File name: JACBudgetHearings2014_20131211_130153.dcr Folder: C:\Documents and Settings\happropriations\My Documents\JAC Audio 2014 0 ~ 12/11/2013 1:10:39 PM ~ 0 ~ 12/11/2013 1:10:39 PM ~ Start Recording 3 ~ 12/11/2013 1:10:41 PM ~ December 10, 2013 PM 048 - WDH - Dpt of Health 28 ~ 12/11/2013 1:11:06 PM ~ Peck: out of home placement, no exception request, gov rec of approval for the std budget 1:04 ~ 12/11/2013 1:11:43 PM ~ Harshman: growth? 1:10 ~ 12/11/2013 1:11:49 PM ~ Peck: some growth but costs down, some children in program who d not qualify for medicaid. 1:31 ~ 12/11/2013 1:12:09 PM ~ Wallis: 10 million inc in base budger? 1:39 ~ 12/11/2013 1:12:18 PM ~ Peck: Net to zero process, medical costs related to these children..medical costs out of children's budget and moved into this budget. not an increase. 2:17 ~ 12/11/2013 1:12:55 PM ~ harshman: where did mnoey come from? 2:25 ~ 12/11/2013 1:13:03 PM ~ Peck 0461 Medicaid Children's services 2:35 ~ 12/11/2013 1:13:14 PM ~ Peck; pg 71 Nursing facility svc. Medicaid eligible individuals, no exc req, gov approval 3:14 ~ 12/11/2013 1:13:52 PM ~ Esquibel: funds until 18? programs that fund between 18 and 21 for a foster out program? 3:40 ~ 12/11/2013 1:14:19 PM ~ Peck: some individuals can qualify up to age 21. 3:59 ~ 12/11/2013 1:14:38 PM ~ Esquibel: through you or DFS? 4:08 ~ 12/11/2013 1:14:46 PM ~ Peck: medical through dept of health, otehr svcs under DFS. Foster care child graduates from High school, there are some transitions services..in a few locations. 4:45 ~ 12/11/2013 1:15:23 PM ~ Peck 0463 - Nursing facility 4:59 ~ 12/11/2013 1:15:38 PM ~ Harshman: pg 71, 2 ,3 5:06 ~ 12/11/2013 1:15:45 PM ~ Peck" correct 5:14 ~ 12/11/2013 1:15:52 PM ~ stubson: ? changes relative to long term care facilities, boomers, more demand,. is availability growing? 5:47 ~ 12/11/2013 1:16:26 PM ~ Forslund: Nursing homes are in varying states of fiscal health. No rate increase in 7 years from medicaid. Not all patients are medicaid..upper 60 % of patients in nursing homes in wyoming are paid by medicaid. depends on mix of medicaid and private pay patients. Long term care study - recommendation for adjustments . 7:22 ~ 12/11/2013 1:18:00 PM ~ meier: LTC study - will it include alternative care besides facilities? 7:46 ~ 12/11/2013 1:18:25 PM ~ Forslund: LTC = nursing homes, full array of svcs that medicaid particpates in, 8:25 ~ 12/11/2013 1:19:04 PM ~ Meier: has aging parent, welcomes more info. 8:46 ~ 12/11/2013 1:19:24 PM ~ Peck: pg 74 - new unit called Hospice, bill requirement, medicaid pay for private hospice days. Moved estimate of total hospice care for division to this unit. 9:43 ~ 12/11/2013 1:20:21 PM ~ Perkins: Hospice - should save some money track amount of care in hospice or hospital 11:00 ~ 12/11/2013 1:21:38 PM ~ Forslund: national studies on expenditures - astronomical in last few months of life. No state study. 11:50 ~ 12/11/2013 1:22:29 PM ~ Perkins: would like to see info if it is available. 12:12 ~ 12/11/2013 1:22:50 PM ~ Bebout: co-sponsor of bill, believes it is a positive impact. 12:46 ~ 12/11/2013 1:23:25 PM ~ Peck: pg 76 - optional services adult covers medicaid svc not required under fed reg but state includes. Biggest component is prescripton drugs for adults, no exc. requ. Gove approval. 13:31 ~ 12/11/2013 1:24:10 PM ~ Bebout: How long for thsi one? 13:44 ~ 12/11/2013 1:24:22 PM ~ Peck: probably since inception of state plan, have probably added services like transplants. 14:18 ~ 12/11/2013 1:24:56 PM ~ harshman: how many affected in state? 14:27 ~ 12/11/2013 1:25:06 PM ~ Peck: 32,000 adults in medicaid program, probably each one has used svc like ambulance. 15:03 ~ 12/11/2013 1:25:42 PM ~ meier: Why is base so high compared to std? 37 m vs 11m 15:19 ~ 12/11/2013 1:25:58 PM ~ Peck: Net zero process. manufacture rebate from prescription drug. moved units, 16:03 ~ 12/11/2013 1:26:42 PM ~ Meier: ? 16:17 ~ 12/11/2013 1:26:56 PM ~ Peck: moved costs to align budgets. 