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A
B
A
Right
committee,
we
have
three
bills
up
this
morning:
I'm
optimistic
that
we
will
get
through
all
three
here
in
two
hours.
First
up,
maybe
the
most
complicated
it's
House,
Bill
81.
For
some
background
for
the
committee,
there
was
an
interim
committee
bill
which
you'll
see
we're
not
hearing.
This
takes
most
of
that
interim
committee
bill
as
well
as
some
needed
fixes
from
the
Appropriations
Committee
in
our
budget.
A
We
put
them
in
a
new
bill,
and
so
really
you
can
consider
this
an
issue
from
the
interim
under
a
different
title,
brought
by
the
good
Vice
chairman
of
Appropriations,
who
wants
to
further
develop
the
concept
and
get
some
stances
out
of
our
budget.
So
with
that,
if
nobody
has
any
opening
comments,
we'll
turn
it
over
to
Vice
chairman
Larson
from
Appropriations.
C
You'll
hear
me
refer
to
it
more
so
as
a
UPL
or
upper
payment
limit
Bill,
and
that
really
is
reflective
of
the
time
that
I
spend
on
in
this
committee.
When
the
supplemental
payments
bill
concept
was
first
implemented
into
our
statutes
in
in
2016.
In
fact,
I
think
I
presented
that
bill
on
the
on
the
floor
and
be
it's
it's
got
some.
C
C
For
my
limited
understanding,
as
I
present
this
bill
to
you,
I'm
going
to
go
back
to
some
really
basic
concepts
that
you're
or
in
in
programs
that
you'll
talk
that
you
talk
a
lot
about
in
labor
and
health
and
I
apologize
if
you're,
already
familiar
with
them
and
and
I'm
not
trying
to
consume
more
time
than
than
necessary.
But
Mr
chairman
I,
think
it's
really
under
important
that
the
committee
understand
the
basis
for
which
this
supplemental
payment
program
is
established,
and
so
I
I
just
want
you
to.
C
We
need
to
understand
first
on
Medicare
Medicare
is
a
federal
health
insurance
for
people
65
and
older,
and
it's
a
federal
program.
No
State
participation
is
funded
completely
by
the
feds
right
and-
and
you
guys
understand
that
and
the
the
agency
that
oversees
that
Center
for
Medicaid
services
we
refer
to
as
CMS
and
so
as
such
when
they're,
when
they
reimburse
providers
for
services
covered
by
Medicare
doctor,
provides
a
service.
Whatever
service
we're
going
to
talk
about,
they
get
to
determine
the
amount
that
they'll
reimburse
it's
their
insurance.
C
C
That
would
be
reimbursable
at
two
hundred
dollars:
okay,
just
for
for
Larson
Math,
which
is
not
complicated,
I
just
I
I
need
to
get
get
it
in
my
mind
how
things
work
so
then,
then
we
come
to
Medicaid
and
medicates
the
joint
federal
and
state
program
that
covers
medical
costs
for
people
with
limited
income
and
resources.
But
it's
the
same
agency
that
oversees
it
that
does
Medicare
CMS
and
so
then
CMS
provides
provides
funding
to
the
state.
C
They
say:
We'll
enter
into
this
partnership
and
we're
going
to
provide
funding
to
you
and
we're
going
to
call
that
we
call
that
the
federal
medical
assistance
percentage
or
fmap,
and
so
in
Wyoming
that
fmap's
50,
so
for
every
dollar
the
state
puts
in
they'll
match
it,
but
they
say
there's
a
caveat
here,
and
that
is
is
that
that
we
will
not
allow
reimbursement
on
the
Medicaid
side
to
exceed
this
upper
payment
limit
that
we
established
with
Medicare.
So
we're
going
to
say,
Medicaid
can't
pay
more
than
Medicare.
C
C
C
C
So
if
our
funding
are
General,
funds
coming
into
there
may
not
be
sufficient
to
allow
us
to
fund
reimbursement
in
Medicaid
on
all
these
Services
up
to
that
upper
payment
limit,
okay
and
so
Medicaid.
The
state
plan
doesn't
require
us
to
have
to
meet
at
the
UPL
levels,
but
if
the
states,
if
we
try
to
exceed
it,
they
just
won't
cover
on
their
end.
We
could
fund
200
percent
if
we
wanted
to,
but
the
FED
side
will
only
go
up
to
that
upper
payment
limit
and
so
we're
restricted
by
the
general
funds.
C
C
Our
providers
that
you
will
hear
to
prove
they
constantly
will
say
are
Medicaid
rates
are
difficult
and
any
way
that
we
can
enhance
that
any
way
we
can
capture
more
of
those
available
funds
is
beneficial
to
the
hospitals.
We
we
have
three
of
these
programs,
hospitals,
nursing
homes
and
one
for
privately
held
ambulance
services.
So.
C
So
what
we've
done
is
is
the
is
the
providers
and
in
the
in,
in
today's
conversation,
hospitals,
their
groups
have
got
together
and
they
created
what
they
call
a
supplemental
payment
program
where
they
assess
themselves
a
fee.
So
we're
trying
to
capture
that
remaining
fifty
dollars.
Remember
that
we
left
on
the
table.
They
says
well
what,
if
we
put
in
some
money
to
the
Department
of
Health,
that
would
increase
the
state's
match,
then
the
feds
would
increase
their
match.
We
could
get
it
up
to
that
upper
payment
limit.
C
So
in
this,
if
the
state
was
going
to
remember
we
put
in
75
dollars
and
the
hospital
this
this
program
they
put
in
through
an
assessment
across
their
Association
put
in
25,
now
we're
back
to
this
hundred
dollars
and
we
can
get
up
to
the
upper
payment
limit
and
that's
what
the
program
does
and
so
they.
So
then
we
capture
that
extra
fifty
dollars
we
left
on
the
table
and.
C
In
half
of
that
is
real
is
what
we
actually
capture,
then
the
Department
of
Health
redistributes
back
their
assessment
and
then
they've
they've
had
a
higher
income
level
that
or
they've
they've
generated
more
revenue
or
captured
more
of
that
Medicaid
dollars.
That
was
out
there
that
we
left
on
the
table.
So
in
essence,
that's
how
the
program
works.
Is
the
associations
whether
it
be
the
hospital
whether
it
be
on
this
nursing
home
one
or
whether
it
be
the
privately
held
ambulance
services?
C
Is
they
make
an
assessment
and
it's
in
it's
there's
a
method
and
a
formula
for
how
much
their
assessment
is.
That
comes
into
the
guitar
Department
of
Health,
to
enhance
and
capture
more
of
that
so
Mr
chairman
I,
if
you
understand
I,
hope
that
that
makes
sense.
I
know
it's
really
Elementary,
but
if
you,
if
you
had
been
here
when
we've
tried
to
explain
this
on
the
floor
several
times,
it
becomes
very
confusing
and
so
I.
We
just
want
to
try
and
make
it
clear.
Let.
A
C
C
F
G
I,
just
I
just
want
to
be
clear
here,
so
you
know,
reading
on
the
the
fiscal
note
it
says,
money
will
be
coming
from
the
Private
Hospital
assessment
account
and
I'm
still
trying
to
wrap
my
mind
around
all
these
different
accounts
that
we
have
so
is
that
account
coming
from
the
state
or
what
I
had
understood
from
you
is
the
the
hospitals
were
actually
assisting
us.
So.
C
Thank
you,
Mr,
chairman
and
representative
Colston,
so
shows
through
through
this
assessment
that
the
hospital
should
generate.
Okay,
that
goes
into
the
Department
of
Health
into
that
account,
and
so
this
account
that
is
referred
to
in
the
fiscal
note
is
not
generated
by
General
funds
of
the
state
it's
generated
by
the
Association
held
to
be
used
to
enhance
the
state's
ability,
the
25
plus
the
75.
C
A
And
technically
representative
Larson,
we
could,
as
a
state,
pay
more
in
general
funds
for
these
Services
should
we
want
to
because
the
legislature
in
general
and
good
fiscal
conscience
has
not
raised
these
limits
or
these
allowabilities
the
private
sector.
If
you
will
has
come
forward
and
basically
assess
themselves
to
help
make
this
work.
Is
that
a
fair
assessment?
It.
