committee Meeting Information
May 7, 2009
Oil and Gas Commission Building
Casper, Wyoming
committee Members Present
Senator Charles K. Scott, Co-Chairman
Representative Jack Landon, Co-Chairman
Senator John Hastert
Senator Rick Hunnicutt
Senator Bill Landen
Senator John Schiffer
Representative Dave Bonner
Representative Kathy Davison
Representative Ken Esquibel
Representative Patrick Goggles
Representative Timothy Hallinan
Representative Elaine Harvey
Representative Lori Millin
Representative Lisa Shepperson
Committee Members Not Present
None
Legislative Service Office Staff
Gerald W. Laska, Staff Attorney
Kelley Shepp, Associate Research Analyst
Others Present at Meeting
Please refer to
Appendix 1 to review the Committee Sign-in Sheet
for a list of other individuals who attended the meeting.
Executive Summary
The Committee met at the Oil and Gas Conservation Commission Building in Casper. The committee heard updates from the Department of Health on federal stimulus funding for the Medicaid program. The Department of Health reported on the method of setting reimbursement levels for providers under Medicaid. The Department agreed to provide additional information on both matters at the next meeting.
The Governor's Task Force on Workplace Safety reported on the activities of the task force to date, primarily its data collection effort. The Research and Planning Division provided data on workplace fatalities and injuries in Wyoming.
The Medical Review Panel presented five possible legislative changes. The Committee voted to consider a bill making panel materials and decisions inadmissible in court.
The Department of Family Services reported on funding increases and changes to the Child Care Development Fund program under the federal stimulus bill. The Committee voted to consider a bill to codify co-payment levels and authorize use of stimulus funds for electronic benefit payments, to support child care infrastructure and for provider reimbursements.
The Committee will meet again on September 9, 2009 in Sheridan to monitor federal health care reform legislation, the use of stimulus funds in the Department of Health, to receive a status report on the Governor's Task Force on Workplace Safety and to inquire further into Medicaid provider reimbursements.
Call To Order
Co-Chairman Landon called the meeting to order at 8:00 a.m.. The following sections summarize the Committee proceedings by topic. Please refer to Appendix 2 to review the Committee Meeting Agenda.
Approval of Committee Vote Rule
Chairman Landon explained the Committee's adopted rule on sponsorship of a bill, which requires the vote of a majority of the Senate members and a majority of the House members. Senator Scott stated that, hearing no objection, the committee would continue with that rule.
Department of Health
Dr. Sherard introduced himself and Department representatives. He distributed a copy of the Department of Health's organizational chart (Appendix 3) and a chart summarizing the health-related provisions of the American Recovery and Reinvestment Act of 2009 and how those provisions might apply to Wyoming (Appendix 4).
Medicaid
Teri Green, State Medicaid Agent, and Bob Peck, Chief Financial Office of the Department of Health, and Lee Clabots, Deputy Director of Administration, addressed the Committee. Ms. Green distributed a folder containing an outline of the Medicaid Program and a CD containing the Medicare annual report for state FY08 (Appendix 5) and a informational handout on "Medicaid Facts" (Appendix 6). Ms. Green proceeded to address the Federal Matching Assistance Percentages (FMAP) for the Medicaid program and that the state will receive an additional 6.2% in federal funds, or approximately $56 Million, under the American Recovery and Reinvestment Act of 2009 ("the stimulus bill"). There are requirements with the funding concerning timeliness of payments and streamlining eligibility determinations. Ms. Green stated that the bottom line is that the program will use less general fund money for the same services.
Senator Scott noted that the budget bill's sweep provisions may violate the stimulus bill's prohibition on using federal funds for a rainy day fun. Mr. Peck replied that the department has asked for an opinion on that from the Center for Medicare and Medicaid Services and will propose a fix in the budget bill if necessary.
