WMS Board of Trustees Sets Direction for 2016 Session

The WMS Board of Directors will meet in its Cheyenne office on Jan. 16. 

CHEYENNE – The Wyoming Legislature will convene on Feb. 8 for a 20-day session in which it sets the state’s budget for the next two years. However, lawmakers will also hear several bills attempting to become Wyoming state laws.

Next weekend in Cheyenne the Wyoming Medical Society’s Board of Directors will meet to consider some of the bills which have been released and take a position on the legislation. Wyoming Medical Society staff will then lobby on behalf of Wyoming’s physicians based on the positions its board takes on these bills.

To make your feelings on these bills known, contact your representative to the WMS Board, which can be found here.

Bills which have already appeared on the State Legislature’s Website

H.B. No. 0004 Medical Marijuana reciprocity
AN ACT relating to possession of marihuana; providing that 2 possession of marihuana pursuant to a medical marihuana 3 card or prescription issued in another state is lawful as 4 specified; and providing for an effective date.

H.B. No. 0005 Prohibited question on job applications.
AN ACT relating to labor and employment; prohibiting an employer from requesting information about an applicant’s past criminal history on an employment application form; providing an exception; and providing for an effective date.S.F. No. 0003 Permissive preference for veterans in private employment.

H.B. No. 0004 Minimum wage.
AN ACT relating to labor and employment; increasing minimum hourly wages; providing for a training wage; increasing minimum wage for tipped employees; requiring employers to pay underpaid tipped wages in a specified time; providing for treble damages, minimum recovery, court costs and attorney fees as specified; repealing an obsolete provision; and providing for an effective date.

Bills in draft form still with the Legislative
Service Office

LSO Draft Bill – 0142 – State health facility missions – statutory compliance
An Act relating to institutions of the state; amending qualifications to receive services from state health care facilities; amending the mission of state health care facilities; conforming statutes; specifying applicable federal standards for rulemaking; updating obsolete language.

The basics – This bill would have involuntary commitments to the state hospital and no longer send those commitments to go to the Wyoming Life Resource Center. it also removes the language of “intellectual disability,” from the reasons to send someone to the state hospital and limit it to mental illness.

LSO – 0259 Upper Limit Programs
AN ACT relating public welfare; establishing a private 2 hospital assessment as specified; providing for the use of 3 assessments to obtain federal matching funds; providing for 4 payments to private hospitals as specified; establishing an 5 account; providing definitions; providing regulatory 6 authority; providing penalties; and providing for an 7 effective date.

The basics: Assesses private hospitals to get their reimbursements to the upper payment limit allowed by the federal government by assessing a fee to the private hospitals themselves which would then be matched by the federal government.LSO-

158 Medicaid plan amendment – gap payment program
An act relating to the Medicaid program authorizing the department of health to obtain an amendment to the state for the governmental nursing facility gap payment program.

The basics: This bill would allow non state-government-owned nursing homes or private nursing homes to partner with non state-owned government hospitals to participate in the upper payment level as well. It could mean around $15 million total to Wyoming nursing homes.

16LSO – 0131 Healthcare facility receivership act
An Act relating to hospitals and health care facilities creating a health care facility receivership act; providing definitions; providing for procedures and standards for establishing and terminating a receivership; establishing powers and duties of a receiver.

The basics:  After nursing facilities in Saratoga and Rock Springs struggled financially due to management issues with Deseret this summer, the Department of Health was asked to look into the process for the state to put health care facilities into receivership. This makes policy decisions on when receivership is appropriate, such as in instances of imminent danger to residents or issues with licensure.

16LSO-0070 Direct Primary Care – Insurance Exemption
An act relating to insurance; exempting direct primary care services from insurance regulation; specifying requirements from insurance regulation; specifying requirements for exemption; providing definitions; and an effective date.

The basics: This bill makes the delineation between what is insurance and what is DPC as payment of services before medical care is delivered is considered insurance. The bill explains 10 things required in a contract needed to exempt DPC from the insurance moniker. The Insurance Commissioner, Tom Glause says he supports the bill and only asked that the committee be wary of retainer agreements with provisions for early termination payments to providers. An amendment saying as much was written into the bill.

16LSO-0278 – Public Nursing Bill
AN ACT relating to public health and safety; specifying 2 options for public health nursing cooperation between the 3 state and counties; repealing temporary provisions related 4 to public health nursing; and providing for an effective date.

