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A
A
A
George,
okay,
good,
so
we're
back,
we'll
reconvene
the
mental
health
subcommittee
on
mental
health
substance
abuse.
This
is
a
subcommittee
of
both
the
labor
health
committee,
as
well
as
the
appropriations
committee
appropriations.
Two
steals
with
money.
Substance
of
issues
on
mental
health
and
subsidies
should
be
dealt
with
by
the
labor
health
committee.
There's
an
intersection,
a
small
intersection
overlap
where
you
know,
appropriations
is
looking
at
cuts
and
we
want
to
make
sure
that
we
understand
before
we
or
the
department
starts
cutting
things
that
we
really
understand
what
it
is
we're
doing.
A
F
Good
afternoon,
mr.
chairman
members
of
the
subcommittee,
my
name
is
Frank
Craig
I'm,
the
president
of
the
Wyoming
Association
of
addiction
professionals,
maybach
Affiliate,
now
and
my
day,
job
and
the
state
director
for
Gateway
foundation,
and
we
provide
one
of
the
institutional
services
for
substance,
use,
disorder,
treatment,
I,
say
one
meaning
one
contract,
there's
another
provider
and
Casper.
That
does
that
as
well.
F
It's
not
gateway
I
noted
earlier
and
with
David
the
Morris
presentation
he
made
specifically
a
mention
about
co-occurring
disorders,
being
significant
and
and
he's
correct,
but
I
think
in
terms
of
what
we're
dealing
with
in
the
criminal
justice
population
is
recognition
of
that
population
as
a
kind
of
kind
of
his
own
animal.
If
you
will,
I
did
provide
a
link
to
an
online
publication
from
the
National
Institute
on
Drug
Abuse,
about
principles
of
drug
abuse,
treatment
for
criminal
justice
populations.
F
It's
a
pretty
easy,
read
and
kind
of
put
some
things
out
there
that
are
are
pretty
easy
understand,
but
also
important
to
understand
and
I'm
not
going
to
go
through
the
whole
thing.
But
it
has
some
highlights.
I
would
like
the
committee
to
be
aware
of
in
relationship
to
what's
going
on
with
with
that
criminal
justice,
Reformation
and
things
that
are
are
coming
about
from
the
CSG
recommendations.
F
I
would
point
out.
I'll
touch
one
of
that
publication
under
about
middle
of
the
page
number
two.
It
says.
Recovery
from
drug
addiction
requires
effective
treatment,
followed
by
management
of
the
problem
over
time
in,
within
that
paragraph,
it's
one
of
the
highlights
is
it
talks
about
multiple
episodes
of
treatment
may
be
required.
F
That's
an
important
thing
to
understand
for
anyone.
That's
going
through
treatment
for
substance
use
disorder,
because
it's
a
chronic
illness
and
for
criminal
justice
populations,
even
more
so
I
think
sometimes
we
we
think
as
we're
providing
the
treatment
and
the
inmate
or
anybody
else
goes
through
the
treatment
that
somehow
they're
cured.
But
that's
not
the
case.
Unfortunately,
where
substance
use
disorder
is
concerned,
and
particularly
when
you
get
into
the
intricacies
of
treating
a
criminal
justice
population
on
page
number,
two
under
number
five
talking
about
tailoring
services
to
fit
the
needs.
We're.
F
G
F
Mr.
chairman,
representing
Larson
the
program
for
example,
residentially,
the
ITU
intensive
treatment
unit,
is
the
portion
that
Gateway
Foundation
provides
that
Torrington
and
at
the
Women's
Center
at
Lusk.
And
yes,
sir.
Those
are
isolated.
Dorms,
if
you
will,
where
the
treatment
takes
place,
where
the
inmates
are
housed
in
that
dorm,
because
we
don't
want
them
to
be
deep,
focused
or
distracted
from
other
things
that
go
on
institutionally
with
other
general
population
housing.
So.
G
Mr.
chairman,
I
think
and
I
appreciate
that,
but
I
think
really.
What
we're
trying
to
focus
on
is
the
the
treatment
and
the
counseling
that
they
would
get
after
they've
been
discharged
from
an
institution
and
maybe
back
in
the
community,
still
under
the
supervision
of
the
Department
of
Corrections,
be
on
parole
or,
however,
that
looks
and
and
not
being
combined
confined
or
isolated
to
within
the
institution.
G
F
Thank
You
sheriff
yes
representative,
that
is
true
and
in
this
publication,
actually
addresses
that
a
little
bit
more
into
it.
I
was
just
trying
to
get
a
little
bit
of
kind
of
a
background
and
setting
to
understand
I'm
what
happens
institutionally
and
why
it
happens
institutionally
because
you're
correct
when
you're
looking
at
a
continuum
of
care
back
out
into
the
community
that
does
become
exceedingly
important.
F
I've
worked
in
some
states
where
that
continuum
of
care
was
an
extension
of
the
institutional
program
and
it
was
set
up
as
such,
with
the
departments
of
Corrections
respectively,
so
that
there
was
a
never
an
interruption.
When
the
person
left
the
facility
and
went
back
into
the
community,
he
actually
went
into
a
specific
transitional
treatment
center
where
the
program
was
continued
on,
and
sometimes
we
missed
that
in
Wyoming
as
having
a
seamless
transition
from
when
they
leave
the
institutional
correction
setting
back
out
into
the
community.
You.
A
Craig
for
pushing
on
to
eight
minutes
and
and
what
we're
trying
to
do
the
agenda
is
understand
an
overview
of
the
justice
reinvestment
project,
particularly
the
the
role
of
the
healthcare
system.
After
these
folks
have
been
discharged,
CSG
gave
us
their
presentation.
Do
C
do
H,
give
us
an
overview
of
where
they
are
we're,
just
trying
to
understand
what
our
what
our
scope
of
services
is
and
but
treatment
is
important
for
people
who
deal
or
in
prison
coming
out
of
prison.
We
get
that
part.
So
can
you
get
to
the
part?
A
F
G
And
mr.
chairman,
in
fairness
to
that,
there
is
a
difference
between
public
comment
and
the
presentation,
and
we
we
had
it
listed
under
public
comment,
but
they
we,
we
as
chairman,
had
requested
the
Department
of
and
WHAM
sack
in
the
Department
of
Health
to
make
the
presentations,
which
is
different
than
a
response
to
the
presentations,
which
is
probably
comment.
That's.
F
Mr.
chairman,
thank
you
when
we're
talking
about
getting
some
consistency,
particularly
like
when
we're
talking
about
assessments
and
I,
do
I
didn't
want
to
speak.
You
know
when,
when
mr.
dimple
was
talking
about
an
ASI
in
particular
is
a
tool.
It's
not
the
end
of
all
ends.
That's
used
as
the
timer's
certain
outcomes
in
things
in
recommendations
and
with
that
respect
to
what
the
CSD
had
proposed.
The
training
for
clear
standards
in
trainings
across
the
state
when
and
again
I'll
draw
that
back
to
working
with
the
criminal
justice
population,
because
it
is
a
special
population.
F
F
That's
concerning
and
I
think
it's
important
to
understand
that
tool
is
a
face-to-face
type
of
structured
interview
by
design
with
you
sit
down
with
the
therapist
in
with
the
individual
and
there's
room
for
significant
inconsistencies.
If
you
don't
have
all
of
the
collateral
information
like
was
referred
to
earlier,
if
you
don't
have
all
of
those
arrests
histories
or
things
like
that,
you
can
miss
a
large
portion
of
what's
really
the
greater
picture
for
for
treatment
of
that
individual
I.
C
C
Are
you
saying
that
that,
given
the
fact
that
most
of
the
mental
health,
the
community
mental
health
center
clients
I
mean
a
large
number
of
them,
50
to
80
percent
or
something
seemed
to
be
criminally
justice
related
all
right?
Are
you
thinking
that
it
would
actually
be
a
better
in
the
state
of
Wyoming
if
we
reduced
mental
health
services,
say
by
80%
and
just
let
them
deal
with
particulars
mental
illness
and
then
set
up
a
Department
of
Corrections
branch
of
community
substance
abuse
programming
of
providers
that
are
specific
to
that
issue?
F
Mr.
chairman
represent
that
Wilson,
yes,
in
terms
of
ideally
and
that's
coming
from
again
some
experiences
and
in
some
how
other
states
structured
that
complete
continuum
of
care
initiated.
You
know
when
they're
first
appear
before
the
judge
until
they,
if
they
do
end
up
going
to
prison
and
then
getting
out
of
prison.
Those
types
of
treatment
facilities
are
typically
contracted
to
a
Department
of
Corrections.
F
Much
like
a
halfway
house,
if
you
will,
but
with
the
specific
focus
on
the
continued
treatment
and
those
could
continue
residentially
and
preferably
if
you,
if
you're
looking
for
the
best
outcomes
in
terms
of
length
of
stay
research,
certainly
suggests
the
longer
that
you're
involved
in
program.
The
greater
offered
chances
that
you're
not
going
to
recidivate
or
return
to
your
addictive
use.
G
Thank
You
mr.
chairman
and
mr.
Craig
I
I,
don't
know
that
I
fully
tracked
with
the
the
timeline
that
you
had
there
sword
were
use.
When
you
said
there
would
be
six
months,
I
can't
remember
what
the
first
time
frame
was
where
they
would
be
isolated
and
a
half
or
you'd
be
kind
of
what
you
referred
to,
as
maybe
like
a
halfway
house
type
scenario.
Is
that
upon
release
from
their
sentence,
or
is
that
while
they
are
serving
their
sentence,.
F
Mr.
chairman
representative,
Larsen,
that
continuum
typically
I've
seen
is
a
combination,
so
so,
for
example,
we
target
a
six-month
to
one
year
on
institutional
residential
setting
to
provide
the
treatment
conceivably
instead
of
the
person
leaving
the
facility
on
their
own.
If
we
had
transitional
treatment,
centers
set
up,
they
would
actually
be
transported
either
by
the
dlc
or
by
that
contracted
provider,
so
that
they
don't
have
opportunities
to
get
out
and
get
distracted
and
it's
gone.
F
Typically,
you
see
that
within
the
first
24
to
72
hours
with
somebody
leaves
the
program
institutionally
and
go
to
the
community.
That
is
the
most
critical
time
frame,
which
is
why
the
peer-to-peer
movement
is
really
necessary
to
be
able
to
connect
networks
from
peer
specialists,
institutionally
the
peer
specialists
down
on
the
street,
but
conceivably
no
separation
in
custody,
as
it
were,
even
though
they're
transitioning
from
in
the
prison
to
a
community
transitional
treatment,
center
or
provider,
to
continue
perhaps
up
to
another
90
days
where
they're
in
the
community.
F
They
live
at
that
facility,
but
they're
getting
a
job
they're
starting
to
report
meet
with
their
community,
provide
parole
officers
or
agents
I'm
getting
connected
with
that
treatment
and
then
step
down
from
there
again,
where
maybe
now
they're
living
on
their
own.
But
they're
still
required
to
do
some
kind
of
outpatient
services.
F
F
F
It
really
doesn't
make
sense,
and
fortunately
that's
how
it
is
and
that
in
the
addictions
world
we
have
to
do
it
too,
and
as
long
as
I've
been
doing
this
since
1998
as
long
as
you're
doing
treatment,
wherever
I
was
working
at
that's
what
you
did
get
a
new
client,
you
do
a
new
ASI
asi,
as
was
pointed
out
by
earlier
by
mr.
dimple.
F
It's
really
the
ACM
that
sets
that
level
of
care
recommendation
to
be
able
to
meet
the
needs,
but
you're
right,
you're,
correct
in
that
observation,
representative
barlow,
for
the
fact
that
if
we
had
a
system
where
there
was
a
baseline
asi,
a
very
thorough
base,
lana
ASI.
That
was
a
starting
point.
When
you're
entering
into
the
criminal
justice
system
and
have
the
ability
to
then
move
that
ASI
with
the
person
is
they
transition
throughout
the
types
of
services,
even
if
it
is
coming
to
prison?
F
And
just
kind
of
FYI
cuz,
we
heard
some
mention
about
about
lawsuits
that
are
going
on.
That's
typically
will
what
that's
about
is
an
inmate
received
an
assessment
and
a
recommended
level
of
care
from
an
ACM
while
they
were
in
the
community,
then
they're
institutionalized
revoked
for
whatever
reason.
Typically,
revocation
is
because
they
popped
hot
with
a
UA.
They
absconded,
they
didn't
report
to
treatment
like
they
were
supposed
to
in
the
community,
and
then
they
got
revoked
and
they
they
come
into
the
system.
They're
reassessed.
