Committee Meeting Information

July 10, 2009

Wyoming Retirement Center

Basin, Wyoming

 

Committee Members Present

Senator Ray Peterson, Cochairman

Representative Keith Gingery, Cochairman

Senator Dan Dockstader

Senator Rick Hunnicutt

Senator Kit Jennings

Senator Mike Massie

Representative Bob Brechtel

Representative Tim Hallinan

Representative Jack Landon

Representative Saundra Meyer

 

 

Committee Members Not Present

Representative Patrick Goggles

 

Legislative Service Office Staff

John H. Rivera, Senior Staff Attorney

Lisa Jeremiah, 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 for one day at the Wyoming Retirement Center in Basin.  The Committee received updates on: activities of the Mental Health and Substance Abuse Services Division and the Wyoming Association of Mental Health and Substance Abuse Centers; and, some capital construction projects. The Committee also considered draft legislation on: Title 25, involuntary hospitalizations; and, the establishment of time limits relating to forensic evaluations.  The Committee set its next meeting for October 15 and 16, 2009, to be held in Thermopolis.

 

Call To Order

Chairman Gingery called the meeting to order at 8:05 a.m.  The following sections summarize the Committee proceedings by topic.  Please refer to Appendix 2 to review the Committee Meeting Agenda.

 

Tour of Wyoming Retirement Center

Ms. Anita Cox-Mills, Director, Wyoming Retirement Center, conducted a tour of the Center. She explained there are two secure wings at the Center, one for patients with Alzheimer's Disease or dementia which currently houses primarily female patients, and another wing for male patients with behavioral problems, including some patients transferred from the State Hospital.  Gottsche Rehabilitation Center has contracted to use some space at the Retirement Center also.   Currently the Center serves 59 patients at the facility, with three more expected in the near future.  It is capable of serving up to 75 patients, optimally, with its current staffing.  There is potential for crisis stabilization services in another wing.

 

Geropsychiatric Facilities

Chairman Gingery provided a background on this issue.  Dr. Pablo Hernandez, former Director of the Wyoming State Hospital (WSH), during a tour of the facility stated he wanted a geropsychiatric facility built at the WSH to address a concern with the expected increase in demand for services for aging baby boomers with psychiatric problems.  The Committee successfully sponsored legislation providing $70 thousand in 2006 for a facility study at the WSH.  The results of the study included a finding that it would be less expensive to build a new unit, rather than to refurbish an existing unit at the facility.  After that study, Dr. Sherard, Director, Wyoming Department of Health (WDH), advised that the WDH would prefer to conduct a statewide survey of existing facilities to determine if those facilities could be used to address the anticipated future needs of the State.  A bill sponsored by the Labor, Health and Social Services Committee to authorize that survey subsequently failed.

 

Mr. Rodger McDaniel, Deputy Director, WDH, advised that Dr. Hernandez was presenting his own view in 2006 with respect to what the needs he believed would be and how the WSH might be able to address those needs.  Those suggestions in 2006 may still be an option, but Dr. Sherard was interested in a broader, and more long term, view of ways to address the issues.  A major concern for Dr. Sherard was to establish a system whereby patients could receive services closer to home and family to facilitate the patient's existing support system.  He explained that the Retirement Center, to accept geropsychiatric patients, would have to alter its mission because it is a currently safety net, licensed as a long-term care facility by the Centers for Medicare and Medicaid Services (CMS).  Currently about 45% of the patients are on psychotropic medications. If over 50% of the patients are on psychotropic medications, the Center would be in danger of  losing its CMS certification as a long term care facility which could result in the loss of federal funding.  The Medicare, Medicaid and private insurance payments the Center receives for services to patients go into the State's general fund.

 

Mr. McDaniel advised that waiting lists at the WSH are smaller and at times nonexistent, due to regionalized service enhancements.  While the problem of serving geropsychiatric patients is not bad now, it is looming with an aging population in the State.  He believes the study Dr. Sherard requested could answer some of the questions about how to address the problem.

