File name: JAC Budget Hearings FY 13-14_20120117_124105.dcr Folder: C:\Documents and Settings\HAppropriations\Desktop\Recordings 2 ~ 1/17/2012 12:45:59 PM ~ Afternoon Session. 21 ~ 1/17/2012 1:02:45 PM ~ Berger: Begin with the Budget Book. 49 ~ 1/17/2012 1:03:13 PM ~ Forsland: Will turn over to Mr. Peck 57 ~ 1/17/2012 1:03:22 PM ~ Peck: Budget changes primarily rated to the IT. Few units eliminated vacant positions, vacant for over 20 months, exception requests, 1:44 ~ 1/17/2012 1:04:08 PM ~ Peck: Pg 18: Adjustment to standard budget of 49+ thousand, exception request to change a full time to part time, making part time full time. Realigning duties, reduction of GF. 56,440 rd eduction in GF 2:53 ~ 1/17/2012 1:05:17 PM ~ Peck: Pg 23, Reduction in GF related to IT funding. Exception request on page 24, replace 4 yr old IT hardware. 3:34 ~ 1/17/2012 1:05:58 PM ~ Meier: 8 drives, still using them? 3:46 ~ 1/17/2012 1:06:10 PM ~ Peck: yes, we are? 3:52 ~ 1/17/2012 1:06:16 PM ~ Berger: convert to microfilm 3:58 ~ 1/17/2012 1:06:22 PM ~ Peck: No microfilm or fiche. 4:08 ~ 1/17/2012 1:06:32 PM ~ Meier: Replace with newer media that is cheaper and more capacity? 4:24 ~ 1/17/2012 1:06:48 PM ~ Peck: Tape drives at facilites that are using old software so cheaper to replace the tape drives than to replace the software. Can find out. 5:02 ~ 1/17/2012 1:07:26 PM ~ Berger: Make certain on list with Mr. Waters and follow up. 5:16 ~ 1/17/2012 1:07:41 PM ~ Peck: Gov recommended reductin from 848 to 763,721. Better prices from mass purchases. 5:50 ~ 1/17/2012 1:08:14 PM ~ Berger: Discussing with Mr. Waters. time of systems beyond the 4 yr life. 6:08 ~ 1/17/2012 1:08:32 PM ~ Forslund: Will follow whatever policies they put forward, equipment and transistion of positinos to OCIO office out of Health Dept. 6:31 ~ 1/17/2012 1:08:55 PM ~ Peck: Part of purchase paid for with federal funds, can not identify which grant until we actually pay. 6:53 ~ 1/17/2012 1:09:17 PM ~ Peck: pg 28: Tax refund for elderly and disabled. Exception request. Changing part time to full time. Swapped two positions, the one I mentioned earlier. 7:37 ~ 1/17/2012 1:10:01 PM ~ Forslund: This program was put into dept of health, not the dept's expertise. Have to hire temps and ramp up and down, inefficient use of resources. Transfer to a revenue dept or other more appropriate place. 8:26 ~ 1/17/2012 1:10:50 PM ~ Berger: Remember why we put it in this division? 8:37 ~ 1/17/2012 1:11:02 PM ~ Nicholas: DFS does similar functions. 8:51 ~ 1/17/2012 1:11:15 PM ~ Meier: Eldery and disabled and health dept had a senior division. 9:07 ~ 1/17/2012 1:11:32 PM ~ Berger? 9:10 ~ 1/17/2012 1:11:34 PM ~ Meier: no comment 9:17 ~ 1/17/2012 1:11:41 PM ~ Berger: In the past, got a chart showing where we began with the refunding and where we are at today. 9:36 ~ 1/17/2012 1:12:00 PM ~ Peck: Can provide the information, applications and paid out for the last year. 9:51 ~ 1/17/2012 1:12:15 PM ~ Nicholas: Bret, staff check with DFS and Revenues to see if better agency for the program. 10:13 ~ 1/17/2012 1:12:37 PM ~ Jones: Will follow up 10:18 ~ 1/17/2012 1:12:42 PM ~ Peck: pg 32 Vital Statistics, GF reduction of 20,763 due to IT funding. exception request t oadjust federal funding, increase of 23,225 . pg 39 Health care financing: std budget reduction, split between GF and federal funds as it is a 50/50 match. Exc. request of funding change for payroll positions. Net effect is reduction in GF and federal funds .Example. Five positions whose funding changed. Next exception: Feds will give us .90 on the dollar to get a new eligibility system. Current system is old and has limitations. Must manually check a box that application is reviewed after one year, New system would have better interface. 30,230,500 request. 3+ million in GF and 26+ million in Federal funds. Two different federal funds as one reimbursment is at 90% and one is at 70% 14:35 ~ 1/17/2012 1:17:00 PM ~ Peterson: System used in other states, tracking, code changing, discussion this morning, fix problems? 15:02 ~ 1/17/2012 1:17:26 PM ~ Forslund: Current system: Someone applies for admittance to the program. DFS worker gathers information, determination of eligibility is manual so potential problems for human error. Director Corsi says info. must be handled manually twice. Very antiquated system that does not work well in determining eligibility. Not good for giving information. On January 1, 2014, must be prepared to take on another 30,000, must be able to link health system into health informattion exchange. Current system won't do that. To encourage participaton, feds have offered funding to update systems to meet new requirements. Most states in same situation we. Some states have systems in place. Talking to vendors and states with systems in place. Ready for RFP, will be run by OCIO office. need appropriaton. Feds will let us have base eligibility system for medicaid and other state programs. Platform 90% paid for by feds. It will be significantly less costly for ohter agencies to tag along. Three agencies working together: OCIO, Health and DFS. Workforce is monitoring. 19:53 ~ 1/17/2012 1:22:18 PM ~ Peterson: Can we do this in-housle, managing the software, getting full use of it? Do we look ata contractor? 20:31 ~ 1/17/2012 1:22:55 PM ~ Forslund: This is a component. Will not be one system that does what we talked about this morning. Need an MISS upgrade. Extract data, analysis, data mining. Key component, won't do everything. Rushed to get it in by Jan 2014. If we get approval this session, think we can make it. 21:48 ~ 1/17/2012 1:24:12 PM ~ Peterson: Federal happenings in health care, sooner the better to get on this. Do you feel it would be beneficial to have a contractor to get the full effects rather than depending in-house and waiting 3 years? 22:36 ~ 1/17/2012 1:25:01 PM ~ Forslund: We anticipate contracting this all out. Looking at buying off the shelf. Information extraction: Do not have a plan but will start to devlop it. This is key and has to be done. 23:45 ~ 1/17/2012 1:26:09 PM ~ Peterson: I see consulting services...How long is contract? 24:04 ~ 1/17/2012 1:26:28 PM ~ Forslund: In by 2014, so bulk of work in next biennium 24:21 ~ 1/17/2012 1:26:45 PM ~ Nicholas: Actual eligibility provided by DFS. Is all data populated by DFS? How does it work? 24:44 ~ 1/17/2012 1:27:08 PM ~ Forslund: New or current system? 24:52 ~ 1/17/2012 1:27:16 PM ~ Nicholas: Both. 24:58 ~ 1/17/2012 1:27:22 PM ~ Forslund: Focus on medicaid: DFS is the intake for applicants for medicaid program, look at, make determiniation for qualifying for program which is done manually. New system, you will ptu information in and answer will be spit out abuot eligibility. In terms of overall eleigibiilty system longer term, SNAP and other programs, this system can make determinations for those programs also. Right now feds will pay 90% for medicaid and for base. If later need to upgrade, we can use this platform and it will be cheaper to upgrade. Feds saying okay to build in a way for non-medicaid compnents to come in at a later time. 27:04 ~ 1/17/2012 1:29:28 PM ~ Nicholas: Program designed to allow you to better mine data and use it for other state uses? 27:37 ~ 1/17/2012 1:30:01 PM ~ Forslund: Yes but it is a step in that direction, to gather info, extract and view it. 28:03 ~ 1/17/2012 1:30:28 PM ~ Nicholas: OCIO maonitor dollars or devlopment of program? 