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B
Good
we'd
like
to
welcome
everybody
who
is
joining
us
on
YouTube
and
those
who
are
going
to
be
participating
our
meeting
today.
This
is
the
joint
Subcommittee
on
mental
health
and
substance
abuse
comprised
of
House
and
Senate
members
from
the
labor
and
health
committee,
along
with
Senate
and
House
members
of
the
joint
appropriations
committee.
B
My
name
is
Lloyd
Larson
and
I'm
from
Lander
I'll
be
co-chairing
with
Senator
Dave
Kinski
from
Sheridan,
and
with
that
said
before,
before
we
take
role.
John
we'd
like
to
recognize
John,
Brodie
and
Elizabeth
Smart
know
from
lso,
who
will
be
staffing
for
today
would
just
take
like
to
make
some
comments
a
little
bit
for
the
intent
of
this
meeting
today
is
really
to
catch.
B
Make
sure
that
the
the
members
from
the
Appropriations
Committee
are
caught
up
with
the
understanding
on
funding
sources
of
funding
population
served
by
our
mental
health
providers
in
the
state
and
then
to
ask
questions
concerning
what
role
the
state
has
in
providing
mental
health
moving
forward.
I
think
you
want
to
be
a
little
bit
careful
on
I.
Think
everybody
looking
at
our
revenue
picture
understands
that
there
will
be
cuts
in
in
budgets
in
the
foreseeable
future.
B
I
don't
know
that
that's
really
part
of
today's
discussion
that
may
come
up
in
in
following
discussions,
but
we're
just
really
trying
to
understand
how
the
how
the
funding
comes
to
those
providers
in
the
statutes
governing
mental
health
centers
at
this
time.
So
with
that
John,
could
we
go
ahead
and
take
the
role?
Yes.
A
I
was
wondering
if
I
might
just
make
a
couple
notes,
if
you
would
please
just
this,
is
an
unusual
subcommittee
being
appropriations
and
mental
health
and
I
appreciate
everything.
The
labor
and
health
committee
has
done
over
the
years.
Part
of
why
we're
all
thrown
together
into
the
basket
is,
and
so
you've
been
on
Appropriations.
A
You
know
what
it's
like:
it's
you,
you
see,
every
single
department
come
in
front
of
you
and
you're
about
a
mile
wide
and
a
half
inch
deep
in
terms
of
your
subject
matter,
expertise
and
when
it
comes
to
the
Department
of
Health
mental
health
and
substance
abuse
budgets,
we've
had
a
lot
of
free,
ranging
discussions
on
Appropriations,
none
of
which
have
really
led
much
in
the
way
of
conclusions
and
I.
Think
part
of
that,
as
we
we
needed
to
have
this
the
the
actual
subject
matter.
A
Experts
at
the
table
as
well
before
appropriations
does
whatever
it
is
that
appropriations
does
and
so
that
we
can
do
no
harm,
which
is
the
first
first
element
of
the
Hippocratic
oath
right
is
first,
do
no
harm,
and
for
that
we
have
to
move
forward
in
a
meaningful,
informed
way
and
I'm.
I
know:
I've
got
a
lot
of
questions
about
mental
health,
substance
abuse
and
the
funding
and
the
models
and
and
concerns
about
where
we
cut
whether
that
might
actually
engender
greater
rather
than
less
expense.
A
So,
I
look
forward
to
learning
from
you
folks,
as
as
we
move
forward
in
this
process
and
I
appreciate
your
time
and
expertise.
I
know
we're
going
to
be
plowed
a
lot
of
the
ground
that
you
folks
have
already
plowed.
So
I
appreciate
your
patience
with
the
balance
of
the
group
and
sharing
of
your
subject
matter:
expertise,
Thank
You.
Mr.
chairman,.
B
We
have
a
quorum.
Thank
you,
John,
so
we'll
move
into
the
review
of
community
mental
health.
Centers
we've
asked
the
Department
of
Health
I,
think
we've
got
Stefan
Johansson
waiting
in
line
and
in
just
again
a
comment
for
those
who
may
be
coming
on
and
speaking
and
getting
ready
for
public
comment.
As
we
start
winding
we'll
try
and
let
you
know,
there's
a
little
bit
of
delay
as
you
watch
on
YouTube
to
the
actual
zoom
meeting
that
we're
participating
in,
and
so
we
may
experience
a
little
bit
of
delay.
B
E
E
chairman,
if,
if
I
go
through
the
presentation
somewhat
quickly
and
take
questions
at
the
end
but
I'm
more
than
happy,
if
there's
something
that
really
doesn't
make
sense
or
isn't
resonating
or
where
you
need
more
detail
to
to
answer
questions
as
we
go,
but
I
think
with
the
the
slide
deck
that
I
sent
to
the
committee
members.
I,
don't
think
I
can
share
my
screen.
E
B
Committee,
if
we
can
will
allow
Stefan
to
make
his
presentations,
but
if
there's
something
that
you
just
really
feel
that
you
need
to
ask
a
question:
raise
your
hand
we'll
call
on
you,
that's
it
or
Kinski.
If
you
kind
of
keep,
if
I
miss
somebody
raising
their
hand,
let
me
know
and
we'll
interrupt
Stephanus
and
move
along.
So
let's
go
to
your
slide
presentation
on
the
on
the
mental
health
and
substance
abuse
overview
Stephanie.
E
A
E
B
E
E
This
is
a
topic
that
for
the
Department
of
Health
and
many
of
you,
both
on
the
joint
labor
and
the
joint
appropriations
side,
that
we've
worked
on
in
different
contexts
over
a
number
of
years,
including
just
in
general,
but
also
in
the
title,
25
context.
The
title:
seven
forensic
behavioral
health
context
as
well.
As
you
know,
various
issues
with
with
funding
Department
of
Corrections
priority
populations.
E
Just
in
the
past
a
couple
months
or
so.
Absol
ittle
bit
of
level
setting.
Mr.
chairman
on
what
the
broader
context
of
behavioral
health
in
Wyoming
from
the
from
various
sources
looks
like
and
then
we'll
dive
into
an
overview
of
the
community
mental
health
and
substance
abuse
system,
both
with
an
overview
of
the
system.
E
A
little
bit
of
an
overview
and
I
would
say
a
a
review
of
the
gatekeeping
statutes
that
are
in
title,
25
and
I
know
several
of
you
on
this
committee
worked
with
us
and
with
another
legislative
subcommittee
years
ago
to
kind
of
refine
some
the
statutes
in
title
25
and
we'll
focus
a
little
bit
on
what
gatekeeping
is,
at
least
from
my
perspective
in
the
department,
what
it
was
intended
to
do
and
kind
of
where
we
are
with
title
25
gatekeeping.
So
moving
on
and
try
to
be
expeditious
with
this
with
this
overview,
mr.
E
chairman,
but
like
I,
said,
feel
free
to
ask
questions
either
now
or
at
the
end,
this
table
on
slide
3.
We
tried
to
put
together
a
kind
of
a
summary
of
the
estimated
annual
expenditures
of
behavioral
health
and,
again
I
want
to
stress
that
this
is
not
just
to
the
community
mental
health
and
substance
abuse
system.
E
This
includes
Medicaid
reimbursements
for
behavioral
health
services
to
to
other
providers,
to
hospitals,
to
to
clinics
that
are
not
necessarily
community
mental
health
and
substance
abuse
centers,
and
on
this
table
you
can
also
see
we
include
a
Department
of
Family
Services
expenditures
for
behavioral
health
related
services,
as
well
as
Department
of
Education
expenditures
when
they
essentially
for
children
on
a
EPS
or
children
who
are
in
residential
treatment,
centers
or
BOCES.
There's
a
Department
of
Education
spending
that
is
behavioral
health
related.
E
So
we
worked
with
those
two
agencies
to
over
the
years,
working
well
together
to
estimate
those
expenditures
as
well
and
then,
like
I,
mentioned
mr.
chairman
on
the
private
insurance.
In
the
Medicare
side,
we
were
able
for
the
Joint
Labor
Committee
a
couple
of
weeks
ago
to
produce
some
estimates
of
what
that
spending
looks
like
and
again
on
the
private
insurance
side.
These
are
the
reason
you
see
the
Tildy
there
is
there's.
E
These
are
estimates
based
on
a
model
that
was
created
with
our
multi-payer
claims
database,
as
well
as
a
census
data
for
the
state
of
Wyoming
to
estimate
out
of
those
that
have
that
are
in
the
census.
Potentially
responding
with
with
some
sort
of
need
like
this
or
fitting
a
demographic
profile,
I
should
say
we
combine
that
with
the
multi
payer
claims
database,
which
is
primarily
the
state
employee
health
insurance
plan.
E
So
we
can
see
expenditures
for
behavioral
health
and
that
plan,
and
essentially
it's
a
big
assumption,
and
this
is
exactly
what
it
is
and
assumption
if
we
assume
that
other
insurance
plans
like
BlueCross,
BlueShield
or
other
privately
insured
plans
are
similar
to
the
state
plan
which
again
it's
it's
an
assumption.
We
can
back
into
a
little
bit
of
an
annual
estimate
on
what
the
the
broader
population
insured
population
is
quote-unquote
spending
or
being
reimbursed
for
when
it
comes
to
behavioral
health.
E
So
all
in
all,
with
all
of
these
sources,
we
estimate
around
two
hundred
and
seventy
two
to
just
over
three
hundred
million
dollars
a
year
in
behavioral
health,
related
expenditures,
the
relatively
large
line
item.
But
when
you,
when
you
have
Department
of
Health,
especially
when
you
include
Medicaid,
which,
on
a
on
an
annual
basis,
you
know
about
eighty
thousand
members
in
Wyoming
Medicaid
on
a
monthly
basis,
a
little
bit
less
somewhere
around
sixty
thousand
because
of
the
churn.
It
is
a
lot
of
people
and
in
the
privately
insured
market.
E
Also,
you
know
a
lot
of
people
far
more
so
than
what
we
see
in
jest.
You
know
one
of
the
areas
of
behavioral
health
in
the
department,
which
is
the
community
mental
health
and
substance
abuse
program.
Mr.
chairman,
moving
on
to
slide
four,
we
divided
just
the
Department
of
Health
behavioral
health
programs,
similar
to
what
you
saw
on
the
previous
slide,
but
with
a
little
bit
more
detail
just
for
the
the
department's
areas
and
that's
across
really
three
areas:
Bhd
which
stands
for
behavioral
health
division.
E
Then
your
public
health
division
and
your
health
care
financing
division,
which
includes
Medicaid.
So
the
first
three
rows
on
this
table
you
can
see
really
is,
is
what
we'll
talk
about
mostly
and
really.
The
first
line
is
what
we'll
talk
about
mostly
today
and
that's
our
community
mental
health
and
substance
abuse
unit
treatment
unit.
Those
are
the
contracts
that
that
our
behavioral
health
division
manages
with
about
18
community
mental
health
and
substance
abuse
centers,
but
also
in
the
behavioral
health
division.
E
We
have
the
court
supervised
treatment
program,
also
affectionately
known
as
the
drug
court
program,
which
represents
you
know
about
about
3.4
million
dollars
in
in
expenditures
and
last,
but
certainly
not
least,
and
behavioral
health.
The
state
hospital
which,
which
cares,
will
provide
services
for
both
civilly
committed
patients
on
the
title
25
side,
as
well
as
outpatient
and
inpatient
forensic
evaluation
services
on
what
we
call
the
title:
seven
side
or
the
criminal
justice
services
unit
of
the
of
the
state
hospital.
E
The
reason
I
bring
all
of
these
up
and
in
this
context,
is,
we've
tried
over
the
years,
both
in
conjunction
with
the
facilities,
Task
Force,
as
well
as
the
Joint
Labor
Committee.
The
title
25
subcommittee
to
really
see
this
behavioral
health
system,
especially
on
the
state-funded
side
as
a
continuum.
So
you
have
your
community
services,
which
can
and
often
do
act
as
an
alternative
or
a
preventive
measure
for
higher
levels
of
care.
E
Like
a
psychiatric
hospital
like
a
correction
setting
whatever
whatever
the
case
may
be,
then
you
have
your
sort
of
higher
levels
of
care
even
up
to
your
institutions
like
the
state
hospital
or
on
the
adolescent
side,
your
psychiatric
residential
treatment
facilities
or
PR
tf's
and
then
again
upon
discharge
from
a
setting
like
that
kind
of
as
a
mirror.
You
have
the
community
continuum
on
the
back
end,
and
so
in
theory.
E
E
chairman,
on
the
public
health
side,
that
that's
that's
the
division
that
houses
our
prevention
programs,
which
go
through
County
contracts
with
county
governments
for
substance,
abuse,
tobacco
and
suicide
prevention,
and
that
accounts
for
about
8
million
dollars
of
expenditures
but
broken
out
at
about
you
know:
50
50,
state,
general
fund
and
and
other
funds
here
shown
us
as
tobacco
settlement
funds
and
finally,
mr.
chairman,
on
the
healthcare
financing
side,
that's
generally
the
big,
the
big
elephant
in
the
room.
E
On
the
Medicaid
side,
we
have
payments
for
those
that
are
covered
or
enrolled
in
Medicaid
for
behavioral
health
related
services,
approximately
40
a
little
bit
over
40
million
dollars
a
year
when
we,
when
we
carve
out
that
claims
data,
I,
believe
and
I
double-check
with
my
folks.
That
does
not
include
pharmacy
spending.
These
are
just
for
mental
health
and
substance,
abuse,
service,
related
claims
and
again,
as
the
as
members
of
the
committee
that
likely
know
those
Medicaid
expenditures
are
generally
matched
at
5050
between
the
state
and
the
federal
government.
E
Also
in
health
care
financing,
we
have
what's
called
the
care
management
entity
or
the
CME,
and
that's
really
wraparound
services.
For
Medicaid
children
who
meet
a
certain
level
of
need
with
mental
health
or
behavioral
health,
so
you
might
have
heard
it
in
in
the
past,
referred
to
as
the
children's
mental
health
waiver,
and
this
is
essentially
that
bat
program,
but
basically
a
wraparound
service
case
management
care
coordination
for
for
kids
at
a
little
bit
higher
level
of
need,
higher
level
of
care
and
the
real
intent
there
is
to
prevent.
E
You
know
the
the
need
for
PRT,
f
level
of
care
or
when
kids
are
coming
out
of
higher
levels
of
care
to
ensure
they
receive
the
services
in
the
community
that
that
keep
them
and
their
and
their
families
stable
and
then
finally,
mr.
chairman,
psychiatric
residential
treatment
or
what
we
call
PRT
F.
That's
another
line
item
for
Medicaid,
that's
basically
residential
psychiatric
treatment
for
for
those
kids
and
adolescents.
E
This
you
might
be
remember
that
it
involves
both
just
Medicaid
kids
on
a
physician
order,
but
also
folks
who
are
in
the
DIA
kids,
who
are
in
the
DFS
system
in
the
custody
of
the
Department
of
Family
Services.
They
are
automatically
eligible
for
why
only
Medicaid,
by
nature
of
being
in
that
system,
and
some
of
some
kids
do
require
in
that
system
a
p
RTF
level
of
care
in
which
medicaid
would
be
the
primary
payer
for
that.
So
all
in
all
with
the
Department
of
Health.
E
While
we
do
a
little
bit
of
a
review
on
the
DFS
side,
this
table
shows
kind
of
your
mental
health
and
substance
abuse,
related
expenditures
for
certain
services
like
counseling
day
treatment,
mentoring
or
outpatient
substance
abuse
and
compares
that
to
kind
of
the
total
services
for
for
the
DFS
side
of
the
budget
when
it
comes
to
mental
health
and
and
other
services.
But
what
I
want
to
point
out
on
the
DFS
side,
mr.
E
chairman,
on
slide
number
six
is
what
I
think
more
people
will
be
more
familiar
with,
which
is
more
your
kind
of
residential
or
facility
based
care
for
DFS.
So
DFS
does
have
a
significant
line:
item
of
expenditures
for
kids,
who
are
placed
in
group
homes
as
well
as
kids,
who
are
placed
in
RTC,
which
stands
for
residential
treatment,
center
or
BOCES
kind
of
a
alternative
educational
setting.
And
you
can
see
those
expenditures
there
for
those
kids
and
then
on
the
last
two
rows.
You
can
see
the
the
fixed
cost
estimates
or
expenditures.
E
E
Mr.
chairman,
like
I
mentioned
in
the
agenda,
will
will
give
you
a
little
bit
of
a
some
more
detail
on
our
estimates
of
privately
insured
mental
health
and
substance
abuse
spending
again
for
the
purpose
of
really
level
setting
with
this
committee
on
some
more
deep
background
for
lack
of
a
better
term
on
on
what
the
what
the
system
really
looks
like
across
the
state.
