JAC Index 12/14/2015pm1 12/14/2015 12:57:36 PM McVicker: page 21, Director’s Office. Harshman: page 12, department priority. Any comments? Forslund: Categorized by priority, low, medium and high, split by 1/3. Would prefer being asked to cut by a certain dollar amount, and let the agency decide where the cuts should be made. McVicker: page 22, Director’s Office. Oversees 4 divisions. No exception requests. Page 25, tax refund for elderly and disabled. $3.6M. page 27, vital statistics. Health Care Financing, 401, Administration for Medicaid, developmental waivers. Exception request and tobacco fund reduction. $11M for administration. Teri Green, Health Care Financing Division/State Medicaid agent: pay additional costs to vendor to process payment. Wasserburger: Eliminate KidCare and put funds toward Medicaid expansion? Forslund: No, it cannot. Funded through 2017. Perkins: Medicaid expansion, page 18 and 19, number 1 exception request. Nicholas: CHIP funding. Less expensive way to finance? CHIP versus traditional Medicaid program. CHIP is 30% more expensive. Forslund: page 35, Electronic health information exchange allows providers and patients more secure access. State will have to run it. Build off existing Medicaid system. Without expansion, $1M budget item. Harshman: If general fund savings JAC will authorize where that money will be spent. McVicker: Unit 402, page 40, upgrades to technology systems, MMIS. Exception request to replace 30 year system. Not relying on single vendor. Unit 420, page 44, CHIP, administered by Blue Cross/Blue Shield. Tobacco fund reduction. Unit 430, page 47, drug assistance program. $950,000 less in general fund if Medicaid expansion. 435 people enrolled. Page 51, 12/14/2015 2:03:12 PM Break 12/14/2015 2:08:45 PM Meeting resumed McVicker: Page 53 No exception requests for unit x – 450,451 wyoming health insurance premiums Unit 453 no exception request. 460 adult services has an exception request Forslund: For individuals with income less than 300% of SSI to buy into program. Stubson: 75% of program would be reduced regardless of Medicaid expansion. Forslund: If you are eligible to be on the exchange, you are eligible for the program Nicholas: Under current program, they are eligible to be on this program. We cannot force them to go on the exchange. McVicker: unit 461 Children’s services no exception request; Perkins: Does this cover medical services not otherwise provided by the S chip program. Green: They don’t work together. CHIP program is separate. They cannot be on both programs McVicker: Unit 462, out of home children. 100$ GF, no exception request . Unit 463, Nursing facility reimbursement, no exception request. Unit 464 Hospice is optional benefit currently covered by Wyoming Medicaid, no exception request. Perkins: Rules issue. Babbitt: Rules have been drafted, are in the dept with our interim rules manager, then will go to director, governor and public comment. Perkins: When do you think it will happen? WE are six months past the effective date of the legislation. McVicker: Unit 465 – exception request for Medicaid exception. 274M. Unit 470, page 81 optional benefits, Tobacco fund reduction will not have a significant impact. Unit 471 Indian health services does not require GF, no exception request. Connolly: Doubling amount going into 17-18? Page 83. Federal funds Forslund: Legislator authorized an expansion in the last session. Nicholas: roughly 17M Connolly: That figure will carry through into future bienniums Forslund correct McVicker: unit 472 no exception request. Unit 480 DD adult waiver, units 485 and 486 Unit 481 children’s waiver, same thing, transitioned into units 485 and 486 Unit 482 Acquired brain injury will end. People on it will be transferred into new program. Unit 483 LT care waiver, 19 years and older, functioning and financially qualify for Medicaid has no exception request. Unit 484, nursing home services and assisted living, client pays for room and board, no exception request. Unit 485 comprehensive waiver, couple of exception requests. Forslund: 1st to be in compliance with dept. of labor regulations, January 1, 2015, home care workers overtime and workman comp. This affects most Medicaid programs. Consumer directed program. Consumer selects provider. State could be determined to be joint employer. By insuring federal minimum wage is met. We need to adjust the rate to be in compliance. Ross: Governor denied Forslund: yes. Medical rate rebasing includes the funding for compliance. If the legislature turns down this, Governor recommends going back and funding the previous. 