16:50 ~ 12/11/2013 1:27:29 PM ~ perkins: non covered drugs ? 17:23 ~ 12/11/2013 1:28:01 PM ~ Peck: donought hole on medicare D. It does not apply here. 17:37 ~ 12/11/2013 1:28:15 PM ~ Perkins: prescription drugs? 17:50 ~ 12/11/2013 1:28:28 PM ~ peck: Medicare part D only applies to dual eligivle individuals - thos who qualify for medicare and medicaid. This picks up those not dual qualified 18:26 ~ 12/11/2013 1:29:04 PM ~ peck Pg 79 - Indian health services, fremont county, 100% match federal funds. Gov approval. 18:47 ~ 12/11/2013 1:29:26 PM ~ Bebout: Medicaid expansion to tribes? select committee recommending it. 19:09 ~ 12/11/2013 1:29:48 PM ~ Forslund: TRibal Relations committee - expand Medicaid, Legislature has prohibited expansion. not in our budget, not proposing it. 20:14 ~ 12/11/2013 1:30:52 PM ~ Bebout: Can you do it incrementally or is it all or none? 20:30 ~ 12/11/2013 1:31:08 PM ~ Forslund: CMS will not allow partial expansion. 20:41 ~ 12/11/2013 1:31:20 PM ~ Peck: pg 81 - Life resource center - no exc - gov approval 21:13 ~ 12/11/2013 1:31:51 PM ~ Meier: If there was an expansion, this population is served by waiver..? 21:31 ~ 12/11/2013 1:32:10 PM ~ Forslund: population is eleigible for medicaid so not eligible for higher rate of FMAP. 21:50 ~ 12/11/2013 1:32:29 PM ~ Bebout: SAvings made within unit stay within unit, not shifted out. How about a footnote saying that? 22:48 ~ 12/11/2013 1:33:26 PM ~ forslund: do not recall. What to do with savings call of legislature. 23:06 ~ 12/11/2013 1:33:44 PM ~ Bebout;... 23:11 ~ 12/11/2013 1:33:49 PM ~ Forslund: caution, we put out recommendations, don't want spending before we get there. Attrition, not overnight windfall. 23:49 ~ 12/11/2013 1:34:27 PM ~ Peck: pg 83 medicaid payments for wyoming state hospital, moved federal funds to 483 so eliminated this unit. 24:22 ~ 12/11/2013 1:35:01 PM ~ Peck: pg 85 DD adult waiver, gov rec approval, exception request. 24:44 ~ 12/11/2013 1:35:22 PM ~ Forslund: 9.7 M for exception request. 50 % GF 50% federal funds ..funds 172 individuals, 18 month or longer on waiting list, majority will be put on support waiver. 103 less people off list, set aside $ for people who will need comprehensive waiver. Reserve 660,000. Avg time for adult on a waiver is 14.3 years. in state 27:12 ~ 12/11/2013 1:37:50 PM ~ Bebout: Status with waiver with feds 27:21 ~ 12/11/2013 1:38:00 PM ~ Forslund: sumbitted to CMs - exchange of questions and answers. takes some time. Current waiver ends in June 2014. Hope for approval in advance. ask for extension from fed gov for existing waiver...contingent on implementation of the new waiver dual system. 28:45 ~ 12/11/2013 1:39:23 PM ~ Bebout: clarification 28:53 ~ 12/11/2013 1:39:31 PM ~ Forslund: with 28:59 ~ 12/11/2013 1:39:37 PM ~ Bebout: how many off list if only have dual? 29:09 ~ 12/11/2013 1:39:48 PM ~ Forslund: 172 would come off with the amount of money we are asing for with the new waiver. with old waiver and sam amount of money only take 69 off the list. 29:40 ~ 12/11/2013 1:40:18 PM ~ bebout: With only the new waiver and no money? 29:51 ~ 12/11/2013 1:40:30 PM ~ Forslund: New system but with no new money? 30:12 ~ 12/11/2013 1:40:50 PM ~ Bebout: correct 30:16 ~ 12/11/2013 1:40:55 PM ~ Forslund: range of 100 to 300 by 2018. 30:28 ~ 12/11/2013 1:41:07 PM ~ Meier: If we don't get approval from feds, but have money what do we do? 31:09 ~ 12/11/2013 1:41:47 PM ~ Forslund: Current waiver ends next summer, state can just let it go away and not provide service or can ask for a new waiver which can be a continuation of existing or something different. something has to get approved or feds won't contribute. All we have submitted is th eredesign. 32:18 ~ 12/11/2013 1:42:56 PM ~ Meier: Concern that old waiver will go away, will only have the new waiver. Is that scenerio? 