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A
C
C
So
I
think
we'll
go
ahead
and
get
started
here
again
Stefan.
Why
don't
we,
if
you
would
like,
maybe
before
we
go
into
the
question
period,
if
you've
got
any
closing
comments
on
gatekeeping
that
you'd
like
to
share
with
us
from
the
Department
of
Health's
point
of
view
and
then
we'll
go
ahead
and
start
taking
questions.
E
Thank
You,
mr.
chairman
and
members
of
the
committee,
just
a
few
excuse
me
a
few
concluding
remarks
dovetailing
off
of
our
gate.
Gatekeeping
conversation
as
I
mentioned
that
program
in
that
statutory
mechanism
is
really
you
know
specific
to
the
title,
25
population
and
an
attempt
to
make
that
system
work
more
efficiently
and
more
effectively
for
those
patients.
E
But
it's
really
a
good
example
of
the
continuum
of
care
that
I
talked
about
before,
where
you
have
community
programs
on
one
end:
higher
levels
of
care
like
the
hospital
or
the
life,
Resource,
Center
or
others,
and
then
on
the
back
end
of
that
again,
your
community
programs
for
for
aftercare
and
for
maintenance
in
the
community
and
again
I
just
lay
that
out
conceptually
a
lot
of
a
lot
of
nuance,
both
legally
and
financially,
with
that.
But
I
wanted
to
take
just
a
minute
or
two
mr.
E
Sustainable
future.
In
that
in
this
past
year,
the
State
Hospital
is
nearing
substantial
completion
in
the
construction
project
and
actually
and
thanks
in
no
small
part
to
representative
Larson
and
representative
Nicholas
good
work
on
the
the
task
force
and
the
work
group.
That's
been
been.
Managing
helping
us
manage
those
construction
projects,
but
in
the
last
year,
like
I,
mentioned
we're
we're
nearing
substantial
completion
of
the
State
Hospital.
In
fact,
we're
gearing
up
by
July
6
to
start
moving
in
staff
and
patients
to
the
new
facility,
and
so
between
September
between
July
and
September.
E
19
million
dollars
of
biennial
title
25
costs
with
a
4.4
million
dollar
budget
in
the
past
to
Baia
Nia.
We
have
cut
those
costs
in
half.
The
legislature
has
been
kind
enough
to
give
us
access
to
some
lizra
funds,
as
well
as
an
exception
request
for
an
appropriation,
but
going
from
from
19
million
dollars
on
the
biennium
to
what
we're
trending
right
now
is
just
over
nine
in
title.
25
expenditures
is
a
testament
to
some
of
the
work.
That's
been
done.
E
Not
only
at
the
hospital,
but
also
in
our
communities,
and
especially
in
our
Medicaid
program,
who
really
took
on
the
claims,
processing
and
the
data
system
and
kind
of
handling,
our
policies
and
our
procedures
when
it
comes
to
a
claims
from
private
and
designated
hospitals
in
title
25.
So
a
good
financial
trend
there
of
reduced
expenditures
in
title
25
is
certainly
a
good
on
the
operational
side
of
the
State
Hospital.
Mr.
chairman
I
wanted
to
mention,
because
it
is
the
first
time
since
I've
been
with
the
department
that
I've
seen
this.
E
We
had
a
lot
of
concerns
from
the
facilities
task
force,
the
Labour,
Health,
Committee
and
other
stakeholders
that
we
would
struggle
and
and
might
not
be
able
to
staff
the
new
facility
with
with
an
increased
vet
capacity,
and
that's
certainly
a
concern
going
forward
to
staff
a
psychiatric
hospital
in
Evanston
Wyoming.
We
we
constantly
struggle
with
with
staffing,
because
not
the
least
of
which
reasons
is
because
of
the
location,
but
also
because
psychiatric
hospitals
are
difficult
places,
but
rewarding
places
to
work
for
our
nurses.
It's
the
first
time
I've
seen
since
I've
been
here.
E
We
about
two
two
and
a
half
months
ago
we
were
full-on
nurses
right
now,
I
think
we
have
to
nurse
vacancies,
and
so
we've
been
really
pushing
on
staffing
that
facility
with
not
having
to
rely
as
much
on
contractors
which
would
charge
a
premium
and
the
recruiting
has
been
really
good,
both
with
our
nurses
and
our
in
our
CMAs
trending
in
it
in
a
positive
direction
since
since
last
summer.
In
addition,
our
turnover
rates
for
nurses
and
CNAs
have
been
on
a
on
a
relatively
steep
downward
trend,
which
is
really
good
to
hear
and
I.
E
And
that
brings
me
to
my
last
comment.
Mr.
chairman,
on
the
continuum
like
I
mentioned,
State
Hospital
and
life
Resource
Center
are
one
part
of
that
and
I
think
the
progress
that
we're
showing
on
the
facility
side,
both
with
physical
plant
and
construction
and
and
and
retention
and
and
general
outcomes
length
of
stay
waitlist,
things
that
are
moving
in
a
good
direction.
E
It
just
again
makes
me
optimistic
that
I
think
some
of
the
tasks
a
committee
like
this
is
taking
on
when
it
comes
to
improving
the
other
ends
of
that
continuum
with
our
community
programs,
with
with
really
doing
the
work
to
define
what
what
a
safety
net
means.
What
what
the
services
that
need
to
be
provided
for
these
different
types
of
populations,
I
think
we
can.
We
can
really
make
progress,
so
I
just
wanted
to
give
the
committee
an
update.
E
The
success
that
I
think
everyone
here
envisions
for
the
continuum
of
care
with
with
a
tough
policy
area
like
behavioral
health,
relies
so
heavily
on
our
ability
to
align
our
communities
with
with
not
only
the
mission
but
the
operations
and
the
and
the
procedures
of
the
State
Hospital.
So
I
commend
this
this
group
for
dedicating
your
time
to
to
help
us
solve
some
of
these
tough
problems
and
hopefully
make
some
progress
and
move
in
the
right
direction.
So,
mr.
E
C
So
Stefan
I
I
have
a
couple
that
I
want
to
make
sure
as
I
listened
to
Andy
and
Paul's
comments
earlier,
and
then
your
presentation,
it
sounds
in
what
I've
run
into
is.
We
do
have
been
consistent
in
consistency
across
the
state
on
how
the
gatekeeping
process
is
administered,
and
so
did
that
and
I
I
then
hear
you
say
that
in
2020
you'll
be
incorporating
that
into
the
gatekeeper
services
contract
with
each
community
mental
health
center.
E
E
You
know:
data
reporting
and
reimbursements
under
under
the
contract,
but
like
I
mentioned,
it
is
a
mixed
bag
in
what
certain
communities
need
in
terms
of
gatekeeping
in
services
for
title
25,
clients
largely
due
to
population
resources
that
are
available
in
the
community.
So
it
kind
of
requires.
Quite
frankly,
mr.
chairman,
when
you
talk
about
title
25
gatekeeping,
we
have
resources
located
in
many
different
parts
of
the
state
and
in
many
different
parts
of
the
community.
Mental
health
and
substance
abuse
system
and
a
good
example
is
a
gatekeeper.
E
But
there's
no
group
home
beds
available
in
Fremont
County,
where
I
think
we
have
some
room
for
improvement,
is
more
coordination
across
the
entire
statewide
system
to
find
where
the
resources
are
and
to
your
point
kind
of
unify
that
approach
of
coordination,
of
where
those
where
those
patients
could
best
benefit
from
resources
that
might
not
be
located
locally
within
that
for
lack
of
a
better
term
that
gatekeepers
jurisdiction.
If
that
makes
sense.
E
Thank
You
mr.
chairman,
just
really
briefly
and
I'll
hand
it
over
to
to
Matt
Petrie
AB
in
chi
fur
in
our
Behavioral
Health
Division,
but
but
very
briefly,
I
want
to
mention
that
I,
don't
think
in
the
short
term
that
legislation
around
gatekeeping
would
be
would
be
necessary.
I
think
we
have
again
the
the
authority
that's
needed
in
statute
to
define
what
those
services
they
had
standardized.
Some
of
what
those
services
might
look
like.
E
B
C
B
B
That
was
a
pilot
program
that
we
consolidated
into
a
service,
a
an
actual
service
definition
that
we
call
emergency,
diversionary,
bundled
service,
and
essentially
what
this
does
is
it.
It
spreads
those
services
to
all
centers
in
the
form
of
an
RD
you
which
they
can
then
deliver
gatekeeper,
services
or
emergency
services
defined
by
the
service
definition
and
then
be
reimbursed
at
a
higher
RVU
rate,
which
incentivize
again
that
diversion
you.
B
Our
bu
is
how
they
are
paid
by
their
service,
our
it's
a
relative
value
units
associating
it
is
simply
a
cost
to
a
service
out.
So
again,
it's
Stefan
I
mentioned
earlier.
The
standard
amount
for
general
population
is
is
$87.
With
this
a
DBS
we
had
hoped
to
go
to
increase
that
to
the
priority
population
level
and
even
beyond
that
to
incentivize
those
type
of
services
and
emergency
services.
B
You
know,
outside
of
their
four
walls
within
their
community
no
health
center
to
include
all
these
things
that
are
traditional
about
gatekeeper
services.
You
know,
court
appearances
case
management
again
responding
to
hospitals
and
detention
centers
to
provide
their
assistance
or
assessments,
but
a
lot
of
the
things
that
were
mentioned
previously
by
the
provider
there
in
Carbon
County
those
emergency
services
that
they
were
previously
not
paid
for.
They
will
now
be
able
to
access
that
rvu
and
be
reimbursed
for
those
those
types
of
gatekeeper
and
emerges
tree
and
urgent
services.
E
Thanks
Ben
mr.
chairman,
does
that
does
that
answer
your
your
question
and
well
we're
happy
to
provide
this
committee
either
virtually
or
when
it
convenes
again
an
update
on
exactly
what
gets
executed
with
the
with
the
contracts
starting
July
1st,
but
I
will
mention
and
Ben
and
matter
are
living
this
right
now
you
know
it's.
It's
somewhat
of
an
uncertain
time.
We've
been
directed
to
prepare
a
pretty
substantial
budget
reduction
packages
for
for
the
governor,
as
you
all
know,
so
all
things
contracting
all
of
our
providers.
E
All
of
our
programs
are
currently
on
the
on
the
table
and
under
discussion
between
my
office
and
the
director
and
our
CFO
and
our
Division
administrators
on
exactly
what
those
reductions
will
look
like.
So
there's
there's
a
few
moving
pieces,
mr.
chairman,
but
we're
happy
to
provide
this
committee
with
updates
as
we
as
we
finalize
what
those
contracts
will
look
like.
Senator.
A
At
that
time.
I,
don't
know
about
representative
Olson
or
Larsen,
but
you
guys
were
dragging
the
chain
at
a
time
when
it
looked
like
there
was
just
going
to
be
no
end
in
sight
to
title
25
expenses,
the
question
I
have
for
Stefan
and
it
leverages
off
of
a
little
bit
of
what
representative
art
Larson
was
saying
where
we
heard
the
Senators
saying
from
their
perspective
was
going:
okay,
I!
A
Guess
that's
a
relative
term,
because
I
know
from
here
at
the
local
level,
the
community
mental
health
center
can
have
all
sorts
of
commitment
to
acting
as
gatekeeper,
but
you've
got
to
have
the
cooperation
of
the
hospital
you
have
to
have
the
education
of
my
in
of
the
physicians
in
the
emergency
room.
You
have
to
have
the
education
of
eirick
buy-in
of
the
county
attorney
the
county
attorney
to
them.
The
patient
may
be
transferred
law
enforcement
in
the
case
of
violent
patients.
A
What's
their
role
in
terms
of
affecting
that
transport
so
going
well
is
a
relative
term.
What
what
what
authority
do
you
have,
whether
it
moral
or
legal,
to
pull
all
the
players
in
on
the
title
25
step
in
and
make
sure
that
there's
buy-in
from
them,
while
we're
paying
the
mental
health
centers
and
controlling
and
ordering
them
to
go,
get
involved?
Thank
You,
mr.
chairman.
C
So
Stefan,
along
that
line
of
Senator
Kinski's
comments,
and
you
and
I
have
had
multiple
discussions
on
that.
Where
we
see
perhaps
our
designated
hospitals,
fool
our
State,
Hospital
fool,
and
so
the
rural
counties
end
up
the
courts
place
them
in
the
jurisdiction
of
a
hospital,
and
so
my
question
then,
as
we
we've
seen
some
back
and
forth
over
who
thence
responsibilities?
Are
they
who
makes
the
assessment?