2nd – statutes require waivers be rebased and submitted. Last one was in 2011 but was not funded. Approved and funded was July 2, 2008. Exception request includes dept. of labor change. $3M was approved last session as a down payment. One time funding. Re- basing came to 6 M for the biennium. If you continue on the 3M, you meet this request. We have a large number of providers who have not received a rate re-basing, in a precarious financial position. Greear: Rebased to what year? Forslund: Effective July 1 of next year. We hired third party to do the review and the recommendation. Recommendation is going to labor, health and social services next month. Greear: what percent of the cost? Presenter x: Proposal based on factors. Ross: What was done with the 3M appropriated last year? Forslund: It is being spent. We will ask for the full 6M for this biennium. Nicholas: Is the report out? Forslund: yes. Will give it. Stubson: I thought the rule change was effective January 1 of this year. Is there exposure for this biennium for the rule change? Forslund: yes, there is. As soon as we get the green light from EMS we will implement using funds in the division. Connolly: will that become the line for future rebasing? Nicholas: Comparison Forslund: It is not a single rate. Some are up, some down. We can’t say that overall the rates are going up by x amount. Nicholas: is it a coincidence that it is the 3 M we appropriated? Forslund: It was close. Perkins: ? Forslund: Assuming you fund it, that is the new rebase. If you do not fund it, that is not the new base. We will pick up from there 2 to 4 years from now. Required to do. You raise the system costs up because their costs are going up but their revenue is not. McVickers: unit 486 – support services waivers, no exception request. 12/14/2015 2:35:01 PM Perkins: Impact on 486? Speaker X: Yes Perkins: Is 6 M sufficient to cover all 3 units Speaker x: Yes 12/14/2015 2:36:05 PM McVicker: Public Health Division No exception request. Unit 502 no exception request. Burkhart: Doesn’t this duplicate what Homeland of Security does? Braund: No. We work cooperatively with Homeland Security. Example is Ebola preparation. Forslund: When event occurs, Homeland security calls in the WDH to help with the health aspects of the overall issue. Burns: employee spreadsheet 4 + 1 = 6 McVicker: it is a rounding error. Greear: Revenue part B requires a 10% state match. Federal funds are still our dollars. Braund: match is through inkind programs. Ex: We contract with public health emergency coordinator in each county. They may be part of public nursing program. Greear: We pay the contract out of our budget for those local folks Braund: yes, through the preparedness budget. McVicker: Unit 503 – no exception request. Unit 510 Rural and frontier health Burns: page 110 – out of state travel, std. budget is increasing about 50%. Why? Braund: Supports out of state travel for everyone Forslund: When I came into the job and went into each line item and raised questions. The distribution of the line items is not necessarily a reflection of how the money is used. Cleaning up line items in the budget. 3 people will not be using that amount of out of state travel. Burns: Why an increase from the base budget by 50%? Forslund: From the base to the budget, I don’t know. We will check. Perkins: Public Health preparedness, 900 series payments to hospitals. What is the nature of those payments? Braund: We give them money to purchase equipment, increase their RAD Capacity. Burns: In state travel. 33000 for base. Over 100,000 Braund: We fund travel to all the counties to interface with county coordinators. Burns: Why is there a 500% increase? Nicholas: Please provide a breakdown of this. (used for cross purposes) Harshman: Tobacco settlement funds being used for what in the administration division. Braund: chronic disease conference, oral health program, unfunded mandates. Harshman: Forslund: point out the ones we are cutting 12/14/2015 2:48:20 PM McVicker: Rural and frontier health has an exception request 230,0000 for telehealth, reduction in that unit Burns: page 118 – unit 222 out of state travel, 42000 to 72000. Advertising 78000 down to 10000. Braund: Additional travel has to do with supplemental funding for ebola preparedness and training for it. Decision made that we can get advertising out through other means. Burns: equipment for 20000 