E
Like
I
mentioned
in
this
estimate
in
this
in
this
model,
we
assume
that
privately
insured
spending
in
Wyoming
is
similar
to
egi,
which
is
the
state
employee
plan
called
employees,
group
insurance,
and
we
define
behavioral
health
spending
as
having
a
behavioral
health,
primary
diagnosis
and
a
hospital
or
behavioral
health
provider,
taxonomy
code
again,
there's
multiple
ways
to
skin
this
cat.
This
is
work
that
that
happened
here
in
the
in
the
director's
office
just
a
couple
of
months
ago
to
to
try
to
get
some
estimates
for
the
legislature.
E
On
what
this
likely
looks
like
in
the
private
sector,
we
will
give
it
a
little
bit
of
a
caveat
that
claims
data,
even
from
our
from
our
privately
insured
plans
and
working
with
the
multi
care
claims
database
is
generally
lower.
Quality
claims
data
than
Medicaid,
so
a
lot
of
missing
fields,
taxonomy
codes,
etc.
E
So
we
only
point
that
out
because
it
is,
it
is
a
luxury
to
have
to
have
Medicaid
data
across
all
of
our
states,
but
what
we
are
able
to
view
in
more
granular
fashion
in
Wyoming
is
generally
higher
quality
than
what
you
see
in
privately
insured
plans.
So
again
just
want
to
give
the
committee
a
few
caveats
that
we
made
some
assumptions
here,
but
I
tried
to
back
in
in
that
in
a
conservative
estimate
of
what
mental
health
and
substance
abuse
spending
looks
like
private
market.
Ok,.
B
E
Chairman,
that's
that's
a
good
question
and
I'll
give
you
an
initial
answer,
but
I
will
confirm
with
the
Department
of
Ed
I,
believe
that
is
just
the
Wyoming
Department
of
Education
expenditures,
but
I
need
to
confirm
if
that
includes.
You
know,
other
spending
at
the
at
the
local
level,
but
they
all
have
to
follow
up
with
the
department
on
that
and
make
sure
that
we
get
that
clarification.
If.
B
B
E
Mr.
chairman,
another
good
question
in
terms
of
the
funding
source
breakout
I,
don't
want
to
shoot
my
mouth
off
saying
this
is
all
general
fund.
I
actually
don't
know
I
think
largely.
It
is,
but
I'll
confirm
that,
with
with
DFS
and
get
back
to
the
committee,
we
I
don't
have
the
funding
break
out
in
front
of
me.
We
can
certainly
get
that.
A
A
Thank
You
mr.
chairman,
just
I
was
looking
at
slide
four
as
well
and
stuff,
and
so
I
I
see
that
we've
I
was
trying
to
run
some
numbers
myself
on.
You
know
the
amount
that
we're
spending
on
community
type
services
and
then
the
amount
on
inpatient
services,
then
I
see
the
Medicaid
is
and
I
thought
well.
Maybe
that's
evenly
divided
or
not,
but
just
to
just
to
clarify
for
for
everyone.
E
Mr.
chairman
representative,
Wilson,
yes-
and
it's
a
good
point
so
just
as
a
as
a
reminder
to
the
committee
on
that
medicaid
line-item
to
be
eligible
for
Medicaid
in
Wyoming,
is
not
just
being
low-income.
In
fact,
just
being
low-income
in
Wyoming
does
not
qualify
you
or
make
you
potentially
eligible
for
Medicaid
you
have
to
meet
as
representative
Wilson
was
alluding
to
what
we
call
a
categorical
eligibility
criteria,
and-
and
madam
chair
you
you-
you
mentioned-
you
mentioned
one
of
them
or
several
of
them.
E
But
yes,
it's
essentially
the
agent
blind
disabled
folks,
who
might
be
in
one
of
our
waiver
categories,
developmentally
disabled
and,
like
you
mentioned
long-term
care
populations
that
might
be
dually
eligible
for
for
Medicare
and
Medicaid.
But
I'll
mention
that,
on
the
on
the
dual
side,
like
you
mentioned,
being
eligible
for
Medicare,
Medicare
would
typically
be
the
primary
insurer,
but
we
run
into
some
issues
with
Medicare,
where
behavioral
health
isn't
isn't
covered
the
same
way
that
it
is
on
the
Medicaid
side.
E
So,
yes
to
answer
your
question
more
simply,
even
though
I've
droned
on
and
on,
you
have
to
meet
a
categorical
eligibility
criteria
to
be
part
of
that
Medicaid,
a
line
item
so
so
again,
kids,
aged
blind,
disabled
and
in
certain
other
special
categories
as
well
and
like
I,
mentioned
that
that
Medicaid
population
is
around
on
a
rolling
monthly
basis
around
60,000
eligible
or
covered
members
in
Medicaid.
Now
not
all
of
them
require.
E
A
Thank
You
mr.
chairman,
mr.
chairman
and
members
I
think
it
would
be
helpful
and
for
yeah.
No,
no,
no
I
don't
want
to
put
this
on
the
department
of
health,
but
it
would
be
helpful
comparatively
between
the
different
agencies
that
have
a
per
member
per
month
or
per
member
per
episode,
or
some
kind
of
a
comparator
between
these
different,
because
I
think
that
at
least
folks
that
have
been
dealing
with
this
file
understand
that
the
reimbursement
rates
are
different
between
the
different
programs
DFS
versus
Department
of
Ag
versus.
A
So
that
would
give
us
not
just
an
indication
of
how
much
money
we
just
grossed
dollars,
isn't
always
the
most
important
thing.
Sometimes
it's
how
or
the
level
of
dollars
per
individual
treatment
and
the
comparison
between
those
and
I
think
we're
going
to
see
some
significant
disparity
in
that
and
I
think
that
will
help
us
get
to
some
of
the
more
policy
based
things
that
we
we
can
maybe
impact.
So.
A
A
There
has
to
be
a
consistency
in
comparison
of
level
of
care,
so
is
it
RTC
is
if
it's
RTC
and
SBRT
see
Department
of
Education
is
paying
or
what
DFS
is
paying
or
what
Medicaid
is
paying
or
what
potentially
general
fund
or
private
insurance
is
paying.
There
are
instances
of
that.
So
so,
if
we're
going
to
get
into
these
use,
these
numbers
we
got
to
have
some
basic
for
comparison
and
I.
Don't
know
if
remember
per
month,
is
the
right
way,
mr.
A
E
So
mr.
chairman
and
then
represented
Barlow
happy
to
take
a
look
at
that
and,
like
I
mentioned
at
the
beginning,
there's
many
different
ways
to
carve
out
this
data.
I
will
certainly
take
a
look
at
that
to
provide
additional
context
at
you,
the
committee,
but
you're
right,
there's
different
funding
sources,
different
different
funding
models
across
all
of
these
different
lines
of
service,
so
to
speak,
I'm
so
happy
to
follow
up
with
some
additional
information
for
the
committee.
I
think.
A
Chairman
there's
gonna
cost
us
to
use
how
we
use
the
word
cost
versus
how
we
use
the
what
we're?
What
we're
talking
about
what
we're
talking
about
is
what's
we're
doing
charge
is
what
we're
paying.
We
actually
probably
don't
know
what
the
cost
is
for
a
lot
of
these
services,
because
we're
not
actually
on
a
cost
based
model
like
we
offered
the
DD
waiver
or
other
things,
and
so
I
just
throw
that
out.
Also
is
something
to
keep
in
mind
as
we're.
A
A
E
E
You
can
see
it's
broken
out
here
in
the
colors
by
by
sex,
so
for
females
and
males
and
again,
this
is
an
estimate
based
on
a
model
using
the
multi
payer
claims
database
and
the
census
data
to
again
just
try
to
get
a
sense
of
what
we
see
on
a
per
member
per
month
basis
in
this
spending.
You
can
see
that
largely
by
age,
which
is
on
your
horizontal
access.
You
do
see
a
spike
kind
of
in
your
adolescence
up
to
your
early
adults
and
then
it
kind
of
tapers.
E
It
goes
a
little
bit
tapers
off
a
little
bit
so
by
year.
Here,
if
you
just
look
at
2019,
we
do
see
kind
of
a
spike
in
the
males
and
females
around
age
15
to
20,
with
a
per
member
per
month,
cost
they're
around.
You
know
twenty
to
forty
dollars
and
again
kind
of
tapering
off
and
and
what
you
can
see.
There
is
kind
of
the
observed
data
points
in
in
the
dots
and
then
the
modeled
modelled
uncertainty
in
those
shaded
shaded
lines.
Similarly,
similarly,
mr.
E
chairman,
on
slide
10,
we
break
that
out
based
on
a
few
different
categories
of
provider,
type
for
these
employer-sponsored
insurance
groups,
and
this
is
what
gets
into
what
taxonomy
codes
for
those
providers
we
have
available
in
the
data
to
model
off
of.
So
what
you
can
see
here
is
about
five
different
provider
types
moving
from
top
to
bottom
and
left
to
right,
a
psychologist
and
psychiatrist
on
a
per
member
per
month
basis
again
by
by
gender
as
well
as
licensed
clinical
social
workers
or
counselors
facility
based
per
member
per
month.
E
E
So
we
estimate
around
a
little
over,
like
I
mentioned
before
60
million
dollars
in
the
privately
insured,
a
market
for
mental
health
and
substance
abuse,
related
spending
and
to
representative
Barlow's
points.
It's
a
great
point
on
the
previous
slides
and
we
were
talking
about
state
what
I
called
costs
and
he's
absolutely
right.
It's
cost
to
the
state,
not
necessarily
the
cost
of
service.
It
really
is
a
mixed
bag
on
you
know,
does
our
contracts
or
reimbursements
cost
base?
Sometimes,
yes,
sometimes
it's
based
on
history.
Sometimes
it's
based
on
RFP
or
we're
competitive
bidding.
E
It
really
is
a
mixed
bag.
So
the
points
well-taken
there
that
on
the
Department
of
Health,
especially
the
department
of
health,
related
spending
when
we
share
those
figures,
it
is
cost
of
a
state
either
through
reimbursements
or
contracting.
Here
again
with
the
private
market,
it's
really
estimated
reimbursement
that
we
think
might
be
out.
There
ranges
that
might
be
out
there
based
on
what
we
see
in
one
private
insurance
plan
with
the
state
employees,
which
is
egi,
so
I
just
wanted
to
make
that
clarification.
Mr.
E
E
The
next
three
rows
really
show
on
the
DFS
side
here:
residential
treatment,
centers
group
homes
in
crisis
beds
again
both
on
an
in-state
and
an
out-of-state
basis,
but
the
primary
the
the
primary
beds
for
group
homes
and
crisis
are
all
in
state
here
and
then.
Finally,
with
the
Behavioral
Health
Division,
we
have
residential
beds
for
substance,
use
disorder
for
adolescents,
again
just
kind
of
a
youth
summary
on
this
table
for
in-state
beds
that
are
that
are
available
there
with
one
provider.
E
So
not
not
a
very
on
substance
use
disorder
for
adolescents,
not
a
high
utilization
there
or
a
high
supply
and
again
no
commentary
on
the
demand
or
met
meter
or
unmet
need
here,
just
a
summary
for
the
Committee
on
what
we
see
in
in
bed
supply
across
these
settings
on
the
adult
side.
Mr.
chairman,
all
behavioral
health
division
related
here
for
substance,
abuse
and
mental
health
beds.
So
you
can
see
starting
at
the
top
of
the
the
table
in
those
first
three
rows.
E
The
number
of
state-funded
beds
for
substance
use
disorder,
as
well
as
substance
use
transitional
beds
and
what
we
call
social
detox
beds
which
happy
to
have
our
behavioral
health
division.
Folks
speak
to
the
difference
across
these,
but
these
are
all
a
different
residential
ads
that
are
part
of
our
mental
health
and
substance
abuse
contracts
in
the
community
system,
which
we'll
get
into
in
more
detail
later
in
this
presentation.
The
last
the
bottom
four
rows
on
this
table.
Mr.
E
chairman
are
our
mental
health,
residential
beds,
so
supervised
living
group
homes
and
crisis
stabilization,
and
you
can
see
what
we
have
in
the
last
two
columns
on
this
table
are
the
number
of
state-funded
beds,
as
well
as
the
number
of
total
beds,
and
the
reason
we
carved
it
out
like
this
is
because,
even
with
our
community
mental
health
and
substance
abuse
centers,
they
are
private,
largely
mostly
nonprofit
businesses
and
the
state.
Clients
are
not
the
only
clients
that
they
serve,
so
those
community
centers
also
serve.
E
E
E
Mr.
Chairman
I
represented
Olson.
A
short
answer
is
yes.
We
can
take
a
look
at
that,
especially
on
the
Medicaid
side,
to
look
at
what
our
kind
of
per
recipient
spending
is
across
those
different
providers,
but
you're
right
it
does.
It
does
vary
and
sometimes
extraordinary
care
rates
are
negotiated
with
out-of-state
providers
depending
on
the
acuity
of
the
child,
but
typically
there
there
is
kind
of
a
set
payment
and
Medicaid
based
on
an
episode
so
we'll.
E
B
Thank
you
and
Stefan,
along
with
that
I
think.
Once
we
go
to
out-of-state
beds,
then
that
funding
formula
changes
a
little
bit
between
particularly
on
adolescents,
on
what
the
Department
of
Health
pays,
the
Department
of
Family
Services
and
then
Department
of
Education
pays
in.
So
maybe
you
can
just
kind
of
refresh
our
memory
on
how
that
works
and,
and
maybe
just
kind
of
give
us
an
example
on
when
we
may
have
to
adjust
that
medicaid
rate
for
an
out
of
state
facility
dependent
on
the
acuity
of
the
the
recipient.
Mr.
E
It
can
take
a
few
different
lines
so
to
speak,
and
we
have
several
cases
even
recently
that
we've
worked
on
on
out-of-state
placements,
where
certain
rates
have
been
negotiated
between
Medicaid
and
the
Department
of
Family,
Services
and
Department
of
Family
Services
agreeing
to
pick
up
the
difference
based
on
the
limit
that
Medicaid
has
of
what
it
can
and
can't
pay
both
by
federal
rule
as
well.
As
you
know,
state
appropriation
Authority.
B
E
E
But
yes,
generally
speaking
for
for
kids
in
this
type
of
treatment,
setting
or
context
the
Department
of
Health
and
Medicaid,
and
we're
really
talking
about
in
this
case,
mr.
chairman
kids,
who
are
in
the
DFS
system,
who
are
covered
with
on
the
health
insurance
side
by
Medicaid
and
then
in
these
other
contexts
like
you're,
mentioning
the
educational
component
is
paid
for
and
provided
or
provided
by
the
Department
of
Ed
and
then
other
services
provided
by
the
Department
of
Family
Services
when
it
comes
to
kind
of
the
custody
in
the
case
of
the
child.
B
A
A
Looking
at
this
slide
on
the
crisis,
beds
and
I
think
on
slide
13,
which
I
think
was
more
adult,
but
you
know
as
far
as
so
crisis
stabilization
I
guess
in
particular,
maybe
some
of
the
transitional,
but
we
see
a
number
of
beds,
but
I
think
it
would
be
helpful
for
us
to
know
the
number
of
providers,
but
also
what
the
locations
of
these
are,
because
as
we
contemplate
how
we
can
pay
for.
Oh
there
we
go
well,
that's
good!
A
You
know
if
a
person
has
to
be
moved
from
Rock
Springs
to
Gillette
fur,
for
residential
care,
that's
okay,
but
obviously
in
a
crisis,
it's
kind
of
difficult
to
take
a
person
from
Aetna
to
Douglas,
or
something
like
that.
You
know
so
I
wonder
the
the
cost
structure
for
some
things
like
that
might
be
a
little
bit
different
just
because
you
may
end
up
with
some
more
fixed
costs
in
rural
areas
in
order
to
maintain
quick
access
to
crisis
beds.
I
just
searched
throwing
that
in
there
for
our
future
contemplation
Thank
You.
Mr.
chairman.
E
Chairman
sorry,
just
taking
down
some
notes,
yeah
representative,
Wilson
I
think
that's
a
good
point,
and
it
goes
back
to
what,
like
you
said,
what
representative
Barlow
was
mentioning
and
what's
not
included
in
this
presentation,
because
it's
it
would
be
a
pretty
comprehensive
undertaking
is
when
we
start
to
talk
about
it.