F
We
look
at
that
information
as
a
failure
that,
whatever
their
recommended
level
of
care,
may
have
been
didn't
work
so,
logically,
that
would
constitute
a
higher
level
of
care
to
meet
the
need-
and
that's
where
these
lawsuits
have
come
from.
This
is
an
impact
of
their
ability
to
pro,
because
if
they're
a
residential
level
of
care,
then
they
do
not
have
access
to
that
in
the
community
to
make
parole
until
they've
completed
an
institutional
program.
A
A
If
you
know
that
private
provider
in
the
prison
do
they
have
access
to
all
that
information,
all
the
history
of
the
crimes
and
offenses
that
that
prisoner
has
had
prior
is
eyes
medical
record.
Do
they
have
continuing
access
to
that
after
the
the
they're
released
back
into
either
transitional
care
or
the
community.
F
Mr.
chairman,
in
in
terms
of
access-
yes,
they
do,
but
it
is
a
pass-along.
If
you
will
so,
the
institutional
provider
would
set
up
a
discharge
summary
and
and
required
information
that
set
by
the
Department
of
Corrections
what
they
expect
to
pass
along
to
the
community
provider
or
that
transitional
treatment
provider
and
in
those
cases
and
States
sort
of
the
provider
in
the
community.
There
could
be
multiple
different
types
of
providers
and
contractors
to
the
state.
It
was
not
a
cannot
like
one
entity
that
had
all
of
that.
All
of
that
service
provided
and.
F
A
A
H
H
Mothball
two
prisons,
because
they
have
been
working
over
a
period
of
six
years
to
model.
This
kind
of
you
know
a
model
that
we
we
reduced
recidivism
because
we
don't
have
I
mean
let's,
let's
face
it.
Mess
usage
is
one
of
the
biggest
problems
we
see
with
the
criminal
aspect.
You
know
where
they're
out
on
the
street
and
they're
they're
breaking
in
a
house
to
support
their
habits,
so
that
was
a
real
big
addition
to
start
I
had
that
that
care
all
the
way
through
and
mothball
to
prisons
in
texas
is
a
really
big
deal.
H
A
So
the
the
request
I
would
pass
along
the
staff
could
make
note
of
it
and
I'd
ask
for
anybody
who
wants
to
respond
to
this,
whether
it's
do-si-do,
H
or
wham,
sack
what
do
we
need
to
do
in
our
model
to
effectively
emulate
what
representative
Wilson
was
talking
about?
What
mr.
Craig
was
talking
about.
You've
got
a
continuum
of
care,
so
you
don't
have
mr.
dimples
people
going
trying
to
administer
treatment
to
a
parolee
and
and
they
can't
obtain
his
criminal
history.
You
know
that
discharge
summary
that
mr.
A
Craig
described
that
should
be
going
straight
to
the
community
mental
health
centers.
They
should
have
that
at
their
hands
before
the
guy
died
or
now
gets
back
into
the
community,
and
so
those
kind
of
things
you
know.
What
do
we
need
to
do
to
make
sure
that
the
mental
health
that
they
are
they're
effectively
they're
going
to
be
contracting
with
these
mental
health
centers?
Just
like
we
heard
the
model
of
mr.
A
A
So
next
we
have
Department
of
Health
updates
on
questions
from
the
first
meeting,
so
we're
leaving
the
topic
of
the
Department
of
Corrections
mental
health
community
mental
health
centers.
Except
is
that
insofar
as
that
may
be
touched
upon
in
these
update
questions
and
then
we'll
go
into
a
discussion
on
where
we
go
from
here.
So
with
that
I'm
gonna
turn
it
over
to
whom.
G
G
Know,
mr.
chairman,
yes,
as
a
matter
of
fact,
as
we
as
we
start
talking,
I
just
sit
down
my
my
agenda,
but
as
we
go
there,
it
is.
Thank
you,
as
we
start
talking
and
listening
to
systems,
discussion,
I,
think
what
this
committee
needs
to
to
do
is
is
to
say,
does
is
to
address.
Does
the
state
have
a
role
of
providing
mental
health
services
and
if
so,
what
is
that
role?
Is
it?
Is
it
a
safety
net
like
we've
done
with
the
life
Resource
Center
or
some
of
the
others
or
but
bottom
line?
G
Do
we
or
do
not
have
a
role
in
providing
mental
health,
and
then
the
question
is:
is
our
current
community
mental
health
system
structure
adequate?
Is
it?
Is
it
structured
the
way
we
need
it
to,
or
does
it
need
tweaking
or
do
we
need?
We
just
heard
from
some
other
people
that
would
suggest
that
it
would
be
completely
I.
Think
representative
Wilson
made
a
comment
that
was
completely
outside
the
box,
but
it
was
probably
one
that
needed
to
be
that
we
should
say
so.
G
A
D
You,
mr.
chairman
and
co-chairman
Larsen,
two
things
on
my
very
brief
presentation
before
I.
Kick
it
back
to
the
committee
for
discussion
and
any
questions.
One
on
the
agenda
you
had
asked
for
us
to
address
questions
from
the
previous
meeting.
I
did
want
to
show
the
committee
we
sent
a
memo
on
June
30th
answering
what
I
hope
is.
The
is
the
list
of
those
questions
that
came
out
of
the
first
meeting
with
this
group
that
was
sent
on
June,
30th
and
I.
Don't
have
to
address
them
all
today,
mr.
D
chairman,
happy
to
follow
up
or
provide
additional
information
for
anything
that
might
not
be
clear,
but
there
were,
as
I
recall,
six
or
seven
six
questions
that
the
committee
asked
the
department,
and
so
we
have
followed
up
on
those
in
this
memo.
I
will
mention
the
Department
of
Family,
Services
I
believe
also
addressed
you
directly
in
a
memo
answering
some
questions
that
were
that
were
directed
from
the
last
meeting
more
in
the
Family
Services
realm
that
the
Department
of
Health
shouldn't
be
answering.
So
hopefully
you
have
that
information.
Mr.
D
Thank
You
mr.
chairman,
so
I'm
on
this
broader
topic.
You
know
this
morning
the
committee
I
was
discussing
as
I
mentioned
kind
of
a
microcosm
of
this
discussion
around
the
mental
health
and
substance
abuse
system
and
what
it
should
look
like
in
Wyoming,
specifically
regarding
the
corrections
population,
but
as
we
as
we
touched
on
last
in
our
last
meeting
and
again
from
the
department's
perspective.
This
question
is,
as
representative
Larson
just
alluded
to
of
what
is
the
role
of
the
state?
D
What
should
the
role
of
the
state
be
as
it
pertains
to
either
providing
mental
health
and
substance
abuse
services
directly
or
funding
mental
health
substance
abuse
services
for
specific
or
general
access
populations?
That
has
ramifications
on
really
everything
that
that
a
committee
like
this
or
the
legislature
and
state
policymakers
have
to
grapple
with
so
answering
the
role
of
the
state
question.
It
will
have
legal
and
statutory
implications
around.
You
know
updating
what
the
what
the
Green
books
say.
D
It
will
most
certainly
have
financial
implications,
as
you
all
have
alluded
to
today,
especially
in
light
of
our
budget
and
revenue
situation
that
the
state
faces
currently
and
then,
maybe,
most
importantly,
it
will
drive
everything
related
to
answers
to
the
role
of
the
state.
Question
will
drive
everything
related
to
policy
operations
at
the
state
executive
branch
level
and
what
performance
outcomes
were
really
we're
really
shooting
for
in
a
system
again,
not
to
not
just
sound
like
a
broken
record,
but
I
think
this.
D
These
are
the
fundamental
and
philosophical
questions
that,
when
you
define
what
the
role
of
the
state
is
in
any
system
similar
to
what
the
facilities
Task
Force
did
for
the
state
hospital
in
the
life
Resource
Center,
it
Cascades
everything
from
there
in
terms
of
legal,
financial
and
policy
decisions.
So
with
that,
mr.
D
So
if
you'll
recall
from
our
previous
meeting
with
this
committee,
the
priority
populations
both
of
the
state
and
the
federal
level
when
it
comes
to
mental
health,
substance
abuse,
there's
quite
a
bit
of
overlap
and
not
a
whole
lot
of
discernible
distinctions
between
you
know:
women,
pregnant
women,
pregnant
IV,
drug
using
women
general.
You
know
adult
population
versus
veterans,
it's
very
difficult
to
say
well
what
separates
a
veteran
and
mental
health
and
substance
abuse
need
from
you
know,
someone
who
is
not
a
veteran
but
might
have
a
similar
condition.
D
So
again,
it
really
is
important
from
our
perspective,
in
dealing
with
the
policy
issues
around
the
role
of
the
state
as
best
you
can
collapse
these
populations
into
sort
of
meaningful
and
manageable
categories.
Otherwise
it
does
become
a
little
bit
unwieldy.
So
really
what
the
facilities
taskforce
did.
Mr.
chairman
was
try
to
answer
the
questions
from
the
taskforce
perspective
and
then
provided
as
recommendations
to
the
legislature
on
a
few
high
level
areas
number
one.
D
The
the
task
force
answered
that
question
that,
yes,
the
Department
of
Health
facilities
should
be
a
safety
net
that
was
actually
defined
in
statute,
which
is
in
title
25
chapter
5,
that
all
Department
of
Health
facilities
should
be
safety
net
facilities,
meaning
that
that
level
of
care
is
either
unable
to
be
provided
in
the
private
sector
or
the
private
sector,
for
some
populations
is
unwilling
to
provide
that
level
of
care,
and
so
that
that's
that
second
bullet
point
there
of
was
the
level
of
care.
The
task
force
looked
at.
D
Were
these
certain
services
or
levels
of
care
available
in
communities
or
the
private
sector
or
not,
and
we
helped
the
Department
of
Health
and
the
LSO
over
the
over
the
course
of
those
years.
Helped
the
task
force
answer
those
questions
so
that
we
could
truly,
you
know,
determine
what
the
what
a,
what
a
safety
net
looked
like
for
a
facility
based
care
in
Wyoming,
and
so
then
the
the
subsequent
question
was.
If,
if
the
answer
is
yes,
then
how
should
the
state
provide
services?
D
So
if
the
state
should
be
a
safety
net-
and
it
should
provide
some
level
in
this
case-
a
facility
based
care
to
a
certain
subset
of
populations-
and
you
can
port
that
over
to
the
discussion
we're
having
now,
should
the
state
be
a
safety
net,
should
the
state
provide
in
some
form
or
fashion
mental
health
and
substance
abuse
care
to
populations,
then
how
should
it
do
it?
Is
it
through
direct
care?
Essentially,
you
know
brick
and
mortar
facilities
that
the
state
owns
and
operates.
D
Like
our
you
know,
behavioral
health
facilities
that
we
have
or
is
it
through
funding
and
reimbursement?
So
think
of
you
know,
Medicaid
developmental
disability
waivers.
We
do
not
treat
those
populations
directly.
We
provide
funding
and
budgets
for
those
clients
to
receive
services
from
community
providers
and
that
all
resulted
mr.
D
chairman,
and
this
kind
of
either
famous
or
infamous
matrix
that
that
the
task
force
developed
and
and
ultimately
this
is
what
guided
a
lot
of
the
legislative
and
policy
decisions
for
the
State
Hospital
in
the
life
Resource
Center,
essentially
a
population's
to
settings
matrix
and
so
you'll
see
everything
in
red
or
green
or
blue
indicated
that,
for
that
particular
population,
the
state
did
have
a
role
and
it
was
either
the
state
hospital
or
the
W
life
Resource
Center.
That
would
provide
that
level
of
care
for
any
box
here.
That's
blank
in
the
course
answered.
D
Similarly,
moving
down
to,
for
example,
what
was
defined
as
hard
to
place,
and
it
was
a
bit
of
a
compiled
definition
in
statute,
but
a
good
example
of
a
hard
to
place.
Client
in
a
facility
setting
was
a
prior
sex
offender,
that
for
liability
purposes,
a
skilled
nursing
facility
or
an
assisted
living
facility
in
the
private
sector.
Just
wouldn't
take
the
state
determined.
The
task
force
determined
that
acute
and
step-down
care
for
that
kind
of
population
would
not
be
provided
at
one
of
our
department
of
health
facilities,
long
term
care
and
skilled
nursing.
D
For
that
hard
to
place,
client
would
be
provided,
and
it
was
determined
that
the
new
skilled
nursing
facility
at
the
life
Resource
Center,
the
wlrc,
would
meet
that
role
of
the
state.
So
again,
not
a
whole
lot
of
lengthy
discussion
here
needed
mr.
chairman,
but
I
wanted
to
point
out
to
the
committee
a
previous
framework
that
was
worked
or
that
was
used
between
the
legislative
and
executive
branch
in
a
task
force
that
was
kind
of
grappling
with
similar
issues
that
that
this
committee
and
the
joint
labor
committee
have
been
when
it
comes
to
our
community.
