Committee Meeting Information

December 10-11, 2007

Room 302, Capitol Building

Cheyenne, Wyoming

 

Committee Members Present

Committee Members Present

Senator Charles K. Scott, Co-Chairman

Representative Jack Landon, Co-Chairman

Senator John Hastert

Senator Bob Fecht

Senator William Landen

Representative Ken Esquibel

Representative Mary Hales

Representative Timothy Hallinan

Representative Elaine Harvey

Representative Jerry Iekel

Representative Tom Lubnau

Representative Lori Millin

Representative Jeb Steward

 

 

Committee Members Absent

Senator Pat Aullman

 

 

Legislative Service Office Staff

Gerald W. Laska, Staff Attorney

Joy N. Hill, Associate Research Analyst

 

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.


Executive Summary

The Committee met on December 10 and 11, 2007.  The Committee considered proposed legislation  and voted to sponsor bills on the following topics:

            Workers compensation amendments                            Clinical trials of cancer drugs

            Medical safety event reporting                                                Reimbursement of Medicaid providers

            Public health emergency volunteers                            Physician recruitment incentives

            Long term care access programs                                 EMT retirement system

            Select committee to review health and social welfare institutions

 

The Committee decided not to sponsor a bill to change the burden of proof in workers' compensation cases involving a positive test for drugs or alcohol

 

Department of Health representatives advised the Committee on current utilization and proposed funding levels for the colorectal cancer screening program and the status of the SCHIP reauthorization legislation.

 

Wyoming Healthcare Commission representatives presented recommendations to expand access to health insurance by expanding the SCHIP program to cover parents of eligible children and poor adults without children.  The Committee declined to take action on those recommendations.

 

 

 

Call To Order (Monday, December 10)

Co-Chairman Scott called the meeting to order at 8:00 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 November 1-2, 2007 Committee meeting were approved without changes.

 

Consideration of Draft Legislation

 

08LSO-0225.W1          Workers compensation amendments.

Gary Child, Director, Department of Employment, explained the draft bill.  The bill would replace periodic extended total disability awards with a lifetime award, allow optional coverage for corporate officers, limited liability company members and general partners, and update provisions for granting premium credits to employers.  Director Child suggested that the Workers' Safety and Compensation Division is not ready to go ahead with the extended benefits change, and suggested that be removed from the bill.

 

The Committee discussed the bill and amended it to:

·         Remove the extended benefit changes from the bill;

·         Change the actuarial contingency for premium credits from "would remain actuarially sound" to " can reasonably be expected to remain actuarially sound";

 

 

Representative Harvey, seconded by Senator Landen, moved that the Committee sponsor the bill.  The motion passed on a vote of 9-4, with one excused.  Senators Scott, Hastert, Fecht and Landen and Representatives Hales, Harvey, Iekel, Millin and Steward voted aye.  Representatives Landon, Esquibel, Hallinan and Lubnau voted no.

 

08LSO-0226.W1          Workers compensation-burden of proof.

Director Child described the bill as an effort to increase workplace safety by creating a rebuttable presumption that an injury is not compensable if the injured worker tested positive to drugs or alcohol.  Senator Scott requested clarification on current law and Staff Attorney Laska explained that current law makes injuries caused by drug or alcohol intoxication non-compensable, but that the employer or the division carries the burden of proving that the intoxication caused the injury.  The Committee discussed various hypothetical situations under the current and proposed statute.  The Committee amended the bill to make the standard of proof a preponderance of the evidence rather than clear and convincing evidence for the employee to rebut the presumption of non-coverage.

 

Senator Fecht, seconded by Representative Iekel, moved that the Committee sponsor the bill as amended.  The motion failed on a vote of 13-0, with one excused.

 

08LSO-0255.W1          Clinical trials.

Susie Mullen, Wyoming Healthcare Commission, explained that the proposed bill (Appendix 6) would require health insurance to provide coverage for certain clinical trials in the treatment of cancer.  According to Ms. Mullen, the bill incorporates all of the recommendations of the Commission, including a limitation to state II, III and IV trials, approval of the study by the FDA or other appropriate agency and limitation of the required coverage to routine patient care costs.  The Committee amended the definition of "Clinical trial" to read "...an experimental course of treatment..." instead of "...a course of treatment...".  The Committee discussed generally the types of treatment that would be required by the bill, and the fact that drug companies no longer pay all of the costs associated with clinical drug trials.  Loretta Wolf, American Cancer Society, distributed copies of a letter (Appendix 7) from Benjamin T. Marchello, M.D. regarding the importance of clinical trials in cancer treatment and a fact sheet (Appendix 8) entitled, "The Costs of Routine Care Provided in a Clinical Trial are Comparable to the Costs of Standard Therapy."