32:52 ~ 12/11/2013 1:43:31 PM ~ Forslund: A new waiver with two tiers, with changes we have worked on. Providers, guardians, family members have been told what the new waiver is or will be. Until it is approved by cms, do not know other changes. People on comprehensive today will go on new comprehensive. new ones coming on will be put on support waiver unless needs are too great. 34:50 ~ 12/11/2013 1:45:29 PM ~ Meiers: People on waiver today will have to go to case management to determine if in comp or support waiver. 35:23 ~ 12/11/2013 1:46:01 PM ~ forslund: No. In 2014, need new waiver in place. CMS apprioval, transition individuals in current comp waiver into the new system. evaluating each for level of care and making some adjustments. If there are no adjustments, no money will be saved. Legislation objective is to serve the people on teh waiting list with the same amount of money ..Case managment - moving towards conflict free - 1 year to transition system. 37:40 ~ 12/11/2013 1:48:18 PM ~ Meier: Concerns - wants delay of new system, maintain old system. 38:39 ~ 12/11/2013 1:49:18 PM ~ forslund: Challenges: Legislature clear, prescriptive. We are folowing intent of the legislature. If we submit old wiaver it becomes the "new" waiver. If legislature says stop, have to pull back the new application and have current waiver extended for several years. 40:26 ~ 12/11/2013 1:51:05 PM ~ Stubson: Avg number of years on list = 14? 40:42 ~ 12/11/2013 1:51:20 PM ~ forslund: Avg amount of time is on the adult waiver. The waiting list changes every month. waiting list continues to grow. Some have been on for over 5 years. Exception request so that anyone on list more than 18 months will be taken off, as of 30 sept 2013. 42:12 ~ 12/11/2013 1:52:50 PM ~ Stubson: analysis of other alternatives, of months on list. ? 42:29 ~ 12/11/2013 1:53:07 PM ~ Forslund: Correct - from everyone off immediately up to 24 months, 43:03 ~ 12/11/2013 1:53:41 PM ~ stubson: Beyone 24 months 43:11 ~ 12/11/2013 1:53:49 PM ~ forslund: Can do that. Arbitrary number but for person on list is big number. 43:31 ~ 12/11/2013 1:54:09 PM ~ Stubson: provide to committee? 43:41 ~ 12/11/2013 1:54:20 PM ~ Forslund: how far up for months. 43:48 ~ 12/11/2013 1:54:27 PM ~ Stubson - up to 30 months. 43:56 ~ 12/11/2013 1:54:35 PM ~ Forslund: For 24 months..12.3 million to wipe off immediatley.. 4 million difference 44:27 ~ 12/11/2013 1:55:06 PM ~ Stubson: List, evaluation. Would people on comprehensive stay no matter how long. 45:05 ~ 12/11/2013 1:55:44 PM ~ Forslund: Grandfathered but not necessarily the same dollar amount, will be evaluated and based on needs, funds will be appropriated. 45:32 ~ 12/11/2013 1:56:11 PM ~ Stubson: time limit? 45:38 ~ 12/11/2013 1:56:16 PM ~ Forslund: No time limit set. 46:14 ~ 12/11/2013 1:56:53 PM ~ Moniz: Request based on assumption of approval of 2 tier system? 46:31 ~ 12/11/2013 1:57:09 PM ~ Forslund: yes 46:36 ~ 12/11/2013 1:57:14 PM ~ Moniz: pretty sure system will be approved? 46:45 ~ 12/11/2013 1:57:24 PM ~ Forslund: working closely with cms during the process. anticipate approval, 47:31 ~ 12/11/2013 1:58:10 PM ~ Esquibel: Cost savings from TANIF last year, what portion of funds in those offsets. Adult DD waiver, if we expanded medicaid, how much of an offset? 48:21 ~ 12/11/2013 1:59:00 PM ~ Forslund: people eligible today, won't change because of the expansion. 17,600 are adults who do not meet requirements of age, blindness, pg woman, categories of eligibility. This group is already eligible so not offsets. 49:40 ~ 12/11/2013 2:00:18 PM ~ Esquibel: can you point out offsets? 49:48 ~ 12/11/2013 2:00:27 PM ~ Forslund: mental health and substance abuse. 49:58 ~ 12/11/2013 2:00:36 PM ~ Peck: pg 88, UV children's waiver, gov approval. Esception req 50:18 ~ 12/11/2013 2:00:56 PM ~ Forslund: Remove children on the waiting list, 115 of 298 children on list will be funded. fAvg time on waiver for a child who transitions from child t oadult is 32.8 years. 15.4 M for all off the list, 4.1 M if all are off list in 24 months. 