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A
Be
ready
to
go,
please
mute
your
phones
but
pay
attention.
If
somebody-
and
that
goes
to
me
too,
if
you
need
to
text,
let
us
know.
A
Good
morning,
everyone
whom
I
who
may
be
participating
with
us
on
youtube
today,
this
is
the
slick
select
committee
on
mental
health.
That's
been
put
together
to
consist
of
people
from
the
joint
appropriations
and
the
labor
health
and
social
service
committee
to
address
mental
health
issues
in
the
state
we
have.
This
is
our
third
meeting
when
we
have
been
the
previous
two
meetings
have
been
having
conversations
on
the
delivery
of
mental
health
through
our
community
mental
health
programs
and
providers
in
the
state.
A
We're
going
to
follow
that
discussion
some
today
and
then,
as
you've
looked
at
our
agenda
on
the
that's
provided
by
lso
we're
going
to
be
going
into
some
adolescent
mental
health
discussion
today,
which
is
a
little
bit
of
new
ground
for
some
of
us
and
address
those
issues
as
well.
So
john,
our
lso
staff,
john
brody,
would
you
take
a
role
please?
C
B
E
C
E
A
So
committee,
as
as
we've
contemplated
the
discussion
on
on
how
we
use
the
the
funds
from
the
the
state
that
goes
into
the
mental
health
supports
and
contracts
of
the
community
mental
health
providers,
the
question
keeps
coming
up
as
what
is
the
state's
role
the
department
of
health
as
they
pro
as
they've,
been
preparing
to
help
us
through
this
and
as
they've
taking
this
issue
before
the
the
labor
and
health
committee.
A
I
participated
with
the
department
of
health
and
are
some
of
the
representatives
from
our
community
mental
health
providers
whamsack
and
their
in
a
meeting
where
they
went
through
a
similar
exercise,
and
it's
it's
interesting
to
see
how
these
populations
fall
into
various
buckets
and-
and
I
think
it's
in
so
we're
going
to
go
through
that
exercise
today
and
we're
going
to
turn
the
time
over
to
the
department
of
health.
A
Jerry
hendricks
is
going
to
take
that
take
control
of
the
wheel
here
and
she'll
be
asking
each
of
us
questions
on
who
we
feel
the
the
state
should
be
serving.
That
doesn't
mean
that
the
our
community
mental
health
providers
aren't
already
providing
those
those
helps
in
those
populations,
but
just
to
who
do
we
see
in
the
state
that
is
worthy
of
those
services
in
our
in
our
opinions
and
then
they'll
kind
of
go
through
an
exercise
of
of
categorizing.
Those
and
we'll
have
some
follow-up
discussion
after
that.
A
So
we're
gonna
give
the
reins
over
to
to
jerry
and
let
her
take
that
I'll
go
all
mute
and
then
we'll
let
her
kind
of
drive
that
show
elizabeth,
so
jerry.
It's
yours.
G
Thank
you,
mr
chairman.
My
name
is
jerry
hendricks
and
I'm
the
policy
administrator
for
the
wyoming
department
of
health,
I'm
first
going
to
have
stephen
johansson.
Our
deputy
director
give
a
brief
introduction
of
the
the
purpose
of
this
exercise,
and
then
I
will
facilitate
us
through
some
of
the
exercises
we
have
prepared.
F
F
You
know
four
or
five
years
that
we've
kind
of
modeled
it
off
of
that
where,
before
there's
any,
you
know
preconceived
notions
or
or
legislative
directions,
executive
branch
changes
to
contracts
where
we
really
found
success
with
remissioning
our
two
safety
net
behavioral
health
facilities
was
in
thoroughly
going
through
an
exercise
that
helps
us
define.
The
role
of
the
state,
helps
us
prioritize
populations
and
then
maybe
could
help
this
committee
or
others
address
what
has
been
articulated
as
a
potential
lack
of
missioning
in
in
this
system,
both
from
a
legislative
perspective
and
an
executive
branch.
F
You
know
contracting
perspective.
What
problems
are
we
trying
to
solve?
What
outcomes
are
we
trying
to
achieve
and
who
are
we
trying
to
to
cover
with
the
general
fund
dollars
that
that
go
through
this
system?
So
really,
what
I'll
do
is
is
hand
it
over
to
to
jerry,
I'm
not
sure
how
many
of
you
have
worked
with
jerry,
she's,
relatively
new
to
the
department
past
several
years.
F
So
we
think
this
could
be
a
fruitful
exercise
and
and
hope
that
hope
that
you'll
you'll
engage
like
we
did
both
internal
to
the
director's
office,
our
behavioral
health
division,
as
well
as
what
representative
larson
mentioned
with
our
provider
groups,
and
again
always
more,
can
be
done
when
you
have
these
discussions.
But
I
think
this
is
a
could
be
a
meaningful
first
step,
so
I'm
going
to
hand
it
over
to
jerry.
F
Franz
fuchs
is
also
on
the
line
and
will
be
able
to
share
his
screen
similar
to
what
we
did
internally
and
with
the
provider
group.
I
will
try
to
capture
visually
what
the
brainstorm
is
is
producing
representative
larson.
Sorry,
I
feel
awkward
calling
on
the
chairman
of
the
committee.
A
Thank
you
stefan
or
jerry,
maybe,
as
as
you
get
going
in
there,
it
might
be
fair
to
the
members
of
the
committee
to
just
kind
of
share
what
populations
our
community
mental
health
providers
serve
now.
So
as
we
contemplate
that
a
little
bit.
So
if
you
try
to
have
a
feel
for
that,
it
would
be
helpful.
F
Sure,
representative,
mr
chairman
and
members
of
the
committee,
it
really
is
kind
of
the
full
gamut
of
populations
and
services,
but
not
the
same
in
every
community.
So
we
have
a
wide
range
of
general
access.
Low
acuity
populations,
as
well
as
populations
that
might
have
more
of
an
acute
crisis,
need
or
more
acute
substance
abuse
needs.
So
it
really
does
kind
of
run
the
gamut
from
everything.
F
From
a
again
a
lower
acuity
general
access
population
to
higher
needs,
kids
higher
needs,
families
higher
needs,
mental
health
and
substance
abuse
clients,
as
well
as
a
kind
of
a
peppering
of
different
types
of
clientele
and
the
residential
services
as
well.
So
what
we've
kind
of
communicated
prior
is,
if
you
think,
just
to
oversimplify
it
a
little
bit.
F
If
you
think
of
a
continuum
of
mental
health
and
substance,
abuse
policy,
where,
on
the
one
extreme,
you
would
have
just
a
pass-through
kind
of
funding
system
where
the
dollars
come
in
from
the
legislature
to
the
department
and
we
pass
them
through
to
the
to
the
providers,
that's
not
to
overly
simplify,
but
that's
similar
to
how
we
fund
our
senior
centers.
There
are,
you
know,
obviously,
contract
and
federal
provisions
that
are
in
there,
but
it
is
especially
with
the
senior
services
board
more
of
a
pass-through
type
of
funding
model.
F
Then,
on
the
other
extreme
into
the
continuum
you
have
very
strict
eligibility
or
insurance
type
systems
like
we
have
in
medicaid,
where
someone
has
to
meet
a
categorical
and
a
financial
eligibility
criteria
or,
in
the
case
of
the
waivers,
meet
a
relatively
strict
clinical
criteria
to
be
part
of
that
system,
and
we
like
to
think
that
our
community
mental
health
and
substance
abuse
system
is
somewhere
in
the
middle,
but
again
what's
been
articulated
by
folks
on
this
committee,
and
others
is
that
that
mission,
both
in
statute
in
in
general
perception,
is
not
as
clear
as
maybe
it
could
be.
F
So
what
is
the
role
of
the
state?
Are
we
trying
to
shoot
more
for
a
you
know,
pass-through
a
funding,
type
of
model
or
a
very
strict
eligibility
safety
net
type
of
role
and
if
we're
somewhere
in
the
middle?
Where
does
this
committee
and
others
in
the
legislature,
our
state
policy
makers,
where
what's
the
preference
to
move
on
that
continuum?
And
again,
no
no
implicit
bias
or
preference
on
our
part.
That's
really
why
we've
developed
this
exercise.
F
So,
mr
chairman,
I
don't
know
if
that
answers
your
your
question,
but
that's
that's
kind
of
my
take
on
it:
okay,
well,
jerry
and
franz.
I
will
kick
it
over
to
you
and
and
turn
my
ugly
mug
off
of
the
off
of
the
screen
here.
So
take
it
away,
jerry.
G
So
first,
I
just
wanted
to
give
a
quick
overview
of
the
exercises
that
we
have
planned
to
to
brainstorm
and
move
us
to
see.
If
we
can
find
some
consensus
on
what
is
the
role
of
the
state
and
what
are
these
populations
to
serve
once
that's
defined?
Then
you
know,
then
the
committee
would
be
able
to
have
the
tools
necessary
to
work
on
legislation
to
operationalize
the
mission
with
things
like
eligibility
that
that
stefan
had
had
just
mentioned
so
quickly.
G
We
will
have
a
brief
discussion
on
the
role
of
the
state,
as
stefan
just
described,
and
then
we'll
move
into
an
exercise
where
we
will
brainstorm
and
categorize
populations
to
be
served
in
our
mental
health
substance
abuse
system.
G
And
then
we
will
run
through
an
exercise
where
we
introduce
resource
constraints
and
it
will
help
us
determine
how
how
we
would
prioritize
those
groups
and
then,
at
the
end
of
our
exercise,
we
will
sort
of
revisit
where
we
are
all
at
with,
where
the
role
of
the
state
is
after
I've
gone
through
after
have
gone
gone
through
that
exercise,
so
franz
is
projecting
his
screen.
Stefan
did
a
really
excellent
job
sort
of
describing
the
two
spectrums
of
sort
of
a
a
general
access
system.
G
Where,
again
this
is
you
can
look
at
a
general
access
system,
it's
just
basically
a
pass-through
of
state
funds
to
providers
very
little
oversight
or
say
on
who
those
are
funds
are
going
to
or
or
how
they're
going
to
be
expended
and
then
sort
of
on
the
other
extreme
of
the
spectrum
is
the
safety
net
where
we
have,
you
know,
maybe
outcomes
monitoring
and
we
have
those
priority
populations
defined
so
right
now
we
are
somewhere
in
the
middle
and
at
this
point
would
like
to
have
a
brief
discussion
of
and
open
it
up
to.
G
Members
of
the
committee
of
we
of
where
you
think
that,
where
you
think
we
should
be
on
this
spectrum
right
now
we're
somewhere
in
the
middle,
should
we
is
the
role
of
the
state
more
general
access,
or
is
it
more
towards
that
more
focused
safety
net?
So
with
that
I'll
open
up
to
members
of
the
committee
for
comments.
G
D
Okay,
well,
you
know
we're
gonna
go
through
this
and
talk
about
some
of
the
constraints,
but
I
think
generally
speaking,
where
we
are
now
is
is
is
pretty
good,
but
I
like
that,
you
know
the
hardest
part,
and
I
know,
I
believe,
is
senator
bouchard
and
I
served
together
on
a
management
audit
and
we
tried
to
do
a
management
audit
on
the
chins
program
last
year
and
we
really
couldn't
because
everything
is
so
siloed
in
in
how
the
how
the
goods
are
delivered,
whether
it's
through
the
court
system
or
you
know,
through
hipaa
restraints
and
everything
else,
no
one
seems
to
be
able
to
talk
to
each
other
to
be
able
to
say
how
we're
getting
these.
D
How
well
we're
doing
so.
I
guess
what
I
would
say.
I
think
we're
about
right,
but
I'd
like
to
see
us
get
more
through
technology
or
what
and
and,
however,
we
can
get
more
to
be
able
to
measure
deliverables
out
all
the
way
through
the
spectrum,
and
so
we
can
chart
and
see
how
we're
doing,
because
we
know
that
the
budget's
going
to
push
us
that
way.
Budget
constraints
are
going
to
push
us
that
way.
G
Yes,
thank
you
any
other,
any
other
comments
on
sort
of
where
this,
where
we
should
move
along
this
spectrum
of
of
the
role
of
the
state
and
I
apologize.
I
can't
see
everyone
up
on
my
screen,
so
I
hope
I
don't
miss
anyone
if
you're
raising
a
hand
well.
H
I'll
just
call
on
myself,
then
thank
you,
I'm
used
to
being
called
upon.
I
think
that
we,
given
the
resource
limitations
to
me,
it's
pretty
clear
that
we
need
to
move
a
lot
more
toward
the
safety
net
side.
H
My
my
mantra
so
to
speak
during
this
meeting
and
during
session
is,
is
just
going
to
be,
and
I'm
moving
slightly
sideways
here,
but
that
there
are
services
where
cutting
them
to
save
a
penny
now
ends
up
being
pound
foolish
later
so
that
the
I
think,
the
focus
that
I'm
going
to
have
on
services
that
we
provide
is
areas
where
a
lack
of
services
has,
and
you
know,
a
lack
of
services
will
impact
all
people
as
individuals,
obviously,
but
where
the
lack
of
services
then
greatly
impacts,
communities
or
or
and
state
budgets.
H
So,
as
you
see
on
the
screen,
the
title
25
just
a
general
inpatient
commitment
at
evanston
the
corrections
folks,
you
know
the
cost
of
of
people
who
are
either
in
those
systems
or
at
risk
significant
risk
for
being
at
those
systems.
H
You
know.
We
need
to
make
sure
that
we
don't
push
so
much
paperwork
burden
on
the
mental
health
providers.
You
look
at
just
physicians
and
all
in
the
community
and
we've
given
so
much
electronic
health
record
and
insurance
billing
that
they
have
multiple
staff
members.
Just
to
do
that,
so
you
know
we
need
to
make
sure
that
in
some
way
we
don't
overwhelm
the
providers
with
paperwork
instead
of
providing
care,
but
yeah
that
that's
a
good
place
for
my
dot.
G
Thank
you
and,
as
you
can
see,
we're
kind
of
taking
an
informal
sort
of
straw
poll
of
where
individuals
are
landing.
So
then,
at
the
end
of
the
exercise,
we'll
be
able
to
see
if
we've,
if
we've
moved
or
if
there's
consensus
on
on
the
role
of
the
state.
I
Yeah
I'll,
I
guess
I'll
jump
in
and
I
guess
my
would.
I
would
put
my
green
dot
slightly
over
the
first
green
dot,
moving
to
the
right
on
the
safety
net,
and
I
wouldn't
I
wouldn't
go
to
the
extreme
of
the
safety
net
side.
And
let
me
explain
that
so.
My
struggle
here
is
one.
I
take
into
consideration
the
state
budget
constraints
and
those
are
obvious
to
me,
but
the
the
thing
that
I
think
about
is
some
of
our
federal
over
the
last.
I
I
guess.
Well
now
it's
been
almost
10
years,
but
over
the
last
10
years,
we've
seen
a
lot
of
reform
at
the
federal
level
and
one
of
the
major
reforms
that
our
country
underwent
was
parity
laws,
and
so
I
think
about
parity
laws
at
the
federal
level
and
how
they
apply
to
insurance.
I
And
if
somebody
has
private
insurance,
a
parity
law
doesn't
allow
that
insurance
to
discriminate
in
this
particular
area
in
mental
health
and
substance,
use
parody
laws,
don't
allow
an
insurance
company
to
discriminate
based
on
populations
and
priorities,
so,
whether
that's
a
a
mental
illness
or
move
up
the
scale
to
physical
disorders
and
diseases.
I
Serious
mental
illness
substance
use
whatever
it
may
be,
so
it
requires
parity
across
populations
of
people
and
across
populations
of
of
service,
and
so
then,
I
think
about
that
and
I
think
about
the
state's
role
and
then
as
the
state,
if
that's
the
requirement
on
someone
who
has
insurance
and
if
the
state
is
going
to
provide
access
to
mental
health
and
substance,
use
treatment
for
adolescents,
for
underserved
populations,
for
offenders
in
in
our
doc,
for
impoverished,
vulnerable
adults,
etc.
I
So
you
go
down
the
list
and
if
we
are
providing
services
to
those
without
insurance-
and
we
don't
require
parity
at
what
we
provide,
so
we
only
focus
on
serving
high
needs
clients,
for
example,
just
looking
at
the
first
bill
point,
then
it
seems
fundamentally
unfair
to
me
that
if
that
someone
with
that,
the
insurance
companies
would
have
that
same
constraint,
but
not
the
state,
and
so
so
I
struggle
with
that,
but
I
do
move
my
dot
to
the
right
on
that
safety
net
because
I
do
think
when
we
talk
about
general
at
least
when
I
think
about
general
access.