 

Senator Hastert, seconded by Representative Harvey, moved that the Committee sponsor the bill as amended.  The motion carried unanimously on a vote of 13-0, with one excused.

 

08LSO-0110.W1          Medical safety event reporting.

Susie Mullen and Fran Cadez, Wyoming Healthcare Commission, presented the draft bill (Appendix 9).  They explained that the bill is the result of recommendations from the Commission's Patient Safety Task Force.  They further explained that the original patient safety reporting statute, W.S. 35-2-912, required reporting by hospitals of specified safety events, that the listed events came from the National Quality Forum ("NQF") and that the NQF is a nationally-recognized coalition of hospitals, the Joint Commission on the Accreditation of Health Care Organizations, the American Medical Association and the American Dental Association.  Since the NQF continues to revise its list of reportable safety events, the bill would repeal the list of specified events and authorize the Department of Health to specify by rule those events that must be reported.

 

The Committee amended the bill to delete the reference to the Joint Commission on the Accreditation of Healthcare Organizations, in directing the Department of Health to adopt rules, and replace it with a reference to the National Quality Foundation.

 

Senator Fecht, seconded by Representative Iekel, moved that the Committee sponsor the bill as amended.  The motion carried unanimously on a vote of 13-0, with one excused.

 

08LSO-0111.W2          Medicaid-provider reimbursement.

Department of Health representatives Brent Sherard, Teri Green, Greg Gruman and Jim Bush addressed the Committee.  They explained that there is no required timetable currently for the review and adjustment of reimbursement schedules for health care providers under Medicaid.  The proposed bill (Appendix 10) would require the Department of Health, as part of its biennial budget process, to establish a new reimbursement schedule for all providers.

 

The Committee discussed whether the bill would require an increase or simply require a biennial review process.  The Committee amended the bill to refer to "providers of services authorized pursuant to W.S. 42‑4‑103" instead of "health care provider services under this chapter".

 

Representative Lubnau, seconded by Representative Hales, moved that the Committee sponsor the bill as amended.  The motion carried unanimously on a vote of 13-0, with one excused.

 

08LSO-0112.W2          Public health emergencies-volunteers.

Dr. Brent Sherard and Dr. Tracy Murphy, State Epidemiologist, addressed the Committee.  They explained that there is currently no systematic way to authorize retired or inactive health care providers to volunteer in a public health emergency such as a flu pandemic.  They explained that the bill would provide civil tort immunity to those volunteers.  The bill would also require the respective state licensing boards to adopts rules for emergency licensing in a public health emergency, and, if time were not sufficient for board licensing, authorize the department of health to issue temporary provider licenses for the emergency.

 

Kevin Bohnenblust of the Wyoming Board of Medicine distributed suggested amendments to the bill (Appendix 12).  Mary Beth Stepans of the State Board of Nursing distributed "Facts Related to Nurse Volunteers needed in an Emergency" (Appendix 13).

 

The Committee amended the bill so that the immunity and licensure provisions apply to "health care providers who are retired, who have an inactive license or who are licensed in another state without a valid Wyoming license and while performing as a volunteer during a declared public health emergency as defined by W.S. 35‑4‑115(a)(i)".

 

Representative Iekel, seconded by Senator Fecht, moved that the Committee sponsor the bill as amended.  The motion carried on unanimously on a vote of 13-0, with one excused.

 

08LSO-0114.W2          Physician recruitment.

Representative Hallinan described the bill, which would authorize the department of health to award grants to local hospitals, medical practices and community organizations for the recruitment of physicians to practice in the grantees' communities.  The grants could in turn be used to pay recruited physicians for such items as travel expenses, relocation expenses, malpractice insurance premiums and signing bonuses, upon the physician's written agreement to practice in the community and provide medical care to poor persons for at least two years.

 

Proposed amendments to the bill were distributed by Representative Lubnau (Appendices 15 and 17), Senator Fecht (Appendix 16) and Representative Hallinan (Appendix 18).

