the status of waiting lists for out-of-home placements, emergency services rules, quarterly reports to the Committee and admissions criteria and procedures for the Training School.  Navigant Consulting, Inc., presented a report and recommendations for a cost-based reimbursement model to compensate private service providers.  The Committee requested a bill authorizing cost-based reimbursement.  The next meeting will be held October 9, 2007, in Casper.

 

 

Call To Order

Chairman Harvey called the meeting to order at 10:30 a.m.  The following sections summarize the Committee proceedings by topic.  Please refer to Appendix 2 to review the Committee Meeting Agenda.

 

Wyoming State Training School – presentation of proposed legislation

08LSO-0107.W2

 

Chairman Harvey advised that the Committee would present the bill (Appendix 3) today but would not vote on it or consider amendments to the bill.  The Committee will receive comments on the bill today and at its next meeting, then consider the bill for sponsorship and any proposed amendments at the next meeting in October.

 

Chairman Harvey described the three general purposes of the proposed bill as:

 

1) Changing the name of the Wyoming State Training School ("WSTS")to the Wyoming Disability Resource Center.  She stated that it is time for a change and that the current name is inaccurate.  The name should reflect statutory purposes, which are not limited or expanded in the bill because the Department's on-going study will address future uses of the facility;

 

2) Reorganization.  WSTS serves same clientele as the Developmental Disabilities Division ("DDD"), but only about 100 of the Division's approximately 5000 clients.  It would make sense to have single, user-friendly point of entry under DDD;

 

3) Modernization of the statutory language.

 

Representatives Dockstader, Berger and Chairman Harvey proceeded to explain the bill in detail.

 

Dr. Brent Sherard, Cliff Mikesell and Diane Baird Hudson of the Department of Health spoke generally in favor of the bill but were opposed to the provisions regarding reorganization of WSTS within the DDD and were disappointed that the bill did not expand the current statutory role of WSTS.  Chairman Harvey explained the Committee's sense that the role of WSTS should not be changed while a department-wide review of facilities and programs is in progress.

 

Brenda Oswald (Governor's Planning Council on Developmental Disabilities), Tom Robeson (Protection & Advocacy, Inc.), Ruth Sommers (Regional Service Providers of Wyoming) and Shawn Griffin (Community Entry Services) spoke generally in support of the bill.

 

Representative Del McOmie addressed the Committee to question the advisability of making department organizational changes in statute and to recommend keeping existing language in W.S. 25-5-103(a) regarding the purposes of the WSTS.

 

Senator Cale Case addressed the Committee and distributed a handout entitled "Issues Regarding the Select Committee's Version of the Proposed Law" (Appendix 4).  He recommended that the bill could go much further in adopting 'people first' language and eliminating stigmatizing references.  He disagreed with reorganizing WSTS into the DDD and stated that the current process of referral and admissions is working well.  He stated that facility management is a huge issue and cannot easily be combined with a system of services by contract providers.

 

Senator Case stated that he believes the bill ignores an Attorney General opinion about customer choice, and that the most integrated and most appropriate services cannot ignore choice.  He stated that the bill waters down the appeals process.  He suggested repealing all provisions regarding involuntary placements and expanding the authorization of services offered.

 

Chairman Harvey advised that the Committee will accept recommendations for specific amendments to the bill for consideration at the next meeting if the bill is moved for sponsorship.

 

Lunch Recess

The Committee recessed at 12:00 noon and reconvened at 1:35 p.m.

 

Department of Health, Developmental Disabilities Division

Waiting list status – out of home placements

 

Cliff Mikesell, Administrator, DDD, advised the Committee that the Division expected a waiting list to develop for this biennium so started keeping statistics for all three programs last year. The  children’s waiver program in particular has had a waiting list.  66 clients have been accepted from the lists but there are still 10 adults and 96 children wait listed.  All of this was paid for by regularly reviewing projected budgets for those already in the waiver program and adjusting those budgets downward where indicated.  Mr. Mikesell distributed an "Out of Home Placement Update" (Appendix 5) and "Real Choice Supports Waiver Update" (Appendix 6).

 

Emergency placements – rules

Chris Newman, Developmental Disabilities Division, updated the Committee on the status of rules adopting for emergency cases, as required by 2007 legislation.  Emergency rules were adopted and permanent rules proposed on September 10^th, covering application procedures, eligibility guidelines (need for 24-hour care, threat to health/loss of home), the screening team, covered services, mandatory  emergency services plan and a plan of action if not found eligible for emergency services.

 

Quarterly report

Cliff Mikesell advised that the Division has continued to issue quarterly status reports on waiver program costs and statistics, but will discontinue those as the legislation requiring them was in the last budget bill and expired on June 30, 2006.