28:20 ~ 1/17/2012 1:30:44 PM ~ Forslund: Viewing it as enterprise system beyond Dept. of Health. Project lead done by OCIO with Health and DFS as major players. Medicaid up and running by Jan 1, 2014 29:19 ~ 1/17/2012 1:31:43 PM ~ Edmonds: What is driving that date? 29:31 ~ 1/17/2012 1:31:56 PM ~ Forslund: Federal law is requiring an eligibility system by that date to handle the health exchanges that are supposed to be in place. Will handle eligible and non-eligible medicaid. 30:21 ~ 1/17/2012 1:32:45 PM ~ Edmonds: Designing upon that exchange? 30:31 ~ 1/17/2012 1:32:55 PM ~ Forslund: Do not have any idea what the exchange will look like, Put in place so that whatever decision is made, ready to take it on. What if AFCA is overturned? We need a new eligibility system anyway. Federal govt will pay 90% so let's take advantage of it. 31:56 ~ 1/17/2012 1:34:20 PM ~ Peterson: Software, programming, software. historical claims data, high list identification list for going after fraudulent users. Will program offer that type of info. Will it tie into AG office for fraud? 32:53 ~ 1/17/2012 1:35:17 PM ~ Forslund: This is an eligibility system. MMIS system contains more of the items you are talking about. Need to increase budget by 35 to 75 million, est. of 50 million for MMIS system. Feds will pay 90% of that, we would need 5 million or a portion put into budget at this time for MMIS upgrade. System needs replaced, written in Cobalt,, needs updated. Why didn't we put it into budget? Not ask for everything at once so start with eligibility. 34:52 ~ 1/17/2012 1:37:16 PM ~ Peterson: Eligivility important. Critical for medicaid reimbursement. 35:10 ~ 1/17/2012 1:37:34 PM ~ Nicholas: 20 years of how to keep track of these things. Feds prepare to pay 90%. Will go away someday. For the size of your budget, 5 million for the whole package is a discussion we should be having. Easy to implement, do not want to wast money, 36:24 ~ 1/17/2012 1:38:49 PM ~ Forslund: Two very large projects. State had one eligibility initiative they took on a few years ago which failed. Suggest fund eligibility system this time and give planning money for MMIS system. All states medicaid programs run a little different so need modification to any system. 100% eligibiity, start down road of MMIS system. 38:03 ~ 1/17/2012 1:40:28 PM ~ Nicholas: Present that plan to us before Monday, by friday. Trying to manage 1.8 billion, not doing a very good job. Put in 5 million to begin process of regulating and monitoring is small investment. 39:04 ~ 1/17/2012 1:41:28 PM ~ Peck: Gov recommended this budget request. Maintenance req. is only for 8 monhts. To fund for next bieenium would have to come back with exc request. IT new project, system needs implemented before maintenance begins. For this project around Nov 1 of 2013,. 8 months in this biennium and fund 16 months in the next bieemium. 40:24 ~ 1/17/2012 1:42:49 PM ~ Nicholas: Proved a spreadsheet showing total committment and federal participation rate at each phase, 5 years. At some point will have dual dystem, then old will drop off. Will be some overlap. Show it. Looka t entire profile: dollars committed, 41:42 ~ 1/17/2012 1:44:07 PM ~ Peck: pg 45, no std budget or exc request due to reorganization pg 48 Children's health, called CHIP or kid care, exception request for 5.1 million, 35% state funds for premium increase. Govenor denied. Wants us to come back with more certain amount, not estimate. 42:59 ~ 1/17/2012 1:45:23 PM ~ Von Flatern: Narrative has % swapped? Line 1, 43:17 ~ 1/17/2012 1:45:41 PM ~ Forslund: The narrative is incorrect, The funding is correct. 43:36 ~ 1/17/2012 1:46:00 PM ~ Nicholas: 10% cuts from Freudenthal era. Cap kid care enrollment at 5000? 44:01 ~ 1/17/2012 1:46:25 PM ~ peck 5800 44:05 ~ 1/17/2012 1:46:29 PM ~ Nicholas: Cuts implemented and have they held. 44:16 ~ 1/17/2012 1:46:40 PM ~ Peck: yes 5558 kids in program as of Jan. 44:26 ~ 1/17/2012 1:46:50 PM ~ Nicholas: Any of 10% cuts restored or have they been maintained? 44:39 ~ 1/17/2012 1:47:04 PM ~ Peck: Only cut restored was for DD providers, restored 50% of cut, ended up at 60% finally. 45:17 ~ 1/17/2012 1:47:41 PM ~ Nicholas: 20 million deficit. Is any part attributable to the re instatement of these cuts? 45:36 ~ 1/17/2012 1:48:01 PM ~ Peck: also cut children's hospital and Governor had us restore those cuts as well, prior administration. 45:55 ~ 1/17/2012 1:48:19 PM ~ Nicholas: Floor initiative, the children's hospital was Governor Freudenthal initiative. 46:18 ~ 1/17/2012 1:48:42 PM ~ Peck: Correct. Children 1.5 millin so we had to absorb in current budget. Infer that it contributes to deficiet. WDI funding would be the same way, absorbed in Dept. 47:11 ~ 1/17/2012 1:49:36 PM ~ Nicholas: See if any other categories were reinstated. Were cuts temporary or permanent? 47:44 ~ 1/17/2012 1:50:08 PM ~ Peck: Medicare cuts reduced and maintained except for DD waiver which was funded. Kept those reimbursement rates. Occasional adjustments for upper payment limits, adjust within program but balancing to funding we have. 48:25 ~ 1/17/2012 1:50:49 PM ~ Nicholas: Caps set by regulation or internal policy? 48:40 ~ 1/17/2012 1:51:04 PM ~ Peck:? 48:44 ~ 1/17/2012 1:51:08 PM ~ Nicholas: CHIP cap of 5800 enrollments. 48:55 ~ 1/17/2012 1:51:19 PM ~ Peck: Did that internally, it is 5900, not in statute, not Governor policy, Internal to achieve 10% cuts. 49:24 ~ 1/17/2012 1:51:49 PM ~ Nicholas: No impact if enrollment is at 5300. If cap is internal, how do we know when you approach it or people are turned away? 49:49 ~ 1/17/2012 1:52:13 PM ~ Peck: Provide a report to the legislature annually of S CHIP program. 50:11 ~ 1/17/2012 1:52:35 PM ~ BErger: move on 50:15 ~ 1/17/2012 1:52:39 PM ~ Peck: Page 52, Prescription Drug Program, no change to std, no exc. request. pg 55 Medicaid part D, no change, no exc request pg 57 Dual eligible excluded drugs: Not covered under medicare part D so pick up under medicaid, no change, no exc req. pg 60 Medicare buyin premiums, no adju, no exc. request. pg 62, WHIPP program, no change, no exception pg 64: Adult services, no adj, no exception request pg 66 children's services for medicaid, no adjustment but several exception requests. 52:44 ~ 1/17/2012 1:55:08 PM ~ Peck: Pg 66 Exception requests, Put together to discuss globally, We would not include in the standard budget and that we would bring it as an excetional requests. This is a one time requests. 55:21 ~ 1/17/2012 1:57:45 PM ~ Nicholas Why aren't we seeing a reduction when unemployment is improving 56:03 ~ 1/17/2012 1:58:27 PM ~ Forslund Essentially Yes There is no request in the exceptions to replace that. In the next biennium we feel that 56:43 ~ 1/17/2012 1:59:08 PM ~ Nicholas We know that 20 mill is to take care of the backlog, why would we just not give you 20 mill one time and not put it in the standard budget. 