MINUTES OF MEETING

      ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES

 

      Sixty-seventh Session

      June 10, 1993

 

 

The Assembly Committee on Health and Human Services was called to order by Chairman Jan Evans at 1:45 p.m., June 10, 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:

 

      Keith Macdonald/State Board of Pharmacy

      Sharon Ezell, Chief/Bureau of Licensure and Certification

      Dr. David Luke/Sierra Regional Center

      Helen Foley/Nevada Nurses Association

      Michael McMahon/NV Association of County Welfare Directors

      Jim Wadhams/Nevada Hospital Association

      Denell Hahn/Clark County Social Service

      Pat Christensen/Nye County Social Services

      Mary Walker, Director of Finance/Carson City

      John Schaper, Administrator/Nye Regional Medical Center

      Bill Welch/Nevada Rural Hospital Project

 

      WORK SESSION

 

 

 

ASSEMBLY BILL 211:      Revises certain provisions relating to persons authorized to possess and administer controlled substances and dangerous drugs.

 

Mrs. Freeman stated the amendment to AB 211 (Exhibit C) had been reviewed by the participants and asked them to come forward with their findings.

 

Speaking first, Keith Macdonald/State Board of Pharmacy, explained AB 211 was an effort by the Board of Pharmacy to encompass the factual performance of the possession and administration of drugs currently occurring in the state. He said a major concern dealt with some of the facility settings and introduced Ms. Sharon Ezell, Chief of the Bureau of Licensure and Certification, who wished to speak to that issue.

 

Ms. Ezell stated a primary objection with the Health Division was they would allow medical facilities to develop policies and procedures and then proceed to allow anyone they so desired to administer drugs under the Pharmacy Act. Reviewing the amendment, Ms. Ezell explained changes in Section 2, subsection 1.

 

During Ms. Ezell's review of Section 2, subsection 2, Dr. David Luke of Sierra Regional Center stated they were in support of that section. He noted intermediate care facilities for persons with mental retardation were separate classes of facilities having their own federal regulations and unique requirements for administrators.

 

Helen Foley/Nevada Nurses Association, stated they objected to Section 3, subsection 5 as well as subsection 6. She noted the issue addressed was the long term care facilities or residential facilities for groups. She added they did not want to include intermediate care facilities as they would require nursing care.

Her recommendation: "The board shall adopt minimum qualifications for administrators and employees of residential facilities for groups."

 

Since prior agreement on the content of the amendment had not been reached by those involved, Mrs. Evans excused all participants and closed the work session on AB 211.

 

      ********

 

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

 

Mr. Gibbons stated Senate Bill 400 was designed to promote public safety and indicated the amendment (Exhibit D) had been accepted by all utility holders.

 

Referencing Section 6, line 2 of the amendment, Mrs. Evans questioned who would decide what portion of cost would be borne and by what party.  Mr. Gibbons indicated the language in the amendment would give direction to the court to decide which damages should be included or excluded.

 

Responding to Ms. Smith's inquiry  concerning department of transportation, Mr. Gibbons indicated the department felt they should be excluded from the bill as they worked continuously along corridors and access routes within the prescribed boundaries of the bill.

 

      MR. GIBBONS MOVED AMEND AND DO PASS SB 400 WITH AMENDMENT       709.

 

      MR. TOOMIN SECONDED THE MOTION.

 

      MOTION PASSED UNANIMOUSLY WITH MR. HELLER BEING 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.

 

Ms. de Braga indicated a subcommittee hearing on AB 460 resulted in a proposed amendment (Exhibit E). Mrs. Evans asked one of the proponents, Mr. Jim Wadhams of Nevada Hospital Association, to address same. Mr. Wadhams indicated the bill merely raised the 1986 level of $438 per month for a single person to $580 per month. The limitation was to the appropriated amount and in no way increased an appropriation. He said it was an attempt to allow more people to receive services and hospitals to receive reimbursement for providing those services.  He stressed it would not change the budget or the rate of reimbursement.

 

Discussion ensued between Mr. Wadhams and Mrs. Evans. Mr. Wadhams explained fewer people would have their service reimbursed out of the fund; however, that did not mean fewer people would be taken care of. He added, "Funds are grossly inadequate and they will be exhausted quicker because more people will qualify but that does not necessarily imply that fewer people will receive care."

