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      MINUTES OF MEETING

      ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES

 

      Sixty-seventh Session

      February 25, 1993

 

 

 

The Assembly Committee on Health and Human Services was called to order by Chairman Jan Evans at l:l5 p.m., February 25, 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:

 

      Mrs. Jan Evans, Chairman

      Mrs. Vivian L. Freeman, Vice Chairman

      Ms. Kathy M. Augustine

      Ms. Marcia de Braga

      Mr. James A. Gibbons

      Mr. William A. Petrak

      Mrs. Gene W. Segerblom

      Ms. Stephanie Smith

      Mr. Louis A. Toomin

      Mr. Wendell P. Williams

 

 

COMMITTEE MEMBERS ABSENT:

 

      Mr. Dean A. Heller - Excused

 

GUEST LEGISLATORS PRESENT:

 

      None

 

STAFF MEMBERS PRESENT:

 

      Kerry Carroll Davis, Research Analyst

 

OTHERS PRESENT:

 

      Gary Crews, Legislative auditor     

      Stephen Shaw, Rehabilitation Division

      Tim Terry, Medicaid Fraud Control Unit

      Dr. Joseph A. Reinkemeyer, President/Nevada State

        Medical Association

      Ed Fend, AARP

      Jerry Ash, President/Nevada Hospital Ass'n.

 

Chairman Evans requested committee introduction of the following Bill Draft Requests:

 

 

BDR R-1075  Directs Welfare Division of Department of Human Resources to shorten application for Medicaid and to make available application written in Spanish.

 

BDR R-1084  Encourages employers to establish programs to promote employee wellness, physical fitness and prevention of disease and accidents.

 

BDR 34-1087Requires Board of Trustees of each school district to provide for daily instruction in physical education to all pupils.

 

      ASSEMBLYMAN FREEMAN MOVED FOR COMMITTEE INTRODUCTION OF BDR       R-1075, BDR R-1084, AND BDR 34-1087.

 

      ASSEMBLYMAN WILLIAMS SECONDED THE MOTION.

 

      MOTION CARRIED UNANIMOUSLY.

 

 

ASSEMBLY BILL 182 -     Prohibits bureau of services to the blind of rehabilitation division of department of human resources from guaranteeing loans to blind persons who are under contract with bureau.

 

Gary Crews, Legislative auditor, speaking in support of AB l82, indicated AB 182 resulted from an audit of the Bureau of Services of the Blind and was presented to the audit subcommittee  last year. It was noted during the course of the audit the Bureau had guaranteed some $327,000 of loans to blind vending operators in June of l99l whereby if they defaulted, the state would have had to meet the obligation. Statutes do not expressly provide authority of this sort. Upon bringing this to the audit subcommittee's attention, it was decided the statute should be clarified to expressly prohibit the guaranteeing of loans to blind vending operators, the main concern being to avoid obligation on the part of the state.

 

A brief discussion ensued. Mr. Petrak requested Mr. Crews  secure figures as to the duration of the existing loans as it was not known whether or not they had been substantially reduced by this time.

 

Stephen A. Shaw, Administrator of Rehabilitation Division, clarified there were no state or federal dollars in the 25 vending stations across the state. When blind vendors set up a station there was a "set-aside" program where a portion of their earnings was put aside for the purpose of going back into the program to create future opportunities for employment. He indicated 3 times in the past a pro forma was presented to the bank without signatures or guarantees. The loan was approved  by simply showing a copy of the legislation and budget, and it was questionable who would be held responsible if the vender defaulted.  Subsequently  the matter was resolved. Mr. Shaw agreed it was more of a "shotgun wedding" at the time but "it was a matter of public policy for future loans there would be no State obligation."

 

Since there were no further questions from the committee, Chairman Evans closed the hearing on AB l82.

 

ASSEMBLY BILL 167 -     Enlarges criminal provisions against false claims for health care.

 

Tim Terry, Director of Medicaid Fraud Control Unit, testifying in support of AB l67, indicated the bill would be an assist in the operation of their program. He listed their responsibilities as two-fold: To investigate and prosecute instances of provider fraud in the Medicaid program and secondly, to investigate and prosecute allegations  of patient abuse or neglect at institutions receiving funds or payments under the program.

 

Mr. Terry indicated a typical line of defense from a provider was the inability to understand the rules and regulations in the program. AB l67 would allow the Fraud Unit to refute that line of defense and would also allow them to charge appropriate counts of attempts to defraud other health programs at the same time. For example, when Medicaid fraud was investigated, cases of Medicare fraud were routinely uncovered.

 

After briefly addressing the components of the bill, Mr. Terry suggested the possible need for a technical amendment in Section 12, changing the reference of "district attorney" to "Attorney General."

 

Answering questions from the committee, Mr. Terry indicated under this proposal, should there be a conviction against a provider,  it would be reported to the licensing board under which the provider was licensed. Mrs. Freeman questioned fraud activity in the area of Home Health Care services. Mr. Terry responded it was not an authorized area of activity at this time for the Medicaid Fraud Control Unit and would require changes in federal regulations. He also specified federal regulations did not allow them to investigate recipient fraud. Those cases would be referred to the Medicaid agency itself which maintained an internal investigative department for that purpose and was able to pursue recoveries.

 

With respect to the different kinds of exclusions resulting from their activities, Mr. Terry noted upon a criminal conviction, a provider would be automatically excluded from the Medicaid or Medicare program for a period of 5 years.

 

Responding to Mrs. Evans' inquiry as to what types of fraud were typically uncovered, Mr. Terry cited the durable medical equipment field as a primary offender, involving companies supplying hard equipment to recipients such as wheelchairs and hospital beds, billing for new equipment but supplying used equipment. In a provider area, a common occurrence involved billing for services rendered to patients who never actually appeared for service on a particular day.

 

President of the Nevada Medical Association, Dr. Joseph A. Reinkemeyer, next spoke in support of AB 167. His prepared testimony is submitted as EXHIBIT C. Inasmuch as the Medical Association protested Section 10 of AB l67, Mrs. Freeman questioned Mr. Terry as to physician fraud. His response indicated one-third of the 54 cases opened since the inception of the Medicaid Fraud Unit directly involved individual physicians or MDs.

 

Mr. Ed Fend, representing AARP, spoke in support of AB l67 (EXHIBIT D) and advocated increased staffing in the Medicaid Fraud Unit.

 

Jerry Ash, President of Nevada Hospital Association, offered testimony in opposition to AB l67. His primary area of contention dealt with the term "medically necessary" as seen on Page 2, Paragraph 1 of AB l67. He noted in all areas "medically necessary" was determined by an entity called the Utilization Review Organization. These UROs were unregulated, generally outside of the State of Nevada, and they "second guess the judgments of physicians on the scene in the State of Nevada." Of concern was the fact that each URO had its own set of standards determining medical appropriateness. They were very protective of these rules and would not in advance share them with the provider of care. Thus, when a provider made a decision that something was "medically necessary" in that process, it could result in a different interpretation from that of the utilization review organization.

 

Mrs. Evans closed the hearing on AB l67 and asked Mrs. Freeman to chair a subcommittee on the bill with Mrs. de Braga and Mr. Heller as members.

 

There being no further business to come before committee, the meeting was adjourned at 2:45 p.m.

 

      RESPECTFULLY SUBMITTED:

 

 

                             

      CHRISTINE SHAW

      Committee Secretary

 

A handout entitled "Informational Presentation to the Senate Commmittee on Human Resources and Facilities" was furnished to each member of the committee by Mr. Terry. EXHIBIT E is on file in the Research Library.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Assembly Committee on Health and Human Services

February 25, 1993

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