C
Is
Mr
chairman
and
not
avoid
avoiding
getting
too
far
down
a
different
Trail
every
every
year?
When
we
do
the
budget,
you
will
see
the
department
of
health
will
come
to
us
and
for
like
the
DD
providers
that,
like
our
community
entry
services
and
Cathedral
homes,
there
may
be
a
re-basing
in
in
their
funding,
and
so
we
we
will
put
money
into
that
on
the
general
fund
side
to
be
matched
by
the
federal
side,
and
so
you'll
see
that
exercise
every
every
year.
C
C
First
thing
is
we
we
go
in
and
we
correct
a
couple
of
things
when
this
bill
was
put
into
place
in
2016.
It
was
kind
of
a
new
program
and
the
Department
of
Health
says
that
we
we
believe
that
CMS
is
going
to
accept
this,
but
we
don't
know
for
sure
if
they
will
and
for
how
long,
and
so
in
the
statute
for
this
bill,
we
said
that
they
needed
to
continue
to
apply
to
CMS
for
authorization
for
this
program
on
an
on
an
annual
basis.
C
C
C
If,
if
the
committee
would
go
back
and
look
at
line,
five
you'll
see
that
there's
an
administrative
expense,
and
so
when
this
program
was
was
recommended
by
the
hospital
associate,
the
the
hospital
participants,
they
agreed
that
the
administrative
expenses
would
come
out
of
their
assessment
and
at
that
time,
that
it
would,
they
felt
that
it
would
one
percent
would
be
sufficient.
The
recommendation
is
to
raise
that
up
to
three
percent
of
the
aggregate
assessment
that
they
collect,
and
so
that's
a
that's
an
existing
statute
change.
C
Then,
if
we
could
go
to
section
two
on
page
five,
this
is
the
new.
This
is
the
conversation
you
guys
had
in
the
interim
where
we
want
to
bring
the
the
psychiatric
Residential
Treatment
Centers,
the
prtfs
that
provide
Psychiatric
Services
to
Children
and
adolescents
to
allow
them
to
participate
in
this
upper
payment
limit
program
for
those
individuals
they
serve.
Who
are
on
Medicaid
so
that
they
could
capture
more
of
that
upper
payment
limit?
C
So
they
we
bring
them
in
under
the
hospital
services,
and
in
doing
that
we
expand
the
scope
of
Hospital
services,
and
then
we
in
on
page
two,
because
we
hadn't
defined
what
hospital
Services
meant.
We
we
put
a
new
definition
in
there
and
it
it
brings
in
psychiatric
residential
residential
treatment
facilities,
owned
or
operated
or
affiliated
with
a
hospital.
So
we
have
a
couple
of
those
in
in
Wyoming
that
provide
services
and
critical
services
to
our
adolescents
and
children.
C
On
the
the
with
this
change
on
page
three,
we
increase
the
assessment
at
the
bottom
of
page
three
down
there
on
on
line
20.
there's
because
we're
bringing
additional
services
in
it
was
recommended.
We
give
the
Department
of
Health
the
ability
to
increase
that
net
patient
Revenue
by
one
percent
from
a
half
percent
up
to
one
percent.
C
A
I
think
we're
going
to
have
a
lot
of
questions
and
we
haven't
really
talked
about
the
need
and
the
explanation
of
the.
Why
which
we're
going
to
hear
and
then,
if
you
want
to
talk
about
the
amendment
now,
certainly
that's
fine
I,
don't
I,
assume
you're
planning
on
staying
with
us
for
a
while.
But
if
we're
not
forever,
okay.
C
C
C
We
talk
about
the
department
has
authorized
this
one-time
position
for
this
act.
This
act
is
just
the
hospital
supplemental
payment
and
they
need
to
have
the
authority
to
also
administer
the
supplemental
program
for
nursing
homes
and
for
the
the
ambulance,
and
so
I
I
failed
to
catch
that
when
I
drafted
it-
and
so
my
Amendment
Mr
chairman,
is
to
just
include
the
references
to
all
three
of
those
programs.
A
And
if
we
have
questions
on
the
amendment
at
the
appropriate
time,
we
will
certainly
bring
you
back
up
that
committee
more
testimony
to
come.
Thank
you,
Vice,
chairman
Larson.
If
it's
okay,
we
normally
would
go
to
the
department
but
I
think
if
we
go
to
the
hospital
Association,
maybe
to
talk
about
the
need
and
then
we
can
maybe
wrap
up
with
the
Department
on
the
mechanics.
H
It's
it's
been
widely
accepted
and
a
very
popular
program
to
help
increase
the
reimbursement
they
receive
for
Medicaid
patients
in
our
state
and
then
a
couple
of
years
ago.
We
also
worked
on
finding
a
way
to
help
our
EMS
services
around
the
state
and
we're
currently
in
the
process
of
getting
that
program.
Stood
up.
H
As
far
as
Staffing
and
other
things,
they're
they're
kind
of
at
a
situation
right
now
where
they
need
some
help,
and
so,
instead
of
coming
to
the
state
and
saying
hey,
we
need
a
bunch
more
money.
We
came
up
with
our
own
solution.
We
want
to
fix
this
on
our
own.
This
is
not
in
any
way
shape
or
form.
Medicaid
expansion
and
I
want
to
reiterate
that
this
does
not
expand
Medicaid.
This
only
provides
funding
for
existing
patients
that
need
help
and
it's
our
solution.
H
We
would
do
this
without
your
permission,
if
we
could,
because
we're
willing
to
the
private
hospitals,
which
are
not
those
that
are
sitting
here,
are
willing
to
assess
extra
money
so
that
we
can
pull
down
additional
federal
funds
so
that
we
can
help
take
care
of
these
patients
and
help
these
two
facilities
in
our
state.
And
hopefully
so.
We
can
help
these
patients
regain
mental
and
Behavioral
Health
to
regain
physical
health
and
become
really
good
citizens
in
our
state
and
go
out
and
have
productive
lives
and
I.
H
A
H
I
I
the
children
in
our
care
are
all
over
from
all
over
the
state
of
Wyoming
we
are.
While
we
are
licensed
to
care
for
62
children,
we
have
62
beds.
We,
unfortunately
right
now
are
only
able
to
to
staff
45
of
those
beds.
We've
had
Staffing
challenges,
just
like
other
Industries
in
the
state,
but
but
our
wait
list
also
continues
to
grow
and
the
phone
continues
to
ring.
I
We
have
over
25
children
on
the
wait
list
that
would
like
services
from
St
Joseph,
Children's
Home
children
come
to
us
in
a
number
of
different
ways:
Sometimes
they
come
to
us
through
the
juvenile
court
system.
Children
in
need
of
supervision
or
or
delinquent
children
can
also
be
referred
to
us
through
a
private
referral,
a
parent
Guardian
who
is
in
need
of
services
and
and
we've
also
received
referrals
from
schools
who
have
done
everything
they
can
to
try
to
help
and
serve
these
children
locally
and
then
in
their
schools.
I
But
they
do
not
have
the
resources
nor
the
expertise
to
be
able
to
to
assist
these
children.
The
children
that
come
into
our
care
have
experienced
significant
trauma,
many
of
them
from
experiences
from
abuse
and
neglect.
Some
of
them
come
from
homes.
Who've
been
plagued
with
substance
abuse
use,
some
of
them
have
their
own
challenges
with
substance
use
and
abuse.
I
Many
of
these
children
can
act
out
violently
against
others,
their
peers,
other
adults.
Some
of
them
also
act
out
and
have
even
attempted
to
try
to
take
their
own
life.
These
are
children
who
communities
have
been
have
done
their
very
best
to
try
to
serve
within
their
communities,
but
they
do
not
have
the
resources
or
the
expertise
to
continue
to
to
help
these
children.
I
J
J
We're
able
to
offer
sort
of
an
intensive
inpatient,
classroom
experience
for
them
during
their
school
day
that
helps
them
stay
within
school,
be
able
to
participate
in
classes
within
school,
but
then
also
go
into
basically
Outpatient
Therapy
during
the
day
to
help
hold
their
spot
in
school.
Oftentimes
kids
need
more
acute
care
than
that
and
then
sometimes
after
they've
experienced
and
trauma
in
their
childhood
and
they've
gone
through
an
acute
care
phase,
they
need
a
more
longer
term
care
and
that's
where
the
psychiatric
Residential
Treatment
Facility
comes
in
comes
into
play.
