MINUTES OF MEETING

ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES

Sixty-seventh Session

March 16, 1993

The Assembly Committee on Health and Human Services was called to order by Chairman Jan Evans at 1:50 p.m., Tuesday, March 16, 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. Dean A. Heller

Mr. William A. Petrak

Mrs. 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:

Denell Hahn, Clark County Social Services; May Shelton, Washoe County Social Services; Michelle Bero, Nevada Association of Counties; David Nicholas, Nevada Health Care Association; David Rowles, Clark County Health District; Larry Matheis, Nevada State Medical Association; Charlotte Crawford, Department of Human Resources; April Townley and Gary Stagliano, Nevada State Welfare Division; and Mary Ellen McCarthy, Nevada Legal Services.

Mrs. Evans encouraged the committee to review the minutes from the previous meetings as they would be considered for approval on March 23, 1993.

Mrs. Evans opened the hearing on Assembly Bill 275.

ASSEMBLY BILL 275 - Creates advisory committee for human services.

Denell Hahn, Director, Clark County Social Services, addressed the committee. Ms. Hahn discussed the composition of the proposed advisory committee and impact due to change of programs.

Mr. Petrak asked for an explanation of the fiscal impact. Ms. Hahn responded many of the participants would serve without compensation. Discussion ensued regarding the fiscal note.

Mrs. Segerblom asked if the proposed membership of the advisory committee had been involved in the drafting of the bill. Ms. Hahn said the proposed membership was a result of subcommittee discussion. Mrs. Freeman clarified the bill was a logical extension of the Human Services Plan.

Mr. Williams called attention to section 4 of the bill. The length of time needed to be specified with regard to compensation.

Ms. Augustine noted the advisory committee should not be compensated at all, however members were entitled to receive per diem.

May Shelton, Director, Washoe County Social Services, spoke in support of AB 275. Human service delivery occurred at different levels and coordination of services would be a benefit. Ms. Shelton recommended a change in section 6, subsection 8 regarding the date.

Michelle Bero indicated support for AB 275 on behalf of the Nevada Association of Counties. NACO has worked with the 17 counties and the State Department of Human Resources to foster cooperation in assessing the health care needs of the residents of Nevada.

David Nicholas, representing the Nevada Health Care Association and the Licensed Nursing Home Association, spoke in support of AB 275. This legislation would allow the professionals in the state to get together on common problems.

Discussion ensued regarding the composition of the board with respect to the various divisions within the Department of Human Resources.

David Rowles, Director of Administrative Services, Clark County Health District, discussed public health services in southern Nevada. Mr. Rowles suggested an amendment which would allow representation from the health districts.

Larry Matheis, Nevada State Medical Association, discussed how various advisory groups would interact and influence public policy. Clear expectations were needed.

Mr. Heller voiced his concern regarding the reports which would be submitted by the advisory committee particularly with regard to the evaluation of activities.

Charlotte Crawford, Deputy Director, Department of Human Resources, commented on AB 275. Ms. Crawford discussed several issues which needed to be clarified (EXHIBIT C).

Mrs. Freeman asked if the reorganization plan had evaluated the current advisory groups. Ms. Crawford said yes, the plan recommended streamlining and redesignating several groups. There was brief discussion regarding need for change, long-range planning and the timing involved.

April Townley, Deputy Administrator, State Welfare Division, presented testimony for Myla Florence (EXHIBIT D).

Mr. Toomin wanted the record to reflect there was a fiscal note attached to the bill of $97,000 for FY 93/94. Mrs. Evans indicated the bill would be discussed further in an upcoming work session.

Mrs. Evans opened the hearing on Assembly Bill 245.

ASSEMBLY BILL 245 - Prohibits unauthorized possession, transfer or use of card evidencing eligibility to receive Medicaid benefits.

Gary Stagliano, Nevada State Welfare Division, spoke in favor of AB 245. A copy of his prepared testimony was submitted as EXHIBIT E.

Mr. Gibbons asked if this was a lesser offense in other fraud statutes. Mr. Stagliano said no, this would be the primary tool. Discussion ensued regarding section 8 of the bill. Mr. Gibbons explained intent would have to be established.

Mrs. Segerblom asked if there was some way to provide identification on Medicaid cards. Mr. Stagliano said there was minimal identifying information on the card. There had been some conversation about electronic cards, however costs were involved.

Mr. Petrak asked how much money was involved in these violations. Mr. Stagliano explained no information had been obtained.

Ms. Augustine felt this was important legislation and should be extended to food stamps as well. Mr. Stagliano indicated administrative penalties were being pursued.

Ms. Smith commented further about the format of the card. Mr. Stagliano noted Medicaid eligibility was determined on a monthly basis. Consequently, a new card was issued each month making photo identification a problem. The division was pursuing pre-eligibility investigations.

Mr. Heller asked who ultimately became liable if a provider accepted a fraudulent Medicaid card. Mr. Stagliano indicated payment would be denied to the provider. Mr. Heller inquired if electronic transfer through the bank was a possibility. Mr. Stagliano indicated the eligibility payment staff was responsible for benefits.

Mrs. Freeman wanted to know if there was any federal legislation dealing with this issue or if other states had similar laws.

Mr. Stagliano was not aware of other state laws. Federal language said a Medicaid card could only be used by the individual to whom it was issued but no penalties were set forth for violations. This legislation was patterned after credit card law.

Mr. Petrak, referring to his Medicare card, concluded there was enough information printed on the card to prevent misuse. Mr. Stagliano indicated unless the provider asked for additional identification there would be no way to prevent misuse.

Mrs. Evans clarified there was no fiscal impact to the state but rather the provider would ultimately be affected. Mr. Stagliano said yes, payment would be withheld from the provider.

In response to a question from Ms. Augustine, Mr. Stagliano noted if Medicaid had already made payment the state would assume the debt.

Mary Ellen McCarthy, Nevada Legal Services, drew attention to section 7, subsection 3 and suggested clarification. Discussion ensued regarding the proposed amendment. Mrs. Evans referred the bill to subcommittee for further consideration.

Mrs. Evans requested committee introduction of the following Bill Draft Request:

BDR 38-222 Makes appropriation for support of Supplementary Nutrition Allocation Program.

ASSEMBLYMAN WILLIAMS MOVED FOR COMMITTEE INTRODUCTION OF BDR 38-222.

ASSEMBLYMAN TOOMIN SECONDED THE MOTION.

MOTION CARRIED UNANIMOUSLY.

There being no further business to come before committee, the meeting was adjourned at 3:05 p.m.

RESPECTFULLY SUBMITTED:

CONNIE CAMPBELL

Committee Secretary

Assembly Committee on Health and Human Services

March 16, 1993

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