File name: JACBudgetHearings2014_20131211_073936.dcr Folder: C:\Documents and Settings\happropriations\My Documents\JAC Audio 2014 0 ~ 12/11/2013 7:57:30 AM ~ 0 ~ 12/11/2013 7:57:30 AM ~ Start Recording 1 ~ 12/11/2013 7:57:31 AM ~ Dept of Health 5 ~ 12/11/2013 7:57:35 AM ~ Harshman, 2:38 ~ 12/11/2013 8:00:08 AM ~ Forslund: Introduction to dept - Life Resource Center Talking about public input. would transfer against wishes of clients. 4.1 to 5.1 annual savings could be generated. Eliminate 114 positions. Vacant positions. Options for decreasing the number of employees. New Administrator for facility. 6:13 ~ 12/11/2013 8:03:43 AM ~ Wallis 4.1 to 5.1 possible savings --40 vacant positions, positions above the vacant to be eliminated?Forslund: 4.1 to 5.1 in annual savings we cangenerate in time. Paert through reduction of staff. Remaining vacancies through attrition. problem with attrition, must fill critical positions while waiting for non critical positions to be vacated. 7:54 ~ 12/11/2013 8:05:24 AM ~ Stubson: Life Resource Center question 8:15 ~ 12/11/2013 8:05:45 AM ~ Forslund: seperate..independent report not tied to reconstruction or repurposing of facility. 8:35 ~ 12/11/2013 8:06:05 AM ~ Bebout: Question: P and A lawsuit in 80's and 90's - had to settle with P and A. Big issue was de-institutionalization. set aside money to modernize. What action do we ned to talk now as legislature ...to transition and make good institution better, and have efficiencys. Building changes. take on timeing and planning. 10:42 ~ 12/11/2013 8:08:11 AM ~ Forslund Purpose of study to close faciilty was public perception. Facility needs to stay open. We need the safety net. It needs modernized. Second study conducted. Recomend legislature sets aside money for these faciilties, put money into reserve account. we clarify purpose of the mission. Over time, faciities are old, purpose haas become unclear. Clarify the prupose and may rebuild. Then design what is needed. Lander, Ebanston and Basin. 14:14 ~ 12/11/2013 8:11:44 AM ~ Bebout: Interim schedule? 14:52 ~ 12/11/2013 8:12:21 AM ~ Forslund: 150 million for plan laid out, multiyear implementation. Immediate needs beginning at state hospital and Life Resource Center. Do not want to spend years, talking and developing phases as there are more immediate needs today. 15:50 ~ 12/11/2013 8:13:20 AM ~ Bebout: Do it in a way that makes sense. Agree with setting aside money, 16:25 ~ 12/11/2013 8:13:55 AM ~ Forslund: When we get clarity the money will be setting there. 16:51 ~ 12/11/2013 8:14:20 AM ~ Bebout: lucky to have abiity to set aside money. Thank goodness for minerals. 17:04 ~ 12/11/2013 8:14:33 AM ~ dockstader: Our independent providers are prepared to handle that. 18:17 ~ 12/11/2013 8:15:47 AM ~ Forslund: Life resource center is a safety net for more challenging clients. Is it a mix of clients or only for developementally disabled. Seniors with phsy problems, dually diagnosed with mental and developmental issues , 20:27 ~ 12/11/2013 8:17:57 AM ~ Perkins: Individuals ICAP service, on waiver versus residences, How do we determine when it is approriate for waiver program versus residency? 21:46 ~ 12/11/2013 8:19:16 AM ~ Forslund: State law erstricts or puts crieria in place for admittance to the life resource center. Report talking about cients spending 20 or 30 years at the facility prior to the availablity of community services. Today not as many people are going to Life resource Center...Upper 80's of clients, a few new ones. Guardian testimony of bad experience at various facilities, life resource center successful for them. Less than 90 people at LRC, vast majority being served in community settings. 23:53 ~ 12/11/2013 8:21:23 AM ~ Perkins: Restricted number of placements - Once current people "age out", situation will be exaceberated . could end up with 15 or 20 residents there. 