51:26 ~ 12/11/2013 2:02:05 PM ~ Peck: Pg 91 - 51:49 ~ 12/11/2013 2:02:27 PM ~ Forslund - 51 people off of waiting list, 4.6 years average time, out of 74 52:36 ~ 12/11/2013 2:03:15 PM ~ Peck: Long Term Care Waiver. Standard budget 53:01 ~ 12/11/2013 2:03:40 PM ~ Peck, page 97, Assisted Living Waiver. Standard budget 53:17 ~ 12/11/2013 2:03:56 PM ~ Bebout: Openings? 53:54 ~ 12/11/2013 2:04:33 PM ~ Green: Open slots, waiting list; people in communities where there are no slots. 54:24 ~ 12/11/2013 2:05:02 PM ~ Peck: Page 101, total 266 positions in division. Page 102, public health divison administration. Standard budget 58:10 ~ 12/11/2013 2:08:48 PM ~ Peck: Page 106, Public Health Preparedness, standard budget 58:27 ~ 12/11/2013 2:09:06 PM ~ Peck: Page 110, Emergency Hospital. Standard budget 58:41 ~ 12/11/2013 2:09:20 PM ~ Forslund: Exeception request to fund trauma review in 3-year review of hospitals statewide. 59:39 ~ 12/11/2013 2:10:18 PM ~ Peck: Page 115, consolidated into Emergency Medical Services Page 117, Rural and Frontier Health, standard budget 1:00:19 ~ 12/11/2013 2:10:58 PM ~ Peck: Consolidated into 510, next 5 units. 511, 513, renal dialysis, organ donation units telehealth unit 1:02:34 ~ 12/11/2013 2:13:12 PM ~ Richards: Total balance in tobacco settlement fund available 1:04:03 ~ 12/11/2013 2:14:42 PM ~ Peck: 132, community and public health admin consolidated 1:05:16 ~ 12/11/2013 2:15:54 PM ~ Peck: unit 135, oral health. Standard budget 1:05:30 ~ 12/11/2013 2:16:08 PM ~ Peck: Unit 139, immunization. Standard budget 1:05:42 ~ 12/11/2013 2:16:21 PM ~ Forslund: $2.7M to children who don't qualify for federal program, exception request. 1:08:17 ~ 12/11/2013 2:18:55 PM ~ Stubson: Vacinnations to children, had to be coverage under affordable care act. 1:09:31 ~ 12/11/2013 2:20:10 PM ~ Forslund: Affordable Care Act, 83,000 people within state without insurance. Tax is relatively small initially; indpendence; lower income levels will have access to immunizations. Slightly higher income levels may not carry insurance, or proivider will not carry, therefore, vaccination issue. 1:12:29 ~ 12/11/2013 2:23:08 PM ~ Braund: Issue of access, but if local provider is not carrying vaccine, no immunization to children. Vaccines are money losers for providers. 1:16:15 ~ 12/11/2013 2:26:54 PM ~ Nicholas: Which ones dropped? 1:21:02 ~ 12/11/2013 2:31:41 PM ~ Braund: Listed 4 which were chosen due to not being required for school entry. 165,000 vaccines administered in 2012. 1:28:18 ~ 12/11/2013 2:38:57 PM ~ Perkins: S-CHIP covered children, are vaccines covered for children? 1:28:43 ~ 12/11/2013 2:39:22 PM ~ Braund: The state annot charge doctors for repayment of vaccines. 1:29:16 ~ 12/11/2013 2:39:55 PM ~ Forslund: Yearly basis for costs of $1.6M, need $3.2M for biennium 1:29:58 ~ 12/11/2013 2:40:36 PM ~ Peck: Unit 44, maternal and child support services. Standard budget 1:30:19 ~ 12/11/2013 2:40:58 PM ~ Peck: page 148, nurse home visitation. standard budget 1:30:34 ~ 12/11/2013 2:41:12 PM ~ Peck: page 151, WIC program. standard budget 1:30:52 ~ 12/11/2013 2:41:31 PM ~ Peck: Unit public health nursing. standard budget 1:31:08 ~ 12/11/2013 2:41:47 PM ~ Forslund: Elimination of public health positon, working with counties. 3 counties did not receive assistance for public nurses, want performance contract. Need extra appropriation for those 3 counties. 1:33:43 ~ 12/11/2013 2:44:22 PM ~ Harshberger: Down 2 public nurses, page 158? 1:34:04 ~ 12/11/2013 2:44:42 PM ~ Forslund; Look into 2 positions 1:34:28 ~ 12/11/2013 2:45:06 PM ~ Jones: 2 positions moved out of this unit 1:34:52 ~ 12/11/2013 2:45:30 PM ~ Jones: Change in base count 1:35:22 ~ 12/11/2013 2:46:01 PM ~ Peck: page 159, transferred to unit 539 1:35:54 ~ 12/11/2013 2:46:32 PM ~ Peck: cancer screening program. standard budget 1:36:04 ~ 12/11/2013 2:46:43 PM ~ Peck: Public health laboratory. standard budget 1:36:48 ~ 12/11/2013 2:47:27 PM ~ Peck: page 170, combined with cancer screening 1:37:21 ~ 12/11/2013 2:47:59 PM ~ Forslund: early cancer screening, send info 1:37:55 ~ 12/11/2013 2:48:33 PM ~ Peck: page 173, standard budget 1:38:07 ~ 12/11/2013 2:48:46 PM ~ Peck: page 177, STD prevention, combined with communicable disease, prior program. 