Committee Meeting Information

October 15 & 16, 2009

Wyoming Pioneer Home

Thermopolis, Wyoming

 

Committee Members Present

Senator Ray Peterson, Cochairman

Representative Keith Gingery, Cochairman

Senator Dan Dockstader

Senator Kit Jennings

Senator Mike Massie

Representative Joe Barbuto

Representative Bob Brechtel

Representative Tim Hallinan

Representative Jack Landon

Representative Saundra Meyer

 

 

Committee Members Not Present

Senator Rick Hunnicutt

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 two days at the Wyoming Pioneer Home in Thermopolis.  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; Medicaid reimbursement rates; projects to assist persons with mental health or substance abuse issues; and, some capital construction projects. The Committee also approved draft legislation for Committee sponsorship during the 2010 Budget Session including: Title 25, involuntary hospitalizations; and, the establishment of time limits relating to forensic evaluations.  The Committee has completed its work for the 2009 Interim.

 

Call To Order (October 15, 2009)

Chairman Peterson called the meeting to order at 8:30 a.m.   The following sections summarize the Committee proceedings by topic.  Please refer to Appendix 2 to review the Committee Meeting Agenda.

 

Approval of Minutes

Minutes from the July 10, 2009 Committee meeting were approved.

 

Tour of Wyoming Pioneer Home

Ms. Sharon Skiver, Facility Manager, Wyoming Pioneer Home, conducted a tour of the Center. She provided Appendix 3, containing information about admissions criteria and costs or services at the Pioneer Home.  The Home is operated under State general funds and any monies received from residents is returned to the general fund.  About one-half (1/2) of the costs of services are reimbursed to the State.  There is a sliding fee scale for persons who have an annual income under $10,000.  Built in 1947 as an independent living facility, the Home is currently used as an assisted living facility.  The facility is undergoing remodeling to increase the size of the sleeping rooms.  While it is capable of serving up to 114 residents, that number will be reduced as a result of the remodeling. 

 

Mr. Jack Tarter, Superintendent, added that 13 counties are represented among the residents at the Home.  A problem exists with respect to serving the elderly poor because any person qualified for federal Supplemental Security Income loses that eligibility under federal law once the person enters the Home.

 

Senator Jennings asked for the size of the legislative appropriation for the Pioneer Home and what amounts are reimbursed to the general fund so Committee members may respond to questions during the legislative session.  Chairman Peterson asked if the Department of Health (WDH) is ramping up to meet the projected increase in demand for geriatric services by the baby boomer generation.  Mr. Lee Clabots, Deputy Director, WDH, stated that the WDH is not looking at expanding capacity at this time.  Dr. Brent Sherard, Director, WDH, added that Wyoming has the fifth highest percentage of baby boomers in the nation.  The biggest issue in the State facing those persons is finding health care providers to serve those persons. Ms. Teri Green, State Medicaid Manager, added that Medicaid will pay for medical services provided in a private facility.

 

Wyoming Meth Project

Ms. Jean Davies, Director, Wyoming Meth Project, introduced Mr. Tom Pagel, Casper Chief of Police and Nathan Bekke, Casper Star-Tribune, who have been instrumental in developing a successful project.  She stated that she will continue to follow the Montana lead and will establish a "Paint the State" campaign art contest.   Since the Project will be losing some grant funding, she may have to approach the Legislature for funding to continue the effort to fight the use of Meth in Wyoming.  She distributed Appendix 4, a Wyoming Meth Use and Attitudes Survey.

 

Mr. Bekke described the advertising campaign that Wyoming adapted from Montana.  He stated the program is working, according to the State survey (Appendix 4).  Although Wyoming still ranks first in use among several classes of persons, the program is having a positive effect.  Representative Gingery stated he is aware of other studies that conclude that positive campaigns are more effective than vilification campaigns.  Ms. Davies said she was aware of those studies, but results of her focus groups suggest otherwise.  Mr. Bekke added that the Wyoming campaign does get families talking about meth. 

 

Mr. Pagel added there is no single approach that is effective.  The approach to meth campaigns should be comprehensive.  He said the State has achieved some successes, but success is not victory.  Now we have to focus on prevention of meth use among the next generation.  One of the biggest reasons the State had reduced the incidence of meth use is because the energy industry has begun requiring drug testing of its employees.  He suggested that the State should begin requiring drug testing of state employees and school teachers.

 

Dr. Joe Roniger, Medical Director, Wyoming State Hospital, reiterated that the developing minds of juveniles are susceptible to addiction after a single use of methamphetamine.