 

Ms. Cox-Mills, explained the missions of the Veterans' Home, The Pioneer Center and the Retirement Center.  The Retirement Center admits the more severe patients that the Veterans' Home and the Pioneer Center aren't staffed to deal with and the Retirement Center could develop the separate wing to be licensed separately to avoid any problems with CMS.

 

After discussion, the Committee directed staff to draft a bill similar to a previous bill sponsored by the Joint Labor, Health and Social Services Interim Committee to appropriate funds for the study of the 5 state institutions supervised by the WDH and including the ability of private facilities to provide services to meet the projected needs for geropsychiatric services.  Senator Massie requested that staff provide information on what state land funds currently go into those 5 state institutions.

 

Wyoming State Hospital Air Conditioning Update

Chairman Gingery explained the background relating to this issue.  When the Committee toured the WSH in 2006, the heat in the criminal forensics unit was almost unbearable.  The Committee sponsored an appropriation to determine the cost of updating the heating ventilation and air conditioning (HVAC) system at the WSH.

 

Mr. Rich Cathcart, Construction Management Administrator, Department of Information and Administration, advised the Committee by telephone on the progress of the project to update the HVAC system. The project would cost $4 million, which was approved by the Legislature last year.  The design phase cost $270 thousand, which was paid out of major maintenance funds.  The design is complete and has been submitted to the federal Health Care Financing Administration for approval.  Once that approval is received, a request for proposals will be distributed to pre-qualified contractors.

 

10LSO-0054.W2, Title 25 revisions

Ms. Carol Day, Facility and Community Service Systems Coordinator, WDH, reminded the Committee that she had sent them the results of a WDH survey (Appendix 3), entitled Title 25: Stakeholder Recommendation Report.  The report was drafted after the study team met with clients, family members, mental health examiners. WSH staff, law enforcement agencies, prosecuting and defense attorneys, judges and court commissioners and advocacy groups in all 23 counties. Over 260 people participated in the study.  Each county conducts the emergency detention and involuntary hospitalization process differently, which results in significantly different treatment from jurisdiction to jurisdiction. The report presents the recommendations from the stakeholders who participated in the study.  The recommendations that would require legislative changes are included in the draft legislation before the Committee. 

 

Chairman Gingery explained the draft bill.  He mentioned that the staff comment relating to the circularity of the definitions contained in W.S. 25-10-101(a)(ii) and (ix) was valid and perhaps the definition of "mental illness" should be revised.  Senator Massie suggested the New Mexico and Colorado definitions provided by staff have some merit.  Senator Massie also expressed concern that the proposed change to W.S. 25-10-112(e) may require the State to pay for medical conditions unrelated to the purpose for the detention, contrary to a bill enacted recently to ensure that people aren't detained pursuant to an order from a health care provider as an excuse to provide an expensive medical procedure that the detainee would otherwise not be able to receive due to a lack of insurance. Chairman Gingery said the bill will be revised for further consideration at the next meeting.

 

Mr. Brian Skoric, Park County Attorney, stated that Title 25 is a morass.  The entire chapter 10 should be repealed and replaced by some other state's process for involuntary commitment.  He believes the proposed bill would make the system worse than it currently is.  Some of the concerns he had with the bill include:

 

Ms. Georgia Antley Hunt, Big Horn County Attorney, agreed with most comments by Mr. Skoric.  She added that she would prefer not to jail detainees, but her county can't afford the 24 hour care requirements of hospitalization.  She also expressed concern with the requirements for transportation of released detainees.

 

Ms. Marion Schulz, Wyoming Association of Psychiatric Physicians (WAPP), thanked Ms. Day and the WDH for their efforts on the survey.  The WAPP will have a position paper on this bill.  She would be willing to work with staff on revisions to this bill and the other bill the Committee will be considering at this meeting.

 

Ms. Day advised the Committee the concerns expressed by Park and Big Horn Counties are not unique to those counties.  Her responses to address those concerns include:

 

Chairman Gingery asked Mr. McDaniel if Mr. Bob Peck could provide information relating to the rates of reimbursement requested by hospitals for emergency detainees and persons involuntarily hospitalized.