I
G
Thank
you,
and
I
would
you
encourage
you
to
to
jot
those
down.
Our
next
activity
will
be
to
sort
of
categorize,
so
you
just
you
know,
identified
a
number
of
possible
categories
of
populations
to
be
served,
but
before
we
move
on
to
that
step,
let
me
check
to
see
who
else
represent
or
chairman
larson.
A
Thanks
jerry,
I
thought
representative
olson's
comments
are
right
to
the
point
of
why
we're
having
this
exercise
and
and
why
we're
having
this
subcommittee
in
reality
is
because
I
think
that
there's
populations,
in
my
opinion
out
there,
that
the
state
should
be
serving
better
with
mental
health
services
in
and
we're
not
in
in
the
parity
that
is
currently
being
administered,
probably
is
lacking
some,
and
so
I
think
to
I'm
I'm
over
there
with
sue
wilson
on
on
that
safety
net
side,
because
I
want
to
ensure
that
we
do
have
parity
on
those
populations
like
our
seriously
persistent
mental
illness,
people
who
are
indigent
in
the
community
and
we'll
we'll
get
into
that
more
later.
A
We're
saying
that
the
role
of
the
state
is
not
to
create
a
new
system
to
take
over
the
the
administration
or
the
services
of
mental
health,
but
to
keep
that
in
place
with
community
mental
health
contracts
that
we
have
around
the
state,
and
I
agree
with
that
and
but
then
to
give
them
to
give
those
community
mental
health
providers
a
little
more
direction.
A
Much
like
we
did
when
some
of
us
first
came
into
the
legislature
and
we
looked
at
long-term
care,
and
that
is
if
we
can,
if
we
can
determine
a
little
better
who
whom
these
services
should
reflect
to,
then
perhaps
we
can
incentivize
more
services
to
some
of
these
really
underserved
people
to
improve
the
parity
that
representative
olsen
was
referring
to,
and
so
I
think,
as
we
get
over
there
and
identify
who
those
are,
then
perhaps
we
can
incentivize
through
perhaps
a
higher
reimbursement
rate
or
something.
E
Thank
you
very
much,
so
this
is
eric.
I
guess
I
I
don't.
I
can't
put
my
dot
on
the
graph
because
I
think
there's
there's
important
things
at
both
ends.
So
I'll
speak
to
two
one.
We
talk,
we've
always
talked
about
a
continuum
of
care,
and
I
I
guess
that
would
mean
it's
a
linear
and
I
don't
know
that.
Can
that
is
accurate
enough.
E
That's
title:
25,
title
7,
department
of
corrections,
youth,
adolescent,
I'd
also
say
there
are
some
things
that
we
should
be
doing:
the
general
access
or
the
general
prevention
side,
such
as
cit
training
for
law
enforcement,
such
as
crisis
stabilization,
at
least
regional
crisis
stabilization,
so
that
whether
it's
coming
out
of
the
private
sector
or
if
it's
a
state-funded
program
they
would
have
those
would
benefit
all
citizens
that
may
be
in
a
in
a
challenging
place,
and
then
we
folk
have
so
those
resources
cover
the
entire
gamut.
E
E
Some
communities
will
have
a
much
different
indigent
population
where
severe
mental
illness
would
be
maybe
greater
in
that
community
and
others
may
have
a
lack
of
private
providers,
so
just
basic
services
may
be
of
the
greatest
value
there.
So
I
don't
know
where
I
I
guess
I
fall
in
the
middle
because
I
think
there's
both
important
things
on
both
and
that
we
still
can
prioritize
in
this
system
and
but
they're,
not
all
within
the
substance,
mental
health
system
or
the
mental
health
system.
E
Some
of
them
are
more
systematic
things
that
I
think
we
could
use
those
substance,
abuse
mental
health
dollars
too
cit
training,
crisis
stabilization,
so
there's
kind
of
infrastructure,
they're
kind
of
generalized
kind
of
general
application,
but
hopefully
they
cut
down
on
the
other
end
as
well.
So
I
guess
maybe
I've
fallen
closer
to
the
middle,
but
for
those
reasons
thank
you.
E
G
J
So
I
would
put
my
dot
on
the
far
right
hand
side.
I
have
to
start
out
by
saying,
though
I
I
think
this
chart
is
a
little
bit
of
a
false
dichotomy,
because
it
carries
the
implications
if
we
just
change
the
mission
of
the
community
mental
health
centers
from
general
access
to
safety
net.
Only
that
somehow
we're
going
to
save
money-
and
I
don't
think
that's
the
case.
J
I
think
that
when
the
community
mental
health
centers
first
started
up
in
wyoming,
there
were
just
not
a
whole
lot
of
private
mental
health
system
period.
When
this
thing
was
passed
by
kennedy
in
63,
I
think
the
northern
wyoming
mental
health
center
opened
up.
J
You
know
late
60s
and
there
just
were
not
mental
health
providers
in
town
there,
weren't
even
surgeons,
for
crying
out
loud
and
all
that's
changed,
and
so
I
think
what
you
find
is
that
the
general
access
population
that
has
insurance
or
resources
is
going
to
the
private
mental
health
providers
and
their
needs
are
satisfied
there
or
if
their
acuity
gets
to
the
point
that
the
those
folks
can't
take
care
of
it,
then
they
fall
back
to
to
the
system.
J
J
I
think
that
if
we
had
the
data
I'd
like
to
know
of
the
current
population
base
of
the
mental
health
centers,
how
many
are
already
this?
This
high
need
population
and
then
in
the
ideal
world
we
would
have-
and
I
don't
know
how
you
would
ever
get
it
without
overburdening
them-
and
I
shared
representative
wilson's
caution
about
creating
a
data
nightmare,
but
if
you
cramp
down
on
the
community
mental
health
centers
and
overwhelming
with
paperwork
and
eligibility,
those
patients
don't
go
away,
they
just
pop
up
in
the
more
expensive
ends
of
the
system.
J
So
your
first
paragraph
there
is
reducing
the
burden
on
other
state
systems.
That's
important!
The
second
paragraph
paper
performance.
I
share
representative
wilson's
caution
about
that.
There's
some
some
of
these
populations,
your
performance
is,
do
they
stay
on
their
meds
and
not
show
up
at
the
er.
That's
your
plan
of
care.
I
mean
some
of
these
folks,
just
that's
where
they
are
in
in
their
mental
health
status.
J
The
plan
of
care
might
be
just
that
you
know
they're,
not
under
a
bridge
or
they
don't
end
up
going
back
to
jail,
so
the
billing,
the
eligibility
verification,
the
tracking
outcomes.
I
think
what
the
the
misfire
we
had
with
qualis
is
a
shot
across
the
bow
imposing
a
20
limit
visit
on
every
patient.
J
Without
a
more
nuanced
approach
of
saying,
some
of
these
folks
are
just
lifetime,
and-
and
our
our
only
expectation
is
that
that
not
that
they're
going
to
get
significantly
better
but
they'll
be
stabilized
and
that's
what
a
representative
barlow's
talking
about
is
the
crisis
stabilization,
so
my
highest
population,
my
highest
priority
populations,
would
be
those
are
at
risk
of
popping
up
elsewhere
in
the
system
if
they're
not
maintained,
and
so
that
would
be
the
seriously
mentally
ill
that
need
to
stay
on
their
meds.
J
If
that's,
if
that's
the
appropriate
plan
of
treatment,
the
populations
that
are
at
risk
of
going
to
jail
or
being
reincarcerated
putting
their
families
on
on
welfare.
So,
and
I'm
not
a
bleeding
heart
on
these
folks,
I
they
need
intervention,
they
need
monitoring.
You
know
whether
it's
continuous
transdermal
monitoring
or
24
7,
drug
and
alcohol
monitoring.
J
They
need
something
to
keep
them
on
the
straight
and
narrow,
while
they're
receiving
their
treatment.
I
worry
that
we
we
saw,
I
think
it
was
four
or
five
years
ago,
represent
barlow
or
sue
may
remember.
We.
We
really
cut
the
amount
of
substance,
abuse
funding
in
the
prison
system
and
it
didn't
take,
but
a
year
or
two
before
we
saw
an
immediate
rise
in
recidivism,
so
it's
a
false
economy.
J
J
G
B
Thank
you
yeah.
I
I
think,
I'm
probably
somewhere
between
our
current
system,
where
we
are
and
the
safety
net
not
not
to
be.
You
know
two
two
at
odds
with
either
group,
because
I
I
feel
like
there's
some
pretty
good.
You
know
discussion
both
ways.
B
What
we
see
a
lot
in
our
community
obviously
are
transition
issues
with
folks.
You
know
coming
out
of
the
state
hospital
and
and
either
not
getting
the
treatment
they
need
or
slipping
through
the
cracks
yeah.
I
think,
obviously,
with
the
life
resource
center.
B
You
know
coming
on
board
in
the
next
little,
while
I
think
that
will
help
us
considerably,
but
we
end
up
having
a
lot
of
folks
that
end
up
either
in
jail
or
at
our
crisis
center,
or
you
know,
or
maybe
should
go
back
to
the
state
hospital,
sometimes
because
we
don't
have
the
kind
of
follow-up
that
we
need
necessarily
with
with
all
of
our
community
resources,
so
I'm
somewhere
in
between
there,
but
I
think
that
the
discussion
you
know
I
could
go
either
way
a
little
bit
depending
on
how
things
go
today.
Thank
you.
B
G
You
thank
you
for
your
feedback.
Senator
bouchard
before
we
move
on.
Do
you
have
any
any
comments
to
add.
K
Yeah,
thank
you.
You
know
I
mean
I
can't
argue
with
a
lot
of
the
points
where
everybody's
put
the
dots,
but
there's
just
a
lot
of
complexities
here,
depending
on.
What's
what
situation
we're
dealing
with,
I
mean
when
we
look
at
corrections.
K
We
look
at
it.
It's
all
safety
net,
because
they're
they're
captured
they're
in
the
system,
even
when
they're
out
of
the
system
or,
let's
say
on
a
release,
they
still
have
us
expectations
to,
especially
when
it's
an
addictions
issue,
and
I
think
some
of
what
I
see
going
on
in
wyoming
is
similar
to
what
I
see
in
in
other
states,
where
they've
made
so
many
mistakes
on
addiction,
services
that
the
problem
turns
worse
and
it's
it.
It
becomes
a
homeless
problem
and
it
just
turned.
K
You
know
it
turns
into
a
lack
of
the
ability
for
people
to
function
properly
because
of
addictions,
and
so
I
have
a
real
hard
time.
Looking
at
this
chart
and
saying
hey,
we
gotta
we've
got
just
one,
you
know,
let's
put
a
dot
somewhere
and
fix
something.
I
think
the
problem
is
systemic.
K
I
think
that
we
we
have
a
hard
time
with
new
ideas.
We
have
a
hard
time
trying
to
really
look
at
addiction
problems
and
trying
to
fix
them,
and
this
stuff
costs
a
lot
of
money
going
down
the
road.
If
we
don't
get
it
ahead
of
it,
and
and
as
you
see
more
legalization
happen,
I
think
you're
you
see
more,
I
mean
I
think
denver
is
having
a
serious
problem
down
there
right
now
with,
and
it's
turned
into
homelessness.
K
It's
money
that
they've
spent
millions
upon
millions
upon
millions
and
nothing's
changed
and
all
the
time
that
they've
had
this
addicted
addictions
population,
that's
even
living
in
the
streets,
so
I
mean
so
that's
where
I'm
just
having
a
hard
time
saying
that
we're
gonna
put
a
dot
and
fix
something.
I
think
we
need
to
go
back
to
the
to
the
systems
that
we're
implementing
and
be
on
the
cutting
edge.
G
Well,
thank
you.
Thank
you
senator,
and
I
just
thank
you
for
all
your
feedback.
I
believe
we
were
able
to
hear
comments
from
everyone.
G
I
did
just
want
to
say
that
this
chart
certainly
certainly
is
over
oversimplified,
but
I
do
appreciate
you
giving
your
thoughts
and
feedback.
This
is
as
a
tool
that
we
can
use
to
to
frame
the
issue
and
and
have
a
discussion.
Certainly
the
mental
health
substance
abuse
system
is
very
nuanced.
Very
you
know
multi-faceted
and
much
more
complex
than
this
simple.
G
You
know
spectrum
chart
that
we
have,
but
I
think
that
that
we
had
some
good
feedback
and,
and
so
and
I
I
think
that
we
are
ready
to
move
on
to
our
next
step
in
our
in
our
process,
but
that
some
of
you
have
already
made
some
great
com
comments
on,
and
this
is
that
we
are
going
to
brainstorm
the
different
populations
to
be
served
so
in
order
to
you
know,
create
policy
or
draft
left
legislation.
G
If,
if
this
committee
decides
to
move
that
way,
we
need
to
define
who
it
is
we
are
serving.
So
I
would
encourage
you
all
to
take
a
couple
minutes
and
brainstorm
on
your
own
jot
down
some
of
the
populations
that
a
few
of
you
have
already
mentioned.
Who
are
all
who
are
all
the
populations
to
be
served
and
then
we'll
come
back
and
share
those
and
get
those
up
on
our
on
our
whiteboard.
So
just
take
a
couple
minutes
to
brainstorm,
and
then
we
will
share.
G
While
you're
all
brainstorming,
I
just
want
to
mention
that
these
categories,
don't
necessarily
have
to
be
clinical
categories
or
any
sort
of
official
definition.
It
can
just
be
any
any
population
that
that
may
have
a
need
for
mental
health,
substance
abuse
and
so
just
wanted
to.
Let
you
know
to
to
be
to
be
free
and
open
with
all
the
different
populations,
you're
thinking
of
of
populations,
to
be
served
with
state.
G
Dollars
and
with
that,
let
me
know
if
anybody
would
be
willing
to
start
sharing
the
the
populations
represented
in
barlow.
E
Sure
I
think
I
I
kind
of
gave
a
prayer
to
this
previously,
but
I
think
anyone,
the
population,
anyone
that's
already
part
of
a
state
program
system,
whether
it's
department
of
corrections
as
senator
kinski
mentioned
or
title
25
title
vii.
Any
of
those.
I
think
that's
a
continuum
of
care
or
circular
circular
circle
of
care
that
this
seems
like
an
automatic
place
where
they
would
be
eligible.
I
think
we're
now
we're
talking
about
an
eligibility
or
the
priority
of
eligibility.
E
E
In
my
community
we
lost
numerous
jobs
and
still
losing
jobs
in
some
of
the
mineral
industry,
placing
strains
on
families
who
lose
health
insurance
so
having
some
kind
of
eligibility
for
those
folks
that
are
going
through,
not
just
eligibility
based
on
income,
I
guess
is
what
it
would
be,
or
loss
of
income
in
the
case
of
these
recent
losses.
E
G
Thank
you
senator
richard.
A
A
It
looks,
looks
like
I'm
all
right,
so
I
would
so
as
I
I
look
at
populations
that
we
ought
to
be
providing
mental
health
services
to.
I
agree
with
representative
barlow
in
that
those
those
individuals
who
are
served
by
you
know.
A
We've
said
some
sort
of
court
decree,
whether
that
be
title,
25
title,
seven
or
correctional,
and
part
of
that
is
diversion
if
we
can
diverge
or
divert
them
away
from
going
into
a
facility
such
as
being
titled
into
title
25
and,
of
course,
on
the
back
end,
bringing
them
back
in
in
to
the
community
and
preventing
recidivism
so
providing
ongoing
services
there
until
that
is
under
control
being
and-
and
I
don't
know
if
representative
bartle
in,
I
think
that
all
of
this
kind
of
is
inclusive
of
the
gatekeeping
intent,
so
just
to
put
that
in
there,
so
that
I
think
that
we
need
to
be
providing
that
gatekeeping
service
in
our
system.
A
I
think
that
the
indigent
population,
particularly
those
the
spmi,
serious,
persistent
mental
illness,
folks
who
maybe
be
in
our
community,
as
senator
kinski,
pointed
out
co-chairman
kinski,
says
you
know,
making
sure
that
we
keep
them
on
their
medications
out
of
the
emergency
room
and
out
of
the
other
institutions,
would
be
a
very
important
function
to
do
that.