 

Early Childhood Social/Emotional Development in Wyoming

Senator Mike Massie, distributed Appendix 5, a copy of his PowerPoint presentation.  Senator Massie explained the problem with increasing numbers of children with social emotional problems being seen in Wyoming.  A "Train the Trainer" model is being implemented that appears to have long-term success in addressing child and family problems.  The last national self-assessments indicated that Wyoming and New Mexico were rated highest with respect to improvements in social/emotional preschool interventions.  A problem still exists because there may not be adequate funds for the interventions to continue in first and second grades, when the preschoolers enter regular school.

 

Medicaid Reimbursement Rates

Dr. Sherard distributed Appendix 6, a written response to Wyoming psychologists relating to the proposed reductions in reimbursement rates for specified services provided under the Medical Assistance and Services Act (Medicaid).  After further review, the WDH has proposed increasing the reimbursement rate for two service codes that represent the most basic primary care services to Medicaid recipients, i.e., individual psychotherapy and psychological testing.  While increased enrollments in Medicaid have placed a strain on services at a time State agencies are under a directive to cut their budgets by 10%,  the WDH is trying to maintain provider reimbursement rates to the extent possible.

 

State Hospital Air Conditioning update

Mr. Rich Cathcart, Construction Management Administrator, Department of Information and Administration (DA&I), advised the Committee that DA&I has received a low bid under the $4 million that was appropriated for the installation of an air conditioning system in Cairns Hall at the WSH.  The bid, along with design and other fees, would push the total amount over the appropriation, but the overage can be covered by the 5% contingency funds that are available.  A problem still exists because, upon completion of the installation of the air conditioning system, Cairns Hall will have to be inspected to ensure that it meets updated building code requirements.  If the building can not meet those updated building code requirements, it may be less expensive to tear down the existing structure and build a new structure.  DA&I has applied for a variance of those new requirements, but Mr. Cathcart does not know if variances will allow avoiding the revised building code requirements.

 

Mr. Clabots stated that Health Care Licensing Division is the agency within WDH that is charged with licensing health care facilities, using standards set by the federal Centers for Medicare and Medicaid (CMS).  The Division will apply to CMS for the variances on the rationale that economic conditions may make it too difficult and expensive to meet the revised life safety code requirements and that the variances should be approved to allow the installation of the needed air conditioning system.

 

In response to a Committee question with respect to the funds used for the remodel project at the Pioneer Home, Mr. Billy Holmes, Project Manager, DA&I,  advised that $5.7 million was appropriated to fund the remodel project, using one-time funding from the Americans with Disabilities Act Account.  DA&I will be seeking $2 million to rebuild that Account.  The design phase of the remodel project is almost complete and it is hoped that construction can begin next Spring on the project.

 

Wyoming Association of Psychiatric Physicians

Dr. O'Ann Fredstrom, President of the Wyoming Association of Psychiatric Physicians, introduced Dr. Steve Brown, Medical Director, Wyoming Behavioral Institute.  If this Committee will terminate this year, she has some suggestions, including that funding for Medicaid and mental health centers should not be reduced.  With respect to 10LSO-0054.W3, Title 25 revisions she recommended: the provision addressing the inability to care for one's self should be kept in the bill; jail is not a good option for persons detained under title 25; and, the requirement for a single gatekeeper in each county should be retained.  She also advised that courts should not place persons in residential treatment facilities until the person has been evaluated by a qualified professional to ensure the person is appropriately placed.  Dr. Brown added that when a child is placed in a psychiatric facility or a corrections facility when the child should have been placed in the other, it is difficult to correct the error.  Representative Gingery agreed that the lawyers often overshadow the mental health professionals in multidisciplinary team meetings and the lawyers wind up deciding placement.  Dr. Sherard agreed with Dr. Fredstrom that placements should only occur after evaluation and consistent with the recommendation of the mental health professional.

 

Dr. Brown stated that the budget cuts appear to be affecting persons with mental illness or developmental disabilities disproportionately.  He wanted to remind the Committee how the mental health system has been improved since the Committee was created because he does not want to see the services dismantled after the Committee ceases to exist.  Before the Committee was created, there were only 2 child psychiatrists in the State, now there are six.  Any budget cuts that are made to the system will have repercussions throughout the system.  In addition to cuts to Medicaid, the CHIPS program has seen cuts that adversely affect children and their families.  He asked the Committee to try to put more money into the mental health system to prevent the reduction in services that will otherwise occur.

