MINUTES OF MEETING
ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES
Sixty-seventh Session
March 18, 1993
The Assembly Committee on Health and Human Services was called to order by Chairman Jan Evans at 1:35 p.m., 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:
Myla Florence, Administrator/State Welfare Division
Mary Ellen McCarthy, Nevada Legal Services
Dr. Nancy Rody, Maternal Child Health Advisory Board member
and Chairman/Presumptive Eligibility Subcommittee of the Governor's Maternal and Child Health Advisory Committee
Frances Doherty, Staff Attorney/Washoe Legal Services
April Townley, Deputy Administrator/Welfare
Yvonne Sylva, State Health Division
ASSEMBLY BILL 245: Prohibits unauthorized possession, transfer or use of card evidencing eligibility to receive Medicaid benefits.
Mr. Gibbons reported the subcommittee's findings on AB 245. He urged committee members Amend and Do Pass Amendment ll6.
MRS. EVANS MOVED TO AMEND A.B. 245 WITH AMENDMENT 116.
MR. PETRAK SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
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MR. GIBBONS MOVED AMEND AND DO PASS AB 245.
MR. TOOMIN SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY.
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BDR R-1841 Urges selection of Nevada as state for testing the evolving National Health Program.
BDR 38-209 Broadening authority of local governments to regulate child care facilities.
ASSEMBLYMAN SMITH MOVED FOR COMMITTEE INTRODUCTION OF
BDR R-1841 AND BDR 38-209.
ASSEMBLYMAN PETRAK SECONDED THE MOTION.
MOTION CARRIED UNANIMOUSLY.
ASSEMBLY JOINT RESOLUTION 17:Urges Congress to enact legislation allowing states greater flexibility in carrying out coordinated programs of health care.
Mrs. Freeman explained AJR 17 came out of a study of the Welfare System and involved the managed care concept for Medicaid patients. She noted in order for the state to require Medicaid recipients use the managed care concept (the state contracting
with an HMO or a preferred provider organization), it must first urge Congress to enact the legislation.
Myla Florence, Administrator/State Welfare Division, spoke in support of AJR 17 (Exhibit C). In order to achieve exceptions from federal regulations, Ms. Florence clarified a lengthy application process must take place with extraordinary data requirements depending upon issues the state would like waived.
Mrs. Freeman stated because the state and feds reimbursed providers at such a low rate, recipients had difficulty finding physicians to treat them. If, however, Medicaid patients were required to belong to a managed care program, although physician choice would not be possible, care would be available.
Responding to Mrs. Evans' questioning the meaning of "greater flexibility." Myla Florence indicated flexibility would be provided by not having to seek a waiver for freedom of choice, statewideness, or comparability of services.
Mary Ellen McCarthy, Nevada Legal Services, expressed some concern relating to statewideness and comparability in the proposed amendments and voiced qualms about rural areas possibly being shut out.
Mrs. Evans closed the hearing on AJR 17 and asked Ms. McCarthy and Ms. Florence to work with Mr. Heller and Mrs. Segerblom on a subcommittee.
ASSEMBLY JOINT RESOLUTION 18:Urges Congress to consider effect of certain proposed legislation upon stability and unity of families in United States.
Mrs. Freeman indicated AJR 18 was a recommendation of the study of the Welfare system and was simply a statement of concern for the family.
ASSEMBLY CONCURRENT RESOLUTION 21: Directs Welfare Division of Department of Human Resources to shorten application for Medicaid and to make available application written in Spanish.
Mrs. Freeman indicated during the course of the hearings, both with the Standing Health Care Committee and the Welfare Study Committee, testimony from a physician revealed a major problem for those administering the programs was the discussion of benefits since materials were not available in Spanish.
Myla Florence, Administrator/State Welfare Division, spoke in support of ACR 21 (Exhibit D). A lengthy questionnaire entitled "Statement of Need" from the Rhode Island Department of Human Services was submitted by Ms. Florence for examination. It is on file in the Research Library as Exhibit E. She indicated the Division had Spanish speaking staff available at every office so individuals could be assisted throughout the application process.
Responding to Mr. Toomin's inquiry regarding a fiscal note, Ms. Florence indicated the automated NOMADS system, allowing clients to complete only one application for all programs for which they might be eligible, and scheduled to be implemented in the summer of 1995, was already provided for within the budget.
Dr. Nancy Rody, MCH Advisory Board member, conveyed the Board's unanimous support for ACR 21. Her written testimony was submitted as Exhibit F. An example of Florida's "Application for Public Assistance" was also submitted as Exhibit G and Exhibit H.