Senator Schiffer asked about auditing requirements of the stimulus bill. Ms. Green stated that the federal government does the auditing but the state is required to provide the data, which she expects to be burdensome. Mr. Peck confirmed to Chairman Landen that the additional funds could mean a refund to the state's budget reserve account and to Chairman Scott that the funds could also be used to offset the state's share of increased Medicaid costs.
Chairman Scott asked about increasing costs. Mr. Peck stated that the state is seeing an increase in eligibility for the first time in several years, but current projections are that the $56 Million stimulus funding would be enough to cover it.
The Committee discussed with Director Sherard and Deputy Director Clabots the Department's plan to comply with the Governor's 5-10% cutback order. The Department stated that each division has been ordered to come up with a plan, primarily by cutting administrative costs because mandated patient care and provider payments could not reasonably be cut.
Ms. Green stated that the state will also receive a 2.5% increase in disproportionate share funding for hospitals that provide care to uninsured persons, $400,000 additional funds for immunization and $5 Million additional for the Community Services Block Grant program. Additional funds for health care information technology are likely but there are no details yet.
The Committee discussed the health care IT bill that passed and the consortium it created. Dr. Sherard stated that he is very optimistic about the project, especially telehealth and health information exchange, and that the stimulus funds could dovetail but the department is awaiting the federal requirements. The consortium is being assembled under Dr. James Bush, State Medicaid Medical Officer. Dr. Bush stated that the first step is to assess the "bones" of a health care IT system, and that there will be cost savings to many department programs. The Committee discussed generally the need for security and the avoidance of creating unfunded liabilities after the temporary federal funds run out.
Child Health Insurance Program
Patricia Guzman, manager of the State Children's Health Insurance Program ("SCHIP") addressed the Committee. She distributed a graph showing the state's unemployment rate and enrollment in the SCHIP and Medicaid children's enrollment (Appendix 7). She reported that there has been a decline in SCHIP enrollment from 6100 to 5585 since last July, due to increasing unemployment and more persons qualifying for Medicaid.
Senator Scott questioned the enrollment changes. Ms. Guzman noted that employer participation has not decreased, but some renewing SCHIP participants now qualify for Medicaid. Mr. Peck added that the average cost/participant is $2,000 for SCHIP and $2,400 for Medicaid.
Ms. Guzman stated that the federal SCHIP reauthorization act will require an increase in dental and mental health coverage costs and a prospective payment system, with a cumulative 22-25% increase in premiums. Rick Schum, Blue Cross/Blue Shield, stated that the company is working on a more specific cost impact. Ms. Guzman believes that the savings from enrollment decreases should be enough to cover the benefit increases, and that the federal share will increase by $5 Million.
The Committee generally discussed the costs and whether a time will come when it is better to opt out of the SCHIP program in favor of private insurance for poor children. Ms. Guzman noted that SCHIP covers preexisting conditions that are generally excluded by private insurance. Ms. Guzman agreed to provide the Committee with firmer numbers on cost drivers and premium when they are available.
Senator Hastert asked about funding for developmental preschool providers. Mr. Peck explained that the Department is required to request an exception budget amount to pay the providers an external cost adjustment the same as the public schools, but that the Joint Appropriations Committee denied the request. The Department was directed, however, to use it's excess salary "float," which has historically been about $11 Million, to pay the ECA. Mr. Peck believes there will be sufficient float to do that. Dr. Sherard stated that the hiring freeze should increase the float.
Medicaid – Reimbursement Levels
Teri Green explained that there are different methods of calculating reimbursement rates for different categories of providers. Facilities are cost-based. Doctors are relative-value based, which is resource based. A rate is established based on difficulty level and resources required, times a conversion factor. We are budget neutral, so greater utilization decreases the conversion factor.
Chairman Scott asked for data on the Medicaid/private insurance reimbursement differential and Ms. Green agreed to provide that.