57:49 ~ 1/17/2012 2:00:14 PM ~ Peck We moved that money after July 1st. 58:06 ~ 1/17/2012 2:00:30 PM ~ Nicholas WE need another 37 mill. to fill the hole but it is a one hole 58:41 ~ 1/17/2012 2:01:05 PM ~ Forslund The hole is filled but we need to look to the future. 59:13 ~ 1/17/2012 2:01:38 PM ~ Nicholas The 48,9 is pulled down..... If we had budgeted in the ARRA funds... or did the budget get expanded 48.9 without legislative buy in? 1:00:19 ~ 1/17/2012 2:02:44 PM ~ Peck Keep in mind everything was being matched by the feds. During that time we were getting ARRA funds the feds were paying more than 50% What happens in 13/14 you still have those obligations If everything was 50/50 you had a holiday of having to provide the state portion. 1:02:31 ~ 1/17/2012 2:04:56 PM ~ Nicholas I wonder if you have free money you don't have to monitor your monies so closely. 1:03:27 ~ 1/17/2012 2:05:51 PM ~ Forslund I'll say on todays conditions, this is the right budget amount. 1:04:15 ~ 1/17/2012 2:06:39 PM ~ Meier Page 70 Is that the line item source If we are only putting in 37.7 at least 11 mill. 1:05:12 ~ 1/17/2012 2:07:36 PM ~ Peck The arra funds were distributed among several agencies. This is not the total, just the unit we are talking about now 1:06:14 ~ 1/17/2012 2:08:39 PM ~ Meier: The gov's message needs to be corrected. 1:06:39 ~ 1/17/2012 2:09:04 PM ~ Peck In stead of putting it in seven different sections and talking about seven different times, we combined them all into one place. You can really say it only applies to the 37 mill 1:08:15 ~ 1/17/2012 2:10:39 PM ~ Meier Your painting the entire 1:08:29 ~ 1/17/2012 2:10:53 PM ~ Nicholas If you are 1:08:54 ~ 1/17/2012 2:11:18 PM ~ Peck: What we would do is wait until we have a goood unit 1:09:47 ~ 1/17/2012 2:12:11 PM ~ Steward: Does that mean you have 37.7 mill in funds some where and waiting for matching federal funds 1:10:47 ~ 1/17/2012 2:13:11 PM ~ Peck You are entitled to be collected 1:11:23 ~ 1/17/2012 2:13:47 PM ~ Steward I would like to see a handout showing a 1:11:59 ~ 1/17/2012 2:14:23 PM ~ Nicholas Your team needs to know what target you are shooting for. Each team member could overspend their budget and go to that bucket and draw the money out. 1:14:00 ~ 1/17/2012 2:16:24 PM ~ Forslund: When a person comes onto a medicaid program, the state has to pay the bill. Your insurance company is going to say it is 1:15:28 ~ 1/17/2012 2:17:52 PM ~ Nicholas I understand cost shifting. I don't know if we will approve the 37.5 mill or not 1:16:16 ~ 1/17/2012 2:18:40 PM ~ Berger: Let's take a break 1:16:36 ~ 1/17/2012 2:42:59 PM ~ 1:16:41 ~ 1/17/2012 2:43:04 PM ~ peck: pg 68 Affordable Act We have to cover this if they are in higher catagory 1:18:04 ~ 1/17/2012 2:44:27 PM ~ Berger: next item 1:18:34 ~ 1/17/2012 2:44:58 PM ~ Forslund Make you aware of ACA 1:19:00 ~ 1/17/2012 2:45:24 PM ~ Peck: This request was denied because the Gov doesn't know what will be covered 1:19:43 ~ 1/17/2012 2:46:06 PM ~ Nicholas: These individuals will be forced on whether they want to or not 1:20:20 ~ 1/17/2012 2:46:43 PM ~ Forslund: Woodwork. Thes people will come out of the woodwork because they are being forced to be on it 1:21:06 ~ 1/17/2012 2:47:30 PM ~ Nicholas: Will the Fed Gov force them to be on by doing income tax check 1:21:53 ~ 1/17/2012 2:48:16 PM ~ Forslund: We don't know how they will check 1:22:22 ~ 1/17/2012 2:48:46 PM ~ ............... Yes Gov will check and force them on 1:22:56 ~ 1/17/2012 2:49:20 PM ~ Nicholas: Explain costs........ 1:23:27 ~ 1/17/2012 2:49:51 PM ~ Forslund: Costs are being paid through other ways. The Fed Gov will be paying 1:24:28 ~ 1/17/2012 2:50:52 PM ~ Nicholas: State cost..... They will payi 100% in the beginning and then it will go down but we don't know what they will really pay 1:25:45 ~ 1/17/2012 2:52:08 PM ~ Peck: page 69 ACA Gov. denied 1:26:22 ~ 1/17/2012 2:52:45 PM ~ Peck: Nursing Facilities Pg 73 S[plit cost between WY and Fed 1:27:47 ~ 1/17/2012 2:54:10 PM ~ Peck: Allowable costs usually of stafff and items they provide 1:29:01 ~ 1/17/2012 2:55:24 PM ~ Nicholas: What kind of vacancy are we seeing in the nurshing homes 1:29:29 ~ 1/17/2012 2:55:52 PM ~ Terry Green: Seen vacancies because people can go other places for rehab We have a cap 1:30:28 ~ 1/17/2012 2:56:52 PM ~ Nicholas What is it? 1:30:38 ~ 1/17/2012 2:57:02 PM ~ Green: I don't know 1:30:54 ~ 1/17/2012 2:57:17 PM ~ Nicholas; There are vacant beds and we are prepaid to cover the cost? 1:31:54 ~ 1/17/2012 2:58:17 PM ~ Peck; If you are below a certain %, they ...... Look at their audit report and positions so we can check. 1:33:48 ~ 1/17/2012 3:00:11 PM ~ Nicholas: Dojthey pay their nurses what we pay ours 1:34:36 ~ 1/17/2012 3:00:59 PM ~ Peck: They pay comperable 1:35:26 ~ 1/17/2012 3:01:49 PM ~ Meire: Nurses pays is more in an alhziemers unit? 1:36:03 ~ 1/17/2012 3:02:27 PM ~ Peck: AWe wouldn't know current costs 1:36:31 ~ 1/17/2012 3:02:54 PM ~ Green: We give each facility a perdiem. We don't have a rate.... 1:37:32 ~ 1/17/2012 3:03:55 PM ~ Nicholas If the Leg choose to reimburse chooses to do it for less and we did a budgetery statue limiting it what would happen? 1:39:09 ~ 1/17/2012 3:05:33 PM ~ Peck: Historic part--when nursing home was in a different budget group, they were given a 3% increase every year SO if we have a decrease in people in nursing homes, do we need to have a footnote to this 1:40:57 ~ 1/17/2012 3:07:21 PM ~ Nicholas: Do we need to do this in case this happens 1:41:27 ~ 1/17/2012 3:07:51 PM ~ Nicholas: This rebasing would apply to other other areas 1:42:04 ~ 1/17/2012 3:08:28 PM ~ Peck: State Statue says that if we rebase we need to have money for this 1:42:47 ~ 1/17/2012 3:09:11 PM ~ Nicholas: Provider needs to kow that we will pay the rate they need. 1:44:06 ~ 1/17/2012 3:10:30 PM ~ Peck One rate could go up and one rate could go down. Budget neutral We would use the cost report analysis and bring everyone's rate according to that. 1:45:11 ~ 1/17/2012 3:11:35 PM ~ Nicholas We reward people with high costs 1:45:35 ~ 1/17/2012 3:11:58 PM ~ Peck That is part of the...... You want to be 90% of the costs. 1:46:15 ~ 1/17/2012 3:12:38 PM ~ Nicholas When the labor committee discussed this, did they consider that. 1:46:49 ~ 1/17/2012 3:13:13 PM ~ Peck One was budget neutral Then they chose 1:47:20 ~ 1/17/2012 3:13:43 PM ~ Nicholas Terry said they did provide other options. We have been trying to keep a percentage above 90%, that is why we chose 92%. Our average cost is 63% 1:49:14 ~ 1/17/2012 3:15:37 PM ~ Berger Remind me if we have a cap on those costs. 85% occupancy 1:49:56 ~ 1/17/2012 3:16:20 PM ~ Peck The gov. did apporve it. Basically a bed tax The first two quarters 1.2 million The gov did approve 1:51:46 ~ 1/17/2012 3:18:10 PM ~ Nicholas What would the rate of increase be? 1:52:03 ~ 1/17/2012 3:18:26 PM ~ Peck Terry thinks 95% 1:52:22 ~ 1/17/2012 3:18:45 PM ~ Nicholas Right now at 80%, they are actually at 85% 1:53:03 ~ 1/17/2012 3:19:27 PM ~ Peck Page 80, IndianHealth services Page 82 Wyoming Life Resource Center Handout 152 Shows the crrent process. 