 

The Committee amended the bill in the following major respects:

·         To authorize 10% of funds to be spent on advertising the recruitment program;

·         To implement an annual timetable for application grants and awards;

·         To provide that grants be prioritized by geographic need;

·         To provide that grants lapse if not used by the grantee to recruit a physician within one year;

·         To limit grants to recruit physicians from out of state, except those employed by the state or federal government;

·         To clarify that a grantee recruiting entity could be a hospital, medical practice or community organization;

·         To add a half-time position and $90,000.00/biennium for administration;

·         To increase the biennial appropriation from $400,000 to $800,000.

 

Representative Hallinan, seconded by Representative Millin, moved that the Committee sponsor the bill as amended.  The motion carried on a vote of 11-0, with Senator Aullman excused and Representatives Hallinan and Steward declaring a conflict.

 

08LSO-0115.W1          Long term care access.

Brent Sherard, Greg Gruman, Cliff Mikesell and Bev Morrow of the Department of Health addressed the Committee.  They explained that the proposed bill (Appendix 19) would authorize a state-funded continuation of a pilot project for long term care outreach that was previously funded by a federal grant.  According to Dr. Sherard, the Aging and Disability Resource Centers ("ADRC") provide a one-stop source of unbiased information about long term care and disability care resources.

 

The Committee discussed generally the expiration of the federal grant and the likelihood that the Centers for Medicare and Medicaid Services would not approve a state plan amendment to fund the centers through Medicaid.  Ken Hoff of Wyoming Independent Living Rehabilitation, Inc., distributed information on the pilot ADRC programs in Glenrock and Douglas, with a map of proposed centers under a state-funded program (Appendix 20).

 

The Committee amended the bill to delete references to a continuation of the federal pilot program, to authorize the department to fund centers through competitive grants and contracts and to make a general fund appropriation to the Department of Health in the amount of $1.5 Million.

 

Representative Hales, seconded by Representative Landon, moved that the Committee sponsor the bill as amended.  The motion carried on a vote of 9-4, with Senator Aullman excused.  Senators Hastert, Fecht, Landen and Scott and Representatives Esquibel, Hales, Harvey, Iekel and Landon voted aye.  Representatives Hallinan, Lubnau, Millin and Steward voted no.

 

08LSO-0250.W1          State health and social welfare institutions.

Senator Scott presented the bill (Appendix 21) to the Committee.  The bill would establish a select legislative committee and a governor's planning committee to jointly conduct a program and facilities review of the Department of Health institutions and programs provided at those institutions.  Staff distributed a budget estimate prepared by LSO for the bill (Appendix 22).

 

The Committee amended the bill to:

·         Clarify that the joint committee would recommend a long-term capital plan for the renovation of facilities required for its recommended program strategies, and for the sale, demolition, renovation, decommissioning or conversion of facilities not required for its recommended program strategies;

·         Add the Wyoming State Training School to the list of institutions to be included in the review;

·         Increase the number of representatives on the select committee from four to six;

·         Remove the joint committee's authority to make recommendations on individual personnel matters;

·         Appropriate $650,000 to the LSO for the select committee's expenses;

·         Appropriate $500,000 to LSO for expenses associated with three new positions and hiring of consultants;

·         Appropriate $45,000 for the expenses of the Governor's planning committee.

 

Senator Scott, seconded by Senator Fecht, moved that the Committee sponsor the bill as amended.   The motion carried on a vote of 12-1, with Senator Aullman excused.  Senators Hastert, Fecht, Landen and Scott and Representatives Esquibel, Hales, Hallinan, Harvey, Iekel, Landon, Millin, and Steward voted aye.  Representative Lubnau voted no.

 

08LSO-0224.W1          Emergency medical technicians.

Jim Mayberry of the Department of Health and Thomas Mann of the Wyoming Retirement System presented the bill (Appendix 23).  Mr. Mann also presented suggested amendments to the bill (Appendix 24).  According to Mr. Mayberry, the bill would create a retirement system for certified emergency medical technicians (EMTs), similar to the retirement system for volunteer firefighters, with costs paid in part by contributions from the entity for whom the EMT works and in part by state appropriation, with a state-funded 'catch-up' provision for half of a person's prior EMT service.