Mary Ellen McCarthy, Nevada Legal Services, noted there were certain basic pieces of information needed on all applications; however, a simplified form would reduce the error rate. In addition to the basic form, she recommended attachments for particular requirements of an individual program. This should adequately meet the legal requirements.
Frances M. Doherty, staff attorney/ Washoe Legal Services, commented with respect to the Spanish translation of the applications, this was not just a cultural accommodation for persons not using English as the first language but a health issue, and "We would all benefit from these services in having a healthier community."
ASSEMBLY BILL 277: Expands eligibility for coverage pursuant to state plan for assistance to medically indigent.
Mrs. Freeman explained AB 277 was a recommendation of the Welfare Study Committee and noted during the course of the hearings the need of presumptive eligibility for pregnant women came up repeatedly. She asked the committee to give the proposal serious consideration.
Myla Florence, Administrator/State Welfare Division, spoke in support of AB 277 (Exhibit I). A brief discussion ensued involving the cost associated with covering prenatal care expenses for low-income women.
In response to Ms. Smith's inquiry regarding payments, April Townley, Deputy Administrator with Welfare, noted if a person went through the entire program, a global fee was paid depending on the type of delivery. If, for example, a person was on the program 3 months and went off, the physician would be paid on a per visit basis.
Mr. Petrak asked for an explanation of "Computer System Modifications." Ms. Florence explained the Division was extremely dependent on data processing capabilities. She noted their earlier estimate for data processing was approximately $270,000 to do the initial programming for a Presumptive Eligibility program, with $30,000 ongoing maintenance of the program. She stressed with any major system change a substantial investment was involved.
Ms. Yvonne Sylva, Nevada State Health Division, said those in the Health Division and also the Welfare Division had been extremely concerned about the lack of data or data in any usable form, so that was why the MCH Advisory Board adopted as a priority coming up with an operative fiscal note. For the past six months the Health Division staff, Welfare Division staff, Data Processing and the Maternal and Child Health Advisory Board conducted data runs on a monthly basis.
Dr. Nancy Rody, Chairman/Presumptive Eligibility Subcommittee of the Governor's Maternal and Child Health Advisory Committee, testified on behalf of AB 277 (Exhibit J). She noted according to the National Commission to Prevent Infant Mortality, the average cost for low birth weight babies was one-half million dollars each, at least 250 times the average cost of medical care during pregnancy. She indicated, "We all pay for these million dollar babies in increased Medicaid payments, health insurance costs, hospital costs and increased educational budgets."
Frances Doherty, representing Washoe Legal Services, also spoke in support of AB 277 and presented information (Exhibit K) gathered for the preparation of the Truckee Meadows Human Services Plan identifying some of the Human Services needs for Washoe County. It represented data both on national and local levels. She encouraged committee support for AB 277, adding the figures "nationally" translated to the figures "locally", and dollars spent up front resulted in significant savings.
Mary Ellen McCarthy informed the committee Nevada was one of the few states not providing a medically needy program; so therefore, had one of the most limited Medicaid programs in the country. On the subject of trying to extrapolate data from other states she cautioned, "States are not going to be able to break out what number of their presumptives are medically needy presumptives and which aren't, so our program is so restrictive in this state that I think that extrapolation is going to be very difficult and we will be overestimating costs if you're using data from a medically needy state."
Mrs. Evans informed the committee she held a letter from Planned Parenthood of Northern Nevada in support of AB 277.
Since there was no further discussion from the committee, Mrs. Evans closed the hearing on AB 277.
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Mrs. Evans entertained a motion to DO PASS AJR 18.
MR. TOOMIN MOVED DO PASS ON AJR 18.
MR. PETRAK SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY. (ASSEMBLYMEN WILLIAMS AND HELLER WERE ABSENT AT THE TIME OF THE VOTE). Assemblyman Heller previously indicated his support.
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Mrs. Evans entertained a motion to adopt ACR 21.
MS. DE BRAGA MOVED TO ADOPT ACR 21.
MR. TOOMIN SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY. (ASSEMBLYMEN WILLIAMS AND HELLER WERE ABSENT AT THE TIME Of THE VOTE).
There being no further business to come before committee, the meeting was adjourned at 3:25 p.m.
RESPECTFULLY SUBMITTED:
CHRISTINE SHAW
Committee Secretary
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Assembly Committee on Health and Human Services
March 18, 1993
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