A
Second
line
item
25
civil
civil
commitments,
acute-phase
Wyoming,
State,
Hospital
I,
know
everybody
I've
heard
a
lot
of
people
in
the
legislature
holding
out
great
hope
that
the
construction
state
hospitals,
gonna,
save
us
money
on
people
that
are
now
going
to
WPI
or
other
facilities.
I,
don't
know
how
that
happens.
A
A
Why
would
you
do
that?
I
mean
all
I
need
is,
is
just
they
just
need
to
get
back
on
their
meds
and
be
stabilized
they're
in
an
acute
phase,
their
title
25
civil
commitment
and
no
way
you're
gonna,
send
them
down
their
list
and
then
so
I
don't
know
what
percentage
of
the
title
25
population
is
in
acute
phase,
long
enough
that
they're
going
to
stand
them
down
to
the
Wyoming
State
Hospital,
so
help
me
to
understand
that
particular
box.
A
D
Chairman,
it's
a
good
question.
The
the
idea
behind
the
the
new
state
hospital
project
is,
there
will
still
be
title
25
volume
that
occurs
in
the
community,
so
just
by
nature
of
the
legal
structure.
When
someone
enters
the
title
25
system,
it's
really
a
matter
of
generally
7
to
10
days
before
they're,
actually
civilly
committed
when
they're
civilly
committed,
which
is
the
final
stage
of
the
title
25
legal
process.
That's
really
when
most
often
they're
committed
to
the
custody
of
the
state
hospital.
D
So
to
your
point,
in
that
really
acute
first
phase,
the
vast
majority
of
title
25
clients,
even
today
before
the
new
State
Hospital,
opens,
don't
make
it
through
that
entire
civil
commitment
process,
if
that
makes
sense,
they're
emergently
detained.
Maybe
the
detention
has
continued
for
10
days
and
within
that
time
period,
perhaps
they
stabilized
and
returned
to
their
to
their
community.
D
The
idea
is
if,
if
the
process
moves
forward,
where
someone
is
in
that
final
stage
of
title,
25
civilly
committed
to
the
state
hospital,
the
new
facility,
both
by
its
its
new
physical
plant,
as
well
as
its
its
new
mission,
to
essentially
get
some
long-term
care
patients
out
of
the
facility
partnering
with
the
life
resource
center,
then
the
idea
is
that
that
waitlist
and
that
system
will
become
much
more
efficient
because
we
won't
have
folks
sitting
from
Sherrod
in
WB
I.
You
know
in
Casper
waiting
for
admission
to
the
State
Hospital.
D
D
So,
moving
on
mr.
chairman,
you
know
I
just
wanted
to
give
the
example
of
the
facilities
Task
Force,
as
kind
of
an
introductory
framework
for
the
conversation
that
I'd
like
to
queue
up
with
the
committee
now
regarding
this
larger
topic
that
you
all
have
been
tasked
with
with
the
community
mental
health
and
substance
abuse
system
and
potentially
reforms
partially
along
some
of
the
lines
you
mentioned.
Mr.
chairman
financial
issues
that
are
coming
as
well
as
what
you
mentioned
in
previous
meetings
around.
Should
we
be
leveraging
more
federal
funds?
Is
the
system
prioritize
to
certain
clients?
D
You
know:
should
it
be
priority
based?
Should
it
be
general
access?
These
are,
are
pretty
pretty
important
and
difficult
questions
to
answer,
unlike
the
facilities
and
the
facilities
task
force,
we're
talking
largely
about
non
direct
care
settings
here,
and
especially
not
state
owned
and
operated
facility
based
infrastructure.
So
again,
it's
a
little
bit
more
difficult
than
the
this
matrix.
D
You
saw
on
the
previous
slide
to
categorize
all
of
the
populations,
but
we
attempted
to
do
that
again
for
the
benefit
that
I
mentioned,
that
it
avoids
overlap
and
allows
policymakers
to
consider
these
buckets
of
populations
at
the
highest
level.
So
over
many
many
years
since
I've
been
here
with
various
committees,
including
joint
labor,
joint
appropriations,
the
title
25
task
force
this
group
and
others.
D
We
have
essentially
categorized
into
two
buckets
what
this
system
essentially
looks
like
and
that's
community
and
institutional
care,
so
the
community
is
really
you
know
the
front
and
back
end
of
higher
levels
of
care.
In
many
settings
to
your
point,
chairman
Kinski
community
providers
are
often
where
someone
might
go
for
services
after
they're
released
from
a
title
25
holes,
but
they
and
committed
to
the
state
hospital
as
well.
As
you
know,
the
front
end
trying
to
divert
from
hospitalization
from
higher
levels
of
care,
folks
recidivating
back
to
the
corrections
system.
D
That
really
is
what
we
all
think
about
is
the
the
you
know:
the
community
providers
role
and
not
just
community
mental
health
centers,
but
lots
of
other
providers,
waiver
providers,
DFS
social
services,
etc.
Then,
on
the
institution
side
it's
really
infrastructure,
both
state
owned
and
not
state
owned
in
and
out
of
state
to
support
higher
needs,
individuals
or
folks
that
are
in
crisis
folks.
That
can't
be
served
for
that
period
of
time
in
their
communities
or
with
community
provider
providers.
D
So
think
of
you
know
the
state,
hospital
psychiatric
residential
treatment
facilities,
prisons
and
jails,
the
corrections
system,
a
variety
of
institutional
levels,
of
care
where
this,
these
various
categories
of
clients,
often
interact
with
more
of
an
institutional
based,
a
service
delivery
system.
So
how
we've
kind
of
visualized
this
mr.
chairman
for
the
community
mental
health
and
substance
abuse
discussion
is,
is
a
framework
where
we
would
just
propose
to
to
look
at
this
role
of
the
state.
D
A
question
and
you'll
see
those
two
buckets
institution
and
community
on
this
slide
with
just
a
handful
of
categories
of
populations
that
again
over
the
years
in
discussions
with
you
all
in
discussions
with
our
own
staff,
we've
tried
to
collapse
into
some
some
meaningful,
but
also
kind
of
discernable
or
or
intuitive
categories
of
the
types
of
clients
that
we
see
going
in
and
out
of
this
system,
and
so
on
the
institutional
side.
You
know
we
have
what
we
call
justice
involved,
adults
and
again
there's
a
lot
of
different
areas
or
sub
sub
definitions.
D
D
So
we
collapsed
that
into
again
a
very
high
level
category
of
the
population
here
and
then.
Finally,
mr.
chairman,
on
the
institutional
side
here,
you're
dually
diagnosed
so
intellectually
and
developmentally
disabled
clients,
who
also
have
a
mental
health
and
substance,
abuse,
diagnosis
or
needs
on
the
community
side.
D
We've
we've
carved
this
up
again
for
discussion
purposes
and
for
a
framework
to
work
in
in
general
access
those
who
have
a
pace
or
so
think
of
kind
of
lower
acuity
people
in
the
community
who
have
insurance
or
can
self
pay,
but
have
you
know,
general
access
to
the
to
the
mental
health
and
substance
abuse
system
like
our
community
mental
health
and
substance
abuse
centers?
Similarly,
mr.
D
D
As
such,
you
know,
due
to
an
institutional
discharge,
you
know
coming
out
of
the
justice
system
coming
out
of
the
state
hospital
system
coming
out
or
in
the
DFS
Department
of
Family
Services
system
or
a
DD
client
with
with
mental
health
needs
and
that
queues
up.
Mr.
chairman,
the
final
slide
that
I
have
on
the
community
and
the
role
of
the
state
is
when
we
talk
about
tweaking
the
system
or
reforming
the
system
prioritizing
the
system.
D
It
really
begs
the
question
from
a
policymaker
perspective
of,
should
the
state
be
a
safety
net
for
for
community
mental
health
and
substance
abuse
services
and
as
representative
Larson
put
it.
If
so,
what
does
that?
What
does
that
mean?
If
not,
if
it's,
if
we
should
be,
you
know
kind
of
a
general
access,
a
system
where
there's
brick
and
mortar
facilities,
outpatient
and
residential
services
kind
of
peppered
throughout
the
state
that
folks
can
can
access.
You
know
kind
of
a
come
one,
come
all
pay
on
a
sliding
fee
scale.
D
D
How
do
we
determine
what
who
and
what
would
be
eligible
under
a
state
safety
net
system
for
community
mental
health
and
substance
abuse
services,
and
we
typically
when
we
talk
about
eligibility,
carve
that
up
along
to
kind
of
macro
dimensions,
and
one
is
some
sort
of
identified
need
so
like
I
described
on
the
first
on
the
previous
slide?
Is
someone
coming
out
of
a
higher
level
of
care
that
should
be
prioritized?
Are
they
coming
out
of
the
justice
system,
a
civil
or
criminal
commitment?
D
Do
they
have
some
sort
of
standardized
assessment
that
says
they
meet
a
level
of
care
or
a
certain
diagnosis
that
that
would
make
make
that
client
a
priority
and
then,
finally,
in
in
many
insurance
and
systems,
medic,
etc.
You
look
at
at
resources
that
more
material
eligibility
criteria
like
income
or
an
ability
or
inability
to
pay
insurance
coverage,
etc.
So
again,
mr.
D
chairman
and
co-chairman
Larsen
I
just
wanted
to
briefly
provide
this
discussion
framework
for
the
committee,
as
it
relates
to
this
really
broad
question
that
I
think
that
I
think
you've
been
tasked
with,
which
is
what
does
a
reform
to
this
system.
Look
like
both
on
financial
and
and
eligibility
means,
and
we
tried
to
suggest
again
a
framework
both
visually
and
kind
of
a
policy
exercise
with
those
questions
to
to
go
through.
If
that's,
where
the
the
committee
wanted
to
go
so
I'll
stop
there.
Mr.
D
G
Thank
You
mr.
chairman
and
members
of
the
committee
I.
If
we
could
go
to
that
slide
on
13
sniffing
I
I
would
almost
if
I
look
at
this
and
we
say
justice-involved,
adults
or
acute
psychiatric
adult
could
almost
be
combined
and
say
these
are
people
that
are
involved
by
the
by
the
judicial
system
they're
either
going
to
go
to
a
state
hospital
or
a
designated
hospital,
because
there
may
be
harming
themselves
or
a
threat
to
harm
somebody
else.
G
They
could
be
somebody
that's
created,
that
is
at
harm
of
hurting
somebody
else
that
has
been
committed
and
also
committed
a
crime.
So
now
we
find
them
at
that
as
a
final
seven,
forensic
psych
situation
or
somebody
that's
committed
a
crime
and
is
has
substance
abuse.
So
those
three
areas
is
that
fair.
So
those
are
that's
kind
of
how
the
judicial
system
is
volved
in
the
institution.
D
Mr.
chairman,
you
know
chairman
Larson,
I,
think
largely
yeah.
I,
don't
disagree
with
that
at
all.
The
only
reason
we
separated
justice-involved
from
an
acute
psychiatric
adult
is
not
all
folks
who
access
psychiatric
hospital
services
are
accessing
them
through
the
judicial
system.
So,
for
example,
very
you
do
have
privately
insured
patients
or
Medicaid
patients
that
get
referred
to
a
hospital
for
psychiatric
services,
but
are
not
necessarily
committed
very.
G
D
Mr.
chairman
and
Roseanne
representative
Larson,
it's
a
good
question.
I'll,
take
it
kind
of
in
reverse
order.
So,
as
an
example,
we
do
have
clients
that,
from
time
to
time,
are
at
the
State
Hospital,
because
they've
been
civilly
committed
through
Title
25,
but
also
have
a
diagnosis
of
a
developmental
disability.
It
is
a
bit
subjective,
depending
on
the
provider
and
depending
on
the
setting.
When
you
get
into
what's
the
primary
diagnosis,
you
know.
D
What's
the
cause
of
this,
of
the
behaviors
we're
seeing
some
clinicians
and
in
those
cases
we'll
say
it's
a
primary
mental
health
diagnosis.
You
know
like
paranoid
schizophrenia,
for
example,
but
also
another
provider
might
might
say.
This
is
a
primary
developmental
disability.
That's
driving
these
behaviors,
so
it's
a
bit
fluid
and
a
bit
subjective
depending
on
the
providers,
but
a
good
example
of
what
that.
D
That
type
of
clientele
who
has
DD
with
exceptionally
difficult
behaviors
and
maybe
mental
health
needs
as
well,
would
be
to
acutely
stabilize
the
state
hospital
and
then
have
more
short-term
and
intermediate
care
at
the
life
resource
center,
with
with
more
appropriate
levels
of
care
there
and
then
hopefully,
a
community
placement,
for
example,
at
a
DD
waiver
provider,
or
with
a
DD
waiver
provider,
to
try
to
foster
that
that
independence.
