October 9, 2007
Central Wyoming Counseling Center
1430 Wilkins Circle
Casper, Wyoming
Senator Hank Coe, Cochairman
Representative Elaine Harvey, Cochairman
Senator Pat Aullman
Senator Mike Massie
Representative Rosie Berger
Representative Bernadine Craft
Representative Dan Dockstader
None
Gerald W. Laska,
Staff Attorney
Alex Kean, 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.
The Committee met for one day on October 9, 2007. The Committee considered, amended and voted to sponsor a bill amending statutes governing the Wyoming State Training School in Lander. Spokespersons for Wyoming Regional Service Providers and the Governor's Planning Council on Developmental Disabilities reviewed the accomplishments of the Committee over the last four years. The Department of Health, Developmental Disabilities Division ("DDD"), delivered statutorily-required reports on developmental preschools and presented updates on the status of waiver program waiting list. Navigant Consulting and DDD staff testified regarding a proposed cost-based reimbursement system for all developmental service providers. The Committee discussed and agreed on the contents of the its final report. The Committee scheduled a final meeting for December 17 in Riverton to consider the cost-based provider reimbursement bill.
Co-Chairman Harvey called the meeting to order at 9:00 a.m. The following sections summarize the Committee proceedings by topic. Please refer to Appendix 2 to review the Committee Meeting Agenda.
Minutes from the September 12, 2007 Committee meeting were approved.
Chairman Harvey invited general comments from the audience about the Wyoming State Training School ("WSTS") bill. (Appendix 5) Sidney Humberson (Appendix 3) and Della Herbst (Appendix 4) presented their comments in writing. Mark Crandall and Kathy Martin spoke generally in support of WSTS and maintaining customer choice in placement of persons with developmental disabilities.
Department of Health Director Dr. Brent Sherard told the Committee that the common goal is providing the best care to clients, but that it must be done in a cost efficient way. He advised that the Department is conducting its own facilities review, which he hoped could be finished before any organization changes are implemented. The Committee discussed generally the need for a master facilities review that would include a programmatic review, the pace of the current review and the degree of the Governor's support for a large-scale review. Dr. Sherard further advised the Committee regarding transfers of some patients from the State Hospital to WSTS.
Senator Cale Case address the Committee and proposed changes to the draft bill (Appendix 6) in the areas of: 'people first' language; consumer choice; restoration of an explicit appeals process; retention of the current organizational structure; changing the name of WSTS to the Wyoming Therapeutic Resource Center; repeal of involuntary commitment provisions; and the addition of skilled nursing services as part of the WSTS functions.
Senator Massie, seconded by Representative Berger, moved that the Committee sponsor 08LSO-0107.W3. The Committee proceeded to amend the draft bill, as follows:
· Page 4, line 23: Change "'Incompetent' means as defined..." to "'Incompetent person' means adjudicated as defined";
· Page 6-line 1: Change "Mentally retarded" to "mental retardation";
· Page 12-lines 19-23: Change categorical descriptors to use 'people first' language;
· Page 13-line 20: Strike "control" and insert "supervision"'
· Page 15-lines 2, 23: Insert reference to federal ICF/MR regulations;
· Page 15-lines 10-13 Replace with "Training for state employees, other service providers and caregivers on disability, medical, developmental and therapy services."
· Page 20-line 24 – page 21-line 2 Delete and insert to read: "...the center offers the recommended and most appropriate services in a least restrictive and most integrated environment;".
· Page 34-line 13 Change 45 days to 75 days for temporary placements;
· Page 37-lines 5-12 Repeal instead of amend subsection (c).
· Page 41-line 14 After "room" insert "or in an area from which the person is physically prevented from leaving".
· Page 44-line 2 Delete "25-5-124(b)"; add that subsection to the bill and provide for appeal to "the director" instead of "the department".
Senator Massie's motion to sponsor the bill was approved on a vote of 6-0-1, with Senator Coe excused.
Brenda Oswald, Governor's Planning Council on Developmental Disabilities, presented a PowerPoint presentation (Appendix 7) highlighting the accomplishments of the Select Committee during its four years of existence.
Cliff Mikesell distributed a packet including the Division's legislative reports (Appendix 8), including:
· Early childhood social-emotional development programs;
· Developmental Disabilities-Developmental Preschools' Compensation and Funding Levels;
· Service Provision in the Least Restrictive Environment;
· Adoption of Evidence-Based Best Practices;
· Parent Expectations and Student Progress.
Mr. Mikesell reported that there are 217 people on waiting lists for all three waiver programs, with projections for 50 adults and 186 children through the end of the biennium. The Committee discussed the Department's budget request for FY08-09 and whether other excess funds could be used to serve persons on the waiting lists. Mr. Mikesell explained that the Department uses excess funds from individual budget amounts for the waiting list. He also advised that 32 people have been funded so far in alternative residential settings, which is close to the projection of 40.
Sue Sharp, Child Development Services of Wyoming, distributed a fact sheet entitled "Wyoming's Developmental Preschool System Facts." (Appendix 9)
Jim Pedersen and Sarah Barry of Navigant Consulting advised the Committee concerning various methods of creating a cost-based payment system for developmental disability providers. They distributed an Options Memorandum (Appendix 10), charts of budget projections under various scenarios (Appendices 11, 12) and charts of possible model-based payment rates for services under the adult, acquired brain injury and children's waiver programs (Appendix 13).