25:31 ~ 12/11/2013 8:23:00 AM ~ Forslund: Point - clarification of mission. Think of today and the future, prepare for the proper role for state govt to provide ..private sector...long term basis 26:33 ~ 12/11/2013 8:24:03 AM ~ Perkins: 60 million on exception budget - is that first installment? 26:55 ~ 12/11/2013 8:24:25 AM ~ Forslund: first step. second study has 151 million in recommendations in two phases - Gov put 60 Milion in as a placeholder. 28:32 ~ 12/11/2013 8:26:01 AM ~ Nicholas: ? 29:36 ~ 12/11/2013 8:27:06 AM ~ Forslund: reply 29:49 ~ 12/11/2013 8:27:19 AM ~ Bebout: Lawsuit concerns - 30:25 ~ 12/11/2013 8:27:54 AM ~ Forslund: Savings by July 1 of next week means we have to move quickly and take dramatic cuts and I would not recommend it. 31:01 ~ 12/11/2013 8:28:31 AM ~ Perkins: Skill set of staff at WRC - What is effect on theraputic community dealing with ICAP? 31:42 ~ 12/11/2013 8:29:12 AM ~ Forslund: I do not recommend that this committee goes away. If positions go away, do not know if they leave the state or the profession. Follow up on clarity of purpose.--We have expertise at LRC for developemental diability, at state hospital for mental health issues. What happends when you have people with both problems> We do not have th combined expertise at either facility> 33:03 ~ 12/11/2013 8:30:33 AM ~ Perkins: Sign expertise encapsulated at state hospital and WRC..do not see leverage across state,.. 34:05 ~ 12/11/2013 8:31:35 AM ~ Forslund: There is a gap in terms of knowledge base in both facilities. Reorganized dept. Bringi expertise of both types to both facility. Evanston is for acute care. Lander is intermediate faciilty. 36:05 ~ 12/11/2013 8:33:35 AM ~ Perkins: Residents there for 5 decades. Lots of services in community based providers. still need transfer of knowlege interface between staff at instituion and community based. Knowledge transfer.. 37:19 ~ 12/11/2013 8:34:49 AM ~ Forslund: Welcome your participation in the study group. 37:31 ~ 12/11/2013 8:35:01 AM ~ Forslund: Report 2 is Facility Master Plan. Dept of health operates state hospital, wyoming life resource centrer, beterans home, retirement home in basin and home in thermopolis. Faciilties had no capital improvement plan. Facility commission arrpoved funding for state hospital review. Provided sufficent funds so all 5 could be reviewed. Facility master plan - safety issues and operational issue at 2 faciliteis, 100 year old buildings. Bldgs cause inc. operational costs. All facilities have unclear missions, needs to be discussed. Rec 151 million in two phases. Gov rec of 60 million for placeholder -special committee. 40:40 ~ 12/11/2013 8:38:10 AM ~ Bebout: Did work at state hospital in last 10 years, did we not work on it? Why is it priority? 41:15 ~ 12/11/2013 8:38:45 AM ~ Forslund: Work has been done, new facility and renovation. Two of buildings..other buildings need work as well as plant infrastructure. Ex: laundry buildings 42:18 ~ 12/11/2013 8:39:48 AM ~ bebout: Lander and Evanston - when built the idea was a campus with large buildings..over time, that construction does not fit the new modal. Fair assessment 43:00 ~ 12/11/2013 8:40:30 AM ~ Forslund: That is the case. Buildings built at a time when there were significantly more clients being served.. WLRC had 799 clients, now down. Not efficient 43:47 ~ 12/11/2013 8:41:17 AM ~ Perkins: # of buildings vacancy - looking at consolidating, funding improvements, large amount of acres. 44:31 ~ 12/11/2013 8:42:01 AM ~ Forslund: Second Report - needs of acreage versus what is available is in report, spin off or lease. 44:59 ~ 12/11/2013 8:42:29 AM ~ meier: Cost benefit analysis? spend 150 million, transportation savings? What is dollar gain on marginal efficiencies. 45:40 ~ 12/11/2013 8:43:10 AM ~ Forslund: Cost benefit is not in the report. will not recoup efficiencies to cover the 150 million. Ex: state hospital - brick buildings on concrete slab, earth quake zone area, not earth quake proof. bldgins will fall if there is an earthwuake. Safety issue, cost efficiency is just on aspect. 47:33 ~ 12/11/2013 8:45:02 AM ~ Forslund: Medicaid reform and redesign. state act 82 last session require redesign Waivers, long term care and medical services. 