I
think
our
high
needs
children,
who
are
at
risk
of
some
sort
of
intervention
from
the
court
system
as
well
fits
into
that
for
for
these
children
and
their
families.
A
I
think,
and
also
I
think,
our
crisis,
our
psychiatric
crisis,
stabilization
that
that
we
see
come
into
our
local
hospitals
and
and
how
we
can
how
we
can
deal
with
those
and
so
terry.
Those
are
kind
of
the.
A
Well,
it
would
it
would.
It
would
certainly
be
more
in
line
with
our
title
25
trying
to
divert
people
from
going
into
the
state
hospital
in
in
doing
what
we
in
incentivizing,
their
community
mental
health
providers,
to
take
advantage
of
of
them
locally
rather
than
going
into
a
facility,
and
it
may
be
a
less
amount
of
time
just
and
and
of
course,
along
with
that,
we
would.
A
A
Jerry
tonight,
sorry
so
on
that
the
spmi
bunch,
you
know,
I
think,
of
the
patient-centered
medical
home,
you
know
where
we're
we're
just
we're
trying
to
maintain
people
and
prevent
them
from
coming
into
the
hospitals.
Something
similar
to
that
approach
is,
I
guess,
what
I
I
kind
of
see
as
an
important
pro,
an
important
service
that
the
community
mental
health
providers
would
provide
I'll
shut
up.
G
Okay,
thank
you,
chairman
larson,
for
your
feedback.
I
believe
I
saw
a
representative
olson's
hand.
Do
you
want
to
go
ahead
with
your
feedback.
I
Yeah
sure
thank
you.
Well,
I
think
I
mean
this
list
is
getting
pretty
comprehensive
and
I
see
I
see
the
world
almost.
I
guess
it's
almost
bifurcated
how
you
have
it
on
your
sheet,
a
left
side
and
a
right
side,
and
I
think
a
lot
has
been
said
about
the
department
of
corrections.
Those
with
court
orders
family
services-
that's
a
huge
world
for
me.
I
wouldn't
add
a
whole
lot
more
to
that
other
than
that's
kind
of
on
the.
I
would
consider
it
more
on
the
back
end.
I
You
have
somebody
who
it's
and
what
I
mean
by
that
is
it's
it's
responsive,
so
it's
not
necessarily
proactive,
but
it's
responsive.
Somebody
has
been
placed
into
our
systems
or
somebody's
families,
etc,
and
now
we're
responding
but
being
responsive,
still
has
an
element
to
proactiveness
to
it.
In
that
I
believe
that
these,
at
least
in
the
incarceration
system.
These
are
alternatives
to
incarceration.
I
If
we
not
just
recidivism,
we
keep
talking
about
that,
but
it's
also
important
to
understand
that
these
are
actually
alternatives
that
if
we
can
get
you
know,
non-violent
offenders
treated
for
mental
health
and
substance,
use
up
front
and
heavy.
Then
we
don't
have
to
necessarily
send
someone
off
to
prison,
so
we
we
may,
we
may
spend
some
time
in
a
county
jail
at
best,
and
so
we
also
we
reduce
incarceration,
not
just
recidivism
so
on
the
on
the
left
side
really
important,
but
then
on
the
right
side.
I
When
I'm,
I
would
echo
the
comments
on
the
unemployed,
the
underemployed,
the
indigene
and
adolescents,
who
aren't
necessarily.
I
In
a
system
with
a
court
order,
but
adolescents,
you
know
adolescents
in
general
who
who
are
going
to
need
access
to
mental
health
treatment
and
to
potentially
the
substance,
use
treatment,
and
especially,
you
know.
Senator
bouchard
said
earlier
as
as
as
laws
change
in
our
perception
of
of
substances
change.
The
the
biggest
impact
I
think
we
would
see
is
is
going
to
be
among
adolescents.
I
It's
going
to
be
in
our
in
our
junior
highs
in
our
high
schools
and
so
that
that
side,
the
right
side
of
the
sheet
I
see
is
a
lot
as
being
more
pro
proactive.
So
we're
trying
to
we're
trying
to
get
to
people
before
they
enter
a
course.
A
court
order
or
a
system.
I'm
not
sure
how
our
our
current
system
really
plays
to
those
individuals.
I
But
I
think,
when
I
go
back
to
the
previous
screen,
for
example,
and
we're
looking
at
the
spectrum
and
the
general
access
to
me
the
if,
if
we
move
that
dot
too
far
to
the
right
on
the
spectrum,
we're
really
on
the
left
side
of
this
sheet
and
we're
very
reactive
now
and
we're
we're
providing
that
safety
net.
So
it's
harder
to
get
out
in
front
of
individuals
who
may
not
be
in
the
system
because
it's
harder
to
see
them
that
they
that
they
exist
and
that
they
need
services.
I
D
Yeah,
I
don't
have
much
to
add
on
you
know.
I
definitely
have
to
you
know,
take
care
of
the
crisis
and
the
statutory
stuff
that
you
know.
Everybody's
talked
about
adolescence.
That's
you
know.
For
the
same
reason,
I
think
that's
that
is
important.
You
know
as
right
at
the
top
of
my
list.
You
know
I
also
too
like
to
talk
and
I
don't
want
to
lose
those.
D
You
know
some
of
the
local
programming
that
we
do,
whether
it's
the
group
homes
or
the
clubhouse
model,
some
of
these
other
things
that
that
I
think,
could
help
with
the
you
know
with
some
of
these
maintenance
issues.
Somehow
you
know
we
write
down
all
this
stuff,
but
then
we
have
this.
We're
going
to
have
this
budget
deal
where
we're
going
to
have
to
make
all
these
cuts
and
and
and
figure
out
how
we're
going
to
do
that.
I
don't
want
to
lose.
D
D
But
I
also
think
that
some
of
the
things
that
we're
doing
actually
have
some
applicability
statewide.
So
I
throw
that
in
there
somewhere,
and
I
also
wanted
to.
D
I
guess
correct,
I
I
said
something
that
representative
wilson
said.
I
hope
I
didn't
give
the
impression
that
I
was
trying
to
create
more
paperwork.
I
was
just
trying
to
create
more
communication
between
the
the
left
and
the
right
side
about
how
we're
how
we're
how
we're
handling
this,
because
sometimes
I
think
that
we
leave
ourselves
open
to
undo
costs
by
not
communicating
about
how
we're
how
we're
handling,
especially
youth.
As
as
we
go
through
this,
these
title
25
cases
and
things
like
that.
If
that
makes
sense.
G
B
Oh
yeah,
I
actually
really
had
two
that
I
wanted
to
focus
on,
and
we've
mentioned
the
adolescence,
we're
still
having
some
issues
around
the
state
with
suicides
with
our
younger
kids,
and
we
just
had
an
eighth
grader
here
just
a
couple
weeks
ago
that
shot
himself
and
I
mean
we're.
You
know
I've
seen
two
or
three
I
mean
we've
had
two
or
three
just
in
recent
months.
I
think
the
suicide
hotline
is
is
going
to
help,
but
we
need
to
do
some
other
things
proactively
to
to
help
prevent
that.
B
B
G
B
G
Thank
you,
representative
wilson.
I'm
do
you
have
any
additional
populations
that
are
not
named
up
here
that
that
you'd
like
to
add
well
so.
H
Mostly
there's
overlap,
but
if
I
could
just
kind
of
talk
through
what
I
was
thinking
and-
and
I
and
I
give
you
what
my
list
started
to
be
and
then
I
circled
back
and
I
wasn't
sure
there
are
some,
I
don't
say
unintended
consequences,
but
so
you
know
I
started
off
with
listing
sort
of
the
justice
involved.
Folks,
we've
got
up
there
period,
people
with
serious
mental
illness
who
are
at
risk
of
either
at
risk
of
institutionalization,
or
they
need
some
sort
of
step
down
services
from
residential
care.
H
Then
you
know
think
picking
up
on
something
senator
bouchard
said
really
homeless,
people
or
people
who
don't
have
social
networks.
H
And
and
then,
though,
as
I
look
at
that
list,
the
problem
with
having
that
be
the
list
is
that
kind
of
what?
What
representative
olson
said
is
that
in
some
ways
you
I
don't
want
to
say
incentivize
people
to
get
on
the
list?
But
you
know,
if
you
draw
the
list
there,
then
you've
got
people
who
are
not
quite
in
that
category
yet
and
because
they're
not
getting
any
service,
they
end
up
in
the
category.
You
know,
because
of
lack
of
prevention
or
the
ability
to
to
reach
those
folks.
H
You
know
that
sort
of
thing
and
prevention,
and
then
the
budget
problem.
So
one
one
other
thing
that
then
I
wrote
down
that
I
I
I
know
and
I'm
not
quite
sure
how
we
would
make
this
happen.
But
one
of
the
challenges
I
think
in
general
in
human
services,
is
that
things
tend
to
be
very
siloed.
I
mean
that's
one
of
the
things
we're
trying
to
overcome
with
the
criminal
justice
reform
and
all.
But
you
know,
you've
got
this
service
for
the
adolescents.
You've
got
something
else
over
in
the
schools.
H
You've
got
this
other
counselor,
you've
got,
you
know
whatever
housing
thing,
or
I
mean
it's
all
broken
out,
and
so
the
more
we
have
to
move
for
financial
reasons,
to
more
of
a
safety
net
side
and
less
of
a
broad,
broader
access,
the
more
we
need
at
least
some
way
of
providing
case
management
assistance,
as
people
get
start,
maybe
having
to
get
their
services
in
the
private
sector,
or
you
know,
there's
a
program
through
a
church
or
something
like
that.
You've
got
providers
that,
and
I
I
think,
one
strength
of
the
community
mental
health
centers.
H
Is
that
because
of
their
experience
with
these
with
clientele,
they
tend,
I
think,
to
know
at
least
what
the
community
resources
are
for
for
housing
or
diversion,
or
you
know,
prescription
assistance
or
whatever
and
as
people
especially
you
know,
even
people
who
have
insurance,
though
so
maybe
they're
going
to
a
private
counselor
for
their
child,
but
they
don't
necessarily
know
how
to
access
all
these
other
services.
So
I
think
maybe
at
least
as
we
have
to
you
know,
maybe
move
the
dot
a
little
to
the
right.
H
If
there
is
some
way
to
have
to
use
the
case
management
resources
of
the
community
mental
health
centers
to
enable
people
who
are
maybe
getting
services
elsewhere
to
tie
together
all
the
parts,
I
just
feel
like
case
management
is
so
key.
I
think
you
know
it's
very
related
to
the
continuum
of
care,
but
just
people
people
just
I
mean
that's.
Why
I
have
people
call
me,
I
mean
who
calls
a
legislator
to
find
out
how
to
get
meds
for
their
opioid
addicted
kid.
H
G
Thank
you,
representative
wilson.
You
all
certainly
have
a
lot
of
experience.
You
know
with
this
issue
I
can
tell
dealing
with
with
constituents
but
sort
of
bring
it
back
to
more
high
level
and
the
the
population
categories
to
be
served.
I
just
wanted
to
see
representative
larson.
G
I
wanted
to
bring
it
back
and
give
you
a
final
say:
do
you
see
any
populations
that
are
that
are
missing
that
that
you
would
like
to
see
added
before
we
move
on
to
our
next
step
in
the
in
the
exercise
or
or
any
other
members
for
that
matter?
Are
there
any
any
big
populations
that
we're
missing.
A
A
And
then
there
is
also
a
concern
as
we
talk
about
this,
is
we
reflect
on
on
state
dollars
as
the
impact
that
that
would
have
on
the
the
samsa
funds
and
who
the
the
designations
there?
A
I
I
don't
know
that
that's
really
part
of
this
discussion,
but
just
a
comment
that
just
to
let
the
committee
know
that
in
in
samsa,
there's
some
some
designations
there
and
we're
not
we're
not
throwing
them
aside,
but
we
recognize
they're
in
the
way
they're
like
veterans
and
minority
populations,
as
well
as
pregnant
women
and
those
sorts
of
things.
So
how
about
a
comorbid.
G
F
G
Okay,
I
think
let's
see
did
I
did
I
miss
every
anyone.
Just
did
everybody
get
a
chance
to
to
share
populations.
H
It
if
I
can
just
make
one
insertion
on
representative
larson's
comorbid
health
conditions
just
to
flesh
that
out-
and
I
I'm
not
sure
about
this-
but
I
it
was
mentioned
to
me
earlier
in
the
year
the
challenges
with
people
who
are
dual
diagnosed
with
mental
illness
and
developmental
disability.
H
That's
not
to
say
that
there
aren't
private
providers
who
are
available
to
that
and,
of
course
those
people
will
typically
at
least
have
medicaid,
so
they
at
least
have
a
payer
source,
but
and
and
that's
not
to
say
that
any
particular
community
mental
health
service
would
necessarily
have
expertise
in
that.
But
I
I
just
throw
that
out
there,
because
it
was
mentioned
to
me
by
some
of
the
providers
that
this
was
a
a
challenging
group
to
find
good
services
for.
G
Thank
you,
representative
wilson,
for
that
edition.
With
that
we'll
go
ahead
and
move
on
to
the
the
next
step
in
the
exercise,
which
is
basically
what
we're
going
to
do
is
look
at
all
of
the
look
at
all
the
populations,
but
we
have
brainstorm
and
we're
going
to
try
to
cluster
and
group
these
together
into
like
sort
of
population
buckets
and
give
them
titles,
and
so
and
then,
of
course,
during
the
course
of
this
exercise.
If
additional
populations
we
we
forgot
to
mention,
come
to
your
mind,
you
know
we
can.
G
We
can
certainly
add
those
as
well,
and
so
it
looks
like
looks
like
franz
started
a
sort
of
grouping
things
together
initially
as
we
started
discussions,
but
are
there
any
groups
that
really
stick
out
that
we
could
sort
of
title
and
group
together
in
one
population
bucket.
A
G
G
So
with
that
with
that
bucket
justice
involved
and
are
there
any
other
items
that
need
to
be
included
under
there,
we
have
department
of
corrections,
title
25,
dfs.
F
F
So,
just
for
the
for
the
group,
because
this
has
come
up
several
times
in
our
other
exercises.
Just
so
you
know
we,
we
understand
there,
there's
plenty
of
overlap
between
these
these
categories.
This
is
really
geared
at
again
when
we'll
come
back
to
kind
of
the
role
of
the
state
conversation
before
introducing
any
financial
or
legal
constraints.
F
F
Population
categories
would
be
again
noting
this
is
not
clinical
or
kind
of
official
definitions,
but
if,
if
you
think
of
you
know
the
kind
of
direction
that
the
the
legislation
from
the
facilities
task
force
gave
the
the
two
behavioral
health
safety
net
facilities-
it
you
know
coming
up
with
those
categories,
was
very
helpful
for
us
and
the
executive
branch
to
get
a
sense
of
what
you
know.
What
problems
we
were
we
were
aiming
to
solve,
for
example,
it
wasn't
clinical
or
again
something
that
came
from.
F
You
know
a
medical
handbook,
but
the
legislature
realizing
at
the
end
of
the
process,
there's
just
some
folks
in
behavioral
health
facilities
that
are
hard
to
place.
You
know
externally,
in
nursing
homes
in
the
private
sector.
What
have
you
and
that
hard
to
place?
Category
actually
became
legislated
to
that
the
executive
branch
could
then
execute.
You
know
what
does
that
mean
to
to
be
hard
to
place?
How
many
facility
rejections
or
nursing
home
discharges
would
have
happened,
so
this
is
kind
of
the
first
stage
in
that
process
of
understanding.
F
From
your
perspective,
as
policy
makers,
what
are
some
of
the
again?
How
do
we
collapse
some
of
these
definitions
into
what,
if
the
the
system
we're
moving
more
towards
a
prioritized
definition
of
service
for
these
state
dollars
in
the
community
mental
health
system?
What
would
those
kind
of
policy
categories
be
that
the
policy
makers
would
be
directing
the
state
to
make
sure
we
design
a
system
around
them?
So
hopefully
that's
helpful,
as
we
start
to
you
know
bucketize
these
for
lack
of
a
better
term,
but
we
totally
understand,
for
example,
right
here.
F
G
Yes,
thank
you,
stefan,
for
that
context,
and
and
for
that
description
of
of
this
portion
of
the
exercise.