You
know
employment,
housing,
etc
that
we,
we
certainly
want
in
those
home
and
community-based
settings.
So
that's
again
a
population
all
of
these
populations.
D
The
reason
for
the
circle
here
is
because
they
do
move
in
these
categories,
depending
on
the
setting
and
depending
on
the
individual
client
representative
Larsen.
That's
probably
not
the
best
answer,
but
I
gave
it
my
best
shot.
So
please,
let
me
know
if
I
can
provide
additional
context
there.
Thank.
G
You
so
mr.
chairman
I
think
on
this
discussion.
It's
interesting
to
me,
as,
as
you
begin
this
discussion
this
morning,
Stephan
pointed
out
that
the
biggest
cost
to
the
Department
of
Health
is
Medicaid,
which
includes
the
the
ID
and
DD
waiver.
The
comprehensive
and
support
waivers
mental
health
substance
abuse,
developmental
preschools,
the
State
Hospital
and
wlrc
and
I.
Think.
Arguably
this
slide
13.
The
top
half
would
impact
four
of
the
five.
G
It
wouldn't
impact
the
developmental
preschools
per
se,
unless
you
had
an
autistic
child
that
they
was
dealing
with,
and
so
as
I
look
I
look
at
this
chart
and
then
I
consider
the
charge
that
we
have
from
management
Council,
which
is
to
evaluate
how
we're
delivering
mental
health
to
the
state
of
Wyoming.
And
then
how
can
we
do
that
more
effectively
to
reduce
recidivism
and
reduce
fiscal
impact
on
the
state?
G
It
appears
to
me
that
then,
the
community,
in
this
slide
13,
if
we
can
somehow
use
our
community
resources
to
divert
or
prevent
people
coming
in
at
the
community
site
from
being
either
going
into
the
institution
or
returning
to
the
institution,
which
is
a
cost
back
to
the
state.
So
you
and
I
sitting
here
is
and
Jared
is,
and
Mike
is
greedy
JC
guys
we're
looking
at
the
impact
on
the
state
and
but
we
also
need
to
consider
the
needs
of
the
citizens
of
the
state
that
have
these
difficult
problems
and
so
I.
G
G
Who
should
they,
who
are?
Are
these
the
same
populations
that
should
be
served
and
if
not
identify
what
those
populations
are?
You
know.
Does
that
mean
that,
as
they
come
out
of
the
corrections,
while
still
under
the
direction
of
Corrections
but
out
of
a
facility
that
that's
a
priority
population
to
ensure
that
they
don't
return
back
into
an
institution
and
bring
them
back
into
the
community?
Is
this?
G
Does
this
mean
that
Quinn,
when
somebody's
titled,
that
they
can
intervene,
and
maybe
prevent
somebody
from
being
titled
down
to
the
state
hospital
and
addressing
that
at
the
community
level,
at
a
much
less
cost
to
the
state
and
a
much
less
social
impact
on
the
individual?
Knowing
that
he
didn't
have
to
go
to
the
State,
Hospital
and
so
I
think?
Our
task,
then,
is
to
if
I
see
it
correctly
to
make
recommendations
back
to
both
committees,
Department
of
Labor
and
Health,
and
the
Appropriations
Committee
on
how
we
see
this
mental
health
system
operating
is.
G
C
C
We
did
see
the
map
this
morning
about
how
many
counties
where
there
are
community
mental
health
centers
and
to
you
know,
to
respect
of
the
private
provider
that
that
commented
as
well.
I
think
what
we
also
would
like
to
know
is
how
many
counties
are
there
in
which
the
community
mental
health
center
is
the
only
provider,
because
you
know
it's
one
thing
to
be
in
Natrona
or
Laramie
County,
but
I
would
suppose
that
there
are
probably
some
counties.
C
Or
both
that's
a
good
question
right.
So
then,
following
on
on
you
know,
representative
Larson
made
comment
about
my
throwing
out
of
an
outside-of-the-box
I,
which
my
question
about
you
know
separating
out
and
spending
most
of
our
effort
on
on
the
criminal
justice
was
really
just
gathered
to
my
intention
on
that
question.
It
was
just
to
sort
of
decipher
discern
what
what
this
idea
was,
but
I
think
one
thing
that
we
really
have
to
think
of
as
we
go
forward,
is
that
you
know
it's.
C
So
it's
all
very
well
to
look
at
Texas,
but
they
have
sixty
times
our
population.
You
know,
and-
and
so
one
of
our
main
problems
in
regular
in
not
and
mental
well
in
ever
need
any
kind
of
health
care
in
Wyoming
is
we've
got
fixed
costs
spread
out
over
not
very
many
clients,
and
so,
if
you
took
say
Paul
temples
area
where
he
said
he
had
fifteen
hundred
clients
and
you
took
eighty
percent
of
them
away.
C
You
don't
have
enough
mental
health
clients
left
to
run
a
shop
really
I
mean
in
the
sense,
so
I
think
that,
although
that
may
be,
you
know,
having
a
lot
of
specialization
is
probably
better
and
great
in
places
like
Texas
in
California
and
Colorado,
but
I'm
not
sure
that
that
will
work
very
well
in
in
Wyoming,
and
so
my
thought,
then.
My
last
thought
then,
from
this
that
I've
been
taking
notes
on
is
I'm
wondering
whether
you
know
to
take
the
the
idea
and
not
forgetting
the
you
know.
C
We
have
severe
needs
that
we
are
hearing
in
labor
committee
about
you,
know:
children,
adults
with
mental
health.
You
know
schizophrenia,
various
things
like
that.
We're
serious
severe
problems,
so
it's
not
only
about
substance,
abuse
and
criminal
justice,
but
maybe
what
we
need
to
add
into
the
contract
or
the
requirements
for
the
community
mental
health
contracts
as
the
safety
net.
You
know
remembering
that
the
providers
provide
private
filters,
though
there
is
some
sort
of
requirement
for
criminal
justice
trained
provider.
C
Folks
there
a
you
just
as
far
as
to
make
sure
that
they're
not
starting.
Oh
I'm,
a
mental
health
center
and
I
also
do
substance
abuse
with
criminal
justice,
but
to
make
sure
that
they
have
the
the
in-house
expertise
and
really
see
that
as
a
part
of
their
operation.
With
the
background
that
those
who
have
testified
today
as
to
that
need
that
they
have
it
but
I
think
I
think
we
don't
need
to
divide
our
services
in
Wyoming
into
more
silos
perfect,
as
that
would
perhaps
be
I.
C
D
A
C
Chairman
earlier
I
had
asked
mr.
Craig
about
you
know
in
his
perception.
Would
it
be
more
ideal?
If
we
were
you
know
starting
from
scratch?
Maybe
we
should
take
80%
of
the
funding
away
from
community
mental
health
and
just
set
up
a
structured
criminal
justice,
focused
substance,
abuse
programming
from
from
soup
to
nuts.
D
Mr.
chairman,
if
I
could
just
great
points
and
comments
and
questions
from
representative
Wilson
I
want
to
frame
this
slide
with
a
little
bit
more
detail
just
to
give
you
a
sense
of
the
exercise
that
we've
gone
through
kind
of
modeling
the
facilities
task
force.
So
when
it
comes
to
the
community,
mental
health
and
substance
abuse
system
and
the
providers
that
we
contract
with
I
would
say
each
one
of
these
seven
categories
that
you
see
here
have
might
have
some
involvement
in
that
system.
D
So
a
community
mental
health
center
sees
justice
involved
and
treats
and
provide
services
to
justice
involved
individuals
to
folks
who
might
have
gone
into
or
are
coming
out
of,
the
State
Hospital
to
certain
adolescents
or
higher
needs
of
families,
also
to
potentially
to
DD
folks.
In
addition,
general
access
is
part
of
the
the
bedrock
of
that
system.
You
know,
like
I,
said
brick-and-mortar
facilities
with
where
folks
can
come
and
get
services
on
a
sliding,
if
you
scale
so
I
think,
there's
a
little
bit
of
everything
in
the
system.
Now.
D
The
point
of
this
exercise
is
you.
You
know
we
kind
of
went
through
this
to
collapse.
These
populations,
as
if
we
had
a
blank
slate,
you
know,
there's
no
policy
or
financial
constraints
on
the
system
we
want
to
design.
So
what
are
these
categories
of
folks?
That
we
think
you
know
are
would
be
part
of
a
community
mental
health
and
substance
abuse
system.
Then
you
know
after
going
through
this
and
again
this
might
not
be
a
comprehensive
list.
I
think
it
captures
most
of
what
we
as
policy
folks
and
policy
makers.
D
Think
of
when
we
think
of
these
populations,
but
then,
after
that
exercise,
you
know
the
reality.
Is
you
have
to
introduce
the
financial
constraint
right?
So
if
we
had
a
trillion
dollars
in
the
system,
it
would
be
no
problem
to
say,
let's
build
by
or
fund
every
one
of
these
populations,
including
general
access
for
everybody
on
a
sliding
fee
scale.
But
we
all
know
that's
not
the
reality
and
even
less
of
a
reality.
D
Now,
as
we
go
through
this
so
in
in
somewhat
of
Defense
of
the
community
system,
now
I
think
being
asked
to
do
a
little
bit
of
everything
and
achieve
those
outcomes
is
a
little
bit
this
place
and
I
think
some
of
the
I
don't
want
to
say
consternation,
but
a
little
bit
of
the
tension
that
we
have
in
the
system
where
it's
it's
kind
of
everything's
a
priority,
and
therefore
everything
is
less
of
a
priority,
because
the
resources
are
spread
so
thin.
So
the
exercise,
mr.
chairman,
here
after
collapsing
into
these
categories,
would
be.
D
If
you
introduced
a
financial
constraint.
How
would
these
then
rank?
What
is
this
this?
The
role
of
the
state
you
know
first
and
then,
if
we
had
another,
you
know
hundred
million
dollars,
would
we
provide
you
know
additional
services
or
levels
of
care
for
and
again
I
don't
mean
to
sound,
like
a
judgement
call
here,
but
folks
with
lower
levels
of
need.
I'm,
not
a
clinician
and
won't
speak
to
that.
D
You
know
part
of
the
of
the
debate,
but
that's
essentially
the
the
point
of
this
exercise
is
to
capture
what
what
the
system
would
look
like
with
a
blank
slate.
Then
the
next
step
would
be
to
introduce
those
financial
or
policy
constraints,
but
with
that
definition
of
the
role
of
the
state,
if
the
committee,
the
legislature
and
the
executive
branch
would
do
that
again,
that
would
inform
what
that
second
step
looked
like
in
in
setting
up
the
policy
and
the
financing
or
two
to
some
of
representative
Wilson
and
Barlow's
previous
points.
D
What
are
the
legal
and
policy
vehicles
to
do
that?
Should
we
look
at
you
know,
waiver
systems.
Should
we
look
at
additional
financing
here,
as
opposed
to
here,
but
I
think
those
are
those
are
solutions
before
we've
again
defines
the
the
problem
or
or
the
role
of
the
state
first
so
just
wanted
to
make
that
and
give
a
little
bit
of
context
behind
what
this
chart
and
what
this
exercise
looks
like.
Mr.
A
Cho
another
907,
Bay
and
dollars
general
fund
that
goes
to
Department
of
Health.
We
got
to
find
two
hundred,
some
plus
so
you're
working
on
your
cuts.
Community
mental
health
centers
are
working
on
how
they
can
restructure,
how
they
can
say
it's
still
an
unknown
to
me,
what
proportion
of
their
their
population
their
cost
structures
related
to
what
we're
calling
non
priority
populations.
A
Hopefully
it's
a
very
large
percentage
so
that
the
cuts
don't
completely
disable
them.
I
suspect
it's,
perhaps
not
a
very
large
percentage
of
of
their
service
population.
We'll
know
just
two
quick
things:
I
want
to
I
want
to
address
your
chart
with
a
couple
of
questions
that
I
want
to
circle
back
around
to
the
narrower
question:
we're
doing
what
today
and
in
chairman
Wilson's
work
today.
So
the
question
I
have
about
this
and
I'm
just
gonna
I'm,
going
to
pick
off
one,
that's
familiar
to
me:
adult
psychiatric,
acute
okay.
A
But
these
are
people
that
are
not
in
the
acute
phase,
but
they
can
be
there
so
where
they
fit.
Where
do
they
fit
Stefan
in
this
chart,
because
there's
a
hell
of
a
lot
of
them
that
fit
into
these
other
categories
too?
They
need
to
tune
up
and
a
little
bit
of
attention
or
they
go
off
the
rails.
Where
did
where
they
fit
in
this
hierarchy
of
yours,
come.