1:54:36 ~ 1/17/2012 3:20:59 PM ~ Nicholas This is the 24milll that we talked about this morning. 1:55:27 ~ 1/17/2012 3:21:50 PM ~ Von Flatern There is a lot of money in this budget. IS that care available in othere facilities 1:56:18 ~ 1/17/2012 3:22:42 PM ~ Forslund, Currently they couldn't 1:56:43 ~ 1/17/2012 3:23:07 PM ~ Von Flatern 138,000 for a couple of ...... 1:57:33 ~ 1/17/2012 3:23:56 PM ~ Peck There are current costs that due qualify for reinmursement 1:59:00 ~ 1/17/2012 3:25:23 PM ~ Asay: Helth Centers meet a need 2:00:05 ~ 1/17/2012 3:26:28 PM ~ Nicholas How we developed a difference 2:00:29 ~ 1/17/2012 3:26:53 PM ~ Asay This is what elderly would qulify for . I also need to pass a ..................................... 2:01:42 ~ 1/17/2012 3:28:05 PM ~ Nicholas 2:01:46 ~ 1/17/2012 3:28:09 PM ~ Asay Federal regualtions require ......... I have to be up 2:02:48 ~ 1/17/2012 3:29:12 PM ~ Von Flatern Is that operation expense in one year? 2:03:42 ~ 1/17/2012 3:30:06 PM ~ Asay Is there ... 2:04:31 ~ 1/17/2012 3:30:54 PM ~ Nicholas About every 2 or 3 years we need to have you come down early and go through the budget. 2:05:46 ~ 1/17/2012 3:32:10 PM ~ Peck The gov did approve this request Page 85 No adjustment 2:06:30 ~ 1/17/2012 3:32:53 PM ~ Nicholas Do you have a chart that shows a waiting list 2:06:56 ~ 1/17/2012 3:33:19 PM ~ Peck We provided that to the budget office 2:07:21 ~ 1/17/2012 3:56:27 PM ~ session resumes 2:07:27 ~ 1/17/2012 3:56:33 PM ~ Berger: ED adult waivers on page 87 2:07:38 ~ 1/17/2012 3:56:45 PM ~ Peck: No adjustment to std budget. Pg 88 DD provider rate rebasing, required by statute every three years. 21 million request, Governor reduced to 2,883,150. When we fund a plan of care for an individual on waiver, do not spend 100% of the funding. Wording in statute requried us to base funding on total cost of services. Historically only spend 92%. Requirement for rebasing is the 2.,883,150 the governor recommended 2:09:25 ~ 1/17/2012 3:58:31 PM ~ Nicholas: Navigant study: Variable or actual costs looked at? 2:09:49 ~ 1/17/2012 3:58:56 PM ~ Newman: Calculation of rates. Clarification: 3 waivers dicsused are fee for waiver, Navigent, built up the rate based on the wage for service provided. Direct service workers, gather data from providers, factored in overhead, Not just based on cost submitting. Not establishing different reimbursemtns for different providers. 2:11:34 ~ 1/17/2012 4:00:41 PM ~ Nicholas: look at group of clients? 2:11:42 ~ 1/17/2012 4:00:49 PM ~ Newman: establish rates depending on level of staff the person needed. One on one up to one to four staff. A staff person with 4 clients. Tehre is a different rate for each level of service. Each person has a budget that is submitted with each persons care. Not negotiated, 2:12:48 ~ 1/17/2012 4:01:54 PM ~ Nicholas: How do you do it equitablly trying to control my cost? 2:13:11 ~ 1/17/2012 4:02:18 PM ~ Newman: Not sure of question 2:13:17 ~ 1/17/2012 4:02:24 PM ~ Nicholas: Rebuild a lower plan, based within parameters of what you are allowed. 2:13:33 ~ 1/17/2012 4:02:40 PM ~ Newman: Rebasing, revising rates to reflect the cost of providers based on what they are paying staff. If not getting sufficient funding, would reduce all those rates tby whatever % itwould take to stay in budget. 2:14:23 ~ 1/17/2012 4:03:29 PM ~ Nicholas: One is revenue neutral, one is this much? 2:14:37 ~ 1/17/2012 4:03:44 PM ~ Newman: 10% reduction,.....data ....what was claculated in what you have in front of you is rates calculated on Navegents rate and 6% . This is 6% plus 4% more . 2:15:30 ~ 1/17/2012 4:04:37 PM ~ Nichoals: Compounding problem that drives up costs? 2:15:41 ~ 1/17/2012 4:04:48 PM ~ Newman: 21 million: have never needed all that money, never asked for that money, knew the utilization rate, Not compounding effect, difficult to explain why that rate is so high. 2:16:36 ~ 1/17/2012 4:05:42 PM ~ Nicholas: 21 here and 13 down below, 4 on ..children. Frustrating answer to receive. Shock effect 2:17:08 ~ 1/17/2012 4:06:14 PM ~ Newman: Required to do that by statute, plan of care and services for all people up to June 30 for preceeding year. 2:17:31 ~ 1/17/2012 4:06:37 PM ~ Nicholas: Statute is work of select committee. How do you explain it to Senator Scott? Formulat drives 21 million whihc we would never ask for unless the statute required it. 2:18:14 ~ 1/17/2012 4:07:21 PM ~ Newman: Intent of select committee, funding to provide for all care needed over a year, always asking for what is in the plan of care. 2:18:46 ~ 1/17/2012 4:07:53 PM ~ Nicholas: Navigent study? 2:18:59 ~ 1/17/2012 4:08:05 PM ~ Newman Navigent report explains how rates are recalibrated based on rates of providers. 2:19:24 ~ 1/17/2012 4:08:30 PM ~ NIcholas: Expert to know? 2:19:30 ~ 1/17/2012 4:08:36 PM ~ newman: Need to know what is in care plan 2:19:38 ~ 1/17/2012 4:08:44 PM ~ Nicholas: ? 2:19:42 ~ 1/17/2012 4:08:49 PM ~ Newman: Valuable process to recalibrate rates to accurately rates of services provided, would reduce them across the board, 2:20:15 ~ 1/17/2012 4:09:22 PM ~ Nicholas: Give you a base so every one gets fair allocation based on recalibration? 2:20:32 ~ 1/17/2012 4:09:39 PM ~ Newman: It does. 2:20:37 ~ 1/17/2012 4:09:43 PM ~ Berger: New program, How people can acquire services? Cafeteria instead of all or non. appropriate time to discuss that. 2:21:20 ~ 1/17/2012 4:10:26 PM ~ Newman: Options waiver discussed in past. Made decision not to pursue that. Biggest cost factor on adult waiver is patient rehabilitation. Cost is significant and had no criteris for that, for people going into group homes. Tightened up the individual budgets. ........ 2:22:23 ~ 1/17/2012 4:11:30 PM ~ Forslund: Recent waiver . may be some discussion in session coming up. on removing this restrictions 2:23:12 ~ 1/17/2012 4:12:19 PM ~ Newman: Over 60,000 a year more per client for going into group home. Hoping to help more people on wait list because not funding that higher care. 2:23:40 ~ 1/17/2012 4:12:47 PM ~ Meier: Priority 24: Avg cost per year assumes 21 million would be forthcoming or at reduced rate of 144,175 in federal and gf? 2:24:13 ~ 1/17/2012 4:13:20 PM ~ Newman: Does not include that 21 million, does not include if we get the money for the additional 21 million 2:24:44 ~ 1/17/2012 4:13:50 PM ~ Meier: medicaid and state waiver? 2:24:53 ~ 1/17/2012 4:14:00 PM ~ Newman: Possible some people are on medicaid, when they get funding for community based, they are automatically qualified for medicaid so they are all getting medicaid funding. 2:25:26 ~ 1/17/2012 4:14:33 PM ~ Peck: Exc. Req to add federal funds to DD provider. Added 1.5 million but did not include the federal match when they restored that funding, asking for funds to get to 50/50 match. 2:26:09 ~ 1/17/2012 4:15:16 PM ~ Forslund: Next three deal with reductions in number of people on waiting list for waiver services. Governor established as one of his priorities. Move list down to a minimum of 12 months. Bill considered takes to 6 months. DD and ABI waiver. clears the waiting list. Narrative talks about need for quick services, like acquired brain injury. 