MINUTES OF MEETING

      ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES

 

      Sixty-seventh Session

      January 26, 1993

 

 

 

The Assembly Committee on Health and Human Services was called to order by Chairman Jan Evans at 1:15 p.m., Tuesday, January 26, 1993, in Room 330 of the Legislative Building, Carson City, Nevada.  Exhibit A is the Meeting Agenda, Exhibit B is the Attendance Roster.

 

 

COMMITTEE MEMBERS PRESENT:

 

      Ms. Jan Evans, Chairman

      Mrs. Vivian L. Freeman, Vice Chairman

      Ms. Kathy M. Augustine

      Ms. Marcia de Braga

      Mr  James A. Gibbons

      Mr. Dean A. Heller

      Mr. William A. Petrak

      Ms. Gene W. Segerblom

      Ms. Stephanie Smith

      Mr. Louis A. Toomin

      Mr. Wendell P. Williams

 

 

COMMITTEE MEMBERS ABSENT:

 

      None

 

GUEST LEGISLATORS PRESENT:

 

      None

 

STAFF MEMBERS PRESENT:

 

      Kerry Carroll Davis, Research Analyst

 

OTHERS PRESENT:

 

      See attached attendance roster (EXHIBIT B).

 

Chairman Evans requested committee introduction of BDR 40-502, BDR 39-441, BDR 40-613, BDR 15-44, and BDR R-771.

 

BDR 40-502 -      An act relating to health care; defining additional offenses related to the submission of false claims for payment; providing penalties; and providing other matters properly relating thereto.

 

BDR 39-441 -      An act relating to mentally ill persons; removing the restriction on the location at which certain medical examinations of allegedly mentally ill persons may be performed; establishing standards for the preliminary medical examination of a person who is being transported to a mental health facility; and providing other matters properly relating thereto.

 

BDR 40-613 -      An act relating to vital statistics; allowing the state board of health to authorize county health officers to supply abstracted birth certificates under certain circumstances; and providing other matter properly relating thereto.

 

BDR 15-44 -       An act relating to dangerous weapons; providing for the issuance of a permit to carry a concealed weapon; providing penalties; and providing other matters properly relating thereto.

 

BDR R-771 -       Assembly Concurrent Resolution--Designating October as Nevada Child Health Care Month.

 

      ASSEMBLYMAN HELLER MOVED FOR COMMITTEE INTRODUCTION OF BDR 40-502, BDR 39-441, BDR 40-613, BDR 15-44, AND BDR R-771.

 

      MR. TOOMIN SECONDED THE MOTION.

 

      THE MOTION CARRIED UNANIMOUSLY.

 

Mrs. Evans asked the committee if they would be available on Monday, February 22, for a joint meeting with the Senate Committee on Human Resources and Facilities regarding managed care.  The committee could not reach a consensus and asked Mrs. Evans to discuss alternatives with Senator Rawson's office.

 

Myla Florence, Administrator, State Welfare Division, addressed the committee.  Ms. Florence indicated the Welfare Division was a very large and complex organization consisting of fourteen major programs.  Ms. Florence handed out an overview which highlighted these programs (EXHIBIT C).  Ms. Florence discussed the public assistance programs, which provide services in the form of cash grants, and the medical assistance programs. 

 

Mrs. Evans asked Ms. Florence to define SSI for the committee.  Ms. Florence explained SSI referred to Supplemental Security Income which was a public assistance program administered by the Social Security Administration.  This program serves needy individuals who are either aged, blind, or disabled.  In Nevada, these individuals must file a separate application for Medicaid.

 

Mrs. Freeman asked whether it was appropriate to have the Weatherization Assistance Program located within the division given all the other issues Welfare deals with.  Mrs. Florence responded it would stay with the organization.  Mrs.  Freeman asked if there was supposed to be a minimum amount of money in the Homeless Fund before it was dispersed.  Ms. Florence said the fund had just reached the threshold and the program would be initiated this fiscal year.  Mrs. Freeman inquired why Medicare recipients were not receiving the full scope of Medicare services.  Ms. Florence explained they would be eligible for the full range of Medicare services but not Medicaid services.  Mrs. Freemean also wanted to know if any effort was being made by the state or the counties to work with the federal government regarding child support issues.  Ms. Florence responded there were a number of bills in Congress  dealing with the issue of reciprocity between states in order to pursue collection.  In Nevada the collection level for out-of-state absent parents is almost as high as in-state.