H
So
jerry
just
to
to
flesh
out
the
justice
involved,
I
I
am,
I
am
taking
department
of
corrections
to
in
a
way
be
a
generic
term,
because
you
know
I
mean
it
would
be
a
pity
if
some
somebody
that
the
hot
springs
sheriff
was
well
acquainted
with
for
several
years
had
to
wait
until
they
went
to
rollins
or
something
before
you
know.
G
J
Building
off
on
work
represent
wilson
said,
I
that's
that's
a
fantastic
point
and
there
might
be
a
better
phrase,
even
the
department
of
corrections,
generic
justice
involved,
I
think,
suits
it
best,
but
so
we
what
we,
what
we
don't
have
here
is,
let
me
see.
I
thought
we
had
somewhere
that
people
that
were
in
danger
of
being
sent
back
or
were
sent
to
the
poke
where,
where
did
that?
One
end
up.
J
What
happened
to
okay,
preventing
recidivism
so
you've
got
a
whole
category
of
people
they
get
arrested.
J
They
need
to
have
the
addiction
severity
index
administered.
They
may
or
may
not
go
to
the
local
mental
health
center
for
that
they
have
not
been
incarcerated,
except
over
the
weekend.
They've
not
been
adjudicated,
they've
not
been
sentenced
and
if
they
and
they
may
be
adjudicated
and
sentenced,
they
may
serve
time
in
a
local
county
jail.
J
So
there's
there's
got
to
be
a
a
broader
moniker
than
that,
because
that's
where
a
lot
of
these
people
still
fall
through
the
the
cracks
in
the
system,
there's
a
waiting
list
for
those
folks
to
get
seen.
Sometimes
we
have
well.
You
know
I've
heard
that
there
are
county
county
court
justices
that
will
send
people
to
private
providers
rather
than
the
community
mental
health
center,
which
means
you're
paying
twice
for
the
same
service.
J
So
I
I
think
sue's
admonition
that
we
need
to
keep
this
much
more
broad
than
just
doc
is
is
a
good
one.
Thanks,
representative
wilson,
that
was
a
good
catch.
G
Yes,
thank
you,
chairman
kinski
and
representative
wilson,
and
the
justice
involved
in
department
of
corrections
has
come
up
in
our
previous
exercises
as
well
and
with
that
intent
that
it
was
the
more
generic.
G
Reference
to
to
corrections
in
general,
and
so
with
the
issue
of
recidivism,
would
that
fall
under
the
with
with
preventive
and
would
that
fall
under
the
justice
involved,
or
is
that
more
of
a
high
need
substance,
abuse
scenario
with
preventing
recidivism.
J
They're
in
danger
of
backsliding,
because
they've
got
drug
and
alcohol
issues.
What's
the
statistic
99
of
the
substance
of
the
abused
clients
through
the
community
mental
health
centers
have
a
their
justice
involved
or
no
of
the
justice
involved.
Clients
99
have
a
substance
abuse
problem,
so
it's
it's
one
in
the
same,
their
danger
so
preventing
I
it's
preventing
incarceration
or
recidivism.
G
Okay,
thank
you.
So
what
about
sort
of
moving
to
the
right,
the
right
part
of
our
screen
here?
What
about
the
indigent
unemployed,
underemployed?
F
And
jerry,
this
is
stefan
for
the
for
the
committee.
I
would
just
mention
again
the
the
first
three
buckets
you
see
here
are
more
kind
of
the
way
we
think
about
it
in
the
health
department.
Our
other
programs
is
categorical,
I
think,
to
to
paraphrase
some
of
senator
kinski's
language
from
the
discussion
and
now
you
know
just
queueing
up
a
question
moving
to
the
the
financial
side
or
what
you
see
in
statute
in
our
contracts.
F
In
many
cases,
is
inability
to
pay,
so
just
want
some
discussion
from
the
group,
if
that
makes
sense
as
a
as
a
population
a
priority
population.
Category
kind
of
in
this
in
this
blank
slate
before
we
introduce
resource
constraints
with
the
role
of
state
dollars
in
the
community
mental
health
and
substance
abuse
system,
should
they
be
geared
towards
those
with
an
inability
to
pay
either
with
categorical.
F
Sure
senator
kinski,
so
you
know
again
thinking
just
in
in
the
context
of
the
role
of
the
state
with
these
state
dollars
for
community
mental
health
and
substance
abuse
services
that
the
department
of
health
manages
would
a
category
of
inability
to
pay
or
indigence
so
uninsured,
you
know
not
able
to
to
finance
or
pay
for
mental
health
and
substance
abuse
services.
F
Does
that
make
sense
as
a
bucket
here
as
a
stand-alone
bucket
as
kind
of
an
eligibility
criteria
or
category
for
the
use
of
those
state
dollars
or
you
know
over,
doesn't
need
to
overlap
with
the
other?
You
know
categorical
elements
that
you
see
on
the
left-hand
side
of
your
screen.
H
You
know,
if
you
think,
of
a
flow
chart,
you
know
a
person
who
is
unemployed,
but
let's
say
they:
they
just
want
marriage,
counseling,
and
I
don't
say
just
because
you
know
marriage
counseling
is
marriage
is
important
and
marriage
counseling
is
important,
but
I
think
that
given-
and
maybe
we
don't
want
to
get
into
resource
constraints
just
yet,
but
I
I
do
think
that
if
a
person
comes
in
and
they're
just
not
able
to
pay
for
marriage
counseling,
let's
say
that.
H
But
I
don't
feel
that
the
state
at
that
this
time
is
going
to
be
able
to
provide
all
services
to
everybody
who
can't
pay
for
the
services
that
they
would
want.
I
I
think
that
this
is
an
area
where
we
need
to,
you
know,
have
the
sort
of
a
flowchart
thing
and
direct
people
to
somewhere
else.
That's
what
I
think.
F
And
representative
wilson,
that's
a
great.
This
is
stefan
and
sorry
to
jump
in
jerry,
but
it
peaked
my
interest
in
terms
of
that
ability
to
pay
representative
wilson
when
we
talk
about
folks
who
are
uninsured,
as
you
know,
with
many
years
on
the
on
the
labor
committee.
That
often
is
measured
by
you
know
the
the
federal
poverty
level
so
to
bring
in
that
conversation
from
earlier
about
access
to
other
resources,
whether
they're
state
financed
or
the
insurance
market,
the
private
market
federal
funds.
F
What
have
you
would
that
be
not
to
be
overly
suggestive
wilson,
but
would
that
be
kind
of
how
you're
thinking
of
of
uninsured
in
a
traditional
sense
would
be
folks
who
in
wyoming
would
be
under
the
federal
poverty
level
and
thus
kind
of
in
that
coverage
gap
not
potentially
eligible
for
not
eligible
for
medicaid
and
maybe
not
qualifying?
For
you
know
federally
subsidized
health
insurance,
or
was
it
kind
of
deeper
than
that.
H
H
You
know,
200
of
the
federal
poverty
level
or
something
like
that,
but
you
know
I
think
that
sometimes
there's
some
gray
area
in
that
I
mean
a
person,
a
person
who
gets
laid
off
in
in
july
and
loses
their
insurance
their
you
know
if
they
were
making
eighty
thousand
dollars
a
year
before,
of
course
they
may
have
savings,
but
I
mean
I
I'm
not
sure
that
I
can
really
pin
down
a
mathematical
point
right
now,
but.
G
Okay,
thank
you
and
again
these
are
just
initial
discussions.
So
plenty
of
time
to
you
know,
discuss
details
of
you
know
as
as
we
move
forward
at
a
future
date.
J
Likewise,
would
adolescence
in
need
of
mhsa
services?
Is
that
going
to
end
up
going
over
on
the
left?
Are
we
talking
about?
Do
they
just
generically,
have
a
need?
Are
we
talking
about
they're
caught
up
in
juvenile
justice
and
protective
services
and
department
of
family
services?
Isn't
that
how
they
get
to
us?
Typically,
that
they're
caught
up
into
the
system
in
some
way
that
shouldn't.
K
H
Personally
I'll
just
say
not
necessarily
because
there
are
an
awful
lot
of
people
and
I'm
speaking
from
you
know
some
personal
knowledge
of
some
people.
H
I
know
you
know
between
the
ages
of
say,
12
and
16
who
their
families
their
schools,
their
churches
are
wrestling
with
how
to
help
this
youth
and
prevent
them
from
ending
up
in
dfs
and
in
juvenile
court
and
through
through,
even
if
people
have
insurance
but
the
inability
to
pull
together
all
the
community
resources,
because
people
are
kind
of
out
there
on
their
own
trying
to
help
their
kid
and
there's
these
silos.
I
mean
I
I
think
we
want
to
if
we
can
catch
these
kids
before
they
get
there.
H
J
Maybe
it
needs
to
be
on
both
sides
of
the
ledger,
then
I
I
I
think
that
you
know
when
it
when
there's
a
child
and
there's
allegations
in
the
family
of
abuse.
You
know
one
of
the
parents
has
a
drug
issue.
J
It
is
more
akin
to
what
we've
got
on
the
left,
so
I,
but
I
also
see
that
another
category
that
sue's
talking
about
where
they
haven't
gotten
to
that
point
and
they
need
some
resource
or
case
management.
So
I
think
this
adolescence
in
need
of
mhsa
has
to
be
over
here
on
this
left
side
of
the
ledger.
That
has
these
people
that
are
all
kind
of
getting
ground
up
or
in
danger
of
being
involved
with
the
justice
system
broadly
conceived.
G
Thank
you:
would
it
warrant,
perhaps
adolescents,
being
their
own
their
own
category,
knowing
that
there
will
be
overlap,
perhaps
with
with
the
justice
involved
category
and
the
inability
to
pay
category.
J
J
I
mean
at
some
point
we're
going
to
have
to
decide
where
we
cut
where
the
cut
line
is
here
in
terms
of
what
we
can
afford
to
fund.
That's
why
I
wanted
it.
I
was
advocating
it
toward
a
separate
locale
on
the
left
hand
side
as
well
as
a
home
on
the
right,
but
whatever
the
group
thinks
or
whatever
you
think.
However,
you
want
to
do
it,
it's
your
exercise.
A
So
kind
of
following
that
discussion,
in
what
I
see
with
adolescents,
is
and
and
there's
kind
of
there's
this
kind
of
this
crossover
issue,
particularly
as
you
get
into
the
16
17
18,
where
you
start
to
see
bipolar
stuff
start
to
exhibit
in
in
in
in
depression,
becomes
and
and
these
these
adolescents
or
young
adults
are
struggling
to
try
and
figure
out
what's
going
on,
and
so
I
agree
that
it's
if
we
can
identify
that
and
provide
the
services.
A
But
will
those
services
are
those
services
provided
in,
and
I
just
want
to
make
sure
that
I'm
understanding
this
exercise
right,
because
how
many,
how
many
of
them
would
be
receiving
services
within
the
school
system
or
through
private
in
in,
does
this
and
we're
not
taking
into
any
consideration
the
pay
source?
I
think
we're
just.
I
so
help
me
with
that
a
little
bit
jerry
right
now,
because
I
agree
with
senator
kinski.
This
is
if
we
can,
if
we
can
get
it
identified
before
they
get
to
the
correctional
problem.
G
Thank
you
to
address
that
france
put
down
a
a
possible
bucket
of
preventative
or
those,
maybe
in
need
of
preventative
or
case
management,
and
if
we
had
adolescents
under
under
that
category,
as
well
as
adolescents,
that
are,
you
know
just
as
involved
with
dfs
or
with
the
court
system.
Perhaps
that's
how
we
can
get
them
on
capture
adolescence
on
both
ends
of
the
spectrum.
G
Pre
pre
involvement,
with
a
with
the
state
institution
and
or
those
at
risk
of
entering
into
a
state
institution
would
would
that
category
capture
sort
of
the
the
concerns.
G
L
And
jerry
and
representative
larson,
if
it's
okay,
I
was
just
gonna
open
up
the
discussion
on
spmi.
I
just
personally
think
this
is
a
little
bit.
This
category
is
a
little
bit
different
from
the
other
ones
in
here,
because
these
folks
might
not
necessarily
have
serious
mental
health
issues
they're.
Just
they
just
can't
pay
it's
kind
of
the
definition
of
the
bucket,
and
I
wonder
if
this
might
fit
better
with
some
of
like
the,
for
example,
the
high
needs
substance
abuse.
You
know
as
sort
of
being
more
of
a
chronic.
You
know
condition.
L
You
know
where
folks
just
kind
of
have
to
be
maintained
over
time
versus
you
know
not
just
having
the
inability
to
pay
but
wanted
to
throw
that
for
discussion.
A
So
I
I
guess
jerry
if
I,
if
I
may
go
in
there-
and
I
appreciate
that,
but
I
guess,
as
I
look
at
state
resources,
if
this
serious
and
persistent
mental
illness
individual
it
has
avail
is,
is
on
an
insurance
policy,
then
I
don't
think
it
would
fit
into
what
the
state
would
provide
services
for.
I
think
that
these
are
the
the
people
that
that
are
out
there
in
our
community
somewhat
indigent,
that
don't
have
a
means
to
pay
and
or
don't
have
insurance
so
help
me
there.
If
you
would
franz.
L
So,
sir,
I
can
add
like
without
means
to
pay
here,
if
you
want
to,
unless
there's
a
discussion
about
the
people
that
do
have.
You
know,
for
example,
to
senator
kinski's
point
about
you
know
there
may
be
people
on
disability
on
medicaid
that
have
spmi
that
maybe
not
be
adequately
served
because
of
the
you
know.
As
senator
kinski
mentioned,
the
the
qualis
utilization
management
limits.
A
Well,
I
guess
I
was
thinking
stefan
if
I'm
yeah,
I
I
guess
steph
and
what
I
was
thinking
was
more
on
those
people
that
have
these
have
these
conditions,
that
don't
that
don't
have
the
means
to
pay.
J
J
H
So
this
is
where
my
discussion
about
sort
of
the
case,
management
and
flow
chart
fits
in
in
a
sense
in
that
you
know
if
people,
so
we
we've
got
sort
of
a
an
intake
case
management
assessment
thing
people
come
in
and
maybe
they've
got
serious
in
percent
persistent
mental
illness,
but
they
can
pay
and
there's
a
community
provider.
You
know
you
can
route
them
there.
It
is
same
with
you
know.
Maybe
I
mean
I.
I
don't
know
how
many
private
providers
of
substance
abuse
treatment.
H
There
are,
but
maybe
there's
another
resource
and
you
might
be
able
to
put
them
there.
Maybe
there's
an
unemployed
person
who
wants
marriage
counsel,
I
mean
so
in
some
ways.
The
case
management
aspect
and
the
inability
to
pay
aspect
kind
of
work
hand
in
hand
in
that.
G
Thank
you.
This
is
turning
into
a
really
really
great
discussion.
I
wanted
to
raise
attention
to
some
some
of
our
categories
that
are
kind
of
outlying,
the
core
comorbid
health
conditions
and
dual
diagnosis,
developmental
disability
and
mental
health.
G
Any
discussions
on
those
being
sort
of
their
own
categories
or
falling
into
one
of
our
existing
categories,
sort
of
on
the
opposite
end
of
the
spectrum
of
acute
psychic
psychiatric.
We
have
sort
of
long-term.
A
So
so
jerry,
if,
if
I
may,
if
we
look
like
at
comorbid
health
conditions
and
dual
diagnosis
as
we
went
through
the
state
health
facility
discussion-
and
we
said
if
there
are
people
that
fit
into
these
categories-
that
the
long-term
care
facilities
are
not
equipped
to
deal
with
the
safety
net.
There,
then
would
be
what
we're
doing
at
with
the
expansion
at
the
life
resource
center,
with
the
intent
that
they
would
then
go
back
out
into
the
community
once
they're,
stabilized
or
or
have
any
way
they
would
have
an
exit
plan.
A
Are
we
looking
at
the
community
mental
health
providers
as
being
the
safety
net
or
leaving
that
on
the
state
facilities
as
a
safety
net?
If
we're
leaving
it
on
the
state
facilities
as
a
safety
net,
then
how
are
we
looking
at
these
two
conditions
being
served
by
the
community
mental
health
providers?
F
And
representative
larson,
this
is
this-
is
stefan
to
jump
in
there.