Who,
who
does
that
and
what
role
does
the
gatekeeper
have
in
that
whole
process?
I'm
assuming
maybe
this
is
too
met.
E
Mr.
chairman
and
Senator
Kinski,
let
me
try
to
take
those
in
order.
Great
questions
by
the
way
in
for
senator
Kent's
keys,
question
I,
think
in
terms
of
our
authority,
either
moral
or
otherwise,
for
bringing
together
all
of
the
players
in
title,
25,
I
think
it's
limited
and
and
there's
a
balance
there
between.
E
You
know
some
local
control
and
kind
of
community
and
County
law
and
policy
that
I
think
most
states,
including
Wyoming,
really
put
that
first
three
to
five
days
of
jurisdiction
in
a
civil
commitment
process
in
the
hands
of
the
locality
or
or
the
county,
and
that's
certainly
what
we
have
here,
I
think
senator
Kinski
in
terms
of
our
moral
authority.
It's
a
great
great
term
and
that's
I
think
the
authority
that
we
have.
E
We
have
been
I
think
somewhat
successful
in
for
lack
of
a
better
term
kind
of
a
naming
and
shaming
tour
many
years
ago
on
counties
or
communities
that
might
have
been
able
to
do
things
better
by
not
anything
really.
The
department
had
direct
control
over
but
better
communication.
Better
coordination,
like
he
mentioned
with
some
of
the
players
in
the
in
the
county
offices.
E
County
Attorney's
law
enforcement,
mental
health,
centers
hospitals
etc,
but
it's
certainly
not
not
perfect
and
that
that
legal
authority,
you
know
only
goes
so
so
far,
but
I
think
when
we
have
aligned
resources
as
much
as
we
can
for
lack
of
a
better
term
incentivize.
Both
providers
and
communities
to
come
together,
pool
resources
and
treat
this
population
as
their
own,
not
a
population
that
you
know
needs
to
go
to
wbi
or
needs
to
go
to
the
state
hospital,
and
that's
that
that's
where
we've
really
seen
success
and
it's
and
you
know
I
won't.
E
I
won't
directly
contest
the
comments
from
our
from
our
friends
at
lamb
sack
earlier
today
on
it's
all
going
smoothly.
I
think
it
can
always
be
improved
and,
like
I
said
earlier,
its
it's
a
mixed
bag
of
not
only
resources
that
are
available
in
in
various
communities,
but
also
different
parties
within
the
title
25
system
that
work
together.
As
this
committee
knows,
title
25
has
a
lot
of
cooks
in
the
kitchen.
It's
one
of
those
areas
of
policy
and
not
unique
to
wyoming.
E
That
literally
involves
almost
every
part
of
county
and
local
and
state
government
between
providers
between
law
enforcement,
between
legal
folks,
case
managers,
mental
health
providers
etc.
Just
it's
it's
a
tough
system
to
standardize
and
unify,
and
senator
Kinski.
We
hear
often
of
proposals
or
concepts
or
ideas
of
hey.
The
department
should
just
take
over
title
25
and
that's
certainly
an
option
and
we
should
fund
it
and
that
kind
of
thing
that
that's
an
option,
but
you
lose
that
local
control
and
that
tacit
knowledge.
E
The
more
you
have
the
state
kind
of
control
that
process
and
then
finally
and
I'll
see
if
our
division
has
any
comments
on
that.
But
finally,
I
would
say
to
representative
wilson's
comments
from
earlier
I
think
this
really
comes
down
to
this
missioning
of
community
resources
and
in
this
case
in
particular,
community
mental
health
resources.
Title
25
is
one
component
like
I
mentioned
of
the
of
this
overall
continuum,
but
the
more
and
more
that
we
prioritize
a
wider
range
of
populations.
E
Then,
as
representative
Wilson
put
it
very
eloquently,
you
start
losing
your
priority
status,
the
more
priority
populations
that
you
have
and
that's
a
tough
conversation.
So
years
ago
you
know
I
think
there
was
some
consternation
about
the
department,
maybe
focusing
community
resources
or
policy
proposals
too
much
on
title
25.
But
that's
the
only
problem
we
needed
to
solve
and
I
think
there's
a
delicate
balance
there,
but,
like
representative
Larson
was
alluding
to
earlier.
E
We
are
seeing
more
and
more
especially
in
this
new
new
ish
coverage
landscape,
not
perfect,
but
more
insurance
for
mental
health,
more
Medicaid
for
mental
health,
more
providers
of
mental
health.
We
are
seeing
in
that
wider
market
and
more
and
more
concentrated
need
for
harder
to
treat
populations
higher
acuity
populations
across
your
geriatrics.
E
Your
high
need
adolescents,
the
population
that
kind
of
floats
between
the
DFS
and
the
Medicaid
space,
and
really
hard
to
treat
hard
to
place
type
of
populations,
your
title
25
populations
and
your
Corrections
populations,
and
that
seems
to
be
more
and
more
again
kind
of
anecdotal
right
now,
which
is
always
against
my
better
judgment.
But
anecdotally,
I
work
on
more
of
those
cases
in
a
given
week.
Trying
to
find
resources
are
trying
to
work
with
Medicaid
and
DFS
as
it
as
a
team
with
our
county
attorneys.
E
With
our
State
Hospital
with
WB
I,
because
we
have
a
specific
client
that
that
is
really
slipping
through
the
cracks
and
either
providers
won't
take
them
the
funding
sources
in
the
line
too,
for
a
variety
of
reasons,
we
just
struggle
with
some
of
these
harder
to
define
and
harder
to
treat
populations
that
are
not
really
your
general
access
type
type
folks,
and
so
again,
that's
not
a
slide
against
any
type
of
provider.
Community
mental
health,
hospitals,
what-have-you.
It
is
just
a
resource
allocation
issue
in
many
cases.
So
again,
going
back
to
my
previous
comments.
E
I
think
that's
really
a
targeted
problem
to
solve
either
either
with
this
committee
or
or
otherwise
of
you
know
again.
What
is
the
role
of
the
state
and
catching
those
populations?
And
it's
not
thousands
I
mean
it's.
It's
probably
hundreds
in
a
given
year.
This
handful
relative
handful
of
clients
that
really
don't
fit
into
a
specific
definition
and
really
have
some
high
acuity
and
some
comorbidities
and
some
tough
challenges
that
we
really
just
don't
have
a
good
system
to
to
catch
them
as
a
safety
net
between
Department
of
Health,
between
DFS
and
so
I'll.
E
Stop
there
I
see
representative
Wilson
has
a
question,
but
she
did
direct
us
in
DFS
on
the
adolescent
side
to
get
together
between
now
and
August
and
kind
of
map
some
of
this
out
for
for
some
of
those
really
high
higher
acuity,
kids
and
adolescents.
That
I
think
is
another
good
microcosm
of
this
overall
problem,
so
senator
Kent's
key
representative
Larson,
sorry
for
the
long-winded
answer.
B
You
mr.
chairman
I
have
a
question
here
that
follows
along
that
somewhat
in
in
the
discussion
about
the
coordination
and
what
I
want
and
I
should
have
probably
asked
it
when
Andy
Somerville
is
still
on,
but
do
the
do.
The
mental
health
centers
have
a
access
to
a
unified
medical
service
record
such
that
we
could.
You
know
the
discussion
about
their
there
in
the
community
mental
health
center.
B
You
know
in
some
ways
it
sounds
a
little
extraneous
to
our
discussion,
but
like
many
things,
if
you
can
kind
of
knock
down
silos
and
improve
coordination,
we
might
actually
be
able
to
take
care
of
people
better,
but
Stephane
or
or
maybe
behavioral,
health,
folks
and
I.
Think
Andy's,
probably
going
on,
but
she'll.
E
Chairman,
if
I
may
and
and
representative
Wilson,
it's
a
good
question,
so
the
the
short
answer
is
is
not
really
when
you're
talking
about
connecting
to
a
wider
health
information
exchange.
But,
like
you
mentioned,
we
are
working
on
it
I'm
trying
to
pull
it
up
right
now,
our
Medicaid
division
or
health
care
financing
division
has
done
a
fantastic
job
in
the
last
really
year
and
a
half
to
take
over
what
was
kind
of
a
flailing
statewide
health
information
exchange
project
and
stand
it
up.
E
So
we
do
have
an
active
health
information
exchange
that
were
that
we're
continuously
adding
providers
to
both
hospitals
and
clinics.
Even
the
state
facilities
life
resource
center
is
coming
online
as
a
viewer
of
that
health
information
exchange
data
with
the
intent
of
exactly
what
you're
saying
that
when
you,
when
you
have
a
client
that
might
have
a
history
with
another
provider
or
medical
or
behavioral
history
elsewhere.
E
The
idea
is
to
have
that
health
information
exchange
that
we
could
certainly
expand
to
the
provider
types
that
you're
talking
about
with
mental
health
and
substance
abuse,
so
I'm
happy
to
follow
up
with
that
information.
I'm
trying
to
pull
up
the
spreadsheet
right
now
on
our
provider
enrollment,
but
I
think
last
year
it
was
in
the
you
know,
less
than
less
than
a
couple
dozen
I
believe
were
in
the
hundreds
now
in
enrollment,
but
I'll
have
to
follow
up
on
those
connections.
B
Thank
You
mr.
chairman
I,
do
have
a
couple
questions.
A
couple
more
questions
on
the
gatekeeper
issues,
but
before
I
do
I
I
feel
like
I,
should
also
add
some
kudos
to
representative
Nick,
Nichols
and
Larson
Nicholas
and
Marcin
I
think
this
facility
that
we're
going
to
they
were
getting
up
here
at
the
State
Hospital
is
turned
out
to
be
a
really
nice
facility.
B
Think
you
guys
made
a
good
hire
with
Bill
Ryan
and
he's
done
a
great
job
of
kind
of
turning
things
around
and
I
would
also
like
to
just
pack
Stephan
on
the
back,
because
that's
a
tough,
it's
been
a
tough
road
to
hoe
over
there
at
times
and
you've
done
a
great
job
being
a
good
liaison
and
I
appreciate
all
you.
Your
work
there
as
well
I
just
wanted
to
say
that
real,
quick
because
I
think
that's
that's
something.
B
That's
really
going
to
help
with
our
title
25
and
a
lot
of
other
issues,
but
anyway,
my
questions.
If
I
can
remember
what
they
were
with
the
gatekeeper
I
wondered
how
they
are
they
on
a
one-year
or
two-year
contract.
How
are
they
funded
and
basically
what
what
happens,
because
I
know
you
have
to
have
the
County
Commission
input
after
the
department
chooses
one
of
them,
but
if
you've
got
one
that
maybe
is
serving
three
or
four
counties,
like
maybe
people
wellness,
how
does
that
work?
Could
you
just
maybe
give
a
little
more
clarification
on
that?
E
Mr.
chairman,
senator
Schuler
I'm
gonna
kick
that
to
to
Matt
or
Ben
to
answer
briefly
about
how
those
contracts,
work,
I,
believe
Ben.
If
I'm
not
mistaken.
Our
current
separate
gatekeeper
contracts
expire
at
the
end
of
this
month,
with
the
end
of
the
biennium
and
like
we've
been
talking
about,
will
be
incorporated
into
that
emergency
service
definition
and
in
the
broader
contract
contracts,
but
Matt
or
Ben.
You
might
talk
about,
especially
our
our
designated
gatekeeper
providers
that
serve
multiple
counties.
Exactly
what
that
looks
like.
B
Sure
I
can
take
that
one,
mr.
chairman,
senator
Schuler,
so
the
answer
to
that
question
for,
for
example,
with
people
on
discovering
multiple
counties
that
are
bu
is
portable.
So,
no
matter
where
that
sir
delivery
happens,
they
can
still
be
compensated
for
that
through
their
reimbursement
of
that
RV.
You.
C
F
Thank
You
mr.
chairman,
so
I'll
make
a
couple
comments
and
then
I'll
have
a
to
specific
questions
for
for
Stefan
and
they're
gonna
be
a
bit
leading
because
I
think
I
know
the
answers
to
him,
but
I
think
I
want
the
committee
to
hear
the
answers
that
Stefan
will
impart
on
us.
So
I'm
just
going
to
go
a
little
bit
back
to
2014
15
16.
There
were
really
three
things
that
the
taskforce-
it
was
a
taskforce,
I
believe
not
a
subcommittee
because
they
were
governor.
The
governor
had
appointees
on
it
as
well.
F
At
the
time
director
for
Aslan
was
part
of
it.
Robyn
Bailey
excuse
me
Robyn
sessions,
Cooley
was
on
it.
There
was
a
county
attorney
with
cetera,
so
I
think
it
was
a
taskforce,
but
maybe
maybe
of
not
getting
the
name
Greg
family.