J
So
the
kids
that
we
will
see
there
will
stay
with
us
for
a
longer
period
of
time
can
be
up
to
six
months,
maybe
use
using
a
broad
spectrum
of
of
modalities
to
help
them.
In
addition
to
therapy
and
psychiatric
treatment,
we
offer
a
fully
accredited
school
program
for
them,
so
we
can
keep
them
at
their
grade
level
or
hopefully
increase
their
grade
level.
So
when
they
return
back
to
their
Community,
they
can
go
back
into
their
into
their
classroom
of
preference
and
stay
with
their
class
so
that
they
don't
lose
ground
there.
J
So
it's
a
challenge,
certainly
from
the
from
that
aspect.
Currently,
our
prtf
or
psychiatric
residential
treatment
facility
is
an
all-female
program
from
10
to
17.,
but
we
have
the.
If
the
need
is
there,
we
have
the
ability
to
shift
or
grow
and
serve
a
broader
Spectrum
or
could
even
go
back
into
serving
adolescent
males
as
well.
J
We
did
that
for
a
number
of
years,
but
somewhere
around
right,
post
covid,
the
mail
volume
dropped
and
we
shifted
to
go
to
more
of
a
female,
a
female
model,
so
primarily
most
of
the
most
of
the
patients
that
we
see
you
know
are
from
same
same
patients
that
St
Joseph
sees
childhood-based
trauma.
Either
abuse
neglect,
substance,
abuse,
abandonment,
all
of
those
all
of
those
things
well,
I
mean
Behavioral
Institute
also
does
participate
in
the
Private
Hospital
EPL.
B
D
H
Mr,
chairman
representative
Hornick
I'll,
try
and
answer
that,
if
not,
we
have
our
our
legal
team
in
the
back
here
that
understands
it
better.
However,
if
you
look
at
the
draft
of
the
bill,
it
talks
about
affiliated
with
with
hospitals,
and
so
we've
created
an
affiliation
for
St
Joseph's
that
we
believe
when
the
Department
of
Health
puts
together
the
state
planum
with
CMS,
with
the
centers
of
Medicare
Medicare
Medicaid
services.
They'll
accept
that
so
we
we've
created
that
affiliation.
I
As
Chairman's
wanted,
sir
St
Joseph's
Children's
Home
is
not
an
acute
stabilization
or
hospitalization,
so
they
would
have
to
be
stabilized
either
in
a
hospital
or
at
wbi's
acute
care
before
they
come
to
St
Joseph
children's
home.
We
are
a
longer
term
care,
so
in
our
our
average
length
of
state
right
now
is
a
little
over
six
months.
We
currently
are
the
only
one
that
serves
youth
under
the
age
of
10
and
we're
currently
the
only
ones
that
can
serve
boys
at
this
point
in
time.
Does
that
answer
your
question?
It.
A
Does
I
just
know,
I've
had
a
lot
of
foster
kids
and
kids
in
the
system
who've
been
at
both
of
your
facilities
and
I.
Think
well,
I
personally,
say:
I
think
you
both
do
amazing
work
because
of
the
experiences
I've
heard
that
have
helped
both
of
them
as
an
aside
represent
representative,
and
you
still
had
a
question
and
then
we'll
go
to
representative.
K
J
H
Mr,
chairman
representative
Ward,
it's
not
a
tax.
It's
an
assessment.
The
three
percent
I
think
that
you're
talking
about
is
the
three
percent
administrative
fee.
We
believe
in
these
programs
and
it's
because
we
don't
want
this
to
have
any
impact
on
the
state
budget,
so
we're
willing
to
take
the
three
percent
out
of
out
of
the
money
we
receive
back
to
pay
for
that
position.
H
As
far
as
the
assessment
is
concerned,
it
there's
a
lot
of
calculations
that
go
into
that,
but
but
the
benefit
is
worth
the
squeeze.
We,
we
actually
I
think
it's
important
to
know
that
I
was
talking
to
Ronda
St
Joseph's,
seven
over
70
percent
of
the
patients
they're
treating
are
Medicaid
patients
I'd.
Imagine
it's
probably
pretty
similar
to
wbi.
M
So
you
mentioned,
thank
you
chairman.
You
mentioned
that
you
have
at
St
Joe's,
you
have
62
beds
and
I.
Don't
think
you
said
exactly
how
many
you
have
staff,
but
you
did
say
you
have
staffing
issues,
and
so,
if
you
could
just
please
elaborate
a
little
bit
on
how
you
feel
like
this
assessment
will
help.
You
fix
your
staffing
issues.
I
Chairman
representative
Penn,
we,
it
will
certainly
help
us
to
continue
to
retain
the
staff
we
have
Staffing
at
St.
Joseph's
is
looking
is
improving,
is
looking
up.
We've
had
challenges
with
recruiting
licensed
practitioners
licensed
professional
counselors
licensed
clinical
social
workers
licensed
marriage,
family
therapists,
that's
kind
of
where
we
have
been
having
some
difficulty.
We
need
to
hire
two
more
in
order
to
fill
our
beds.
I
And
again
we
have
done
that
with
very
little
change
or
adjustment
to
the
to
the
reimbursement
rates
that
we
receive,
and
so
I'm
hopeful
that
this
will
continue
to
help
us
us
to
maintain
and
sustain
the
wages
that
we
need
in
order
to
hire
and
retain
competent
and
train
trainable
staff.
Does
that
answer
your
question
representative
Penn.
M
May
I
please
determine
thank
you,
so
I,
actually
on
my
way
back
here
to
Cheyenne
last
night,
was
having
a
conversation
with
a
co-worker
who
works
in
the
emergency
room.
I
used
to
work
in
and
and
this
is
in
Utah.
But
this
problem
is,
is
not
you
know
we're
not
in
a
vacuum
in
Wyoming,
the
staffing
issues
exist
everywhere
and
it
seems
like
in
the
last
couple
of
years,
they've
been
significantly
worsened
and
so
I
have
to
I.
I
Ahead
Sherman's
wanted
sir
representative
pin
because
we
receive
federal
Medicaid
dollars.
We
are
under
the
federal
vaccine
mandate.
I
I
will
tell
you
that
I
feel
like
we
have
done
a
night.
Oh,
a
good
job
of
creating
a
policy
that
does
allow
for
people
to
to
to
apply
for
an
exemption
for
those
vaccine
mandates
both
a
medical
exemption
as
well
as
a
a
religious
exemption,
and
so
we
don't
I
I,
don't
believe
that
it
has
been
detrimental
to
our
ability
to
hire
or
retain
our
staff.
J
Same
question:
Mr,
chair
representative
of
Penn
aye,
pretty
much
the
same
as
Rhonda.
You
know,
because
we
were
federally
funded
facility,
we're
under
the
federal
mandate.
We
also
during
the
coveted
rollout
of
the
vaccines
you
know
offered
the
medical
and
religious
exemptions.
I,
don't
believe
we
lost
any
staff
during
that
during
that
specific
time
of
those
exemptions
and
any
new
staff
fall
under
those
same
those
same
types
of
regulations.
So
there
is
a
medical
or
religious
exemption
with
those
things.
A
A
J
Thank
you,
Mr
chair.
We
also
take
insurance
as
well,
so
but
yes,
they're
under
under
the
Medicaid
Program,
the
options
are
more
limited
than
they
are
with
someone
that
has
private
commercial
insurance,
and
it's
just
as
a
follow-up
to
representative
Ward.
It's
not
that
we
didn't
lose
any
staff
during
that
time
frame.
We
just
didn't
lose
any
specifically
because
of
the
vaccine
mandate
because
of
the
other
things
that
were
in
place.
J
H
Might
address
your
question
too
I.
This
has
nothing
to
do
with
Department
Health.
They
do
a
great
job,
but
our
current
rates
that
are
set
right
now
are
low,
and
so
for
these
patients
to
be
seen
by
out-of-state
providers.
We
try
to
send
them
out
of
state.
We
we're
kind
of
at
the
bottom
of
the
totem
pole
as
far
as
the
amount
that
they're
they're
going
to
receive
in
compared
to
what
other
states
are
paying
for
those
patients
to
be
referred
out
of
state
and
so
wbi
in
St.
