MINUTES OF MEETING

      ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES

 

      Sixty-seventh Session

      June 3, 1993

 

 

 

The Assembly Committee on Health and Human Services was called to order by Chairman Jan Evans at 1:45 p.m., June 3, 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. Wendell P. Williams

 

 

COMMITTEE MEMBERS ABSENT:

 

      Mr. Louis A. Toomin - Excused

 

GUEST LEGISLATORS PRESENT:

 

      None

 

STAFF MEMBERS PRESENT:

 

      Marla McDada, Research Analyst

 

OTHERS PRESENT:

 

      Paula Treat/Desert Springs Hospital

      Jerry Ash, President/Nevada Hospital Association   

      Mae Shelton, Director/Washoe County Social Services

      Denell Hahn, Social Service Director/Clark County

      Fred Hillerby/Washoe Medical Center

 

 

      WORK SESSION

 

 

 

ASSEMBLY BILL 444:      Creates presumption of knowing use of controlled substance under certain circumstances.

 

Although AB 444 had been Indefinitely Postponed at a prior meeting, Mrs. Evans asked it be "resurrected." Since two-thirds of the committee was present, Mrs. Evans called for a motion to re-consider AB 444.

 

      MR. WILLIAMS SO MOVED.

 

      MR. HELLER SECONDED THE MOTION.

 

      MOTION CARRIED WITH ASSEMBLYMEN SMITH AND TOOMIN ABSENT AT       THE TIME OF THE VOTE.

 

Ms. Paula Treat, representing Desert Springs Hospital, expressed appreciation to the committee for giving them a vehicle in which to express their grievance. She then gave an explanation of the proposed language changes as seen in Exhibit C.

 

Mr. Gibbons called attention to Section 2, No. 9, stating the words "or more" should be inserted following the figure 400,000. Ms. Treat agreed. She noted the definition would apply merely to Desert Springs and only for the duration of the problem they were facing.

 

      MR. HELLER MOVED AB 444 BE AMENDED AND RE-REFERRED TO           THE COMMITTEE OF HEALTH AND HUMAN SERVICES.

 

      MR. GIBBONS SECONDED THE MOTION.

 

      MOTION CARRIED WITH ASSEMBLYMEN EVANS, SMITH AND TOOMIN         ABSENT AT THE TIME OF THE VOTE.

 

      ********

 

ASSEMBLY BILL 460:      Requires counties to use level signifying poverty for Nevada in determining eligibility of indigent persons for financial and medical assistance.

 

Jerry Ash, President/Nevada Hospital Association, speaking in support of AB 460, submitted to committee members an amendment (Exhibit D) in the form of a re-written bill. He indicated the proposed amendment resulted after conferring with NACO representatives as well as the Nevada State Welfare Directors Association.

 

Walking the committee through the amendment, Mr. Ash indicated federal poverty guidelines were printed February of each year by the Federal Department of Health and Human Services and were used in the Nevada State Welfare Division. He noted the effect of AB 460 would not occur until the budget year of l994 for the counties. To clarify: In February of 1994 the next federal poverty level guidelines would be established; the counties would then have up to the beginning of their next fiscal year to adjust the eligibility level.

 

Mae Shelton, Director/Washoe County Social Services, speaking in opposition to AB 460, referred to her letter of May 2l to Mrs. Evans (Exhibit E) which explained how eligibility was determined and the effect on clients if the bill passed.

 

Denell Hahn, Social Service Director/Clark County, speaking in opposition to AB 460, expressed concern regarding the Department of Human Resources setting the eligibility standards for a county program since the county had to allocate budget funds for that program. She was equally concerned State standards for assistance to an Aid to Dependent Children family were quite a bit lower than the standards currently used by the counties.

 

Ms. Hahn noted the existing language would cause the county programs to automatically increase regardless of funding. She pointed out in Clark County they were at the federal poverty guideline currently and had raised eligibility every year. However, in addition to base eligibility, extra assistance monies were available as County programs could be very flexible in accommodating special circumstances that occurred.  The only area federal poverty guidelines were not permitted was if someone was receiving free room and board...then the eligibility standard would be reduced.

 

Ms. Hahn said she did, however, agree with the revision of the definition of "household" in the amendment proposed by Mr. Ash and encouraged the committee to accept that part of the amendment.