So
there's
three
things:
one
was
directed
outpatient
commitment,
I
believe
that
was
a
significant
part
of
those
discussions
which
is
in
current
statute.
Gatekeeper
was
a
second
Cygnet,
considerable
part
of
that
discussion
and
then
a
lot
of
minor
changes,
adjustments,
etc.
F
Probably
the
thing
that
made
the
most
significant
difference
to
Senator
Kinski
co-chairman
Kinski's
point
about
costs
was
what
the
department
did
internally
within
shark
B
and
Medicaid
I
think
anybody
that
Stefan's
nodding
his
head
I
think
anybody
that
actually
followed.
You
know
the
trend
lines
and
the
costs
and
the
provision
of
services
says
that's
where
actually
costs
were
improved,
I'm,
not
suggesting
that
the
care
went
up
or
down
I'm,
just
saying
that's:
where
cost
containment
or
cost
understanding
at
least
came
to
most
from
others.
F
The
others
played
a
role,
but
that's
probably
where
it
became
in
place.
The
most
value,
which
was
an
executive
function,
not
a
legislative
function,
although
we
certainly
talked
about
it.
So
two
questions
and
two
changes
that
came
also
out
of
those
several
bills.
But
that
came
out
of
that
discussion
and
subsequent
discussions
were
one
is
the
72
hours,
which
is
a
component
of
statute.
That's
a
legislative
choice.
We've
made
that
the
counties,
of
course,
that
72
hours,
plus
and
minus
weekends
and
holidays
or
plus
weekends
and
holidays
that
the
county
pays.
F
But
one
of
the
things
that
we've
done
we
asked
is
that
County,
Attorney's
and
subsequently
gatekeepers
notify
the
state
about
when
they
were
having
these
in
these
actions,
whether
it
was
an
emergency
detention
of
109,
a
110,
any
anything
any
emergency
action
in
this
thing.
So
my
first
question
is:
are
you
getting
notifications
in
the
absence
of
gatekeepers
ie
from
County
Attorney's,
because
they
are
actually
making
that
decision
to
go
forward
with
an
emergency
detention
or
a
by
each
hearing,
110
hearing
to
the
courts
and
to
does?
F
Are
we
paying
the
gatekeepers
for
the
first
72
hours
in
current
statute,
its
allowable,
like
my
agreement,
that
the
state
would
take
over
the
gatekeeping
costs?
If
you
will
provision
of
those
services
for
the
72
hours?
So
two
questions
one.
Are
you
getting
the
notifications
in
a
timely
manner,
which
is
currently
by
statute
24
hours
from
any
of
those
one
out,
actions
and
two,
whether
this
new
contract
concept
is
anticipating
that
we're
going
to
start
with
gatekeeping
service
from
our
zero
Thank
You?
Mr.
chairman
Thank,.
E
Mr.
chairman
and
representative
Barlow
take
care
I'll,
take
your
questions
in
order
and,
if
you'll
bear
with
me,
real
quick
I
am
going
to
share
my
screen
because
to
your
question
representative
Barlow.
With
that
statutory
requirement,
we
did
create
a
number
of
years
ago
a
website
for
County
offices
to
go
to
to
make
that
notification
a
little
bit
easier.
E
So
the
simple
answer
to
your
question
is
you
we
are
getting
notifications,
I
would
pull
up
the
spreadsheet,
but
that
would
be
a
major
HIPAA
violation,
no
offense
to
the
committee,
but
you're
not
entitled
to
see
that
information
of
what
we're
getting
because
it
doesn't
contain
patient
info.
But
this
is
the
form.
Essentially,
the
county
attorneys
can
or
have
their
offices
fill
out
when
one
of
those
events
and
emergency
detention
continued
attention
directed
outpatient
commitment,
involuntary
hospitalization.
E
When
that
happens,
they
can
go
in
here
and
just
fill
fill
this
in
and
it
feeds
a
back-end
spreadsheet
in
a
dashboard
that
we
have.
So
we
are
getting
information.
I
would
say
it's
a
mixed
bag
with
the
24
hour
compliance
and-
and
you
and
I
have
talked
about
this
I've
shot.
My
mouth
off
in
other
committees,
who
didn't
necessarily
like
my
comments,
that
it's
not
necessarily
that
we
need
the
data
within
24
hours,
especially
like
you
mentioned.
If
we
have
the
community
partners
involved,
if
we
have
a
gatekeeper,
community,
mental
health,
center
or
provider.
E
That
is
you
know,
managing
that
case.
Coordinating
those
services,
then
the
information
flowing
to
the
department.
You
know
it's
not
something
that
we're.
You
know
turning
a
siren
on
or
something
when,
when
we
see
an
emergency
detention
come
through,
because
that
still
needs
to
work
its
way
through
through
the
process.
But
we
are
getting
those
notifications,
I
would
just
say
the
the
variability
is.
Do
we
get
them
within
within
24
hours?
E
Not
always,
but
most
counties
are
pretty
good
at
at
least
sharing
that
information
with
us
retro
actively,
sometimes
on
a
monthly
basis
in
a
spreadsheet,
and
you
have
some
turnover
in
your
county
attorney
offices
that
you
get
a
new
person
in
there
and
they
didn't
know
about
that
requirement.
So
I'll
get
a
phone
call
hey.
How
do
we
do
this
and
I'll
send
them
this?
This
form
to
fill
out
to
your
second
question
about.
E
Let
me
just
pull
this
off
the
screen
here
to
your
second
question
about,
if
gatekeepers,
when
they're
designated,
are
paid
in
that
first
72
hours.
The
answer
is
yes,
and
it's
it's
somewhat
of
an
indirect
yes,
because
it's
been
mentioned
right
now.
Those
are
separate,
gatekeeping
contracts
and
so
those
you
know,
those
are
contractual
obligations
and
there's
nothing
that
prevents
the
gatekeeper
from
providing
those
services
within
that
first
72
hours.
E
So
that
does
mean
that
that
statutory
change
that
you
and
I
talked
about
years
ago
about
ensuring
that
you
know
there
isn't
a
fight
essentially
between
counties
in
the
state
of
Him.
Who
could
pay
for
that.
So
essentially
we
are.
We
are
covering
those
costs
when
the
gatekeeper
is
designated
and
going
forward,
as
has
been
mentioned,
to
have
that
part
of
the
normal,
the
larger
contracts
as
the
ability
to
essentially
be
reimbursed
for
emergency
services,
including
gatekeeping.
E
That
will
be
consistent
with
that
that
if
we
have
a
designated
gatekeeper,
that's
operating
in
a
community
in
a
County
and
it's
a
community
mental
health
center.
Under
these
contracts
they
that
first
72-hour
designation,
that's
in
title
25
statute
in
terms
of
usually
the
hospital
bills
that
are
needing
to
be
paid.
That
wouldn't
be
a
barrier
in
my
mind
in
those
contracts,
but
I'll
let
mater
ban
way
and
if
they
disagree
or
just
shake.
E
Mr.
chairman,
if
I,
if
I
may
I
did
want
to
give
representative
Wilson
an
update,
I
just
pulled
up
that
data
on
the
what
we
call
the
Wi-Fi
Wi-Fi.
It's
the
statewide
hie
project
as
of
this
month,
I
am
showing
71
live
contributors
13
in
active
implementation,
17
in
pending
implementation
and
about
10
or
20
between
10
and
20,
that
are
there
we're
kind
of
waiting
for
a
response
or
an
initial
enrollment.
So
it's
not.
You
know.
E
E
I
will
touch
base
with
our
folks
over
at
healthcare
financing
to
see
what
the
plans
are,
if
any,
if
it's
short-term
or
long-term,
when
it
comes
specifically
to
mental
health
and
substance
abuse
providers,
because
the
focus
initially
I
think
has
been
on
on
hospitals
on
rural
health,
centers
and
federally
qualified
health
centers,
as
well
as
patient-centered
medical
homes
and
things
of
that
nature.
So
I'll.
C
You
so
Stefan
I,
just
I'd
like
to
follow
up
on
representative
Barlow's
questions.
So
when
a
when
there's
a
a
commitment
process
in
place,
somebody
brings
the
somebody
to
the
hospital.
As
soon
as
the
the
community
mental
health
center
who
may
have
that
gatekeeping
responsibility
becomes
involved,
then
they
can
be
compensated
for
those
efforts
because
they
have
to
go
up
and
do
the
evaluation
to
determine
if
it's
worthy
of
commitment
and
and
those
sorts
of
things
is
that
not
great.
E
Mr.
chairman,
that's
a
hundred
percent,
correct
and
I
think
just
really
quickly
it.
You
know
as
much
as
we
can
put
into
law
and
rule
and
policy
and
contract
of
you
know,
here's
how
that
works.
It
really
comes
down
to
awareness
at
the
community
level
of
who
is
doing
what
job
and
I
think
that's
something
we
can
all
in
the
in
the
department
and
with
our
providers
and
with
our
communities,
improve
on
and
not
to
not
to
completely
dine
out
at
the
center
part
of
the
state.
Mr.
E
Then
that's,
where
we
really
see
a
progress
that
it
doesn't
matter
if
the
department
has
a
requirement
that
someone
notify
us
within
24
hours,
because
it's
a
knee-jerk
response
for
the
hospital
to
say.
Oh,
we
got
law
enforcement
brought
us
a
potential
emergency
detention,
we're
calling
the
community
mental
health
center.
That's
the
first
call
and
a
lot
of
the
time,
that's
exactly
how
it
works,
because
a
lot
of
our
mental
health
centers
do
those
evaluations
and
are
the
point
person
for
it.
E
But
then,
when
it
comes
to
kind
of
the
back
end
of
that
commitment
process,
when
it's
time
to
identify
resources
or
think
creatively
about
alternatives
to
hospitalization
or
what
representative,
Barlow
and
I
have
seen
over
the
past
several
years
with
communities
experimenting
with
directed
outpatient
commitment,
which
I
think
everybody
would
like
to
see.
More
of
that's
that's
where
I
think
we
have
some
some
room
for
improvement,
both
with
our
with
our
policies
and
our
rules
and
our
regs,
but
also
again
going
back
to
this.
This
mission
in
this
role
of
the
state
conversation.
G
E
F
You
know
the
the
court
also
has
to
be
a
part
of
this
discussion,
and
we've
had
good
discussions
with
judge,
Christensen
and
judge
fan
and
others
over
the
past
years.
But
if
we're
gonna,
as
we
start
to
think
about
other
ways
to
do
this,
and
whether
it's
not
the
funding
funding
side,
it's
important,
but
we
also
are
the
ones
that
laid
out
if
your
danger
to
self
others
or
inability
to
care
for
yourself,
then
we
we
laid
this
out.
This
is
our
system,
so
we
can
make.
F
It
is
inefficient
and
ineffective
as
we
choose
to
or
as
efficient
and
effective
as
we
choose
to
so
I.
Don't
know
where
this
goes
with
Title
25
per
se,
but
I
don't
want
to
over
overlook
the
fact
that
the
legislative
branch
laid
it
out.
Executive
branch
execute
it,
but
we
rely
on
the
courts
to
actually
implement
to
actually
do
those
make
those
tough
decisions
in
this
process.
So
that's
just
more
of
a
broad
comment,
but
thank
you,
mr.
chairman.
Thank
you.
Thank.
C
C
C
D
You
I'm
just
gonna,
be
super
quick
and
I
just
want
to
show
you
guys
three
different,
slides
and
and
then
talk
about
how
the
title
or
25
how
the
gatekeeping
process
is
working
in
our
four
counties
and
how
it's
not
working
and
I
apologize.
The
committee,
if
I
I'm,
not
quite
sure
what
I
said,
but
if
I
gave
the
the
opinion
or
it
came
across
that
gatekeeping
was
working.
Fine
because
that's
not
necessarily
the
case,
but
it's
more
complicated
than
that.
D
Okay,
so
you
should
be
able
to
see
a
slide,
says
number
and
percentage
of
individuals,
so
this
was
in
a
document
that
I
had
sent
you
shared
with
you
that
we'd
actually
sent
the
Behavioral
Health
Division
on
an
update
on
the
K
keeping.
This
is
for
FY
19
and
the
numbers
of
what
happened
that
and
how
did
people
get
diverted
or
not?
Diverted
and
you'll
see
that
at
the
ultimate
13
people
were
directed
outpatient,
committed,
I'll
talk
about
that
59
or
the
majority
are
actually
just
released
for
various
reasons.