 

Wyoming Mental Health and Substance Abuse Services Division update

Mr. Rodger McDaniel, Deputy Director, Mental Health and Substance Abuse Services Division, briefly described the history of the legislation that has made his job less difficult and more pleasant, including 2002HB0059, 2006HB0091 and 2007SF0076.  Now, with budget shortfalls, his and Dr. Sherard's jobs are much more difficult.  Many of the goals of the Select Committee will have to wait for the next period of economic boom in the State.  He expressed his appreciation of the work of present and past Committee members, of mental health centers and their boards of directors, and of his own staff.  Some budgetary issues that remain to be addressed include substance abuse residential treatment services in the southeast region of Wyoming and crisis stabilization acute care services at the Cheyenne Regional Medical Center (CRMC) and in Basin.  He will be working with the Legislature to try to meet the State's obligations to the providers and their clients.  The WDH, in its consideration of mandatory budget cuts, has focused on cutting bad programs and good programs that have met their goals, while trying to retain good programs that have not yet met their goals.

 

Senator Massie distributed Appendix 7, an article entitled Vets' Mental Health Diagnoses Rising, New York Times, July 16, 2009.  The author, James Dao, wrote that the rate of veterans with diagnoses of Post-Traumatic Stress Disorder or depression has risen significantly since the U.S. invasions of Iraq and Afghanistan.  Senator Massie stated his purpose in distributing the article was to prevent cuts to the veteran's outreach program that was funded under legislation sponsored by this Committee.

 

Ms. Anna Edwards, Director, NAMI Wyoming, stated that, on average,  a person with mental illness will have a life expectancy of 25 years less than a person without mental illness.  While she recognizes that budget cuts are necessary, she asked the Committee to look closely at protecting vulnerable persons with mental illness.

 

Ms. Phyllis Sherard, CRMC, said she would send the Committee a 2 page brief describing the activities of the crisis intervention center at CRMC.

 

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

Mr. Mark Russler, Director, Cloud Peak Counseling Center, distributed Appendix 8, a summary of accomplishments of mental health centers as a result of legislation sponsored by this Committee, and Appendix 9, describing the increased administrative costs mental health centers have incurred as a result of reporting requirements in their 2010 contracts with the WDH.  Mr. Russler would like to work with the WDH to plan budget cuts in ways to minimize the impact on important direct services.

 

Mr. Dave Nees, Director, Pioneer Counseling Center, distributed Appendix 10, a chart illustrating the lengths of stay of persons in need of crisis stabilization in Evanston.  The chart shows how the availability of services and the nature of the groups served determine the length of stay in crisis stabilization.  Two-thirds of crisis stabilization patients in Evanston are not residents of Uinta County, but many wind up staying in the County after their release.  Only one person has gone into a more intensive treatment program (i.e., Wyoming State Hospital), while another 7 went into the crisis stabilization program at Pioneer Counseling Center.

 

10LSO-0081.W1, State health and social welfare institutions

Chairman Peterson advised that Dr. Sherard would not be able to attend the meeting on Friday, so the Committee would hear his comments on the bill this afternoon, even though the bill will not be considered until Friday due to the lateness of the hour.

 

Dr. Sherard advised the goal of the WDH is to use the Life Resource Center in Lander more efficiently.  To effectuate that goal a study is necessary, but perhaps not a study as comprehensive as outlined in the draft legislation before the Committee.  It may be better to scale back the study and its related costs to focus primarily on the Wyoming State Hospital in Evanston, the Life Resource Center in Lander and the Retirement Center in Basin.

 

Meeting Recess

The Committee recessed at 5:15 p.m.

 

Call To Order (October 16, 2009)

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.

 

Brain Injury Association of Wyoming

Ms. Dorothy Worrell, Director, Brain Injury Association of Wyoming, distributed Appendix 11, consisting of several materials providing information about the Association and how to contact its office.  The Association is an advisory council to the Mental Health and Substance Abuse Services Division.  One-third of its funding is due to expire in April, 2010. She also asked for help with proposed legislation, including a budget amendment requiring county fines to go to a trust fund.  Twenty percent of brain injuries are caused by motor vehicle accidents.  Ms. Worrell was advised the Wyoming Constitution requires all fines and penalties to go into the school fund of the respective counties.  Chairman Gingery suggested that the additional penalties could be called a surcharge to avoid the constitutional restriction. Chairman Gingery said the legislation Ms. Worrell requested would require an individual sponsor, so she should start talking to legislators to find a potential sponsor.