 

 

Wyoming Mental Health and Substance Abuse Services Division update

Mr. McDaniel introduced Ms. Korin Schmidt, Administrator of the Division, who would assist him in his presentation.  He stated that the Divisions of Mental Health and Substance Abuse, which were created as separate divisions within the WDH under the administration of Governor Geringer were merged a couple of years ago as a result of an audit by the Management Audit Committee.  As a result, the WDH was able to reduce the staffing of the Division by 10 FTEs.  The Division had 4 core functions including: performance based contracts and performance; policy and planning; data collection and analysis; and, quality improvement. He distributed Appendix 4, containing the second edition of the trends and outcomes in mental health and substance abuse.  Forty percent of inmates are incarcerated for probation or parole violations. Of those, 70% of the violations involve alcohol or substance abuse.  Two issues the WDH is watching closely is national health care reform efforts and law addressing mental health parity in insurance contracts.  These two issues may put significant federal monies into the system and provide more competition and availability of services for behavioral problems.

 

Mr. McDaniel distributed Appendix 5, listing the proposed budget cuts for FY10 that the Division may be implementing; Appendix 6, containing a graph comparing funds allocated in 2001, 2009 and proposed for 2010; and, Appendix 7, a memorandum explaining the proposed budget cuts.  The year 2001 was a watershed year because 01HB0059 appropriated significant funds to combat drug abuse.  Then, in 2006 significantly more money was appropriated as a result of the creation of this Select Committee.  Even with the proposed budget cuts totaling about $3.8 million, there will still be a significantly more monies for services than existed at the beginning of this decade.  He explained that there are also substantial funds that are not included in the standard budget, but will be requested through the exception budget.  Senator Massie asked that the community system of care working agreements with schools include an effort by the three agencies involved to include preschool infants in the process.

 

Mr. McDaniel also distributed Appendix 8, a WDH newsletter describing the children's mental health waiver that was approved by CMS.  The waiver program is proceeding well.  It waives income requirements, so parents won't have to surrender custody of their child to get mental health services for the child in need.  The WDH has contracted for case management services for veterans' outreach program the Committee sponsored.  The WDH will have a report on this program soon.  One of the caseworkers in the program can point to 7 potential suicides that have been prevented as a result of the program.

 

Chairman Gingery asked Mr. McDaniel to send the executive summary of 2005 Datacorp Social Indicator and Gap Analysis Study to the new members of the Committee

 

Wyoming Association of Mental Health and Substance Abuse Centers (WAMHSAC) Update

Mr. Mark Russler, President of WAMHSAC, announced that today was the last day of his term and he will be replaced as President by Ms. Alice Russler, Director, Yellowstone Behavioral Health.  He distributed Appendix 9, outlining WAMHSAC providers' accomplishments. WAMHSAC was one of three chosen participants in the Access Redesign Quality Improvement Initiative (see Appendix 10).  Providers also collaborated with Ms. Day on development of a memorandum of understanding with the WSH for discharge of patients and on the proposed Title 25 changes draft legislation the Committee heard earlier.  He advised that community mental health centers often perform the role of gatekeepers in their counties, despite having limited resources to perform those duties.  With respect to proposed Division cuts, Mr. Russler suggested such cuts should be decided at the local level, so he hopes that the actual cuts made by the Division are consistent with the recommendations from the local programs.  He expressed concern about the new training requirements for boards of directors of the local programs, without any additional funding to implement such training. 

 

Mr. McDaniel explained the board of directors training requirement is a result of the consent decree filed in 2002 in the lawsuit filed by Protection & Advocacy System, Inc. on behalf of patients at the WSH.  He has tried to make the training requirement as flexible and inexpensive as possible for providers.

 

Senator Peterson asked if the WDH and the WAMHSAC providers were any closer to having compatible data collection and analysis software.  Mr. Russler asserted that the providers can and do provide accurate information, but the WDH can't process it accurately, which delays payments to the providers.  Mr. McDaniel stated that the WDH has contracted with an independent contractor who found the state computer system operates properly (see Appendix 11).  The problem appears to be 9 different software systems trying to communicate with the State system.