1:38:30 ~ 12/11/2013 2:49:08 PM ~ Peck: Page 180, standard budget 1:38:41 ~ 12/11/2013 2:49:19 PM ~ Peck: page 183, STD elimination, transferred to communical disease unit 1:39:10 ~ 12/11/2013 2:49:48 PM ~ Peck: page 87, standard budget 1:39:23 ~ 12/11/2013 2:50:02 PM ~ Peck: page 191, chronic disease prevention. standard budget 1:41:08 ~ 12/11/2013 2:51:47 PM ~ Meier: 10 positions over base 1:41:23 ~ 12/11/2013 2:52:02 PM ~ Peck: moved people from 531 into this unit. 1:42:14 ~ 12/11/2013 2:52:53 PM ~ Jones: Reflected in chapter 17 report. 1:42:31 ~ 12/11/2013 2:53:10 PM ~ Peck: page 195, infectious disease. standard budget 1:42:55 ~ 12/11/2013 2:53:34 PM ~ Peck: page 199, suicide prevention are formally in public health division. standard budget 1:43:37 ~ 12/11/2013 2:54:16 PM ~ Peck: Behavioral Health 1:50:16 ~ 12/11/2013 3:00:54 PM ~ Pause 1:50:16 ~ 12/11/2013 3:12:56 PM ~ Resume 1:50:19 ~ 12/11/2013 3:13:00 PM ~ 3:15 WDH continued 1:50:29 ~ 12/11/2013 3:13:09 PM ~ Peck: pg 203 - Summary. pg 204 base budget , gov rec was a reduction of 16 positions. pg 205 Behaviorla health, gov rec; 1:51:32 ~ 12/11/2013 3:14:13 PM ~ Stubson: in state travel - and out of state travel - 1:52:19 ~ 12/11/2013 3:15:00 PM ~ Peck: net to zero process, will give break out where it was, where it is , and what was used for. 1:52:42 ~ 12/11/2013 3:15:23 PM ~ Peck: broke out unit 2502, tried to put in just the services, pg 210 shows instate travel decrease . 1:54:10 ~ 12/11/2013 3:16:50 PM ~ peck: pg 208 Recovery support - moved mental health outpatient, inpatitent, substance abuse in and out patient moved into new units..This was an area of offsets. 1:54:50 ~ 12/11/2013 3:17:31 PM ~ Forslund: Cost centers that were small, mental healht, substance abuse had a huge number, wanted to cnosolidate some of the smaller units, break behavioral helath apart for better understanding. Listing of 14 programs - reduced and reverted over. 198 M in funds that could be divereted or transferred to medicaid. 121 M from mental health and substance abuse. 1:56:27 ~ 12/11/2013 3:19:07 PM ~ bebout: ? program initiated in 2003 or 04 and grown .. 1:56:45 ~ 12/11/2013 3:19:26 PM ~ Forslund: yes. Select committee, budget inc. sign. 2nd largest program after medicaid in this dept. 1:57:22 ~ 12/11/2013 3:20:03 PM ~ Bebout ? cuts 1:57:30 ~ 12/11/2013 3:20:11 PM ~ Forslund: If medicaid was expanded, could cut back in this area. money in block grants, Decision not to expand impact. Challenge is for those with no insurance at all. Organizatons will need state support. 1:59:31 ~ 12/11/2013 3:22:11 PM ~ Bebout: Has huge amount of tobacco funds. What happens to program when it goes to zero? 1:59:50 ~ 12/11/2013 3:22:31 PM ~ Forslund: Dollar amount was in one big pot, hard to segregate, have set up 4 areas, will now be able to track and answer questions better. 2:00:54 ~ 12/11/2013 3:23:35 PM ~ Bebout: Tobacco funds going away, impact? 2:01:08 ~ 12/11/2013 3:23:48 PM ~ Peck: most of tobacco settlement funds allocated to WDH, were to behavioral health. in substance abuse. Tobacco cessation moved. 2:01:49 ~ 12/11/2013 3:24:30 PM ~ Bebout: how much money on ads for prevention> Where does it come from? 2:02:06 ~ 12/11/2013 3:24:47 PM ~ Esquibel: 12 M represents 1/2 of the tobacco trust money in the WDH. There is 11.5 of tobacco money in corrections dept. Attorney generals office takes a junk. 2:02:51 ~ 12/11/2013 3:25:32 PM ~ Harshman: List of who isspending trust 2:03:00 ~ 12/11/2013 3:25:41 PM ~ Peck: Recovery support unit - does not deal in direct services. No exc request, gov approval 2:03:26 ~ 12/11/2013 3:26:07 PM ~ Peck: Pg 213 - Court supervised treatment- funded with tobacco funds, 4.8 M. over half is tobacco funding. No exc requ. gov approval 2:04:04 ~ 12/11/2013 3:26:45 PM ~ Peck: pg 217 - tobacco prevention and cessation 2:04:18 ~ 12/11/2013 3:26:59 PM ~ Peck 7.5 million in tobacco cessation and prevention program 2:04:37 ~ 12/11/2013 3:27:18 PM ~ Peck: gov approval and exc requests 2:04:47 ~ 12/11/2013 3:27:28 PM ~ Forslund: Pg 222, 223 Exception request: 415000 for replacement of state hospital equipment from state land fund. 2.4 Million in that fund. 400000 for hospital maintenance from state land fund; first of 3 items for master faciities plan. 15 m from strategic investments fund. Placeholder. 