 

Several people accompanying Ms. Worrell described the effect of a brain injury upon the individual and upon his family. 

 

10LSO-0055.W2, Criminal procedure-time limits for competency evaluations

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 and recommendations from the American Bar Association.  Chairman Gingery explained the bill, then opened the meeting up for public comment.

 

Mr. Mike Blonigen, 7th Judicial District Attorney, believes it's a good bill but sees some room for improvement, including:

 

Senator Massie moved, seconded by Representative Barbuto, for the Committee to approve sponsorship of the bill in the 2010 Budget Session.  After amendments to the bill were adopted, the bill carried on a roll call vote, with 7 ayes, 3 nays and 2 excused.  Senators Massie, Meyer and Peterson and Representatives Barbuto, Gingery, Hallinan and Landon voted aye. Senators Dockstader and Jennings and Representative Brechtel voted nay.  Senator Hunnicut and Representative Goggles were excused.

 

The following amendments were adopted:

 

10LSO-0054.W3, Title 25 revisions

Ms. Carol Day, WDH, explained the bill and proposed changes.  Ms. Day distributed Appendix 13, a sample financial affidavit that could be used to determine if a person released from emergency detention or involuntary hospitalization has income or assets to reimburse the costs of the detention or hospitalization.  She recommended that the Committee delete the new W.S. 25-10-112(g) created by the bill because it could impose a financial burden that counties may not be able to absorb with respect to establishing a single point of entry for involuntary hospitalization hearings.  Options for that provision could be to delete the subsection and wait until funding can be made available to counties, or implement the concept as a pilot project in one or two counties.  Statewide, the program could cost over $1 million.

 

Mr. Bob Stahl, Interim Superintendent, Wyoming Sate Hospital (WSH), explained that convalescent leave for patients at the WSH is currently implemented as a medical decision.  For the last two fiscal years, 8 decisions were made to grant convalescent leave.  Only one of those patients was from outside of Uinta County.  Chairman Gingery asked if the rule making authority created by the bill was necessary if convalescent leave is a medical decision.  Mr. Stahl replied that there are persons other than just the patient who are affected by the decision.  Ms. Day added that current law addresses convalescent leave  (W.S. 25-10-127) and the intent of authorizing rule making authority for the WDH is to set criteria for the process of convalescent leave.  Dr. Roniger stated that convalescent leave is a useful tool for the treatment of patients, but guidelines for implementation of the leave would be helpful.  The purpose would be to establish a process that would allow a person on convalescent leave to return to the WSH, when necessary, without having to undergo a full involuntary hospitalization proceeding.

 

Mr. Bryan Skoric, Park County and Prosecuting Attorney, expressed his concerns with the bill and provided some alternative language for some proposed changes in the bill.

 

Ms. Anna Edwards, Director, NAMI Wyoming, said she was part of the working group that Ms. Day assembled to consider developing proposed changes to Tile 25.  She stated that the Title 25 involuntary hospitalization process does not work, despite what some may assert.  Many people in need of services are still falling through the cracks.  She advised the Committee of provisions in the draft bill that she believes are critical.

 

Ms. Charlotte Kinnear advised the Committee that she has a son who was diagnosed with schizophrenia at age 21.  He had been doing very well in school until that time, but since then has dropped out of school. She was advised that the only basis Natrona County could use to begin an involuntary hospitalization proceeding was if her son was a danger to himself or others.  The provision relating to "unable to care for self" would only be used if he was dying on the street.  As a result when no other options were available, he was jailed and has a criminal record now, when what he needed was treatment.

 

Senator Meyer moved, seconded by Senator Massie, for the Committee to approve sponsorship of the bill in the 2010 Budget Session.  After amendments to the bill were adopted, the bill carried on a roll call vote, with 8 ayes, 1 nay and 3 excused.  Senators Dockstader, Jennings, Massie and Meyer and Representatives Barbuto, Gingery, Hallinan and Landon voted aye.  Representative Brechtel voted nay.  Senators Hunnicut and Peterson and Representative Goggles were excused.