You
know
whether
it's
the
community
programs
or
or
other
types
of
service
provision
here,
what
is
the
cost
that
it
takes
to
deliver
that
service?
We
again
we
have
that
in
certain
contexts
and
don't
have
it
in
others.
E
A
cost
study
of
residential
services
could
be
done
again.
That's
not
information
that
I
that
I
have
and
would
be
a
little
bit
of
a
project
to
do,
but
we
do
have
representative
Wilson
and
the
data
is
a
little
bit
outdated,
but
we
presented
it
to
a
subcommittee
and
I
believe
joint
labor
year.
Before
last,
we
do
have
the
ability
to
track
cost
reports
and
IRS
tax
filings
for
certain
types
of
providers,
so
on
hospitals
and
nursing
homes.
E
E
We
have
that
ability
to
kind
of
show
cost
structure
for
those
settings
and
then
across
some
of
your
nonprofit
settings
like
mental
health,
community
mental
health,
centers
developmental
preschools,
some
other
provider
types
they
file,
typically
nonprofits
of
a
certain
size,
have
to
file
a
Form
990
with
the
IRS,
which
again
gives
us
some
estimates,
not
the
full
picture,
but
some
estimates
of
cost
structure
labor
cost
essentially
what
they
report
to
the
IRS
in
terms
of
their
in
terms
of
their
business
for
tax
purposes.
So
we
do
have
a
website.
B
We
have
been
the
cost
there,
but
we
know
popular
the
number
serve
so
I
would
assume
that
the
counseling
services
would
probably
would
perhaps
be
serving
a
larger
number
of
individuals,
hence
representing
the
larger
cost.
But
if
you
could
clarify
that
for
me
and
then
well,
let's
answer
that
and
then
I
have
one
other
quick
follow-up
question.
Mr.
E
Chairman,
don't
have
a
direct
answer
for
you,
yet
that's
something
again
want
to
clarify
on
slide
11
here.
This
is
these:
are
estimates
of
the
privately
insured
reimbursements
so
to
speak,
based
on
on
a
model,
but
that
that
model
would
likely
also
have
volume
attached
to
it?
So
we
can
follow
up
on
that
and
give
estimates
of
you
know
how
many
potentially,
how
many
recipients
that
would
be
again
based
on
it,
modeled
off
of
our
state
employee
plan,
which
is
about
30,000
covered
lives.
So
it's
a
good
data
set.
E
B
Slide
13,
where
you
talk
about
your
state-funded
beds
and
your
total
beds
are.
The
total
beds
are,
for
example,
in
the
substance,
use
disorder
primary
the
additional
to
suit
the
additional
61
beds
are
those
by
private
nonprofits
or
you
know,
like
I'm,
trying
to
figure
out
like
where
VOA
comes
into
to
play
there
they
state-funded
or
they.
E
Chairman,
it's
a
it's
a
good
question.
So
what
this
represents
here
in
this
table
is
these
substance.
Abuse
and
mental
health
beds
would
be
located
at
our
community
mental
health
and
substance
abuse
centers
well,
but
what
the
state
contract
essentially
pays
for
or
subsidizes
is
that
is
that
penultimate
column
there,
the
state
two
beds
and
then
those
same
providers
like
he
mentioned
VOA
or
you
know
central
Wyoming.
Various
providers
that
have
these
beds
might
also
have
additional
supply
that
they
provide
and
leverage
other
pay
sources
work.
Thank
you.
E
So
slide
14
and
15.
Mr.
chairman,
again
just
the
same
data
you've
just
seen
across
these
different
settings,
just
visualized
on
a
map
for
for
in-state
and
then
on
slide
15.
We
show
for
the
PRT
F
and
the
RTC
a
data
that
you
saw
before
kind
of
where
that
network
of
out-of-state
providers
are
and
on
the
P
RTF
side
it.
E
It
ranges
pretty
widely,
but
you
can
see
some
density
in
our
surrounding
states
with
Montana
Idaho
Utah
is
a
big
location.
A
bigger
location,
I
should
say,
I.
Think
three
providers
in
that
area
that
are
accessed
frequently
for
for
Wyoming
children
on
for
PRTs,
but
also
you
know
you
can
see
going
down
to
to
the
southeast
of
the
country.
E
We
have
some
providers
that
that
we
reimburse
or
for
Wyoming
kids,
that
are
placed
out
of
State
on
the
RTC
side,
a
little
bit
less
dense,
three
providers
in
in
Colorado
and
and
one
up
in
up
in
Montana
again
on
the
RTC
side
that
is
and
I
don't
want
to
speak
for
DFS,
because
I'm,
it
would
be
way
out
over
my
skis
with
my
level
of
knowledge
on
this
system.
I've
been
on
the
RTC
side:
again,
that's
a
DFS
reimbursed
service
and
the
the
vast
majority
I
believe
are
provided
in
state.
E
So
mr.
Chairman
I
I
will
stop
there
I
see
if
there
are
any
questions
that
the
next
slide
on
slide.
16
kind
of
gets
us
into
our
introduction
and
overview
specifically
now
the
community,
mental
health
and
substance
abuse
system.
Now
that
we
have
a
little
bit
of
a
broader
picture
when
it
comes
to
behavioral
health,
reimbursement,
service
provision,
statewide
and.
E
On
Thank
You,
mr.
chairman
slide,
16
again
I
do
my
maiya
culpa
for
the
joint
labor
folks.
This
is
kind
of
some
deja
I've
moved
for
them
just
from
a
couple
of
weeks
ago.
Seeing
this
overview.
But
again
we
do
believe,
depending
on
the
discussions
that
happen
in
this
committee
or
others.
It
is
helpful
to
to
provide
the
summary
and
again
do
some
level
setting
on
what
these
different
systems
look
like.
E
So
now
we're
talking
members
of
the
committee
specifically
about
the
community
mental
health
and
substance
abuse,
a
system
which
is
a
State
Department
of
Health
funded
system
of
about
18
contracted
providers
across
the
state,
both
mental
health
and
substance
abuse
providers.
Sometimes
a
provider
will
provide
both
mental
health
and
substance
abuse
services.
But
what
folks
might
have
referred
this
heard
heard
referred
to
in
the
past
is
the
State
Block
Grants
for
mental
health
and
substance
abuse.
E
So
that's
essentially
what
we're
talking
about
now
is
the
department
of
health
and
behavioral
health
divisions,
funding
for
community
providers
so
again
much
more
a
specific
and
there
than
what
you've
seen
in
the
first
fourteen
or
fifteen
slides
of
this
presentation
when
it
comes
to
all
of
those
systems,
you
know
Medicaid
DFS,
Department
of
Education
private
insurance.
Again,
the
behavioral
health
landscape
is
much
much
larger
than
any
one
of
these
components
so
just
want
to
be
clear
that
now
we're
talking
about
very
specific
treatment
contracts
that
are
funded
by
the
Behavioral
Health
Division.
B
E
Chairman
that
that's
correct,
it's
a
it's
a
mixed
bag
and,
like
I,
said
the
providers.
You
know
it
depends
some
are
more
dependent
on
on
state
contracts
than
others,
but
certainly
provide
services
to
a
wider
clientele,
so
to
speak,
and
just
the
state
contracts
they're
they're
funded
here.
Thank
you,
like
I
mentioned
mr.
chairman
18
contracted
providers
statewide
both
mental
health
and
substance
abuse
services
and
the
funding
in
those
contracts
and
include
base
payments
and
on
especially
on
the
outpatient
side,
what
we
call
per
hour
reimbursement.
E
So
these
centers
offer
a
mix
of
outpatient
and
residential
services.
As
representative
Wilson
was
referring
to
earlier,
not
all
of
our
areas
of
the
state
or
all
of
our
centers
provide
the
full
menu
of
residential
services,
because,
quite
frankly,
it
wouldn't
make
sense
on
an
on
scale
to
have.
You
know
all
your
levels
of
care
provided
in
a
very
smaller
rural
or
frontier
community,
for
example,
because
there
wouldn't
be
enough
volume
or
demand
to
support
it.
E
So
this
mix
of
outpatient
and
residential
services
try
to
indicate
in
these
last
two
bullet
points
in
general,
how
these
reimbursements
happen.
So,
on
the
outpatient
side,
services
are
reimbursed
at
87
dollars
an
hour
for
the
general
population
and
120
dollars
an
hour
for
priority
populations,
like
those
you
can
see,
indicated
here,
SMI
as
a
priority
population
category
work,
someone
with
serious
mental
illness.
What
I
want
to
clarify,
though
mr.
E
chairman
and
members
of
the
committee,
is
when
we
say
reimbursed
I,
want
to
put
a
caveat
on
that,
because
it's
not
really
a
fee
for
service
or
a
reimbursement
model
in
this
system.
The
way
these
contracts
are
developed
is
essentially
a
service.
Our
target
on
the
outpatient
side,
so
for
mental
health
or
for
substance
abuse.
A
provider
will
have
a
certain
amount
of
hours
in
a
given
year
or
a
contract
period
that
the
department
in
the
state
expects
them
to
provide.
E
Then
those
services
that
service
our
quota,
if
your
lack
of
a
better
term,
is
multiplied
by
by
these
figures
to
kind
of
get
the
overall
contract
amount.
Now
recently,
the
the
behavioral
health
division
has
moved
to
more
of
an
invoice
basis,
so
kind
of
a
hybrid
of
the
two
approaches
between
straight
grains
and
their
contracting
and
fee-for-service,
so
that
in
in
essence
and
the
on
a
monthly
basis,
those
hours
are
essentially
invoiced
for
the
state
clients
that
are
receiving
services
to
determine
you
know
the
the
1:12
payment
that's
made
for
that
particular
month.
E
So
again,
it's
what
I
want
to
point
out
to
the
committee,
though,
is
just
a
little
bit
of
nuance
that
very
different
from
how
medicaid
reimburses
services
on
a
straight
V
for
service
basis.
You
know
the
client
is
eligible
for
Medicaid,
the
sinner
bills,
Medicaid
for
that
service
and
medicaid
reimburses
that,
what's
in
the
fee
schedule
for
that
service,
this
is
a
little
bit
different
and
historically,
going
back
to
the
1970s
has
run
on
more
of
a
grant
model
with
certain
performance
targets
associated
in
those
in
those
contracts
for
both
service.
E
Our
provision,
as
well
as
things
like
wait
time
and
other
areas
that
are
that
are
measured.
The
residential
services,
on
the
other
hand,
are
funded
separately.
You
often
through
the
same
contract,
but
it
kind
of
in
a
different
part
of
the
statement
of
work
and
generally,
as
representative
Barlow
mentioned
before,
on
a
per
bed
basis.
E
So
the
Department
of
Health
will
have
contract
with
a
certain
Center,
for
example,
to
provide
six
crisis
stabilization
beds
in,
in
a
certain
area
of
the
state,
for
example,
and
on
those
residential
services
that
ranges
from
supervised
living
settings
supported,
living
like
an
apartment
that
might
have
some
services
or
people
that
would
visit
it
all
the
way
up
to
group
homes
and,
like
I,
mentioned
crisis
stabilization.
So
a
variety
of
different
services
provided
on
the
residential
side,
but
again
that's
not
reimburse
or
reimbursed
on
a
per
hour
basis.
It's
largely
on
a
per
bed
basis.
E
B
E
Mr.
chairman,
good
questions,
so
it's
interesting
because
it
seems
like
more
and
more
of
these
days
everyone
fights
to
be
the
payer
of
last
resort,
including
the
state,
Medicaid,
private,
insurance,
etc.
But
I
will
point
out
that
in
the
contract
language
for
these
for
these
centers,
it
is
put
in
the
contract
that
these
dollars
cannot
be
used
to
to
reimburse
when
there
is
another
funding
source
like
Medicaid
or
private
insurance.
Now,
there's
some
nuance
there.
E
When
it
comes
to
services
that
might
not
be
covered
by
you
know,
insurance
or
Medicaid,
and
then
potentially
the
contracts
can
be
leveraged,
but
this
mr.
chairman,
in
in
general
and
and
I'll
just
say
that
this
should
be
for
for
state
clients
that
are
essentially
do
not
have
another
pay
source
or
another
insurance
to
reimburse
for
that
service.
Thank
You.
Mr.
A
A
Emphasis
is
self-evident,
perhaps
to
you,
because
you
spend
so
much
time
on
it,
but
we
here
on
on
on
Appropriations.
Well,
these
mental
health
centers
one
they're
regarded,
is
just
another
prior,
but
actually
they're,
almost
like
a
quiz,
quasi
governmental
agency.
We,
you
know
the
state
made
a
decision.
There
were
to
use
these
not-for-profit
models
instead
of
providing
these
services
directly,
but,
more
importantly,
this
$87
per
hour
people
see
that
they
see
that
$120.
Now
they
say
well,
these
these
advocates
have
no
incentive
to
ever
tell
anybody.
A
Well,
they
just
created
this
spinning
door,
revolving
door
and
these
these
people
just
keep
coming
through
the
door
and
they
spit
them
out
and
they
come
back
in
their
building
for
$87
they're,
making
all
kinds
of
money,
and
it's
important
to
understand.
You
know
if
they
get
but
writing
flying
straight
between
the
posts
and
don't
see
him
again.
They
have
that
incentive.
A
If
that
patient
keeps
coming
back
and
back
and
back
and
back
and
back
they're,
not
getting
87
dollars
an
hour
every
time
that
patient
walks
back
in
the
door
and
I'm
the
set
and
said
that
this
is
basically
a
basically
contract
to
use
at
87
dollars.
It's
a
proxy
and
say
here's
your
per
your
quota
powers,
that's
what
you
can
and
if
you
see
that
patient
20
times
or
2
times,
you've
got
to
fix
feed
basis.
I
want
to
make
sure
that
I'm
understanding
that
correct
is
that
a
correct,
Steffen.
E
Mr.
chairman,
senator
Kinski,
yeah
I
think
you
make
a
good
point
and
I
don't
want
to
get
too
far
into
the
weeds
with
the
history
of
this
but
you're
right.
It's
it's.
The
state
decades
ago
made
a
decision
to
have
brick-and-mortar
places
like
community
mental
health
centers,
where
folks
can
go
kind
of
on
a
general
access
basis
and
receive
subsidized
or
sliding
scale
services.
E
It's
not
really
a
rate
by
certain
service
where
we
say
okay
for
medication
management
by
a
psychiatrist.
That's
going
to
be
a
hundred
and
fifty
dollars
for
that
for
that
hour,
whereas
a
group
session
from
a
clinician
with
you
know
eight
or
nine
folks
in
the
room
we're
going
to
reimburse
that
at
nine
dollars
per
person
that
was
in
the
group
per
hour.
That's
what's
not
done
in
this
system.
To
your
point,
senator
Kinski,
it
really
is.
E
E
You
know
an
hour
of
group
services
when
there's
ten
people
in
the
room
that
would
that
would
get.
That
would
get
very
expensive,
but
it's
it's
not
really
reimbursed
on
a
fee-for-service
basis
like
that,
but
I
will
say
that
you
know
there's
again
just
from
the
economics
perspective
and
no
judgment
call
here
there
there
is
a
certain
incentive
so
to
speak.
E
For
you
know
what
we
see
across
the
state
on
the
outpatient
side
is
a
lot
of
group
services
delivered
by
like
by
clinicians
in
group
settings
and
again
no
no
judgment
call
there,
because
I
know
that
the
centers
in
the
system
and
the
providers
and
the
patients
certainly
benefit
from
that.
But
the
point
here
was
that
it
is
very
different
from
you
know:
private
insurance
model,
where
you
say:
okay,
here's
the
fee
structure,
its
reimbursement,
you
deliver.
The
service
will
do
some
auditing
or
accounting
to
make
sure
you
deliver
the
service.
E
A
His
model
and
said,
rather
than
under
the
old
system
you
had
to
have
a
higher
licensed
clinician
sign
off
on
services
as
necessary.
We
threw
it
open
to
every
social
worker.
Every
mental
health
counselor
to
Bill
Medicaid
direct
those
people
are
getting
it
on
a
fee-for-service
basis,
they're
getting
whether
it
is
$80
an
hour.
Ninety
dollars
an
hour,
a
hundred
dollars
an
hour
and
the
more
hours.
Those
outside
providers
see
that
patient
the
more
they
they
not
make
correct.
That
does
have
difference
between
them
in
the
community
mental
health,
centers.
E
Mr.
chair,
as
Senator
Kinski,
again
not
to
be
overly
frustrating,
it
is
a
mixed
bag
because
our
community
mental
health
centers
also
bill
Medicaid,
but
you're
right
that
in
recent
years,
Medicaid
did
open
up
the
ability
for
other
types
of
providers
to
Bill
Medicaid
for
services.