47:59 ~ 12/11/2013 8:45:29 AM ~ forslund: Waiver programs - support and comprehensive. Objective - to optimize svc to current client and to extend svc to clinet on waiting list..reducing funding for those on waivers to free up money for those on waiting list. Case study free of conflict of interest. Required 2 meetings. Dept had 25 meetings, 37 changes , review of CMS is ongoing, submit changes this spring. 49:33 ~ 12/11/2013 8:47:03 AM ~ Forslund: Long term care redesign_ 150 stakeholders attended, steering committee with 4 sub groups. implement changes by end of 2014. Payment reform changes recommendations wil be coming out. Nursing home. 50:35 ~ 12/11/2013 8:48:05 AM ~ fHastert: Waiver detail? 51:00 ~ 12/11/2013 8:48:30 AM ~ forslund: Exception request dealing with waivers. 51:20 ~ 12/11/2013 8:48:50 AM ~ Hastert: correspondance - reduce funding for those on waivers to free funding for those on the list, Impact on waiting list? avg wait time? 53:00 ~ 12/11/2013 8:50:30 AM ~ Harshman - finish overview 53:34 ~ 12/11/2013 8:51:04 AM ~ Meier: waiver expansion, Arbitrary change in number of clients , ratio of clients to provider. Ratio of provider to client,, . Diversified services in Goshen county. - theraputic jobs lost. Legislation not to take people off list but start a tier 1 and tier 2 list for services, get everyone off list, so everybody on list gets some level of care... 58:01 ~ 12/11/2013 8:55:31 AM ~ Harshman: Comfortable with questions, finish presentation, 58:30 ~ 12/11/2013 8:55:59 AM ~ Forslund: quick overview, more depth later. Redesign: Medicaid options study -Address costs int he medicaid rogram. Control costs. Dept worked with labor committe, put together options report. phase 1 - looked at costs 2nd phae - look at options 3 rd phase - final. Committee selected areas for us to focus. Out of study bill was passed last session. Waivers = 24% ogf spending in medicaid program, 2300 people on syustem. 151 millionf or 2400 people for both waivers and life resource wcenter. 600 on waitng list at the time. labor committee language - extend services to people on waiting list within the current budget. Only way to do that was to take funding from those in the system, give some to those on waiting list. WDH came up with plan. comprehensive wiaver for people with most needs. Support waiver for others. No clients or businesses wanted to lose funding. WDH is following through on the directive. Have not implemented because current waiver does end ....no dollar savings at this time. Complication of cutting 19 million of GF. For every dollar out of medicaid program, lose 1 dolar federal match. People think cuts are because of waiver but it is because of budget cuts. Comprehensive waiver for those most in need and a support waiver with a cap. As people come onto list, will be put into support waiver, unless they have comprehensive needs,.Will keep the 2300 on comprehensive wiaver but will assess each of them to check level of funding. will scale back to get savings. Ifwe make no changes and do not get new money, no one will come off the list, unless someone passes away or moves out of state. Sign reduction phased in over time. Assessments have not started yet. Plan being submitted to CMS. Discussion with Governor - need additional money to speed up process. Recommending anyone who has been on waiting list for 18 months or longer will be put on support waiver. 1:07:20 ~ 12/11/2013 9:04:50 AM ~ Harshman: out of 100 ratio of comprehensive or support waiver. 1:07:36 ~ 12/11/2013 9:05:06 AM ~ Newman: Very few on comprehensive right away..We have processes for emergency placement. less than 10% 1:08:24 ~ 12/11/2013 9:05:54 AM ~ 1:08:40 ~ 12/11/2013 9:06:10 AM ~ Perkins: Calrification - Report - most on support wiaver? 1:09:40 ~ 12/11/2013 9:07:10 AM ~ Harshman: over 90% 1:09:46 ~ 12/11/2013 9:07:16 AM ~ Forslund: yes - rework of program shows challenges of redesigning or changing existing govt program. People complain about how it is but making sign changes .... 