I
think
it's
a
it's
a
great
question,
the
with
with
the
dd
population
that
might
have
you
know
dual
diagnosis
with
mental
health.
I
think
that
between
the
new
missions
of
the
two
state
facilities
as
well
as
are
already
established,
you
know:
medicaid,
waiver
programs,
home
and
community-based
service
programs
do
in
in
part,
if
not
a
substantial
part
capture
a
lot
of
that
population.
So
your
question
is
a
good
one.
When
we
bring
this
this
exercise
back
to.
F
Is
there
a
role
for
the
state
funds
in
the
community,
mental
health
and
substance
abuse
system
for
a
population
like
that?
F
I
think
you,
you
find
people
in
the
legislature
with
much
more
responsibility
than
us,
you're
thinking,
kind
of
statewide
right,
because
it's
difficult
not
to
you
think
of
mental
health
and
substance
abuse
services
as
across
department
of
health
corrections,
department,
family
services,
other
other
systems,
which
is
which
is
totally
appropriate,
but
in
this
particular
exercise
I
would
answer
the
question
with
another
question,
respectfully,
sir,
that
if
you
know,
is
there
some
role,
some
safety
net
role
for
the
community?
F
Mental
health
and
substance
abuse
centers,
with
state
funding
to
target
a
population
like
comorbidity
with
or
a
dual
diagnosis
between
dd
and
mental
health,
and
I
don't
I'm
not
suggesting
one
answer
over
another,
but
I
think
it's
it's
difficult
to
not.
F
You
know,
think
of
that
population
within
some
of
these
buckets
that
have
already
been
developed
here,
for
example,
to
your
point
representative
larson,
about
this
two-state
facilities
that
population
that
the
facilities
task
force
and
legislature
determined
would
be,
you
know,
served
on
an
acute
basis
at
the
state
hospital
and
then
discharged
to
the
life
resource
center
for
further
stabilization
and
ultimate
discharge
back
to
community
providers
or
community
supports
that
to
me
in
the
dd
plus
mental
health
world
would
fit
into
you
know
a
pre
or
post-institutional
category.
F
A
So
jerry,
if
I
may,
I
I
agree
with
that,
but
the
role
in
in
our
community
mental
health
system
for
these
is
what
and-
and
I
would
see
it
if
we
already
have
services
or
through
behavioral
health
and
our
community
providers,
to
address
these
issues.
Is
it
the
role
that
the
community
mental
health
providers
just
to
make
to
to
assess
and
make
referrals
what
what
would
be
their
roles?
Because
we
don't
want
to?
I
I
don't
see.
I
think
we
need
to
be
careful
that
we're
not
duplicating
services.
G
Thank
you,
chairman
larson.
That's
a
great
question
on
what
to
do
with
this
group.
That's
you
know
already,
you
know,
there's
a
safety
net
for
them
in
our
state
facilities
as
their
thoughts
on
the
group
of
what
the
role
of
the
community
providers
are
with
what
dual
diagnose
and
comorbid
help
those
with
comorbid
health
conditions.
I
I
don't
have
a
I
I'm
gonna
tangently,
take
us
slightly
away
from
that,
because
I
I've
been
meaning
to
mention
this
for
a
while.
But
I
I
almost
I
think
in
our
current
system,
it's
where,
in
my
mind,
we're
missing
a
completely
third
category.
It's
not
just
justice
involved
in
inability
to
pay,
but
there's
an
access,
and
maybe
that's
more
of
a
resource
question,
but
there's
a
whole
category
of
access,
and
we,
if
we're
talking
about
the
system
that
we
have
you
know
and
where
we
have
our
our
community
health
providers.
Okay.
I
But
if
we're
talking
about
the
future
of
our
system
and
maintaining
it
access
is
a
is
a
category
for
me
and
then,
of
course,
there's
some
type
of
function
that
narrows
down
who
receives
services,
but
in
a
rural
state
like
in
a
rural
state
that
we
have,
there
are
communities
where
it
doesn't
make.
It
might
not
make
profitability
sense
for
a
foreign
institution
to
set
up
shop
there
and
that's
why
there
isn't
an
institution
there
and
so
having
one
of
the
states
functions.
I
I
think
should
be
to
provide
access
in
those
rural
areas
where,
where
the
services
don't
otherwise
make
economical
sense
from
the
private
sector,
and
so
you
may
not
have
a
justice
involved
scenario,
you
may
not
even
have
your
complete
economic
hardship,
you
just
simply
don't
have
the
resources
because
of
the
rural
community
and
those
tend
to
really
compound,
because
when
you
have
geographic
isolation,
you
know
mental
health
issues
etc.
I
G
Thank
you.
That's
a
that's
a
great
point
and
franz
added
that
as
an
additional
category,
are
there
any
specific,
popu
populations
that
that
you'd
want
to
add
under
this
or
is
it
just
you
know
rural
populations
or
anything
anything
else.
You
want
to
add.
I
Involved
systems,
it's
going
to
filter
through
them
for
the
most
part
we're
it's
gonna,
it's
gonna
double
touch
those
people,
but
I
I
guess
I
would
envision
potentially
their
scenarios
where
someone's
not
unemployed
and
they
have
insurance,
but
they
need
a
facility
to
go
to
right
so
or
they
need
providers
they
or,
and
they
may
not
be
in
their
community-
and
I
would
say
that's
a
that's.
I
A
function
still
of
our
system
is
to
is
to
help
establish
those
providers
in
those
communities
where,
even
if
they
have
insurance
or
they
are
employed,
they
still
need
access
to
it
and
that
becomes
a
whole
different
universe,
of
course,
than
what
we're
talking
about,
because
the
cost
of
the
state
is
much
different.
But
I
think
we
end
up
double
dipping
those
because
we
put
our
resources,
obviously
towards
the
more
high-risk
categories.
But
I
think
world
populations
is
fine.
A
But
is
that
not
the
structure
of
our
community
mental
health
system?
Currently
that
general
access
is
available?
And
then
there
is
a
structure
to
reimburse
through
to
the
program
those
some
of
these
difficult
populations?
So
nobody,
so
I
think
the
intent
of
the
currently
is
to
allow
for
some
general
access
to
services.
I
G
Okay,
thank
you
and
trying
to
to
wrap
up
this
section
of
the
exercise.
We
still
have
those
dual
diagnosis,
hormone,
core
health
conditions-
excuse
me
that
there
may
need
to
be
further.
K
So
you
know
watching
the
conversation
on
and
addictions
have
popped
up
several
times
here
and
I
don't
know
this
is
a
bucket,
but
look
I
we
mention
of
how
sometimes
we
try
to
keep
people
out
of
a
system
or
we
we're
we're,
seeing
them
recur,
recurringly
coming
into
the
system
and
what
I
see
is
we
need
to
really
revisit
the
whole
thing
with
addictions,
because
what
we
see
are
our
states
that
have
become
tougher-
and
I
say
tougher
in
the
fact
that
people
do
become
arrested
and
incarcerated,
and
when
you
look
at
some
of
this
population
that
has
been
addicted
for
over
25
years
and
they
finally
come
to
grips
with
what
happened
in
their
whole
life.
K
They
said
that
the
system
finally
saved
them,
and
I
want
to
think
about
all
the
cost
that
has
happened
in
a
25-year
plus
cycle
of
incarceration
and
letting
them
out
in
and
out
and
getting
in
trouble
and
trying
to
go
through
addiction
services
on
the
outside.
But
what
kind
of
finally
happened?
Is
the
system
got
it
right
said
this?
Is
you
can't
do
this?
We've
got
a
couple
of
options
for
you
and
you
have
to
complete
these
things.
K
Sometimes
they
use
drug
treatments,
they
use
pharmaceuticals
to
actually
treat
people
who
have
been
habitual
for
many
years
and
they
have
to
take
those
those
drugs
and
it
counter
balances
how
their
system
reacts
with
that
that
desire
to
to
be
addicted.
You
know
to
take
drugs
anyway,
to
narrow
it
down.
K
We
have
to
revisit
how
we're
treating
those
people
when
they
first
get
in
the
system,
and
you
know
there's
this
tendency
where
we
want
to
go
well,
let's,
let's
just
make
this
easier
and
let's,
let's,
let's
make
it
a
an
outpatient
thing:
let's
try
to
get
them
through
this
crisis
coming
to
find
out,
all
we're
doing
is
harming
them
because
they're
just
stuck
in
a
cycle
they
can't
get
out
of
until
we
say
hey
enough
enough.
We've
got
to
stop
this
now.
This
is
what
you
know.
There's
there's
there's
punishment,
that's
in
place
for
correction.
K
There
are
states
that
have
there
have
gotten
tougher
and
they
put
these
systems
in
place
and
when
they
and
when
people
get
out
of
the
prison
system,
they
actually
go
to
a
an
outpatient
type
system
where
they
have
to
go,
get
their
their
drugs
to,
and
I'm
saying
drugs
that
actually
treat
the
the
addiction
part
in
their,
and
you
know
the
chemistry
of
that
so
and
if
that's
the
way
they
they're
treating
it,
it
depends
on
what
what
type
of
drugs
they're
addicted
to
there's
other
cases
where
they'll
go
to
an
outpatient
when
they
get
out
but
and
they
may
use
other
methods
of
treatment.
K
But
the
bottom
line
is
if
we,
if
we,
if
we
just
keep
thinking
we're
going
to
bounce
them
around
for
20
plus
years,
look
at
the
cost.
That's
involved
to
all
that
so
like
like
I'm
saying,
I
know
if
it's
the
right
for
for
a
bucket,
but
it's
certainly
we
have
to
revisit
how
this
is
working,
because
it's
not
working.
G
Thank
you
for
that
comment.
Any
any
response
from
the
group
on
addiction,
whether
that
should
be
its
own
category.
Do
you
feel
like
it's.
Those
with
addiction
are
adequately
capped
or
captured
in
sort
of
our
existing
categories.
L
Jerry,
if
I
could
suggest
real
quick,
this
is
franz.
Maybe
we
could
subdivide
this
bucket
and
to
just
for
the
purpose
of
this
discussion.
Kind
of
maybe
break
out
sort
of
the
the
higher
needs
folks,
without
ability
to
pay
from
the
lower
needs.
I
guess
is
I
mean
not
to
I'm
sure
people
that
maybe
are
unemployed
or
uninsured
have
have
needs,
but
you
know
to
send
your
bouchard's
point
into
you
know.
L
I
think
there
is
sort
of
a
a
little
bit
of
a
divide
here
between
sort
of
an
inability
to
pay
an
inability
to
pay
like
high
needs.
You
know
category
and
kind
of
thinking
of
them
differently,
treating
them
differently
from
the
sort
of
broader
inability
to
pay
slash,
uninsured
population.
If
that's
okay
with
that
with
the
group-
something
like
like
this,
but
again
this
is
an
exercise
for
you
all.
So
if
you
disagree,
we
can
certainly
change
it
back.
G
Okay,
any
any
concerns
with
sort
of
subdividing
that
group
okay,
all
right.
Well
in
the
in
the
interest
of
time,
I
think
that
we
will
just
put
our
our
last
two
categories:
sort
of
in
a
parking
lot
area.
This
was
certainly
a
a
great
discussion.
Thank
you
all
for
your
for
your
comments
and
and
sharing
your
your
thoughts
and
experiences.
G
This
certainly
isn't
the
the
end
on
and
be
all
right.
We'll
have
time
to
you
all
will
have
time
to
refine
and
go
through
these.
You
know
at
a
future
date
in
more
detail
and
make
revisions.
This
was
simply
a
an
exercise
to
to
to
to
start
to
see
where
we're
at
with
with
with
these
populations
that
that
the
state
would
be
serving
so
moving
on.
I
guess
chairman
larson
did
you
have
any
any
thoughts
on
this
before
we
move
on
to
the
next
exercise.
G
G
All
right,
so
this
is
we've
gone
through
and
identified
populations
to
be
served,
sort
of
attempted
to
categorically
group
them
together.
This
was
just
sort
of
throw
everything
at
the
wall
exercise
who,
who
are
the
people
that
what
we
would
want
to
serve,
and
now,
let's
introduce
some
constraints,
and
so
you
know
in
an
ideal
world
we
would
have
enough
resource
to
serve
all
of
them,
but
now
that
we
are
introducing
funding
constraints,
how
would
we
go
about
sort
of
prioritizing
each
of
these
categories?
G
And
so
I
want
you
to
take
take
a
moment
and
think
about
how
how
perhaps
you
would
rank
these
with
a
percentage
right?
If
we
had
x
amount
of
of
dollars,
we
had
what
percentage
of
our
state
funding
would
go
towards
each
of
these
we'd
go
towards
each
of
these
categories.
A
G
Yes,
I
think
percentages
would
be
first
to
your
first
point.
Percentages
would
be
a
a
great
way
to
consider
those
percentages
of
priorities,
and
then
franz
do
you
want
to
flip
back
to
the
previous
slide?
Please.
So
these
are.
G
Why
don't
you
take
a
look
at
these
and
think
about
how
you
prioritize
them
take
a
minute
or
two,
and
then
we
can.
We
can
share,
share
and
have
a
discussion
on
thoughts
moving.
G
G
G
Populations,
so
no
no,
no
fears
about
the
you
know
the
way
one
thing's
allocated
here
is:
you
know
how
it
will
end
up
in
in
legislation
or
anything,
but
just
more
of
an
exercise
to
see
if
we
can
come
to.
E
Thank
you.
So
my
question
is
in
considering
how
we
reign
is.
Do
we
do
should
we
make
any
assumption
whether
some
of
these
folks,
I'm
just
I'm
looking
at
the
justice
involved
first
box
just
involved,
they
have
a
choice:
whether
to
use
community
mental
health
or
private
providers
with
the
same
access,
or
do
we
have
to
make
an
assumption
that
they
would
not
have
the
same
access
to
provide
private
providers
as
they
would
community
mental
health?
Thank
you.
G
F
Yeah,
thank
you
jerry.
This
is
stefan
and
representative
barlow,
it's
a
great
question
and
I
think,
for
the
purposes
of
the
exercise
again,
I
want
to
funnel
this
as
much
as
we
can
back
to
the
role
of
the
community
mental
health
and
substance
abuse
system.
So
I
think
for
the
justice
involved
populations,
it
would
be
kind
of
an
assumption
that
you
know
the
the
court
system
or
the
legal
system
would
be
funneling.
F
You
know
towards
the
community,
the
state
funded
community
providers
because
otherwise
I
think,
as
you
kind
of
alluded
to,
sir,
it
just
gets
too
big.
It's
the
same,
as
you
know,
with
you
know,
title
25
directed
outpatient
commitment
where
the
court
does
have
the
option
and
and
clients
and
patients
often
have
an
option
to
use
a
private
provider,
but
I
think
we
assume
for
this
exercise
that
we're
talking
about
that
safety
net
role,
when
maybe
there
isn't
another
option
in
the.
F
G
All
right,
thank
you,
stefan
for
that
clarification,
and
if,
if
we're
ready
franz,
can
you
click
to
the
next
slide.
G
And
we
will,
I
guess,
open
it
up
for
discussion
on
how
did
on
prioritization
of
these
categories
that
were
defined.
L
Sorry,
jerry,
I
think
I
clicked
leave
the
meeting
when
on
the
share
screen.
F
B
G
Right,
hopefully,
it's
not
too
small
and
everyone
can
still
see.
Also
the
the
titles
of
the
populations
are
listed
on
the
left
side
of
franz's
chart
there.
But
if
you
want
to
see
the
detail,
it's
available
on
the
right
side
of
the
screen.
G
H
Right,
I
was
hoping
I'd
end
up
being
last
there,
but
I
see
you
play
pulled
a
teacher
trick
on
me
and
start
on
the
other
end
of
the
alphabet.
So
you
know,
as
I
did
this,
I
really
realized
that
I
wish
that
I
could
like
make
them
green
and
yellow
instead
or
something
because
I
I'm
really
you
know
hopefully
we're
not
visualizing
a
community
mental
health
center
that
has
one
poor
overworked
staffer
and
that's
all
they
are,
and
they
have
to
actually
to
send
people
out
into
the
road.
H
H
I
guess
I
I
don't
know
it's
kind
of
not
anyway
just
put
the
top
justice
one
number
three,
but
that
to
my
mind
that
one
two
three
is
a
kind
of
a
big
wad
there
in
and
then
four
is
inability
to
pay
high
knees
and
five,
the
case
management
and
then
really
I
personally,
I
think
inability
to
pay
in
general
access
are
both
six.