Now
that's
set
on
a
fee
schedule
that
a
community
mental
health
center
or
a
private
clinician,
that's
an
enrolled
provider
and
eligible
to
provide
that
service
would
get
the
same
reimbursement,
for
example,
for
an
hour
of
counseling.
E
So
you
know
a
private
psychologist,
for
example,
that's
enrolled
in
Medicaid
or
a
community
mental
health
center.
That's
also
enrolled
in
Medicaid
would
receive
the
same
reimbursement
from
Medicaid
for
that
service,
but
you're
right,
it's
a
different
funding
model
than
what
the
state
contracts
from
the
Behavioral
Health
Division
offer.
E
Now
we
can
provide
some
more
information,
senator
Kinski,
on
exactly
what
was
opened
up
at
that
time
period.
It
was
legislative
I
believe
to
to
make
that
essentially
provider
pool
wider
across
the
state
where
different
types
of
essentially
non
community
mental
health
centers
could
bill
Medicaid
for
certain
types
of
services.
Happy
to
provide
that
that
history.
A
You
mr.
chairman
I
just
had
a
question
on
the
the
providers.
The
18
providers
I
got
I've
often
wondered
if,
if
there's
any
consistency
in
terms
of
their
reimbursement,
services
I
mean
I.
Do
you
have
any
data
on
that
in
terms
of
those
bases,
I
understand
the
base
payments
in
the
per
hour,
and
maybe
those
are
similar.
But
do
you
have
any
data
which
shows
some
differences
or
similarities
between
those
18
providers
in
our
state.
E
Mr.
chairman,
senator
Schuler
absolutely
and
happy
again,
we
could
spend
about
a
week
of
a
presentation
here,
carving
it
up
by
center.
You
know
who
who
is
able
to
provide
what
what
that
service
provision
vol
looks
like
but
happy
we
can
have
a
discussion
offline
and
determine
what
would
be
best
to
see
you
know
by
centre,
but
your
your
I
think
your
question
is
well
intended
and
it's
absolutely
right
on
that.
You
have
different
centers
around
the
state
that
provide
a
different
levels
of
service,
especially
on
the
residential
side
like
I
mentioned
before.
E
It's
just
not
something
that
wouldn't
it
be
nice
if
we
had
a
crisis
stabilization
facility
in
every
community,
that
would
be
great
for
title
25,
but
the
cost
structure
likely
for
for
breaking
warden,
brick-and-mortar
and
demand
would
not
make
sense
there,
but
happy
senator
Schuler
to
provide
that
breakout
on
the
next
I.
Believe
two
slides
from
now
will
show
the
aggregate
funding
just
by
fiscal
year,
but
just
keep
in
the
back
of
your
mind.
All
of
that
could
be
carved
out
by
I
sent
early.
A
You,
mr.
chairman,
first
just
a
comment
and
then
a
question
one
is
regarding
to
Senator
Kinski's
discussion
and
I
look
forward
to
looking
ahead,
maybe
to
the
slides
and
the
payment
mix.
Cuz
I
did
look
over
it,
but
it's
been
a
couple
of
days.
You
know
to
remember
that
most
people
that
those
the
centers
see
if
they're,
but
if
they're
adults
between
the
ages
of
19
and
64
are
probably
not
covered
by
Medicaid,
because
we
have
not
expanded
Medicaid.
A
So
you
know
the
discussion
of
Medicaid's
mix
is
maybe
not
as
relevant
to
the
patients
that
these
people
see
as
we
might
like
to
think
of
because
they're
they
probably
haven't,
got
any
coverage.
But
the
quote
that
I
have
a
question
for
Stefan,
which
is,
if
you
could
remind
me,
are
these
one-year
contracts
or
three-year
contracts,
and
are
they
capped?
A
So,
for
example,
if
if
in
coming
up
with
the
the
contract
amount,
they
hypothesize,
let's
just
say
a
hundred
patients
of
the
general
population
at
87
dollars
on
an
hour
and
200
patients
with
with
priority
populations
at
120.
If
your
population
mix
changes,
for
example,
after
we
did
our
sum
of
our
criminal
justice
reform
and
in
the
House
bill
31
last
year,
you
know
trying
to
get
more
of
the
post-discharge
Corrections
patients
in
there,
and
many
of
those
might
be
in
a
priority
population.
A
E
Chairman
representative
Wilson,
it's
a
great
question.
I
think
the
simple
answer
is
yes,
that
we
don't
pay
in
excess
of
that
contract
amount
and
to
your
question
about
one
or
three
years.
I
believe
right
now
we're
on
two-year
contracts
that
they
do
term
on
June
30th
this
month
and
will
will
be
renewed.
I,
don't
know,
I
have
to
double-check,
with
our
behavioral
health
division,
folks,
if
they
are
doing
another
two-year
period,
if
it
will
be
one
year,
memory
serves
from
discussions
over
the
past
couple
of
months.
E
It
will
be
a
one-year
contract,
but
can
follow
up
on
that,
but
we
moved
a
couple
of
years
ago
to
two-year
contracts
to
reduce
some
of
the
administrative
costs
and
burden
on
the
state,
especially
in
kind
of
a
downs
revenue
environment,
of
not
having
to
do
all
the
contracting
but
you're
right.
So
this
is,
you
know,
a
question
of
a
funding
model
and
you
know
all
models
are
bad
and
some
are
better
than
others.
E
So
there's
pros
and
cons
to
whether
you're
you
know
straight
fee-for-service,
whether
you're
a
grant
model,
whether
you're,
somewhere
in
between
you
know
you,
you
get
what
you
pay
for,
so
to
speak,
and
we
we
don't.
We
don't
have
the
ability
when,
when
a
center
delivers
in
excess
of
its
service
hours,
you
know
that
is
essentially
and
for
lack
of
a
better
term
not
reimbursed.
E
A
A
There
was
a
time
before
we
through
Medicaid
billing,
wide
open
where
that
person
was
medicate,
might
have
been
more
likely
to
come
into
a
mental
health
center,
more
likely
screened
by
somebody
who's
a
with
a
higher
level
of
licensure
as
to
the
adequacy
or
or
compliance
with
criteria
for
any
services
they
receive,
and
then
they
could
build
and
collect
that
Medicaid.
Now
that
patient
that's
got
Medicaid
or
private
insurance
can
walk
into
any
social
worker
and
health
worker,
and
so
that
potential
fee
for
service
revenue
that
would
help
support
the
community.
E
B
Please,
as
you
do,
maybe
you
can
clarify
for
me
because
I'm
a
little
confused
with
with
what
I
heard
from
chairman
Kim
ski
on
this
is
that
if
the
person
is
on
Medicaid
is
is
eligible
to
be
billed
by
Medicaid
and
a
seen
by
a
private
provider,
they
can.
They
can
bill
Medicaid
repeatedly
but
correct
me,
but
I
think
that
the
community
mental
health
centers
would
have
that
same
opportunity,
and
so,
if
you
could
maybe
incorporate
that
into
your
comments,
please
mr.
E
Chairman,
that's
right
and
Senator
Kent
Steve,
it's
no
different
than
you
know.
Another
medical
service,
where
a
individual
on
Medicaid
or
on
private
insurance
is
essentially
free
to
choose
a
provider,
that's
in
network
or
or
in
on
the
Medicaid
side
and
enrolled
an
enrolled
provider.
So
you're
right
that
some
some
changes
were
made
years
ago
to
kind
of
open
that
up
a
little
bit
and
there's
there's,
you
know,
benefits
and
bugs
to
any
decision
like
that.
In
this
case
you
know.
E
Increased
access
for
Medicaid
beneficiaries
is
certainly
a
good
thing
to
be
able
to
choose
a
provider
but
you're
right
over
the
years,
especially
with
the
advent
of
the
Affordable
Care
Act
on
the
private
insurance
side,
more
mental
health
and
substance
abuse
reimbursement
on
private
insurance.
It
does
open
up
the
market
for
for
providers
and
but
to
Representative
Larsen's
chairman
Larson's
point.
It
is
certainly
something
that
you
know
the
community
mental
health
centers
that
enroll
and
can
bill
Medicaid
could,
for
lack
of
a
better
term,
compete
for
the
same
clients.
E
What
I
want
to
do
for
at
the
risk
of
getting
on
a
quick
soapbox
is
I.
Think
that
forces
the
conversation
that
this
committee
and
and
others
have
wrestled
with
over
the
the
recent
years,
which
is
kind
of
that
role
of
the
state
question
when
it
comes
to
what
what
is
the
purpose
for
the
community
mental
health
and
substance
abuse
system
in
this
landscape
and
era
of
a
change
in
the
coverage
for
these
types
of
services,
both
on
the
private
side
and
on
the
Medicaid
side?
E
And
it's
not
you
know
it's
not
an
easy
question
to
answer,
but
I
think
it's.
The
fundamental
problem
to
solve
is
what
is
the?
How
does
the
state
now
want
to
set
up
this
system
and
and
for
whom,
because
senator
Kinski
to
your
point
you're
absolutely
right-
we're
a
community
mental
health
center
with
the
services
that
it
provides
in
theory
and
oftentimes
in
practice,
can
provide
much
more
in
terms
of
community-based
and
wraparound
services
than
say
a
private
psychologist
who
really
only
wants
to,
or
only
does
provide
you
know,
counseling
or
something
to
that
effect.
E
We're
a
community
mental
health
center
in
its
history
and
it's
in
its
origin
was
supposed
to
be
a
kind
of
a
D
institutional
type
of
framework
to
get
people
out
and
keep
people
out
of
institutions
or
higher
levels
of
care
or
settings
like
that.
So
it
really
comes
back
Senator
Kinski!
It's
your
your
very
good
question
of
you
know
what
is
the
role
now
of
that
system?
Given
this
this
new
landscape
of
mental
health
coverage
and
service
provision
in
the
private
sector?
That
is
just
here
with
us.
E
Thank
You
mr.
chairman,
slide
17
members
of
the
committee
for
the
state
contracts
for
community
mental
health
and
substance
abuse
services
just
wanted
to
give.
The
committee,
like
I,
mentioned
before
a
general
overview
of
the
priority
populations
that
are
included
in
the
contract,
language
on
the
mental
health
treatment
side.
E
Children
with
severe
emotional
disturbance
or,
what's
often
called
sed
adults
with
serious
mental
illness
or
SMI
and
veterans,
are
part
of
the
priority
population
categories
that
like
I,
mentioned
in
terms
of
the
in
terms
of
the
grant
and
how
its
invoiced
are
reimbursed
at
a
hundred
and
twenty
dollars
per
hour
on
the
outpatient
side
versus
the
general
$87
on
the
substance
use
side.
Mr.
chairman,
about
five
categories,
some
of
them
overlapping,
somewhat
the
pregnant
IV
drug
users,
pregnant
women,
IV
drug
users,
women
and
parenting,
women
and
veterans.
So
again,
some
overlap
across
those
categories.
E
But
again
just
want
to
point
out
that
you
can
see
in
the
in
the
text
below
those
populations
are
reimbursed
at
one
hundred
and
twenty
dollars
and
again
reimbursed
kind
of
in
quotations
at
$120
per
hour.
And
then
all
other
populations
are
at
that
eighty-seven
figure.
Mr.
cherrick
I
see
representative
Wilson
has
a
question.
She
does
Thank.
A
You,
mr.
chairman,
so
Stefan,
since
we
passed
House
bill,
31
I
think
I'm,
remembering
them
number
right.
Let
me
back
up.
Could
you
identify
for
us
the
the
prioritization?
Is
that
primarily
driven
by
state
statute
by
stamps
or
regulations,
and
then,
as
we
get
into
I,
assume
the
new
contracts
you're
going
to
work
in
the
Department
of
Corrections
post
discharge
population?
Could
you
just
let
us
know
where
the
priorities
come
from
and
and
what
you
see
with
the
correction
scopes.
E
Mr.
chairman
I
represented
Wilson,
oh
I'll,
take
that
in
in
kind
of
blocks.
First
question:
yes,
the
the
priority
population
categories
that
you
see
here
have
been
kind
of
adapted
and
brought
over
from
the
federal
priority
populations,
which
is,
as
you
mentioned,
from
Samsa
that
stands
for
the
substance:
abuse
mental
health
services
administration,
which
is
a
kind
of
a
subsidiary
of
the
US
Department
of
Health
and
Human
Services.
They
have
a
mental
health
and
substance
abuse,
Block,
Grant
federal
dollars
that
come
to
states
and
we
receive
it
all.
E
So
it's
relative
to
our
overall
program
budget
of
on
a
biennium
basis
around
a
hundred
million
dollars
for
this.
It's
relatively
small
I
think
a
three
to
five
million,
if
I'm
not
mistaken,
but
can
follow
up
on
that
and
those
priority
population
categories.
I'll
just
read
them
to
you
on
the
mental
health
side,
adults
with
serious
mental
illness
and
children
with
serious
emotional
disturbances.
E
So
you
can
see,
with
the
exception
of
veterans
on
the
state
priority
populations,
largely
mirrors
the
the
federal
requirements
and
likely
going
back
to
again
before
the
state
really
increase
its
investment
in
this
program
area.
The
mental
health
and
substance
abuse
bla
grant
from
Samsa
for
many
states
was
a
larger
share
of
the
funding
for
these
types
of
services.
So
I
think
it's
kind
of
a
natural
progression.
Natural
History
to
define,
have
defined
the
populations
in
a
in
a
similar
way
on
the
substance,
abuse
block
grant
from
the
federal
government.
I.
E
Just
read
you
these
priority
in
categories
that
my
fine
folks
at
the
Behavioral
Health
Division
sent
over
pregnant
women
and
women
with
dependent
children,
IV
drug
users,
tuberculosis
services,
early
intervention
services
for
HIV
and
AIDS
and
primary
prevention
services,
so
a
little
bit
different
on
the
on
the
substance,
use
side,
but
again
relatively
broad
categories,
with
the
exception
of
TV
and
and
AIDS
on
the
federal
side.
But
what
I
want
to
point
out
here?
Mr.
chairman,
the
last
two
bullet
points
in
terms
of
these
populations.
E
What
I
want
to
just
briefly
address
and
kind
of
throw
this
out
there
for
the
committee
is
they're.
You
know
thinking
if
you
asked
a
hundred
people
legislators
executive
branch
members
of
the
public
who
are
the
priority
populations
for
behavioral
health
in
Wyoming.
You
probably
get
a
hundred
different
answers.
So
again,
going
back
to
my
comments
about
the
tough
task
that
a
committee
like
this
or
others
studying
this
issue
have
is
determining
you
know:
what
should
those
priorities
be?
E
E
Is
you
know
what
should
the
role
of
the
state
be
in
a
system
like
this,
especially
and
I
hate,
to
say
this,
but
especially
in
the
situation
that
we're
going
to
face
and
that
we're
working
on
right
now
is
really
a
significant
trimming
of
state
budgets
because
of
the
revenue
situation
really
puts
us
in
a
in
a
unique
and
tough
spot
to
to
answer
these
questions,
especially
as
we
anticipate
very
significant
budget
reductions
going
forward
as
as
quick
as
the
next.
You
know
month
or
two
across
the
Department
of
Health
and
other
agencies
or.
E
Chairman
sure,
it's
and
I
think
the
service
array
that
would
be
available
in
a
particular
center
that
someone
would
go
to
or
call
for
for
services
would
be
the
same,
so
it's
just
their
needs
might
be
different
and,
for
example,
and
I'll
just
use
myself
as
a
hypothetical
I
could
call
locally
here
in
Cheyenne
my
community
mental
health
center
would
be
peak,
wellness,
I
could
call
peak
wellness
center
and,
you
know
say
I'm
struggling
at
work
or
at
home
or
I.
Have
you
know
some
some
issues
with
substances?
E
Substance
use,
definitely
not
true,
but
could
call
Peak
wellness
center,
and
you
know
they
they
would
ask
if
I
had
any
insurance
and
I
would
be
insured
by
the
state
plan,
but
in
the
hypothetical
that
I
wasn't
directors,
the
BIOS
decided
to
fire
me
I
lost
my
state
insurance
I
could
also
go
to
peak
wellness
center.
With
that
same
kind
of
call
of
you
know,
I'm
I'm,
not
you
know
dangerous
or
violent
or
suicidal,
but
I'm
having
some
problems.
E
A
Thank
You
mr.
chairman,
just
to
follow
up,
but
so
stuff,
and
so
I
didn't
really
hear.
So
it
is
the
thought,
since
we
passed
HB
31
to
draft
the
new
contracts.