1:10:38 ~ 12/11/2013 9:08:08 AM ~ Harshman: appreciate your work ...Waiting lists will grow so need to move forward. 1:11:04 ~ 12/11/2013 9:08:34 AM ~ Meier: Round numbers cost of two waivers? 1:11:16 ~ 12/11/2013 9:08:46 AM ~ Peck: Current waiver 65000 per year. 25000 per year for support waiver. 1:11:41 ~ 12/11/2013 9:09:11 AM ~ Burkhart: overview of services of waiver 1:12:03 ~ 12/11/2013 9:09:33 AM ~ Forslund: comp waiver = group home, residential care, sign intensive services, . Support waiver is dollar amount and the individual and case manager determine particular services the client needs... 1:13:20 ~ 12/11/2013 9:10:49 AM ~ Perkins: Support waiver - All waiverswill use the 25,000 or is there a review? 1:13:52 ~ 12/11/2013 9:11:22 AM ~ Forslund: Number includes support cost and medical costs. Support waiver services is a budgetr per person...may spend it all in one year, may not, will not be penalized for by reducing the amount for unspent funds., do not anticipate all of it being used. 1:14:57 ~ 12/11/2013 9:12:27 AM ~ Perkins: Example - 14000 benefits of adult waiver and happy with it. Get services you need versus everything that is out there. Not creating perverse incentive 1:16:08 ~ 12/11/2013 9:13:38 AM ~ Forslund: Take medical costs out, talking about support services, do not anticipate use of all money and can't spend over. Part of requirements of law is case management. Case manager for client without relationship to company providing the services, helpful in managing the budget. 1:17:18 ~ 12/11/2013 9:14:48 AM ~ Nicholas: Every waiver client has teh same amount or based on needs? 1:17:53 ~ 12/11/2013 9:15:22 AM ~ Forslund: support waiver per person. Amount less medicaid? 1:18:09 ~ 12/11/2013 9:15:39 AM ~ Newman: Budget for every adult is 16,500 per year. Child under 18 will 12,500 per year. children get support throug hearly intervention or special education, amount just for services, 1:19:53 ~ 12/11/2013 9:17:22 AM ~ moniz: Difference in 25000 versus costs given of 16,500 1:20:20 ~ 12/11/2013 9:17:50 AM ~ Peck: Total cost of 25000 includes 16500 for waiver, 6500 for medical and 3000 for case management. 1:20:50 ~ 12/11/2013 9:18:20 AM ~ Meier" Case management - requirements have increased, being paid 11 - 12 dollars per hour. Grandfather clause. Need to pay 12 or 15% for management? 1:22:17 ~ 12/11/2013 9:19:47 AM ~ Forslund: Dilema - explanantion of process - input based. Issues created with different drafts being questioned. Case managenment was changed based on input. A total of 37 changes based on input. Some things you have mentioned have been modifiedand changed. 1:25:43 ~ 12/11/2013 9:23:13 AM ~ Meier: understand process, 1:27:11 ~ 12/11/2013 9:24:41 AM ~ Forslund: Managed care - study is undereay hope for a mid year completion, present to labor committee this summer. Lots of changes being made, Bill passed last session. 1:27:58 ~ 12/11/2013 9:25:28 AM ~ Harshman: How have other states done that - hire others? 1:28:12 ~ 12/11/2013 9:25:42 AM ~ Forslund: 48 or 49 have hired others. Wyoming has not. open mind, Unique challenges, Pay per member per month for coordination of care system - hiring a thrid party - capitate the rate - gives clear costs. 1:30:04 ~ 12/11/2013 9:27:34 AM ~ Forslund: modernization of medicaid system infrastructure. MMIS - medicaid management syste and eligiblity system. Elegibility system is priorty 1 - hired Northrup ...system in place, will go live next month. system built; a rules based system. Elegibility is determined electronically..info can be checked. ..DFS inputs data twice on 30 year old system currently., determination of elegivility by DFS. Current system - client finds office, fills out paper application. Concept of One Stop SHop. new system gives multiple options for applying - 1. call center 2. Personal or library computer through federal exchange. if you don't qualify for federal exchange, qualify for medicaid will kick to our system or can go directly to our system 3. Can still go to DFS office and talk to a person. 