Title XXV and Mental Health Have their Day at JLHSS

The temporary Wyoming State Capitol, The Jonah Building in Cheyenne.

By Tom Lacock
Wyoming Medical Society

CHEYENNE – It was a packed house during the Joint Labor Health and Social Services Committee meeting in Cheyenne on Tuesday as the incoming legislators and committee members joined the current  committee members who were attending their final meeting on the committee. Tuesday morning saw Title 25 front-and-center with much of the conversation as an update on the issues and progress made by last year’s Senate File 058. The law allowed for the gatekeeper process to take hold as well as outpatient commitments by the judiciary, and convalescent leave from hospital settings for mental health patients.

According to WDH Policy Analyst Stefan Johansen there has been some progress made in the Title 25 arena thanks to SF058. Central Wyoming Counseling Center has been designated as the gatekeeper for Natrona County. Wyoming Department of Health is also working on designating Southwest Counseling in Sweetwater County as becoming a gatekeeper as well. Wyoming Department of Health has offered a gatekeeper grants, a one-time money to help develop policy and infrastructure to let these organizations develop into gatekeepers. Those grants are up to $65,000 each.

Wyoming Department of Health reports Title 25 spending is trending down for the first three months of the year, but admits it is too early to suggest a long-term saving.

Later in the day, Wyoming Department of Health Director Tom Forslund explained the Title 25 deficit to the Legislature’s Joint Appropriations Committee, which was also meeting in Cheyenne. He points out he has been denied extra funding for the last two years by the JAC and has been asked to absorb the cost of Title 25 overruns internally. As a result he has not filled 65 open positions in the agency and has incurred $18 million in costs. This biennium he has been appropriated $4.4 million and can no longer absorb the extra costs of Title 25 spending. For that reason the Governor has asked for a $20.1 million contingency appropriation to be taken from the Legislative Reserve Account (the rainy day fund) to be used only if needed.

The JLHSS committee killed a potential bill that would have resulted in a new payment model for the community mental health centers. Erin Johnson, executive director of WAMSHAC said her group was not able to find common ground with the Department of Health on the payment reform despite the fact everyone agreed some level of payment reform is needed.

Senate Committee Chair Charles Scott (R-Casper) said he appreciates the fact community mental health centers are able to serve both those who most need services as well as clients who are looking for things such as marriage counseling. He is concerned that if this bill moved forward that would change due to the incentive payments and for that reason if the bill made it out of committee he would work to kill the bill. Rep. Andy Schwartz (D-Jackson) adds that he would like to see lower level outcomes to reward mental health clinics.

The vote was 11-1 to kill the bill, but Wyoming Department of Health Director Tom Forslund says he would be interested in working with a few community mental health centers who are interested in acting as a pilot project to try out the new payment system with the blessing of Joint Labor, Health, and Social Services.

One bill will move forward from the committee thanks to work today. 0196 is considered far from perfect, but seeks to have federal agencies such as Veterans Administration pay for clients when they are treated by the state for Title 25. The question is who is asked to collect when it is established that a federal agency could pay.

Few legislative committees have been as busy this interim as the State Facilities Task Force, which was charged with looking at the condition and mission for the five state facilities, including the Wyoming State Hospital, and the Life Resource Center in Lander. The task force has met 13 times this year with more planned for later this month.

Over those 13 meetings, the committee has moved to the point of a level 3 design study for both facilities. The State Hospital’s initial design will build out to 92 beds, with a shell built out for another 10 to be added at a later date in time. The Life Resource Center will be built out to 110 beds and exist for intellectually disabled patients as well as those who are designated as hard to place.

At this point the funding picture for the construction of these two facilities is becoming more clear. There is $45 million which will be available later this winter in money already appropriated. Another deposit of $25 million will be made in mid to late fall of next year. Two more appropriations are contingent upon investment performance after June 30, 2017 and June 30, 2018. Another $37 million was originally appropriated with roughly $27 million of that having been spent on various designs and other efforts related to this construction. This year they will ask the design architects for two bids – one for a complete build of both facilities, and another which would just rebuild Wyoming State Hospital. Final schematics of the newly re-modeled facilities should be available this month.