MINUTES OF MEETING

      ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES

 

      Sixty-seventh Session

      June 22, 1993

 

 

 

The Assembly Committee on Health and Human Services was called to order by Chairman Jan Evans at 2:24 p.m., Tuesday, June 22, 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

 

GUEST LEGISLATORS PRESENT:

 

      Roy Neighbors, Assembly District 36

 

STAFF MEMBERS PRESENT:

 

      Kerry Carroll Davis, Research Analyst

 

OTHERS PRESENT:

 

      John Sarb, Division of Child and Family Services; Fred Hillerby, Nevada State Board of Pharmacy; Helen Foley, Nevada Nurses' Association; Les Bradshaw, Nye County; Jim Waddams, Nevada Hospital Association; Dr. Brian Callister and John Schaper, Nye Regional Medical Center.

 

 

      WORK SESSION

 

SENATE BILL 411   Allows use of certain benefits paid to child to pay portion of cost of care and support of children in Nevada children's homes.

 

John Sarb, Division of Child and Family Services, testified SB 411 came out of the audit subcommittee of the legislative commission.  The provision for monies received for the children's support were not being used to offset the cost of care in the children's home.  It was the intent of the subcommittee to bring that practice into conformance.  Mr. Sarb believed the language in Section 4 was confusing and could be deleted.

 

Ms. Augustine suggested deleting the reference to the northern Nevada children's home and insert "in a Nevada children's home."  Mr. Sarb noted the application of this bill would be for a period of 6 months and would apply only to the southern Nevada Children's home.

 

Mr. Petrak indicated the concern with Section 4 could be resolved by eliminating the word "not" on page two, line one.

 

Mr. Gibbons thought if money was directed to the State, the court order would have to be amended accordingly.  Mr. Sarb said there were two types of court orders which dealt with support payments.  They could not always be used for cost of care.

 

Mrs. Segerblom questioned the language "but must be held in trust for the child."  Mr. Sarb reiterated other statutes would come into play if Section 4 were taken out.

 

Discussion ensued regarding the specific language to be amended.

 

      ASSEMBLYMAN PETRAK MOVED TO AMEND AND DO PASS SB 411 BY DELETING SECTION 4 AND CHANGING THE REFERENCE TO THE NORTHERN NEVADA CHILDREN'S HOME OR SOUTHERN NEVADA CHILDREN'S HOME TO A NEVADA CHILDREN'S HOME.

 

      ASSEMBLYMAN AUGUSTINE SECONDED THE MOTION.

 

Mr. Gibbons clarified lines 16 and 20 on page one made reference to Section 4 and would have to be changed.

 

      MOTION CARRIED BY THOSE PRESENT (ASSEMBLYMEN SMITH, WILLIAMS, AND TOOMIN WERE ABSENT AT THE TIME OF THE VOTE).

 

Mrs. Segerblom agreed to handle the floor statement on SB 411.

 

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

 

Fred Hillerby, Nevada State Board of Pharmacy, called attention to the amendment (EXHIBIT C) and discussed the changes made to the original bill.

 

Mrs. Smith asked what exactly did this bill accomplish.  Mr. Hillerby responded:

1.    the bill allowed residential facilities for groups to assist people in taking their own medication;

2.    it defined ultimate user;

3.    it added to the statute others who had not been previously included;

4.    it clarified dialysis; and

5.    it added authority to the Board of Nurses regarding investigations.

 

Mrs. Freeman noted a question had been raised by Sharon Ezell in regard to whether or not it was necessary to have a care plan in a non-medical facility.  Mr. Hillerby indicated this issue was a matter of interpretation and legislative intent.

 

Helen Foley, Nevada Nurses' Association, indicated a physician or registered nurse should be involved in the development of an ultimate user plan with regard to the operation of an organization.  This was intended to be generic, not resident specific.

 

      ASSEMBLYMAN HELLER MOVED AMEND AND DO PASS AB 211.

 

      ASSEMBLYMAN SMITH SECONDED THE MOTION.

 

      MOTION CARRIED BY THOSE PRESENT (ASSEMBLYMEN TOOMIN, AUGUSTINE, AND EVANS WERE ABSENT AT THE TIME OF THE VOTE).

 

Mrs. Freeman asked for a subcommittee report on Senate Bill 60.

 

SB 60Expands requirement for testing persons arrested for certain sexual offenses for exposure to sexually transmitted diseases.

 

Mrs. de Braga made reference to the most recent amendment and indicated the subcommittee was in agreement with this language.

 

Mrs. Freeman opened the hearing on Assembly Bill 197.

 

AB 197      Limits liability of county under certain circumstances for medical services provided to indigent persons.