 

Admissions criteria/procedures

The Committee generally questioned DDD staff regarding the current referral and admissions process for services at WSTS or from regional service providers.  Mr. Mikesell advised that the Division has beefed up the Area Resource Specialist ("ARS") positions at the urging of the Committee, and that the ARS is the primary point of contact and information for prospective clients.  The Committee further discussed the practicality of adding WSTS clients to the ARS caseload, and whether there should be additional ARS positions especially if the caseload were increased.

 

Real Choice Waiver Update

Cliff Mikesell informed the Committee that the Division is currently in the process of hiring a new program manager.  The tragic loss of the previous manager has delayed implementation of the program.  He distributed "Real Choice Supports Waiver Update" (Appendix 6) to the Committee.

 

Navigant Consulting report: cost-based reimbursement study

Cliff Mikesell introduced two representatives of Navigant Consulting, Jim Pedersen and Sarah Barry.  They presented to the Committee the results of their study of a possible new system to reimburse private developmental disability service providers on a cost basis rather than the current individual budget/negotiated fee basis.  They presented their report in the form of a PowerPoint presentation (Appendix 7).  They discussed:

·         the current rate structure;

·         advantages of a cost-based system;

·         suggested phases in the conversion process;

·         elements of a model-based rate structure;

·         cost-of-living adjustment factors;

·         geographic variation adjustment factors;

·         preliminary rate models;

·         impacts of various models on funding needs;

·         impacts of various models on provider payments;

·         the impact of a "budget neutral" requirement on the various models;

·         implementation timeline possibilities.

 

Mr. Pedersen distributed a budget impact analysis for the 2009/2010 biennium (Appendix 8) and an analysis of differences between current provider payments and draft rates under the proposed model (Appendix 9), assuming a budget neutrality requirement.  Ms. Barry discussed four possible transition plans from the current to a new reimbursement system, and one possible pilot plan.

 

In response to questioning from the Committee, Mr. Mikesell stated that the Department would prefer a transition plan that included blended rates over a period of time, but that the federal Center for Medicare and Medicaid Services has strongly favored a "cold turkey" approach in other states that have adopted cost-based reimbursement models.

 

Chairman Harvey polled the Committee for their interest in a bill authorizing implementation of the cost-based reimbursement model.  The Committee elected to request that a bill be drafted.  The Navigant Consulting representatives agreed to provide the LSO staff with information for purposes of bill-drafting within two weeks.

 

Public Comment

Brett Allard of Riverton stated that he is the guardian for his brother, who formerly was a resident at WSTS for 20 years and is not a client of Community Entry Services.  He cautioned the Committee to remember that real people are affected by all of the discussion of funding models and formulas, and that they should keep the people in mind in making their decisions.

 

Meeting Adjournment

Chairman Harvey reminded the Committee that the next meeting has already been scheduled for October 9, 2007 in Casper.  There being no further business, Chairman Harvey adjourned the meeting at 4:30 p.m.

 

Respectfully submitted,

 

 

 

Senator Hank Coe, Chairman

 

 

 

Representative Elaine Harvey, Chairman

Wyoming Legislature

Committee Meeting Materials Index

Select Committee on Developmental Programs

 

September 12, 2007

Park County Courthouse

Cody, Wyoming

 

All meeting materials and handouts provided to the Committee by the Legislative Service Office (LSO), public officials, lobbyists, and the public are referenced in the Meeting Materials Index and are attached at the end of the minutes.  The table below provides a summary of the materials provided to the Committee.  These materials are on file at the LSO and are part of the official record of the meeting.  Please contact the LSO at 307-777-7881 to review these documents.

 

Appendix	Appendix Topic	Appendix Description	Appendix Provided By
1	Committee Sign-In Sheet	Lists meeting attendees	LSO
2	Committee Meeting Agenda	Provides a general outline of the topics the Committee planned to address at meeting	LSO
3	WSTS – proposed legislation	08LSO-0107.W2	LSO
4	WSTS – proposed legislation	Issues Regarding the Select Committee's Version of the Proposed Law	Senator Cale Case
5	Dept. of Health, Developmental Disabilities Division	Out of Home Placement Update	Cliff Mikesell, DoH
6	Dept. of Health, Developmental Disabilities Division	Real Choice Supports Waiver Update	Chris Newman, DoH
7	Navigant Consulting Report	PowerPoint: "Navigant Consulting"	Jim Pedersen, Sarah Barry
8	Navigant Consulting Report	HCBS Waive Ratesetting Impact Analysis	Jim Pedersen, Sarah Barry
9	Navigant Consulting Report	Frequency of Difference Between Current Provider Payments and Draft Rates	Jim Pedersen, Sarah Barry