Braund: Ebola preparedness equipment. We acquired the ability to test for ebola in our state labs this year. Agar: There is an option for agencies to do a net to zero to align line items in budget to more effectively describe the work they are going to do. There should not have been money added into the std. budget for equipment. Presented as a supplemental request. Next year, it will fall out. Moved into one time object line so it will go away. Burns: Should this equipment be ongoing or one time? Agar: Equipment is never ongoing. Forslund: CDC flowed money out to the states to prepare for Ebola. We received grants. We will not build it into the budget Burkhart: amount spent for EBOLA. Braund: none of it was state. It was federally funded. I will get that for you. Ross: 1 M from loan repayment, Forslund: 1 M – awards given yearly 7 or 8 and 3 to 4 to hospitals for recruitment. The remainder is for telehealth. Polycom system. 175 to 190 calls per month. 235000. Ross: Tele health is the wave of the future. Forslund: We were asked to reduce out of the tobacco tax. Ross: Why was it in there? It is not tobacco related. Forslund: explained by Sen Peterson that in the past, legislatures wanted money for programs, took it out of tobacco funds, not the dept. that did that. 12/14/2015 2:57:10 PM McVicker: No exception requests in oral health, Unit 522 Vaccines no exception requests Harshman: In news yesterday, that we are 49 out of 50 for immunizations. Forslund: #46. We have a base minimum for immunizations for children to attend school but state law allows students to opt out. We have reduced funding for this program in past years. Perkins: Possibly because immunizations should happen earlier than they do. Part of it is delay. Braund: That is a unfortunate stat. Some parents do wait until school age. Larger issue is that access remains a big problem. Financially and physically. Physicians, public health nurses offer state sponsored immunizations. Most of the counties do not purchase vaccines for non-school required vaccinations. Burns: Immunization is the opt out. Different states have different exemptions. Where are our laws? Braund: Medical, needs doctor excuse. Religious exemption, some states require documentation or proof. Philosophical exemptions. Some states have gone away from any non-medical exemptions. 12/14/2015 3:02:22 PM Break. 12/14/2015 3:12:53 PM Maternal and health care services, page 133, unit 523. Braund: Various programs in place. McVicker: Unit 525. WICK. Special nutritional program. Money received based on services provided to women and children. Wasserburger: page 143, contractural services, 900 series. What for? Braund: EBT system on-going maintenance. McVicker: Unit 526, public health nursing. Unit 531, cancer screening. Reduction if Medicaid expansion to general fund. Harshman: Page 148, tobacco trust fund? Braund: program operated on blended funds. Realignment of unit within public health division. Connolly: Decrease of funds and amount of screening…..when better funding, more cases discovered? Braund: Over 3,000 screenings with 52 discovered cases with colonoscopy. More screenings for cervical and breast cancer as opposed to colon cancer. McVicker: Unit 532 Laboratory Services Greear: Contract with other states to perform bio-terrorism testing? Braund: Important to maintain bio-terrorism testing readiness…. Forslund: Received federal ebola testing funds earlier… McVicker: Unit 534, communicable diseases. Reduction of general funds if Medicaid expansion. Stubson: HIV case numbers? Braund: Numbers have stayed constant. McVicker: Unit 536, occupational health. Grant does not pay for radon mitigation. Unit 538, chronic disease and. Tobacco trust funding Unit 539, chronic disease prevention Unit 540, infectious disease Unit 550, substance abuse and suicide prevention. Tobacco fund reduction, Medicaid expansion would reduce general funds. 