D
In
brief
answer
and
I,
see,
representative
Larson
has
his
hand
up
the
idea
here
again
in
this
framework,
and
these
are
this
is
this.
Is
hypothetical
here
would
be
a
client
like
that
who
was
in
an
institutional,
acute
psychiatric
setting
like
the
state
hospital
or
WB
I?
Would
then,
if
you
look
at
the
bottom
of
the
of
the
chart
here,
coming
out
of
there
through
an
institutional
discharge,
would
be
considered.
D
A
A
You
know
he
didn't
qualify
for
anymore
visits
and
which
is
just
wrong
and
and
say
the
guy
never
went
to
the
State
Hospital
say
he
just
shows
up
at
the
local
emergency
room
periodically
needing
a
tuna,
so
I
just
I
want
you
to
be
aware
that
there's
that
there's
a
large
at
least
my
understanding
from
from
the
mental
health
folks,
there's
a
large
segment
of
people
that
kind
of
cycle
in
and
out
the
only
analog
I
have
stem
from
his
oxygen
patients.
I
dealt
with
him
for
13
years.
A
If
they
stayed
on
their
meds,
if
they
were
compliant,
they
didn't
show
up
at
the
ER,
but
if
their
Kanaan
compliant
they,
the
nurses,
used
to
call
it
a
tune-up.
Oh
I
just
got
back
from
the
hospital
for
three
days.
He
went
in
for
a
tuna
nice
back
home
smoking
again,
so
you
know
it's
it's
there's
some
of
these
people
just
needed
a
continuing
intervention
Lloyd.
A
G
Mr.
chairman
I
think
that
you're
exactly
on
track
with
with
with
what
I'm,
thinking
and
I
agree
with
with
Stefan.
Yes,
the
example
you
used
is
not
an
acute
situation,
but
it
certainly
is
a
high-risk
population.
A
high-risk,
individual
and-
and
the
goal
is
to
do
exactly,
as
you
said,
is
to
keep
them
on
their
meds
keeping
in
the
community
and
living
on
their
own,
and
so
it
becomes
so
then
how
do
we
get
the
community
mental
health
centers?
G
G
Think
that
that
goes
largely
to
keeping
them
out
of
going
into
these
high-cost
areas
there
and
so
I
think
I
think
what
we
are
kind
of
task
at
doing
them
and
saying
who
then,
as
with
this
whole
discussion,
who
are
the
high-risk
populations?
Is
that?
Is
it
a
pregnant
woman
or
a
veteran,
or
is
it
by
a
diagnosis
of
what
the
individual
has
I?
Think
that
that's
a
discussion
that
this
group
should
happen
and
come
back,
I
think
it's
worthy
discussion,
but
I
think
that
high-risk
population
is
much
more.
C
Thank
You,
mr.
chairman
and
and
one
other
thing
in
here
is
I.
Think
and
I
want
to
check
this
with
Stefan,
because
I,
don't
I,
don't
know
the
numbers
on
this,
but
you
know
when
we
pick
out
veterans,
there's
a
whole
nother
service
for
veterans.
I
mean
not
saying
that
they
have
everything
available,
but
you
know:
we've
got
two
VA
hospitals,
they've
got
the
VA
clinics.
There
are
services
for
veterans
if
you're
a
pregnant
woman,
you're
and
you're.
You
know
you
are
a
certain
income.
You
are
on
Medicaid
met.
C
The
person
like
you're
describing
chairman
Kinski
is
not
necessarily
when
you
mentioned
Qualis.
Unless
the
person
has
been
has
gone
through
the
whole
SSI
thing
and
is
on
Medicare
as
disabled.
You
know,
and
under
65
this
person
might
not
be
a
Medicaid
person.
They
may
be
a
person,
a
high-risk
person,
with
no
Oh
payer
source
other
than
this
block-grant
thing
we
give
to
CR
and
CI
and
I.
C
D
Mr.
chairman,
representative
Wilson,
it's
it's
a
great
question:
I,
don't
know
the
exact
number,
but
you're
right
that
and
I'll
use
the
state
hospital.
As
an
example,
we
for
our
the
majority
of
our
adult
clients
that
aren't
on
disability
or
don't
meet
a
categorical
Medicaid
eligibility
criteria.
They're
not.
D
So
you
have
a
forty
year
old
woman
who,
who
gets
committed
to
the
State,
Hospital
and
I.
Think
there's
a
large
assumption
that
coming
out
that
client
would
be
unmedicated
those
categorical
criteria,
so
age,
blind
disabled
that
would
qualify
you
for
Wyoming
Medicaid.
It's
really
limited
coverage,
so
I
think
you're
right
that
in
these
buckets
that
you
see
on
the
screen
here.
D
None
of
these
assume
that
that
Medicaid
is
the
is
the
financer
of
services
which
again
I,
can
kind
of
cues
up
the
question
of
not
to
sound
like
a
broken
record,
but
is
the
role
of
the
state
to
to
act
as
that
safety
net
in
lieu
of
some
other?
You
know,
and
I
won't
try
to
poke
this
bear
too
much,
but
in
lieu
of
Medicaid
expansion
for
a
coverage
vehicle
or
a
financial
vehicle.
D
You
know,
person
coming
out
of
the
State
Hospital,
maybe
not
acute,
but
has
more
of
us
of
a
serious
mental
health
condition
that
might
require
more
frequent
services.
The
community
mental
health
system
is
paid
the
same
for
those
services
that
they
are
for
any
other
client
in
the
system
as
we're
kind
of
garishly
describing
as
a
general
access
population
again,
not
not
at
really
a
clinical
term.
But
that's
really.
D
You
know
appropriate
for
the
the
staffing
and
services
that
our
community
mental
health
center
have,
but
you
know
again
hardly
because
they're
not
set
up
financed
for
that
type
of
a
population
they're
not
staffed
for
that
type
of
a
population
in
many
cases,
and
it
is
a
mixed
bag.
That's
really
the
point
here
is
that
again,
there's
no
difference
in
financing
across
these
populations.
You
see
on
the
top
that
I
think
our
community
mental
health
centers
often
do
and
could
in
a
in
a
greater
capacity,
wrap
around
a
client
like
that.
A
So
I
think
I
sent
to
the
department
a
question
about
for
the
green
box
in
the
yellow
box.
What
picked
adhere,
what
the
turnover
is
and
if
those
who
are
eliminated
from
service
do
you
just
if
you
just
cut
them
all
off
immediately?
What
do
we
think
we'd
say
if
you
just
said
we're
not
taking
on
anybody
new
that
doesn't
meet
the
high
risk
or
priority
population?
A
How
long
look
at
your
turnover
and
and
look
at
how
long
it
would
take
before
that
population
dwindled
down
to
nothing
and
so
we're
waiting
for
those
questions,
but
I
want
to
follow
up
with
where
you
were
going
I'm
with
you,
somebody
who
is
40
years
old
is
chronically
mentally
ill.
He
called
bender
and
better
to
get
him
signed
up
on
Medicare
or
Social
Security
to
get
a
month's
SSDI
and
after
2
years,
they're
eligible
for
Medicare
and
once
they're
on
Medicare,
then
the
state
buys
them
into
many
many
so
that
medicaid
covers
the
copay.
A
You
know
it's!
It's
I,
don't
understand
why
the
summit
I'm
frankly
just
mystified.
Why
such
a
high
percentage
of
our
budget
for
this
population
is
general
fund
and
I
had
a
and
maybe
the
department
Stephan?
Maybe
you
answered
my
question
like
sent
some
time
ago
and
I
and
I
just
lost
the
memo,
because
I
get
so
damn
many
memos
but
I
see.
I
gave
you
a
listing
of
the
percentage
of
mental
health
substance.
A
Budget
covered
for
each
state
and
and
Wyoming
was
below
the
middle
of
the
pack.
We
weren't
the
lowest,
but
there
were
other
states
that
had
a
much
higher
percentage.
Now,
maybe
it's
just
maybe
it's
just
they
unless
you
qualify
that
you
don't
give
me
any.
Maybe
that's
what
it
is,
but
I
can
tell
you
that
just
from
a
prior
life
and
I'm
up
and
I
think
this
might
be
work
that
chairman
Wilson
was
gone.
There
was
a
I
was
lived
in
Sunnyvale
and
there
was
that
hospital.
You
know
everybody.
Every
big
community
has
that
hospital.
A
Where
that
side
town
goes
to
this
Medicaid
hospital
and
when
you
walked
in
to
the
emergency
room
entrance.
The
first
thing
you
saw
was
a
screening
office
and
if
you
came
in-
and
you
had
a
knife
out
of
your
chest-
there's
a
nurse
there
with
a
clipboard.
Are
you
a
veteran?
Do
you
have
Medicaid?
What's
your
income
and
they
did
everything
they
could
to
get
them
signed
up
for
and
that
relates
to
so
I.
A
Don't
know
how
aggressive
we
are
throughout
the
system,
but
given
everything
we've
seen
about
the
lack
of
a
continuum
of
care,
we're
probably
not
all
that
aggressive
at
it
at
some
other
states
that
have
been
so
resource
constrained.
So
one
of
the
questions
I
had
the
Department
answered
is:
do
we
do
we
sign
them
up
for
Medicaid
when
they're
in
the
correctional
system?
Well,
the
answer
was
well
they're
not
eligible.
A
Well,
no
I
know
that
it's,
but
if
your
Medicaid
eligible
and
you
get
arrested
and
sent
to
jail,
you
you
can't
collect
on
Medicaid,
but
you
can
remain
enrolled
continuously,
so
other
states
don't
dis,
enroll
them
when
they
go
into
the
prison
system.
In
fact,
they
enroll
them
they're
not
eligible
until
they
come
out,
but
they
screen
him
so
the
day
that.
B
A
Have
a
source
of
payment
for
his
treatment?
So
it's
that's
a
topic
that
that,
if
that's
where
you
were
headed,
you
know
I'd
get
mr.
Craig
back
in
or
one
of
these
other
outfits
from
other
states
to
our
topic
today,
which
is
you
know,
the
continuity
of
care,
mental
health,
substance,
abuse
for
the
correction
system
and
bring
instantly
folks
from
other
states
and
find
the
contracted
providers
how
they
do
it.
A
C
Mr.
chairman,
the
thing
is
is
that
the
majority
of
the
states
have
expanded
Medicaid
to
cover
childless
adults
between
19
and
64.
We
have
not
so
unless
a
person
is
either
a
pregnant
woman
which
doesn't
go
on
forever
or
disabled
a
person.
The
average
person,
the
Department
of
Corrections
between
19
and
64,
is
not
eligible
and
isn't
going
to
be
eligible
until
they
turn
65
years
old.
So
we
have
deliberately
chosen
to
not
have
those
people
be
eligible
for
Medicaid.
C
The
only
way
that
we
can
make
them
eligible
for
Medicaid
is,
if
you
have,
and
and
because,
through
my
translation,
work,
I
have
translated
a
lot
of
applications
for
people
trying
to
get
themselves
on
the
SSI,
the
disabled
list.
It
takes
a
lot
of
paperwork,
a
lot
of
case
management
years.
It
takes
years
to
become
determined
disabled
so
that
you're
on
Medicare
as
a
50
year
old,
or
something
like
that
and
then
eligible
for
Medicaid.
But
there
that's
not
very
much
of
our
prison
population.
I
You,
mr.
chairman
yeah,
my
question
is:
is
right
on
the
same
track
with
representative
Wilson
I
I'm
kind
of
wondering?
If,
because
we're
not
a
Medicaid
expansion,
state
I'd
like
to
know
I,
think
there's
what
37
or
36
states
that
have
I'd
like
to
know
about
the
other
states
that
have
not
expanded
what
they're
doing
with
their
Medicaid
situations
with
their
waivers?
I
Folks,
probably
you
know,
could
could
definitely
be
in
better
shape
if
they
had
the
ability
to
to
be
on
a
waiver
and
not
have
to
go
through
the
whole
SSI
situation
that
represented
Wilson
was
just
talking
about
so
I'm
just
wondering
if
we
could
do
some
a
deep
dive
into
seen.
What
those
other
states
that
have
not
expand
that
with
Medicaid,
maybe
they're
doing
something
creative,
that
we
could
kind
of
jump
on
board
with
I'm,
not
sure.
Thank
you.
B
Olson
yeah
Thank
You
mr.
chairman
I,
just
wanted
to
dogpile
on
this
Medicaid
expansion
concept,
taking
a
step
further.
What
senator
Schuler
said,
because
when
we
started
this
meeting,
I
wrote
down
something
there.
Representative
Barlow
said,
which
was
adult
mental
health
waiver
and
so
the
19,000,
approximately
19,000
people
that
fall
within
the
gap
that
chairman
Wilson's
talking
about
the
19
to
was
the
age
65.