 

Mr. Petrak inquired about the WIC program.  Ms. Florence replied the WIC program was administered by the Health Division.  The Welfare Division worked closely with the Health Division in order to exchange information as well as refer clients.  Mr. Petrak asked if there was a duplication of efforts.  Ms. Florence explained the WIC program was intended to meet other nutritional needs for high risk children and pregnant mothers.  WIC recipients often were eligible for food stamps but WIC supplemental foods were in the form of a food package which specifically dealt with the dietary needs of the mother and child, therefore, it would not result in duplication. 

 

Mrs. Segerblom asked if a person received both ADC and food stamps would they need to go to two different offices.  Ms. Florence indicated not for the initial application but in order to pick up food stamps they would have to go to an issuing center.  Mrs. Segerblom inquired if they could be combined into one office.  Ms. Florence responded at one time they were combined, however in an attempt to alleviate mail loss problems as well as minimize the burden on the eligibility staff they were separated.  Mrs. Segerblom noted that Elko was not included in the Training and Employment or Weatherization Programs.  Mrs. Florence said it was hoped the Employment and Training Program could be expanded, and the Weatherization Program is limited to certain geographic areas.  There was an attempt to rotate the program around the state.

 

Mr. Toomin asked how many employees were involved in the Welfare program.  Ms. Florence indicated there are 833 authorized positions.  Mr. Toomin wondered if there were any thoughts to streamlining the Welfare Program.  Ms. Florence said the division had experienced significant reductions, caseloads had increased, and support staff had dwindled down significantly.

 

Mrs. Evans mentioned pursuant to federal guidelines there were only so many days allowed to respond to applications.  The state  went to court because Nevada was unable to provide services within the given time frames.  Ms. Florence said case processing time was a concern for the division.

 

Ms. Florence discussed caseload growth and expenditures (EXHIBIT D).  She pointed out in January 1992, the Welfare Division implemented a budget reduction plan to save $3.7 million in general funds which essentially meant that the same amount was lost in federal funds.  In January 1993, the Welfare Division targeted a reduction of general funds in the amount of $16.7 million.  This primarily involved the Medicaid budget with severe cuts in services to recipients.  Mrs. Freeman asked the current status of the provider tax.  Ms. Florence explained the provider tax was in the Governor's recommended budget with funding coming into the Medicaid program.  Mrs. Freeman asked if Welfare was anticipating the same amount of revenue.  Ms. Florence said it was less than what had been received during the last biennium.  Mrs. Freeman asked why.  Ms. Florence said it was partly a result of changes in the federal rules and also the non-institutional portion of the provider tax was no longer available.

 

Ms. Florence identified the issues confronting the Welfare Division.  She briefly discussed caseload, health care, welfare reform, managed care, and data processing.  Mr. Florence also handed out a summary of 1993 proposed legislation (EXHIBIT E).

 

Ms. Augustine asked Ms. Florence to comment with regard to incentives for accuracy in caseload management.  Ms. Florence explained the federal government required the quality assurance error rate fall within a particular target, otherwise the state would be penalized.  Because of the increase in the food stamp caseload the error rate has also been increasing.

 

Mr. Toomin asked if Ms. Florence was familiar with a proposal from Data Resources to tie all the entities into one data bank.  Ms. Florence indicated she had heard some discussion about the proposal and the Department of Data Processing has had contact with them. 

 

Mary Ellen McCarthy, Attorney, Nevada Legal Services, Inc., addressed the committee and focused her remarks on the issue of Medicaid (EXHIBIT F).  Ms. McCarthy discussed problems with delivery of managed care systems and indicated several things that could be done to improve Medicaid.

 

Mrs. Freeman asked Myla Florence what the plans were for increasing staff relative to the issue of managed care.  Ms. Florence stated the agency requested three positions to provide a mandatory managed care program.  Given the fact it was not recommended by the governor, the agency would have to look at existing resources to proceed with the proposal.  Mrs. Freeman inquired if the administration of a managed care program would be really burdensome.  Ms. Florence responded it may be burdensome to the provider but it would eliminate the thousands of requests for preauthorization which were received each month by the Welfare Division.