2:06:26 ~ 12/11/2013 3:29:07 PM ~ Bebout: Why is this maintenance unique-not under A and I? 2:06:48 ~ 12/11/2013 3:29:29 PM ~ Forsludn: Too small of items 2:06:57 ~ 12/11/2013 3:29:37 PM ~ Bebout: How is it determined? 2:07:09 ~ 12/11/2013 3:29:50 PM ~ Peck: Guess - Any individual request around 25000. 2:07:37 ~ 12/11/2013 3:30:17 PM ~ Peck: pg 221 exception requ - emergency funds. 6 m in budget. avg 10 M over last biennium. Trying to make more beds availalbe. Gov denial, use 100 series vacancy savings to cover costs. 2:08:38 ~ 12/11/2013 3:31:19 PM ~ Forslund: Hospital is required to pick up a cost at the local level through the 25 process then we gt billed. Have not had full appropriation for this so each time ask for additional funding. Told to absorb through vacant positions so we keep vacant positions. 2:09:49 ~ 12/11/2013 3:32:30 PM ~ Meier: put it all on top of table. 45 positions vacant.. Eliminate vacant postions being used for that purpose. 2:10:42 ~ 12/11/2013 3:33:23 PM ~ Peck: pg 225 foot note - std -allows revenue from state hospital to be used for involuntary hospital, title 25,... ask to retain foot notes. 2:11:21 ~ 12/11/2013 3:34:02 PM ~ Bebout: Legislation for title 25? 2:11:46 ~ 12/11/2013 3:34:27 PM ~ Forslund: Judiciary bill 2:11:53 ~ 12/11/2013 3:34:33 PM ~ Bebout: impact on budget? 2:11:59 ~ 12/11/2013 3:34:40 PM ~ Forslund: hope to save money but don't know. 2:12:23 ~ 12/11/2013 3:35:03 PM ~ Nicholas: Bill in judiciary two years ago..thought it had passed. 2:12:41 ~ 12/11/2013 3:35:22 PM ~ Perkins: Not all candidates are reported.. 2:13:24 ~ 12/11/2013 3:36:05 PM ~ Peck: pg 228 Mental health outpatient 42 M total, most GF, some tobacco funds, no exc requ. Gov approval 2:13:51 ~ 12/11/2013 3:36:32 PM ~ Bebout: Places to spend less money might be here? 2:14:03 ~ 12/11/2013 3:36:44 PM ~ Forslund: Yes, in terms of overall mental health and stubstance abuse area. move money over 2:14:34 ~ 12/11/2013 3:37:15 PM ~ Bebout: Mental health providers bill under medicaid...providers get state money and then bill medicaid. where does this show? 2:15:24 ~ 12/11/2013 3:38:05 PM ~ Forslund: Scattered in 4 areas. 2:15:35 ~ 12/11/2013 3:38:15 PM ~ Bebout: does that happen? 2:15:43 ~ 12/11/2013 3:38:24 PM ~ Forslund: Social secutiryt number to run through to check for double billing. At this point in time, no mechanism to check medicaid database and community health database. 2:16:15 ~ 12/11/2013 3:38:56 PM ~ Bebout: I can go in, qualify unde te state and be qualified under medicaid? 2:16:31 ~ 12/11/2013 3:39:12 PM ~ Forslund: Possible 2:16:38 ~ 12/11/2013 3:39:19 PM ~ Bebout: how much goes on? 2:16:45 ~ 12/11/2013 3:39:26 PM ~ Forslund: we don't know. 2:16:51 ~ 12/11/2013 3:39:32 PM ~ Meier: What are th qualifications, income based? 40 M or is it direct payment to community providers for theri operations. 2:17:21 ~ 12/11/2013 3:40:01 PM ~ Forslund: Community health independent businesses, array of services and client, not dependent on income status. 2:18:57 ~ 12/11/2013 3:41:38 PM ~ Meier: what qualifies local outreach to bill the state? 2:19:08 ~ 12/11/2013 3:41:49 PM ~ Newman: CMHSA centers reimbursed through grant program. Select by county, formulat based on population and other factors.....must report what services they are b illing for, 30% of clients have been reported that they have medicaid, trying to figure out how much medicaid should be paying. Open door policy for blaock grants 2:21:25 ~ 12/11/2013 3:44:06 PM ~ Meier: svc center of 100,000 population gets a per capita of grant? 