MINUTES OF MEETING
ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES
Sixty-seventh Session
April 27, 1993
The Assembly Committee on Health and Human Services was called to order by Vice Chairman Vivian Freeman at 1:39 p.m., Tuesday, April 27, 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. 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:
Mrs. Jan Evans, Chairman (excused)
GUEST LEGISLATORS PRESENT:
None
STAFF MEMBERS PRESENT:
Kerry Carroll Davis, Research Analyst
OTHERS PRESENT:
Jim Waddams, Nevada Hospital Association; Fred Hillerby, Washoe Medical Center; Bill Welch, Nevada Rural Hospital Project; Jon Sasser, Nevada Legal Services; May Shelton, Washoe County Social Services; Michelle Bero, Nevada Association of Counties; Kirby Burgess, Clark County; Myla Florence, State Welfare Division; Michael McMahon, Nevada Association of County Welfare Directors; Jan Lewellyn-Davidson, University Medical Center.
Mrs. Freeman opened the hearing on Assembly Bill 460.
AB 460 Requires counties to use level signifying poverty for Nevada in determining eligibility of indigent persons for financial and medical assistance.
Jim Waddams testified in support of AB 460 on behalf of the Nevada Hospital Association and described the purpose of the bill. The original language was passed in 1987 and was designed to set a statewide dollar amount to match the federal guidelines for determination of poverty level. The counties had an obligation to provide care for the indigent. Although there had been a significant increase in the determination level signifying poverty, the county levels had not been raised in accordance with the federal standard. This bill would require the Department of Human Resources to adopt regulations establishing the level signifying poverty for the state. These regulations could then be amended from time to time as necessary.
Fred Hillerby, Washoe Medical Center, explained indigency level varied from county to county. There should be one standard established so citizens would have some assurance of public assistance. Currently the statute did not address many people in need of public assistance. In addition, the provider tax proposal included an intergovernmental transfer which would allow the state to receive federal matching dollars.
Mr. Gibbons asked if there would be an increased cost to the counties for indigent care. Mr. Waddams responded no, the funds were raised by ad valorem taxes. This bill would not increase the dollars expended by the counties in support of indigent care.
Mrs. Segerblom inquired who was picking up the tab for the excess costs. Mr. Waddams explained the excess cost was borne by the hospitals. Mr. Hillerby added the costs were ultimately passed on to other patients. Mr. Waddams provided some clarification regarding the current federal poverty level figures.
Bill Welch, Nevada Rural Hospital Project, indicated he agreed with the remarks made by Mr. Waddams and Mr. Hillerby. He noted the rural hospitals were not asking for additional funds but were asking for access to current funds.
Jon Sasser, Nevada Legal Services, spoke in favor of AB 460. This bill would update the definition of poverty and would give
a true picture of the level of need.
May Shelton, Washoe County Social Services, spoke in opposition to AB 460. She handed out graphs relating to the health care assistance program and discussed the growth in Washoe County. This year Washoe County would be $1/2 million short. Currently, people were being served who exceeded the guidelines due to deductions in income for various circumstances.
Mrs. Freeman noted the difference between outpatient and clinic expenditures. Ms. Shelton explained it cost less to treat patients in the clinic than the emergency room. The biggest growing area was nursing home care.
Michelle Bero, Nevada Association of Counties, indicated 16 of the 17 counties had levied the maximum amount of indigent health care taxes. Ms. Bero clarified the proposed use of the intergovernmental transfer. In response to a question from Mrs. Segerblom, Ms. Bero reiterated the state, not the counties, would receive more federal dollars.
Kirby Burgess, Clark County, indicated opposition to AB 460 because the bill would require counties to care for individuals based on state set regulations.
Mr. Toomin asked why a fiscal note was not attached to the bill. Myla Florence, State Welfare Division, responded she did not receive a request from bill draft for any fiscal information.
Ms. Florence testified in opposition to AB 460 (EXHIBIT D) and suggested any wording related to the State Welfare Division be removed from the bill.
Michael McMahon, Nevada Association of County Welfare Directors, agreed it would be good public policy to create a system without gaps. However, the bill was asking for the county welfare systems to be tied to a floating poverty level. He noted the State Welfare Division did not have a float, they were capped, therefore the county welfare eligibility requirements would encroach into the eligibility criteria for the state system. Also, the State Welfare Board would be making determinations for local government. Mr. McMahon thought this bill would create problems for the smaller counties and suggested the Welfare Association and the Hospital Association work together to resolve this in a more effective manner.
Fred Hillerby answered previously asked questions and made concluding comments. In response to questions from Ms. Smith, Mr. Hillerby noted NRS 428 already set the standard and the legislature required the counties to take care of indigents. The counties were concerned because matching federal dollars would only return to the hospitals for hospital care. The counties also had other responsibilities such as clinics and long term care. However, their obligation would not go beyond the tax dollars authorized for that purpose.
Mr. Williams voiced his concerns and Mr. Hillerby reiterated the poverty level would continue to increase and this measure was a way to deal with reality.
Ms. Augustine asked if AB 460 was in any way a response to the issues raised in AB 197. Mr. Hillerby said no, there was no relation.
Mr. McMahon responded to some of Mr. Hillerby's arguments.
Mrs. Freeman closed the hearing on AB 460.
Mrs. Freeman called for testimony on Senate Bill 311.
SB 311 Revises provision concerning examination of persons alleged to be mentally ill.
Jan Lewellyn-Davidson, University Medical Center, spoke in support of SB 311 which codified hospital policy by removing the word "detention" from the statute which means "locked down." She explained there was not an acute care hospital in Southern Nevada which had a lock-down unit at this time. The last sentence stated a person could be taken to a public or private hospital for medical examination for possible commitment.
Mrs. Freeman asked if this bill was related to AB 168. Ms. Lewellyn-Davidson said no, AB 168 referred to transportation of patients.
Mrs. Freeman closed the hearing on SB 311 and no action was taken.
Mrs. Freeman asked Ms. Smith to review the amendments to AB 383 (EXHIBIT E).
ASSEMBLYMAN SMITH MOVED TO AMEND AND DO PASS AB 383.
ASSEMBLYMAN SEGERBLOM SECONDED THE MOTION.
MOTION CARRIED BY THOSE PRESENT (ASSEMBLYMEN EVANS, WILLIAMS AND TOOMIN WERE ABSENT AT THE TIME OF THE VOTE).
There being no further business to come before committee, the meeting was adjourned at 2:33 p.m.
RESPECTFULLY SUBMITTED:
CONNIE CAMPBELL
Committee Secretary
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Assembly Committee on Health and Human Services
April 27, 1993
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