2:27:33 ~ 1/17/2012 4:16:40 PM ~ Nicholas: Waiting list, required to give care to person on list longest. 2:27:51 ~ 1/17/2012 4:16:57 PM ~ Newman: Alternate betrween longest time on and greatest need. 2:28:02 ~ 1/17/2012 4:17:08 PM ~ Nicholas: Alternate. ABI patient need services within first 12 months will not get to them, unless you modify your plan. 2:28:34 ~ 1/17/2012 4:17:41 PM ~ Newman: Clarify why requesting funding for entire waiting list for ABI. 2:28:56 ~ 1/17/2012 4:18:02 PM ~ Nicholas: No waiting list and you live in Ft. Collins with a waiting list, drive to Laramie. 2:29:11 ~ 1/17/2012 4:18:18 PM ~ Newman: Must be a Wyoming resident. 2:29:21 ~ 1/17/2012 4:18:28 PM ~ Nicholas: Take a day 2:29:26 ~ 1/17/2012 4:18:33 PM ~ Newman: Requires an address. 2:29:33 ~ 1/17/2012 4:18:40 PM ~ Nicholas: anyone else come to Wyoming, get an address and w will take care ofyou. 2:29:46 ~ 1/17/2012 4:18:53 PM ~ Newman: People are coming to the state, other states have waiting list. 2:30:23 ~ 1/17/2012 4:19:30 PM ~ Nicholas: If went to Gov rec, would have shortest waiting list around. 2:30:38 ~ 1/17/2012 4:19:45 PM ~ Newman: Correct 2:30:43 ~ 1/17/2012 4:19:49 PM ~ Peterson: Funding for one year, then what. 2:30:52 ~ 1/17/2012 4:19:59 PM ~ Newman: Calculation is for biennium, Point in time waiting list, list grows month by month. 2:31:23 ~ 1/17/2012 4:20:29 PM ~ Nicholas: Constituency, will only solve problems for people who get benefits? 2:31:41 ~ 1/17/2012 4:20:48 PM ~ Berger: Clear the list and the next person to go on may wait two years. 2:31:59 ~ 1/17/2012 4:21:05 PM ~ Harshaman: Federal requirement for residency? 2:32:09 ~ 1/17/2012 4:21:16 PM ~ Newman: Different states with different requirements, determined by medicaid. 2:32:27 ~ 1/17/2012 4:21:33 PM ~ Harshman: Ours is one day 2:32:36 ~ 1/17/2012 4:21:42 PM ~ Newman; Correct 2:32:40 ~ 1/17/2012 4:21:46 PM ~ nicholas: Cap on what can provide, longest time to get on wait list? 2:32:54 ~ 1/17/2012 4:22:00 PM ~ Newman: Can check 2:32:59 ~ 1/17/2012 4:22:05 PM ~ Berger: Decided in rules and regulations or by statute 2:33:10 ~ 1/17/2012 4:22:16 PM ~ newman: In financial eligibility, must follow guidelines. 2:33:26 ~ 1/17/2012 4:22:33 PM ~ Berger: If we change the residency wait, would it change.... 2:33:50 ~ 1/17/2012 4:22:57 PM ~ Newman: 2:33:55 ~ 1/17/2012 4:23:02 PM ~ Peck: State plan sets the time and would need to be changed for the residency. 2:34:16 ~ 1/17/2012 4:23:23 PM ~ Nicholas: Lengthen residency, shorten list. Issue is maintenance of effort, maintenance of resources. Can you argue that we are providing more services for residents? 2:35:00 ~ 1/17/2012 4:24:07 PM ~ Peck: CMS would have to approve change in residency, 2:35:26 ~ 1/17/2012 4:24:33 PM ~ Nicholas: Permissible in federal regulations, some states have different times. 2:35:41 ~ 1/17/2012 4:24:47 PM ~ Newman: Would have to do for everyone on Medicaid not just Medicaid waivers. 2:36:05 ~ 1/17/2012 4:25:11 PM ~ Wallis: This makes sense. ABI where timliness matters, could ther be a rule that these folks would be on the list immediately if accident occurs in Wyoming? 2:36:34 ~ 1/17/2012 4:25:41 PM ~ Newman: Can check on. 2:36:41 ~ 1/17/2012 4:25:47 PM ~ Nicholas: Whatever residency requirement we require applies to all medicaid . Do we have any way of knowing because of style of living, lower cost of living, lower cost at college, that people stretching resources move to Wyoming. 2:37:39 ~ 1/17/2012 4:26:46 PM ~ Newman: Not aware of how to track. We do get calls from out of state people requesting wait list and residency info? 2:38:10 ~ 1/17/2012 4:27:17 PM ~ Nicholas: Are there states that tract that? 2:38:22 ~ 1/17/2012 4:27:29 PM ~ fNewman: Do not know 2:38:26 ~ 1/17/2012 4:27:33 PM ~ Berger: Report submitted 2:38:32 ~ 1/17/2012 4:27:38 PM ~ Newman: Correct 2:38:40 ~ 1/17/2012 4:27:46 PM ~ Peck: pg 91 Children's waiver, no adj to std budget, exception request to reduce waiting list to 12 months. 90 children at 4.6 million. 50/50 gf and federal fund, one time funding. 2:39:24 ~ 1/17/2012 4:28:30 PM ~ Peck: pg 95 exception request for grant going away. 50/50. used funds to get additional funds from the feds. will not renew this grant. Governor recommended that request. 2:39:59 ~ 1/17/2012 4:29:05 PM ~ Peck: pg 95 exception to reduce waiting list entirely for ABI. 50/50 split 2:40:32 ~ 1/17/2012 4:29:39 PM ~ Nicholas: pg 92 onetime or ongoing? 2:40:40 ~ 1/17/2012 4:29:47 PM ~ Peck: One time 2:40:45 ~ 1/17/2012 4:29:51 PM ~ Nicholas: Code would not know it, have to know Gov rec? 2:41:05 ~ 1/17/2012 4:30:11 PM ~ Peck: Correct...pulled out to create base budget for 15/16 2:41:19 ~ 1/17/2012 4:30:25 PM ~ Nichoals: If we put in in one time funding, what would our wait list be. 2:41:33 ~ 1/17/2012 4:30:40 PM ~ newman: Have some projections but if funding not approved would have to lower services or take people off the list. 2:41:54 ~ 1/17/2012 4:31:00 PM ~ Nicholas: Money has to go to meet clients needs or have same number of people leaving program 2:42:16 ~ 1/17/2012 4:31:23 PM ~ Newman: Correct 2:42:21 ~ 1/17/2012 4:31:27 PM ~ Nicholas: Double problem... 2:42:30 ~ 1/17/2012 4:31:37 PM ~ Newman: Correct 2:42:35 ~ 1/17/2012 4:31:41 PM ~ Nicholas: Is an option to take people off? 2:42:45 ~ 1/17/2012 4:31:51 PM ~ Newman: I do not think we do. Option once we say we are funding them, work within the budget we have and lower services people are receiving 2:43:09 ~ 1/17/2012 4:32:16 PM ~ Nicholas: Navigent rate of pay, more recipents and pro rata based on navigent assessment 2:43:35 ~ 1/17/2012 4:32:42 PM ~ Newman: In theory can do that. We have to meet assurances with waivers to get the federal match. Example given. Health and saffety needs must be met. 2:44:17 ~ 1/17/2012 4:33:24 PM ~ Nicholas: Plans can be adjusted down but must meet assurance level 2:44:34 ~ 1/17/2012 4:33:40 PM ~ Forslund: Will it put us in same position two years from now that we face today with lost ARRA funding? Told to find in existing budget 2:45:05 ~ 1/17/2012 4:34:12 PM ~ Nicholas: Discussed with chief executive officer, what was the response? 2:45:19 ~ 1/17/2012 4:34:25 PM ~ Forslund: All costs are so large, so important, should nto be put in standard budget, should be brought back and discussed again. 2:45:51 ~ 1/17/2012 4:34:58 PM ~ Berger: If funds go away, must review plans, lose out on continum of care. 2:46:09 ~ 1/17/2012 4:35:16 PM ~ Nicholas: Large program needs review every year, then expectation is to do review. Governor saying want vehicle examined every two years. Assume same threshold. In two years take care of these folks and eliminate the waiting list. Same test in two years. cost us 2.3 million plus we have to pick up the waiting list. Fair assessment? 2:47:42 ~ 1/17/2012 4:36:48 PM ~ Forslund: way I understand recommendation. If funded will take people off the waiting list and receive services. In two years if they are still receiving services will have to make budget exception request to fund it. Next year, can take funding away. 2:48:38 ~ 1/17/2012 4:37:44 PM ~ Newman: Our maintenance effort is a point in time, so have flexibility for number to go up to limit but not above it. Management of waiver. 