 

The Committee discussed generally: the similarities and differences between the proposed system and the firefighters' retirement; whether an EMT could stay in the system after no longer serving as an EMT; how long an EMT would have to be a participant to be vested; how vesting would work for someone who stopped volunteering as an EMT but left money on deposit in the retirement fund; and how much the state has appropriated to fund the volunteer firefighters' and law enforcement retirement funds.

 

The Committee amended the bill to:

·         Provide for annual actuarial audits of the fund;

·         Provide a surviving spouse's benefit equal to 50% of the retired EMT's benefit;

·         Amend the authorized retirement age, which would depend on the age of entry into the system;

·         Authorize an annual cost-of-living increase for beneficiaries based on the Wyoming cost-of-living index and not to exceed 2%/year;

·         Provide for vesting after five years of participation;

·         Provide one year of prior service credit for each two years of documented prior EMT service, exercisable until December 31, 2009;

·         Amend the one-time appropriation for prior service credits to $3.3 Million;

·         Authorize purchase of up to five years of service credit;

·         Authorize a participant with ten years' service to remain in the retirement system and continue to make contributions on his own behalf.

·         Appropriate $978,000 for the biennium for the difference between the amounts contributed on behalf of members and the actuarial cost of the retirement benefits.

 

LSO Staff Attorney Laska advised the Committee that there may be constitutional problems with the proposed bill.  He cited: Article 3, Section 30, prohibiting extra compensation to public officers after services are performed; Article 3, Section 36, prohibiting appropriations for charitable or benevolent purposes to persons not under the absolute control of the state; and Article 16, Section 6, prohibiting donations to any person except for support of the poor.  Chairman Scott reviewed the cited sections and requested a memo from LSO before the first standing committee meeting on the bill, especially as to the retroactive compensation provision.

 

Representative Steward, seconded by Senator Fecht, moved that the Committee sponsor the bill as amended.  The motion carried on a vote of 13-0, with Senator Aullman excused.

 

Department of Health Updates

Brent Sherard and Kim Rogers, Department of Health, presented an update on the Colorectal Cancer Screening Program enacted during the 2007 General Session.   They distributed a "Progress Report" on the program (Appendix 25).  The Committee discussed the inadequacy of the funding in the Governor's budget for continuation of the program.  Senator Scott noted that the proposed funding level would provide only a small fraction of the screenings contemplated by the Committee when the bill was passed last session.

 

Wyoming Healthcare Commission Updates

Rex Arney and Susie Mullen of the Healthcare Commission addressed the Committee.  They distributed a folder (Appendix 26) containing updates on the Commission's insurance access and affordability study and the status of federal legislation to reauthorize the State Child Health Insurance Program ("SCHIP").  They were jointed by Patty Guzman of the Department of Health KidCare Program.

 

The Commission recommended a state-funded expansion of the KidCare/CHIP Program in Wyoming to cover the parents of eligible children, state-funded insurance for the estimated 10,800 adults without children whose incomes are below the federal poverty level.  Ms. Mullen and Mr. Arney presented cost estimates for several eligibility and contribution scenarios.

 

Ms. Guzman reported that the state currently has sufficient funding to continue the KidCare/CHIP Program through June 30, 2008, but plans to begin preparing waiting lists in the spring if federal reauthorization legislation does not pass.  She also reported that the Department has submitted a waiver request to cover the parent's of KidCare eligible children, as authorized by 2007 legislation, that no response has been received from the Centers for Medicare and Medicaid Services and that every other state that has received a response has been denied the waiver.

 

Committee members generally discussed the cost of the proposals, the Governor's and the Legislature's degree of support for a state-funded health insurance program and the level of funding for KidCare/CHIP in the budget proposal.  Chairman Scott advised that, even if there were enough Committee votes for KidCare expansion, there would not be enough votes to pass the entire Legislature.  Chairman Landon agreed that he did not perceive the necessary enthusiasm to proceed with new state-funded health insurance programs at this time.

 

Statutorily Required Reports

Staff distributed a list of statutorily required reports from executive branch agencies to the Committee (Appendix 27).  By voice vote, the Committee selected those reports from the list that are no longer necessary and could be included in a repealer bill to be prepared by LSO.  Senator Scott moved that the Committee make a recommendation to the Legislative Management Council that all reports to legislative committees be limited to 2,000 words unless a longer report is specifically requested.  The motion carried on a voice vote.