 

Michael McMahon/NV Association of County Welfare Directors, spoke in opposition to AB 460. He said tying eligibility standards to the federal poverty level for both state and county programs was a good mechanism to enhance the delivery of human services in Nevada and an opportunity to be able to provide more medical assistance to working poor as well as alleviate some of the distress hospitals were facing. However, he felt it would place a new and increased fixed burden on counties without any revenues to be able to provide for that increase and need. It would not release caps the state programs had and would not tie things to a floating federal poverty level. He termed it a "quick fix."

 

Additionally, Mr. McMahon stated it would remove the ability of local officials to hold public hearings and would fail to address the growing gap between state and county services. His thought was it would force many counties to the point where they would not have the ability to take care of their indigents.

 

Mr. Gibbons stated he thought a provision existed where the state of Nevada was accepting responsibility for some of the indigent care so as to relieve counties in the future. Ms. Denell Hahn/Clark County Social Service, responded by stating "SB 494 is proposing to change the way we reimburse for in-patient and out-patient services in Clark County where we will surrender all our money to the Department of Human Resources for purpose of federal match. It has not passed the Assembly at this time but it is one proposal that clearly would have some impact on how we deliver care."

 

Ms. Hahn voiced concern if SB 494 did not go through, hospitals would have the right to insist on payment before other bills were paid since the money was all in one account. Mr. Gibbons argued the bill did not address how much reimbursement was for hospitals; it simply broadened the group of people eligible for indigent care.

 

Responding to Ms. Smith's inquiry as to why hospitals could not receive their portion up front, Ms. Hahn explained there was no way to segregate hospital payments from everything else.

 

Pat Christensen/Nye County Social Services, concurred, stating the rural part of the county used hospitals in Las Vegas and the northern part of the county used hospitals in Washoe County. There would be no way to figure amounts due each hospital.

 

Ms. Hahn, at the request of Mrs. Freeman, gave the following explanation of SB 494:

 

"SB 494 is the inter-governmental transfer/provider/hospital tax and it is a mechanism whereby hospitals will be taxed and county hospital districts will surrender tax money to the Department of Human Resources for the purpose of achieving the matching federal dollars to supplement some medicaid shortfall. The counties then would be held harmless for their in-patient bills and in Clark County for their in-patient bills and out-patient bills in exchange for the money we would be spending. In Clark County's case, we would be giving $l9,750,000 as our share; Washoe County $3 million, and the rurals somewhere around $3 million in the aggregate. It would not pay hospitals, or in our case, out-patient bills the way we're paying them right now. It would be paying the hospitals in terms of how many county eligibles they are serving and they would get paid by the Department of Human Resources in disproportionate share payments."

 

Ms. Hahn added she thought an appropriate suggestion would be to require the boards of county commissioners to have annual public hearings in order to set standards for eligibility for people in their community. She also suggested hospitals lobby the individual boards of county commissioners as that was where decisions were made.

 

Mary Walker, Director of Finance/Carson City, stated currently they were at the top of their caps and making payments to the hospital in accordance with the law. However, if forced into a situation where the income level was increased while not having the necessary resources, it would result in a welfare crisis.

 

John Schaper, Administrator/Nye Regional Medical Center in Tonopah, stated his hospital had been diligent in making determination of possible indigents. In an eight month period, 150 to 200 indigent applications were sent to the county of which only three had been approved. The remainder had to be listed as bad debts. He noted, had the eligibility criteria been less stringent, there would have been a higher rate of approval.

 

Bill Welch, Executive Director/ Nevada Rural Hospital Project,

stated the reason the issue was brought before the legislature was because county commissioners when asked to consider increasing eligibility, declined. The reason given was legislation passed in 1987 set the eligibility criteria. This left no alternative other than to come before the legislature again.

 

Mrs. Evans voiced concern as to a lack of cooperation with stakeholders working with the subcommittee and said there would be no vote taken on the measure until the following Tuesday.

 

There being no further business to come before committee, the meeting was adjourned at 3:07 p.m.

 

      RESPECTFULLY SUBMITTED:

 

 

                             

      CHRISTINE SHAW

      Committee Secretary

??

 

 

 

 

 

 

 

Assembly Committee on Health and Human Services

June 10, 1993

Page: 1