The Committee discussed with Mr. Pedersen and Ms. Barry the pros and cons and fiscal impacts of full implementation versus budget neutral implementation, maintenance of current disparities among the three waiver programs versus parity, various phase-in methods versus immediate conversion, geographic adjustments versus single statewide rates and the prospect of approval by the Center for Medicare and Medicaid Services. Ms. Barry estimated the cost of the new model rates at $5.7 Million per biennium, with parity among the programs and implementation as service plans were renewed.
The Committee decided to schedule another meeting, in order to afford more time to study the many scenarios presented, and asked staff to revise the draft bill to provide for rate parity among the waiver programs and a 'hold harmless' provision for those providers who would be negatively impacted by the changes. Senator Massie requested Navigant to be prepared with a specific rate calculation and an explanation of the calculation. Representative Berger asked that the Department and providers come forward with any specific amendments or additions to the bill.
Committee members discussed elements that should be in the Committee's final report to the Governor and Management Council. They agreed on the following elements:
· Prohibition on transfer of funds;
· Recommendation to Joint Appropriations Committee to fully fund the waiting lists;
· Reminder to Joint Appropriations Committee that the schools' external cost adjustment should be applied to developmental preschool providers;
· Recommendation to Management Council that appropriate interim committees be tasked with updating the guardianship laws and using 'people first' language in all statutes;
· Recommendation to the Department of Education that student tracking numbers be assigned at an earlier age;
· Listing of the Select Committee's accomplishments and the DD Division's progress;
· Support for a program and facilities study in the Department of Health;
· Inclusion of a behavior assessment tool in setting individual budget amounts;
· Continued development of the Real Choice Waiver program
Shawn Griffin, Community Entry Services and Regional Service Providers of Wyoming, advised the Committee that the cost-based payments bill is the most important item to providers. He reminded the Committee that the LSO Program Evaluation study was primarily concerned with payments to providers, and the Navigant study shows that the providers are underfunded, sometimes drastically so.
John Holderegger, Mountain Regional Services, stated that the current reimbursement formula method is not a bad one, if it is adequately funded, and that the DOORS method is not a "negotiated" payment system and has been approved by the Center for Medicare and Medicare Services, which has even recommended it to other states.
The next meeting was called for December 17 in Riverton. There being no further business, Co-Chairman Harvey adjourned the meeting at 4:50 p.m.
Respectfully submitted,
Senator Hank Coe, Co-Chairman
Representative Elaine Harvey, Co-Chairman
Appendix |
|
Appendix Topic |
|
Appendix Description |
|
Appendix Provider |
1 |
|
Committee Sign-In Sheet |
|
Lists meeting attendees |
|
Legislative Service Office |
2 |
|
Committee Meeting Agenda |
|
Provides an outline of the topics the Committee planned to address at meeting |
|
Legislative Service Office |
3 |
|
Proposed legislation: Wyoming state training school amendments. |
|
Letter to Committee from Sidney & Sharon Humberson |
|
Sidney Humberson |
4 |
|
Proposed legislation: Wyoming state training school amendments. |
|
Letter to Committee from Senator Della Herbst, Retired |
|
Della Herbst |
5 |
|
Proposed legislation: Wyoming state training school amendments. |
|
08LSO-0107.W3 Wyoming state training school amendments. |
|
LSO |
6 |
|
Proposed legislation: Wyoming state training school amendments. |
|
Suggested amendments |
|
Senator Case/LSO |
7 |
|
Comments from Regional Service Providers |
|
PowerPoint: The Select Committee on Developmental Programs 2002-2007 |
|
Brenda Oswald |
8 |
|
Dept. of Health-Developmental Disabilities Division |
|
Legislative Report: Early Childhood Social-Emotional Development Program |
|
Dept. of Health/Cliff Mikesell |
9 |
|
Proposed legislation: Developmental programs-cost based reimbursements. |
|
Wyoming's Developmental Preschool System Facts |
|
Child Development Services of Wyo./Sue Sharp |
10 |
|
Proposed legislation: Developmental programs-cost based reimbursements. |
|
HCBW Waiver Ratesetting Impact Analysis 2009/2010 Biennium Projections: Scenario Options Memorandum |
|
Navigant Consulting |
11 |
|
Proposed legislation: Developmental programs-cost based reimbursements. |
|
HCBW Waiver Ratesetting Impact Analysis 2009/2010 Biennium Projections: Handout 1 |
|
Navigant Consulting |
12 |
|
Proposed legislation: Developmental programs-cost based reimbursements. |
|
HCBW Waiver Ratesetting Impact Analysis 2009/2010 Biennium Projections: Handout 2 |
|
Navigant Consulting |
13 |
|
Proposed legislation: Developmental programs-cost based reimbursements. |
|
HCBW Waiver Ratesetting: Draft Model-Based Service Rates SFY 2008 |
|
Navigant Consulting |
14 |
|
Proposed legislation: Developmental programs-cost based reimbursements. |
|
08LSO-0154.W1 Development programs-cost based reimbursements |
|
LSO |