 

Mrs. Segerblom asked if managed care was the same as an HMO.  Ms. McCarthy explained there are different systems but an HMO was one type of model.

 

Ms. McCarthy explained, in response to Mr. Heller's question, if someone worked 40 hours a week at minimum wage and there were two or more members of the household, they would fall below 100 percent of the poverty level.

 

Minor Kelso, Member, Nevada State Legislative Committee, AARP, addressed the committee regarding Nevada's Medicaid Program (EXHIBIT G).  Mr. Kelso also expressed concurrence with the recommendations contained in the Welfare Study Report.

 

Dr. Owen Peck, Associate Dean, University of Nevada School of Medicine, discussed the development of the managed care program (EXHIBIT H).  Dr. Peck indicated the number of patients increased dramatically and the program needed to be expanded.

 

Mrs. Freeman asked if the services of the Medical School need to be expanded as well.  Dr. Peck explained there are 65,000 Medicaid patients in the state and he believed the Medical School should set the standard but not take over the program for the entire state.  Mrs. Freeman asked if this could be done incrementally.  Dr. Peck said yes, the intent was to use the private doctors in the community.  Mrs. Freeman asked if the program was discussed with the governor's office.  Dr. Peck said yes.

 

Mr. Toomin asked if Dr. Peck had any data with regard to the cost of the program.  Dr. Peck said he could provide that information and it appeared there had been a cost savings.

 

Mrs. Segerblom asked what hospitals were used in Las Vegas.  Dr. Peck responded primarily UMC but a patient could request another hospital.  In Reno, Washoe Medical Center was used and occasionally St. Mary's.  Mrs. Segerblom asked if there was any objection to the program from private groups.  Dr. Peck said at first but not in the last five years.  For example, there was not one doctor in Carson City that would accept a Medicaid patient.

 

Chairman Evans asked if Dr. Peck saw any other role or involvement for the Medical School.  Dr. Peck said more study and research was needed.  The Medical School should be more involved with the private hospitals in trying to improve health care including access, quality and cost containment.  Dr. Peck also mentioned the need to be involved in delivery systems and preventative care.

 

Ray Rodriguez, Attorney, Nevada Legal Services, handed out materials relative to welfare reform and explained the Fill-the-Gap proposal (EXHIBIT I). 

 

Mr. Toomin asked if Mr. Rodriguez would provide the committee with the appropriate updated graphs.  Mr. Rodriguez replied yes.

 

Mike McMahon, Chairman, County Association of Welfare Directors, commented on the partnership that existed between the state and county welfare programs.  Mr. McMahon encouraged the committee to look at the system as a whole because decisions made would impact the counties as well as the state.

 

Sally Bilyeu, Children's Health Coalition, introduced herself to the committee and explained the work of her organization.  The coalition is a group of parents interested in legislation regarding the needs of medically challenging children.

 

Jerry Ash, President, Nevada Hospital Association, addressed the committee with regard to the Medicaid program (EXHIBIT J). 

 

Mr. Heller inquired if the reason Medicaid reimbursement only covered 38 percent of the cost was due to the fact Nevada had the second highest hospital costs in the nation.  Mr. Ash explained 38 cents of every dollar was a net loss which drove up hospital costs to other patients.  Hospital charges do not have anything to do with what Medicaid pays.  Each state pays according to its own plan.

 

Mr. Gibbons noted some Medicaid payments were based on the federal poverty level standard versus the state established rate for poverty and these amounts could vary greatly, therefore, how can payments to the hospitals be changed.  Mr. Ash said the formula used by the State of Nevada was so convoluted no one understood it.  The requirement for the state was to provide a payment equal to what was customarily paid by others.  However, the state had been unable to meet this requirement.  The association had a lawsuit pending regarding this issue.

 

There being no further business to come before committee, the meeting was adjourned at 3:28 p.m.

 

      RESPECTFULLY SUBMITTED:

 

 

                             

      CONNIE CAMPBELL

      Committee Secretary

??

 

 

 

 

 

 

 

Assembly Committee on Health and Human Services

January 26, 1993

Page: 1