2:49:25 ~ 1/17/2012 4:38:31 PM ~ Nicholas: Proof in history, Bob, any instance of one time funding did not have to continue because the cost went down? 2:49:51 ~ 1/17/2012 4:38:57 PM ~ Peck: Likely to have to rqeuest more money for this program. For childrens program, move 90 but only 83 may still receive services in two years and so ask for funding for them. May receive savings in Medicaid, need to be up front about it. Instead of 4.6, may say 3.9 then say due to medicaid cuts somewhere else must fund these. 2:51:11 ~ 1/17/2012 4:40:18 PM ~ Meier: Maintenance agreement: Number of clients irregardless of level of service means you are good to go. 2:51:36 ~ 1/17/2012 4:40:42 PM ~ Newman: Will double check that. Children's waiver have high turn over so had to work hard to stay above that number. Adhering to medicare waiver . 2:52:20 ~ 1/17/2012 4:41:26 PM ~ Meier: Irregardless of level of service? 2:52:28 ~ 1/17/2012 4:41:34 PM ~ Newman: Correct, taking into acocunt health and safety fearutre 2:52:46 ~ 1/17/2012 4:41:52 PM ~ peck: ABI one time funding. 2:52:53 ~ 1/17/2012 4:41:59 PM ~ peck: pg 98: long term care waiver, no adj or exc budget requ. 2:53:10 ~ 1/17/2012 4:42:17 PM ~ peck: pg 100 Assisted facility waiver, no adj, no exc request 2:53:24 ~ 1/17/2012 4:42:30 PM ~ Peck: Public Health Division, pg 104, State Health officer, IT services adj, Exception request at bottom of page for funding changes for all positions. 594,489 net savings for all of these 27 positions. Gov approval. 2:54:21 ~ 1/17/2012 4:43:28 PM ~ Peck: pg 110. adj to standard of 50489 in federal funds, no except. Public Health preparedenees Pg 114; 115, gov rec of reduction in federal funds. Have 3 exception requests, all related to funding added in JAC mark up last session. emergency medical unti, EMT training for 248,000, Total of 366, or 376, ooo . Biennializing this. Gov denied request. 2:55:54 ~ 1/17/2012 4:45:01 PM ~ Peck: Next esce request, physicam medical stipend, 204, oo0 biennialized to 408. Gov denied. Last request, 55000 biennialized to 110. Gov approved for one time funding 2:56:44 ~ 1/17/2012 4:45:51 PM ~ peck: pg 120: Poison Center, no adj, no Budget exc. Funding has not changed in 8 years Pg 122: Rural health unit, adj to std budget of 12,296 in federal funds, exc request to correct federal funing, net increase. one time funding 2:57:54 ~ 1/17/2012 4:47:01 PM ~ Wallis: EMS and trauma, Prioirty #13. Have trauma system in state, in place for a # years, functioning as it needs to. This expenditure looks like a redo. Reason we need to do this again? 2:58:41 ~ 1/17/2012 4:47:48 PM ~ Berger: jpg 117 2:58:46 ~ 1/17/2012 4:47:52 PM ~ Forslund: Referencing exc. request. told JAC had added it in mark up. 2:59:21 ~ 1/17/2012 4:48:27 PM ~ Wallis: I guess that doesn't get to my concern. This is not for creation of system. It is for a review of it. Anything preventing us from saying we do not need to review? 2:59:55 ~ 1/17/2012 4:49:01 PM ~ Forslund: State statute requires office of EMS to provide comprehensive system. Passed in 2008 to fund local trauma. not included in 11/12, JAC approved added monies for fiscal year 12. Initially set up, no funding for it. Subsequent years, JAC added money. Intent of JAXC 3:00:51 ~ 1/17/2012 4:49:58 PM ~ Edmonds You say this an ongoing expense. 3:01:34 ~ 1/17/2012 4:50:40 PM ~ Forslund The statute has stated that. I think the intent is that there would be a viable support for the rural community. If JAC says no, we will go back to 3:02:57 ~ 1/17/2012 4:52:04 PM ~ Pedersen On the gov's rec on page 124 3:03:29 ~ 1/17/2012 4:52:36 PM ~ Jones This came up in some of our prior discussion The gov wants to look at these 3:04:10 ~ 1/17/2012 4:53:17 PM ~ Jones No a B11 accomplishes the same thing 3:04:32 ~ 1/17/2012 4:53:39 PM ~ Peck Page 128 3:04:45 ~ 1/17/2012 4:53:51 PM ~ Nicholas As you understand the mechanism to set up the OCIC 3:05:34 ~ 1/17/2012 4:54:40 PM ~ Peck Most of the federal money we pay today are paid out of our federal grant money. Almost like billing for services. If we could help fund OCIC We provide the granting outhority Say we are going to spend $10,000 on IT, etc We do have 25% adjustment authority. We could 3:08:27 ~ 1/17/2012 4:57:34 PM ~ Nicholas Not paying for contract you 3:08:45 ~ 1/17/2012 4:57:52 PM ~ Nicholas Another option, can you just move it to another part of your budget 3:09:28 ~ 1/17/2012 4:58:34 PM ~ Peck If you don't spend the money, you would draw it down so it would just stay with the feds. I don't think you would actural....... Maybe just a billling and stay in the same expense What I would probably just ask the program manager and ask them to contact their federal counter part Page 134 No exception request Page 136 Organ Page 138 Page The is an Page 143 Oral Health $126,000 position state dentist part-time Standard budget for IT is about $15,000. 3:14:05 ~ 1/17/2012 5:03:11 PM ~ Forslund The position was one hold We got close to filling but the change in admin stoppped it. 3:15:04 ~ 1/17/2012 5:04:11 PM ~ Peck We are required now to pay that 3:15:25 ~ 1/17/2012 5:04:32 PM ~ Meier IS there any special provesions? 3:15:50 ~ 1/17/2012 5:04:57 PM ~ Peck They are not billing the feds directly 3:16:11 ~ 1/17/2012 5:05:17 PM ~ Nicholas Are these manatory services? 3:16:45 ~ 1/17/2012 5:05:51 PM ~ Peck It took special docs. It takes mulitple years too complete the process. 3:17:40 ~ 1/17/2012 5:06:46 PM ~ Meier I'm looking over on page 143 It also talks about access to care 3:18:18 ~ 1/17/2012 5:07:25 PM ~ Peck This program has more programs than just 3:18:50 ~ 1/17/2012 5:07:57 PM ~ Meier Is there any funding left in the oral section? 3:19:15 ~ 1/17/2012 5:08:22 PM ~ Peck We contracted with the schools and we provide Page 147 Reduction of the standard budget Request to continue for 3 mill to provide immuzinations. 3:20:31 ~ 1/17/2012 5:09:38 PM ~ Forslund The program was short of funds. We could not pay for all the coverage. WE scaled back, similpy the resources were not there to pay for it. If the Legislation wishes to return to fulll coverage. We estimate that cost to be 5.2 million That will return us to full coverage 3:22:31 ~ 1/17/2012 5:11:37 PM ~ Nicholas How do you dermine who gets it. 3:22:55 ~ 1/17/2012 5:12:01 PM ~ Braund: Universal coverage means all kids would get imuzinations Universal Select 3:24:03 ~ 1/17/2012 5:13:10 PM ~ Nicholas Does the existing budget allow enough resources to continue the program. 3:24:32 ~ 1/17/2012 5:13:38 PM ~ Braund: Yes 3:24:44 ~ 1/17/2012 5:13:51 PM ~ Edmonds Under the universal select, does 3:25:17 ~ 1/17/2012 5:14:24 PM ~ Braund: Approximately 40 % are covered 3:25:34 ~ 1/17/2012 5:14:41 PM ~ Peterson If we provide that to all kids when we are one of the lowest in the United States 3:26:18 ~ 1/17/2012 5:15:24 PM ~ Braund: Universal coverage is about access to vaccinations. The study is expensive and therefore it is based on a very small sampling 3:27:43 ~ 1/17/2012 5:16:50 PM ~ Peterson How much were we short? 