A
So,
if
they're
not
fully
staffed
and
have
available
beds,
our
kids
sit
in
emergency
rooms
for
days,
if
not
weeks,
in
some
places
waiting
for
a
bed
in
one
of
these
facilities
to
open
up
it's
correct,
Mr,
chair,
okay,
all
right!
Thank
you
much
Department
of
Health
or
any
other,
not
taking
any
other
questions.
Thanks
for
being
here,
don't
go
too
far.
A
N
Mr
chairman
members
of
the
committee,
Stefan
Johansen,
with
the
Department
of
Health,
would
love
to
introduce
you
to
Lee
Grossman,
who
is
our
newly
appointed
State
Medicaid
agent.
We
also
the
senior
administrator
of
our
division
of
healthcare
financing
happy
to
have
him
on
board.
Lee's
been
working
with
the
department
since
2011
and
a
variety
of
different
roles.
Most
recently
is
the
manager
of
our
home
and
Community
Based
waiver
programs,
both
for
the
developmentally
disabled
and
the
our
long-term
care
populations.
Lee
anything
you'd
like
to
add
there.
A
A
N
You
Mr
chairman
I,
was
preempted
by
good
representative
from
Fremont
County
to
introduce
you
to
Jesse
Springer,
who
is
our
business
office
manager
in
in
the
division
of
healthcare
financing,
also
handles
all
of
our
technology
and
Technology
projects.
Again
with
that
project.
Over
the
past
seven
or
eight
years,
him
and
his
team
have
done
an
admirable
job,
getting
us
to
completion
and
implementation
on
what
was
a
pretty
Monumental
effort
with
that
Mr
chairman
I'm,
going
to
be
very
brief.
N
We
can
certainly
ask
or
stand
for
any
questions
you
may
have
on
how
these
programs
operate.
Suffice
it
to
say,
from
my
perspective,
just
to
reiterate
what
was
mentioned
before
these
programs,
these
supplemental
payment
programs.
We
do
in
a
variety
of
areas
for
both
private
and
public
hospitals,
private
and
public
nursing
homes,
private
and
public
ambulance
services,
which
is
in
process
and
also
private
physicians,
which
are
generally
affiliated
with
with
hospitals.
N
Members
of
the
committee.
Essentially
what
this
does
as
you've
heard
before,
is
we
assess
providers
within
that
group?
We
essentially
collect
revenue
from
them
and
I'm
going
to
explain
this
in
the
way
that
makes
sense
in
my
head.
We
put
that
money
in
a
bucket
and
then
we
take
that
bucket
and
we
match
it
with
an
equal
amount
of
federal
funds,
and
then
we
redistribute
all
of
that
back
to
providers
this.
N
These
programs
have
an
effect
of
increasing
what
we
call
Cost
coverage
on
on
behalf
of
these
providers,
where
we
have
these
programs,
so
hospitals,
nursing
homes,
ambulances
and
if,
if
this
were
to
pass,
allowing
psychiatric
residential
treatment
facilities
for
kids
to
benefit
from
from
the
hospital
program,
that's
what
we
do.
We
increase
cost
coverage
without
having
to
appropriate
State
funds
by
nature
of
of
having
assessing
providers
collecting
that
Revenue
matching
it
with
federal
funds
and
essentially
growing
the
pie
you'll
see
in
the
bill.
There's
there's
a
lot
of
complexity.
It's
really
kind
of
shrouding.
N
N
Why
would
a
public,
nursing
home
or
a
private
hospital
or
a
public
Hospital
want
to
do
this,
and
essentially
the
end
result
is
because
the
net
effect
is
a
revenue
increase
for
all
of
the
all
of
the
providers
by
nature
of
drawing
down
additional
additional
funding
with
that
Mr
chairman
members
of
the
committee
department
is
certainly
in
in
support
of
this
bill.
Should
the
legislature
choose
to
to
move
it
forward?
A
I
just
want
to
clarify
a
bit
when
you
say
you
assess
them.
These
groups
have
generally
come
forward
and
said
we
would
like
this
assessment.
They've
agreed
to
this
assessment
and
you're
just
the
holder
of
the
bucket
as
a
the
central
repository,
because
of
the
way
the
federal
reimbursement
system
works.
It's
not
like
the
Department
of
Health
is
out
there
beating
down
our
hospitals.
Our
ambulance
is
saying:
give
us
money.
They've
agreed
to
this
correct
and
you're
just
the
kind
of
the
central
point
of
of
services
for
this
funding
distribution.
Mr.
L
N
Go
ahead,
director
Mr,
chairman
representative
Ward
I'll
defer
to
Mr
Springer
here.
If
he
knows
these
assessments
are,
are
assessed,
I
think
on
a
provider
specific
basis
and
not
duplicative
like
that.
What
I
hear
you
saying
is:
if
it's
a,
we
do,
have
a
program
like
this
for
Physicians
that
are
affiliated
with
hospitals.
K
P
It's
the
revenue
at
the
facility,
so
in
this
case
we're
looking
at
private
hospitals
and
psychiatric
residential
treatment
facilities,
so
be
the
revenue
the
facility
brought
in
so
that
that
provider
might
have
gone
to
three
facilities,
but
they
brought
in
a
portion
of
Revenue
that
was
booked
to
the
facility.
So
the
it's,
the
net
revenue
of
the
facility,
not
not
the
revenue
of
that
specific
provider.
N
A
Been
a
couple
of
things
in
my
tenure
where
we
put
footnotes
in
the
budget
year
after
year
after
year
and
after
so
many
years,
you
know
we're
pretty
confident
and
comfortable
that
there's
no
further
need
to
to
put
in
the
budget,
and
it
just
makes
sense
to
allow
the
department
to
do
these.
In
this
case
the
Department
of
Health
thank.
K
N
I
think
you
could
ask
a
similar
question
that
you
know
why
why
psychiatric
residential
treatment
facilities
now
and
and
to
to
answer
that
if
I
my
own
question,
if
I
may,
this
is
a
concept
we
will
explore
with
CMS
to
see
if
it's
approved
to
to
allow
prtfs
to
benefit
from
the
hospital
program.
But
specific
to
that
question
about
the
position
over
the
years
since
2014,
15
and
16.
N
The
legislature
has
has
added
these
programs
because
I
think
they
are
beneficial
to
increase
cost
coverage
for
providers
with
with
minimal
State
or
no
State
investment
going
from
you
know:
public
hospitals,
adding
private
hospitals,
public
nursing
homes,
adding
private
nursing
homes,
private
physicians,
now
ground
ambulance,
and
then
this
these
are.
These
are
significantly
there's
a
significant
administrative
need
here
from
the
Department
in
managing
these
programs
to
comply
with
Federal
policy.
A
lot
of
reporting,
Actuarial
work,
Management
on
on
these
programs
and
and
for
the
past
six
seven
years
we
have.
N
We
have
managed
that
internally
I
think
as
these
grow
and
I
I
know
I'm.
The
selfish
bureaucrat
saying
I
need
I,
need
more
staff
and
need
positions,
but
as
these
programs
have
grown
one
of
the
impacts
of
that
as
we
try.
For
example,
we've
been
nearly
two
years
in
implementing
the
the
ambulance
for
payment
limit
program.
I
worry
that,
as
as
we
continue
to
rely
on
these
tools,
the
department
will
be
slower
and
slower
and
slower
and
being
able
to
manage
these
quickly
and
efficiently.
N
M
You
chairman,
so
going
back
to
kind
of
follow
up
a
little
bit
on
what
representative,
Ward
and
her
comment
on
private
or
on
Physicians,
and
this
assessment
so
clarify
for
me
again
is:
will
a
physician
be
getting
a
separate
I
mean
there
was
something
that
was
said
in
there
at
some
point
that
made
it
sound
like
the
physician
has
a
separate
assessment
or
is
it
complete?
The
assessment
is
based
completely
on
the
total
revenue
of
the
hospital.
D
D
N
Q
N
A
an
artifact
of
the
recent
legislative
history:
it's
been
reauthorized
through
a
footnote
for
years
and
years
and
years
again
at
this
point,
not
a
federal
requirement,
depending
on
the
administration's
in
in
DC
going
forward.