B
B
Maybe
this
is
a
good
opportunity
to
expand
upon
exactly
what
that
opportunity
might
be
in
terms
of
what
portion
of
the
population
that
we
are
talking
about
inside
the
gap
could
be
touched
and
addressed
by
this
mental
health
waiver
as
I
understand
that's
Medicaid,
so
that
would
that
would
also
take
us
away
from
that
whole
SSI,
deep
hole
that
chairman
Wilson
is
talking
about
in
terms
of
being
cumbersome
and
getting
somebody
on
that
and
covered.
So
I'd
like
to
learn
a
little
bit
more
about
about
that
waiver.
H
H
This
individual
waiver
I
think
chairman
Wilson
had
a
interesting
or
maybe
was
Senator
shooter
about
of
the
states
that
did
not
expand
Medicaid
wholly
how
many
of
them
have
the
adult
waiver,
because
they
one
would
supplant
the
whole,
would
supplant
the
waiver
so
of
the
ones
that
don't
haven't
expanded,
who
has
a
waiver,
but
as
far
as
what
the
waiver
would
bring
to
us
and
the
eligible
populations,
etc.
I
think,
first
of
all,
that's
a
design
of
bars
and
an
application
to
the
CMS,
but
mr.
Johanson
has
probably
speak
to
more
fluently
about
the
examinations.
H
A
You
before
we
defer
represent
Barlow
because
of
your
your
tenure
and
your
longevity.
Let
me
let
me
ask
you
this
so
right.
Let's
look
at
this
chart
that
we've
got
here
cross
out
the
green
box
in
the
yellow
box
and
largely
everybody
up
there,
we're
paying
for
out
of
general
fund
or
just
majority
of
it's
coming
out
of
general
fund.
If
nothing
else
came
in
your
prior
deliberations,
if
that,
if
you
just
regard
this
whole
picture
is
static,
nothing
else
changes.
H
Mr.
chairman,
I
guess,
certainly
that
depends
on
the
demographics
of
those
folks
of
the
folks
that
we're
serving
now
but
I
do
think.
First
of
all
the
50-50
that
happens
all
too
well
I
should
say
generally,
that
is
the
Medicaid
match.
So
one
if
you
leverage
50%
general
fund
dollars,
you
get
the
other
50
from
the
feds.
Even
if
you
picked
up
25
to
30%
of
this
population.
H
Is
that
enough
to
offset
the
potential
cuts
if
you
will
to
serve
to
funding
which
inevitably
change
the
number
of
services
being
provided,
combined
that
the
red
boxes
with
then
the
reduction
or
the
maybe
limitation
for
the
yellow
and
green
to
have
access
to
the
system
which
some
of
them
would
act
have
access?
Maybe
through
this
mental
health
waiver
and
I
think
actually,
it
is
something
we
should
be
examining
is
how
do
we
take
those
same
general
fund
dollars?
H
You
were
talking
about
leveraging
for
the
population
that
could
use
them
and
what's
our
value
and
I
like
I,
said
I'm
going
to
let
mr.
Johanson
to
speak,
see
if
there's
been
any
analysis
of
that,
because
you
know
in
the
past
times,
there's
always
been
a
propensity
to
push
toward
Medicaid
expansion,
not
the
waiver.
Thank
you.
D
Mr.
chairman,
and
to
address
representative
Barlow's
good
points
briefly,
all
mentioned
that
the
same
process
that
we
would
go
through
with
you
all
to
develop
and
implement
a
Medicaid
mental
health
waiver
would
be
very
similar
to
what
what
we're
proposing
for
the
for
the
system
as
a
whole.
Here
you
have
to
answer
a
few
questions
for
what
the
waiver
would
cover,
who
it
would
cover
a
generally
a
Medicaid
Waiver
is
a
homing
community-based
alternative
to
some
sort
of
other
level
of
care.
D
So,
instead
of
providing
care
to
someone
in
a
psychiatric
hospital,
you
develop
a
home
and
community-based
service
waiver
that
would
cover
mental
health
services
as
well
as
potentially
medical.
You
know
full
Medicaid
medical
benefit
for
for
a
population.
That's
essentially
what
an
adult
mental
health
waiver
is.
What
a
developmental
disability
waiver
is,
what
a
long-term
care
waiver
is.
It's
it's
some
sort
of
alternative
to
another
level
of
care
that
would
be
kind
of
an
optional
and
and
expanded
medicaid
coverage
for
a
certain
population
that
needs
to
be
defined.
D
There
has
to
be
criteria
in
a
waiver
that
you
say
these
people
would
be
eligible
and
and
it's
it's
can
be
condition
based
financial.
You
know:
income
based
geographically
based
there's,
there's
many
different
options,
so
the
process
that
I
think
were
we're
pushing
to
go
through
as
a
state
would
be
very
similar
as
what
we
would
go
through
and
developing
a
medicaid
waiver.
But
in
theory.
D
Could
you
could
cover,
through
a
medicaid
waiver,
a
certain
type
of
population
that
would
be
paid
for
with
Medicaid
funds,
which,
at
our
match
rate,
would
be
50/50
federal
funds
and
general
funds?
And
the
question
becomes:
how
do
you
come
up
with
the
state
match
with
the
50
percent
state
match?
Do
you
do
you
cut
it
out
of
mental
health
and
substance
abuse?
Do
you
do
you
appropriate
it?
Do
you
develop
a
new
tax
to
have
that
money?
D
The
system
to
look
like
so
who
are
the
populations
that
that
the
state
has
a
role
in
either
providing
services
to
or
providing
funding
for,
and
we
listed
just
everything
that
we
think
is
part
of
the
system
today.
But
again,
this
exercise
is
meant
to
be
a
blank
slate
to
look
at
who
those
populations
are,
and
then
you
would
introduce
the
policy,
reimbursement
and
legal
vehicles
in
which
to
to
cover
them.
A
G
Mr.
chairman
I'd
like
to
go
back
to
a
comment
that
you
made
and
make
sure
that
I'm
getting
this
accurate
because
you
we've
got
the
community
mental
health
program
as
it
is
funded
today,
and
then
we
look
at
the
services
that
you
provided
and
then
you
brought
in
the
challenge,
with
with
koalas,
doing
an
evaluation
and
for
for
the
services
provided
and
koalas
for
everybody
is
one
of
the
contractors
that
Department
of
financial
or
the
Department
Medicaid
and
Medicare
in
the
state
office
uses
to
evaluate
these
Medicaid
reimbursements.
G
D
Mr.
chairman,
co-chairman
Larson,
in
terms
of
the
what
you
called
the
Block
Grants,
essentially,
the
contracts
are
grants
from
the
state
with
AD
with
the
community
mental
health
and
substance
abuse.
Centers.
No,
there's
there's.
No,
you
know
prior
authorization
or
utilization
management
contractor
like
there
is
for
all
behavioral
health
providers,
community
mental
health,
centers
and
others
in
the
Medicaid
program,
which
is
a
policy
decision.
D
The
state
contracts,
the
Block
Grants,
as
you
as
you
called
them,
are
carved
up
along
basically,
four
different
areas:
mental
health,
outpatient,
mental
health,
residential
substance,
abuse,
outpatient
and
substance,
abuse,
residential
and
there's
certain
contract
requirements,
namely
the
amount
of
service
hours
that
are
required
to
be
delivered
in
in
the
contract
period.
But
it
is
not
set
up
in
a
fee-for-service
model
like
Medicaid
is
not
does
not
go.
A
A
Representative,
Larson
and
I
were
talking
about.
We
thought
because
of
our
exposure
on
Appropriations
of
his
on
other
committees.
Then
we
had
a
rough
idea
of
the
mental
health
and
substance
abuse
system
as
it
related
to
the
chronically
mentally
ill
and
and
so
forth,
but
the
prisons,
the
correctional
system,
was
just
unknown
to
us,
and
so
we
didn't
know
what
everybody
else's
level
of
knowledge
was.
A
So
the
objective
today
was
to
get
us
up
to
your
level
of
education
and
and
for
myself,
I'm
satisfied
that
I
don't
know
everything
I
need
to
know,
but
I
don't
have
a
lot
more
than
I
did
and,
let
me
say,
I
just
don't
I
mean
of
what
work
you've
done
with
CSG.
It's
phenomenal
as
I
was
listening.
It
reminded
me,
you
probably
had
experience
and
somewhere
in
your
work
life
with
whether
it's
continuous
process,
improvement
or
quality
assurance
or
Qi
or
Six
Sigma.
A
That's
all
it
is,
is
there's
just
all
these
discontent,
booty's
in
the
in
the
continuity
of
care
and
so
a
lot
of
those
solutions.
You
know
80%
of
your
things,
just
comes
from
putting
together
as
a
standardized
procedure
manual
and
going
out
and
educating
people,
and
that
in
itself
may
resolve
quite
a
bit
and
then
to
that
there's
some
other
things
that
dial
it.
C
Mr.
chairman,
thank
you
first
I
would
just
like
to
say,
but
you're
so
kindly
calling
our
work
is
the
work
of
Department
of
Health
and
Department
of
Corrections
and
CSG
and
frankly,
the
labor
committee
has
had
really
almost
nothing
to
do
with
it
other
than
to
occasionally
provide
a
forum
for
presentations
and
ask
questions,
but
really
the
agencies
and
the
providers
have
done.
C
C
One
of
our
further
requests
ought
to
be
to
look
at
the
states
that
have
not
expanded,
Medicaid
and
see
if
they're,
using
waivers
or
you
know
what
they're
using
to
not
use
general
fund,
because
if,
if
we,
if
we
don't
want
to
go
that
route,
we
need
to
consider
that
and
I.
Think
then,
just
following
up
on
on
our
idea,
a
little
bit
of
yeah
I
mean
I
I.
Think
it's
really
clear
that
the
criminal
justice
involved
population
has
got
to
be
a
prey,
a
high-risk
area.
C
You
know
it
it
it's
it's
really
a
challenge.
I
mean
I
I,
just
I,
don't
I
don't
want
to
be
here
just
saying.
No,
you
can't
cut
anything
because
hey
I
did
my
two
years
on
Appropriations
and
I
know
that's
not
a
thing,
but
just
as
as
appropriations
looks
through
the
whole,
you
know
through
the
next
six
months.
C
There
are
certain
areas
of
our
general
fund
spending
mental
health.
Criminal
justice
may
be
DFS,
Child,
Protective,
Services
type
of
areas
that
it.
If
we
cut
them
it
will
just
kill
us
in
the
next
five
years.
You
know
I
mean
it
would
just
kill
the
state,
the
communities
everybody
around,
and
so
we've
just
got
to
be
so
wise
on
on
what
those
services
are
for
the
safety
net,
not
only
for
the
person
but
for
the
community
around
them
so
know.
C
A
I'll,
take
those
I'll
take
those
in
reverse
order,
so
the
direction
to
John,
Brodie
and
Elizabeth
Martin
L
would
be
to
I
guess
first
to
to
look
at
the
work.
That's
already
been
done
on
the
waivers,
there's
no
sense
reinventing
the
wheel
legislatively
and
then
what
would
you
suggest
that
they
to
reach
out
to
see
what
other
states
have
done?
What
checking
within
CSL?
C
C
Think
that
would
be
if
we
could
get
it
in
sort
of
a
matrix.
You
know
States
how
they
how
they
cover
their
non.
You
know
mental
health
services
for
non
Medicaid
people,
some
tips
from
them,
so
that
and
and
if
we
can
look
at
it
far
enough
ahead,
so
that
we
can
really
come
in
and
say,
okay.
This
really
sounds
good.
C
A
And
so
then,
as
a
heads-up
to
John
or
Elizabeth,
you're
gonna
want
to
ask
the
same
set
of
questions
with
respect
to
adolescents
caught
up
at
the
justice
system,
whether
it's
girls
at
the
girls
school
boys
at
the
boys
school.
Whatever
other
states
do
there's
discussion
with
DFS
about
converting
the
girls
school
from
a
Correctional
Facility
to
a
treatment
facility.
They
don't
know
whether
they
do
that
the
boys
school,
because
they
they
have
to
keep
that
crew,
that
they're
tougher
it's
tougher
cases.
A
They
have
to
keep
that
correctional
status,
but
so
you're
gonna
get
the
same,
rounded
questions
and
we
started
talking
about
adolescent
and
juveniles
caught
up
in
the
justice
system.
So
you
may
as
well
take
a
look
at
one
other
states.
Do
there
as
long
as
you're
gathering
data
represented
Larson
can
I
finish
up
with
one
thing,
with
sue
Wilson,
so
sue
I
appreciate
you,
you
the
accolades
that
he
gave
to
staff
and
CSG
and
that's
important,
but
that
you
know
there's
a
great
danger.