D
45
were
sent
to
a
designate
hospital,
primarily
Kaspar,
another
psychiatric
hospital
I'm,
not
quite
sure
where
that
was
at
and
then
for
sent
directly
the
Wyoming
State
Hospital,
which
is
very
rare,
and
we
actually
had
one
that
the
State
Hospital
is
great
here
recently
in
the
last
two
weeks
where
they
took
them
directly.
For
various
reasons,
the
next
one
is
enrollment
status
and
why
this
is
important.
It
says
who's
involved
with
community
male
health
center
who's,
not
out
of
the
hundred
and
twenty
six.
Only
twenty
seven.
Let
me
scroll
that
down
a
little
bit.
D
Only
twenty
seven
were
current
client
of
the
mental
health
center,
and
this
is
just
northerns
data.
Ninety
nine
of
the
hundred
and
twenty
six
or
clients
of
ours,
and
so
what
we
know
is
if
people
get
involved
with
us,
they're
less
likely
to
be
in
that
system
these.
For
some
of
these
folks,
this
was
their
first
entry
into
our
system.
D
So
with
that
I'm
gonna,
stop,
sharing
and
I'm
gonna
give
an
overview
or
just
a
quick
I
was
excited
about
the
the
the
the
gatekeeping
additions
to
the
statutes.
One
of
the
pieces
we
put
in
there
that's
not
been
mentioned
was
when
we
tried
to
do
previous
convalescent
leave.
There
was
a
problem
that
people
had
to
come
back
under
Title
25,
even
though
they're
under
convalescent
leave
in
order
to
get
back
in
the
system.
So
what
was
added
I
think
is
a
measure
to
deal
with.
D
That
was
the
ex
parte
part
of
the
title
25
statute,
which
allowed
a
judge
without
the
client
being
there
to
say
you
know
if
we
went
and
reported
back
they're
not
on
their
medications.
They're
they're
not
dangerous
yet,
but
we're
heading
there
for
them
to
say
on
the
directed
outpatient
commitment,
we're
gonna
revoke
it,
we're
bringing
them
back
in
the
last
report.
I
had
up
in
our
area
was
I.
Think
five
I
think
there
was
five
or
six
ex
parte
orders
given
to
a
judge
from
this
one
county
attorney,
none
of
them.
D
The
judge
signed
for
legal
reasons,
for
what
reasons
I
don't
know
so
that
piece,
for
whatever
reason,
is
not
that
that
mechanism
isn't
working
to
get
people
back
in
the
system
before
they
end
up
very
dangerous
to
themselves
or
others.
The
other
thing
that's
really
important
here
is
and
and
quite
frankly,
I
hate
the
word
gay,
keeping
because
gay
keeping
means
I
have
control
and
we
have
no
control
over
this.
We
can
comment.
D
We
can
give
opinions,
we
can
do
a
lot
of
things,
but
the
one
thing
and
I
think
it
was
mentioned
here
that
what
happens
is
a
doctor
will
do
the
title
25.
Then
they
call
the
mental
health
center
gatekeeper
to
say
is
it
you
know?
Do
we
approve
that
never
happens,
because
there's
no
authority
for
them
to
do
anything.
D
There's
no
authority
for
us
to
intervene.
There's
no
authority
for
us
to
get
keep
until
who's
in
who's
out,
and
it
creates
some
issue
issues
and
what
it
actually
does
is.
There's
one
specific
case
and
I
have
a
large
number
of
these
that,
because
we're
and
I'm
designated
as
gatekeeper
in
all
four
counties
and
where
we've
set
up
all
kinds
of
different
things
to
do
this.
The
typical
case
out
really
happens
if
somebody
gets
under
Title
25
and
in
a
very
small
County,
and
they
end
up
maybe
at
the
local
health
facility
or
in
jail.
D
D
We
can
start
saying
we
can
do
this,
that
and
the
other
which
we're
doing
so
and
in
terms
of
the
idea
of
gay
keeper.
There
really
is
no
gay
keeping
process
going
on
from
from
from
my
standpoint,
because
I
have
no
authority
but
I
we
have
made
an
impact
to
get
people
better
services.
Get
them
in
the
it
has
has
got
us
in
the
system
better
quicker.
C
Questions
for
for
mr.
dimple,
so
Paul
I've
got
a
couple.
My
first
one
is
is
I'm
interested
on
your
use
of
the
directed
outpatient
commitment,
because
there's
seems
to
be
some
coordination
between
the
gatekeeping
component
of
that,
with
an
understanding
from
the
county
attorney
and
the
judge
that
that's
even
a
possibility
and
in
I
would
be
interested
because
you
serve
a
number
of
counties,
your
success
in
getting
that
done
and
and
how
you've
managed
to
do
that
or
if
you
feel
like
there
still.
D
D
So
we
met
with
the
judge,
the
county
attorney,
the
representative
attorney
and
said
this
could
be
a
really
good
way
for
people
not
to
have
to
go
to
the
hospital
and-
and
so
it
was
a
buy-in,
mostly
at
the
end
of
the
day,
the
the
judge
won't
consider
it
unless
the
county
attorney
like
and
I,
don't
know
what
the
legal
terms
are.
The
county
attorney
has
to
present
it
as
a
option
and,
and
then
the
judge
will
say,
yea
or
nay
so
I
think
it's
been
successful.
D
There's
a
lot
of
that.
The
other
parties
may
not
see
if
all
the
work
we
do
and
where
people
could
end
up
back
in
the
system,
but
at
the
end
of
the
day
the
reason
it
works
here
is
because
we
had
players.
That
said,
let's
give
it
a
try
if
I
would
had
just
one
of
those
players,
especially
the
county
attorney
or
the
judge
say
I'm,
not
interested.
You
wouldn't
see
any
numbers.
C
So
then,
I'd
like
to
follow.
Thank
you.
That's
very
helpful
because
it's
been
a
challenge
in
in
my
part
of
the
world
to,
and
it
seems
like
a
very
reasonable
approach
to
diversion
help
me
understand
you.
You
said
you
said
forty
five
to
designated
hospital
and
four
went
to
the
State,
Hospital
and
I'm.
Trying
to
understand
that
rationale
was
that
because
the
state
hospital
was
full
or
do
you
use
the
designated
hospital
first
well.
D
Years
ago
we
used
to
be
able
to
send
people
directly
State
Hospital.
Those
days
are
over
and
in
fact
it's
only
been
more
recent
and
probably
the
last
year,
maybe
with
the
new
superintendent
down
at
the
State
Hospital
that
we've
been
they've
been
they've,
been
very
open
for
us
to
call
him
and
say
we
got
one,
the
you
know
we
got
a
and
and
and
to
help
us
out
as
their
triaging.
D
C
E
D
The
ones
that
ended
up
directly
to
the
state
hospital
were
some
super
high
end
cases
where
they're
very
difficult
there
I
mean
everybody
agrees,
there's
no
Pat,
you
know,
we've
got
a
they're
coming
there
and
the
state
hospital
been
good
about
moving
it.
So
we
don't
decide
who
we're
gonna
pick
it's
more!
Here's
the
system,
where's
a
bed.
C
E
Mr.
chairman,
I,
don't
disagree
with
anything
Paul
said:
I'll
speak
from
the
legal
and
the
department
side
of
how
this
works
so
just
for
the
committee's
edification.
The
reason
that
folks
go.
Let
me
let
me
back
up
the
vast
majority,
probably
99%
of
actual
involuntary
hospitalization
orders
commit
a
patient
to
the
Wyoming
State
Hospital
to
the
custody
of
the
Wyoming
State
Hospital.
E
Primary
reason
why
designated
hospitals
like
WB,
I,
Cheyenne,
Regional
ivanson
in
Laramie,
has
it
as
a
few
beds,
believe
Campbell
County
has
a
few
beds.
Psychiatric
beds,
I
mean
the
reason
those
hospitals
are
leveraged
is
because
of
the
wait
list
of
the
state
hospital,
not
necessarily
because
the
judge
or
an
order
said
this
person
is
not.
G
E
Majority
of
title
25
s
they're,
essentially
taken
to
a
designated
hospital
while
awaiting
admission
to
the
State
Hospital.
The
reason
I
brought
up
the
the
facility's
construction
project
earlier.
This
is
a
nice
segue
is
because
I'm
really
optimistic
that
when
we
move
into
that
new
facility-
and
especially
you
know
next
in
2021,
when
we
bring
the
life
resource
center
online.
E
This
is
all
to
increase
capacity
on
for
the
number
of
beds
that
we
have
at
the
state
hospital,
both
in
terms
of
physical
plant
and
like
I,
mentioned
before,
with
the
new
missions
of
folks
that
will
be
treated
at
the
State
Hospital
and
those
who
will
be
transferred
to
the
and
potentially
served
at
the
life.
Resource
Center
I'm
really
optimistic
that
we're
going
to
be
able
to
improve
not
only
the
the
wait
time.
E
B
E
Think
that's
a
possibility,
then
we
should
see
more
availability
for
communities
for
courts
and
folks
like
like
Paul,
to
be
able
to
be
able
to
get
into
the
state
hospital
quicker.
So
that's
essentially
how
that
commitment
process
works,
but
when
folks
are
committed
to
after
a
1:10
hearing
to
the
state
hospital,
our
admissions
folks
at
the
state
hospital
do
coordinate
as
much
as
as
possible
with
those
designated
hospitals
to
try
to
find
a
placement
option,
especially
if
those
hospitals
are
full
and
the
the
last
thing
that
I'll
mentioned
mr.
E
chairman
to
to
Paul's
point
he
made
a
great
point
is
that
we
do
have
some
prey
is
for
the
wait
list
of
the
state
hospital,
for
example,
when
folks
are
in
detention
centers
under
a
civil
commitment
and
that
we
don't
want
that
to
happen.
I,
don't
think
anybody
in
the
legislature
wants
that
to
happen,
but
in
emergency
circumstances,
and
because
of
resource
constraints,
it
does
happen
and
we
prioritize
folks
who
are
in
detention
centers
and
not
receiving
active
treatment.
E
We
prioritize
folks
who,
who
might
be
in
emergency
rooms,
not
receiving
active
treatment
but
again
going
back
to
our
conversation
before
we
can
prioritize
everybody,
but
when
the
volume
is
as
high
as
it
was
say
four
years
ago,
that's
what
really
created
that
downward
pressure
on
the
communities
to
not
be
able
to
find
resources,
and
we
have
made
a
good
progress
on
that
and
again
optimistic
that,
with
with
the
new
facilities
coming
online,
we'll
continue
to
to
go
in
that
direction.
The
final
thing,
mr.
E
chairman
I,
do
want
to
echo
a
comment
that
Paula
mentioned,
because
he
and
represented
Barlow
and
several
of
of
you
who
were
either
part
of
or
related
to
that
title
25
taskforce.
It
was
a
big
discussion
on
gatekeeping
of
does
a
designated
gatekeeper,
have
bed
management
authority
either
at
the
State
Hospital
or
at
another
designated
Hospital.
And
ultimately
we
didn't.
E
We
didn't
as
a
state
go
in
that
direction,
but
Paul's
not
wrong
to
bring
it
up
that
when
you
say
if
we
were
to
say
community
mental
health
center
or
any
other
provider,
you're
responsible,
either
financially
or
based
on
outcomes
for
a
patient,
an
individual
going
through
title
25,
the
providers
are
right
to
say
well,
I
need
some
admission
discharge.
Authority
and
states
have
have
experimented
with
that.
But
it's
a
it's
a
much
larger
conversation
and
I.
Think
brings
me
back
to
my
broken
record
feel
which
is
really
if
we.
E
If
we
want
to
move
in
that
direction,
then
we
have
to
have
a
larger
conversation
about
the
true
mission
and
the
true
role
of
our
community
mental
health
system,
because
it's
just
and
frankly
not
to
be
overly
blunt.
Mr.
chairman,
but
as
we
prepare
this
next
round
of
budget
reductions,
then
I
don't
see
a
way
to
increase.
E
You
know
authority
or
the
role
of
the
community
mental
health
center
without
turning
something
off,
because
you
know
we
we
are
not
going
to
be
in
a
position
in
the
foreseeable
future
to
be
adding
funding
to
to
a
system.
It
is
really
a
tough
conversation
about
limiting
what
that,
what
that
role
is,
or
targeting
and
prioritizing
it
so
apologize
for.
You
know
again
sounding
like
a
broken
record,
but
it's
it's
very
real
when
it
comes
to
this
title.
25
tasks.
Thank.
G
Thank
You
mr.
chairman,
so
hopefully
this
will
be
pretty
short
and
sweet.