I
mean
I,
assume
this
list
of
priorities
is
part
of
the
contract
so
that
they
know
which
ones
they're
getting
paid.
What
for
is
the
corrections?
Population
gonna
be
added
to
the
list.
E
Mr.
chairman,
representative
Wilson,
we
are
working
on
designing
that
Corrections
program
now,
whether
that
happens
when
the
new
contracts
start
on
July
1st
or
whether
it's
incorporated
you
know,
once
we've
worked
through
those
those
issues
of
what
that
looks
like
and
I'm,
not
sure
exactly
on
the
date.
But
yes,
that
would
be
similar
in
whether
it's
part
of
the
quote-unquote
priority
population
categories
that
are
defined
in
in
the
contract
or
kind
of
a
separate
line
item
on
the
statement
of
work
or
the
deliverables
should
have
the
same
effect.
E
E
So
it's
a
really
nice
microcosm
of
the
larger
issue
that
we're
talking
about
here
in
in
that
you
know
who
are
the
priority
populations
and
how
should
they
be
financed
and
I
think
that's
something
we
will
experiment
with
this
year,
largely
dependent
on
what
happens
with
our
with
our
budget
reductions.
But
we
will
experiment
with
that
of
how
to
incorporate.
You
know
more
specifically,
a
priority
population
and,
as
the
bill
states
develop,
which
we
will
develop
over
the
course
of
this
next
fiscal
year.
E
I
think
it
was
called
a
competitive
outcomes
based
funding
stream
for
that
population,
and
that's
something
that
again
is
a
welcome
to
experiment
and
exercise
to
kind
of
change.
The
landscape
of
how
some
of
these
contract
mechanisms
work
to
pay
for
outcomes
as
opposed
to
paying
for
volume,
so
represented
Wilson.
We're
working
on
designing
that
I
just
don't
know
the
date
of
implementation.
At
this
point.
E
Mr.
chairman,
moving
on
to
slide
18,
like
I
mentioned
as
Senator
Schuler,
here's
a
breakdown
on
the
community,
mental
health
and
substance
abuse,
treatment,
funding
by
by
source
and
by
fiscal
year,
so
updated
through
the
current
fiscal
year
fiscal
year
2020.
You
can
see
it
broken
out
by
general
funds,
federal
funds
and
tobacco
funds
for
the
total
there
and
then
the
last
two
columns
we
do
have
primary
and
what
are
called
secondary,
a
contractor
contract
elements
and
just
real
general
explanation.
E
Here
there
are
certain
elements
of
funding
to
community
mental
health
and
substance
abuse,
centers
that
are
I,
think
more
specific.
So
things
like
peer
specialists,
legislative
acts
that
might
be
passed,
representative,
Wilson
I
know
there
was
no
appropriation
on
the
House
bill
31,
but
other
programs
in
previous
years
have
been.
You
know:
hey
do
this
at
a
you
know,
fund
this
service,
and
so
those
are
what
we
largely
consider
secondary
contracts,
your
contract
elements.
E
So
you
can
see
it
represents
a
relatively
small
or
smaller
share
of
the
total,
but
we
we
are
for
fiscal
year
2020.
Looking
at
about
55
million
fifty
five
point:
seven
million
dollars
total
contracted
to
community
mental
health
and
substance
abuse,
centers,
and
that
includes
all
of
those
funding
sources
on
the
general
fund
side
about
forty
three
point:
three:
a
million
dollars
in
this
most
recent
fiscal
year
contracted
to
community
mental
health
substance
abuse
centers.
E
So,
like
I,
mentioned
before
the
total
biennial
appropriation
across
these
units,
mental
health,
outpatient,
mental
health,
residential
substance
use,
outpatient
substance,
use
residential
has
been
historically
around
a
hundred
million
dollars,
a
biennium
after
the
cuts
from
from
four
or
five
years
ago,
we're
sitting
in
around
ninety
eight
ninety
eight
million
dollars
and
then
through
those
secondary
programs.
You
know,
there's
peer
specialists,
other
things
that
have
that
have
been
added
in
in
the
past.
E
E
Mr.
chairman
I
will
stop
there
I'm
sort
of
the
community
mental
health
and
substance
abuse
populate
their
contracts,
populations
and
funding
before
I
move
on
to
sort
of
an
overview
of
the
gatekeeping
statutes
per
your
request,
but
only
only
a
couple,
slides
left
and
then
happy
to
answer
any
questions,
but
I'll
stop
here
since
I
gave
you
kind
of
a
thirty
thousand
mile
an
hour
overview
of
the
of
the
community
system.
A
A
Stefon
I
have
a
December
12
2019
memo
from
my
Ceballos.
If
it
answers
a
series
of
questions
that
were
posed
to
the
department
and
I
appreciate
that
been
longer,
there's
a
question
I
posed.
That
is
germane
to
this
slide
18
but
I.
Maybe
I
got
an
answer
back
on.
My
Mis,
which
is
I
had
forwarded,
study
I,
think,
was
a
cue
macarthur
study
that
showed
that
the
percentage
of
mental
health
and
substance
abuse
funding
state-by-state
that
comes
from
the
general
fund,
as
opposed
to
Medicaid
and
other
sources.
A
A
A
But
I
was
hoping
that
when
we
look
here-
and
we
see
43
million
in
2020
from
the
state
general
fund
and
six
point
nine
federal
funds
and
then
tsf
what
I'm
not
sure
what
the
TS
f
stands
for-
not
gladden,
ok,
tobacco,
so
but
43
over
55,
that's
coming
out
of
the
state
general
fund.
What
could
we
do
to
impact
that
balance
if
we
just
left
the
model,
otherwise
alone
their
mission
and
what
they're
doing?
Is
there
any
way
to
shift
that?
So
that's
closer
to
a
50/50
split.
E
Stefon,
sir
mr.
chairman,
senator
Kinski
a
great
question
and
and
happy
to
revisit
it
right
now
after
our
discussion
at
JC
several
months
ago,
you're
you're,
absolutely
right
in
in
that
study
and
others
that
have
been
done
in
more
recent
years.
Wyoming
is,
is
in
a
minority
of
states.
I
would
say
that
don't
have
a
larger
share
of
federal
funds
or
Medicaid
spending
in
their
in
their
mental
health
and
substance,
abuse,
community
programs
and
there's
a
variety
of
reasons
for
that.
But
to
your
specific
question
of
you
know
no,
no
mission
change.
E
Let's
assume
no
mission
change,
no
role
of
the
state
conversation,
no
big
reform
projects.
How
could
we
get
a
larger
share
of
Medicaid
paying
for
these
services
and
and
a
simple
answer
to
that
question
is
operationally
challenging
and
so
what
it
comes
down
to
for
for
Medicaid
is
eligibility,
and,
like
representative
Wilson
mentioned
you
know,
Medicaid
eligibility
and
Wyoming
compared
two
states,
for
example,
that
it
expanded
Medicaid
under
the
ACA
is
more
limited
and
a
population
or
category
specific.
But
you
know
we've
talked
about
this
in
concept
in
the
past
that
a
you
know.
E
If
that
makes
sense,
so
that's
something
that
can
certainly
be
done.
It
comes
at
a
and
potentially
a
monetary
cost
to
continuously
screen
for
either
insurance
or
eligibility
for
Medicaid
to
see
if
that
reimbursement
could
be
there.
So
that's
that's
one
senator
Kinski
to
your
to
your
point.
That's
one
thing
that
that
could
happen.
I'm,
not
saying
it's.
It's
a
good
idea
or
a
bad
idea,
but
that
Medicaid
churn.
E
As
you
know,
we
see
about
20
to
30
percent
churn
in
the
Medicaid
program,
where
someone's
eligible
one
month
and
not
eligible
the
next
month
or
vice-versa.
So
that's
one
way
that
that
you
know
Medicaid
reimbursement
into
a
system
like
this
could
be
could
be
improved
for
lack
of
a
better
term.
The
others
and
I
don't
mean
to
to
suggest
this
I
mean
mention
this
without
judgment
or
comment
on
that.
E
Some
of
the
states
that
you
mentioned
I
know
the
study
was
prior
to
the
implementation
of
the
Affordable
Care
Act,
but
those
states
that
you
mentioned
senator
have
expanded
Medicaid
under
the
Affordable
Care
Act.
So
that's
another
way
that
the
population
served
in
community
systems
like
community
mental
health
or
substance
abuse
when
states
expand
Medicaid
and
now
give
a
90%
reimbursement
from
the
feds.
Many
of
them
have,
you
know,
eliminated
state
funding
or
or
reduced
state
funding.
I
should
say
for
for
community
programs,
because
they're
leveraging
those
federal
dollars
comes
with
benefits
and
bugs.
E
As
everybody
knows,
it's
just
different
different
systems
being
introduced
there.
The
the
last
thing
I'll
mention
a
third
senator
Kinski-
is
something
that's
been
tossed
around
as
an
idea
for
a
number
of
years,
both
in
the
department
governor's
office.
The
joint
labor
health
committee
is
the
idea
of
another
waiver
for
for
Wyoming
Medicaid.
You
know
we
have.
E
Essentially,
a
waiver
is
something
that,
instead
of
providing
a
service
or
in
lieu
of
a
service
like
skilled
nursing
facilities,
you
can
carve
out
a
home
and
community-based
service
for
a
specific
defined
population
to
essentially
waive
out
of
some
federal
regs
in
the
Medicaid
program
and
provide
an
alternative
type
of
service.
There
are
states
that
have
done
what
we
call
adult
mental
health
waivers
where
a
specific
population
is
is
defined.
E
B
E
That's
a
good
question,
mr.
chairman,
so
it
looks
like
I
had
two
slides
left,
representative,
Barlow
and
I
did
work
a
lot
years
ago
on
the
gatekeeping
program.
So
really
depends
on
the
level
of
discussion
that
we
have
there.
I
could
I
could
go
through
these
slides
in
another
three
or
four
minutes
and
then
maybe
come
back
for
questions
after
the
break
I
totally
up
to
you,
or
we
can
break
now
and
and
wrap
up
afterwards.
B
B
B
D
B
Chairman,
so
committee
I
want
a
couple
of
things
before
we
move
on
with
Stefan.
Is
that
here
my
office?
We
got
some
kind
of
some
funky
Internet
stuff
going
on
so
if
I
disappear,
senator
Kinski
will
jump
in
and
move
forward.
I
think
Stefan
for
you.
If
I
might
ask
on
the
funding
portion
of
this.
If
you
look
at
our
agenda,
this
would
be
an
appropriate
time
to
do
public
comment
on
the
funding
portion
before
we
move
to
two
gatekeeping,
but
I
would
like
to
know
for
you
on
the
funding
aspect
of
it.
B
B
Want
me
to
ask
again
please
my
children
pay
that
much
attention
when
I
speak
to
so
so
my
question
is:
is
we
really
probably
should
be
going
to
probably
comment
if
you're
done,
with
the
conversation
on
on
funding
and
in
before
we
go
into
the
gatekeeping
portion,
so
is
there
any
other
portion
of
the
handouts
that
you
give
us
regarding
funding
or
anything
else
that
you
would
like
to
cover
on
funding
before
we
go
into
public
comment?
Mr.
E
Chairman,
thank
you
for
repeating
that
and
and
know
the
the
the
only
two
things
I
might
mention.
Just
in
closing
on
the
first
part
of
that
presentation
is
number
one.
In
addition
to
the
slide,
deck
would
like
to
point
the
committee
members
to
the
memo
that
Senator
Kinski
referenced,
that
we
prepared
and
sent
to
the
joint
Appropriations
Committee
in
December
in
advance
of
our
budget
hearings,
that
that
attempt
to
answer
a
number
of
questions
about
the
funding
stream
for
community
mental
health,
as
well
as
Medicaid
provision
and
service
delivery
for
behavioral
health
services.
E
So
to
some
of
the
discussion
items
from
this
morning
about
you
know,
opening
up
the
the
market
so
to
speak,
for
additional
providers
to
be
able
to
build
Medicaid
for
behavioral
health.
We
did
trying
to
address
a
lot
of
that
in
that
document
and
in
that
in
that
memo,
which
I
believe
the
LSO
distributed
to
to
all
of
the
committee
members.
E
So
we're
happy
to
follow
up
on
those
items
or
and
answer
any
questions
that
the
committee
might
have
an
hour
or
in
the
future,
feel
free
to
funnel
those
through
LSO
or
contact
us
directly
and
then
the
last
thing,
mr.
chairman,
that
I
mentioned
just
as
we
close
out
kind
of
the
the
the
background
on
community
mental
health
and
substance,
abuse,
funding
and
contracts
is
again
not
to
sound
like
a
broken
record,
but
I.
E
Those
those
hard
questions
were
were
discussed,
debated
and
ultimately
answered
in
in
statute
on
what
populations
should
be
served
at
the
State
Hospital.
What
populations
should
not
be
served
at
the
State,
Hospital
and
concurrently?
What
population
should
be
served
in
in
the
in
the
Wyoming
life
resource
center
and
what
population
should
not
be
served
again?
E
Not
it
not
an
easy
conversation
to
have,
but
one
where
I
think
there's
a
model
going
back
to
that
task,
force
to
potentially
replicate
something
similar
between
the
legislative
and
executive
branches
when
it
comes
to
a
system
like
this
on
missioning
that
type
of
system
for
the
future
for
a
sustainable
future.
Given
the
the
landscape
that
we
see
with
behavioral
health,
with
financial
issues,
with
coverage
with
Medicaid,
with
private
insurance,
Affordable
Care
Act,
all
of
these
different
things
that
have
changed
over
the
years
again.
E
That
just
seems
to
be
what
we
keep
coming
back
to
in
the
department
is,
is
not
and
representative
Arlen,
not
2/3,
of
under
the
bus,
but
you've
brought
this
up
a
number
of
times
over
the
past
year.
So
what
does
the
statute
say?
And
a
lot
of
the
statutes
are
antiquated
and
you
know
coming
from
the
80s
and
the
90s
on
local
or
county
based
mental
health
boards
that
made
funding
decisions,
and
it
has
just
changed
over
over
the
years
and
so
there's
a
there's,
a
response
or
an
instinct
to
to
go.
E
Let's
go
change,
those
statutes,
let's
go
update
them
and
that's
exactly
what
the
facilities
Task
Force
had
to
do,
but
they
started
with.
Let's
talk
about
that
role
of
the
state,
let's
talk
about
the
populations
that
are
currently
served
and
we're
kind
of
similar
to
what
we
outlined,
not
in
much
detail,
but
this
morning
on
the
general,
you
know
state
of
behavioral
health
across
different
funding
sources
and
we
can
go
deeper
and
quantifying
who
those
populations
are
can't.
You
know
quantifying
as
much
as
we
can.
Where
are
they
being
served?
How
are
they
being
served?
E
Are
they
being
served
to
try
to
help
answer
those
questions
that
would
come
from?
That
is:
okay
now
we
know
the
landscape.
Now,
what's
the
role
of
the
state
in
in
you
know,
are
we
a
safety
net?
Are
we
a
general
access
before
we
talk
about
vehicles,
policy
and
legal
to
make
changes
like
waivers,
or
you
know,
funding,
source
changes
or
rate
changes
or
rebasing
x',
whatever
you
want
to
call
them,
I
think
those
fundamental
questions
again
apologize
for
the
soapbox.
Mr.
B
Thank
you
committee
questions
before
we
go
to
public
comment
and
and
I
would
just
request,
also
committee
as
we
go
through
these
as
you
have
these
questions
and
ideas
come
to
your
mind
whether
it
be
on
funding
priorities
or
who
the
state
should
serve.
I'd
hoped
that
you'd
write
those
down
and
we'll
we'll
collect
those
questions
and
develop.
How
maybe,
how
the
next
meeting
looks
and
and
what
we
address.
Okay.
So
with
public
comment,
I
try
to
take
these
in
order
of
how
they
were
submitted.
B
I
think
each
of
us
received
a
letter
from
Sean
hommerson
hope
that
that
was
passed
out.
She
is
not
going
to
be
making
public
comment,
but
wanted
her
written
comments
presented
for
the
committee.
You
should
have
that
I
think
in
order
for
all
damn
Paul
the
CEO
of
northern
Wyoming
mental
health
center
he'll
be
followed
by
Andy
Somerville,
who
represents
wham
sack,
and
then
they
will
be
followed.
B
D
D
D
B
B
B
B
A
B
D
Now
out
of
that,
when
I
say
criminal
justice
system
there's
a
large
chunk
of
those
folks
that
are
on
probation,
there's
a
smaller
number
that
are
on
parole,
coming
out
of
prison
and
then
there's
a
subset,
that's
criminally
adjusted
involved.
