Appropriations committee works draft to create rural health perpetuity fund, pares back out‑of‑state telehealth language

The Joint Appropriations Committee reviewed draft 26LSO400, legislation to implement Wyoming’s federal Rural Health Transformation award by creating a perpetuity fund, an advisory committee, and a suite of ongoing and time‑limited initiatives intended to improve rural health infrastructure and workforce.

LSO staff described a structure that seeks to hold a large portion of the federal award in a perpetuity fund invested and managed by the State Treasurer, with an annual required distribution (a working target of 4% of the fund) to finance four ongoing initiatives: critical access hospital incentives, EMS regionalization, workforce education supports and postgraduate medical education programs. The draft also lists several time‑limited initiatives (integrated primary care, technology adoption, diet and exercise infrastructure, telehealth platforms, workforce start‑up grants, care coordination, centralized billing, transportation coordination and administration) with percentage targets for allocations.

Why it matters: the proposal would direct the state how to hold and spend a major federal award over multiple years. The committee examined investment policy language (whether the treasurer 'shall' or 'may' invest in equities), the irrevocability of the perpetuity fund, and whether percentage targets in the draft should be binding or aspirational. LSO advised specifying targets as goals to maintain flexibility; the Department of Health said the federal award and CMS oversight impose constraints but that some reallocation within the approved program is possible if properly coordinated with the federal agency.

Telehealth and scope of practice were a focal point. The bill as drafted extended telehealth practice authority and included conforming amendments across many practice acts to allow out‑of‑state providers to deliver telehealth to in‑state residents under specified conditions. The committee voted to remove the out‑of‑state telehealth conforming pages for separate consideration, leaving in‑state telehealth policies and portal/reporting requirements for the funds in the bill.

Department of Health director Stefan Johansen told the committee the department appreciated LSO’s drafting and asked for flexibility to work with the federal Center for Medicare & Medicaid Services (CMS) to finalize budget details. "We are hopeful that before you meet again in early February, we’ll have additional detail," he said, and urged targets be treated as aspirational goals rather than hard requirements.

Key procedural changes adopted: language was amended to make investment in equities permissive rather than mandatory (change 'shall' to 'may'), a numeric percentage in a program allocation was corrected to 9.8%, the phrase that required a 2/3 vote for a particular investment authority was removed, 'promotion' language for diet/exercise was changed to 'program' to reduce confusion, and the committee removed the out‑of‑state telehealth conforming pages for separate consideration.

Next steps: the committee accepted the bill for further work and tabled final votes to its next meeting (the chair indicated the body will meet again in early February to finalize language). LSO and the Department of Health will update the draft to reflect adopted changes and provide additional details requested by CMS, the department, and committee members. The committee also directed staff to draft language to allow the advisory committee and department to revisit program allocations over time and to ensure reporting and accountability tools (an electronic public portal) are implemented.

The committee voted to remove the out‑of‑state telehealth conforming pages and to proceed with the rest of the draft; members emphasized they will continue to narrow and refine investment and program language before final floor action.