I
just
have
one
slide
to
show
you
guys
and
then
I
want
to
add
a
little
bit
more
context
to
a
couple
of
the
items
you
already
discussed
regarding
gatekeeping,
so
just
a
real
simple
what
it
is
for
a
community
mental
health
center,
what
it's
not
as
it's
kind
of
been
alluded
to
the
community
mental
health
centers
certainly
are
the
middle
middle
people
in
this
discussion.
G
In
terms
of
the
fact
that
they
don't
have
a
lot
of
authority,
they
give,
they
can
do
assessments,
they
can
provide
recommendations
and
opinions,
but
ultimately
the
County
Attorney's
and
the
judicial
system
really
make
a
lot
of
those
decisions,
not
the
community
mental
health
centers.
So
about
so
a
couple
of
things.
So
less
than
half
of
our
commitment
to
health
centers
are
designated
gatekeepers
and
I.
Think
mr.
Kafer
mentioned
earlier.
There
was
only
four
of
them
that
were
actually
accessing
funding
for
that
directly
through
those
previous
grant
programs.
G
However,
I
want
to
point
out
that
if
you
ask
the
directors
of
community
mental
health
centers,
they
will
tell
you
they
all
function.
As
unofficial
gatekeepers
in
their
in
their
counties,
it's
frankly,
it's
an
expected
service
from
the
local
communities,
whether
it's
with
the
hospital
in
the
county,
attorney's
the
County
Commission.
G
It's
expected
that
they'll
be
there
and
provide
that
24/7
on-call
response
when
somebody
shows
up
at
the
hospital
well,
what
we
like
about
gatekeeping
is
it's
it's
successful
and
diverting
clients
into
community-based
services,
which
is
again
the
crux
of
what
community
mental
health
centers
do.
What
we
don't
like
right
now
is
that
it's
not
consistent
across
the
counties
which
has
already
been
mentioned.
G
It
really
varies
quite
a
bit
in
terms
of
what
the
process
is
for
the
County
Attorney
hospitals
have
different
policies
on
how
they
want
to
handle
that
and
when
to
call
community
mental
health
centers
of
how
to
involve
them
in
the
process.
And
then
we
touched
you
guys
touched
a
little
bit
on
reimbursement.
So
I
would
say:
reimbursement
is
split.
Three
ways:
some
a
few.
A
select
few
receive
have
an
agreement
with
the
hospital
to
receive
some
kind
of
payment
for
the
services
when
they're
called
to
the
hospital
to
do
a
title.
G
25
assessment
we're
engaging
in
gatekeeping
or
diversion
services
like
we
like
to
call
them
a
few
again.
A
small
few
have
agreements
with
their
counties
directly
their
county
commissions
to
receive
some
kind
of
compensation.
For
that.
Usually
it's
in
the
form
of
I
believe
I'll
make
the
example
of
Teton
County.
It's
it's
wrapped
up
in
it
kind
of
a
bigger
service
contract
that
they
provide
directly
with
the
community
mental
health
centers
in
the
County
Commission.
G
However,
the
majority
of
them
don't
receive
right
now,
reimbursement
for
those
services,
and
so
that
has
it's
an
expectation,
but
it's
not
something
that
they're
usually
paid
to
do
so.
I
want
to
kind
of
go
back
to
a
previous
conversation
and
say
that
the
changes
that
mr.
tiefer
and
Matt
described
in
terms
of
the
contract
and
that
Stephan
described
coming
up
WAM
sac
your
command
mental
health
source
centers
are
very
supportive
of
those
changes
in
terms
of
making
that
reimbursement
available
through
the
contracts.
I
have
not
had
any
communication
with
any
of
my
centers.
G
That
said,
they
don't
want
to
be
part
of
that
in
their
contracts.
I
think
you
would
hear
directly
from
some
of
them
that
it's
tough
being
the
middle
person
in
those
conversations
in
terms
of
making
that
all
work
and
I
can't
stress
enough.
It
is
absolutely
based
on
local
relationships
with
the
hospital,
with
the
any
attorney
with
all
the
players
that
are
involved
and
there's
some
work
to
do
there
and
I
want
to
clarify.
G
G
There
is
still
a
lot
of
room
for
improvement
in
this
as
gatekeeper
or
title
25
process
when
it
comes
to
the
community
mental
health,
centers,
there's
there's
a
lot
of
work
to
do
and
in
fact,
in
Judiciary
Committee.
We
are
supposed
to
be
going
back
along
with
the
county
attorneys
in
August,
with
some
discussion
and
maybe
recommended
changes
to
address
some
of
these
issues.
G
Three
years
determine
representative
Wilson
on
the
the
weihai
health
record
program,
so
why
I
came
and
met
with
all
the
center
directors
last
late
last
fall
and
introduced
the
program
to
them,
made
them
aware
that
they
could
register
they
have
that
information
for
us
right
now.
It's
not
a
great
tool,
it's
not
terrible,
but
it
does
not
include
any
mental
health
or
substance
abuse
records,
so
it
would
be
medical.
They
could
view
medical
information
only.
G
There
are
considerable
HIPAA
requirements
that
have
not
that
that
that
system
does
not
meet
yet
I
had
a
conversation
directly
a
couple
of
weeks
ago
with
the
state
staff
that
was
involved
in
that,
and
they
said
they
are
watching
how
to
see
how
Colorado
does
that
it
integrates
mental
health
and
substance
abuse
records
into
that
electronic
system
before
they
recommend
any
Leafs
for
us
in
general.
They
we
would.
We
would
love
to
see
some
type
of
a
universal
system
where
we
could
provide
more
on-demand
information.
It
absolutely
would
improve
care
improve.
G
You
know
the
time
it
takes
to
do
things
to
just
be
able
to
access
those
records
and
especially
for
clients
that
move
between
counties
or
move
between
different
centers
right
now.
It's
it's
kind
of
old-fashioned
to
pick
up
the
phone
or
you
know,
have
somebody
send
those
records
over
or
that
provider
conversation.
So
we
can
definitely
improve
in
that
we're
supportive
of
the
project,
and
we
hope
that
it
can
move
forward
and
provides
some
better
access
to
us
in
the
future,
but
a
couple
of
hurdles
to
go
there.
G
I
also
wanted
to
just
touch
on
directed
outpatient
commitment,
as
it
relates
to
the
community
mental
health
centers
so
again,
not
to
to
beat
this
drum
to
death,
but
directed
outpatient
commitment
aligns
with
the
community
mental
health
centers
priorities.
However,
there
have
we've
had
some
discussions
about
some
issues
potentially
and
we're
broaching
those
right
now
with
the
county
attorneys
in
terms
of
enforceability.
If
somebody's
on
a
directive
outpatient
commitment,
how
do
you
actually
get
them
through
the
process?
G
G
G
You
know
in
terms
of
budget
cuts
and
how
this
all
rolls
down.
There
are
concerns
about
what
that
will
do
to
services
and
programs
and
certainly
gatekeeping,
and
how
the
community
mental
health
centers
can
respond
due
to
budget
cuts
is
a
concern.
You
know,
keeping
24/7
on-call
staff
is
an
expense,
especially
for
the
small
and
medium-size
centers
that
are
out
in
the
rural
areas.
You
know
we're
trying
to
explore
all
the
possibilities.
Can
you
do
an
assessment
via
telehealth?
You
know
what
what
does
that
look
like?
G
Can
we
improve
a
policy
of
the
hospital
to
try
to
provide
more
coverage?
All
of
those
things
that
are
gonna
come
up
for
discussion
very
very
soon,
so
we
support
the
program
we
want
to
keep
it
going.
We
suppose
changes
in
the
contract,
but
I
just
want
to
caution
everybody
again.
We
do
not
know
what
the
budget
cuts
will
look
like
and
we
may
be
back
with.
You
know
some
some
different
information
in
a
month
or
two
so
with
that
I
would
stop
and
and
stand
for
any
questions.
Mr.
chairman,.
C
Andy
I
I
would
just
like
to
go
back
to
Majer
comments
on
this
on
this
portion.
As
you
refer
to
the
slides
you
talked
about
being
on
24/7,
and
you
says,
however,
all
community
mental
health,
spider
community
health
centers
understand
that
they're
on
call
24
hours
a
day
when
the
call
comes
that
they
need
to
be
up
there.
Are
you
sure
that
all
the
community
mental
health
centers
understand
that.
G
C
Perhaps
in
the
way
that
you
would
lead
me
to
believe
in
your
comments
and
so
and
and
and
it's
been
somewhat
and
so
I'm
just
trying
to
understand.
If
that
is
indeed
what
the
community
mental
health
centers
expect,
their
people
to
do,
particularly
those
are
on
call
or
not
so,
representative
Bardo,
menthol,
I,
seen
your
hand.
F
Thank
You
mr.
chairman,
so
it
I
think
we
were.
We
were
digressing
a
little
bit
away
from
gatekeeper
to
now
an
examiner
someone
who
actually
does
an
assessment
of
somebody
after
they've
been
detained
so
I
want
to
make
sure
that
we're
we're
all
understand
where
there's
a
little
bit
of
a
divergence
here
into
what
a
what
a
role,
a
statutory
role
of
someone,
what
the
duty
they're
performing
so
I
guess.
My
question
and
I'm
not
I'm,
not
suggesting
representative
Arshad-
is
incorrect.
Chairman
Larson
is
incorrect.
F
That
there's
there's
differences
in
how
people,
but
all
we
ought
to
talk
about
the
gatekeeper
function,
we're
talking
about
an
examiner
function,
because
I
think
those
are
also
Concha
dealt
with
through
contract
may
be
leaked
differently
to,
and
maybe
Stephan
could
get
back
on
and
talk
about
the
examiner
issue,
because
that
is
a
separate.
In
my
view,
that
is
a
separate
issue
from
the
gatekeeping
component.
C
F
C
Represent
Amaro
indeed,
I
would
agree
with
that
and
and
I
would
I
would
just
suggest
that
I
would
that
was
kind
of
the
direction
I
understood.
That
is
that
you
know
come
whatever
time.
A
day
comes
that
were
there
to
meet
the
needs
and
and
I
so
I
think
that
that
is
separate
from
the
gatekeeping,
but
it
is
part
of
the
examiner
portion
of
that
and
is
that
defined
differently
and
each
mental
health
centers
contractor.
Is
that
pretty
much
standard
across
the
state
Paul?
Maybe
you
can
help
us
with
that.
D
D
We
do
go
up,
we
do
provide
services
and
we
do
do
follow-up
services.
How
that
came
about
was
when
I
first
got
here
to
sharing
them.
That
is
the
drain
and
demand
on
the
community
mental
health
center
was
they
were
we
weren't
able
to
see
we'd
have
people
over
there
all
the
time
for
all
kinds
of
things,
and
so
it
was
in
basically
a
blank
check
to
at
their
beck
and
call
come
over
and
do
stuff,
and
we
wanted
to
help.
D
But
I
had
talked
with
the
the
folks
involved
and
said
in
order
to
continue
that
and
not
cancel
services,
not
cancel
groups.
I
need
to
find
another
way
to
help
fund
this
and
support
funding
it.
So
we
had
talked
about
the
possibility.
The
hospital
could
kick
in
and
help
with
some
of
the
funding
and,
at
the
end
of
the
day
they
decided
to
hire
their
own
social
workers.
Actually
do
that,
although
I
think
the
examiner
probably
is
mostly
the
doctors
doing
it.
D
So,
at
the
end
of
the
day,
that's
the
the
service
is
an
expectation
became
we're,
giving
you
money
so
do
all
of
these
things
and
it
just
became
untenable,
and
so
that
that
was
really
a
way
to
try
to
to
do
that
and
again,
at
the
end
of
the
day,
the
hospital
opted
to
go
a
different
direction
now
in
counties
in
terms
of
County
money.
I,
don't
really
have
in
any
four
counties.
Think
we're
gonna
give
you
this
amount
of
money
to
do
this.
D
D
D
D
So
mr.
chairman
I
think
that's
I.
Hope
that
gets
to
your
thing
are
all
the
mental
health
service,
because
when
people
say
crisis
services,
that's
a
broad
thing
and
I
hope
I
didn't
overstep
by
assuming
that
you
were
thinking.
Are
they
going
to
the
hospitals
and
doing
the
evaluations
for
the
hospitals.
C
H
Mr.
chair,
your
comments
about
inconsistencies
across
the
counties
is
absolutely
correct.
I
can
speak
to
the
process
here
in
Carbon
County,
where
we
had
a
county
employee
who
was
responsible
for
the
24-hour
services
for
the
gatekeeping
and
process.
Unfortunately,
he
decided
to
retire
last
year
and
we
have
as
a
community
being
able
to
hire
someone
in
his
role
because
of
what
Paul
has
said
is
absolutely
correct
as
well.