We
have
seen
interest
or
scrutiny
on
upper
payment
limit
supplemental
programs
in
the
past,
mostly
on
the
fiscal
side
from
from
the
federal
perspective,
but
this
this
reauthorization
every
couple
of
years,
basically
through
our
budget,
would
not
be.
You
know
it's
not
a
federal
requirement.
It
would
not
be
necessary.
N
It's
really
the
legislators
legislature's
purview
on
on
how
to
do
that.
Obviously,
if
the
If
This
Were
to
pass
or
any
of
our
supplemental
payment
programs,
if,
if
you
all,
as
a
body
said,
we
don't
want
to
do
that
for
nursing
homes
or
hospitals
anymore,
that
purview
is
certainly
there
within
the
within
the
Green
books.
D
N
Mr
chairman
representative
hornock
I
I,
might
be
confused,
so
bear
with
me
that
this
program
would
allow
the
prtfs
to
be
added
to
the
hospital
Assessment
Act
that
you
see
in
in
statute
I.
Think
by
clarifying
some
of
that
reauthorization
language.
It
would
remove
the
requirement
for
us
to
have
a
budget
footnote
every
two
years
which
I
believe
for
the
past
six
or
seven
years
has
said.
The
department
is
authorized
to
basically
continue
this
program,
negotiate
with
centers
for
Medicare
and
Medicaid
services
to
implement
the
upper
payment
limit
program.
N
P
Chairman's
wants
her
representative
Warnock,
the
the
legislative
oversight
of
the
budget,
but
no
none
of
the
other
programs
have
a
specific
budget
fund
out.
So
we
have
a
nursing
home
program.
That's
been
in
place
since
2011..
It
doesn't
have
a
budget
footnote
saying
this
program
may
continue
for
the
next
two
years.
P
It's
just
in
statute
that
the
program
exists,
but
if
funding
needs
to
be
increased,
then
we
come
with
a
supplemental
budget
exception
request
to
the
legislature
and
they
approve
that
or
disapprove
that
if
Pro,
you
know,
the
scope
of
the
program
is
going
to
be
changed.
Those
changes
are
brought
to
the
legislature
for
consideration,
so
it
doesn't
put
the
program
on
Auto
Drive.
It
just
removes
that
there's
a
large
number
of
these
programs
already
in
statute.
P
Only
this
one
is
at
this
point
going
back
every
year
for
a
budget
footnote,
because
the
way
the
the
original
statute
was
written.
So
it's
just
creating
this
this
budget
for
note
that
really
in
most
cases
for
these
type
of
programs
is
not
necessary.
So
that's
I
think
what
this,
what
this
language
is
trying
to
do,
not
remove
the
legislative
oversight,
but
just
make
it
more.
Like
the
other
programs.
A
And
we'll
probably
hear
from
representative
Larson
again
later
to
discuss
why
Appropriations
has
asked
for
this
step
and
how
they
oversee
the
department
of
Health's
budget
through
positions
and
other
means
that
this
might
not
be
so
controversial
with.
When
you
realize
the
power
that
Appropriations
has
over
the
Department
of
Health.
D
My
follow-up
question
Yeah
final
question
and,
and
thanks
for
clarifying
this,
this
is
this
is
as
easy
to
understand
as
as
anything
so
you
did
mention
and
and
I
did
some
research
over
the
weekend
and
found
some
Language
online.
That
led
me
to
think
and
I'm
curious
to
get
your
opinion
that
there
is
a
desire
or
can
be
a
desire
from
the
federal
government
to
clamp
down
on
these
systems,
because
it
is
costing
the
federal
government
a
lot
of
additional
money
to
match
something
that
a
hospital
is.
D
N
R
N
The
in
the
past,
seen
like
I
mentioned
scrutiny
or
Congressional,
or
even
executive
branch
with
CMS
HHS
discussion
over
the
years.
What's
the
sustainability
of
these
programs
in
relation
to
federal
spending
in
the
budget,
I
think
there's
a
tension
here
even
from
the
federal
perspective
that
we
and
and
the
Medicaid
programs
across
the
country
and
from
from
the
feds
they
want
access
for
our
for
our
safety
net
populations.
We
need
that
we're
actually
required
to
provide
access
for
these
types
of
services
and.
N
We
didn't
see
that
happen,
and
these
are.
These
are
programs
that
are
authorized
at
the
federal
level
and
every
state
takes
advantage
of
that
to
increase
cost
coverage,
thereby
increasing
access.
Should
the
federal
government
in
the
future
change
these
we
would
obviously
be
as
Mr
Springer
was
mentioning,
there's
legislative
oversight
here
through
statute.
We
would
obviously
bring
that
to
the
attention
of
the
legislature
and
try
to
manage
accordingly,
but
I
can't
tell
you
exactly
what
future
current
or
future
administrations
would
do.
N
Only
that
I
think
there's
probably
limits
on
the
executive
side
with
HHS
and
CMS
on
on
what
they
could
change
based
on.
What's
authorized
in
law
and
and
certainly
would
see,
I
would
anticipate.
We
would
see
Congressional
discussion
there,
since
so
many
states
take
have
these
programs
implemented
and
when
you
think
of
the
scale
of
a
Texas
or
a
California
or
a
New
York,
with
their
supplemental
payment
programs,
we're
talking
in
the
hundreds
of
millions,
if
not
billions,
of
dollars.
R
E
Good
morning
my
questions
to
the
Medicaid
person
I'm,
looking
at
the
fiscal
report
and
the
detail
of
Appropriations
and
I
know
Medicaid
is
a
stickler
for
coding
and
under
here
it
has
it
for
admin,
administrative
cost
and
Adult
Services.
However,
this
morning
we've
been
talking
about
juvenile
Services.
Is
there
not
a
code
for
juvenile.
N
Mr,
chairman
representative
Trujillo,
if
I
may,
and
certainly
defer
to
Mr
Grossman
or
Mr
Springer.
If
there's
other
detail,
this
is
the
Private
Hospital
again
we're
adding
a
provider
so
to
speak,
psychiatric
residential
facilities
that
serve
youth
to
be
able
to
benefit
from
Private
Hospital
Assessment
program,
which
is
typically
in
in
unit
460.
We
call
it
Adult
Services.
We
do
have
a
unit
specifically
for
adolescent
child
services
that,
from
the
budget
perspective,
is
coded
differently,
but
this
program
largely
exists
in
that
unit.
If
that
makes
sense,
foreign.
N
T
N
Variety
of
units
in
Medicaid
and
across
the
department
where
there's
overlap,
and
so
we
we
have
the
ability
to
move
money
to
different
units
as
needed,
because
you
know
hospitals,
don't
just
treat
adults,
but
that's
essentially
where
most
of
the
on
the
mechanics
of
the
budget,
where
that's
coded.
But
it
doesn't
prevent
us,
for
example,
from
transferring
money
from
The
Adult
Services
Unit
to
the
to
the
Child
Services
Unit.
T
T
So
the
amount
that
is
assessed
is
calculated
as
a
uniform
percentage.
The
assessment
rate
will
shall
be
determined
by
the
department
and
based
on
the
net
revenue
generated
needed
to
generate
an
amount
to
not
exceed
the
non-federal
portion
of
the
UPL
right.
So
what
is
the
current
amount
that
we
assess
on
Hospital,
Revenue
Mr.
N
Chairman
I'll
defer
to
Mr
Springer
if
he
knows
otherwise
we'll
get
back
to
you.
I
will
say
that
on
these
programs
there
is
a
six
percent
cap
from
the
federal
person
you
can't
assess
more
than
than
six
percent
through
these
programs,
but
in
terms
of
where
we
are
on
the
Private
Hospital
Assessment
Act
I'll
hand
it
over
to
Mr
Springer.
S
P
So
it's
not
that
it's
been
continually
increased
since
implementation.
It's
that
this
one-time
implementation
of
adding
two
new
providers
to
a
relatively
small
group
of
private
hospitals
causes
it
to
increase
in
that
one
period,
and
then
it
likely
would
be
stable
at
that
point,
with
minor
adjustments.
A
N
Mr,
chairman
representative
Penn
It's,
really
because
we
this
authorizes
us
to
explore
with
CMS
adding
those
two
providers
which
are
are
different
traditionally
from
hospitals.