2:21:45 ~ 12/11/2013 3:44:26 PM ~ Newman: correct - .. 2:22:07 ~ 12/11/2013 3:44:47 PM ~ Meier: state payments..if we expand medicaid need to have pool to reduce block grant based on formula, needs developed to fairly reduce the block grant. 2:22:48 ~ 12/11/2013 3:45:28 PM ~ Forslund: correct, offset review, no way to reduce all funding. Step down by 50% over a 4 yr time period. Would have block grant and could bill private insurance and medicaid. 2:23:35 ~ 12/11/2013 3:46:16 PM ~ Meier: base line? 2:23:44 ~ 12/11/2013 3:46:24 PM ~ Forslund: yes. 2:23:48 ~ 12/11/2013 3:46:29 PM ~ Bebout: block grant - is there an MRU..? If they don't get to level f number of people served, does it revert back. Is there a catch all? 2:24:34 ~ 12/11/2013 3:47:15 PM ~ Newman: Contracts with block grants specific to services provided. if they don't meet threshhold then we withhold payment at end of contract year. 2:25:19 ~ 12/11/2013 3:48:00 PM ~ Bebout: meant to incentive them to bring people in. Reverse that? 2:25:34 ~ 12/11/2013 3:48:15 PM ~ Newman: Revamp the entire system. Need to reimburse for these services. Need some GF for warp around services, no health insurance that covers those, 2:26:39 ~ 12/11/2013 3:49:20 PM ~ Bebout: look at medicaid component - double dipping? 2:26:52 ~ 12/11/2013 3:49:33 PM ~ newman: yes we will, medicaid is helping to pull data. 2:27:04 ~ 12/11/2013 3:49:45 PM ~ Peck pg 230 - outpatient substance abuse unit, broken out from 2502, gov approval 19 M with 8.4 tobacco funds 2:27:40 ~ 12/11/2013 3:50:21 PM ~ Peck Pg 233 Residential mental health, no exc requ, gov approval, no tobacco funds 2:27:58 ~ 12/11/2013 3:50:38 PM ~ Peck: pg 235 Residential sub abuse, broken fout from 2502, no exc request, gov approval, 27 M budget 2.9 Million tobacco funds, rest GF 2:28:29 ~ 12/11/2013 3:51:10 PM ~ Perkins: ? Outpatient therapy as beneficial as in patient therapy but residential moe expensive. look at that, develop efficiencies? 2:29:20 ~ 12/11/2013 3:52:00 PM ~ Forslund: Needs to be looked at, on radar screen, not high priority, will get to it in time. 2:30:10 ~ 12/11/2013 3:52:50 PM ~ Peck: pg 237 School services no exc request, gov approval 2:30:26 ~ 12/11/2013 3:53:07 PM ~ peck: pg 242 - 2:30:39 ~ 12/11/2013 3:53:19 PM ~ Stubson: Stautory requirement for capitalization - DD program - Did nto include aditional funding last time around. Did you work off statutory requirement or how calculated? 2:31:40 ~ 12/11/2013 3:54:21 PM ~ Forslund: operating off fact we had a 1.4 M reduction for 13 -14 and biennialized for 15-16 2:32:04 ~ 12/11/2013 3:54:45 PM ~ Stubson - would need similar language? 2:32:17 ~ 12/11/2013 3:54:58 PM ~ Forslund: Maintenance of efforts back before markup 2:32:48 ~ 12/11/2013 3:55:29 PM ~ peck: pg 242 - 100% GF for respite care, people waiting to get on waiver, no exc requ, gov approval, 2:33:10 ~ 12/11/2013 3:55:50 PM ~ peck pg 245 Wyoming Life Resource center, gov approval of std, exception requests. 2:33:26 ~ 12/11/2013 3:56:07 PM ~ Forslund: same as state hospital 334000 pg 236 and 237 for equipment replacemtn - from Land fund. no GF, 2:34:27 ~ 12/11/2013 3:57:08 PM ~ Harshman: had report last year of consititional funds .look again Forslund: pg 249 capital construction . 10M request as a placeholder , Gov replaced with 30 M. W/O putting money in budget will delay process, 2:36:01 ~ 12/11/2013 3:58:42 PM ~ Dockstader: so much in question to be placeholding money 2:36:33 ~ 12/11/2013 3:59:13 PM ~ Forslund: placeholding one time money for reconstruction, Gov wanted money for all three faciities to start the discussion, 80M for phase I and 70 M for phase II depending on how you want the facilities to go. 2:37:59 ~ 12/11/2013 4:00:39 PM ~ Meier ; 252 - hires? 2:38:19 ~ 12/11/2013 4:00:59 PM ~ Forslund: We put a freeze on vacancy positions. .... 2:38:50 ~ 12/11/2013 4:01:31 PM ~ Meier: Directive that anything vacant moe than two years be stripped out. WEre you spared? 