12/14/2015 4:04:30 PM Break Behavioral Health 12/14/2015 4:16:11 PM Meeting resumed McVicker: page 181 No exception request. Burns: Does the state pay for the travel of the patient. Newman: No, Amount is significantly higher than it should be McVicker: Unit – has a tobacco fund reduction Nicholas: unit 2501 – will you give us a revision? Newman: yes Greear: Veteran’s outreach – what coordination or overlap with Veterans dept. Newman: Give case management to military without veteran’s benefits or some type of stigma. Can help with homeless. We work with the Veteran’s dept. but it is a separate program Greear: Advocates? Newman: Two Greear: Worked to get the veteran’s staff spread throughout the state. Newman: Legislative intent to have an alternative, not tracked by name or identified. We have raised the question if this makes sense for us to do. Veteran’s commission is appreciative of advocates. Greear: Number of veteran’s reached? Newman: I will get it to you. Burkhart: page 183 – no funds from Tobacco Trust Fund under 5617, there is X$ on page 185 Newman: We will check on that. Burns: Veteran’s outreach cost of program. Newman: $236, 791 for 2015 served 155 people. Two contractors. Burns: VA is in final part of negotiating contract with VOA of Rocky Mountain. Is this inclusive of this program or do they work in cooperation? Newman: They are exclusive. Yes, it is separate from the Veteran’s commission. Forslund: If the legislature preferred, we would have no issue with transfer this program over to Vet’s commission. McVicker: Court supervised program – tobacco fund reduction Forslund: 56% of the program are covered by tobacco funds, cost per participant $5946, rates of recidivision Burns: is there a court in every county? Forslund: No Burns: page 190 medical lab supplies, line 235 What are they? Newman: For testing for drugs. Forslund 19 funded drug court programs 11 adult, 2 juvenile, I combined, 2 tribal wellness, 1 dui Nicholas: Are we paying for drug testing? Newman: My understanding that the program covers that. I will check Greear: 64% retention rate means how many complete the program> Forslund: correct. We have most of the data on our programs. Stubson: electronic link would be good. Forslund: We will make it available before you go into session. We are trying to determine outcomes and efficiencies. Greear: Does LSO keep a list of all we requested? Richards: We do. Greear: I would like a copy. McVicker: Hospital in Evanston, exception request, tobacco fund reduction Forslund 165+thousand dollars, no impact to remove it from the budget Perkins: What was it supposed to be used for? Forslund: not sure how it got there but we are not using it. Burns: Travel expenses. Newman: State pays for transportation to state hospital. Nicholas: How many state vehicles is that? Forslund: We will get that for you. Nicholas: Unit 0223, vehicles assigned? Forslund: over the road vehicles Nicholas: Vehicle repairs? Change from base budget. Forslund: $409,581 special revenue to replace equipment, like beds, dishwashers. Money comes from state land grazing fees For repair and maintenance, repairs to structure that are not major maintenance. Greear: Title 25 half way house – we would see an increase of 12 employees in this unit then a reduction Forslund: correct. I am not sure it will hit this budget. Perkins: Page 196 code 0871 loan Forslund: To build new facility and was to be repaid from revenue from the state hospital. I will double check. McVickers: mental health centers has an exception request Forslund: 10.9 M reduction in this unit, that would be repurposed for Medicaid match requirements. Perkins: tobacco trust fund money Forslund: The tobacco funds for this area are out McVicker: out for unit 2506. Perkins: it is in the base budget. McVicker: unit 2507 – outpatient treatment services – exceptions request related to ACA Forslund: 2 M+ reduction. Nicholas: funds to health care providers, Impact on fee for service in terms of reporting? Forslund: It could. If you put both together at the same time too much of a shock to the system. Do one first then follow up with the second McVicker: Unit 2508 – Community Mental health centers exception request related to ACA Greear: back to unit, how did we arrive at the reduction amount? Forslund: block grant. Explanation of process. Greear: Johansson – Numbers for the 4 units for reductions. Analysis for current system data from community mental health systems, cross walked with what we have in the Medicaid data. Fairly conservative estimate. Nicholas: Time used Johannson -8 fiscal years Connolly- Curious about block grants to centers, figure billed to feds, increased services in relation to dollar amounts from feds and us. Forslund: The person who is low income today is already eligible to receive services at those community health services. Put block grant into the match. Community services bills and fed. Gov pays 90% of costs while state would pay 10% or less. Johannson: Connolly: What should community health services expect with the expansion of Medicaid? Woodwork effect, that one person