1:35:06 ~ 12/11/2013 9:32:36 AM ~ Bebout: System set up to do what fed system can't do? 1:35:30 ~ 12/11/2013 9:33:00 AM ~ Forslund: How it should work once the fed system works - not seamless at this time. currently being sent a flat file and we have to verify it. Must rely on feds because we elected not to build our own exchange. 1:36:44 ~ 12/11/2013 9:34:13 AM ~ Bebout: Can you quantify savings? Definable outcome based info? 1:37:15 ~ 12/11/2013 9:34:44 AM ~ Forslund: 36 million on new syste. fed paid 90%. Cost savings or efficiencies from dollar system would probably be error rates. Error rates of someone not meeting qualifications being brought on. 1:38:16 ~ 12/11/2013 9:35:46 AM ~ Bebout: Computer software upgerades...keep cositng more, new system in anotehr 5 years. What is long term use tof this system? 1:38:41 ~ 12/11/2013 9:36:11 AM ~ Forslund: System is 2 parts - a base, components into base. Idea that social services programs have consistent, standardized system. First component is medicaid.. good system for long time.. upgrades will be needed. DFS will come in and ask for upgrade to put their component into base...ultimately system will be for all social services in state for years to come. DFS and WDH involved together in choosing system .Last time tried to change system, multi million dollars and scrapped. 1:41:12 ~ 12/11/2013 9:38:42 AM ~ bebout: In discussions with Mr. Waters or doing own thing? 1:41:34 ~ 12/11/2013 9:39:04 AM ~ Forslund: ETS is intimately involved in process, part of selection, development and implementation team. 1:41:54 ~ 12/11/2013 9:39:24 AM ~ Harshman: ETS service? Need to know how it is working. get work done? 1:42:27 ~ 12/11/2013 9:39:57 AM ~ ll satisfied, would liket o see some improvements...tremendous management challenge for Mr. Waters. 1:44:08 ~ 12/11/2013 9:41:38 AM ~ harshman: Managed care - What is in otehr states for cost savings..different modals, what is possible? 1:44:30 ~ 12/11/2013 9:42:00 AM ~ Forslund: Other states all over the board. Depends on the modal used, model that works. If managed are drives costs down, what does it do to infrastructure of state. If health care providers say they won't service medicaid patients, denial of access. Must balance . Coordinate care for 90,000 medicaid individuals that does not deny their ability to get care. We are on of the highest acceptance in the country for medicaid patients. We reimburse well nad promptly. 1:47:08 ~ 12/11/2013 9:44:38 AM ~ Stubson: clarification? Eligibilty system live next month - excahnge ready now? 1:47:37 ~ 12/11/2013 9:45:07 AM ~ Forslund: Today is not a seamless transition between the federal exchange to any state...still a technological issue. Citizen of Wyoming going on exchange to determine medicaid eligibility, the feds send it to us. 1:48:30 ~ 12/11/2013 9:46:00 AM ~ Stubson: plugged into old sytem or new?3Forslund: old system 1:48:43 ~ 12/11/2013 9:46:13 AM ~ Esquibel: Setting up our own exchange? 1:49:07 ~ 12/11/2013 9:46:37 AM ~ Forslund: Challenge technologically, elegibilty system has been relatively painless, good vendor, . if state made that decision, look at state that is working well. 1:50:06 ~ 12/11/2013 9:47:36 AM ~ Esquibel: Citizen from Wyoming navigating through fed system, navigating through all other states on the system. 1:50:42 ~ 12/11/2013 9:48:12 AM ~ Bebout: State exchange cost of 10 million provided? 1:50:58 ~ 12/11/2013 9:48:27 AM ~ Forslund: Insurance dept tasked with exchange problems, not WDH 1:51:12 ~ 12/11/2013 9:48:42 AM ~ perkins: reduction in error rate. What is it now? Goal? 1:51:27 ~ 12/11/2013 9:48:57 AM ~ Green: Review claims in DFS. took over by WDH 1 1/2 year ago. Fed partner is CMS. 10 major groups in medicaid. error rate historically is 3 to 40% - part of reason took tasks back in house. 40 to 50% was a small poulation but can be very costly. 