This
will
be
a
study
without
a
champion.
A
Somebody
like
you
in
the
legislature
that
says
you
know
what
do
we
need
to
do
legislatively
make
this
happen?
What
do
we?
What
do
we
need
to
as
legislative
advocates
and
champions
to
make
sure
that
this
really
moves
floor,
because
you
know
Department,
corrections
and
Department
of
Health
will
ultimately
hit
the
same
roadblocks
that
the
community
and
mental
health
centers
will
there's
a
judge
who
doesn't
understand.
There's
a
county
attorney
who's
never
heard
of
it.
There's
some
probation
officers,
don't
believe
in
it.
A
You
know
and
there's
just
there's,
just
a
almost
a
whole
Evangelization
function
and
then,
frankly,
there
is
a
legislative
role
like
we
believe
in
decentralization.
We
believe
in
local
choice:
Amy
to
butcher
the
County
Sheriff
be
able
to
say:
I
will
not
participate
in
24/7
when
it's
been
proven
to
reduce
recidivism
and
drunk
driving
by
40
percent,
because
that's
our
system
now
we
let
each
County's
sheriff
decide
whether
he's
going
to
whether
he's
going
to
participate
not
or
not
and
I.
A
Don't
know
you
know,
maybe
maybe,
if
they're
receiving
state
funds
they
should
just
do
it
a
single
point
of
entry.
You
know
for
juveniles.
That
was
a
mandate
I,
don't
believe
in
federal
mandates.
Much,
but
that's
one
that
worked
I.
Think
that's
this
one
single
reason:
the
juvenile
crime
has
fallen
by
40
to
50
percent
in
the
last
15
years,
is
a
federal
mandate
that
said,
you're
gonna
stop
letting
these
kids
drop
to
the
cracks.
You're
gonna
have
multi
disciplinary
teams
and
you're
gonna
triage
and
we're
gonna
give
them
the
right
treatment
on
that
way.
A
A
G
G
chairman,
oh
I,
think
the
other
thing
that
I
we
would
like
I'd
like
to
see
us
get
ready
for
is.
Is
we
get
this
other
matrix
on
what
other
states
are
doing?
I
think
it
would
be
also
helpful
if
we
could
just
once
again
put
fill
in
these
boxes
on
the
famous
slide
13
and
say
what
services
are
now
being
provided
by
the
community
mental
health
providers
so
that
we
can
determine.
G
Maybe
look
at
at
which
of
those
would
absolutely
need
to
be
required
as
a
priority
or
which
ones
would
would
maybe
be
ranked
down
there,
but
I
think
we're
gonna
have
to
I.
Think
we're
gonna
have
to
at
some
point
if
I'm
here
in
the
mental
health
providers
correctly
they're
wanting
some
direction
rather
than
us
just
coming
in
and
telling
them
with
less
money.
Please
do
more
I
think
they
need
to
have
some
direction,
and
we've
indicated
that.
H
I'll
be
very
brief,
so
first
I
want
to
point
out
to
see
us
G
work.
The
justice
reinvestment
that
was
actually
taking
a
lead
was
by
the
judiciary
committee
for
several
years
of
Jared.
Olsen
was
probably
there
in
the
beginning
days.
Some
of
that
got
shifted,
as
chairman
Wilson
noted,
to
the
Health
Committee,
but
most
of
the
work
that
most
of
the
legislation
came
out
the
judiciary.
The
second
thing,
I
guess,
is
on
the
county
level
to
representative
Larson,
co-chair
Larson's
question
and
and
chairman
Wilson's
question
about
access
within
a
County
I.
H
Think
access
within
a
county
a
year
ago
looks
sounds
a
lot
different
or
looks
a
lot
different
than
it
does
now
with
just
where
we've
been
with,
where
we
are
now
with
telemedicine
and
and
folks
having
different
access.
I.
So
I
think
that
what
we
thought
a
year
ago
is
different
than
what
we
might
think
of
access
now.
H
I
yeah,
when
I,
when
I,
listen
to
our
discussion.
What
I'm?
What
I'm
struggling
with
in
my
own
mind,
is
the
executive
branch
is
making
budgetary
changes
now.
So
we
are,
we
are
going
to
respond
and
potentially
in
a
special
session,
but
more
likely,
broad,
more
broadly,
in
a
general
session,
the
upcoming
general
session
of
the
new
legislature
to
we're
going
to
be
reactionary
to
what
they
did.
H
We
are
it's
not
going
to
be
it's
not
hand
at
hand,
it's
reactionary
and
we're
going
to
be
trying
to
either
fill
gaps,
add
funding,
fine
alternative
funding,
etc,
or
a
just
policy
statute
statute
that
needs
to
be
adjusted
so
I
guess
when
we
talk
about
all
these
different
things,
I
think
they
have
to
be
boxed
into
that.
Is
it
reactionary?
Is
it
policy
adjustment,
or
what
are
we
going
to?
How
are
we
going
to
try
to
respond
or
to
whatever
changes
that
come
about?
H
The
final
thing
I'd
make
say
is:
is
that
if
there's
one
gap
in
Wyoming
statute,
it
is,
there
is
no
definition
of
community
mental
health
and
substance
abuse
and
how
it's
what
is
expected
and
where
it
goes.
There's
lots
about
prevention,
there's
lots
about
other
programs,
but
as
far
as
mental
health
and
substance
abuse
as
what
general
access
or
not
it
doesn't
matter,
it's
just.
H
A
C
C
A
Then
I
think
representative
Larsson
his
hand
up,
but
I
just
wanted
to
follow
up
on
something
to
represent.
Barlow
sit
represent
Wilson
because
he
gave
kudos
to
the
Judiciary
Committee
and
I
was
off.
That
was
my
first
committee
assignment
after
John
Shefford,
nine
and
I
gradually
kind
of
discerned
where
he
had
been
heading
the
whole.
A
The
whole
CSG
Q
thing
had
kind
of
died
with
him
and
then
gradually
we
kind
of
got
our
legs
under
us
and
brought
it
back,
but
my
whole
experience
there
was
were
five
years
into
it
and
it
could
have
been
a
much
shorter,
except
if
the
legislature
does
its
work,
my
committees
right,
and
so
it
was
kind
of
a
Judiciary
Committee
thing
and
then
they
got.
And
then
they
said
you
know
it's
past
us
now
it's
a
labor
and
health
thing,
but
in
all
that
in
the
states
and
that's
what
I
was
hoping.
A
A
The
Chief
Justice
of
the
Supreme
Court,
the
governor,
the
Attorney
General
and
the
president
sent
in
the
speaker,
the
house,
because
they
said
there's
no
point
in
doing
any
of
this
work.
If
those
people
are
not
on
board
and
and
so
it
was
instructive
to
me
that
all
five
of
those
people
signed
onto
it,
but
all
five
of
those
people
are
gone,
and
so
it's
another
conversation
sue
but-
and
maybe
you
and
I
don't
have
a
little
bit
later.
If
you
haven't
completely
burned
yourself
out
on
it
today,
but
I,
don't
know
where
we
we've.
A
We've
got
to
get
those
folks
back
on
board
and
it
may
take
some
legislative
champ.
We
can
cut
and
cut
and
cut
and
study
all
we
want
with
CSG
Wes,
but
there's
a
whole
lot
of
cats
and
the
system
need
to
be
heard.
Take
a
look
at
just
do
a
search
on
the
the
Chief
Justice
of
the
Ohio
Supreme
Court.
That
was
the
champion
there.
She
decided
they
had
to
do
something
about
their
opioid
crisis
and
she
was
the
pivot
point.
A
She
called
all
the
players
to
the
table
and
said
we're
going
to
do
something
about
this.
We're
gonna
get
it
done
as
intractable
as
it
is,
and
it
takes
somebody
in
that
kind
of
position
to
really
make
a
difference
and
to
help
drive
forward
what
we
hope
we
can
do.
So
that
really
is
the
end
of
my
soapbox,
Lloyd.
G
G
We're
the
ones
that
have
been
having
the
discussion
to
this
workgroup
and
and
make
sure
that
we've
kind
of
got
that
and
then
hand
that
off
to
both
committees,
I
I
think
that
it's
an
inefficient
use
of
committee
time
to
go
back
and
forth
between
this
workgroup
and
the
Committee
on
making
those
decisions.
So.
A
Before
we
before
we
wrap
up,
you
know,
the
last
thing
we
want
to
do
I
think
is
to
is
to
get
staff
to
give
us
back
some
feedback
on
what
all
we've
asked
at
various
players,
but
before
we
do,
I
do
want
to
get
Venn
diagram.
We've
been
assigned
kind
of
the
intersection
of
appropriations
and
mental
health
and
substance
abuse
is
still
an
elephant
and,
as
we
move
forward
with
our
agenda,
I
just
wanted
to
see
what
part
what
get
some
feedback
from
members
of
the
committee
and
if
staff
could
take
notes.
A
What
would
you
see
is
like
to
see
us
explore
next
or
somewhere
in
the
process?
What
are
some
agenda
items
you'd
like
to
see
what
are
some
things
that
you'd
like
to
to
learn
that
we
haven't
explored?
Just
give
me
some
feedback.
I'm
I,
don't
want
to
get
too
far
ahead
of
the
committee
I'd
like
to
know
where
the
committee
would
like
to
go
any
feedback,
thoughts,
ideas,
Jared.
A
H
I
Think
mr.
chairman
I
think
we've
had
some
really
good
conversation
and
some
good
things
have
come
up.
I
would
still
like
to
maybe
see
if
there's
some
way,
we
could
maybe
streamline
our
mental
health
centers.
Just
a
little
bit
more
I
talked
a
little
bit
earlier
about
seeing
if
we
could
do
some
more
collaboration
with
private
or
independent
sources,
because
I
know
that,
for
instance,
if
you
know
just
take
northern
mental
health
if
they
have
two
psychologists
and
an
addiction,
professional
and
I,
don't
even
know
how
many
professionals
they
have
on
board.
I
But
if
we
could
maybe
collaborate
more
with
some
of
the
folks
that
might
be
able
to
contract
and
make
it
cheaper.
Because
you
know
let's
say
I
mean
you
know:
personnel
costs
are
huge,
especially
when
you
add
in
your
you
know,
insurance
and
all
your
benefits
and
all
that
so
I.
Just
wonder.
If
there's
any
way,
we
could
streamline
our
mental
health
centers
and
make
them
more
efficient
than
what
they
are
now
and
I.
Do
like
the
idea
of
looking
in
the
waivers
and
seeing
what
other
states
are
doing
that
haven't
expanded
with
Medicaid.
A
C
C
You
know
I
I,
think
and
by
the
way
I
was
just
thinking
to
say
before
I
stepped
away
that
I
am
probably
going
to
be
meeting
with
the
governor's
health
policy
advisor
this
week.
So
maybe
get
some
some
insight
from
her,
but
you
know
I
think
got
to
representative
Barlow's
discussion
in
some
ways
the
agenda
may
be
a
little
bit
steered
by
what.
A
C
You
know
the
the
labor
committee
did
have
a
bill
in
the
last
session
to
create
a
behavioral
health
task
force
to
really
bring
in
legislators
and
providers
and
law
enforcement
and
all
to
really
discuss
and
that
that
bill
ended
up
not
passing,
and
there
was
a
lot
of
there
were
enough
legislators.
That
said,
oh,
we
don't
like
task
forces.
We
should
just
do
it
in
in
our
committees.
Well,
so
we're
kind
of
the
mini
version
of
a
behavioral
health
task
force.
C
We
just
have
to
think
three
times
as
hard
for
you
know
for
lack
of
more
people,
but
you
know,
since
senator
shippers
days
I
mean
since
we're
looking
at
the
same
problems
that
we
had
in
2005-2006.
If
you
go
back
to
the
task
force
then-
and
so
hopefully
we
can
just
be
creative
enough
to
really
yeah
not
just
respond
to
the
governor,
but
just
try
to
think
think
conceptually,
but
I.
Don't
really
have
an
answer
for
that
right
now:
okay,.
A
So
just
one
thing
that
I
would
like
to
see
a
follow-up
from
staff
on
for
for
a
future
consideration
and
I'm,
going
to
turn
my
attention
away
from
the
criminal
system.
But
what
we
found
out
when
we
were
working
on
the
Retirement
Center
is
there's
nurses
over
there
in
the
basin
that
don't
want
to
work
for
state
government
for
25
years
and
walk
out
with
a
pension.
You
know
one
said
my
husband's
a
cop
I,
don't
need
all
that
crap!
A
You
know,
couldn't
give
me
25
bucks
with
a
pension,
give
me
35
bucks
and
I'll
just
work
per
diem.