So
we
have
all
kinds
of
people
that
aren't
in
prison
yet
but
they're
somewhere
in
the
system,
so
we're
providing
services
they're
in
court
they're
in
that
system,
but
wouldn't
fall
under
the
previous
two
categories
and
so
within
substance
abuse.
D
How
do
we
get
paid
again?
I
just
ran
the
numbers
and
said
what
are
the
primary
benefit
of
Simonton
I'm
not
going
to
get
down
into
the
weeds,
but
in
my
world
there's
primary
secondary
and
tertiary
benefit
assignments.
Primary
usually
is
who's
paying
first
and
then
everybody
knows
about
with
multiple
insurance
that
can
waterfowl.
This
is
how
my
breakout
is
currently
and
I.
Just
ran
this
last
night,
that
about
19%
of
our
folks
are
primarily
Medicaid.
D
The
count
right
now
is
a
hundred
and
seventy
two
different
insurance
companies,
there's
there's
tons
of
them
and
then
there's
the
folks
that
what
we're
calling
a
self-paced
they
don't
have
Medicaid,
they
don't
have
private
insurance,
they
don't
have
anything
else
and
then
there's
that
three
percent
other
and
we
have
kind
of
some
odd
offshoot
things
like
say
we
got
contracted
for
an
EAP
or
a
school
district
specifically
contracted
with
us.
To
do
something
for
a
specific
kid
that
that's
not
that's
not
much.
D
D
Fifty
two
percent
of
the
number
one
money
coming
in
the
door
from
providing
services
is
from
the
state
contract
fee
income.
Now
that
includes
Medicaid
prime
insurance,
anything
where
we
do
a
fee
for
service,
and
somebody
pays
us
goes
into
that
bucket
and
that's
about
thirteen
percent
of
our
dollars
then,
and
the
reason
I
broke
up
the
next
three.
This
way
is
because
that's
how
our
contracts
do
it
so
the
next
there's
federal
substance,
abuse
grants,
and
so
that
supports
the
subs
abuse
services,
and
so
that's
thirteen
percent
and
those
are
federal
dollars.
D
The
tobacco
funds
is
about
thirteen
percent
and
then-
and
this
is
going
away
this
year,
but
there
was
a
section
three
part
of
the
contract
that
wasn't
part
of
the
general
contract
where
last
year
we
could
apply
for
it
or
two
years
ago.
I
guess
we
could
apply
for
it
to
specifically
provide
gatekeeping
which
we
did
and,
and
so
that
was
there
and
then
at
the
end
of
the
day,
how
much
money
do
we
bring
in
from
clients
on
the
sliding
fee
scale
and
I'll
remind
the
the
committee
that
the
community
mental
health
centers?
D
It's
we're,
not
a
competitive,
we're
a
private
nonprofit,
but
we
don't
operate
in
the
competitive
realm.
We
can't
because
the
way
our
contracts
are
set
up
is
that
yeah
we
have
all
these
things
and
I
am
required
by
the
contract
to
make
sure
people
have
insurance
and
all
those
things.
In
fact,
we
check
everybody's
name
every
day
when
they
come
in.
D
For
a
service
against
a
database
in
real
time
to
say,
are
they
on
Medicaid,
so
we
can
capture
that
and
insurance
and
those
kinds
of
things
the
the
difference
is
if
I
was
just
on
a
fee-for-service
thing,
I
have
to
provide
services
to
everybody,
regardless
on
a
sliding
fee,
scale
and
and
in
anyway,
so
now
and
I
hope
you
can
see
number
three:
the
fee
income
miss
Cheerilee,
just
nod.
You
can
see
that.
B
D
So
this
tells
you
because
people
say
well
who's
insured
and
where
does
the
money
come
from
so
number
three
says:
here's
the
breakdown
and
the
amount
expected
is
what
our
usual
and
customary
fee
would
be
for
some
folks
which,
for
insurance
company
is
$125
an
hour
for
individual
services.
Our
usual
customary
fee
for
Medicaid
is
used
to
be
87,
but
we
got
to
cut
it's
like
I,
think
84,
12
or
something
so
on
the
Medicaid
line.
That's
what
we're
expecting
so
I'm,
not
gonna,
spend
a
lot
of
time
on
here.
D
I'll
describe
the
columns
amount,
expected
total
amount
denied
and
then
the
third
column
is
the
total
write-off.
Well,
what
is
that?
So
if
we
send
a
bill
to
an
insurance
company-
and
they
send
us
$100,
but
it
was
$25,
but
they
have
a
secondary
insurance,
we'll
go
and
try
to
get
that
recoup
those
dollars
elsewhere.
D
If
we
just
can't
recoup
them
elsewhere,
there
is
no
secondary
or
anything
else.
Then
what
happens?
Is
it's
a
write-off,
so,
at
the
end
of
the
day,
if
you
take
private
insurance,
we
build
almost
$700,000
and
recouped
about
a
hundred
and
seventy
thousand
I've
seen
this
these
types
of
numbers,
my
entire
career,
it's
not
unusual.
There
there's
talk
about
parity
and
everything,
but
and
there's
a
lot
of
reasons
for
that.
D
One
of
the
reasons
is
people
say
somebody
has
insurance
and
they'll
tick
it
off
like
we
get
paid,
there's
a
huge
number
of
folks
who
get
insurance
but
they're
the
working
poor
and
they
can't
afford
the
deductibles
and
co-pays,
and
so
they
essentially
have
catastrophic
and
we
don't
see
any
of
those
dollars
because
they
don't
have
them
anyway.
I'll
kind
of
leave
that
you
this
as
you
can
see,
and
then
I'm
going
to
the
next,
which
says
my
comments:
private
insurance
is
my
lowest
average
service
provider
and
again
the
average
service
payment.
D
D
The
other
thing
when
you
think
about
the
state
contract-
and
this
is
where
it
really
gets
in
the
weeds,
but
this
is
the
reality
of
my
world
when
they
change
the
state
contracts
to
go
to
priority
populations
and
then
start
saying
anybody
who
has
insurance
the
state's
not
paying
for
in
my
world
what
that
meant
was
the
illusion
was
if,
if
they
have,
insurance
insurance
will
pay
for
it.
But
what
really
happens
is
say:
an
insurance
company
comes
back
and
says
because
of
deductibles
copays
or
whatever
the
reason
we
bill.
D
You
know,
I,
don't
know
two
hours
worth
us.
Two
hundred
fifty
dollars
worth
of
services
I
get
ten
dollars,
that's
what
I
get
and
so
from
the
state's
perspective
insurance
paid
for
that.
From
my
perspective,
I
got
ten
dollars
for
two
hundred
and
fifty
dollars
where
the
service
and
nowhere
else
to
count
it
and
I
think
what
happened
a
couple
years
ago
we
went
the
priority
populations
and
did
this
some
of
the
committee's
discussions
and
certainly
deputy
directors
discussions
was.
The
system
was
really
set
up
to
say.
D
We
want
a
community
mental
health
center
system
and
we're
going
to
subsidize
everything,
because
we
know
people
don't
pay
and
then
we
started
getting
into
these
things,
and
so
we
still
have
a
community
mental
health
center
system
by
design.
But
the
payment
model
has
shifted
to
something
something
else
on
the
sliding
fee
scale
which
were
required
to
do
on
everybody
that
comes
in
the
door
if
they
don't
have
another
pay
source.
My
average
service
Fame
is
$14.
Now.
D
Part
of
the
there's-
and
this
is
really
in
the
weeds
but
there's
some
of
my
folks
who
get
their
student
loans
paid
for
through
hersa
and
in
order
to
be
able
to
do
that
and
be
signed
up
for
all
that
we
have
to
have
a
sliding
fee
scale
for
everybody.
It's
just
part
of
the
deal
and
and
and
that's
where
we
get
our
sliding
fee
scale
and
to
cut
the
state
contract.
You
know
we
don't
set
that
the
the
it's
really
based
on
their
model.
So
anyway,.
B
D
D
Over
when
I
came
here
in
2015,
we
had
34
clinicians
through
a
series
of
cuts,
that's
not
being
able
to
get
reimbursement
all
of
the
things
when
they
opened
up
Medicaid.
What
happened
was
all
the
paying
folks
so
with
kids,
especially
in
stuff,
private
providers
kind
of
took
those
guys
some
of
them.
We
still
have
some,
but
then,
as
soon
as
they
run
out
of
Medicaid
they're
back
at
our
doorstep.
So
and-
and
we
have
take
every
private
providers-
don't
have
to
take
everybody
and
can
say
everybody
has
to
have
a
pay
source.
D
D
Staff
and
that's
the
reality
of
my
world
at
at
the
deeper
level,
is
that
we've
been
trying
to
make
it
work
for
a
lot
of
years,
but
I
think
the
problem
system
it.
The
system
has
been
problematic
all
the
way
along,
but
we've
been
figure
and
now,
especially
with
the
the
co
vid
stuff.
What
has
been
problematic?
It
just
highlights
it,
and
this
isn't
hyperbole.
D
You
know
I
started
out
with
a
800
thousand
dollar
deficit
because
of
a
lot
of
things
right,
I've
got
it
down
to
maybe
a
hundred
thousand
I'm
still
trying
to
figure
out
what
to
do
with
that.
Last
hundred
thousand,
knowing
that
I've
got
probably
at
least
ten
percent
coming
from
the
state,
possibly
some
Medicaid
rate
cuts.
D
The
other
thing
I'll
tell
you
when
you
see
Medicare
reimbursement,
that's
a
fallacy
and
that's
a
fallacy,
because
just
because
somebody's
on
Medicare
doesn't
mean
we
get
paid
because
in
the
federal
system
you
have
to
have
a
licensed
social
worker
yeah,
mostly
the
people
we
hire,
because
a
volume
is
licensed
professional
custom.
We
lose
all
of
those
dollars.
A
D
Federally
and
we've
been
trying
to
work
with
Senator,
Barrasso
and
Enzi,
and
everything
to
get
exceptions
for
that
for
rural
places.
Saying
because
you
know
you
were
hiring
people
that
we
can
get
and
licensed.
Professional
counselors
are
just
as
well
qualified,
but
we
lose
a
ton
of
money
in
that
counselor
is
isn't
an
LCSW.
D
So
anyway,
I
you
know
where
things
go,
and
I
have
no
idea,
I'm
just
trying
to
make
things
work,
but
this
my
hope
is
this,
gives
the
committee
and
again
the
this
is
just
out
of
my
system.
I
said:
what's
it
look
like
and
I
threw
it
on
here
so
with
that
mr.
chairman
I'll
stand
for
any
questions,
Thank.
B
Paul
I
I
do
have
one.
If
you,
you
made
the
comment
and
I
just
like
you
to
walk
me
through
how
that
works.
When
you
says
that
they'll
they'll
go
to
another
provider,
if
they're
on
Medicaid
and
then
when
Medicaid
runs
out,
then
they
come
to
you
guys
and
in
then
it
goes
that
way.
So
is
there
a?
Is
there
a
limit
on
the
number
of
times
you
can
see
somebody
if
they're
on
Medicaid
want
me
to
how
that
works
and
how
that
scenario
would.
Mr.
D
Chairman
I
think
it's
three
or
a
three
to
three
years
ago:
Medicaid
instituted
some
changes
on
caps,
and
so
what
happened
was
and
the
caps
don't
count
per
provider.
It's
total
for
the
with
further
recipient,
and
so,
if
somebody
goes
somewhere
and
burns
out,
their
Medicaid
caps
and
the
private
provider
says
we
absorbed
those
caps
and
what
happens
is
the
within
the
system.
But
it's
not
just
the
caps
because,
as
the
deputy
director
said,
people
kind
of
go
on
and
off
Medicaid.
D
But
in
essence,
what
happens
is
if
people
can
say,
especially
with
with
where
I've
seen
it
primarily
is
in
Children
Services,
because
those
services
tend
to
be
very
extensive.
That
can
happen
a
lot
so
I.
It's
it's
more
complicating
that,
but
by
and
large
is
Medicaid
capped.
Yes,
and
we
can
apply
to
do
to
whoever
their
folks
are
there's
a
different
one.
D
Now
to
say
we
need
to
continue
to
provide
this
service,
then
what
will
happen
is
they'll,
come
back
and
approve
like
months
more
worth
of
services
or
something
so
now
we
have
to
keep
doing
that
and
what
happens
in
sometimes
there's
a
disagreement,
although
I
will
say
it's
gotten
better,
but
we
have
had
some
instances
where
person
was
in
the
state.
Decompensated
was
in
the
state
hospital
for
almost
a
year
got
out
of
the
state
hospital
got
onto
Medicaid.
We
stabilized
them
got
the
medications
everything.
Two
months
later.
D
They
said
we're
not
going
to
prove
anymore,
except
for
once
a
month
because
the
person
is
stable
and
then
this
just
popped
in
my
head
and
I'll
throw
this
out
there.
I
can
honestly
say
when
people
think
about
what
are
we
incentivized
to
do?
I'd
be
shocked
if
you
asked
one
of
my
clinicians
who
decide
what
the
services
are,
if
they
could
tell
you
what
the
pay
source
was,
I
I
would
be
shocked
because
the
people
that
decide
the
services
they're
not
me,
it's
the
clinicians,
and
so
what
happens?
D
If
you
see
that
on
the
subsidy
side,
group
is
by
and
large
the
largest
services,
that's
because
evidence-based
practices
say
at
an
io
p
level,
which
is
a
high
level
like
people
that
need
a
lot
of
services.
The
state
requires
that
we
follow
our
ACM
criteria
requires
at
that
level
that
they
get
group
and
it's
the
right
thing
to
do,
because
it's
evidence
based.
So
those
are
really
how
our
decisions
are
made,
not
based
on
what
the
pay
sources
and
the
clinicians
who
decide
who
dude
the
side
I'm
a
do.
A
Mr.
chairman,
so
thank
you
for
the
for
the
presentation
actually
seats
on
this
material
before
one
of
the
things
that
it
looks
to
me
like
when
I
look
in
your
screen
is
not
shared
anymore.
So
there's
two
categories:
one
is
the
payer
mix
and
the
second
one
is
the
amounts
received
from
the
different
payers.
It
looks
to
me
like
it
was
40
40
percent
self
pay
and
three
percent
other,
and
then
we
got
to
the
next
column.
It
was
53
percent
I.
A
Think
state
contract
well
43
to
52
what
maybe
is
43
percent
to
52,
and
then
you
talk
about
the
underpayment
of
private
insurance.
It's
such
a
non
payment
of
with
private
insurance.
As
such,
it
seems
like
the
only
two
payers
that
are
actually
paying,
probably
at
least
close
to
what
they're
being
with
what's
being
provided,
is
Medicare
and
Medicaid.
Is
that
an
accurate
assessment?
Thank
you
and
then,
and
basically,
then,
state
state
contract
makes
up
for
everybody
else's
either.
A
D
Chair
chairman
representative
Barlow,
that
that
is
pretty
accurate,
but
I.
The
only
way
I
would
change
and
in
the
answer
to
your
question,
would
be
Medicare
that
that
Medicare
I
mean
I
I.
Last
year,
I
brought
in
a
grand
total
of
sixteen
thousand
dollars
in
Medicare
because
of
the
LCSW
rule,
so
that
that's
a
little
bit
different,
but
the
the
best
payer
is
Medicaid,
the
only
you
know
by
and
large,
if
you're
talking
about
a
fee-for-service
and
the
only
the
system
really
is
set
up.
That
way,
the
state
is
subsidizing.
All
of
this
other
stuff.
B
C
Right
Thank
You
mr.
chairman
Andy
Somerville,
representing
WAM
sac,
the
association
of
mental
health
and
substance
abuse,
centers
and
mr.
chairman
I,
will
resist
that
temptation
because
Paul
covered
a
lot
of
ground.
So
hopefully
we
can
speed
up
meeting
just
a
little
bit
here.
I'm
gonna
share
my
screen.
With
your
permission,
please.
B
C
Right
great,
so
I
just
wanted
to
do
a
just
a
real
brief
overview
for
the
committee
and
I
know.
Labor
health
has
heard
this
from
us
before,
but
just
a
little
bit
about
what
makes
up
a
community
mental
health
center.
So
I
want
to
thank
deputy
director
Johansson
for
his
presentation.
He
really
covered
a
lot
of
those
points
as
well,
so
I
just
wanted
to
show
you
this
map.