1:53:18 ~ 12/11/2013 9:50:47 AM ~ Perkins: goal of error rate 1:53:30 ~ 12/11/2013 9:51:00 AM ~ Green: Elegibility system whre we will see reduction in error rate. automating decision making for accuracy and consistency. interfaces with other info for verification like for income. 1:55:10 ~ 12/11/2013 9:52:40 AM ~ Perkins: New eleigibility system - medical and financial needs 1:55:35 ~ 12/11/2013 9:53:05 AM ~ Gren: Numerous interfaces and checks and balances to track income of clients. 1:55:57 ~ 12/11/2013 9:53:27 AM ~ Perkins: What will this do to timliness of go or no go for eligibility? DFS caseworkers lost institutional knowledge. will this help with transition? 1:56:54 ~ 12/11/2013 9:54:24 AM ~ Green: Rules based syste has captured institutional knowledger, Eliminating personal interpretation. Many determinations wil be immediate. May refer them to ohter programs rto marketplace. 1:57:52 ~ 12/11/2013 9:55:22 AM ~ Perkins: Backstop for eleigibility system.? 1:58:06 ~ 12/11/2013 9:55:36 AM ~ Gren: Numerous quality control steps in processes and systems. random samples for eleigibiity, claims processing, 1:58:40 ~ 12/11/2013 9:56:10 AM ~ Wallis: Infrastructure 30 years old. MMIS ? timeline 1:59:01 ~ 12/11/2013 9:56:30 AM ~ Forslund: MMIS Medicaid Managment Information System 1:59:20 ~ 12/11/2013 9:56:50 AM ~ Harshman -break 1:59:25 ~ 12/11/2013 9:56:55 AM ~ Stubson: If a determination is adverse, is there an avenue to appeal? 1:59:48 ~ 12/11/2013 9:57:17 AM ~ Forslund: Yes, there is an appeal process in the old and new system. 2:00:08 ~ 12/11/2013 9:57:38 AM ~ Harshman: Be back at 12:10 2:00:28 ~ 12/11/2013 9:57:58 AM ~ 2:00:31 ~ 12/11/2013 9:58:01 AM ~ Pause 2:00:31 ~ 12/11/2013 10:11:26 AM ~ Resume 2:00:55 ~ 12/11/2013 10:11:50 AM ~ Forslund: MMIS performs various functions - claims for medicaid. Old system is antiquated and needs replacement...funds provided, and moving forward this year. $75M, federal government pays most. 2:02:37 ~ 12/11/2013 10:13:31 AM ~ Forslund: Performance Initiative - Performance Appraisal System, wanted to see bell-shaped curve. Met timelines; 8.6% excellent, 82.9% competant, remainder needed improvement. Health Stat info which looked at inputs, outputs and outcomes, which are now included in managers goals in the performance appaisal system. 2:05:25 ~ 12/11/2013 10:16:20 AM ~ Forslund: FY14 cuts implemented. $19M reduction, general fund. Also lost federal match. 5 programs were reduced. Preschool program cuts as to if maintenance of effort will be met for education grants. Should not reduce general fund contribution, $1.4M would be needed to maintanin federal dollars in FY15. Information relayed to joint labor committee. Department contacted AG office to verify nformation regarding preschool program. 2:11:45 ~ 12/11/2013 10:22:39 AM ~ Stubson: $1.4M serves as? 2:12:01 ~ 12/11/2013 10:22:56 AM ~ Forslund: $1.4M represents FY14 reduction in preschool program. $2.8M for the next biennium, if not cut. Program 78% federally funded and local organizations also contribute to this program. 2:14:20 ~ 12/11/2013 10:25:14 AM ~ Bebout: Built in COLA? 2:14:35 ~ 12/11/2013 10:25:29 AM ~ Forslund: Yes, must be brought to legislature. 2:14:52 ~ 12/11/2013 10:25:46 AM ~ Bebout: Biennium funding for DOH. 2:15:06 ~ 12/11/2013 10:26:00 AM ~ Richards: DOH cut was only for FY14, as most agencies were cut for FY14 and became standard budget. 2:15:56 ~ 12/11/2013 10:26:51 AM ~ Forslund: FY15-16 overview. Maintain status quo budget, including inflationary increases absorbed by agency. 6 exception requests include affordable care act implementation and coverage for those; federal policy change with regard to VA medications; continuation of modernization of medicaid infrastructure and transfer of staff for call center from DFS to DOH; reduction of existing medicaid waiting list; discussion for facilities updgrade process; legislative intiatives or requirements for hospital trauma; and immunizations. 