So
I
don't
know
if
you
can
want
to
put
them
both
six
or
six
and
seven.
I
don't
care
how
you
do
that.
H
G
Thank
you.
I
appreciate
you
being
willing
to
go
first,
and
I
recognize
that
it
is
really
difficult
to
to
rank
these,
especially
after
our
discussion
talking
about
the
importance
of
of
each
of
these
categories
and
how
they,
you
know
how
how
nuanced
and
multi-faceted
multi
mental
health
and
substance
abuse
is
so
appreciate
that
again,
just
the
way
to
gauge
general
consensus.
Do
you
see
generally,
where
everyone
is
these
categories
wouldn't
be
up
here?
Unless
you
know
you
all
agreed
that
they
were
important
in
in
some
way.
G
So
I
want
to
make
sure
that,
like
I
said
just
an
exercise,
fine
consensus,
would
there
be
anybody
else.
A
A
So
so
my
question
is:
do
you
want
us
to
rank
him
in
what
we
think
is
priority,
because
that's
a
little
difficult
for
me,
because
I
see
some
if
I'm
looking
at
resources,
I
may
look
at
some
of
them
as
equals,
so
it
so
help
me
understand
how
your
is,
how
you
want
to,
because
I'll
go
back
and
do
that.
I
just
want
to
make
sure
I'm
understanding
the
instruction
correctly.
G
Oh
yes,
thank
you.
Well,
the
instruction
was
for
percentages
right
so
then
we
would
be
able
to
sort
of
rank
two
categories
the
same
with,
if
necessary,
but.
A
So
so
let
me
make
a
stab
at
that
and
then,
if,
if
sue
wants
to
come
back
and
and
look
at
that
a
little
later
on,
but
and
and
if
I'm
doing
it
wrong,
please
please
correct
me,
but
but
I
but
I
thought
I
heard
that
a
little
bit
differently
so
the
way
I
would
have
the
way.
I
would
do
that
on
that
first
justice
involved
30
of
that's
that's
where
I'm
at
is
30,
then
the
next
the
next
one
is
the
justice
of
non-state
would
be
10
percent.
A
A
Yep
15
and
then
on
inability
to
pay
15
high
needs,
so
you'll
have
three
three
of
those
in
a
row
that
are
fifteen
percent
and
then
the
last
two
at
five
percent.
That's,
if
my
I
remember
I'm
using
land
or
math,
and
so
if
that
doesn't
make
a
hundred
percent
I'll
have
to
go
back
and
correct.
It.
G
H
H
H
Oh
yeah
yeah,
okay
10.
There.
H
B
J
J
Okay,
one
would
be
acute
psychiatric.
J
J
Yeah,
I
I
like
the
ordinal
ranking
system.
I
think
it
forces
us
to
make
choices,
which
is
what
we've
got
to
do.
One
is
acute
psychiatric
two
is
justice
involved
state
institutions.
J
G
Thank
you
again.
This
is
just
a
like.
I
said,
because
it's
an
exercise
just
to
engage
consensus.
I
think
whether
you
feel
more
comfortable
with
with
number
rankings
or
percentage
whatever
is
easier
for
you
to
conceptualize
like
either
way
at
the
end
of
this
exercise,
we'll
be
able
to
gain
a
sense
of
consensus
of
where
the
committee
stands.
So,
let's
see
anybody
ready
to
go
next.
D
Well,
I
gotta
stick
with
my
senator
on
on
senate
way
of
doing
this,
so
I'll
stick
with
senator
kinski's
model
and-
and
I
would
actually
go
exactly
the
same
as
his
but
I'd
swap
a
cute
psychiatric
and
justice
involved.
Oh
one
yeah
there
you
go
there,
you
go
and
then
just.
B
Thank
you
I
guess
I'll
go.
I
had
percentages
and
numbers
so
I'll,
stick
with
the
senators
and
go
with
the
numbers,
so
I
had
justice
involved
number
one
from
state
institutions,
justice
involved,
non-state
institutions,
number
two
acute
psychiatric
number,
three
inability
to
pay
for
preventative;
five
inability
to
pay.
I
need
six
general
access,
seven.
G
Thank
you,
and
since
you
did
have
percentages,
would
you
be
willing
to
share
those
so
we
can
throw
those
in
as
well.
B
Sure
I
had
25
and
then
20
for
number
two.
B
I'm
gonna
have
to
check
my
math.
Now
too
acute
psychiatric
15.
B
G
Okay,
thank
you
and
and
moving
forward
for
the
purpose
of
the
exercise.
I
think
that
percentages
would
be
preferable,
gives
us
a
little
bit
more
more
data
or
insight
on
what
what
the
group's
thinking
so
would
encourage
the
remaining
members
to
consider
percentages
if,
if
possible,
so
let's
see
it
looks
like
we
have
senator
bruce
or
I'm
sorry.
Representative.
Olson
is
your
hand
up.
I
G
And
looks
like
representative
barlow:
do
you
have?
Are
you
ready
to
share
with
the
group.
E
Sure
so
can
I
use
an
alpha
coding
abc.
Would
that
would
that
mess
anybody
up
I'll
start
start
at
the
top
15.
15
20.
E
E
G
Okay,
thank
you,
representative,
farlow
and
then
finally,
senator
bouchard.
K
Yeah,
I'm
I'm
really
torn
here,
because
I
I
see
the
justice
involved
and
unless
we
were
to
undo
laws
I
mean
that
stuff's
gonna
happen
whether
or
not
we
decide
to
spend
money
on
it.
It's
gonna,
it's
gonna,
accrue
costs,
so
my
percentages
are
gonna,
be
high
on
the
on
the
on
those.
K
But
at
the
same
time
I
got
to
balance
the
needs
with
everything
else,
so
I
mean
mine's
going
to
be
a
lot
more
simplistic,
but
I'll
do
a
number
ranking
first,
so
the
number
ranking
would
go
going
down
one
two,
three
five,
four
six
and
seven
and
then
what
I
would
do
is
I
would
take
the
top
three
lines
and
those
would
all
be
20
percent,
and
then
I
just
want
to
be
fair
to
everybody.
I
would
do
the
rest,
the
remainder
of
ten
percent.
K
I
mean
we
have
all
those
issues
there.
I
mean
preventative
case
management.
If
we're
not
doing
that,
we
fail.
If
we
I
mean
we're.
Gonna
have
some
general
access
issues
that
are
gonna
fall
in
the
rural
areas
that
we
need
to
take
care
of
inability
to
pay
high
needs.
K
Obviously,
we
have
a
problem
there,
inability
to
pay
the
people
are
having
problems,
we're
just
we're
going
to
get
stuck
there
with
that
with
that,
anyway,
I
mean
that's
what
we're
dealing
with
we're
dealing
with
the
people
that
can't
take
care
of
these
things
themselves.
So,
like
I
said,
mine
looks
a
lot
more
simplistic
in
nature,
but
I
think
I'm
I'm
being
pragmatic
and
seeing
what
the
what
the
problems
are
and
we're
going
to
have
to
address
them
anyway.
K
G
All
right,
senator
garu
did
you
have
a
comment.
D
G
D
G
All
right,
thank
you.
I
know
that's
a
difficult
exercise
and
I
think
it's
an
exercise,
though,
to
see
to
see
where,
where
everyone
stands,
taking
a
step
back
and
looking
at
this
at
this
chart
any
any
thoughts
or
discussion
you
want
to
have
about
this
any
any
changes
or
before
we
move
on.
F
Oh
excuse
me
jerry.
This
is
stefan
very
briefly
for
the
committee,
I'll
just
mention
that
we're
more
than
happy.
You
know,
following
this
meeting
to
clean
these
slides
up
format
them
a
little
bit
and
kind
of
show
what
the
feedback
was.
We
totally
understand
going
through
this
exercise.
F
F
You
know
rumination
and
thought
about
what
this
all
means,
but
I
think
it's
helpful
again
for
us
and-
and
I
think
the
process
to
quantify
as
much
as
we
can
with
what
the
committee's
initial
feedback
was
as
we
prepare
for
what
what
this
subcommittee
and
other
legislative
bodies
might
do
with
this
with
this
topic
so
again,
color
coding
some
of
this
stuff
to
see
where
the
the
priority
of
the
prioritization,
if
I
can
make
it
sound,
complicated
how
that
would
shake
out,
but,
as
jerry
mentioned
happy
to
happy
to
take
additional
feedback
now
before
we
wrap
up.
A
J
Do
25
each
on
my
first
four
choices.
Everything
else
would
be
zero.
D
Surprising
that
a
democrat
would
do
that,
wouldn't
you
yeah
25
to
acute
side.
G
Thank
you,
everyone
so
much
for
your
for
your
feedback
and
your
discussion,
as
stefan
mentioned
the
the,
but
we
will
take
your
feedback
and
the
information
and
notes
that
we
have
clean
this
up
and
return
it
to
you
to
this
committee
as
a
as
a
deliverable
and
as
a
tool
to
to
help
you
moving
forward
with
what,
with
you
know,
determining
policy
decisions
now
about
the
role
of
the
state
populations
to
be
served,
how
we
might
consider
those
populations
once
restraints
are,
are
presented,
and
I,
if,
unless
anybody,
has
any
any
final
comments
about
or
discussion
items,
I
would
like
to
turn
the
time
over
to
representative
larson
to
sort
of
close
up
and
and
discuss
next
steps.
A
A
How
how
our
number
come
out?
I
would
like
to
go
back
and
ask
a
question
to
franz
and
ask
him
if
he's
seen
this
these
numbers
and
these
buckets
significantly
different
from
what
they've
done
in
the
department
of
health
or
what
they've
done
in
with
wamsack.
And
then
I'd
like
to
make
your
co-chairman
go
to
some
public
comment
and
then
maybe
come
back
with
some
recommendations.
L
Yes,
sir,
mr
chairman,
I'll
just
pull
that
up
just
to
go
through
what
our
discussion
with
wamsack
look
like.
So
this
was
initially,
it
was
a
very
similar
exercise
with
me.
Trying
to
you
know,
put
things
on
a
whiteboard.
We
started
off
with
this
sort
of
brainstorm
of
all
these
different
populations.
L
L
I
think
a
lot
of
similar
focus
there,
of
course,
were
you
know
some,
for
example,
some
of
the
samsa,
the
the
federal
designations,
for
example,
iv,
drug
users,
pregnant
iv,
drug
users.
You
know
women
and
children-
I
think
were
were
included
on
here.
So
this
was
sort
of
the
brainstorm
of
all
the
different.
You
know
that
first
slide
and
then
we
sort
of
went
to
bucketizing
them
with
with
wamsack.
I
think
this
was
some
successful
with
some
to
some
degree.
You
can
see
it's
as
similar.
L
We
have
the
sort
of
institutional
transition
bucket,
although
this
committee
sort
of
divided
that
a
little
bit
into
sort
of
state
institutions
versus
more
local
correctional
processes,
judicial
processes,
dfs
and
heinz
kids
was
an
individual
bucket
here
and
then
we
also
had
a
high
needs
substance,
abuse
bucket
that
was
broken
out,
and
then
I
think
we
we
kind
of
stopped
the
exercise
before
we
were
able
to
find
it
finished
bucketizing
the
rest
of
these
folks,
but
these
were
sort
of
the
main
buckets
that
came
out
of
it
and
the
discussion
sort
of
shifted
to
roll
the
state
and
chairman
larson
is
a
little
bit
different
from
the
exercise
that
we
just
did
with
this
committee.
L
I'm
happy
to
go
through
the
slide,
but
it's
not
as
it's
not
there's
no
comparison.
I
guess
that
we
did,
and
this
was
kind
of
more
brainstorming.
L
You
know
what
is
the
role
the
state
with
respect
to
you
know
from
the
provider
perspective,
you
know
what
should
the
state
be
doing,
what
shouldn't
the
state
be
doing
and-
and
there
was
discussion
about
sort
of
this
balancing
between
the
contract
language?
You
know
how
much
really
should
the
state
be
be
micromanaging
the
contracts
versus
getting
out
of
the
business
of
the
rest
of
the
the
rest
of
the
business,
because
the
contracts
are
not
the
entire
business
of
the
mental
health
centers.
L
You
know
looking
at
flexibility
and
state
policy
really
trying
to
align
between
agencies,
because
there
are
a
lot
of
silos,
as
was
mentioned
in
this
discussion
and
a
lot
of
interaction
between
budgets.
So
how
do
you
really
braid
and
coordinate
those
those
those
payment
sources?
L
You
know,
I
think
we
really
concentrated
in
this
discussion,
mostly
on
the
state
general
funds
going
to
the
mental
health
centers,
but
there's
also,
you
know,
medicaid
funds
on
both
the
for
you
know
prtf
side,
for
example,
you
know
other
funding,
sources
that
are
available,
samsa
grants,
federal
grants,
and
so
this
is
sort
of
again
a
brainstorm
on
on
really
what
what?
What
is
the
role
of
the
state?
I
think
this
sort
of
focus
on
the
safety
net
was
also
brought
up,
so
you
know
really
what
is
the?
L
What
is
what
is
the
the
role
of
the
state
contract
specifically,
and
how
does
that
interact
with
the
rest
of
the
business
that
they
do
was
kind
of
the
focus
of
this
of
this
slide?
L
Do
you
have
any
other
questions
represent
chairman
larson
or
co-chairman.
A
Members
of
the
committee
any
questions
for
franz.
What
we've
got
here,
I
can't,
I
can't
see
all
of
you.
So
just
let
me
know
if
you
see
anybody
there
dave
that
raising
their.
A
Hand
so
I
think
let's
go
staff
elizabeth
could
do
we
have
anybody.
That's
want
to
make
public
comment
on
this.
J
A
A
I
think
that
that
is
probably
the
suggestion
of
the
day.
We
will
take
a
we'll
take
a
how
many
minutes
did
you
say
I
want
to
make
sure
that
I
get
this
right.
A
A
A
L
L
D
G
A
You
know
that's,
like
mrs
larson
always
looks
at
people's
shoes.
I
never
even
noticed
she
didn't
have
one
on
mike.
So
sorry,
thank
you.
Thank
you,
oh
yeah,
so
I
think
every
committee
we're
back
and
we're
ready
for
comment.
I
think
we
have
one
public
comment:
miss
somerville,
who
is
the
with
our
website
group?
If
you'd
like
to
come
on,
introduce
yourself
and
provide
some
comments,
we
and
then
we'll
ask
questions.
C
Thank
you,
mr
chairman.
Andy
somerville
represented
ramstack
and
all
your
community
mental
health
centers.
So
my
comments
are
pretty
brief.
I
want
to
thank
you
guys
for
going
through
the
exercise.
C
C
C
It's
really
hard,
sometimes
to
know
what
bucket
people
fall
into
until
we
get
them
in
the
door.
So
one
of
the
things
that
we've
been
discussing
is
does
general
access
mean
that
at
least
everybody's
entitled
to
an
assessment,
so
we
get
them
in
the
door
and
figure
out
what
their
needs
are
and
then
maybe
refer
them
out
to
other
resources.
C
So
I
just
want
to
put
that
out
there
for
discussion
and
further
discussion
in
the
future,
and
then,
mr
chairman,
if
it's
okay
with
you
I'd
like
permission
to
share
my
screen
real
briefly
to
just
show
you
guys
a
definition
of
what
we've
worked
off
in
the
past.
I
didn't
want
to
give
it
to
you
guys
prior
to
color
your
discussion,
but
I
thought
I'd
share
it
now,
if
that's
acceptable.
B
A
C
C
This
came
from
the
department
of
health
and
used
to
be
agency,
language
that
was
included
in
all
of
the
community
mental
health
center
contracts.
That
language
is
no
longer
included,
and
I
apologize
to
the
committee.
I
have
no
idea
if
that
was
a
just
a
paperwork
reduction
or
if
there
was
a
change
in
policy.
I've
been
unable
to
determine
that,
but
this
is
what
used
to
be
in
there,
and
I
just
wanted
to
highlight
a
lot
of
the
things
that
we
talked
about
or
that
you
guys
have
discussed
this
morning.
C
Case
management,
clinical
assessments,
early
intervention,
medication
management,
geotherapy
services,
services
for
children
and
adolescents
with
sed
again
just
a
lot
of
the
things
that
have
already
been
discussed
and
what
I
think
is
important
about.