That's
that's
the
that's
the
term
of
art
in
health
care.
It's
called
just
working
per
diem.
When
we
need
you,
we
call
you.
No,
we
don't
need
you.
We
don't
call
you
in
so
that
when
the
census
is
full,
you
bring
them
in
and
pay
him
a
higher
daily
rate
or
hourly
rate.
Then
full
time
on
staff
people
and
what
was
happening.
The
retirement
centers.
A
Those
nurses
would
leave
they'd
go
to
work
for
an
agency,
and
the
state
would
hire
them
back
at
$70
an
hour
through
the
agency
because
they
didn't
want
to
change
the
rules
at
A&I,
and
so
we
are
working
with
Lisa
Oswald.
This
is
for
Elizabeth
and
John
Lisa
Oswald
and
she
was
trying-
and
this
is
for
the
veterans
home.
This
is
for
the
State
Hospital,
it's
a
model
of
the
1950s.
A
You
come
on
board,
we
hand
you
a
pension,
you
retire
in
thirty
five
or
twenty
five
or
twenty
years
you
get
a
gold
watch
and
that
you
know
there's
a
lot
of
people
don't
want
to
work
that
way,
and
so
we
were
trying
to
get
a
and
I
to
just
say,
create
us
create
a
status
called
per
diem.
Let
us
pay
nurses,
thirty
five
bucks
an
hour
or
whatever
it
is,
don't
want
to
work
full-time
for
the
state
and
Dan
was
like
pulling
teeth.
A
I,
don't
know
if
it's
done
yet
I
don't
understand
what
the
resistance
to
a
and
I
was
but
I'd
like
a
presentation
on
where
we
are
on
that.
If
we've
created
a
status
of
employees
that
are
just
called
per
diem
contra,
you
know
they're,
not
contract
they're,
just
per
diem,
they're
non
benefited
and
you
can
see
you
know
a
and
I
it's
state
government.
They
don't
want
to
do
that,
but
I
think
it's
important,
particularly
in
health
care,
so
sue.
A
You
remember
in
the
90s
when
the
government
really
or
started
reforming
all
the
payment
models
and
I
had
nurses
on
staff.
Full-Time
pharmacists
on
staff.
Full
time
had
to
call
them
in
and
say
you're
full
time
and
you're
full
time.
The
rest
of
your
all
working
per
diem.
Every
hospital
had
to
do
it.
Every
nursing
agency,
every
homecare
agency,
you
I,
was
just
not
gonna
pay
for
people
to
be
on
staff
full
time
what
the
census
isn't
for,
except
when
it's
state
government
running
the
institution
or
paying
the
bill.
A
H
A
A
B
So
I
I
need
to
mute.
I.
Think
I
need
to
meet
my
alright.
So
can
you
still
hear
me?
Yes,
okay,
so
sorry
died.
I
just
joined
a
half
hour
forty
minutes
ago
from
State
Building
Commission
meeting
so
I
apologized
for
that
in
in
testimony
day
that
you've
heard
from
mr.
Craig
when
it
was
directly
in
regards
to
Department
of
Corrections.
B
A
G
A
To
that
I
would
add,
represent
larson
people
who
are
post-arrest
predisposition,
post
disposition,
priests
sentencing
and
then
post
sentencing.
Whatever
their
status
is
whether
it's
you
know
waiting
to
go
to
prison
or
or
halfway
house
drug
treatment,
probation
parole,
so
it's
not
just
not
just
after
they've
been
released
from
the
poke
in.
B
B
A
Guess
I'd
say
this
about
that
and
then
I'll,
let
representative
Larson
go
I,
get
it
I,
don't
think
we
have
the
time
for
that
right
now.
If
we're
gonna
get
anything
done,
we're
gonna.
If
we're
gonna,
win
on
them
down
and
say
you
don't
take
in
non
priority
populations,
we
need
to
integrate
more
tightly
into
the
correction
system.
I,
don't
think
we
have
time
to
go
out
to
bid
to
create
a
whole
new
companion
system
to
run
beside
the
system.
We
have
to
three
or
two
three
years
down
the
road.
A
Maybe
we
Circle
that,
but
this
is
this,
is
this
is
what
we
got
and
I
just
I.
Just
don't
see
us,
you
know
the
committee
may
take
a
different
direction,
but
you
know
we
have
enough
enough
issues
in
the
system
in
terms
of
coordination
and
continuity
of
care
without
adding
new
players
or
or
additional
players
into
the
system.
As
missus
my
view
represent
Larson.
G
Thanks
representative,
we
really
what
we've
been
trying
to
talk
about
here
is
the
current
funding
of
mental
health
as
it
exists
now,
and
that
really
doesn't
contemplate
bringing
additional
people
in
to
that
system.
We're
trying
to
figure
out
how
we
reduce
those
well,
it
could.
If
we
say
we
don't
think
the
community
mental
health
providers
are
working,
then
that
system
is
broke
then
then
we
could
start
from
scratch.
G
I,
don't
know
that
that
this
committee
is
at
that
point
in
making
that
decision,
but
in
fairness
to
the
discussion,
sure
that
could
be
one
of
the
options
start
completely
over
again
and
then
we
could
just
send
it
out
to
on
a
bid
basis
every
year
and
say
this
is
what's
what
is
expected,
but
I
think
initially
the
conversation
was
is
how
do
we
take
that
systems,
that's
in
place
and
better
use
or
how?
Who
do
we
serve
and
with
the
reductions
we
see
in
funding
with
the
money
that
we
have.
B
B
Also
but
again,
we've
standard
Bouchard
is
is
done
more
work
on
this
than
I
and
we
we've
tried
to
work
on
those
issues,
but
it
have
received
a
lot
of
opposition
so
but
anyway,
I
appreciate
the
comments
and
in
the
time
and
appreciate
the
committee's
good
work
any.
If
there's
anything,
I
can
do
I'm
one
of
the
sole
people
in
in
the
Republican
Party
that
believes
Medicaid
expansion
might
work
right
now
so
and
I
understand.
Senator
Schuler
brought
some
issues
up
and
and
you're
going
to
be
looking
at
that.
B
B
H
B
E
A
E
Oh
Thank
You
mr.
chairman
I,
would
like
to
just
say
to
the
committee.
Thank
you
for
your
diligence
on
these
very
difficult
topics.
I
have
watched
up
close
and
personal
and
from
afar
your
work,
senator
Kinski
for
the
last
several
years
as
chair
and
obviously
chair
wilson,
you
guys
have
been
absolutely
awesome.
I
did
take
an
opportunity.
The
Kaiser
Foundation
does
provide
that
information
for
senators,
Schuler's
and
representative
Wilson's
questions
about
the
expansions.
There
are
multiple
types
of
waivers
that
I
do
believe.
A
H
E
E
It
would
most
certainly
collapse
the
small
and
medium-size
centers
and
probably
very
seriously
affect
the
large
centers
as
well,
because,
as
I
explained
in
my
last
meeting,
this
system
and
the
funding
system
that
supports
community
mental
health,
centers
is
really
a
giant
puzzle
and
everything
is
built,
whether
its
city
and
county
state
funding
state
funding
is
the
largest
piece
for
a
lot
of
our
centers
in
terms
of
revenue.
So
again,
we
just
want
to
be
careful
on
how
we
move
this
system
going
forward.
E
A
J
Sorry
I
got
caught
off
guard
with
the
delay.
Mr.
chairman
members
of
the
committee,
I
just
had
a
couple
of
things.
There
were
some
questions.
I
wanted
representative
Wilson
to
ask
you
know
what
percentage
of
folks
adults
18
to
64
were
on
Medicaid,
so
I
ran
some
quick
data
and
this
is
just
northern,
because
I
have
everybody
else's
data.
Overall,
twelve
percent
of
the
folks
we
see
have
Medicaid
sixteen
percent
of
the
females
we
see
have
Medicaid
and
nine
percent
of
the
male's
have
Medicaid.
So
that's
our
current
breakdown
of
that.
J
They
allow
us
to
provide
a
lot
of
services
Medicare,
on
the
other
hand,
has
limitations
and
because
of
the
LCSW
limitation,
if
I
got
a
LPC
in
Cook
County,
we
just
basically
get
no
dollars
for
any
Medicare
and
and
I
know
the
National
folks,
or
have
been
trying
to
work
on
that
for
some
time
in
terms
of
the
community
mental
health
system
and
the
idea
of
private
providers
versus
not
there's
a
distinct
difference
between
private
providers.
In
the
community
mental
health
system
and
that
distinct
difference
is
it's
not
just
providing
therapy?
J
It's
a
wide
array
of
services,
mission
on
the
very
seriously
ill
one,
but,
most
importantly,
we're
all
carve
accredited
everybody
that
the
contracts
with
the
state
or
carve
accredited
they
come
every
three
years.
They
comb
through
everything
with
a
couple
of
thousand
different
criteria.
They
look
at
all
our
records
they're
reviewed
extensively.
Not
only
do
we
get
reviewed
extensively
there,
we
have
internal
quality
control
as
well,
that's
required
to
for
us
to
pull
charts
and
appendant
lis.
Look
at
them.
The
therapist
doesn't
look
at
their
own
chart.
J
Somebody
else
does
and
take
remedial
action
if
we
find
some
issues
there.
Additionally-
and
it's
been
less
so
because
of
I-
think
the
constraints
of
staffing
and
everything
going
on,
but
historically
the
state
has
come
in
once
a
year
to
our
shops.
Look
through
everything,
so
the
community
mental
health
center
systems
are
highly
structured,
highly
organized
and
have
tons
of
oversight.
G
C
You,
mr.
chairman
I'm,
Paul
I
do
have
one
thing.
So
thanks
for
the
data
on
the
percentage
of
your
patients
who
are
Medicaid
and
so
I'm
asking
you
something
now
to
kind
of
off
the
hip,
you
know
I
talked
about
if
the
person
were
disabled
and
then
they
could
get
on
Medicare
and
thus
on
Medicaid.
Do
you
have.
J
Second
thing:
there
is
a
program
called
soar:
SOR
a
and
the
soar
program
is
really
designed
to
get
people
trained
up
and
to
fill
out
the
forms
correctly
and
work
with
the
person
and
and
do
everything
they
can
to
ensure
as
best
you
can
somebody's
going
to
get
on
Medicaid
or
on
disability.
It's
really
disability
that
they're
getting
on,
and
it's
a
very
time
intensive
process
and
the
data
says
the
people
that
have
somebody
providing
soar
have
more
success
and
get
on
quicker.
The
the
flip
side
of
that
is
especially
in
the
current
environment.
J
In
order
for
me
to
have
somebody
who
would
just
do
soar
because
it's
so
time
intensive
I
would
have
to
take
a
service
provider
offline
but-
and
we
had
one
I-
think
two
different
people,
true
story,
I
think
some
other
centers
are
doing
it
nationally.
It
seems
to
work
so
I
think
it'd
be
something
for
the
state
to
look
at
the
other
thing.
I'll
tell
you
too.
Is
we
check
everybody
every
time
they
come
in
against
instantly?
Are
the
unmedicated
we're
very
aggressive
about
that?
So.
G
G
J
G
Okay,
John,
maybe
what
we,
if
I,
could
just
ask
you
to?
Maybe
you
and
Elizabeth
put
a
summary
together
of
all
of
the
things
that
we've
asked
you
to
do,
that
might
be
volumes
you
it
was.
It
was
a
boatload
and
then
maybe
senator
Kinsey
and
I
can
go
over
those
with
you
and
we'll
we'll
sort
out
the
how
we
need
to
proceed
forward.
I
would
just
remind
the
committee
to
that
so
so.
Thus
far,
we've
talked
about
community
mental
health.
G
G
G
When
we
talk
about
silos
man
there
they
are,
and
so
we'll
be,
bringing
that
in
some
form
back
to
this
committee,
to
have
a
discussion
and
understand
and
and
see
if
we
need
to
do
anything
there,
I
would
I
would
also
just
in
closing,
share
to
the
committee
that
you
know
this
committee.
The
intend
this
committee
is,
we
need
to
look
and
see
and
make
recommendations
back
on
where
statute
should
be
changed.
How
this
should
look
differently.
Look
at
this.
G
This
whole
system
in
in
just
like
any
other
select
committee
and
let's
kind
of
come
up
with
a
format
and
then
we'll
bring
that
back
to
the
the
two
committees
labor
and
appropriations
to
move
any
legislation
forward
that
we
need
to.
But
you
know
we've
been
doing
the
work
here
and
Ian
focused
on
that,
and
so
that's
be
ready
to
continue
that
and
with
with
that
drawn
them
Elizabeth
that
there
is
there
ain't
else
that
you
have
I
know.
I've
asked
you
that
wants
one
time.
No.