Chairman Landon stated that the number one constituent complaint relates to Medicaid reimbursement levels, which he has been told are only 50% of a hospital's costs. Dr. Sherard replied that reimbursements are determined in consultation with various professional advisory groups, but that there are always budget constraints.
The Committee generally discussed the inadequacy of reimbursement levels, cost shifting, lack of data and the effect of reimbursement levels on provider recruitment/retention and access to care. Chairman Scott stated that the Committee needs to understand the reimbursement methods, be prepared to respond to a new federal mandate to cover the uninsured and address any irrationality in the reimbursement/budgeting process.
Workplace Safety
Gary Hartman, Governor's Policy Analyst, addressed the committee by telephone. He described the formation and work to date of the Governor's task force on workplace safety. The task force has been particularly interested in a similar effort in Alaska, which reduced its workplace fatalities by 49%. The approach will be an epidemiological one, based on data and not aimed at fixing blame. Data is being collected from the National Institute for Occupational Safety and Health, as well as the state workers' compensation and occupational safety programs.
Chairman Scott asked about preliminary conclusions. Dr. Paul Anderson, epidemiologist and task force member, stated that the most fatalities are in the mining, transportation and construction industries, with 50-70% of those being travel related.
The Committee discussed generally if the proposed remedies would require legislation. Dr. Anderson stated that the fatality reductions in Alaska were achieved with industry cooperation, when the data made clear where safety could be improved. There was then a general consensus on legislation. Mr. Hartman agreed that any legislation in Wyoming will not be timely until the 2011 general session. Mr. Hartman and Dr. Anderson agreed to provide the Committee with additional data at its September meeting, included other factors in transportation-related injuries such as substance abuse, economic cycles and employer size.
Gary Child, Department of Employment Director, and Carola Cowan, Research and Planning Division, and Wendy Tyson, Assistant Administrator for Employment Security, distributed a packet of statistics on workplace fatalities in Wyoming and a report on occupational injuries from the U.S. Department of Labor (Appendix 8). They reviewed the data collected based on accident reports, workers' compensation injury reports, police reports and news reports.
Representative Shepperson introduced Sienna Grant, a worker who was injured on the job but was not covered by workers' compensation. The committee generally discussed coverage and that under the Wyoming Constitution only those industries defined by the legislature as extrahazardous are covered by the exclusive state fund. Chairman Scott explained that Ms. Grant was not covered because she worked in the retail industry, which is not defined as extrahazardous. Senator Scott suggested that the Committee consider a bill for the general session to expand coverage to the retail industry.
Medical Review Panel
Eric Easton, Director, Medical Review Panel, addressed the Committee and distributed a written report with recommendations for legislative changes (Appendix 9). He stated that the number one priority would be to make inadmissible in court the information collected by the panel and the panel's decision. In addition, instead of an early and informal process, a later and more formal process would be better. Mr. Easton also recommended that the executive director be authorized to conduct hearings rather then having to farm them out to the Office of Administrative Hearings, and that some incentive or disincentive be added to discourage health care provider defendants from waiving the panel review.
Mr. Easton reported that of 148 medical malpractice cases filed in 2009 to date, in 107 cases the defendant waived review by the panel. He believes the reasons for the waivers included uncertainty over the admissibility of panel proceedings, the cost and time involved and tactical reluctance to 'reveal one's hand'.
In response to Chairman Landon, Mr. Easton stated he thinks the panel has been successful in reducing claims substantially, especially in getting some parties dismissed who were named in a shotgun complaint, and dismissal of cases where the plaintiff could not find an expert to support the claim. He also believes the process encourages settlements; half of all cases scheduled for hearing have settled before hearing. Otherwise, the insurance commissioner is tracking the number of medical malpractice claims but it is probably too early to detect a trend. He agreed to work with the Insurance Department and insurance carriers to come up with effectiveness data.
Committee members discussed generally how the success of the review panel could be measured. Mr. Easton stated that there are savings to the state in having fewer trials and better prepared trials. He said that only one case went to court after the panel determined the claim not to have merit.