 

Ms. Mae Shelton reviewed the above-mentioned letter of May 21 and commented if the bill were to pass, changes would have to be made on how eligibility was determined. Some or all of the disregards would necessitate being eliminated and the passage of AB 460 would result in denying health care to the most needy in the community.

 

Responding to Ms. Augustine's inquiry as to why child care was deducted as a disregard, Ms. Shelton explained the County Commissioners' policies allowed for work related expenses to be deducted.

 

Following committee discussion Mrs. Evans noted there were portions of the bill that could be salvaged. She asked Ms. de Braga to chair a subcommittee with members Williams and Gibbons in order to resolve existing differences.

 

Mr. Fred Hillerby, representing Washoe Medical Center, asked to be involved with the subcommittee. Mrs. Evans welcomed his participation.

 

      ********

 

ASSEMBLY BILL 602:      Makes various changes regarding payment of fees for treatment of indigent clients in state mental health facilities.

 

Ms. Hahn, speaking in opposition of AB 602, spoke specifically to Section 7, objecting to counties having to shoulder responsibility for emergency medical type services in a state facility. In addition to current responsibilities they were required to pay for emergency dental care for mental health patients admitted to Division facilities.

 

Paula Treat, representing Desert Springs Hospital, indicated their basic objection, with cuts being made in mental health services at the state level, was more and more responsibility being shifted down to counties.

 

Reference was made to a letter from Washoe County Department of Social Services (Exhibit F) where it stipulated it would seem unreasonable to require counties to provide dental care for state mental health patients when the same service was not available to county patients. They asked the committee delete "emergency dental" from lines 15 and 25 on Page 3 of the bill. Mrs. Evans indicated letters had been received from nine difference counties with the same request.

 

      MRS. FREEMAN MOVED TO AMEND AND DO PASS AB 602 BY DELETING       "EMERGENCY DENTAL" FROM LINES 15 AND 25 ON PAGE 3 AND TO        REMOVE THE BRACKET FOR "NON RESIDENT' ON LINE 29.

 

      MRS. SEGERBLOM SECONDED THE MOTION.

 

      THE MOTION CARRIED UNANIMOUSLY (ASSEMBLYMEN TOOMIN AND          SMITH WERE ABSENT AT THE TIME OF THE VOTE).

 

Mrs. Segerblom was appointed to handle the bill on the floor.

 

      ********

 

SENATE BILL 400:  Prohibits certain activities near overhead line carrying high voltage.

 

Mr. Gibbons reported the bill was currently in bill draft and was expected to be out shortly.

 

      ********

 

SENATE BILL 184:  Permits physician to authorize registered nurse to make pronouncement of death under certain circumstances.

 

Mr. Gibbons indicated he had met with Senator Rawson, proponent of SB 184, to discuss the liability with regard to expansion of the declaration of death by a nurse. The Senator felt it would not be a problem in that the Nurses Association and everyone who had heard the bill accepted the language and was willing to work with it. The recommendation was that no changes be made.

 

Mr. Gibbons stated a small amendment would be needed on line 22 to more clearly define that a doctor would have a period of 24 hours once the certificate was presented to him within which to sign the medical certificate of death. He noted this was an issue brought out by Mr. David Rowles, Clark County Health District Director, in a letter to Mrs. Evans dated May 19, l993.

 

      MR. GIBBONS MOVED AMEND AND DO PASS SB 184 BASED ON THE         RECOMMENDATIONS OF DAVID ROWLES WHICH WOULD AMEND THE           PERIOD OF TIME OF 24 HOURS FOR THE DOCTOR TO SIGN THE           CERTIFICATE ONCE IT WAS PRESENTED TO HIM.

 

      MR. PETRAK SECONDED THE MOTION.

 

      Responding to Ms. Augustine's concern regarding the possible deletion of 120 days on line 11, Mr. Gibbons stated Senator Rawson thought a time was a little broader expression of authority vs. patient specific, so it was done for convenience to leave it at a 120 day period.

 

      MOTION CARRIED WITH MS. AUGUSTINE VOTING NO AND MR. TOOMIN       ABSENT AT THE TIME OF THE VOTE.

 

      ********

 

 

There being no further business to come before committee, the meeting was adjourned at 3:00 P.M.

 

      RESPECTFULLY SUBMITTED:

 

 

                             

      CHRISTINE SHAW

      Committee Secretary

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Assembly Committee on Health and Human Services

June 3, 1993

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