3:27:59 ~ 1/17/2012 5:17:05 PM ~ Forslund. This biennium we were short 3:28:28 ~ 1/17/2012 5:17:35 PM ~ Edmonds Do we have the number we actually vacinated. 3:29:06 ~ 1/17/2012 5:18:12 PM ~ Braund The number of vaccinations provided is in the budget book 3:29:36 ~ 1/17/2012 5:18:42 PM ~ Edmonds So the children could be getting vacinated in a childrens clinic 3:30:24 ~ 1/17/2012 5:19:31 PM ~ Braund: Yes, that is correct 3:30:40 ~ 1/17/2012 5:19:47 PM ~ Edmonds The school enrollment requires those seven shots. 3:31:18 ~ 1/17/2012 5:20:24 PM ~ Berger We haven't impliminted a co-pay elament 3:31:45 ~ 1/17/2012 5:20:51 PM ~ Pedersen Why did you leave those 4 off 3:32:29 ~ 1/17/2012 5:21:35 PM ~ Braund: They looked at the cost of the vaccine and the mortality associated with them. Infintile pnemenio 3:33:39 ~ 1/17/2012 5:22:45 PM ~ Pedersen 3:33:48 ~ 1/17/2012 5:22:55 PM ~ Braund :That is correct for those who don't 3:34:19 ~ 1/17/2012 5:23:25 PM ~ Peterson I don't remember of the children who don't have insurance is in the minority. If the state pays for the drug and those with insurance pays again. There are two different providers 3:36:14 ~ 1/17/2012 5:25:20 PM ~ Nicholas I guess that the charges made by the insurance company are that they Immuzanation is so important, that we have made very inexpensive.. They would take trips overseas and always got them. The people who can afford them don't get them? 3:38:30 ~ 1/17/2012 5:27:36 PM ~ Braund: I think that people with insurance will get their kids shots. Bit I think we need to be mindful of their needs. Multiply shots 3:39:55 ~ 1/17/2012 5:29:02 PM ~ Nicholas If it is free, you just get another one. If you pay for it, you look up your records 3:40:37 ~ 1/17/2012 5:29:44 PM ~ Wallis Who has the immunization records? Lady 3:42:34 ~ 1/17/2012 5:31:41 PM ~ Wallis: Most parents have their children vacinated If parents have insurance whyi are we paying for them to go to the county health and we end up payuing for it? 3:43:54 ~ 1/17/2012 5:33:00 PM ~ Braund:: With our support of the program, it helps get all children vacanated 3:45:04 ~ 1/17/2012 5:34:11 PM ~ Wallis: if we did away with the entire program entirely and only did the vacination for the children who qualified... 3:46:01 ~ 1/17/2012 5:35:08 PM ~ Braund It is cheaper through the federal program, but if we only took care of the ones who qualify, we would be compromising the program 3:47:51 ~ 1/17/2012 5:36:58 PM ~ Edmonds: Which of these 13 shots are combined? 3:48:35 ~ 1/17/2012 5:37:42 PM ~ Braund: Yes, some of them are combines...... 3:49:01 ~ 1/17/2012 5:38:08 PM ~ Peck: This program was establishes through a statue so a new one would have to be done 3:49:29 ~ 1/17/2012 5:38:36 PM ~ Peck Maternal and Family on pg 152 Newborn screening needs an additional $58,00 Next is a reduction in block grant. Last request on page on 158 was for a home visitation. We have deleted this last one because of the time involvement 3:52:16 ~ 1/17/2012 5:41:23 PM ~ Nicholas: Lets take a short break and when wwe return if we just go through the ones that have an exceptions/ 3:53:14 ~ 1/17/2012 5:54:34 PM ~ Berger: 5 minutes only 3:53:21 ~ 1/17/2012 5:54:41 PM ~ 3:53:37 ~ 1/17/2012 5:54:57 PM ~ Peck pg 162 NextPg 166 3:54:19 ~ 1/17/2012 5:55:39 PM ~ ForslandPg 166 Nurses in both counties have been..... Then theyi changed their miind and wanted to be a part of it again. Some nursses were paid !00% and some weren't Sweetwater is county had changed their mind. Performance contract was what was approved. I was informed that I am not allowed and so When another district wanted to do that I had to say No We have 15 possions that have been vacant. This money is in the budget now. Natrona and Sweetwater are still interested but I need directions on this issue. 3:58:36 ~ 1/17/2012 5:59:56 PM ~ Hastert: I was in the middle of this with Natrona. I am aware of this Problems were difference in pay, days off, car provided etc. I met extensively with these counties to provide services with county instead of state perxssonnel. It oped up a lot of issues. I don't know if it could be done with a footnote instead of changing a statue. Not have state and county nurses under same program. I would be very interested in facilitating this 4:01:59 ~ 1/17/2012 6:03:19 PM ~ Nicholas We have 14 full time and 1 part time 4:02:23 ~ 1/17/2012 6:03:43 PM ~ Forlund: All in Sweetwater and Natrona Both counties ended their contracts 4:03:25 ~ 1/17/2012 6:04:45 PM ~ Haasert: In Sweetwater county they had had an issue with this years ago so they lost lots of monney. 4:04:24 ~ 1/17/2012 6:05:44 PM ~ Nicholas: If they can't get along and don't want the money.... 4:04:56 ~ 1/17/2012 6:06:16 PM ~ Hasert: It wasn't that they didn't want the money but their were lots of problems 4:05:33 ~ 1/17/2012 6:06:53 PM ~ Forslund Positions are in the budget 4:05:54 ~ 1/17/2012 6:07:14 PM ~ Pg 175 4:06:07 ~ 1/17/2012 6:07:27 PM ~ Peck Foot note on pg180 4:06:24 ~ 1/17/2012 6:07:44 PM ~ Peck pg 189, pg 192 --rebate money. pg 197--STD adjustment to the Fed grant pg 203 fund 4:08:03 ~ 1/17/2012 6:09:23 PM ~ Peck pg208 TB Pg228 positions 4:08:39 ~ 1/17/2012 6:09:59 PM ~ pg229 funds requested 4:08:56 ~ 1/17/2012 6:10:16 PM ~ pg243 Emergency detention Had problems with this No beds at hospital for person with mental problems. State picked the cost of the firsr\t few days and then go back to community. When thatrt bed is full and we can't transfer them back, causes a problem 4:11:27 ~ 1/17/2012 6:12:47 PM ~ Berger: Counties are looking at this 4:11:44 ~ 1/17/2012 6:13:04 PM ~ Forslund: Yes, this is a cost that has really shot up. They have issues of all kinds 4:12:40 ~ 1/17/2012 6:14:00 PM ~ Berger: Will this be dealt with this session 4:12:59 ~ 1/17/2012 6:14:19 PM ~ Forslund: There is no legislation planned for this session It is a concern for State Hospital and the county hospitals. We're to come up with the answer 4:14:11 ~ 1/17/2012 6:15:31 PM ~ Nicholas: Have District attornies found ways to shift the cost and a responsibillity 4:14:56 ~ 1/17/2012 6:16:16 PM ~ Forslund: Some have tried 4:15:10 ~ 1/17/2012 6:16:30 PM ~ Nicholas: Come back to us with an idea.... Howa do we know it's not bad management of beds 4:16:10 ~ 1/17/2012 6:17:30 PM ~ Forslund: We don't know and that 's why we dont have legislation at this time as we don't know all the problems 4:16:59 ~ 1/17/2012 6:18:19 PM ~ Nicholas: Who is consuming this bed? Who is paying 4:17:26 ~ 1/17/2012 6:18:46 PM ~ Forslund: We don't know because some of them are private hospitals 4:18:02 ~ 1/17/2012 6:19:22 PM ~ Forslund: Timing of transfer, beds, available..... 4:18:41 ~ 1/17/2012 6:20:01 PM ~ Nicholas: Alcohol, mental illness or ... 