 

Roy Neighbors, Assembly District 36, testified the intent was to clear up any misunderstandings regarding what the bill was trying to accomplish.  Mr. Neighbors stated he lobbied during previous sessions to get the existing law changed.  He did not believe the county should pay for any patient unless they were indigent, and there were numerous lawsuits which dealt with this issue.  The concern was with the past interpretation of NRS 450.  Mr. Neighbors referred to two court decisions which addressed this issue (EXHIBIT D). 

 

Les Bradshaw, Deputy District Attorney, Nye County, called attention to the suggested amendment which was included as an attachment in the handhout (EXHIBIT D).

 

Jim Waddams, Nevada Hospital Association testified in opposition to AB 197.  He noted the bill addressed two issues.  One was the county's obligation to reimburse another county, which was based on the indigency determination.  However, the existing statute said that upon admission to the emergency room a person was entitled to treatment.  Therefore, subsection 3 of NRS 450.420 had public policy implications.

 

Mr. Neighbors commented the hospital had the responsibility to take the patient to court after diligent efforts to collect payment had failed.

 

Dr. Brian Callister testified on behalf of Nye Regional Medical Center.  He indicated indigency and support of the emergency room were two separate issues.  Nye County had not paid any of the uncollectible emergency room bills and the hospital had initiated a lawsuit against the county.  Dr. Callister clarified the procedures used by the hospital in their collection efforts.  He noted the hospital would not survive without the support of the county.

 

John Schaper, Administrator, Nye Regional Medical Center, clarified this was a difference of opinion between the hospital and the Nye County Commissioners.  The statute read that the county was responsible for the "cost" of care as distinguished from the "charge" for care.  Cost was determined to be the Medicaid rate for services.  Approximately one out of five people seen in the emergency room were admitted, many of whom did not have insurance.  Without some type of financial backing to reimburse costs, a lot of hospital business would be uncompensated.  This would compromise the quality of care.

 

Mr. Heller stated he was concerned because the state was asked to help the hospital while the county was unwilling to do so.

 

Dr. Callister noted all other rural counties supported their emergency rooms because of the legislative intent.

 

Mr. Heller commented he was also concerned with the kind of precedent this would set.

 

      ASSEMBLYMAN HELLER MOVED TO INDEFINITELY POSTPONE AB 197.

 

Ms. Smith asked if there was some agreed upon language that clarified the definition of indigent person which would meet both needs.

 

Mr. Schaper indicated the county position was they could not pay as a result of the Delapeza case, regardless of the definition.

 

Mrs. Smith inquired who was responsible for the payment of emergency room bills if the patient did not pay.  Dr. Callister said the hospital would attempt to collect from the patient for six months and then turn the bill over to the county.  Mrs. Segerblom asked if other sources of payment were pursued.  Dr. Callister said yes, and the hospital billing practices were perceived to be overly aggressive.

 

      ASSEMBLYMAN FREEMEN SECONDED THE MOTION.

 

Mr. Neighbors responded to Mr. Heller's concern.  He remarked last year the sales tax was divided and Nye County received $400,000 to keep the hospital open but a lot of other counties also received money.

 

Les Bradshaw reiterated this was a statewide problem which needed attention.  NRS 450.400 and 450.420 (3) prohibited the county from carrying out its statutory duty to set standards of eligibility for recipients of county charitable medical aid.  The current statutory scheme was scattered throughout four separate chapters of NRS.  Therefore, the intent was not clear and a great deal of confusion existed.  Mr. Bradshaw called attention to Judge Blake's comments in the Delapeza decision (EXHIBIT D).  The county commissioners were obligated under state statute to set standards of eligibility.  Mr. Bradshaw commented all but two of the other counties were having the same problem.  The legislature needed to clarify the public policy as to who was going to bear the burden of medical treatment to people who could not afford to pay.  Mr. Bradshaw summarized the legal analysis which was included in the handout.  It was apparent the legislative intent under the present statutory scheme was that the county commissioners were required to set standards of eligibility.  The statutes were ambiguous and needed clarification.  The language suggested by Nye County would clearly set forth the class of persons for whom a county was responsible.

 

Mrs. Evans noted the other counties were not present and this appeared to be an isolated issue.   She suggested Nye County work together with NACO in order to obtain statewide support.

Ms. Smith commented if there was ambiguity in the language, all parties needed to work together to decide on what language could be agreed upon.  Mrs. Evans called for a vote on the motion to indefinitely postpone. 

 

      MOTION CARRIED BY THOSE PRESENT (ASSEMBLYMEN TOOMIN AND AUGUSTINE WERE ABSENT AT THE TIME OF THE VOTE).

 

 

There being no further business to come before committee, the meeting was adjourned at 3:45 p.m.

 

      RESPECTFULLY SUBMITTED:

 

 

                             

      CONNIE CAMPBELL

      Committee Secretary

 

 

 

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Assembly Committee on Health and Human Services

June 22, 1993

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Assembly Committee on Health and Human Services

June 22, 1993

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