B
C
C
B
C
C
That's
okay,
welcome
to
zoom
meetings
right,
so
you
just
want
to
highlight
that
that
what
makes
a
community
budget
all
Center
a
community
mental
health
center
is
that
it's
a
comprehensive
community-based
services
for
mental
health
and
substance
abuse
and
it's
regardless
of
the
ability
to
pay
it
really.
The
history
of
this.
C
In
the
1960s
there
was
federal
legislation
to
bring
about
community
mental
health
centers
we
as
a
state
as
I,
understand
the
history
decided
to
go
with
the
nonprofit
model,
as
Senator
Kinski
indicated
kind
of
a
quasi-governmental
model
I
in
order
to
pull
funding
down
into
the
state
just
to
provide
those
services,
and
that's
pretty
much
why
we
have
the
model
we
have
now.
But
again,
this
regardless
of
ability
to
pay
is,
is
a
pretty
important
part
because
we
serve
everybody,
and
these
are
the
lists,
so
you
have
outpatient
residential
for
both
substance
abuse
and
mental.
C
C
They
are
pretty
comprehensive
for
what's
needed
in
that
particular
community,
and
what
that
Center
is
able
to
provide.
As
you
can
see,
it's
it's
much
more
than
just
just
counseling,
frankly
ranges
from
psychiatric
services.
They
provide
24/7
emergency
on-call
response,
especially
for
title
25
assessments
group
therapy.
They
also
do
something
that's
not
always
mentioned.
Is
they
do
a
lot
of
community
engagement,
suicide
prevention
and
education?
They
respond
in
any
type
of
emergency
where
mental
health
support
might
be
necessary,
such
as
a
natural
disaster
or
a
pandemic,
and
they
also
do
early
intervention
diversion
services.
C
All
of
the
mental
health
community,
all
the
community
mental
health
centers
that
are
providing
services
have
some
type
of
psychiatric
services.
Now
what
type
it
varies
a
lot
of
the
centers,
especially
the
smaller
ones,
contract
with
a
nurse
a
nurse
psych
practitioner
or
a
psychiatrist
who
provides
those
services
via
telehealth
because
they
cannot
afford
to
keep
a
psychiatrist
on
staff.
Some
of
the
larger
centers
do
have
psychiatrists
on
staff,
so
it
varies
a
little
bit,
but
it's
really
important
in
terms
of
the
medication
management.
That's
one
of
the
issues
that
we've
been
talking
about.
C
You
know
specific
to
potential
budget
cuts
coming
up
and
what
that
looks
like
it's.
Psychiatric
services
is
one
of
the
most
expensive
line.
Items
for
community
mental
health,
centers
I
mean
sometimes
psychiatrists-
can
be
two
hundred
and
fifty
dollars
an
hour
to
provide
those
services,
and
so
how
we're
going
to
keep
that
going
in
terms
of
budget
cuts.
As
a
recent
discussion,
thank.
B
C
So
I
wanted
to
give
you
just
a
snapshot
of
what
your
comand
mental
health
services
in
fiscal
year.
Nineteen.
So
that's
our
most
recent
complete
data
set
right
now,
so
you've
got
outpatient
mental
health,
just
almost
17,000
people
were
served
two
hundred
and
sixty-five
thousand
hours.
That's
that's
not
a
misprint.
That's
actually
what
was
what
was
served
and
then
you
can
see
here.
We've
talked
a
little
bit
already
in
the
meeting
about
SMI
and
sed,
and
you
can
see
that
makes
up
a
pretty
high
percentage.
C
You
know
over
two-thirds
of
those
two
categories
as
priority
populations
in
outpatient
or
sorry
in
residential
mental
health.
We
have
fewer
data
fields
on
that
right
now.
Data
is
always
improving,
but
for
crisis
stabilization.
Three
hundred
and
seventy
people
group
homes,
152
and
supervised
living
as
one
hundred
and
thirty
six
were
served
under
the
state
contract
in
fiscal
year.
Nineteen
outpatient
substance
abuse
is
a
little
less.
C
As
you
can
see,
mental
health
outpatient
makes
up
a
pretty
big
bulk
of
the
services,
but
they
still
served
over
6,000
people
and
160
program
hours
and
I
kind
of
outlined
just
just
to
keep
you
up
to
date.
These
were
they
the
primary
diagnosis
or
issues
that
they
were
seeking
treatment.
For
you
can
see
alcohol
methamphetamine
I
know
we
talked
a
lot
about
opioid
epidemic,
but
opioids
is
pretty
far
down
on
our
list
and
then
residential
substance
use
apologies
a
little
bit
over
a
thousand
people,
but
sixty-nine
thousand
days
in
total.
C
When
you
take
the
number
of
people
versus
the
days,
they
were
there
and
I
wanted
to
highlight
this.
In
the
previous
conversation
today
we
talked
a
little
bit.
I
believe
represented.
Barlow
talked
a
little
bit
about
utilization
rate
for
beds.
This
would
be
one
of
the
categories
that's
paid
per
bed,
the
utilization
rate
isn't
was
91%
for
fiscal
year.
Nineteen,
the
contract
target
and
for
those
centers,
maybe
not.
F
B
B
A
B
C
Mr.
chairman,
if
I
understood
the
question
is
basically,
what
do
the
facilities
share
beds
when,
yes,
so
they
they'll
work
very
closely
together
and
I'll?
Give
you
the
the
most
recent
example
in
March
in
early
April,
due
to
cases
at
one
of
the
facilities
in
Wyoming,
the
community
mental
health
centers
were
participating
in
bi-weekly.
Bed
management
calls
to
do
exactly
that
to
rearrange
beds
so
that
they
could
have
appropriate
number
of
isolation.
Beds
still
provide
crisis
services.
It
was
a
logistical,
interesting
logistical
conversation
in
terms
of
transport,
but
they
do
work
very
closely
together.
Thank.
B
C
So,
just
in
terms
of
what
they
have
done,
we're
pretty
happy
with
that.
The
next
thing
I
wanted
to
highlight
was
just
a
quick
overview
of
what
the
contracts
actually
look
like
right
now,
so
I
promised
mr.
chairman,
we
won't
get
in
the
weeds
deputy
director.
John
Hanson's
already
spoke
a
lot
about
about
this,
but
these
were
the
changes
that
were
made
in
2018.
So
this
this
particular
set
of
requirements
is
still
fairly
new
and
we
had
every
intention
of
continuing
to
work
with
Department
of
Health
to
us.
C
There
is
a
124th
max
payment
and
I
want
to
clarify
that's
on
a
biennium
contract,
because
it
is
a
two-year
contract
right
now.
So
just
to
highlight
that
conversation
that
was
had
before
this
is
a
fixed
contract.
So
when
the
centers
outperform
their
contracts,
they
don't
get
any
more
money.
Now
there
are
financial
potential
financial
penalties.
If
they
don't
perform
to
their
contract
standards,
they
do
have
some
room
in
the
contract.
To
request
exception
payments
and
things
along
those
lines,
but
there's
no
more
money.
There's
no
Avenue
for
that.
C
I
also
wanted
to
highlight
in
this
contract
apologize
that
their
contracts
required,
that
they
keep
operations
in
each
County,
that
they
have
a
contract
for
so
physical
operations.
That
is
something
that
may
be
up
for
discussion
depending
on
how
budget
cuts
roll
out.
So
mr.
dimples
Center
runs
in
four
counties
right
now
he
has
a
primary
location
in
Sheridan
and
then
three
other
counties
that
are
served
with
smaller
offices
that
are
kind
of
a
remote
office.
If
you
want
to
say
and
they're
already
in
discussions,
you
know
potentially
what
that
will
look
like
and
mr.
C
mr.
Dental
Center
is
not
the
only
one.
If
you
remember
from
the
map,
we've
got
several
of
our
committee:
mental
health
centers
that
are
serving
two
three
four
counties.
Their
contracts
also
require
that
they
must
serve
everyone,
I
think
that's
been
highlighted
pretty
well.
They
can't
turn
anybody
away,
even
if
they've
maxed
out
their
contract
and
and
I
wanted
to
highlight
here
and
I'm
happy
to
bring
some
more
specific
data
back
to
the
committee.
C
C
They
certainly
did
example.
If
their
contract
had
a
thousand
hours
of
month
of
service,
they
provided
1300
hours
of
service.
They
got
their
payment
for
a
thousand
hours
of
service
and
didn't
receive
any
additional
compensation.
But
again
their
contract
specifies
that
they
have
to
serve
everybody,
that
they
can't
turn
anybody
away
and
then,
on
the
residential
side,
just
a
quick
example.
These
contracts
are
a
little
bit
different,
as
mr.
Johansen
highlighted
they
can
be
in
the
same
contract,
but
they
have
different
requirements
again.
C
On
the
residential
side,
they
get
equal
payments
over
the
course
of
the
biennium
contract.
They
have
to
hit
these
utilization
rate
completion
rate
for
the
program
on
the
substance,
use
disorder,
side
and
then
just
highlighting
that
in
the
recent
years
we
have
also
added
reporting
requirements
to
track
out
came
out
come
base,
so
that's
part
of
their
contract
as
well.
C
With
your
permission
here,
I'm
gonna
jump
down
a
slide
that
I
had
later,
but
it
seems
again
just
just
to
highlight
one
item
in
terms
of
discussion.
That's
already
happened
on
the
contracts
now,
what
has
changed
since
about
2010
those
Medicaid
caps
I
wanted
to
clarify
when
Medicaid
was
open
to
private
providers
a
number
of
years
ago
before
it
was
open.
Community
mental
health
centers
were
the
primary
Medicaid
provider,
essentially
in
the
state
for
mental
health
and
mental
health
services.
C
There
was
a
loss
of
revenue
in
terms
of
those
Medicaid
clients
that
went
out
to
private
providers.
So
I
just
wanted
to
highlight
that
previous
very
quickly.
This
is
just
a
shot
of
what
Paul
Venable
already
presented
in
terms
of
his
pairs
and
average
service
payments.
If
you
have
any
questions
on
that,
I'm
happy
to
answer
them,
but
I
think
I'll
skip
over
that
a
priority
population.
So
this
is
the
the
new
piece
of
the
contract.
That
was
added
in
recent
years.
C
C
Essentially
it's
what
it's
called
for
probation
and
parole,
so
that
is
all
assuming
that
that
remains
in
the
contract
through
the
rest
of
the
review
process
and
those
are
signed
that
will
be
that
will
be
in
there
as
a
first
step,
at
least
that's
that's
what
my
centers
have
seen
in
their
contracts
and
again
on
this
particular
conversation
about
the
DLC
population.
What
we're
finding
in
this
is
that
we
we
need
to
continue
to
tighten
up
the
data.
The
data
by
senders
have
says
that
they,
they
are
already
serving
this
population
under
the
state
contract.
C
Quite
a
bit,
some
of
them,
some
of
the
centers,
have
30%
our
probation
parole.
As
you
heard
from
mr.
temple,
some
programs
are
well
over.
90
percent
are
criminally
involved,
so
in
line
with
House
bill
31
we're
working
with
Department
of
Health
to
continue
to
tighten
up
those
those
data
reporting
requirements
so
that
we
can
accurately
capture
that
and
report
that
back
to
the
state.
C
Mr.
chairman,
I
have
a
little
bit
of
discussion.
There
was
an
agenda
on
the
item
item
on
the
agenda.
My
apologies
regarding
assessment
tools
used
to
determine
severity
scale
of
patients.
Would
you
like
me
to
speak
to
that,
since
it
wasn't
in
the
Department
of
Health
presentation,
or
would
you
like
to
skip
that.
C
Well,
mr.
chairman
I,
don't
know
how
much
I
will
I
will
help.
I
am
NOT,
a
clinician
and
I
was
I,
was
told
pretty
much
to
stay
out
of
the
weeds
by
my
providers
as
well.
There
are
numerous
tools,
ACM
guidelines.
There
are
tools
such
as
the
ASI
and
other
items
that
they
use
to
assess
severity
of
patient
the
difference.
So
right
now
we
have
priority
populations,
so
it
doesn't.
C
What
we've
seen
in
terms
of
priority
population
data
is,
the
reporting
has
continued
to
improve,
but
what
my
centers
are
reporting
is
that
their
client
mix
has
not
changed
really.
What
we've
done
is
again
tightened
up.
The
data
reporting
requirements
to
get
a
better
idea
of
exactly
who
we're
serving,
and
so
in
terms
of
what
do
we
want
to
go
down
this
road
or
not?
I
think
we
have
to
ask
a
couple
of
couple
of
questions.
C
So
if
the
contracts
are
over
service
right
now,
does
it
say
to
him
based
on
either
priority
population
or
severity,
truly
work?
Does
it
matter
if
they're
maxing
everything
out
the
cases
that
are
presented
today?
When
somebody
comes
in
for
their
initial
assessment,
they
never
check
one
box,
they
never
say.
One
thing
is
wrong:
the
cases
are
complex,
they're,
poly,
diagnostic
they're,
full
diagnosis,
there
they're
not
simple
anymore,
and
so
how
do
we
account
for
those
services
right
now?
C
Before
we
can
even
get
into
this,
we
really
have
to
ask
who
the
community
mental
health
center
should
serve
and
does
and
does
either
of
these
methods
support
those
policy
goals,
and
we
we
want
to
support
the
Department
of
Health
and
their
conclusion
that
those
discussions
and
decisions
have
to
be
first
before
we
can
get
into
the
weeds
on
any
potential
contract
changes
or
what
that
might
look
like.
So
with
that,
mr.
Chairman
I
will
stop
and
pause
and
stand
for
any
questions.
You
have
right
now.
Thank.
A
Restyle
them
as
a
waiver
program
and
limiting
the
waiver
payments
to
the
community
mental
health
centers
so
that
we
know
it's
the
it's
the
priority
targets
that
are
being
served,
not
not
opening
it
up
to
every
provider
and
they
just
cherry-pick
off
the
easiest
to
serve
patients,
but
to
say
we're:
gonna
create
a
waiver
program
which
looks
90%
like
what
we've
got
now
and
shift
50%
of
the
expense
over
the
Medicaid
program.
It
I
hope
that
makes
sense.
How
tough
would
that
to
be
be
to
do?
If
you
understand
my
question.
C
Mr.
chairman,
mr.
chairman,
I,
do
understand
the
question
and
it's
a
it's
a
question.
We've
been
kicking
around
here
for
a
little
while
now
and
unfortunately,
the
answer
is
it's
not
a
simple
process?
It's
a
long.
It
can
be
a
long
process.
There's
a
variety
of
states
that
use
this
this
system,
where
they
have
either
Medicaid
expansion
or
the
behavioral
health
waiver
and
so
they're
a
community
mental
health
system
is
substantially
supported
by
Medicaid
dollars.
C
That
way,
there's
also
anything
out.
There
called
a
certified
community
mental
health
center.
So
it's
a
CC
MHC
program
through
Samsa
that
provides
additional
dollars
to
come
in,
unfortunately,
the
position.
This
is
prior
to
my
it's
fine,
but
we're
under
decision
to
apply
to
the
planning
grants
first
and
before
that
a
few
years
ago,
and
we
are
bad
breath
we
can
start
to
plant
and
potentially
look
at
those
programs
as
well.
A
C
D
There
is
that
it
I
was
involved
with
that
at
the
national
level,
National
Council
and
the
certified
community
behavioral
health
centers.
We
didn't
really
pass
it
up.
What
happened
was
the
feds
came
out
and
said
we're
gonna?
Do
these
certified
community
mental
behavioral
health
centers,
similar
to
the
community
health
centers
that
they
did
or
the
FQHCs?
And
so
then
what
happened
was
they
only
gave
it
to
eight
states
and
then
the
next
thing
they
did
is
they
opened
it
up
a
little
wider
and
only
gave
it
to
a
few
more
states.
D
Every
certified
behavioral
health
center
has
to
have
various
things,
and
so,
when
you
get
into
the
more
rural
populations,
it
may
not
be
feasible
how
the
federal
regulations
are
looked
at.
So
we're
very
interested
in
that
because
you
get
enhanced
payments,
but
really
because
the
federal
stuff
is
just
not
been
feasible.
B
A
A
But
if
we
were,
you
know
when
you,
when
you
have
a
lot
of
priorities,
then
there's
no
priorities
and
if
we
were
to
try
to
say
okay,
some
people
have
are
going
to
I,
don't
know
if
you
even
can
turn
people
away,
but
some
people
are
going
to
not
be
seen
for
60
days
or
I.
Don't
know
what
I
mean
but
is?
Are
you
aware
what
I'm
aiming
at
is?
A
In
other
words,
what
I'm
trying
to
get
at
is
even
among
our
priorities
are
there
some
people
who
and
I
don't
want
to
dismiss
the
the
pain
in
their
own
life,
but
who,
who
is?