This
definition
is
to
kind
of
understand
how
the
community
mental
health
system
was
built
up
in
wyoming
and
for
the
last
you
know,
50
years,
60
years
or
so.
This
is
pretty
much
the
outline
of
how
they
operate,
so
all
of
your
centers
provide
case
management.
C
They
provide
what
I
would
call
wrap
around
services
just
again
to
highlight
the
difference
between
maybe
going
to
a
private
provider
versus
coming
to
a
community
mental
health
center
very
central
to
their
their
mission
is
providing
and
connecting
other
services
for
these
clients
and
that's
both
for
clients
on
the
state
contract,
as
well
as
clients
that
come
in
that
maybe
have
a
medicaid
pay
or
a
medicare
pay
or
our
insurance
paid
all
of
those
things.
C
So
I
just
wanted
to
highlight
that
I
did
forward
that
for
this
definition
to
ms
martinel
and
asked
her
to
send
it
on
to
you
guys
and
I'd,
be
happy
to
have
any
further
discussion,
but
just
just
to
provide
a
little
context
onto
the
services
that
they
provide
now
and
kind
of
how
that's
based.
So
with
with
that,
I
would.
I
don't
have
any
further
comments.
Mr
chairman,
I'd
be
happy
to
stand
for
questions.
E
Eric
thank
you,
mr
chairman,
mrs
somerville.
Thanks
for
the
reminder
of
what
has
been
a
part
part
of
your
mission
or
understood
in
your
mission
for
for
many
for
some
time.
My
question
is
of
these.
E
If,
if
this
were
still
in
place
and
the
and
the
state
was
the
payer-
and
I
know
there
will
be
a
range,
but
if
there's
an
average
or
a
range
that
you
could
give
of
the
community
mental
health
centers
that
are
in
existence
today,
what
percentage
of
the
service
that
they're
providing
are
paid
for
by
the
state
and
fit
under
these
categories
under
this
broad
charge?
Thank
you.
C
Thank
you,
mr
chairman
representative
barlow.
I
think
you
would
there
would
be
a
range
some
of
our
centers.
You
know
the
state
contract
is
35
percent
of
their
budget,
some
of
our
centers,
and
this
would
be
the
smaller
and
medium-sized
centers.
It
can
be
as
high
as
65
to
70
percent.
Our
state
contract
paid
clients
that
fit
within
these
range
of
services.
C
I
would
say
that
the
majority
you
know
more
than
probably
80
percent
are
receiving
a
variety
of
these
services
across
the
spectrum
state
contract,
medicaid
and
private
insurance
clients
that
come
into
the
community
mental
health
centers.
B
Thank
you,
mr
chairman,
now
just
to
follow
up
on
on
representative
barlow,
I
was,
I
was
interested
in
knowing
just
exactly
if
you
had
an
idea
or
are
fairly
close
to
an
idea
of
how
many
actually
have
private
insurance
versus
those
that
have
the
contracts
and
and
so
on.
Do
you
have
an
idea
on
that?
Thank
you.
A
C
Mr
chairman,
senator
schuler
for
our
community
mental
health
centers,
the
number
or
percentage
of
clients
with
private
insurance
is
incredibly
low.
Less
than
10
percent,
probably
closer
to
three
to
four
percent.
In
most
of
the
community
mental
health
centers,
our
two
largest
payers
are
the
state
contract
and
then
medicaid.
E
Mr
chairman,
so
I
guess
you
know
saying
we
have
a
state
contract
and
medicaid
is
our
two
largest
payers
really
for
me.
Those
are
both
public
benefit
payers,
one
being
primary
one
being
fifty
percent
state
funds,
the
other
being
a
hundred
percent
state
funds.
E
So
maybe
we
should
tease
that
out
a
little
more
because
what
I
don't
want
to
end
up
is
with
an
access
problem
for
either
group
either
the
state
directed
state
funds
or
the
medicaid
fund,
so
certain
communities
there
have
a
certain
challenge
with
different
challenges
with
that,
but
I
think
that's
something
else.
We
at
least
we
need
to
pay
attention
to
in
this
discussion
about
general
access
and
some
of
the
we
rated
them
lower
percentage-wise.
E
But
do
the
services
actually
go
away
or
potentially
disappear
into
certain
communities
if
we
don't
have
if
for
those
other
payers,
if
we
don't
have
a
state
system
that
at
least
supports
them
at
some
level,
I
think
that
was
to
represent
olson's
point
early
in
the
conversation.
Thank
you,
mr
chairman.
H
Thank
you,
mr
chairman.
I
guess
then
just
and
I
understand
that
this
was
maybe
previously
under
all
the
contracts,
but
andy.
Could
you
give
us
a
sense?
You
know
where
our
our
discussion
about
rural
areas
so
do.
I
would
I
understand
correctly
that
all
of
the
community
health,
mental
health
centers
would
be
providing
all
of
these
services
one
and
then
in
how
many
of
the
counties
would
you
say
that
the
community
mental
health
center
is
the
only
or
one
of
only
a
few
providers
in
general
in
that
county
that
make
sense.
C
Mr
chairman,
representative,
wilson
or
excuse
me
chairman
wilson,
just
I'm
just
scanning
it
really
quick
to
make
sure
I
don't
miss
speak,
but
I
would
say
all
of
the
community
mental
health
centers
provide
these
services,
although
they
may
be
in
slightly
different
form.
So
the
example
would
be
on
right
here.
It
says
group
therapy,
so
group
therapy
in
casper
might
be
a
variety
of
groups,
so
let's
say
a
women's
sud
group
as
well
as
a
men's
sud
group.
C
If
you
take
that
up
to
crook
county,
for
example,
that
might
just
be
one
group
that
has
to
be
combined.
It
might
not
be
the
best
practice
ideally,
but
we
just
don't
have
the
patient
volume
or
the
providers
to
run
separate
groups,
so
they
might
look
slightly
different
in
each
county,
but
in
general
they
have
some
type
of
all
of
these
services.
C
In
all
the
counties,
we've
got
four
four
counties
that
I
can
think
of
that
you
know
have
the
major
centers,
where
I
would
consider
them
large
centers
that
provide
a
substantial
array
of
services,
the
rest
of
the
counties.
Again,
it
varies
county
to
county.
I
think
we've
only
got
maybe
two
or
three
counties
that
are
really
sparsely
populated
where
the
community
mental
health
center
is
the
truly
the
primary
provider.
C
We
don't
have
any
counties
where
there's
not
other
providers
again,
I'm
I
apologize
for
picking
on
the
northeast
corner
of
the
state,
but
that's
a
smaller
population
there's
just
not
enough.
There
there's
just
not
enough
clinicians.
We
certainly
face
in
the
community
mental
health
center.
We
certainly
face
recruitment
issues
with
clinicians
in
our
rural
counties,
and
so
that's
an
issue
that
I
believe,
extends
to
private
providers
as
well
in
those
counties.
So
there
there's
not
any
county
that
doesn't
have
a
private
another
private
provider
in
it
representative
wilson.
If
that
answers
your
question.
A
A
Then,
as
I
look
at
the
medication
management
and
monitoring
and
then
look
at
those,
if
that's
an
expectation,
there's
there's
certainly
some
gaps
in
that
as
to
those
services
being
provided
in
our
system
now,
particularly
as
we
see
in
bighorn
and
hot
springs
county
and
then
some
in
the
substance,
abuse
management
of
medications
doesn't
exist
at
all,
and
so
I
I
and
I'm
not
I'm
just
saying
I
don't
know
if
that's
just
not
required
in
contract
anymore
or
if
this
document
provided,
even
though
it
is
kind
of
a
definition
that
has
been
there
for
some
time
and
maybe
the
community
mental
health
centers
rely
on
it.
A
A
C
Thank
you,
mr
chairman.
I
think
that's
a
great
point.
So
this
document
is
fairly
old.
I
would
say
eight
to
ten
years
at
a
minimum,
since
it's
been
in
contract
language
for
the
community
mental
health
centers,
it
certainly
does
need
some
updating.
As
mr
chairman,
you
pointed
out,
early
invention
intervention
birth
to
five
years.
C
C
C
You
know
a
center
in
one
of
our
larger
populations
has
more
resources
to
be
able
to
put
towards
that
than
maybe
somebody
in
the
center
part
of
the
state
in
a
rural
county,
and
I
think
those
are
important,
ongoing
discussions
in
terms
of
what
those
services
are
and
how
we're
providing
those
and,
if
there's
major
gaps
that
we
need
to
that.
We
need
to
address,
and
I
would
also
say
that's
also
true
for
sud
and
medication
management
as
well.
A
So
well,
and-
and
I
guess
the
the
point
is-
is
if
this
was
a
current:
if
this
language
was
under
a
current
contract,
then
it
would
reflect
it
reflects
back
on
the
services
currently
being
provided
and
and
and
so
then
my
follow-up
question
is.
Is
I
believe
that
in
the
current
contracts,
you
have
an
attachment
c
that
really
does
define
what
a
community
mental
health
center
is?
Do
you
have
that
available.
C
C
I
think
that
the
definition
in
general
is
a
little
bit
more
streamlined
in
the
current
contracts
than
than
the
ones
that
maybe
are
reflected
on
this
particular
document.
There's.
Certainly,
we
refer
to
those
more
as
contract
deliverables
and
with
this
document
we
think
of
this
more
as
an
all-encompassing
kind
of
to
show
what
a
community
mental
health
center
brings
and
what
they
do.
C
A
So
then,
of
my
fun-
and
I
guess
to
to
my
point
on
that
andy:
is
he
you
just
you
he's
just
trying
to
understand
current
versus
old,
so
I
I
think
it
would
have
been
it.
It's
helpful
to
be
on
the
same
page
where
you
are
currently,
as
you
looked
at
the
our
exercise
and
as
we
used
some
percentages
on
those
populations
we
identified,
and
I
know
that
you're
just
you're
you
and
you're,
you
don't
have
the
input
of
members
and
I
respect
that.
C
I
think,
there's
certainly
a
reflection
of
the
conversations
we've
been
having
over
the
last
couple
of
years
about
the
justice
involved,
population
and
and
what
services
they
need
and
how
that
impacts
the
entire
system,
and
I
think
that
might
have
been
different
than
it
was
a
number
of
years
ago,
but
nothing
that
really
surprised
me.
As
I
indicated
my
earlier
comments,
the
only
thing
that
I
wanted
to
make
sure
didn't
get
glossed
over
was
that
general
access
piece
and
how
we
get
get
people
in
the
door
for
their
first
assessment.
A
Is
that
concerning
or
is
or
you
think,
that's
the
first,
an
appropriate
first
step.
C
Thank
you,
mr
chairman.
I
think
that
we've,
our
members,
have
had
a
lot
of
conversation
about
where
the
appropriate
place
for
defining
what
we're
really
talking
about.
We,
we
talk
a
lot
about
these
priority
populations
and
what
populations
we
should
serve,
but
we're
we're
generally
talking
about
eligibility
who
is
eligible
for
state
services
and
and
how
much
of
state
services
are
they
eligible
for.
We
see
some
pros
and
cons
to
putting
language
in
the
statute.
The
con
that
we're
concerned
about,
I
guess
I'll
start
with
the
pros.
C
The
con
is
that,
as
we
kind
of
go
along
and
and
items
change,
we've
generally
couched
this
in
the
department
of
health,
and
they
certainly
have
more
flexibility
at
an
executive
branch
level
to
make
changes
year
year
to
year
on
who's
who's
receiving
services
or
what
programs
are
important
based
on
kind
of
current
conditions
on
the
ground,
and
so
we
want
to
make
sure
we
maintain
some
of
that
flexibility
so
that,
as
things
change,
so
we
find,
for
example,
maybe
in
the
next
year
or
two
or
three
are
our
suicide
prevention.
C
All
of
those
pieces
that
we're
putting
together.
Maybe
that
becomes
that's
a
really
successful
program
and
we
can
shift
some
resources
over.
If
that's
highlighted
in
statute
as
a
top
priority,
then
we
may
not
have
the
flexibility
to
do
that.
We
may
see
changes
in
how
doc
or
justice
involved
clients
are
served,
maybe
that
evolves
and
and
turns
into
something
outside
of
the
community
mental
health
centers
in
the
future
or
more
doc.
Driven,
that's
a
conversation
that
surfaced
a
few
times
again.
C
A
It
does,
and
so
to
ask
your
question
is
so
if
we
and
again
my
question
is,
is
this
a
reasonable
first
step
and
and
your
point
to
eligibility
I
think,
is
really
a
critical
one
that
would
that
really
warrants
additional
discussion,
maybe
as
based
on
what
the
how
we
get
the
statutes
in
line
then
determine
how
eligibility
is
maybe
in
the
next
interim.
Is
that,
like
a
reasonable
approach.
C
So
if
we
make
some
statutory
changes,
this
session
kind
of
in
line
with
your
your
priorities-
and
we
preserve
that
flexibility
through
and
discuss
eligibility,
whether
it's
I
would
assume
it
would
be
couched
at
maybe
a
department
of
health
level.
I
think
that
that
makes
some
good
sense,
and
can
I
give
you,
mr
chairman,
can
I
give
you
an
example
of
one
of
the
discussions
we've
had
if
you
promise
not
to
hold
me
to
it?
Quite
yet
in
terms
of
eligibility?
C
Maybe
it's
a
conversation
with
department
of
health
about
everybody
comes
in
and
if
you
meet
these
criteria,
you're
eligible
for
three
visits
and
then
we
have
to
refer
you
out
to
other
community
resources,
so
it
becomes
kind
of
almost
a
level
of
service
conversation.
Instead
of
just
a
population
conversation.
A
Well,
I
think
you
guys
are
the
are
certainly
the
experts
and
and
understand
that
what
we're
trying
to
do
is
not
to
much
clip
your
wings,
but
just
say
how
do
we
use
the
resources
that
we
have
to
better
serve
the
state?
And
so
we
want
to
do
that.
I,
I
was
a
little.
You
mentioned
the
suicide
and
we
fund
that
under
public
health,
do
we
not.
C
Mr
chairman,
generally,
yes,
there
are
public
that
was
separated
out
to
the
public
health
division.
Most
of
our
centers
are
involved
in
some
type
of
prevention
programming,
with
their
coalitions.
I
think
we
discussed
that
at
the
last
labor
health
meeting.
If
my
memory
is
not
too
fuzzy,
they
are,
they
are
involved
in
it.
It's
a
significant
piece
of
of
what
they
do
in
terms
of
community
outreach
and
programming.
A
J
Follow
up
andy,
I
just
want
to
make
sure
that
I
I
want
to
make
sure
I
understood
what
you
said
so
correct
me.
If
I'm
wrong
what
I,
what
I
thought
I
heard
you
say
is
rather
than
the
legislature
outlining
getting
too
specific,
you
would
feel
better
if
there
was
greater
flexibility
for
the
department
working
with
the
centers
to
determine
those
priorities
which
may
change
so
I
I
interpret
that
looking
at
this
sample
of
a
contract
here,
which
lists
a
whole
host
of
services
and
says,
serve
everybody.
J
J
The
department
says
well
with
the
bucks
we've
got,
which
is
going
to
be
probably
a
third
less
than
you
know,
given
the
state's
revenue,
let's
theoretically
say
it's
a
third
lesson:
you've
got
now
or
did
have
the
department
works
with
you
to
say,
here's
how
we're
gonna
address
those
priority
populations
and
everything
below
priority.
Four
just
maybe
gets
a
visit
or
two
to
assess,
and
that's
it
you'd
rather
do
that
than
us
just
being
very
specific
as
to
any
more
specific
than
the
approach
than
that.
C
Thank
you,
mr
chairman.
Senator
kinski
in
general.
That's
that's
been
the
collective
discussions
of
all
of
your
community
mental
health
centers
is
is
where
do
we?
Where
do
we
put
that?
How
do
we
balance
getting
clear
direction
versus
balancing
flexibility,
and
I
think,
you've
kind
of
hit
it
in
terms
of
trying
to
keep
the
statutory,
maybe
statutory
changes,
thirty
thousand
level
put
and
then
let
the
department
have
flexibility
on
how
they
they
implement
those,
I
don't
think,
there's
anything
necessarily
bad
about
identifying
some
high
level
goals
or
not.