2:22:08 ~ 12/11/2013 10:33:03 AM ~ Peck: Director's Office. Exception request 2:23:20 ~ 12/11/2013 10:34:15 AM ~ Forslund: Replacement of computers, $389,000 2:23:47 ~ 12/11/2013 10:34:41 AM ~ Stubson: Biennium item? 2:24:26 ~ 12/11/2013 10:35:20 AM ~ Forslund: Regular replacement program, 1/3 replaced every year. Could be made part of standard budget. 2:25:42 ~ 12/11/2013 10:36:36 AM ~ Stubson: 44 to 58 employees 2:26:07 ~ 12/11/2013 10:37:02 AM ~ Forslund: Reorganization and movement of fiscal from other divisions into director's office. 2:26:42 ~ 12/11/2013 10:37:36 AM ~ Hasburger: Any reclassififcations? 2:27:17 ~ 12/11/2013 10:38:12 AM ~ Forslund: No 2:27:21 ~ 12/11/2013 10:38:16 AM ~ Meier: Gain efficiencies? 2:27:55 ~ 12/11/2013 10:38:50 AM ~ Forslund: Gained consistency in operations, expertise and ability to project spending in particular programs, bench strength for future, communication in fiscal area. 2:30:35 ~ 12/11/2013 10:41:30 AM ~ Harshberger: 400 computers 2:31:35 ~ 12/11/2013 10:42:30 AM ~ Peck: If personnel travel, they get a laptop, not, receive standard. Truly replacement for 400 people 2:32:07 ~ 12/11/2013 10:43:02 AM ~ Peck: ETS consolidation, exception request. 2:32:59 ~ 12/11/2013 10:43:54 AM ~ Jones: Request for expanded ETS payments for cloud storage service and other IT needs of specific agency. 2:38:30 ~ 12/11/2013 10:49:25 AM ~ Burkhart: ETS versus DOH budget differences 2:39:06 ~ 12/11/2013 10:50:01 AM ~ Jones: Multiple units 2:39:46 ~ 12/11/2013 10:50:40 AM ~ Perkins: Depreciation Reserve utilized? 2:41:06 ~ 12/11/2013 10:52:00 AM ~ Jones: Not related to individual pieces of hardware placed in individual agencies. 2:41:51 ~ 12/11/2013 10:52:46 AM ~ Peck: Information Technology unit. Moved remaining costs into director's Office 2:43:01 ~ 12/11/2013 10:53:55 AM ~ Peck: Refund of sales, use of property taxes in this program.7400 applications annually. Steady applicatons last 4 years. Average refund $625 annually. 2:45:37 ~ 12/11/2013 10:56:32 AM ~ Meier: Potential budget cuts? 2:45:57 ~ 12/11/2013 10:56:52 AM ~ Forslund: 8% potential budget cuts for FY15-16. Not mandated yet, so no reduction planned. 2:47:38 ~ 12/11/2013 10:58:33 AM ~ Peck: Vital Statistics, standard budget. ETS data hosting request. 2:48:08 ~ 12/11/2013 10:59:03 AM ~ Peck: Health care financing division. Standard budget 2:50:01 ~ 12/11/2013 11:00:56 AM ~ Forslund: Exception requests include health care financing administration, $1.1M general fund to determine eligibility for manadatory population coverage by federal government. Administrative costs to processing claims. If fewer than anticipated people apply, will not spend funds. 2:54:33 ~ 12/11/2013 11:05:28 AM ~ Forslund: There are people who are eligible now, but have not signed up yet. Federal deadline of January 1, 2014 for coverage or face a penalty will encourage those eligible individuals to file. Over 700 people have come forward the last 2 months in the health exchange 2:58:32 ~ 12/11/2013 11:09:26 AM ~ Forslund: $1.8M request to replace current system; potential of costing $75M, eligible for 90% federal match. 2 more requested staff to manage project and contractor. Multi-year timeframe, 4 years, possibly 6 years. 3:00:36 ~ 12/11/2013 11:11:31 AM ~ Bebout: How much is needed for FY17-18? 3:00:56 ~ 12/11/2013 11:11:51 AM ~ Forslund: $5M 3:01:15 ~ 12/11/2013 11:12:10 AM ~ Nicholas: Time frame 3:02:01 ~ 12/11/2013 11:12:56 AM ~ Forslund: Is time limited, or match goes down from federal government 3:02:25 ~ 12/11/2013 11:13:19 AM ~ Green: 90/10 funding has been in place since inception of medicaid 3:02:52 ~ 12/11/2013 11:13:47 AM ~ Stubson: Broad selection of vendors? 3:03:21 ~ 12/11/2013 11:14:16 AM ~ Forslund: 6 bids received on new eligibility system. Explore contracting for services, as opposed to building system themselves. 3:05:54 ~ 12/11/2013 11:16:49 AM ~ Stubson: $75M request, however, other states have spent far less. Why? 3:06:29 ~ 12/11/2013 11:17:24 AM ~ Forslund: $75M is an estimate only, and early in process; other states numbers are also early in their process, whereas CO has spent $80M. 3:08:05 ~ 12/11/2013 11:19:00 AM ~ Forslund: Transfer of DFS personnel to department of health, 12 positions. Reclassified as jobs changed. 