One
is,
as
you
heard,
wbi
has
a
is
a
private
hospital
that
operates
a
prtf,
St
Joseph's
would
presumably
affiliate
with
the
hospital
to
to
make
this
work
so
the.
Why
now
is
we
would
be
adding
to
another
level
of
care
to
benefit
from
this
program
and
exploring
approval
of
that
with
CMS.
A
A
C
C
This
authorization
is
was
to
initially
was
to
get
authorization
from
CMS
so
that
they
would
provide
their
increased
contribution
to
this.
Through
our
amended
state
plan.
They
no
longer
require
it.
We
still
have
oversight.
If
we
don't
like
the
program,
we
did
we
we
go
in
here
and
tweak
it.
You
can
do
it.
I
can
do
it,
but
we
don't
do
voice
oversight
of
that.
Only
thing
this
does
is
remove
this
requirement
for
the
footnote
to
ask
for
approval-
that's
not
required
by
anybody,
but
this
arcade
initiatory
language.
C
One
of
the
reasons
we
want
to
get
rid
of
that
is
because
it's
footnote
it's
it's
a
budget
footnote
and
the
fewer
of
those
we
can
have
the
cleaner.
Your
budget
bill
is
and-
and
so
as
we
was
looking
at
this
fiscal
staff
or
else
so
fiscal
staff
said
boy-
we've
got
enough
history
there
do
you
think
there's
a
can.
We
could
we
get
rid
of
that
footnote.
So
that's
what
we're
attempting
to
do
then
Mr
chairman
on
the
government
clamped
down
which
I
they
think
is
also
from
representing
porno.
C
We've
understood
that
since
2016
that
there
may
be
a
chance,
but
that's
no
different
than
if
you
get
into
DEQ
and
abandoned
mind
Reclamation
stuff,
there's
programs
out
there
that
the
the
federal
government
funds
that
may
end
at
a
point
in
time
that
is
undetermined
at
this
time
or
really
about
any
of
the
other
agencies
that
have
Federal
programs.
We
realize
that
they're,
not
you
know,
always
in
perpetuity
and
so
we'll
have
to
adjust,
as
as
those
are
adjusted
and
we've
seen
those
in
in
our
history,
then
the
other.
C
C
C
So
if
court
orders
in
through
DFS
this
child
with
high
behavioral
needs
to
go,
someplace
needs
to
go
to
a
psyche,
and
that
would
come
from
the
court.
It
goes
to
a
psychiatric
Residential,
Treatment
Center,
that's
fine
and
dandy.
We
can
send
them
to
WBIR
to
tyrande's
place
if
they've
got
rumor
capacity,
but
if
they
don't
because
of
they
because
they're
they
may
have
beds,
but
they
don't
have
the
staff.
Then,
where
do
those
kids
go?
And
it's
not
always
in
a
hospital?
C
You
might
see
them
in
a
County
Jail,
which
is
not
the
place
for
an
adolescent
to
be
sitting
and
they
don't
get
the
services
or
or
they
could
be
a
just
your
your
local
hospital,
it's
a
problem
that
we
have
and
that
we
need
to
address
further.
But
this
is
a
step
forward
in
helping
solve
the
ability
for
our
residential,
our
psychiatric
Residential
Treatment
Centers,
to
have
the
capacity
to
take
some
of
these
kids.
When
we
see
them
we
do
need.
We
do
need
wbi
to
take
adolescent
boys.
M
So
my
question
is
in
reference
to
page
three
line,
one
it
says
to
so
this
on
on
page
two
lines:
20
and
21.
It
says
that
this
Private
Hospital
assessment
account
shall
be
used
exclusively
for
exclusively
for
the
following
purposes
and
then
on
page
three
to
pay
administrative
expenses
incurred
blah
blah
blah,
so
the
administrative
expenses
incur
incurred.
M
What
are
we
talking
about
there
and
how
does
that
reconcile
that
for
me
with
the
Wyoming
Constitution
article
16,
section
6
that
says
that
we
can't
give
State
funds
to
Aid
any
individual,
Association
or
Corporation,
except
for
the
necessary
support
of
the
poor?
So
what
what
administrative
expenses
are
we
talking
about.
C
Thank
you,
and,
and
thank
you
Mr
chairman
representative,
pin,
so
we're
not
paying
These
funds
don't
go
out
to
anybody.
This
is
the
administrative
expenses
incurred
by
the
Department
of
Health
to
administer
this
program,
and
the
funds
are
coming
in
to
the
Department
of
Health
through
the
assessment
from
the
private
hospitals
and
so
16
1
is
that
you
can't
I
can't
the
department
that
we
can't
fund
Fred's,
Bar
and
Grill
is
a
private
entity
with
State
funds
right
we're
not
sending
any
money
out
in
this.
C
C
That's
right,
and
in
so
so
the
additional
the
additional
position
and
fund
is
in
addition
to
the
the
assessment,
the
administration
assessment
in
in
section
three
right
and
in.
Why
both
is
that
the
question,
because
that's
the
need
it
would
take
to
administer
everything
that
we
we
do
in
this
now
I
would
I
would
suggest
to
you
it's
similar
to
I'm,
trying
to
think
of
some
other
examples.
A
N
Chairman
representative
Penn,
if
I
may
representative
Larson,
is
absolutely
correct
in
what
the
administrative
expenses
support
here
and
as
I
mentioned
before
these
are.
These
are
complex
programs
that
the
feds
require
a
lot
of
reporting
on
and
a
lot
of
Actuarial
work
so
part
of
that
administrative
expense,
because
we
don't
hire
and
have
a
bunch
of
state
employees
that
are
actuaries.
We
contract
that
out
to
to
our
our
Consultants,
so
part
of
the
administrative
expenses
go
to
things
like
that,
so
that
we
can
generate
the
required
reports.
N
The
cost,
reporting
Etc
in
terms
of
the
position
I
think
from
the
committee
Bill
to
this
bill
and
over
the
discussion.
There's
there's
been
some
some
changes,
we're
I'm,
relatively
confident
in
terms
of
this
bill
that
if
the
general
funds
were
stripped
out
and
instead
Federal
fund
Authority
was
was
put
in
here,
we
can
make
I
think
we
can
make
that
work
again.
N
Federal
fund
Authority
for
us
to
spend
I
think
the
the
assessments
that
are
collected
for
the
administration
expenses
here
could
be
the
other
half
of
that
position,
if
that,
if
that
makes
sense
so
you'll
see
in
in
relation
to
these
programs
in
private
hospital,
supplemental
payment
programs
that
one
to
three
percent
depending
on,
if
this
passes
relatively
small
admin
but
again
I-
think
we
can
make
this
work.
If
it
were
the
committee
or
legislature's
pleasure,
with
with
a
zero
general
fund
obligation.
N
A
All
right
for
the
questions
for
repent
of
Larson,
primarily
saying
none
all
right.
Another
public
comment
anything
else,
representative
Larson,
no,
sir.
My
nodes
can
I
appreciated
the
basic
walk
through
there,
confusing
stuff
all
right
committee
with
that.
What
is
your
pleasure
on
house
ability?
One
of
the
bill
Mr
chair,
moved
by
Yen
seconded
by
Chadwick.
A
A
A
We
do
this
from
time
to
time
where
agencies
submit
an
agency
impact
and
say
this
will
cost
us
money
and
the
legislature
says
find
a
way
to
do
it,
but
after
you
get
to
so
many
of
those
find
a
way
you
get
to
the
point
of
okay.
Maybe
you
really
do
need
a
new
position
and
I
would
remind
the
committee
that
all
of
this
will
go
through
the
good
Appropriations,
Committee
or
representative
Larson
will
have
to
fight
with
his
colleagues
on
whether
or
not
to
get
this
position
approved.
L
A
L
I'm
going
to
be
a
no
on
this
and
here's
the
reason
it
expands
government
by
adding
an
additional
employee
to
the
Department
of
Health
to
quote
comply
with
federal
policy,
and
that
leads
me
to
additional
funding
from
the
FED
always
comes
with
strings,
and
here
we
are
hiring
an
additional
person
to
comply
with
federal
policy.
It
amounts
to
essentially
a
three
percent
tax
or
an
assessment
on
hospitals
in
so
on,
and
I
can't
believe
that
all
private
providers
are
in
support
of
that
I.