recommends services. We are providing at a lower cost, providing to more individuals. How much funding can local centers expect? Possibility to expand services? Forslund: We are moving from a block grant to a fee for service, at least partially. We can’t answer if there will be more walking in the door of each center. Nicholas talking about reform of system. Reimburse at a higher rate for higher need which is not what we are doing now. We need to balance our system to incentivize centers to prioritize care for high need clients. Perkins: with the expansion, if you take out the numbers, close to 9M. How much would come out of the block grant? Forslund: All of the dollar amounts reduced would come out of the block grant in those programs. McVicker: Unit 2509 – reduction. Unit 2510 – exception request. Forslund: Unit 2510 – we are required statutorily to make a request to receive an increase for childhood development centers. 2.73% increase = $954,601 for the external cost adjustment Burns: Has it ever been denied? Forslund: In 2011. Burns: Is on chart. Stubson: Is number either or? Forslund: This is not an either or situation, it is both. Child count and then external cost adjustment, regardless of the count. Stubson: enrollment growth with ECA attached on top. Forslund: Correct. You are not required to fund it. As soon as you do, it ratchets it up. Stubson: only for ECA, not enrollments Ross: How many CDC’s? Newman: # Hastert: Delayed effect on kids. Year lag. CDC’s are usually further behind McVicker: unit 2511 – no exception requests. Perkins: For in home care, waivers , minimum wage Newman: yes. Usually only six hours approved. McVicker: Unit 2512 – exception request Forslund: $314,120 request to pay for replacement of equipment. LO9 funding, which is leases, grazing fees. Nicholas: Background of that fund and balance. McVicker: 4 to 5 M in each acct. I will get back to you. Harshman: Don? Richards: 298000 for FY 15 investment 3.7 M corpus Agar: After the request made in this budget, as well as allowance for budget request made this biennium Harshman: McVicker: Two requests from LO8 Agar: State hospital = 2.6M approx. Burkhart: Misc. for $400.000 Newman: will get back to you Greear: Unit 223, vehicles? Newman: I will run a list for you. Ross; Do they have GPS? McVicker: yes Burns: Therapies, what is hippo therapy? Newman: Horses. Burns: 410 FT positions, 260 staff provide direct care. That leaves 150 with other support services? Forslund: We have vast portion of employees provide direct care. They have to be covered 24/7. CNA’s and others. Support staff is kitchen, maintenance. We have an over allocation of support staff and have been doing that over the last 2 years. Burns: Frozen in support staff Forslund: 112 currently. GPS – received an email from AandI that an employee was driving at 95 mph on Wyoming Boulevard. Oops sorry, not your agency. We receive notices of employees speeding. We approach those employees and counsel them. Burns: No one was questioning the wisdom. We were questioning the authority to do so and where did they get the money. We wished they would have asked us first. McVicker: 12/14/2015 5:06:45 PM Break – Aging Division 12/14/2015 5:15:23 PM McVicker: Aging Division Unit 502, Senior Care. Unit 503, Nutritional Services. Unit 504, Elder Rights. Unit 505, Senior Volunteer Services. Unit 507, Senior Services Board; senior centers Unit 510, Health Care licensure Unit 5040, Pioneer Home, assisted living, Thermopolis, 48 residents. Half residents pay $2000 or $2200, but if assets are less than $10K, formula to determine rate. Forslund: Originally set up as a safety net facility, now serves those needing assisted living in that area of the state. McVicker: Unit 5050, Veterans Home. Resident pays fee, state picks up remainder. 74 residents. No associated nursing home facility. Forslund: Title 25 and problems at State Hospital/Wyoming Life Resource Center are linked, getting a handle on this is key. Harshman: Medicaid expansion as a key to get a handle on that? Forslund: No. State can save some serious $$ by doing so. Harshman: Capcon, remove some of this? Forslund: Finish Level I and II studies, and then move forward with construction of the 2 facilities. Harshman: 212 vacancies, 50 vacant over a year. Forslund: If keep in reserve, will not have to ask for more at a later date when construction completed. Do not penalize an agency for being cooperative in saving $$ and then ask for more. 12/14/2015 5:59:42 PM Meeting closed.