One
person
doing
24/7
services
is
unattainable,
we
have
lots
of
gaps.
H
Two
individuals
from
the
community
mental
health
center.
However,
only
one
provides
those
24-hour
services
as
the
gatekeeper
and
if
she
is
tied
up
in
groups
or
her
daily
work,
then
the
we
have
a
huge
gap,
nine
times
out
of
10.
What
happens
is
that
the
emergency
room
physician
will
contact
whoever
the
provider
is
if
they
have
a
therapist
or
counselor.
H
We
are
a
small
enough
community
that
we
get
those
phone
calls
and
they
will
advise
that
hey
one
of
your
clients
is
in
here.
How
soon
can
you
get
over
to
evaluate
so
we
do
have
that
good
working
relationship.
I
would
love
nothing
more
than
to
have
someone
from
the
Centers
and
that
funding
have
someone
24/7,
but
it
just
is
it's
not
possible
in
our
current
situation.
H
I
can
tell
you
that
when
I
do
go,
if
my
client
is
on
Medicaid,
there
are
some
reimbursements
that
I
get,
but,
for
the
most
part,
I
spend
eight
hours
attempting
to
get
someone
to
wbi
or
to
Denver
Children's
I,
don't
even
contact
the
state
hospital.
It's
just
not
an
option
for
us,
so
we
do
divert
from
that
process
by
virtue
they
never
take
them
or
have
an
open
bed.
So
we
we
stand
at
a
loss
with
that
on
an
average
of
getting
someone
into
WBAI.
It
depends
on
their
bed
space.
H
Therefore,
I
don't
have
access
to
any
mental
health
records,
so,
for
example,
if
I
have
a
client
that
is
evaluated
I'm
on
the
phone
with
wbi,
they
say
send
us
your
information.
I
literally
have
to
leave
the
hospital
come
to
my
office
print
off.
All
of
my
records
go
back
to
the
hospital
fax,
my
information,
along
with
the
emergency
rooms,
information
and
then
wait
another
three
or
four
hours
to
see
if
they
will
accept
my
client
or
not
for
placement
and,
unfortunately,
that's
not
just
wbi,
it's
any
of
the
other
designated
hospitals.
H
So
if
you're
not
within
that
realm
of
credentialed
by
your
local
hospital
accessing
or
part
of
the
community
mental
health
centers,
we
have
no
access
to
other
records
whatsoever.
So
that
is
a
challenge
as
well
and
we
do
a
disservice
frankly,
to
our
clients
and
to
our
community
members
who
are
in
crisis.
E
Mr.
chairman,
thank
you
for
the
opportunity
that
to
Miss
full
and
one
of
them
is
fallens
comments
and
she's
not
entirely
wrong
about
the
challenges.
We've
had
the
state
hospital
like
I
mentioned
before,
with
with
wait
lists
and
with
wait
times,
I
would
still
encourage
anybody
in
the
communities,
especially
during
the
title
25
process,
with
your
adult
clients
that,
when
that
process
reaches
its
culmination
through
an
involuntary
hospitalization
order,
our
state
hospital
does
work
diligently
to
either
admit
the
patient
or
try
to
help
find
a
placement
for
the
patient.
E
But
I
just
want
to
make
it
clear
that
we
essentially
wait
for
our
legal
authority
until
someone
is
in
our
custody
of
the
state
hospital
to
to
do
that.
Admissions.
Coordinating
to
do
that.
Work
to
Miss,
fallens
comments
about
working
with
adolescents
or
children
with
psychiatric
issues,
and
you
know
trying
to
send
them
to
W
bi
or
Denver
Children's
Hospital.
What
have
you
I
will
reiterate
to
the
committee
that
we
do
not
take
kids
at
the
State
Hospital?
E
Currently,
the
questioned
policy
question
is:
should
the
state
hospital,
or
should
a
state
facility,
be
a
safety
net
for
children
in
psychiatric
distress
or
kind
of
that
safety
net
for
psychiatric
adolescent
populations?
And
that's
it
that's
a
broader
question,
but
I'll
be
blunt
with
the
committee
that
the
State
Hospital
we
are
not
staffed
for
it.
E
We
are
not
resourced
for
it
to
to
have
a
an
adolescent
or
a
child
unit
at
the
State
Hospital
Senator
Shula
at
our
last
joint
labor
committee,
brought
that
up
that
in
previous
years
the
State
Hospital
has
had
an
adolescent
unit.
It's
been
a
number
of
years
and
Senator
I,
don't
know
even
even
decades
before
my
time
that
we
did
admit
children
to
that
facility,
but
the
the
reality
and
the
truth
is
we.
E
We
don't
right
now
that
Hospital
is
set
up
in
its
current
scheme
for
title
25,
civil
commitments
and
title
seven
forensic
evaluations
on
an
inpatient
basis.
We
would
have
to
be
very
targeted
in
strategic
as
a
state
in
setting
up
a
facility
for
children
on
a
psychiatric
basis
and
I
think
when
it
comes
to
civil
commitment.
The
very
definitions
and
the
civil
commitment
statutes
of
you
know,
danger
to
self
or
others
is
one
inability
to
care
for
oneself.
E
These
sort
of
civil
proceedings
and
again
just
from
my
perspective,
assume
you
know
an
adult,
a
client
when
you're
talking
about
a
civil
commitment.
Now
title
25
is
used
on
occasion
by
courts
and
I'm,
not
saying
it's
inappropriate
but
used
in
emergency
situations
or
what-have-you,
when
there's
no
other
option
for
children
and
the
court
uses
its
authority
to
essentially
force
a
placement
or
at
least
force
that
discussion
of
the
placement.
So
mr.
chairman,
just
those
were
just
my
few
remarks
to
Miss
full
ins,
testimony
and
I
think
there's
always
opportunity
for
improvement.
E
We
anticipate
a
lot
of
progress
there
and
from
previous
eras
before
before
my
time,
I
heard
one
county
attorney,
put
it
as
the
rule
of
45
either
there's
45
people
on
the
waitlist
or
it's
at
least
45
days
to
get
into
the
state
hospital,
and
that's
certainly
not
the
case
anymore,
but
there
are
still
significant
challenges
with
with
volume
and
with
wait
times,
I'm,
not
not
candy-coating,
that
at
all,
but
I
think
we're
making
progress.
Thank
You,
mr.
chairman.
C
Who
is
that
we
should
be
serving
and
what
is
the
role
and
then
I
think
committee,
members?
What
I
I
think
we
should
do
Danis
is
is
Stefan
kind
of
wounds
us
down
here
is
is
gather
our
thoughts
and
kind
of
put
these
same
questions
and
submit
them,
and
that
and
we'll
share
them
all.
Have
that
I'll
have
John
and
Elizabeth,
compile
all
the
questions
and
we'll
share
them.
C
Amongst
the
committee
chairman,
Kinski
and
I
I
will
take
time
to
in
rely
upon
represented
Barton
and
chairman
Wilson
and
kind
to
figure
out
how
we
approach
the
next
meeting
and
what
we
focus
on
we've
talked
about
waivers.
Can
we
can
could
we
can
we?
How
do
we
incorporate
warfare
dollars
and
relieve
the
burden
on
general
funds?
I
think
these
are
all
fair
questions,
but
I
don't
know
that
we
need
to
start
plowing
that
ground
today.
E
A
C
A
Just
curious,
evidently,
we
won't
get
to
it
today
as
I
see
and
for
the
home
gate.
But
a
third
of
our
charge
relates
to
the
Department
of
Corrections
visa
vie
mental
health
and
substance
abuse,
and
so,
if
we're
not
going
to
touch
on
that
in
this
meeting,
hopefully
we
would
spend
a
fair
amount
of
time
on
it.
A
We
dwelt
a
lot
on
Judiciary
Committee
about
how
we
deal
with
that
patients
or
convicts
being
discharged
or
people
on
parole
or
probation
and
their
mental
health
services,
and
it
sounds
to
me,
like
that's,
that's
intricately
caught
up
with
the
community
mental
health
centers,
but
we
really
haven't
spent
a
whole
lot
of
time
on
that
today.
So
and
that's
okay
as
long
as
you
at
a
future
date,
but
before
before
we
shut
er
down
and
I
have
some
questions
on
that
Ridge.
C
E
E
I
was
I
believe
before
during
the
legislative
session
and
before
the
Cova
19
outbreak,
which
has
consumed
a
lot
of
our
time
the
past
couple
of
months,
but
we
did
start
the
work
with
our
internal
staff
on
coming
up
with
a
process
and
mapping
out
conceptually
what
these
categories
of
populations
would
look
like
again,
not
not
to
develop
the
vehicles
to
make
improvements,
whether
that's
policy
vehicles,
waivers
financial
what-have-you,
but
to
start
kind
of
blank
slate
and
look
at.
If
if
we
were
creating
a
system,
how
would
we
categorize
populations
in
need,
then?
E
The
second
step
would
be
to
quantify
in
a
very
general
sense
kind
of
like
we
did
today
who
who
are
those
populations?
Where
are
they?
What
are
the
covered
funding
sources
etc?
And
we
can
do
that
on
a
narrower
basis.
As
I
mentioned
this
morning,
chairman
Wilson
and
chairman
Scott
did
from
joint
labor
task
the
Department
of
Health
in
the
Department
of
Family
Services,
to
do
that
on
a
more
targeted
basis
with
our
adolescent
and
child
population
and
we'll
be
starting
at
work
with
the
Department
of
Family
Services
very
soon
and
I.
E
Think
that
dovetails
nicely
here.
So
the
short
answer
to
your
question,
mr.
chairman,
is
what
I
think
we
can
do
that
to
to
kind
of
facilitate
not
from
the
Department
of
Health's
perspective,
but
facilitate
the
exercise
for
a
committee
like
this
to
go
through
that
to
do
that,
work
in
in
population,
definitions
and
understanding,
you
know
who
they
are,
where
they
are,
how
they're
served
or
how
they're
not
served
to
ultimately
make
decisions
on.
E
You
know
what
the
role
of
the
state
is
with
regards
to
those
populations
and
then
questions
to
be
answered
about
the
vehicles
to
to
get
us
there.
The
stick
and
the
spokes
of
all
of
this
right
now,
in
addition
to
this,
this
pestering
virus
that
we're
dealing
with
on
a
daily
basis
is
also
the
the
looming
budget
cuts.
E
So
the
one
suggestion
again
not
to
don't
want
to
overstep,
but
the
one
suggestion
I
would
have
for
for
this
committee
and
this
topic
in
general
senator
Kent's,
get
to
your
point
also
about
the
Department
of
Corrections
populations,
and
that
that
facet
of
this
is
we
will
know
more
in
the
coming
weeks
and
especially
as
we
move
into
July
of
what
exactly
what
our
budget
reduction
proposals
will.
Look
like
the
reason
I
bring.
E
That
up
is
is
not
to
you
know,
a
punt
or
delay
that
the
work
of
a
committee
like
this
or
the
work
that
you
will
task
us
with.
We
will
get
started
on
that,
but
it
will
it
could
potentially
change
outcomes,
and
so,
if
we're,
if
we
as
a
Department
of
Health,
are
going
to
reduce
you
know
major
areas
of
funding
because
we
have
to
or
senator
Kinski
if
the
Department
of
Corrections
has
to
move
in
the
same
direction.
E
Based
on
on
the
directives
we've
received,
the
bat
could
be
I,
think
interesting
context
for
a
committee
like
this
or
others
to
determine
what
that
means
for
reform.
What
that
means
for
solutions
that
may
or
may
not
be
possible,
so
I
just
offer
that,
as
a
little
bit
of
a
suggestion
from
the
Department
of
Health
and
Senator
Kinski,
to
your
point
happy
to
take
your
questions
now
on
the
Department
of
Corrections
population
and
what
work
we've
done
and
and
plan
to
do
with
with
that
agency.
E
A
I'd
like
to
throw
them
at
you
and
I'll,
be
fairly
quick.
First
of
all
on
the
Department
of
Corrections
I
appreciate
an
overview
on
where
these
folks
are
getting
their
mental
health
substance
abuse
counseling,
either,
while
on
probation
or
after
being
discharged,
halfway
house
or
or
to
the
community.
My
understanding
is
that
they
be
reimbursed
for
Medicaid
if
their
Medicaid
eligible,
except
when
they're
incarcerated,
so
when
they're
in
a
transitional
unit,
evidently
Medicaid.
Okay.
At
that
point,
it's
also
my
under
state.
A
The
Medicaid
doesn't
require
when
somebody's
incarcerated
they
just
disenrolled
from
Medicaid,
you
can
keep
them
continuously
enrolled,
and
so
I'd
like
to
find
out
do
see
is
screening
people
for
Medicaid
rolling
those
are
eligible
keeping
them
enrolled,
even
though
they're
not
eligible,
but
the
minute
they're
discharged.