U
T
Again,
Mr
chairman
and
representative
hornock,
so
maybe
a
question
on
whether
it
would
be
friendly
to
keep
lines
one
through
sorry
line,
seven
through
nine
up
until
the
amendment
that
we
had
before,
where
we
still
authorized
the
position.
But
we
just
don't
have
the
funding
for
the
position
in
it
is
that
friendly
Mr.
A
C
So
I
would
I
would
suggest
and
I
think
it
was
a
good
question.
They
still
need
to
be
able
to
fund
the
position
but
to
maybe
remove
the
general
funds
and
appropriate
half
of
that
from
federal
funds,
and
then
they
can
use
the
assessment,
so
it
it
leaves
in
place
and
so
we're
removing
the
general
funds
that
I
think
that
represented
primbada,
but
maybe
I
misunderstood
it.
C
But
you
may
want
to
consider
that
in
NFL
you
got
that
wrong,
I
I
apologize,
but
to
allow
you
still
need
to
fund
the
position
and
the
director
says
they
could
do
that
with
federal
funds.
So
if
you
reduce
that
amount
by
half,
which
is
the
50
that
we've
talked
about
earlier,
then
that
would
accomplish
it
and
they
could
use
the
assessment
money
to
fill
in
the
other
half
and
cover
it
with
non-federal
funds.
R
A
D
Mr
chairman,
thank
you.
So
let
me
just
make
sure
that
I
understand
as
I
read
this
I
wondered
and
I
didn't
ask
a
question,
but
maybe
I
should
have
that
that
97
660
dollar
appropriation
I,
was
under
the
impression
that
that
was
just
the
appropriation.
The
half
appropriation
required
from
our
state
and
it
didn't
include
the
federal
government
assessment
already.
C
C
Representative
hornock,
when
you,
when
you
see
a
new
appropriation
and
it
will
give
it,
will
appropriate
and
authorize
all
fund
sources,
so
you
would
show
General
funds
and
then
it
would
have
listed
federal
funds
or
private
funds
in
that,
so
that
it
would
be
authorized
without
it.
You
don't
have
authorization
for
the
federal
funds.
D
D
A
L
L
A
D
A
So
the
amendment
would
be
no
General
funds
at
all.
The
department
would
have
to
find
the
other
47
000
somewhere
in
their
billion
dollar
budget,
but
we
could
ask
for
the
half
from
the
feds
okay.
Is
there
a
second
for
that
seconded
by
representative
o'hern
in
Maryland,
just
making
sure
you're,
mostly
with
us
and
if
not
I
will
meet
with
you
after
okay
discussion
on
that
Amendment
saying
none
all
right!
I.
A
A
D
Yeah
Mr
chairman,
just
just
to
kind
of
comment
on
that.
We
have
heard
in
the
in
past
testimony
that
the
it
seems
the
Department
of
Health
can
find
within
their
budget
things
to
overcome
gaps
in
fund
and
state
funding.
So
that's
what
I'm
I'm
looking
for
this
is
this
seems
actually
fairly
small.
Thank.
L
A
G
A
D
Chairman,
thank
you,
so
I
would
like
to
yeah
thank
kind
of
reiterate
what
representative
Penn
said,
but
but
also
I
do
appreciate
that
one
term
wasn't
mentioned,
but
this
does
fall
into
that
category,
and
that
is
the
term
free
money,
so
I'm,
I'm,
very
hesitant
on.
It
seems
like
we're
asking
for
that
free
money
from
the
federal
government
to
fund
systems
in
Wyoming,
but
there
is
no
such
thing
as
free
money.
D
D
D
However,
we're
asking
the
state
we're
asking
the
government
to
take
care
of
those
entities
and
I
just
don't
believe
that
is
the
the
the
right
place
for
government,
and
this
is
not
free
money,
so
I'm
I'm
not
gonna,
be
in
favor
of
this.
But
but
thank
you
for
those
those
two.
There
should
be
ten.
There
should
be
a
dozen
there
should
be
a
hundred
of
these
facilities
throughout
the
state
because
they
are
necessary
and
I
I
hope
that
they
can
be
in
in
whatever
means
necessary,
fully
funded.
D
A
O
M
M
I
know
it
firsthand.
Based
on
my
experience,
especially
you
know,
I
spent
10
10
years
working,
the
emergency
department
and
I
I
have
been
there
when
you
have
patients
who
need
assistance
and,
and
you
don't
have
anywhere
for
them
to
go
and
so
I.
This
has
been
a
struggle
for
me
today,
going
back
and
forth
on.
What
is
the
right
thing
to
do
here
because
they're,
the
need
is
there
and
it
is
great
at
the
same
time,
I
have
a
responsibility
to
the
to
the
taxpayers.
M
M
I,
like
the
fact
that
this
isn't
coming
to
the
state
for
additional
funds,
and
that-
and
you
know
we're
but
at
the
same
time
we're
putting
this
off
on
the
federal
government
and
federal
funds.
Well,
guess
what
the
federal
government
government
doesn't
have
any
money,
they
get
their
money
from
the
people
and
they
get
their
money
from
the
taxpayers,
and
so
this
once
again,
this
has
been
a
real
struggle
for
me
to
know.
M
A
Bye
all
right
reppin
of
Larson.
This
will
go
to
a
well
I'm
going
to
discuss
if
it
goes
to
approach
or
not.
Now
that
we're
passing
it
without
any
state
general
appropriation,
so
I'll
talk
to
Chairman
Nicholas
if
he
needs
it
or
it'll,
go
right
to
the
floor,
but
I
assume
you'll
be
covering
it
great.
With
that
committee,
we're
going
to
go
next
to
house
bill
18.,
not
sure
we're
gonna
get
through
two
bills
in
25
minutes,
but
we're
gonna.
Try
is
that
also
you
ripped
on
a
Larson
Truman,
okay,.
C
A
C
There's
an
interesting
thing
that
that
came
about
this
last
year
that
was
presented
in
our
tribal
Relations
Committee,
and
that
is
with
the
Amber
Alert,
that's
really
dealing
with
children
and
they
brought
to
attention
a
a
bill.
A
national
bills
called
the
Ashanti
Bill
and,
and
it's
named
after
Billy
Ashanti,
who
was
19
year
old
woman
who
disappeared
in
night
in
2017
in
Hampton,
Roads
Virginia.
C
So
what
this
bill
does
is
is
put
the
provisions
for
the
Ashanti
bill
into
our
statutes,
along
with
what
we've
done
with
the
amber
alert
and
what
this
does
is.
It
focuses
on
three
things:
individuals,
over
the
age
of
17.,
missing
adults,
with
special
needs
or
circumstances
and
redefine
that
missing
adults
who
are
endangered,
who
have
been
involuntarily,
abducted
or
kidnapped,
and
so
Mr
chairman.
C
C
We
have
to
go
into
the
homeland
security
statutes
and
then
then,
into
the
highway
patrol
statutes
and
in
those
we
we
identify
adult
at
risk
and
so
at
the
bottom
of
page,
two
starting
on
line
19
and
similar
languages
in
the
highway
patrol
section.
We
say
a
doll
at
risk
means
an
adult
who
has
developmental
disability,
who
suffers
from
Alzheimer's
or
dementia
or
who
suffers
from
and
could
without.
Access
to
medications
suffer
from
con
congenital
impairment.
C
If
impairment
would
likely
render
the
adult
incapable
of
getting
to
a
familiar
location
without
assistance,
and
so
it
was
a
gap
in
the
Amber
Alert
that
we
we
just
find
because
it
didn't
cover
adults
and
people
with
these
disabilities.
We
think
that
the
committee
feels
that
it's
important,
the
tribal
Relations
Committee,
felt
that
this
field
fits
in
very
nicely
with
the
other
work
we've
done
and,
and
that
be
happy
to
answer
any
questions.
R
Thank
you,
Mr
chairman,
just
research
has
shown
that
the
first
hours
that
a
person
goes
missing
are
the
most
critical
for
recovery,
so
the
longer
that
we
wait
in
issuing
these
alerts,
the
less
likely
it
is
that
we
recover
these
individuals.
So
we
did
feel
it
was
important
to
make
sure
that
we
were
looking
at
not
just
children
but
older
adults
and
along
those
lines.