 

The following amendments were adopted:

"(xvi)  'Dangerous to himself' means that a person evidences a substantial probability of physical harm to himself as manifested by evidence of recent threats of or attempts at suicide or serious bodily harm;

(xvii)  'Dangerous to others' means that a person evidences a substantial probability of physical harm to other individuals as manifested by a recent overt homicidal act, attempt or threat or other violent act, attempt or threat which places others in reasonable fear of serious physical harm to them;

(xviii)  'Unable to satisfy basic needs' means that the person evidences behavior manifested by recent acts or omissions that, due to mental illness, he is unable to satisfy basic needs for nourishment, essential medical care, shelter or safety so that a substantial probability exists that death, serious physical injury, serious physical debilitation, serious mental debilitation, destabilization from lack of or refusal to take prescribed psychotropic medications for a diagnosed condition or serious physical disease will imminently ensue, unless the individual receives prompt and adequate treatment for this mental illness.  The behaviors manifested by recent acts or omissions may be exhibited through a totality of recent circumstances and may include a history of mental illness, including previous hospitalizations or detention under this act. No person, however, shall be deemed to be unable to satisfy his need for nourishment, essential medical care, shelter or safety if he is able to satisfy those needs with the supervision and assistance of others who are willing and available.".

"(f)  When a person is detained under emergency circumstances, treatment may be given during the emergency detention period, if the person voluntarily and knowingly consents. The parent or guardian of a minor or incompetent person may consent to treatment. Treatment may be given without the consent of the detained person or his parent or guardian when treatment is limited to diagnosis or evaluation or when treatment is necessary to prevent immediate and serious physical harm to the person or others. Prior to treatment, the person shall be fully advised of the scope of treatment, and a report of the treatment shall be filed with the court if involuntary hospitalization proceedings are commenced. An examiner or a physician who provides treatment in good faith pursuant to this subsection shall be immune from civil liability for the treatment except there shall be no immunity from liability for negligent acts or deliberate misconduct.".

 

10LSO-0081.W1, State health and social welfare institutions

Chairman Gingery provided a background on the study of institutions under the supervision of the WDH.

The Committee discussed the proposed cost of the study authorized by this bill and considered scaling back the scope of the study.  Because this meeting would be the final meeting of the Committee, the Committee decided that it would not have adequate time to consider the significant changes the bill would require to have a chance for full consideration during the 2010 Budget Session.  No motion was made to consider the bill further.

 

Meeting Adjournment

There being no further business, Chairman Gingery adjourned the meeting at 3:35 p.m.

 

Respectfully submitted,

 

 

 

 

Senator Ray Peterson, 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

 

Materials on Wyoming Pioneer home

 

Describes services available at the Pioneer Home and admission requirements.

 

Ms. Sharon Skiver, Facility Manager, Wyoming Pioneer Home

4

 

2009 Wyoming Meth Use & Attitudes Survey

 

Provides the results of a survey measuring attitudes and behaviors towards methamphetamine use in Wyoming

 

Ms. Jean Davies, Director, Wyoming Meth Project

5

 

Wyoming Early Childhood Social-Emotional Development System

 

A PowerPoint presentation describing model services for provision of  early childhood social-emotional development

 

Senator Mike Massie

6

 

Fact sheets about Medicaid reimbursement to psychologists and psychiatrists

 

Explains the process used by the Wyoming Department of Health (WDH), in making mandated cuts for Medicaid reimbursements

 

Dr. Brent Sherard, WDH Director

7

 

New York Times Article, Vets' Mental Health Diagnoses Rising

 

Describes the increase in diagnoses of post-traumatic Stress Syndrome and depression among veterans of the Iraq and Afghanistan conflicts

 

Senator Mike Massie

8

 

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

 

Describes the accomplishments of Wyoming mental health centers as a result of legislation sponsored  by the Select Committee

 

Mr. Mark Russler, Director, Cloud Peak Counseling Center

9

 

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

 

Describes the increased administrative costs incurred by mental health centers as a result of  contracts required as a result of legislation sponsored  by the Select Committee

 

Mr. Mark Russler,  Director, Cloud Peak Counseling Center

10

 

Statistical Chart relating to length of stay in crisis stabilization beds

 

Illustrates the length of stay in crisis stabilization beds in Evanston, including characteristics of patients receiving services

 

Mr. David Nees, Director, Pioneer Counseling Center

11

 

Materials from Wyoming Acquired Brain Injury Task Force

 

Describes the causes for brain injury in Wyoming ,activities of the Brain Injury Association of Wyoming and a request for legislation

 

Ms. Dorothy Worrell, Director, Brain Injury Association of Wyoming

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

13

 

Title 25 Financial Affidavit & Certification

 

An example of the WDH financial affidavit that would allow a hospital to dispense with bill collection efforts against a Title 25 emergency detainee or involuntarily hospitalized patient.

 

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

 

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