Then
they've
already
got
all
paperwork
done.
So
is
there
a
process
as
as
mr.
dent
will
describe,
everybody
comes
the
doors
continuously
being
checked?
A
I
D
A
They're
discharged:
do
we
have
any
data
on
where
they're
getting
those
services
are
they
going
to
private
providers?
We
saw
data
from
mr.
Gimbel
that
97%
of
those
involved
with
substance
abuse
counseling
are
involved
with
the
justice
system.
That
might
be
the
entire
universe
of
people,
but
there
might
be
people
going
somewhere
else.
Does
the
Department
of
Health
have
any
idea?
What
percentage
of
of
those
who
are
receiving
treatment
are
they're
receiving
any
reimbursement
for?
Does
it
go
to
the
Department
of
Correction?
A
Is
somebody
else
billing
and
collecting
so
I'd
like
to
I'd
like
to
know
that
the
total
segment
of
that
population
going
to
community
mental
health
after
discharge
and
and
if
they're
not
going
there?
Where
are
they
getting
their
treatment,
who's
paying
for
it
and
what
apparatus
are
in
place
to
try
and
collect
that
the
other
one
is
I,
think
you
so
now
I'm
off
with
do
see
now,
I'm
on
the
girls
school,
two
boys
school,
the
girls
school
is
not
on
a
prison
model
or
whatever
you
call
it.
A
C
A
The
girls
school
clientele
and
the
boys
school
clientele
and
then
when
they
are
in
the
facility
as
well
as
post-discharge
and
then
I,
would
just
now
it
off
of
do
see
the
community
the
idea
of
having
a
waiver,
but
what
I'm
curious
about
is.
We
talked
about
a
waiver:
that's
where
the
provider
is
the
community
mental
health
center
they're
being
paid
on
priority
populations,
including
DLC?
A
You
know:
that's
I
have
that
as
around
a
twenty
four
twenty
five
million
dollar
savings,
because
half
the
cost
we're
paying
now
at
a
tobacco
fund
and
general
fund
could
go
to
Medicaid
on
that
kind
of
model.
And
then
is
there
the
potential
to
pick
up
some
additional
savings
on
monies?
We
may
be
spending
out
of
our
own
pockets.
That
could
be
that
could
be
foisted
off
onto
the
Medicaid
system
out
of
the
DLC
side,
and
so
that
exhausts
those
questions.
And
then
the
other
is
I.
You
guys
are
making
your
plans.
A
The
governor's
direction
was
clear.
He
said.
Look
at
wiping
out
whole
programs
instead
of
crippling
programs
by
just
cutting
them
all
across
the
board.
So
I
would
like
a
list
and
I
think
you've,
given
it
to
me
previously
on
a
proce
of
all
programs.
We
are
not
required
by
the
feds
to
implement
on
top
one
is
the
s
chip
program.
That's
grown
way
beyond
what
it
was
supposed
to.
A
We
matched
dollar-for-dollar
with
the
facts.
The
feds
are
reducing
their
commitment
to
that
program.
We
don't
have
to
adopt
it
once
adopted,
we're
not
forbidden
from
repealing
it.
I
know
that
sounds
terrible
kids
130
to
200
percent
of
poverty
level,
but
we're
in
a
pretty
tough
spot
so
I,
just
like
a
listing
of
all
the
programs,
we're
not
required
to
adopt
we're,
having
adopted
that
we're
not
required
to
keep
Thank
You.
Mr.
chairman,
thank.
E
You
and
mr.
chairman
and
senator
Kinski
took
notes
on
that
list
of
items.
Much
of
it
we
have
some
of
it
could
use
some
updating,
so
I
will
will
certainly
follow
up
with
you
and
with
this
committee
on
some
of
these
items
as
it
relates
to
the
budget
reductions,
I
will
just
mention.
The
entire
Medicaid
program
is
optional.
E
So,
as
we've
gone
through
before
with
many
of
you
and
with
appropriations,
it's
it's
a
it's
a
tough
order
to
take
the
kind
of
money
that
we're
talking
about
out,
because
we
have
to
hit
those
five
areas
that
really
just
represent
the
bulk
of
our
budget
and
that's
all
money
that
goes
out
to
communities
that
goes
out
to
providers.
With
the
exception
of
our
you
know,
support
for
the
staff
at
those
two
facilities.
E
That's
really,
are
you
know,
overhead
or
administrative
cost
in
the
department,
relatively
speaking,
I
mean
again
ninety-one
percent
of
our
budget
in
those
of
our
general
fund
budget
in
those
five
areas
so
certainly
going
to
be
tough
times
ahead.
We
will
get
through
it.
We've
all
been
here
before
and
I'm,
confident
we'll
come
out
on
the
other
side,
but
a
senator
Kinski
will
we'll
get
started
on
either
updating
or
preparing
the
information
that
you
requested.
E
Representative
Larson,
I,
hope,
I
answered
your
questions
in
in
closing.
I
just
want
to
say
again:
this
is
a
policy
area
and
a
topic
I,
never
seven
years
ago,
thought
I'd
be
into
but
appreciate
the
the
committee's
time
and
it's
an
area
that's
near
and
dear
to
a
lot
of
our
hearts
and
I
think
we
can
make
some
progress.
So
thank
you
for
the
opportunity
to
testify
today.
Thank.
F
Thank
You
mr.
chair,
so
my
query
is
regarding
the
timeline
our
fist,
the
next
biennium
starts
in
14
days
and
my
understanding
is
contracts.
New
contracts
for
community
mental
health,
centers
start
in
15
days.
So
if
we
are
impact
going
to
reduce
services
or
impact
or
looking
at
budget
issues
with
this
our,
what
what
is
I
guess
actively
going
to
be
in
those
contracts
that
are
different
than
what
is
our?
What
is
in
this
year's
contracts,
whether
they're,
one-year
or
two-year
contract
is
irrelevant.
What
does
July's
contract
going
to
look?
F
How
is
it
gonna
look
differently
than
June's
contract,
because,
if
we're
still
going
to
require
them
to
serve
all
comers,
if
we're
still
going
to
require
them
to,
you
know,
add
duties
such
as
gatekeeping
etc.
It
seems
hard
for
me
to
gather
get
my
head
around
the
fact
that
you're
gonna
say
we're
gonna.
We
were
able
to
cut
twenty
percent
of
the
budget.
F
So,
unless
we're
willing
to
take
away
responsibilities,
it
seems
I'm
struggling
with
how
how
you
can
say
do
the
same
responsibilities
with
a
whole
lot
less
or
with
less
funding
and
to
how
you
know
what
that
is
in
ie
fifteen
days.
Because
that's
when
that,
though,
that's
when
their
contracts
take
effect.
So.
F
Mean
I
heard
the
comment
mr.
chairman
about
you
know
we'll
know
more
in
July,
we'll
know
more
in
August.
Well,
July
first
is
when
their
contracts
start,
so
either
we're
gonna
go
on
a
month-by-month
basis
with
these
folks
creating
a
whole
nother
level
of
challenge
and
uncertainty
and
not
go
by
a
year
or
two
year
contract
or
something
else
is
going
on.
F
C
E
Mr.
chairman
and
represent
the
Barlow,
it's
a
it's
a
great
question
and
the
simple
answer
is
the
contracts
will
be
executed
before
the
budget
cuts
are
implemented.
That's
just
a
timing
issue
with
when
the
direction
to
to
cut
the
budget
has
has
been
given.
So
this
is
very
similar
back
in
2016
for
the
2017
2018
biennium,
when
we
took
about
a
hundred
million
dollars
out
of
the
general
budget
as
well,
those
weren't
all
finalized
until
after
the
biennium
had
started.
E
So
essentially
what
you
do,
the
more
you
you
know
go
on
through
July
through
August
what-have-you.
It's
the
same
across
a
lot
of
our
service
areas,
not
just
behavioral
health.
You
essentially
now
you
have.
Instead
of
24
months
of
budget,
you
have
23
months
to
get
that
that
number
out
and
then
22
months,
so
we
will
be
through
areas
that
do
receive
reductions.
E
This
week
and
we'll
we'll
have
that
that
discussion
with
the
governor's
office
this
month,
but
what
I
want
to
be
clear
on
representative
barlow
is
it's
not
again
it's
a
timing
issue,
but
it's
not
full
implementation
of
the
reductions
by
July
1st,
because
that
would
that
would
be
impossible
with
the
contracts.
You
know
hundreds
of
Department,
of
Health
contracts
that
are
ongoing
for
the
next
fiscal
year.
E
Mr.
chairman,
we
are
in
in
communication
with
with
all
of
our
providers.
It's
it's
certainly
not
perfect,
because
we
don't
our
selves,
know
the
exact
landscape.
I
think
we
anticipate
another
Craig
report,
an
emergency
Craig
report
coming
in
in
July,
which
will
inform
you
know
either
further
cuts
beyond
the
initial
round
or
or
some
other
scenario,
but
we
are
whether
it's
in
Medicaid
or
whether
it's
in
behavioral
health,
aging,
Public,
Health
we're
in
we're
in
communication
on
anticipating
changes
and
anticipating
reductions.
E
B
You,
mr.
chairman,
two
things
to
follow
on
from
Senator
Kinski's
discussion.
The
first
is,
as
the
labor
committee
members
know,
CSG
spent
two
years
working
on
the
topic
of
the
substance,
abuse
programming
available
to
people
coming
out
of
the
Department
of
Corrections
custody,
and
that
was
the
genesis
of
last
year's
House
bill
31.
So
we
have
all
that
report
that
was
given
to
the
labor
committee
last
year
that
it
was
a
you
know,
survey
of
the
entire
state
and
the
where
the
services
are
provided.
B
Everything
so
I
will
share
that
with
all
the
members
of
this
subcommittee
and
then
the
second
thing
just
to
not
take
away
from
whatever
wonderful
work.
Stephan
will
do
for
us,
but
just
a
reminder
that,
because
we
are
not
a
Medicaid
expansion
state,
the
vast
majority
of
people
in
Department
of
Corrections
custody
ages
19
to
64.
Hardly
any
one
of
those
people
is
Medicaid
eligible
so
where,
while
there
might
be
a
few
people
who
would
be
eligible
for
Medicaid
coverage,
unless
they
you
know,
are
disabled
or
or
have
end-stage
renal
disease,
or
something
like
that.
B
E
Please,
mr.
chairman,
just
if
I
made
two
representative
Wilson's
comments
and
Senator
Kinski's
questions
earlier
that
work
with
Council
of
state
governments
over
the
past
two
years,
we
actually
built
their
their
model,
for
it's
called
a
survival
model
to
look
at
the
crosswalk
between
Department
of
Corrections,
clients
and
community
mental
health
and
substance
abuse,
clients
and
what
that
might
look
like
if
we
were
to
able
able
to
reduce
recidivism
based
on
targeting
kind
of
your
higher
acuity.
C
A
C
B
Actually
would
probably
answer
this
better
than
I.
We
have
been
looking
or
considering
the
possibility
for
a
couple
of
years
in
a
vague
sort
of
way
of
a
Medicaid
expansion,
I'm,
sorry,
a
mental-health
expansion.
However,
I
am
not
sure
that
Medicaid
would
ever
cover
incarcerated
people.
In
any
case,.
B
That
the
waiver
discussion,
that
we
were
just
having
about
and
that's
one
of
those
things
where
you
just
need
to
run
the
numbers,
because
again
it's
not
an
expansion
and
an
Obamacare
expansion
where
we
would
have
to
only
pay
10%.
We
would
be
paying
our
current.
The
feds
would
pay
the
current
map,
which
is
50/50.
But,
as
you
see,
we
are
plainly
spending
a
fair
amount
of
money
in
that
anyway,
which
was
when
way
back
in
2013
and
2014
when
we
were
considering
the
ACA.
B
That
was
where
Department
of
Health
proposed
getting
most
of
the
savings
from
there's
been
a
lot
of
cuts
since
then,
so
that
that's
no
longer
a
thing
but
I'm
sure
Department
of
Health
you
know
is-
is
readily
able
to
run
some
numbers
on
that,
and-
and
it's
just
one
of
those
other
waiver
type
things
that
we
have
to
see
how
the
numbers
play
out-
probably
stuff.
That
has
something
to
add
on
you.
A
Thank
you
thanks.