R
You
know
the
Department
of
Homeland
Security
actually
holds
the
contract
to
implement
things
like
the
amber
alert,
but
it's
our
Highway
Patrol,
so
I
believe
there
are
some
individuals
in
the
room
who
can
speak
answer
those
questions
directly,
but
the
department
has
been
taking
steps
to
start
looking
at
what
it
would
like
to
implement
this
act
without
legislation
and
I
applaud
them
for
doing
that.
But
I
think
our
greater
concern
is
the
permanency
of
it.
You
know
when
you
establish
a
program,
it
can
come
and
go
at
the
whim
of
an
agency.
R
This
would
ensure
that
this
program
is
in
the
books
until
the
legislature
decides
that
it
maybe
doesn't
want
to
have
it
or,
but
that
would
be
a
legislative
decision.
So
that's
the
real
value
in
having
this
codified
in
our
statutes
is
to
ensure
the
continuity
Beyond.
You
know
any
particular
Governor's
Administration
so
happy
to
answer
any
questions,
but
we
did
work
on
this
quite
a
bit
and
had
good
discussion
in
the
interim.
All.
R
Thank
you,
Mr
chairman.
These
are
designed
to
be
in
the
area
where
there's
likely
to
be
recovery,
so
we
won't
be
getting.
You
know,
alerts
from
Delaware
or
anything
of
that
sort.
It's
really
aid
in
recovery,
something
that
we're
very
sensitive
to
the
fact
or
we're
very
sensitive
to
the
fact
that
we
don't
want
these
alerts
to
be
issued
too
much
so
there's
over
saturation
saturation
like
a
car
alarm.
So
really
these
are
you
know,
I!
Don't
we've
talked
about
this
a
lot
too
I.
C
I,
don't
know
the
answer
to
that
frankly:
I
I
guess
as
I
think
about
that
representative
pin
if
I
think
the
person
making
the
call
to
identify
that
the
person
is
is
missing
in
in
that
process
of
asking.
You
know
what
is
it
that
is
impairing
their
ability
and
if
that's
alcohol
or
other
substance
abuse
issues
that
then,
how
would
that
play
into
it?
I'm
not
quite
sure.
M
A
U
Good
morning,
Mr,
chairman
and
committee
Lynn
bud
I'm,
the
director
of
the
office
of
Homeland
Security
for
the
state
of
Wyoming
I
will
be
very
brief,
because
I
believe
that
this
is
a
pretty
simple
bill.
In
order
to
create
some
good
work
for
our
state.
We
work
in
partnership
with
communities
in
law
enforcement
and
local
families
and
everything,
and
we,
our
goal,
is
just
to
assist.
However,
we
can
in
bringing
those
loved
ones
home
foreign.
V
Mr,
chair,
Colonel,
Tim,
Cameron
I'm,
the
newest
member
of
the
Wyoming
highway
patrol
today
is
day
10
for
me.
I'm
very
pleased
to
be
here
and
I
would
tell
you
that
the
Wyoming
highway
patrol
supports
this
bill
as
written
it
uses
existing
systems
to
get
that
critical
information
out
quickly.
I
would
defer
to
Major
Germain
for
any
specific
questions
you
may
have.
Thank
you.
A
W
Thank
you.
Mr
chairman
members
of
the
committee,
I'm
kit,
wentland
special
counsel
for
the
governor's
office
and
I
also
function.
I
wear
another
hat
as
the
tribal
relations
policy
lead.
Other
other
folks
have
testified
to
this
in
enough
detail.
Just
saying
this
is
something
the
governor's
office
supports.
He
mentioned
it
in
his
State
of
the
State,
and
we
are
currently
in
the
process
of
implementing
the
new
Ashanti
alert.
W
A
X
You
chairman,
zawan,
sir,
my
name
is
Ann
Clement
I'm
here
on
behalf
of
the
Alzheimer's
Association
Wyoming
chapter
I
just
wanted
to
highlight
the
inclusion
of
folks
living
with
dementia
and
other
related
diseases.
There
are
about
10
000
wyomingites
that
do
have
either
Dementia
or
Alzheimer's.
I
will
say
that
estimate
is
back
from
2020,
so
the
likelihood
of
that
being
a
much
larger
number
is
very
real
as
well
about
60
percent
of
those
with
dementia
will
have
a
Wandering
episode
about.
Five
percent
of
those
folks
will
make
their
way
back
home
safely
and
unharmed.
X
The
first
24
hours
is
the
most
important
and
because
wandering
behaviors
are
not
about
finding
somewhere
safe
to
wait
until
you're
located
they're,
even
at
a
higher
risk.
If
I
can
just
indulge
the
committee
for
a
quick
moment
about
dementia
and
Alzheimer's,
if
you
understand
that
the
disease
that
is
essentially
an
unraveling
of
the
things
that
we
have
learned,
but
it
also
excuse
me,
it
also
affects
our
ability
to
integrate
visual
cues.
So
someone
with
dementia
will
not
be
able
to
navigate
their
path
safely.
X
The
way
someone
without
dementia
would
so
they
don't
understand
dangers.
They
don't
recognize
things
that
we
would
otherwise
be
able
to
dissuade
from
engaging
with
if
we
were
wandering
on
our
own
and
they're,
not
looking
for
a
safe
place
to
be.
We
do
have
programs
we're
aware
of
that
exist
from
around
the
state
to
help
track
people,
but
if
you'll
acknowledged
that
someone
with
dementia
is
having
an
episode
when
they're
wandering
that
may
not
be
an
adult
who's
willing
to
be
tracked.
X
F
F
These
alerts
have
appeared
on
on
message
signs
on
the
roadway
to
alert
orders
to
be
on
the
lookout
for
missing
seniors,
and
history
has
told
us
that
these
alerts
work
in
the
state
of
Wisconsin,
which
started
Civil
alerts
in
August
2014.
Over
the
year,
18
silver
alerts
were
issued.
15
of
those
18
alerts
ended
with
the
missing
person
being
reunited
with
their
loved
ones.
So
we
are
very
much
in
support
of
this
bill.
F
Q
Q
A
Q
A
C
Is
Mr
chairman?
It's
just
clarifying
which
processes
you
know
are
we
are
we
using
Zoom
teams
or
Google's
meets,
and
this
clarifies
it
so
that
it
it
gets
in
the
right
place.
So
if
you
you
have
the
the
you
have
the
right
language,
I
believe
in
front
of
you
online
to
page
two
line
13
after
integrate.
We
delete
the
remainder
of
that
line.
C
Then,
on
page
two
line
18
we
delete
the
existing
language
and
replace
it
with
America's
missing,
broadcast
emergency
response,
which
is
Amber
and
then
page
two
line
19
we
delete
system
page
three
line.
14
we
have
to
integrate.
We
delete
with
existing
alert
systems,
leave
the
rest
of
that
in
page
3
line
18
after
scope
of
the
we
delete
the
remainder
of
the
line
and
insert
again
the
the
America's
missing,
broadcast
Amber
stuff
and
then
page
3
line
19.
C
A
K
A
E
D
A
C
C
The
federal
language
of
the
Indian
Child
Welfare
act
equal
into
our
state
statutes,
and
then
this
and
that
we'll
consider
later,
which
is
to
have
a
task
force
on
it
with
the
reason
for
all
of
that
is
the
Supreme
Court
is
hearing
iqua
and
that
Holy
new
child
welfare
act
may
be
overturned.
I
think
it
would
be
worth
your
time
because
it
is
not
a
simple.
C
It
is
not
a
simple
discussion,
and
so
is
it
when
you
have
nothing
else
to
do
which
I
know
is
not
the
case,
but
look
that
up
and
and
maybe
get
just
a
little
primer
on
in
when
you
go
to
the
you'll,
see
all
of
that
information.
It
will
only
help.
You
better
understand
this
when
it
comes
up.
Mr
chairman
thank.
A
You
and
so
committee
we
were
will
here:
House
Bill
19,
the
state
Indian
Child
Welfare
act
task
force
first
on
Wednesday,
and
then
after
that
we
will
hear
House,
Bill
66
from
representative
Ward
and
I
might
throw
a
third
one
up,
just
in
case
we
get
through
those
too
quickly.
With
that
anything
else.
To
go
to
the
order
committee.