The basics:  The Department of Health and the counties may be into a memorandum of understanding where the county public health nurse essentially becomes a state employee with the county paying 65 percent of the cost to the state for the organization, management, delivery and 18 financing of public health nursing and related functions.

16 LSO 165 Medicaid-dietitian
An Act relating to Medicaid; authorizing direct Medicaid payment for services rendered by a dietician; and providing for an effective date.

The basics:  Dieticians asked to add services of dietician (licensed) to definitions of all the services allowed to be reimbursed by Wyoming Medicaid program. Dieticians cannot currently bill as an individual entity but can if they are working under a physician. Department of Health suggests $.03 per member per month to Medicaid. State Medicaid Officer Terri Green suggests WDH has spoken with the dietitians regarding these services and they are comfortable with the bill. There is no increase in fiscal requests for dietician programs and Medicaid feels it can use this to offer enhanced benefit to their clients. Ultimately, Medicaid seems to think there is cost savings in allowing dieticians to Medicaid, specifically due to diabetic use.

16 LSO 132 Treatment of mental illness
An Act relating to hospitalization and treatment of mentally ill persons; modifying procedures for involuntary hospitalization; providing for directed outpatient treatment; amending convalescent status; providing for and amending definitions; amending provisions relating to representation by the state and county of an involuntarily hospitalized or treated person; clarifying provisions relating to payment by the county for involuntary hospitalization and treatment; and providing for an effective date.

The basics:  This is a bill over a year in the making put together by the Task Force on Title XXV. The State has spent more than $11 million more than planned so far this biennium on involuntary hospitalizations. While everyone admits there is work to do, this is the first step of the task force that is actively trying to continue its work into next year. Among the requests of the hill are assigning a gatekeeper or case manager and incentivizing the community health centers to keep clients in the community.

Perhaps the biggest piece of the bill would allow the court to do outpatient commitments to those who are deemed mentally ill and in need of treatment after an evaluation.

The Department of Health is also working with consultants on ways to reform the payment process to offer a base payment to centers to keep their doors open, then a fee-for-service approach which would end if the patient would end up at the State Hospital. Director Forslund asserts that currently it is all too common for police to pick up someone in a psychotic episode and take them directly to a hospital or WBI, which sends them into the state system without any intervention from the local groups. He wants to see that change.

Among those speaking in favor of the bill was WMSAC which likes the new payment model, but wants to make sure it is fully vetted before it takes effect. They claim to have diverted 62 percent of those to walk through their doors from the state mental health system. Peggy Trent, the Albany County Attorney also testified suggesting there is no case management system for these clients and asked that such a system be a part of any funding.

16 LSO 62 Free-standing emergency centers
An Act relating to public health and safety providing a definition of freestanding emergency center including free standing emergency centers; in the definition of a health care facility.

The basics: The bill defines what a freestanding Emergency Departments is, and adds it to the list of existing medical facilities. They want to allow them under a hospital license as well. For a facility it wouldn’t require a new license. If not a licensed hospital, but operating one as part of a hospital district, they will be allowed to run the ED.

Potential bills

Optometric Association Bill
The Wyoming Optometric Association offered the Joint Labor, Health, and Human Services Subcommittee a preview of a bill they plan to run during the Jan. 7 meeting of JLHHS in Cheyenne. Dr. Dana Day presented the outline of the bill, which is still being drafted. He said it is for the protection of patients and consumers in Wyoming.

The bill would require a doctor-patient relationship instead of going to a kiosk where a 3D photo of the eye can be taken for contact lens measurement or through uses of apps on smartphones. There is concern that without the doctor-patient relationship there is no follow-up and no real way to know if the contacts are properly fitting.

Rep. Kasperik suggests this is an effort to limit telemedicine. Day said they aren’t trying to limit telemedicine, rather they want to make sure someone has a doctor should they need one. An inability to get to a doctor after a lens fitting could result in blindness or increased public healthcare costs.

Expansion of children in CHIP to 1,300 additional WY children. 
FMAP changed in 2015 for Kid Care CHIP from 65-35% to 88-12% providing cost savings to WY.  Enhanced match generates nearly $2 million in annual savings to the State of Wyoming compared to FY 2015. Currently children are covered up to 200% FPL ($48,504 annual gross income for a family of four) Proposed CHIP expansion increases upper limit to 250% FPL for children up to age 19 – includes medical, dental and vision care. BCBS administers Wyoming Kid Care CHIP.