Mr.
chairman
Thank
You
representative,
the
the
reason
on
judiciary
is,
we
came
up
with
all
kinds
of
great
ideas
how
we
could
reduce
the
prison
population,
save
millions
upon
Bane's,
but
it
hinged
on
the
right
sort
of
support
infrastructure
being
available
in
each
community,
and
there
were
very
few
and
law
enforcement
that
were
confident
that
that
was
in
place.
So
it's
it's.
The
own
killed
two
birds
with
one
stone.
If
we
can
sounds
like
you've
taken
a
good
hard
look
at
that
and
I'll
look
forward
to
seeing
your
report
Oh.
C
D
F
F
F
Approach
and
even
even
when
people
are
incarcerated,
you
know
the
cost
of
continually
them
going
back
into
the
prison
system
is
a
is
a
big
cost
to
the
state
so
and
a
lot
of
people
that
do
Lobby
on
that
issue.
Don't
work
in
the
prisons,
so
I
like
I,
said
I
mean
we
need
to
touch
it
at
some
point.
We
need
to
come
back
and
start
looking
at
real
numbers.
I
Thank
You
mr.
chairman
I,
do
think
I
like
a
few
things
that
Senator
Kinski
brought
up
by
I,
wish
that
were
a
greater
opportunity
out
there
to
have
some
type
of
an
expansion
on
just
mental
health
that
tremendously
interests
me
I,
also
like
what
Senator
Kinski
said
about.
Basically
an
exit
counseling
option
in
our
prisons
and
jails
for
people
that
are
heading
out,
you
know,
I,
don't
know
what
do
see
is
doing.
I
Think
one
of
the
program's
we've
yet
to
see
the
full
advantages
of
our
is
our
quick
dip
program
thankful
that
we
were
able
to
get
that
funded
in
the
last
budget.
It
seems
to
me
the
biggest
impediment
with
that
is
what
we're
talking
about,
that.
There
aren't
necessarily
I
think
senator
sharp
mentioned
it.
There
aren't
necessarily
providers
in
our
most
rural
areas
that
can
offer
a
lot
of
the
services
and
the
county
jails
that
would
really
make
quick-tip
effective.
I
I
understand
the
biggest
impediment
is
actually
whether
jells
participate
in
the
quick
dip
program
or
not,
and
that
is
hinges
upon
whether
there
prea
compliant
or
not,
something
we
would
have
control
over
at
the
state
level
as
to
whether
we
were
to
mandate
that
to
our
counties
or
do
some
type
of
cost
sharing
with
counties
so
that
they
were
prea
compliant
if
their
prea
compliant
I
understand
that
to
be
the
biggest
impediment
as
to
whether
they
even
participate
in
quick
dip
or
not.
But
yeah
comes
I.
Think,
mr.
I
You
know
we
can
stand
up
all
day
long
and
talk
about
how
it's
necessary
and
helpful
for
our
people,
particularly
in
our
do-si,
to
have
substance
and
mental
health
treatment
up
front
and
to
have
a
lot
of
it
intensive
upfront,
because
we
know
we
just
know
that
that
reduces
recidivism.
It
reduces
an
incarceration
and
reduces
costs
overall.
But
if
we're
not
gonna
fund
that
at
our
local
level,
then
we're
not
gonna
see
those
results.
So
you
know
what
can
this
committee
do
in
terms
of
that?
I
Well,
I
think
you
know
the
whole
prea
compliance,
that's
probably
something
maybe
more
for
judiciary
but
as
a
whole,
I
think
funding
making
sure
that
the
funding
is
available
for
those
community
providers
who
are
offering
it
particularly
in
the
rural
areas
may
be.
Telemedicine
is
another
avenue
to
try
to
get
some
of
that
counseling
and
stuff
into
the
rural
areas.
Thank
You,
mr.
chairman,.
B
I
all
memories
from
my
two
years
on
labor
health
are
all
coming
back
under
good
chairman
Barlow
and
the
many
meetings
that
we
spend
talking
about
all
these
discussions,
title
25
and
and
all
this
coming
back
on
my
first
meeting
actually
I
spent
as
a
representative
elect
I,
was
sitting
next
to
chair
Wilson
and
talking
about
these
very
subjects
and
I,
guess,
there's
somebody
just
kind
of
overarching
thing
that
hit
me
and
going
back
to
once
again,
another
committee
I
serve
on
about
that
Qin's
program.
B
We
took
up
in
management
a
lot
of
it,
something
that
here
Wilson
said.
You
know
one
thing
it
seemed
like
we
have
to
do
overarching
through
all
these
things
were
talking
about.
We
have
to
break
down
these
silos.
We
have
no
way
of
evaluating
these
programs
to
see
how
well
they're
doing
who's
doing
what
and
how
the,
how
the
the
clients
getting
the
service
and
how
much
we're
spending
on
each
client
because
they're
not
talking
to
each
other,
and
we
still
don't
have
a
good
handle
on
that
before
we
start
just
taking
it.
B
Whack
at
cutting
programs
I
think
we
really
need
to
commit
ourselves
to
try
to
work
on
that
goal.
On
I,
don't
know
I
even
joked
with
someone.
Is
there
some
what
we
can
do
a
blockchain
where
we
just
assigned
everyone
a
number,
so
we
don't
know
their
identity.
So
that
way,
that
is
so.
We
can
keep
our
HIPAA
requirements
safe
and
pass
that
information
between
groups,
so
they
can
watch
that
number
and
how
those
people
are
getting
the
hair
and
getting
they're
getting
their
services.
B
I,
don't
know,
but
also
something
that
representative
Olson
said
is
key,
is
gonna
be
on.
My
question,
too,
is:
what
role
can
telehealth
get
us
to
try
to
save
these
costs
and
the
only
other
thing
I'd
say
and
I'll
get
in
trouble
for
saying
it.
But
since
ever
since
I
have
a
rule,
when
someone
says
Obamacare
at
least
twice
in
one
meeting,
I
always
have
to
respond.
We're
saying
why
the
hell?
Don't
we
just
expand
Medicare
and
be
done
with
it.
So
that's
just
those
are
kind
of
be
the
sin
of
my
questions
and
Thank.
B
Thank
You,
mr.
chairman,
really
good
discussions.
A
lot
of
really
good
information
from
everybody.
I
really
appreciate
that
Department
of
Health
and,
of
course,
Stephan
he's
he's
always
on
spot
with
with
everything
that
I
usually
two
steps
ahead
of
what
I'm
thinking
but
yeah
I
think
you
know.
Obviously
our
budget
concerns
are
you
know?
That's
that's
the
upper
most
I
guess
priority
is,
is
what
do
we
do?
I
mean
I.
Think
we've
got
to
find
ways
to
fund
our
community
health
centers,
because
I
think,
if
we
don't,
you
know
you
either
pay.
B
Now
you
pay
later,
do
you
want
to
pay
that
forty-five
thousand
dollars
when
they
go
into
the
state,
pen
or
whatever
so
I
think
telehealth
is,
is
certainly
a
way,
maybe
I
think
they're
having
good
luck
with
that
and
those
data
that
I've
seen
says
it's
pretty
effective,
actually,
maybe
it's
as
effective
as
in-person,
so
think.
That's
something
we
need
to
look
at
and
obviously
we
didn't
really
touch
on
Corrections.
But
that's
going
to
be
a
big,
lift,
I
think
and
you
know,
I
told
hope
we
continue
with
her.
You
know
the
reforms.
B
Are
we
done
with
you,
know,
justice
reforms
and
whatnot,
but
I
think
we've
we've
covered
a
lot
of
it,
but
we've
got
to
do
something.
I
think
with
funding
issues
and
I
have
a
couple
of
ideas,
but
you
know
I
think
I'll
wait
till
maybe
the
next
one
I
want
to
do
a
little
percolating
on
them
and
and
maybe
a
little
more
research
I'd
like
to
kind
of
see
what
some
other
states
are
doing
with
waivers
and
those
kinds
of
things.
C
Thank
you.
So
today's
the
16th
committee,
and
if
you
could
could
please
try
and
have
your
thoughts
put
together
and
back
to
us
by
Friday
and
then
the
Chairman
and
I'll
kind
of
sit
down
with
Ellis
Owen
and
put
out
some
dates
for
a
follow-up
meeting
and
in
start
preparing
and
agenda.
I.
Think
that
we
don't
want
to
be
pedaling
around
here,
because
we
want
to
try
and
have
this
stuff
done
for
as
labor
in
health
and
JC
Meade
in
their
in
their
committee
meetings.
Does
that
sound?
Okay
with
you,
chairman,
Kinski.
C
Okay,
so
with
that
mind
appreciate
the
comments
of
everybody.
I
know
that
we
covered
a
lot
of
ground
and
really
appreciate
our
labor
and
health
people,
as
they
heard
this
for
the
umpteenth
time.
I
know
that,
but
it
was
good
for
for
us
on
jay-z
to
hear
that
and
again,
as
Senator
Carruth
pointed
out,
we
does
bring
back
fond
memories.
So
with
that
Elizabeth
John,
is
there
any
cleanup
that
we
need
to
do
before?
We
close
our
committee.
B
C
D
D
We've
had
discussions
over
the
last
year
of
really
as
community
mental
health
centers
being
committed
to
having
those
real
discussions
with
the
Department
of
Health.
So
we
can
come
up
with
something
that's
not
handed
out,
but
something
that
we
all
say
this.
This
is
going
to
work,
and
so
that
would
be
on
my
only
thing
that
that,
in
those
discussions
that
that
that
happened,
I'm
sure
the
deputy
director
already
has
that
on
his
radar,
but
other
than
that
I.
Just
thank
you.
So
much
and
I
appreciate
the
committee's
work.
That's
it
Paul.
G
Thank
You
mr.
chairman
I
just
had
copal
comments.
Thank
you
again
for
the
time
and
attention
to
this
topic.
You
know
we.
We
had
a
plan
to
have
these
conversations
and
it's
gotten
a
little
bit
derailed
by
kovat
and
budget
cuts,
but
I
think
that
it's
still
good
conversation
and
mr.
chairman,
to
your
comment
about
requests
about
whether
we
were
thinking
about
what
those
services
or
populations
might
need
to
look
like
I
just
wanted
to.
Let
you
know
those
conversations
are
underway
right
now
in
all
of
your
community
mental
health.
G
Centers
again,
just
echo
deputy
director,
Joe
Hanson,
everything
will
depend
on
what
comes
out
in
July
and
we
will
certainly
communicate
that
back
to
this
committee
and
work
on
work
on
that
as
things
unfold.
But
in
the
meantime,
we're
just
happy
to
have
the
conversation
so
and
as
always,
Webb
sack
is
available
to
answer
questions
or
what
it's
your
local
center
or
the
system
in
general
Thank
You.
Mr.
chairman,.
C
If
I
might
and
I
appreciate,
you
saying
it
kind
of
depends
on
what
comes
out
in
July,
but
if
you
were
making
recommendations
as
to
what
those
priority
populations
would
be
I,
you
know
we're
wanting
to
include
your
input
as
we
make
these
decisions.
So
that's
you
know,
I'd
really
request
we'd
be
a
little
more
proactive
than
reactive
on
that,
and
so
the
same
question
would
apply
if
you've
got
suggestions
or
ideas
that
we
could
start
looking
at.
That
would
be
greatly
appreciated.
G
G
C
C
H
You
mr.
chair
members
of
the
committee,
thank
you
for
the
opportunity.
As
always
to
speak
to
you
I
know.
The
focus
tends
to
be
on
the
community
mental
health
centers,
but
I
always
like
to
let
the
committee's
remember
that
those
of
us
that
are
in
private
practice
are
just
as
much
part
of
the
system
as
the
those
with
contracts
and
directives
legislatively
and
statutorily.
H
We
are
here
to
assist
and
provide
information
that
tends
to
get
lost
when
we
look
at
the
overall
system,
and
especially
those
of
us
in
very
small
areas
having
practiced
in
Evanston
where
we
had
to
send
most
of
our
people
over
the
border
to
what
Utah,
because
we
just
don't
have
the
resources
available
and
in
Carbon
County,
where
there's
only
eight
of
us
four.
However,
hundreds
of
miles
we
we
exist.
H
We
weren't
looking
for
any
of
these
challenges
any
more
than
what
we
had
on
a
regular
basis
and
if
any
of
us
can
assist,
we
we
want
to
be
able
to
give
some
creative
input
and
alternatives,
especially
in
the
telehealth
situation.
Telehealth
is
great
for
adults,
not
so
much
for
kiddos,
which
tends
to
be
70%
of
my
population
little
hard
to
do
child
therapy
over
telehealth,
but
we
we
are
looking
for
any
ways
to
assist
you
in
being
successful
in
helping
the
citizens
of
our
wonderful
state.
Thank
you.
Thank.