3:10:23 ~ 12/11/2013 11:21:17 AM ~ Forslund: Transfer DFS system maintenance to new eligibility system in department of health. 3:11:14 ~ 12/11/2013 11:22:09 AM ~ Peck: Children's health insurance program. Standard budget 3:11:52 ~ 12/11/2013 11:22:47 AM ~ Perkins: CHIP/medicais coverage 3:12:21 ~ 12/11/2013 11:23:16 AM ~ Forslund: Medicaid medical program, 6900 children, not on CHIP program 3:13:28 ~ 12/11/2013 11:24:23 AM ~ Sol: Chip Program 200% of poverty level. May be eligiible for medicaid program. Changes January 1, such as income sources 3:15:50 ~ 12/11/2013 11:26:44 AM ~ Meier: Transferring 1000 children from CHIP to medicaid, but keeping budget same. Why? 3:16:28 ~ 12/11/2013 11:27:23 AM ~ Peck: That is true, due to new criteria, however, there are new applications to SCHIP program. However, program premiums continue to rise. 3:18:15 ~ 12/11/2013 11:29:10 AM ~ Nicholas: How many are increased in the SCHIP program, and increased premium? 3:20:53 ~ 12/11/2013 11:31:48 AM ~ Green: Will supply at later date. 350 children increase over past 8 months 3:21:16 ~ 12/11/2013 11:32:10 AM ~ Peck: Prescription Drug Assistance Program. Standard budget 3:21:34 ~ 12/11/2013 11:32:29 AM ~ Stubson: Demands decrease due to mandatory expansion? 3:22:20 ~ 12/11/2013 11:33:15 AM ~ Forslund: New people will include 100% poverty and above, not eligible for medicaid. 3:23:40 ~ 12/11/2013 11:34:35 AM ~ Forslund: 17,000 potential eligible, not eligible for medicaid or the health exchange. 3:25:59 ~ 12/11/2013 11:36:53 AM ~ Peck: Medicaid, Part B premiums. Standard budget. 3:26:24 ~ 12/11/2013 11:37:19 AM ~ Bebout: Increasing due to retirees? 3:26:54 ~ 12/11/2013 11:37:48 AM ~ Peck: Have not seen increase 3:27:20 ~ 12/11/2013 11:38:14 AM ~ Meier: Fallback on page 51? 3:27:38 ~ 12/11/2013 11:38:33 AM ~ Peck: Medicaid eligible provided medicare prescriptions, state had to continue to pay % of insurance, but had a reduction in state's percentage. Federal government controls premiums stayed within budget past several years. 3:29:10 ~ 12/11/2013 11:40:04 AM ~ Peck: Dual Eligible Dual Drugs, Medicare Part D coverage. Consolidated into Prescription Drug Program. 3:30:16 ~ 12/11/2013 11:41:10 AM ~ Bebout: Federal requirement to provide? 3:30:32 ~ 12/11/2013 11:41:26 AM ~ Peck: No. Voluntary, and 50% reimbursement. 3:30:54 ~ 12/11/2013 11:41:49 AM ~ Peck: Medicare Buyin Premiums. Less expensive than covered by medicaid. Standard budget. 3:31:33 ~ 12/11/2013 11:42:27 AM ~ Peck: WY Health Insurance Premium Program. Qualified for medicaid, but less expensive to participate. Standard budget 3:32:43 ~ 12/11/2013 11:43:38 AM ~ Perkins: Assistance with co-pays and deductibles? 3:33:13 ~ 12/11/2013 11:44:07 AM ~ Sol: Cost effectives, pay lower of co-pay or deductible. 3:34:17 ~ 12/11/2013 11:45:12 AM ~ Peck: Medicaid Adult Services Program. Standard budget. Footnote to close out prior 07-09, 11-12 bienniums. 3:35:57 ~ 12/11/2013 11:46:52 AM ~ Bebout: Any further outstanding funds? 3:37:09 ~ 12/11/2013 11:48:04 AM ~ Peck: No. 3:37:15 ~ 12/11/2013 11:48:09 AM ~ Peck: Outstanding tobacco settlement funds revert back to federal program 3:38:24 ~ 12/11/2013 11:49:19 AM ~ Green: 90,000 people in medicaid, just 1/3 are adults annually 3:39:42 ~ 12/11/2013 11:50:37 AM ~ Peck: Children's Services Program. Standard budget 3:40:19 ~ 12/11/2013 11:51:14 AM ~ Forslund: Exception request for medicaid coverage, non-optional. 3,700 = $31M, with federal covering 50%; 6900 children, $30.6M with federal match of 65%. 3:42:26 ~ 12/11/2013 11:53:21 AM ~ Stubson: 6900 children moving from another program, now due to affordable care act, 3:43:41 ~ 12/11/2013 11:54:36 AM ~ Jesse: Study, 4600 children from private health care program 1000 from S-CHIP, another 1000 eligible, but no enrolled but will 3:44:40 ~ 12/11/2013 11:55:35 AM ~ 3:51:48 ~ 12/11/2013 12:02:43 PM ~ Stop Recording