C
Gold
colleges,
high
level
priorities
in
the
statute
and
then
give
the
give
that
flexibility
down
to
the
department
of
health
and
and
one
reason
that
comes
to
mind
in
particular,
is
as
we've
discussed
a
little
bit
before.
Every
community
is
different,
and
so
we
do
have
some
concerns
about
imposing
kind
of
unilateral.
You
will
serve
these
people
only
under
the
state
contract
across
the
state,
some
of
our
smaller
rural
centers.
C
To
be
very
honest,
just
don't
have
the
population
to
be
able
to
to
cut
out
maybe
all
of
the
general
access
and
still
keep
that
center
financially
sustainable,
that's
something
that
requires
a
lot
more
discussion
as
we
kind
of
go
along,
as
we
include
talk
about
that
rural
access
piece.
So
again,
I
think
that
flexibility
with
department
of
health
may
be
pretty
important.
J
Let
me
ask
a
follow-on,
mr
co-chair,
please
if
I
may
andy
what
percentage,
if
the,
if
these
community
mental
health
centers
are
like
the
schools,
the
small
ones,
the
rural
ones
are
three
or
four
percent
of
the
total
budget
and
and
the
real
money
is
being
spent
in
the
larger
population.
Centers
is
that
true
of
the
community
mental
health
centers
too,.
C
Mr
chairman,
senator
kinski
in
general,
you
will
see
that
type
of
contract
differential
between
the
contracts
for
the
services
that
are
are
in
the
larger
counties
versus
the
smaller
counties.
There's
certainly
a
significant
amount,
a
difference
in
dollar
amount.
I
don't
know
that
it's
exactly
the
same
as
the
schools,
but
there
certainly
is
a
difference
in
dollars
being
put
in.
A
You
know
they
don't
have
any
oversight,
and
so
they
they
run
amok
and
put
all
these
requirements
in
our
contract
and
and
and
don't
fund
it
and-
and
you
know,
they're
the
the
simon
degrees
of
mental
health
administration
and
and
we
need
we
need
protection
from
from
them.
And
then
now
I'm
hearing
you
saying
whoa,
whoa
whoa,
don't
don't
get
carried
away,
because
we
want
the
department
of
health
to
have
flexibility
there
to
allow
us
to
do
some
things,
and
so
you
know
in
in
fairness
to
that
conversation.
I
think
that
there's
some
am.
A
C
Mr
chairman,
I
think
that
that's
an
important
point
to
make
in
terms
of
how
the
relationship
has
changed.
We
certainly
have
conversations
ongoing
conversations
with
department
of
health.
All
the
time
about
specific
things
in
the
contract
you
know
I'll
give
one
example
is
all
of
our
centers
are
required
to
report
all
of
their
patients,
regardless
of
pay
source,
so
their
private
pays.
Their
insurance
pays
their
medicaid.
All
of
that
into
what
we
call
the
wcis
system,
which
is
the
system
that
was
designed
to
take
information
about
the
state
paid
clients.
C
So
we
we
do
all
of
that
data
entry,
but
there's
a
question
about
you
know:
are
we
being
compensated
for
it?
There's
differing
discussions
and
and
ongoing
discussions
with
department
of
health
in
general.
In
the
last
year,
we've
had
really
great
discussions
with
the
department
of
health
moving
forward,
and
I
think
part
of
that
is
just
again
having
those
discussions
and
being
more
open
and
honest
with
department
of
health
about
the
situation
on
the
ground.
What
that
truly
looks
like
now,
I
apologize.
Mr
chairman.
C
I
can't
speak
to
the
dynamic
before
about
18
months
ago,
but
I
have
heard
those
same
concerns
and
what
I
can
tell
you
today
is
that
right
now
they
they
don't
exist
currently
now,
whether
that's
a
further
discussion
about
what
kind
of
sideboards
you
put
on
that
potential
so
that
maybe
it
doesn't
matter
who's
in
the
seat
at
the
time
these
are
kind
of
the
the
sideboards
for
those
discussions.
C
I
think
that's
maybe
something
to
discuss,
but
right
now
we
feel
pretty
good
about
being
able
to
have
those
conversations
with
the
department
of
health.
A
B
A
Thanks
andy,
it's
important
that
we
have
your
input
in
this
as
we
move
forward
viewing
counseling
and
all
of
those
that
are
participating
in
that.
So
any
other.
Any
other
questions
before
we
close
public
comment.
A
I'm
scanning
my
committee
here
andy.
Thank
you
very
much.
So
thank
you.
I
think,
mr
chairman
and
members
committee.
What
I'd
like
to
do
is
I'd
like
to
take
the
the
documents
that
department
of
health
will
get
cleaned
up
for
us
and
then
have
our
lso
staff.
Look
at
those
and
compare
them
with
our
current
statutes
and
say
if
we
were
to
say
these
are
the
required.
This
is
and
we
can
play
with
the
language,
but
the
this
our
policy
as
a
state
is
these.
A
Are
the
populations
that
we're
focusing
on
with
the
appropriation
for
mental
health?
Is
there
anybody
that
feels
we're
premature
on
on
starting
to
have
that
discussion
and
if
so,
what
you
know,
I'm
I'm
open
to
that?
I
don't
know
that.
I
think
that
then
we
could
come
back.
A
Maybe
have
have
a
look
at
kind
of
what
we've
found
out,
but
I
would
like
to
get
if
we're
going
to
move
something
forward
for
an
initial
approach
to
this.
Mr
chairman,
I'd
like
to
get
it
back
before
chairman
wilson
and
chairman
scott's
committee
before
their
next
meeting
in
october.
So,
if
you're,
okay
with
that,
is
there,
mr.
J
I
you
know
I
I
just
speaking
for
myself,
but
I
think
that's
a
fine
approach.
I
think
we've
heard
from
the
department
they'd
appreciate
more
clarity
in
the
statute,
which
is
a
broad
mandate
to
serve
all
you've
heard
it
from
the
providers
that
they
understand
the
budget
situation
and
they'd
appreciate
some
clarification
in
the
in
the
mandate.
J
It's
it's
all
in
how
we
do
it
and
what
we
heard
them
say
I
think
is
do
it,
but
do
it
with
a
very
deft
pencil,
and
so
I
think,
the
sooner
we
get
something
in
writing
in
front
of
us.
The
sooner
we'll
be
able
to
find
out
whether
we've
got
consensus
from
the
department
of
the
provider
community
and
also
to
see
whether
it's
even
going
to
impact
the
budgets
at
all.
J
A
Senator
guru-
please,
oh
you
just
waving
at
me:
okay,
so
john
and
elizabeth,
we'll
clarify
that
up
a
little
bit
move
forward
and
then
come
back
to
the
committee
with
with
some
of
these
suggestions
and
see
if
they're
comfortable,
with
moving
that
forward
to
after
next
discussion,
moving
it
forward
to
the
labor
and
health
committee.
F
Mr
chairman,
this
is
this
is
stefan,
I
think,
matt.
I
do
see
him
in
in
the
meeting.
If
he
I
mean
he,
he
can
certainly
answer
any
questions
that
you
all
might
have
our
if
you'll.
Let
me
share
my
screen
briefly
here.
Our
mental
health
related
budget
cuts
really
fall
on
a
few
areas.
F
Let
me
know
if
you
can
see
my
screen,
mr
chairman.
We
can
okay,
very
good,
so
what
I've
done
here
is
just
highlighted.
What
I
totaled
is
about
6.8
million
dollars
in
this
first
directed
round
of
budget
cuts
that
are
mental
health
and
substance
abuse
related.
What
I
want
to
point
out
here
that
you'll
see
on
the
document
that
that
most
of
you
should
have
a
table
five
of
our
budget
reduction
plan
in
the
division
of
healthcare
financing.
F
Really
in
the
medicaid
space,
you
can
see
various
areas
of
mental
health,
related
budget
reductions
that
do
have
some
impact
on
community
mental
health
and
substance
abuse
providers,
as
well
as
the
larger
market
of
reimbursed
behavioral
health
providers
that
accept
medicaid
clients.
So
what
you'll
see
here
on
the
first
line
is
our
kind
of
across
the
board
rate
reduction
to
most
provider
types.
F
The
only
provider
types
that
were
really
exempted
here
were
those
that
have
federally
set
reimbursement
rates
and
so,
generally
speaking,
across
hospitals,
clinics,
behavioral
health
providers,
most
providers
have
have
received
a
two
and
a
half
percent
reimbursement
rate
reduction
out
of
that
11.3
million
dollars
of
general
fund
that
that
generates.
F
We
estimate
around
600
000
of
that
would
be
of
medicaid
rate
reductions
would
be
related
to
behavioral
health.
That
doesn't
mean
that
that's
all
allocated
to
community
mental
health
and
substance
abuse
centers,
as
I
mentioned,
there's
a
much
wider
market
or
enrolled
provider
network
of
behavioral
health
providers
in
medicaid
than
just
the
community
providers.
F
Secondly,
mr
chairman,
we
have
implemented
or
will
be
implementing,
and
many
of
these
require
cms
approval
or
authorization,
a
service
limitation
on
behavioral
health
for
youth.
Again,
this
will
operate
similar
to
the
adult
service
limitation.
It's
not
a
hard
cap,
it's
essentially
after
a
certain,
in
this
case,
30
visits
on
the
outpatient,
behavioral
health
side.
A
demonstration
of
medical
necessity
will
will
need
to
be
completed.
These
types
of
utilization
controls
give
us
a
little
bit
more
flexibility
than
just
slashing
rates.
F
A
So
can
could
I
go
back
to
those
cats
that
the
the
the
30,
how
many
and
then-
and
I
I
don't-
want
to
take
a
lot
of
time
there,
but
can?
If
you
can
help
me
you're,
saying
that
that's
not
a
firm
cap
that
then
they
come
back
and
can
have,
for
all
intents
and
purposes
of
a
prescription,
to
request
additional
caps
and
and
that
can
be
for
maintenance
as
well
as
for
rehabilitation.
F
A
So
in
some
of
the
some
of
the
families
that
I'm
sure
members
of
this
committee
have
heard
from-
and
I
certainly
have
one
of
the
questions
that
comes
up
is
is:
did
the
department
consider
allowing
some
flexibility
in
shifting
some
of
the
resources
in
their
in
their
in
their
plan,
for
example,
if
they
felt
that
they
didn't,
they
would
rather
have
more
ongoing
maintenance,
physical
therapy
rather
than
respite
services.
A
F
Mr
chairman,
good
question:
I
think
we
might
be
talking
about
two
separate
things
and
I'm
happy
to
follow
up
with
our
folks
at
medicaid
and
get
back
to
you
and
the
committee.
Essentially,
this
would
what
I
believe
you're
talking
about
is
more
on
the
waiver,
home
and
community
based
service
side,
where
there
are
budget
amounts
that
are
set
as
as
opposed
to
this,
which
would
be
mostly
in
state
plan,
so
kind
of
on
a
fee-for-service
basis.
What
utilization,
controls
or
rate
reductions
are
are
happening.
F
A
F
So,
moving
on
away
from
the
healthcare
financing
division
just
wanted
to
give
the
committee
again
when
we
at
the
department
talk
about
behavioral
health
reductions,
we
can
be
talking
about
the
behavioral
health
division
or
larger
behavioral
health
reimbursements
that
we
make,
which
often
include
medicaid
so
wanted
to
give
you
a
an
overview
of
the
the
mental
health
or
behavioral
health
related
cuts
in
in
medicaid
in
terms
of
the
behavioral
health
division.
Specifically,
and
I'm
glad
I
have
matt
petrie
on
the
line
to
answer
any
specific
questions.
F
You
can
see
kind
of
four
high
level
categories
where
cuts
were
made
again
for
a
variety
of
reasons.
The
department
of
health
and
the
governor's
office
did
largely
minimize
reductions
on
the
behavioral
health
continuum,
including
community
mental
health
and
substance
abuse
services
in
this
first
round
of
reductions,
as
well
as
the
two
behavioral
health
state,
safety
net
facilities,
the
state
hospital
and
the
life
resource
center.
F
But
you
can
see
some
cuts
both
in
the
court
supervised
treatment
area,
the
recovery
supports
area,
some
position,
eliminations
and
the
elimination
of
the
respite
care
program
and
again,
all
across
the
board.
So
department-wide
healthcare,
financing
and
behavioral
health
division
included.
I
estimate
around
6.8
million
dollars
of
general
funds
that
that
came
out
in
this
first
reduction.
F
Obviously
in
medicaid
that
comes
with
with
basically
matched
federal
funds
that
would
also
be
would
also
be
foregone.
I'm
so
happy
to
to
answer
any
questions
from
the
committee
or
matt
if
you're
on
the
line-
and
I
misstated
anything,
especially
in
behavioral
health
division,
please
feel
free
to
weigh
in
and
correct
me.
F
Mr
chairman,
I'm
not
sure
I
fully
understood
the
question.
That's
totally
on
my
end.
Would
you
mind
repeating
it.
A
No,
so
my
understanding
generally
is
in
in
somebody
receiving
services
health
services
for
children,
that
most
of
that
or
that
they
allow
for
rehabilitative
services,
but
not
for
maintenance
services.
F
F
Mr
chairman,
again
I
believe
on
the
home
and
community-based
waiver
side,
that's
generally,
where
you
find
more
allowance
of
habilitative
services,
but
let
me
get
you
a
more
thorough
breakdown,
so
I
don't
miss
speak.
Thank.
B
Thank
you
so
much,
mr
chairman,
I
just
needed
a
clarification
if
I
could
from
stefan
mainly
on
the
respite
care,
and
maybe
I
I
might
be
misreading
it-
is
that
just
for
the
birth
through
two-year-olds
or
is
it
or
do
we
eliminate
all
respite
care
programs?
Thank
you.
F
Mr
chairman
and
senator
schuler
I'll
let
matt
weigh
in
on
that
the
respite
care
program,
I
believe,
is
separate
and
distinct
from
the
early
intervention,
the
developmental
preschool
program,
but
matt
do
you
have
information
there
thanks?
Stefan
thank
you,
co-chairman,
larson
and
representative
or
excuse
me
senator
schuler
stephanie
is
correct
in
that.
I
think
what
you
may
be
referring
to
is
the
early
intervention
and
education
program,
which
is
essentially
broken.
B
F
B
F
A
F
Good,
okay,
chairman
that
that
concludes
the
presentation
of
our
behavioral
health
related
budget
reductions.
I
will
mention
that,
as
part
of
this
reduction
package
we
are,
we
will
be
implementing
a
rate
reduction
for
the
2122
biennium
in
our
title:
25
per
diem
reimbursement
rates,
so
that
will
come
down
we're
working
on
the
implementation
likely
effective
january
1st
from
677
per
day
to
610
per
day.
We're
hoping
that
a
lot
of
the
that
could
be
offset
by
the
capacity
we're
going
to
increase
at
the
state
hospital
with
a
new
facility.
Again.
F
Another
reason
that
that
largely
the
state
hospital,
the
life
resource
center,
with
a
few
exceptions
were
were
exempted
so
to
speak
from
this
first
round
of
budget
reductions.
That
does
make
it
harder
in
other
areas
so,
for
example,
with
a
directed
nine
percent
cut
and
and
the
two
facilities
and
mental
health
substance
abuse
largely
being
unscathed,
with,
with
a
few
exceptions
that
cost
us
to
to
cut
heavier
elsewhere,
both
in
healthcare
financing
the
director's
office
and
the
aging
division
absorbed
of
far
more
than
a
nine
percent
cut.
F
So
we
tried
to
be
strategic
with
these,
especially
on
the
behavioral
health
side,
knowing
that
multiple
committees,
including
this
one,
were
we're
looking
at
the
performance
and
the
missions
of
these
of
these
systems
and
didn't
think
it
prudent
if
we
could
all
avoid
it,
at
least
in
the
first
round,
to
to
really
alter
the
the
financing
before
some
of
these
larger
policy
decisions
were
made
but
happy
to
answer
any
further
questions,
mr
chairman.
But
that
concludes
our
our
presentation.
A
Looking
thank
you
all
right.
Any
public
comment
scheduled
for
this
portion
of
our
meeting
elizabeth.
A
J
A
Before
I
think
we
have
to
take
a
break
anyway
to
if
memory
serves
me
correct,
john
elizabeth,
you
can
let
me
know,
I
think,
that's
our
agreement
with
on
our
technology
side
that
we
have
to
take
10
or
15
minute
break
if
we
go
into
the
afternoon
well,.