 

Criminal Procedure Time Limits for Competency Evaluations-draft Legislation

Ms. Amber Martines, Wyoming State Hospital (WSH), distributed Appendix 12 in support of the draft legislation.  She explained the process each accused person who is being evaluated to determine his fitness to proceed to trial must undergo and the problems that occur during those processes.  The presentation included a flowchart of the evaluation process.

 

Mr. John Connor, Uinta County Deputy Attorney, believes it's a good bill to set time limits on forensic evaluations.

 

Chairman Gingery advised the Committee would not work the bill at this meeting.  He has requested that prosecutors and the public defender review the bill and provide comments.  Perhaps the bill will be reworked in detail at the next meeting after the comments are received.

 

Senator Peterson asked for the number of persons in long term forensic evaluations at the WSH and the length of stay of the longest such evaluation.

 

Committee Discussion

Chairman Gingery advised that the Committee would be considering 3 bills at the next meeting, including the two presented today and a bill to authorize and fund a review of state institutions under the supervision of the WDH. 

 

After discussion, the next meeting was set for October 15 and 16, 2009, to be held at the Wyoming Pioneer Home in Thermopolis.

 

Meeting Adjournment

There being no further business, Chairman Gingery adjourned the meeting at 4:10 p.m.

 

Respectfully submitted,

 

 

 

 

Senator Ray Peterson, Cochairman                              Representative Keith Gingery, Cochairman

 

 

 

 

 

 

 

 

 


Appendix

 

Appendix Topic

 

Appendix Description

 

Appendix Provider

1

 

Committee Sign-In Sheet

 

Lists meeting attendees

 

Legislative Service Office

2

 

Committee Meeting Agenda

 

Provides an outline of the topics the Committee planned to address at meeting

 

Legislative Service Office

3

 

Title 25: Stakeholder Recommendation Report

 

Provides the recommendations of the stakeholders consulted in a survey of  Title 25 detentions and commitments

 

Ms. Carol Day, Wyoming Department of Health (WDH)

4

 

Wyoming Trends and Outcomes in Mental Health and Substance Abuse, 2d, ed.

 

Describes the trends and outcomes related to mental health and substance abuse problems in Wyoming

 

Mr. Rodger McDaniel, WDH

5

 

FY10 Budget Cuts: Mental Health and Substance Abuse Services Division (the Division)

 

Provides a table listing the proposed budget cuts the Division may be implementing for FY10

 

Mr. Rodger McDaniel, WDH

6

 

Graph comparison of funds allocated in specific years

 

Provides a graph to illustrate the funds allocated by the Division in years 2001, 2009 and 2010

 

Mr. Rodger McDaniel, WDH

7

 

Memorandum of provider contracts and FY10 budget cuts

 

Describes the contracts between the Division and local providers and explains the budget cuts for FY10 that will affect those contracts

 

Mr. Rodger McDaniel, WDH

8

 

Newsletter of the Division on the Children's Mental Health Waiver

 

Describes the progress and provisions of the Wyoming Children's Mental Health Waiver, as approved by the Centers for Medicare and Medicaid Services

 

Mr. Rodger McDaniel, WDH

9

 

Report from Wyoming Association of Mental Health and Substance Abuse Centers (WAMHSAC)

 

Describes the activities of the WAMHSAC providers in FY09

 

Mr. Mark Russler, President, WAMHSAC

10

 

Access Redesign Quality Improvement Initiative (ARQII)

 

Describes the ARQII and the how WAMHSAC providers will be participating in the Initiative

 

Mr. Mark Russler, President, WAMHSAC

11

 

Memorandum from Andy Corbin to Dr. Brent Sherard

 

Provides the findings of the independent contractor who evaluated the computer system used by the WDH to process information provided by WAMHSAC providers

 

Mr. Rodger McDaniel, WDH

12

 

Copy of PowerPoint presentation re: Criminal Procedure Time Limits for Competency Evaluations

 

Describes the process for forensic evaluations to determine the competency of an accused who may not be fit to proceed to trial

 

Ms. Amber Martines, Wyoming State Hospital

 

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