4:19:06 ~ 1/17/2012 6:20:26 PM ~ Forslund: Police get called to a business and they don't want to put them in jail so they get taken to the hospital 4:20:02 ~ 1/17/2012 6:21:22 PM ~ Forslund: Iss there some place we can put them? Train officers as how to treat or work with these people 4:20:55 ~ 1/17/2012 6:22:15 PM ~ Nicholas: Can the hospitals do it 4:21:13 ~ 1/17/2012 6:22:33 PM ~ Forslund: Hospitals don't waant to deal weith it State Hospital has their funds being used. It is the last resort. Patients that are there have patients much lonnger than they should. Qualified staff is another problem 4:23:08 ~ 1/17/2012 6:24:28 PM ~ Nicholas; Same population trying to keep them out of jail? 4:23:20 ~ 1/17/2012 6:24:40 PM ~ Forslund: How much are we putting into mental health services across the board for dept of health? Staggering around 134 million per year in 2011. Mental health related areas includes the State Hospital. Lot of money going to mental health facilities and also to private providers. WAMSAC representatives needing more money, so asked about cost escalation over the last 6 years. Emergency detentions, PRTF. More we put in, the more sick people we deal with. Where is return on investment? Not going in for request for mental health services, have to go in and ask for money for emergency detention which is 10 times higher than it was,. I do not have a lot of answers . 4:26:29 ~ 1/17/2012 6:27:49 PM ~ Nicholas: Families, young adults end up at SW Health. 4 or 5 appts, see counselors, not real providers, family members end up in hospital. Share your views. Putting money into mental health services for preventative care. Conclusion: not working. What units have services that go through mental health or substance abuse servcies. Say no to cost increases. Req increases for mental health and substance abuse, which units are looking for increases. 4:28:33 ~ 1/17/2012 6:29:53 PM ~ Forslund: ? 4:28:43 ~ 1/17/2012 6:30:03 PM ~ Nichoals: Mental health and substance abuses that want rate increases , say no 4:28:58 ~ 1/17/2012 6:30:18 PM ~ Forslund: Did not submit any request for increases in rates. 4:29:55 ~ 1/17/2012 6:31:15 PM ~ Peck: Pg 245 Shift nurses, pay for out of 100 series float 4:30:34 ~ 1/17/2012 6:31:54 PM ~ Forslund: If we have vacancies have to have temporaries, can not use vacancy position money, put in request. 4:31:06 ~ 1/17/2012 6:32:26 PM ~ Peck: pg 246: 5 requests related to equipment, repair and maintenance for state hospital. Revenue source is state hospital land account, 4:31:48 ~ 1/17/2012 6:33:08 PM ~ Nicholas: Why land fund account? 4:31:56 ~ 1/17/2012 6:33:16 PM ~ Peck: Have done that in the past, do not know what is in the incoem account. If you want to fund it through income account it is fine with us 4:32:23 ~ 1/17/2012 6:33:43 PM ~ Nicholas: Land account requires legislative approval, the income account, slipboard. Last budget swept a bunch of money back into the account so income account may be down. Two balances? 4:33:13 ~ 1/17/2012 6:34:33 PM ~ Jones: Skiiped a few items, position reductions, page 189 eliminate part time position in unit 0534, page 235, reduce GF from B!! process, agency 39, discussion in December. Page 243, reduction in GF associated with elimination of 2 Full time positions 4:34:20 ~ 1/17/2012 6:35:40 PM ~ Berger: page 247 4:34:28 ~ 1/17/2012 6:35:48 PM ~ Peck: page 254, First request federal grant funding. Second request required by statutue to adjust funding for preschool based on actual child account on November 1. Have a change for that. Gov recommended funding be reduced. We recalculated, can be reduced to 529344. Current funding level 4:35:45 ~ 1/17/2012 6:37:05 PM ~ Berger: page 255 and 256 4:35:52 ~ 1/17/2012 6:37:12 PM ~ mai: Land funds; State Hospital Land Fund 4.1 million ; land fund is 37.1, Income account is 472,000 4:36:41 ~ 1/17/2012 6:38:01 PM ~ jones: pg 256 Gov rec, reference to overstatement in GF of 270,814. We failed tro remove funding from item 626 on page 258. 4:37:26 ~ 1/17/2012 6:38:46 PM ~ Berger: repeat, pg 258, htsny psymrny 026 4:37:40 ~ 1/17/2012 6:39:00 PM ~ Jones: pg 256, 270,814 4:37:51 ~ 1/17/2012 6:39:11 PM ~ Meier: Land funds. 4.1 million, another land fund at 37.1 million, 4:38:17 ~ 1/17/2012 6:39:37 PM ~ Mai: State hospital permanent land fund at 4.1 million; Omnibus permanent land fund 37.1 million, Omnibus income 472000. 4:38:56 ~ 1/17/2012 6:40:16 PM ~ Berger: Thank you 4:39:00 ~ 1/17/2012 6:40:20 PM ~ Peck: Exception request 4:39:08 ~ 1/17/2012 6:40:28 PM ~ Nicholas: pg 256 Priority 2, 874 for sayus additional children, caption says for ECA. 4:39:34 ~ 1/17/2012 6:40:54 PM ~ Peck: Original request was going to have an ECA, pulled it out seperately. Next request deals with ECA and is more than just ECA. Cut funding by 10% in past, 8743 funding level instead of 9203 prior to cuts. Statute: need to bring foward request to restore funding level in statute. Amt required is 3,718,000 . 4:41:09 ~ 1/17/2012 6:42:29 PM ~ fNichoals: One time funding? 4:41:14 ~ 1/17/2012 6:42:34 PM ~ Peck: Page 265, equipment at wyoming life resource center. Postion reduction included in std budget rec total funding redictopm fpr 3 Fi;; to,e [psotpms. / 414,625 request approved by govt. Funding change at life resource center. includes the GF and federal fund. Funding from unit within dept of health, it is a transfer of fuids but medicaid will being making the payments. Footnote . 4:43:26 ~ 1/17/2012 6:44:46 PM ~ Peck: AGing division: page 274 exc requ to change positions. All are at our faciites. Requires an inc in GF and a dec in other funds. moved from retirement cneter which is funded 50/50 GF and medicaid, et. Reduction in GF. Page 278, pg 280 request is to biennialize. 4:45:06 ~ 1/17/2012 6:46:26 PM ~ peck: page 283, additional funding for federal grants 515, b376 page 286, page 299 is reduction in other funding source for pioneer home, more relect what they actually get. Pg 303 reduction in funding from ohter funds of 162,500 paid by sheriffs dept to provide meals, providing their own. Pg 312 to replace laundry facility at state hospital, through state building commission. SBC and Governor approved. SBC for 530000 two work on a master plan for the state hospital. 4:47:05 ~ 1/17/2012 6:48:25 PM ~ Berger: Congratulations and thank you. Laundry Facility. SBC recommending master plan. Do we complete laundry facility wihtout knowing the future of the facility. 4:47:32 ~ 1/17/2012 6:48:52 PM ~ Forslund: Facility in dire need of updating. More cost effective to build new. There is a need there. Legitimate capital improvement plan. We did not have plan. Need long term cpaital improvement plan to follow. At meeting, Nicholas asked better to fit or better to build new. Look at role of hospital lng terem and vision for future and infrastructure needed in place. Building commission approved money. Decision not made yet. If it is first part, we think 500,000 is more than we need, would like to look at other faciliteies. If it is second part...... 4:50:38 ~ 1/17/2012 6:51:58 PM ~ Berger: Thanks. 4:50:43 ~ 1/17/2012 6:52:03 PM ~ Meier: Think about privatizing the laundry services? 4:50:55 ~ 1/17/2012 6:52:15 PM ~ Forslund: No, have not looked at this. Asked question at Life Resource Center why paying so much, have lack of vendor. Contract with one firm, not sure if firm in Evanston can handle it. 4:51:43 ~ 1/17/2012 6:53:03 PM ~ BergerL Concludes today. Higher Ed at 8:00 tomorrow. 4:52:01 ~ 1/17/2012 6:53:21 PM ~ Mai: Board of equalization is up. 4:52:18 ~ 1/17/2012 6:53:38 PM ~ Berger: Schedule for tomorrow 4:52:26 ~ 1/17/2012 6:53:46 PM ~