 

Public Comment

Dan Perdue, Wyoming Hospital Association, advised that the Association will be seeking to restore funding for hospitals' uncompensated emergency medical care.  He also advised that changes to the State Loan and Investment Board have made it more difficult for hospitals to access funds for capital construction, so the Association is considering the possibility of a separate capital fund for hospitals.

 

Loretta Wolf, American Cancer Society, asked for the support of Committee members in restoring full funding for the colorectal cancer screening program.

 

Committee Business/Assignment of Sponsored Bills

Co-Chairman Scott advised that this Committee has traditionally deferred to the co-chairmen in assigning the bills to the respective chambers for introduction.  There being no objection, Chairmen Scott and Landon will divide the bills between the Senate and the House of Representatives.

 

Meeting Adjournment

There being no further business, Co-Chairman Scott adjourned the meeting at 4:20 p.m.

 

Respectfully submitted,

 

 

 

Senator Charles K. Scott, Co-Chairman

 

 

 

Representative Jack Landon, 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

 

08LSO-0225.W1  Workers compensation amendments.

 

LSO

4

 

Proposed legislation workers' compensation amendments

 

Memo to Chairmen from Dan Neal, Equality State Policy Center

 

Equality State Policy Center / Neal

5

 

Proposed legislation

 

08LSO-0226.W1  Workers compensation-burden of proof.

 

LSO

6

 

Proposed Legislation

 

08LSO-0255.W1  Clinical trials.

 

LSO

7

 

Proposed Legislation: Clinical trials

 

Memo from Nancy Skramsted to Benjamin T. Marchello, M.D.

 

American Cancer Society / Wolf

8

 

Proposed Legislation: Clinical trials

 

Fact Sheet:  "The Costs of Routine Care Provided in a Clinical Trial are Comparable to the Costs of Standard Therapy"

 

American Cancer Society / Wolf

9

 

Proposed Legislation

 

08LSO-0110.W1  Medical safety event reporting.

 

LSO

10

 

Proposed Legislation

 

08LSO-0111.W2  Medicaid-provider reimbursement.

 

LSO

11

 

Proposed Legislation

 

08LSO-0112.W2  Public health emergencies-volunteers.

 

LSO

12

 

Proposed Legislation: Public health emergencies-volunteers

 

Proposed rule; proposed bill amendments

 

Wyoming Board of Medicine / Bohnenblust

13

 

Proposed Legislation: Public health emergencies-volunteers

 

"Facts Related to Nurse Volunteers Needed in an Emergency"

 

Wyoming State Board of Nursing

14

 

Proposed Legislation

 

08LSO-0114.W2  Physician recruitment.

 

 

LSO

15

 

Proposed Legislation:  Physician recruitment

 

Proposed amendment

 

Representative Lubnau

16

 

Proposed Legislation:  Physician recruitment

 

Proposed amendment

 

Senator Fecht

17

 

Proposed Legislation:  Physician recruitment

 

Proposed amendment

 

Representative Lubnau

18

 

Proposed Legislation:  Physician recruitment

 

Proposed bill amendments

 

Representative Hallinan

19

 

Proposed Legislation

 

08LSO-0115.W1  Long term care access.

 

LSO

20

 

Proposed Legislation: Long term care access.

 

"Aging  and Disability Resource Center (ADRC):  The Resource Center"; ADRC Statewide Proposal

 

Wyoming Independent Living Rehabilitation, Inc.

21

 

Proposed Legislation

 

08LSO-0250.W1  State health and social welfare institutions.

 

LSO

22

 

Proposed Legislation: State health and welfare institutions

 

Appropriations calculations

 

LSO

23

 

Proposed Legislation: 

 

08LSO-0224.W1  Emergency medical technicians

 

LSO

24

 

Proposed Legislation:  Emergency medical technicians

 

Proposed amendments

 

Wyoming Retirement System / Mann

25

 

Department of Health Updates

 

Progress Report: Wyoming Colorectal Cancer Early Detection Program

 

Dept. of Health

26

 

Wyoming Healthcare Commission Updates

 

Folder containing WHCC recommendations on healthcare access and affordability

 

Wyo. Healthcare Commission / Mullen

27

 

Committee Business

 

Chart:  Reports to Labor Committee

 

LSO

 

                                          


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