Dennis Ellis, Wyoming Medical Society, testified that his organization believes the review panel is worthwhile and doing a good job cost effectively.
Marcia Shanor, Wyoming Trial Lawyers Association, testified that their members have mixed feelings about the panel, but believe that it is effective to weed out baseless claims, to encourage settlements and to decrease litigation costs. The Association supports strengthening the inadmissibility provisions.
Public Comment
Richard Leslie, Wyoming Epilepsy Association , asked the Committee to consider a special program to enhance support services for persons with epilepsy, so that more could stay in supported employment and not have to resort to public assistance programs. Increased provider reimbursements would also help, according to Mr. Leslie.
Tom Jones. Wyoming Healthcare Association, asked the Committee to remember nursing homes when reviewing Medicaid provider reimbursements, and suggested a tiered payment system, considering a facility's patient mix, would be better. He also requested consideration of some way to pay for capital construction, especially the updating of current facilities.
Toni Decklever, Wyoming Nurses Association, asked the Committee to extend the Wyoming Investment in Nursing program, which is set to sunset in 2011 and which has helped 440 nurses pay for their education. She also asked that the Committee consider requiring health insurers to pay claims for direct care by nurse practitioners.
Shane Sheid, Wyoming Liberty Group, asked the Committee to reconsider a midwife licensing bill. Chairman Scott responded that that would be outside the Committee's interim topics and would require an individual sponsor.
Child Care Development Fund
Sue Bacon, Early Childhood Division Administrator, Department of Family Services, addressed the Committee regarding the Child Care Development Fund block grant program, which was extended by the American Recovery and Reinvestment Act of 2009. She distributed a chart entitled "Options for the Child Care Development Fund from the American Recovery and Reinvestment Act of 2009" (Appendix 10). The program will receive additional funding for improvements in quality ($213,000) and for increased availability of infant/toddler care ($130,000). The Department plans to use stimulus funds to increase eligibility from 200% to 250% of the federal poverty level, which would be up to $55,000 for a family of four. The program also drafted emergency rules to allow job searches by unemployed parents, and to pay weekly rather than six weeks in arrears.
Ms. Bacon explained the sliding scale payments by parents, being a low of forty cents per day to a high of
sixty-five cents/child/hour. The state's highest contribution is $650/month for infants; its lowest is $350/month. Average pre-school statewide is about $500/month from the state. There is a "cliff effect" where a little more income makes a person ineligible for a greater amount of assistance.
The Committee generally discussed use of the stimulus funds to increase eligibility, to increase payments or to contribute to capital facilities. Ms. Bacon noted that the stimulus funds cannot be used for capital costs.
Committee Business
Chairman Scott proposed a bill on the child care development fund to codify the co-payment levels, to appropriate stimulus money to implement electronic benefit transfer, to authorize infrastructure grants to build capacity and to use any leftover stimulus funds to increase provider reimbursements. Representative Harvey seconded the motion, which passed by a voice vote.
Representative Harvey proposed a bill to make the proceedings and decisions of the Medical Review Panel inadmissible in court. Senator Landen seconded the motion, which passed by a voice vote.
Meeting Adjournment
There being no further business, Co-Chairman Landon adjourned the meeting at 4:50 p.m.
Respectfully submitted,
Senator Charles K. Scott, Co-Chairman
Representative Jack Landon, Co-Chairman
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Labor, Health and Social Services
May 7, 2009 Oil and Gas Conservation Commission Building Casper, Wyoming
All meeting materials and handouts provided to the Committee by the Legislative Service Office (LSO), public officials, lobbyists, and the public are referenced in the Meeting Materials Index and are attached at the end of the minutes. The table below provides a summary of the materials provided to the Committee. These materials are on file at the LSO and are part of the official record of the meeting. Please contact the LSO at 307-777-7881 to review these documents.
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