Who,
if
you
don't
see
them
right
away,
have
less
impact
on
the
community?
I
mean?
Are
you
aware
of
any
kind
of
research
that
way
other
than
just
sort
of
anecdotally.
C
Mr.
chairman,
chairman
Wilson,
it
makes
perfect
sense
and
echoes
a
discussion
we
had
amongst
women
act
directors
last
week
as
far
as
specifically
served
there
is,
there
is
a
lot
of
material
out
there.
I
would
have
to
go
back
through
and
pull
out
some
some
good
stuff
to
send
you
that
kind
of
ran
the
gambit,
but
I
do
believe
that
there
there
are
some
states
that
have
used
those
models
and
I
would
defer
to
Paul
a
little
bit
on
in
terms
of
what
that
look.
C
D
Chairman
representative
Wilson,
probably
the
best
model
to
look
at
that
in
terms
of
cost
savings
and
trying
to
pare
down
kind
of
who's
in
and
who's
out
and
where's.
The
most
bang
for
the
buck
is,
if
you
look
at,
especially
in
Missouri
the
behavioral
health
home,
where
they
were
trying
to
figure
out
for
the
seriously
mentally
ill
seriously,
persistently
mentally
ill
they're
trying
to
draw
down
costs
well
the
cost
that
they
drew
down.
D
What
they
knew
was
if
we
get
the
community
mental
health
system
involved,
we're
not
necessarily
going
to
drive
the
community
mental
health
center
system
cost
down,
but
we're
really
going
to
drive
down
our
other
medical
costs
related
to
Medicaid.
So
the
majority,
but
a
large
portion
of
people
we
see,
have
related
health
issues
like
severe
diabetes
and
I
mean
really
serious
problems
so
there,
but
they
found,
was
if
those
people
are
involved
with
community
mental
health
system
as
their
primary
driver
to
get
them
to
appointments
and
stuff
they
drove
down
these
other
costs.
D
Soon,
at
the
end
of
the
day,
you
only
got
so
much
money
and
there's
realities
and
the
tough
to
have
questions
are
who's
in
and
who's
out.
And
where
do
we
draw
that
line
and
there's
going
to
be
cost
to
that?
But
I
think
that's
a
discussion
with
the
legislature
and
the
Department
of
Health
and
the
providers
to
kind
of
come
together
to
say
what's
going
to
be
best
there,
given
the
realities
of
our
dollars,.
A
Thank
You
mr.
chairman-
and
this
was
probably
for
either
mr.
demora
mr.
Somerville
I,
whichever
one
of
you
can
answer
it,
but
the
third
bullet
there
and
you
talked
about
contracts,
mean
over
surface.
Where
does
the
incentive
truly
work?
I
guess
I
have
two
questions.
Actually
what
type
of
incentives
are
in
place
right
now
for
community
health,
centers
I
mean?
Does
it
have
to
do
with
recidivism
I'm,
not
sure
and
then?
B
C
Chairman
senator
Schuler,
so
the
answer
sort
of
the
first
question:
what
incentives
are
available
in
the
contracts
to
mental
health
centers?
That
is,
the
priority
populations
that
were
put
in
the
contract,
so
that
was
devised
as
I
understand
it
to
be
an
incentive
to
the
community
mental
health
centers
to
make
sure
they
were
really
focusing
on
those
populations
and
really
again,
as
mr.
dimple
mentioned,
driving
those
costs
down
for
the
seriously
mentally
ill
or
youth
or
kids
with
serious
emotional
disturbance.
C
That's
the
extent
of
the
any
incentive
they're
in
the
contracts
right
now,
as
far
as
what
we
can
look
at
yes,
there
are,
there
are
a
plethora
of
different
models
out
there
in
terms
of
how
you
can
incentivize
a
system.
If
you
want
to
go,
go
that
direction,
but
before
you
can
start
to
look
at
incentives,
you
really
have
to
again
decide
who
the
system
is
serving
and
what
type
of
payment
do
you
want
to
have.
But
there
are
options
out
there.
Thank.
D
F
We
take
in
as
private
practice
providers,
we
do
work,
I
hope
well
with
our
County
facility
and
serving
the
populations.
The
best
we
can
I
can
speak
to
my
client
base,
which
is
very
similar
to
the
community
mental
health
center,
because
they
only
have
two
licensed
providers,
often
tie
myself
and
the
other
licensed
private
practice.
Folks
are.
F
The
unfortunate
part
is,
unless
the
providers
here
take
met
our
McKay
Medicaid
providers,
roof
providers.
We
end
up
doing
a
lot
of
pro
bono.
Work.
I
wrote
off
several
thousands
of
dollars
last
year
because
there
was
no
funding
source
available
for
the
clients
that
I
was
working
with
the
other
funding
base.
That
I
have
as
well
is
the
Department
of
Family
Services.
If
I
have
a
client
who
is
within
a
FEA
neglect
case
and
I
have
one
of
the
parents.
F
F
F
Unfortunately,
there's
not
a
lot
of
reimbursement,
as
Senator
Schuler
has
recognized
in
the
past
discussions
on
the
labor
committee,
I
can
have
a
child
at
the
hospital
for
three
or
four
days
until
we
can
figure
out
transport,
which
is
usually
by
ambulance
and
Medicaid,
does
not
cover
that
service
oftentimes.
If
they're
nonviolent,
our
Sheriff's,
Department
or
police
department
will
transport
again,
that's
an
unreinforced.
F
F
Unfortunately,
as
was
brought
up
earlier
from
a
pediatric
perspective.
My
my
options
are
very
very
limited
right
now:
Primary
Children's
in
Salt
Lake.
Will
it
accept
lambing
Medicaid
I
have
to
go
through
several
steps
to
get
someone
placed
outside
of
Wyoming,
because
we
don't
necessarily
have
the
services
I'm
working
with
a
seven-year-old
right
now.
Wb
I
can't
take
them
because
of
because
of
age.
I
have
to
then
work
with
Medicaid
for
pre-approval,
which
means
I
have
to
locate
a
pediatric,
a
board-certified,
pediatric
neuropsychologist.
F
B
E
B
E
Answer
it
mr.
Chairman
I
appreciate
it.
This
is
perfect
because
I
think
my
question.
It's
based
on
the
last
discussion,
but
it's
really
first
step
and
I
think
in
that
I'm
new
to
all
of
this.
So
please
excuse
me
if
our
members
of
health
already
know
the
answer
to
this,
but
on
one
of
the
points
Cheryl
raised
was
transportation
issues,
and
could
you
just
touch
on
that
a
little
bit?
Is
that
I
don't
know
how
that
works
in
terms
of
it
not
being
reimbursed?
Is
it
because
of
in
her
scenario,
I,
don't
I'm?
E
If
you
were
listening
to
the
testimony
that
she
provided
sounded
like
somebody
would
have
been
transported
from
Rollins
all
the
way
to
Casper.
My
question
is:
is
it
because
of
distance?
Is
it
just
not
reimbursed
as
a
whole?
Just
give
me
some
insight
on
what
that
looks
like
why
it
looks
that
way
and
if
there,
if
we've
tried
to
do
something
there,
we
can't
or
what
can
we
do
just.
E
Chairman
representative
Olson
a
good
question:
it
is
a
mixed
bag
depending
on
the
client,
depending
on
the
coverage
source
and
depending
on
the
situation,
so,
for
example,
for
adult
clients
and
in
the
in
the
rarer
circumstances,
when
adolescent
client
is
going
through
the
title,
25
process
and
civilly
committed
transportation
beyond
the
first
72
hours
of
the
title.
25
process
is
provided
and
can
be
reimbursed
by
the
Department
of
Health
for
the
transport
of
psychiatric
patients
in
in
civil
commitment
that
comes
through
line
items
in
the
state
hospitals
budget.
E
So
that's
that's
one
very
specific
instance:
where
transportation
is
provided
on
the
Medicaid
side.
Medicaid
does
reimburse
for
non-emergency
medical
transportation.
But
again,
like
we
talked
about
this
morning,
not
every
client
adolescents
included,
qualify
or
are
enrolled
or
eligible
for
Wyoming
Medicaid.
So
then
we
move
okay
out
of
title
25
out
of
Medicaid
community
mental
health
or
substance
abuse
centers.
There
are
some
funding
sources
for
transportation
and
I
believe
what
we
call
quality
of
life.
E
Funds
can
be
used
to
arrange
for
transportation
of
clients
to
appointments
things
of
that
nature,
but
I
think
you
likely
run
into
like
you
alluded
to
representative
problems
of
scale.
Where
you
know
do
you
have
the
transportation
resources
to
get
someone
from
you
know
the
southwest
corner
of
the
state
to
the
center
of
the
state.
All
the
time,
probably
not
so
I
guess.
My
point
representative
is
there's
not
we
don't
have
a
behavioral
health
transportation
program
so
to
speak,
that
arranges
for
all
of
these
different
kinds
of
scenarios
or
clients.
E
B
E
You,
mr.
chairman,
members
of
the
committee,
I'll
wrap
up
our
Department
of
Health
presentation
I
relatively
quickly
here.
The
committee
asked
for
an
overview
you
of
gatekeeping,
which
now
we've
moved
kind
of
nicely,
I-
think
in
a
stair-step
fashion.
Through
this
presentation
we
started
really
wide,
with
kind
of
a
statewide
look
at
the
funding
and
and
some
of
the
populations
and
the
service
provision.
E
It
actually
grew
out
of
a
previous
statute,
previous
statutory
language
that
was
called
a
single
point
of
responsibility
and
it's
largely
still
how
it's
defined
in
statute,
but
going
back
to
2016
several
years
ago,
when
the
title
25
subcommittee
was
formed.
This
was
one
of
the
one
of
the
major
changes
to
statute
that
that
took
place
so
I'll.
Just
mention
a
few
of
them
and
then
we'll
get
into
some
of
the
duties
or
the
statutory
intent
as
we
see
it
from
the
Department
of
what
gatekeeping
is
before
I
go
there.
E
Various
entities
in
the
community,
starting
at
the
county
level,
can
start
the
process
of
emergency
detention
and
voluntary
hospitalization
and
that's
found
in
title
25,
chapter
10.
So
this
gatekeeping
idea
is
a
is
a
small
subsection
of
that
statue
that
grew
out
of
the
title
25
subcommittee
from
several
years
ago,
and
essentially,
what
it
what
it
did
was
it
allowed
the
department
to
designate,
what's
known
as
a
title,
25
gatekeeper
and
some
of
the
duties
outlined
in
that
statute,
which
you
can
see,
there's
is
25
10,
112
G.
E
The
gatekeeper,
that's
designated
by
the
department
is
largely
tasked
with
providing
guidance
on
issues
of
detention
and
involuntary
treatment,
monitoring
and
coordinating
timely,
efficient
and
effective
patient
treatment.
These
are
all
directly
pulled
from
the
statute
and
doing
this
guidance,
monitoring
and
coordination
prior
to
during
and
after
emergency
detention
or
involuntary
treatment.
E
So
again
in
the
in
the
language
of
the
statute,
and
and
just
remembering
back
to
my
my
days,
working
with
the
the
title
25
subcommittee
and
several
members
who
are
on
this
committee
now
we're
part
of
those
discussions.
It
was
really
intended
for
almost
as
a
case
manager
for
lack
of
a
better
term,
but
again
someone
or
an
entity
that
would
make
recommendations
to
courts
on
the
best
way
to
to
serve
a
client
going
through
this.
E
This
legal
system,
and
often
that
meant
recommending
alternative
resources,
like
I
mentioned
that
could
be
used,
community
resources,
services
etc.
Some
of
the
things
you
all
have
brought
up
like
transportation,
vacation
and
pharmacy
access
was
a
big
point
of
discussion
when
this
was
being
developed
of
things
that
can
potentially
limit
someone's
need
or
an
individual's
need
to
be.
You
know,
have
their
rights
taken
away
through
civil
commitment
and
be
treated
in
a
hospital
setting.
That
really
was
the
the
point
of
gatekeeping
but
again
nono
slide
on
any
community
or
any
provider.
E
That's
been
designated
by
the
department
to
do
this.
We
do
have
quite
a
wide
variation
across
the
state
in
what
gatekeeping
is
and
what
it
means,
and
a
lot
of
that
is
a
function
of
like
we've
been
talking
about.
Communities
do
have
different
needs,
different
populations,
smaller
larger
populations
and
and
I
think
that
standardization
for
a
system
like
this,
especially
with
title
25
and
the
relatively
you
know,
low
volume
of
patients
that
we
see
in
this
system,
especially
those
that
escalate
higher
into
the
civil
commitment
process.
E
E
Your
your
last
slide
slide.
Number
20
on
gatekeeping
just
gives
you
a
sense
of
since
that
statute,
change
kind
of
what
we
have
currently
when
it
comes
to
designated
gatekeepers.
So
right
now
we
have
12
title
25
gatekeepers
around
the
state.
Some
of
those
you
know
it
seems,
seems
low
when
we
have
23
counties,
but
some
of
these
serve
multiple
counties.
For
example,
peak
wellness
is
the
designated
gatekeeper
in
in
the
southeast
region,
and
their
catchment
area
is
three:
if
not
four
counties,
so
there's
some
overlap
with
with
some
of
our
gatekeepers.
E
You
know
to
wrap
around
people
in
the
community
to
keep
them
out
of
higher
levels
of
care,
help
them
maintain
and
also
improve
their
lives
in
the
community.
So
the
vast
majority
of
these
have
been
with
community
mental
health
centers
and
those
those
services
like
I
mentioned.
Are
they
vary
and
are
vary
by
county
and
by
needs.
E
So,
for
example,
in
the
early
days
of
this
change,
2017
ish
2018,
we
had
some
money
that
was
allocated
both
with
with
state
funds
and
federal
funds
of
what
we
called
gatekeeper
incentive
grants
and
that
was
to
get
community
mental
health,
centers
and
others.
You
know
again
kind
of
injected
into
this
title
25
process
more
than
then
we
had
seen
in
the
past,
and
those
of
you
might
remember.
Part
of
this
was
due
to
a
bit
of
a
problem.
E
E
So
the
the
services
and
those
incentive
grants
really
varied
by
by
community
going
forward
after
July
1st
of
this
year,
those
gatekeeper
services
are
intended
are
going
to
be
incorporated,
the
larger
contracts
that
we
talked
about
before.
So
there
will
be
some
standardization
of
the
gatekeeping
requirements,
but
just
to
give
the
committee
a
sense
of
how
we
do
these
gatekeeper
designations,
we
reach
out
to
the
County
Commission
in
in
a
community.
To
essentially
let
them
know
we
intend
on
designating
this
provider.
Is
your
title?
E
25
gay
keeper-
and
we
kind
of
have
it
back
and
forth
with
the
County
Commission,
if
that's
an
issue
or
if
there's
other
recommendations,
there's
nothing
in
statute.
That
specifically
says
this
has
to
be
a
community
mental
health
center.
So
we
have
worked
with
counties
in
the
past
who
wanted
to
go
in
a
different
direction.
Maybe
have
a
third-party
provider
do
these
services
and
we've
we've
worked
with
counties
to
do
that
as
well.
E
So,
like
I
said
it's
a
mixed
bag,
but
the
real
intent
of
this
of
this
statute
was
to
have
sort
of
a
point
of
responsibility
to
manage
not
only
the
the
patient
but
make
recommendations
on
the
resources
to
to
courts
and
to
the
various
entities
involved.
And
this
really,
you
know
highest
level
of
care
in
many
cases
in
the
behavioral
health
continuum,
which
is
often
triggered
by
Title
25,
which
commits
people
to
either
a
psychiatric
hospital
or
the
Wyoming
State
Hospital.
So,
mr.
chairman,
that's
a
really
down
and
dirty
overview
of
the
gatekeeping
statutes.
E
But
again,
like
we
talked
about
before,
it's
it
kind
of
represents
a
microcosm
of
the
previous
topic,
which
was
a
microcosm
of
the
previous
topic.
So
hopefully
it
flowed
relatively
well
but
happy
to
stand
for
any
questions
about
about
gatekeeping,
since
the
information
on
your
slides
was
very
general
I
think.
B
Committee,
it
is
1256,
I
think
that
we're
in
a
good
position,
because
I
think
the
questions
that
might
be
coming
to
Stephan
to
answer
and
public
comment
could
take
a
little
bit
of
time.
I
think
we'll
go
ahead
and
break
for
lunch
and
come
back
at
one
o'clock
and
Stephan
will
be
ready
to
ask
you
questions
at
that
time.
So
please
mute
and
stock.
Your
video.