2:39:15 ~ 12/11/2013 4:01:56 PM ~ Forslund: Exempted direct care staff............. 2:39:52 ~ 12/11/2013 4:02:33 PM ~ Meier: recap 45 not hired theres, 90 could reduce. Is the 45 in the 90? 2:40:12 ~ 12/11/2013 4:02:53 PM ~ Forslund: 45 is part of that number. . Study requested by legislature in terms of transitioning people out, also had comprehensive review of the facilites, reports coming togeyher. Decisions need to be made. What is proper role of each faciity? Who do I have the discussion with. shoudl be decided at elected level...JAC, or labor commitee or a small select group. I would like direction..multimillion dollar decisions, 2:42:20 ~ 12/11/2013 4:05:00 PM ~ Bebout: Governor's office,> If you need support from legislature, if you need help from JAC, I think it is reasonable. political decision made bu ys, you implement. reasonable request. 2:43:12 ~ 12/11/2013 4:05:52 PM ~ Dockstader: Legitimate concerns. Who gives director answers? 2:43:49 ~ 12/11/2013 4:06:29 PM ~ Moniz: Any discussion with Labor and Health Committee? 2:44:08 ~ 12/11/2013 4:06:48 PM ~ Forslund: Report on facilities given to Labor and Health Committee. Discussion has begun. 2:45:04 ~ 12/11/2013 4:07:45 PM ~ Peck: Aging Division, page 254, Aging, standard budget 2:46:05 ~ 12/11/2013 4:08:46 PM ~ Peck: Page 258. Senior Care Unit 2:46:44 ~ 12/11/2013 4:09:25 PM ~ Forslund: Additional $200,000 to cover aging center; exception request for biennium. Family members to find options for aging relative. 2:49:35 ~ 12/11/2013 4:12:16 PM ~ Meier: Same services provided by senior centers? 2:49:54 ~ 12/11/2013 4:12:35 PM ~ Forslund: Statewide program. 2:50:53 ~ 12/11/2013 4:13:34 PM ~ Peck: Senior centers paid from block grant 2:51:33 ~ 12/11/2013 4:14:13 PM ~ Bebout: Either fund for the biennium or not 2:52:50 ~ 12/11/2013 4:15:31 PM ~ Peck: page 262, nutritional unit, standard budget 2:53:04 ~ 12/11/2013 4:15:44 PM ~ Peck: page 265, standard budget 2:53:16 ~ 12/11/2013 4:15:56 PM ~ Peck: Senior volunteer program, standard budget 2:53:34 ~ 12/11/2013 4:16:14 PM ~ Peck: page 271, WY Senior Services Board, standard budget 2:53:53 ~ 12/11/2013 4:16:33 PM ~ Peck: 2014 budget cuts included $485,000 for senior centers. $200,000 was reinstated during session. Carried forward, but not into current year. 2:58:54 ~ 12/11/2013 4:21:34 PM ~ Peck: page 274, health care licensing and surveys, standard budget 2:59:10 ~ 12/11/2013 4:21:51 PM ~ Peck: page 278, Pioneer Home, standard budget 2:59:27 ~ 12/11/2013 4:22:07 PM ~ Peck: page 282, Veterans Home, standard budget 2:59:46 ~ 12/11/2013 4:22:27 PM ~ Forslund: Exception requests, $420,000 pharmacy costs for residents as no longer covered by federal government past per diem cost per person. $2.3M revenue, costs are $3.4M. $15M for facility upgrades. 3:02:44 ~ 12/11/2013 4:25:24 PM ~ Stubson: Increase of 1 position; reassignment? 3:03:08 ~ 12/11/2013 4:25:49 PM ~ Peck: Net to zero transaction. 3:03:50 ~ 12/11/2013 4:26:30 PM ~ Peck: page 287. standard budget 3:04:21 ~ 12/11/2013 4:27:01 PM ~ Peck: Exception request, more beds being filled over last 2 years, but also more medicaid collections. $282,000 incresase, but savings due to collections. 3:05:33 ~ 12/11/2013 4:28:14 PM ~ Forslund: Costs neutral. Less general fund needs. 3:06:10 ~ 12/11/2013 4:28:50 PM ~ Forslund: Pioneer home recently rehabed, but need clarification on Basin unit. 3:07:10 ~ 12/11/2013 4:29:51 PM ~ Bebout: Percent utilization in Basin? 3:07:40 ~ 12/11/2013 4:30:20 PM ~ Forslund: No numbers with him, but count is going up. Being utilized by patients, some challenging patients being served after being in other centers, but asked to move due to minor mental health issues. 3:09:52 ~ 12/11/2013 4:32:32 PM ~ Bebout: Tobacco settlement another 6 years. Breakdown of costs, especially advertising 3:10:21 ~ 12/11/2013 4:33:02 PM ~ 3:14:11 ~ 12/11/2013 4:36:52 PM ~ Pause 3:14:11 ~ 12/11/2013 4:36:57 PM ~ Resume 3:14:14 ~ 12/11/2013 4:37:00 PM ~ Stop Recording