MINUTES OF THE JOINT MEETING OF

      ASSEMBLY COMMITTEE ON WAYS AND MEANS

      AND

      SENATE COMMITTEE ON FINANCE

 

      Sixty-seventh Session

      February 9, 1993

 

 

The joint meeting of the Assembly Committee on Ways and Means and the Senate Committee on Finance was called to order by Chairman Morse Arberry Jr., at 8:05 a.m., on Tuesday, February 9, 1993, in Room 119 of the Legislative Building, Carson City, Nevada.  Exhibit A is the Meeting Agenda.  Exhibit B is the Attendance Roster.

 

ASSEMBLY COMMITTEE MEMBERS PRESENT:

 

      Mr. Morse Arberry, Jr., Chairman

      Mr. Larry L. Spitler, Vice Chairman

      Mrs. Vonne Chowning

      Mr. Joseph E. Dini, Jr.

      Mrs. Jan Evans

      Ms. Christina R. Giunchigliani

      Mr. Dean A. Heller

      Mr. David E. Humke

      Mr. John W. Marvel

      Mr. Richard Perkins

      Mr. Robert E. Price

      Ms. Sandra Tiffany

      Mrs. Myrna T. Williams

 

SENATE COMMITTEE MEMBERS PRESENT:

 

      Senator William J. Raggio, Chairman

      Senator Raymond D. Rawson, Vice Chairman

      Senator Lawrence E. Jacobson

      Senator Bob Coffin

      Senator Diana M Glomb

      Senator William R. O'Donnell

      Senator Matthew Q. Callister

 

ASSEMBLY COMMITTEE MEMBERS ABSENT:

 

      None

 

SENATE COMMITTEE MEMBERS ABSENT:

 

      None

 

STAFF MEMBERS PRESENT:

 

      Mark Stevens, Fiscal Analyst

      Dan Miles, Fiscal Analyst

      Gary Ghiggeri, Deputy Fiscal Analyst

      Bob Guernsey, Deputy Fiscal Analyst

 

EHHS ADMINISTRATION - PAGE 613

 

Jerry F. Griepentrog-Carlin, Director, Department of Human Resources gave an overview of the base budget for the proposed Department of Education, Health and Human Resources.  Mr. Griepentrog stated the budget funded the central office which operated the provider tax program and hospital cost containment program.  He stated General Fund expenditures had been significantly decreased due to maximum use of non-General Fund resources.  The Title IV-A block grant, a child care federal funding source totaling $1.3 million, had also helped to decrease expenditures.  The grant had not been budgeted for during the 1991 session, however matching funds were approved by the Interim Finance Committee (IFC) when the Department was guaranteed funds at the county level.

 

In addition to the Title IV-A block grant a standard child care development block grant totaling $2.7 million was expected to have an increased funding need of $800,000 over the next biennium due to the population increases for the state.  The Department had also planned to bring the management of the Title XX program into the central office.  The operations and salary cost for this program were estimated to be $70,000 over the biennium. 

 

The hospital cost containment program collected $329,366 from insurance companies over the last biennium, $40,000 of these funds were transferred to the Legislative Counsel Bureau to fund the Legislative Standing Committee on Health Care.  The hospital cost containment program, instituted by 1991 Legislature, limited any increase in bill charges which directly impacted the medical component of the Consumer Price Index (CPI).

 

Funding in the agency transfer category, $225,465 in FY 94 and $224,370 in FY 95, was derived from the provider tax.  Mr. Griepentrog-Carlin stated a proposed bill draft request (BDR) and fiscal note would provide needed changes in the operation of the provider tax which would likely alter the agency transfer category.  A brief description of the Provider Tax Program is given in Exhibit C pages 2-5.

 

Mr. Griepentrog-Carlin explained although operating expenses appeared to decrease from $206,000 to $104,000 these figures actually represented an increase.  Formerly Attorney General Services totaling $97,000 had been budgeted into the operating expense category.  Now they were contained in a line item called Attorney General Costs.  The increase in operating expenses were represented by $57,000 in dues paid by the Education Department to the National Association of Education.  The only other significant change in the expenditures category was automated processing which increased from $2,505 in FY 92 to $10,682 in FY 95.  The increase was a result of the centralization of all service and maintenance agreements for computer equipment into a single line item.

 

Chairman Arberry asked Mr. Griepentrog-Carlin to explain the Title IV-A child care grant.  Mr. Griepentrog-Carlin explained the grant was a federal grant not requiring matching funds.  The grant was passed on to community organizations such as the Economic Opportunity Board in Las Vegas and the Child Resources Council in Washoe County for child care programs.  The Department took some funds out to cover administrative costs but most of the funds went directly to the programs.  Mr. Griepentrog-Carlin added approximately 1,300-1,400 children received subsidized child care as a result of the Title IV-A grant.

 

Senator Glomb asked for an explanation of the legalization impact funds.  Mr. Griepentrog-Carlin stated they were federal funds used to facilitate the assimilation of legalized aliens into Nevada communities.  The program was enacted in 1986 to assist people who could document residence in the United States, legal or illegal, to become legalized aliens.  Senator Glomb asked to whom the money was provided.  Mr. Griepentrog-Carlin responded some funds were allocated to county health districts but the bulk of the money went to community colleges to sponsor English as a second language programs.  Mr. Griepentrog-Carlin stated the program, although budgeted for the biennium, was scheduled to be terminated September 30, 1993.  However there is a legal challenge pending in the courts to keep this program from being discontinued.

 

Mrs. Evans asked if the Title XX administrator would also manage the children's trust account.  Mr. Griepentrog-Carlin stated some committee members had communicated interest in this change and he believed the change would be beneficial.

 

Chairman Arberry questioned why there was an increase in automated processing from $2,813 to $10,682.  Mr. Griepentrog-Carlin stated the $8,000 increase represented the combined maintenance agreement costs for all data processing and computer equipment.

 

Ms. Giunchigliani asked what portion of the $11,985,780 in federal funds was Title XX money.  Mr. Griepentrog-Carlin stated only $70,000 was Title XX money, about $1.5 million was legalization impact funds, and the remainder represented at-risk child care and the child care block grant.

 

Senator Glomb inquired about status of the child care program.  Mr. Griepentrog-Carlin stated waiting lists, which did not exist until 6 months ago, were currently developing within the state.  Senator Glomb asked how the program was advertised.  Mr. Griepentrog-Carlin stated the most common source of advertising was community agencies.  Mr. Griepentrog-Carlin stated the funding was prioritized to serve the lowest income families first and the people on the waiting list were not low income families. 

 

Senator Glomb asked if any of the funding for the child care program was going to be budgeted for the workfare program.  Mr. Griepentrog-Carlin stated the workfare program had separate funding sources.  Mr. Griepentrog-Carlin added child care and transportation funding was available from the jobs program for ADC recipients who participated in education or employment training.  Mr. Griepentrog-Carlin commented the welfare reform package would include expanded funding for child care apart from these funds.  A brief description of the Nevada Welfare Reform Conceptual Framework is provided in Exhibit C pages 6-8.

 

Mr. Griepentrog-Carlin commented a reclassification increase totaling $20,770 was budgeted because of an occupational study performed by the Department of Personnel.

 

HEALTH RESOURCES COST REVIEW - PAGE 619

 

Mr. Griepentrog-Carlin stated this budget had two basic expenditure items: (1) data entry expense, which was used to reimburse UNLV for UB82 data entry costs (UB82 data is a service directory comprised of the status of patients discharged from Nevada hospitals, the number of patients and financial sources, types of diseases, and the length of stay); (2) indigent penalty, which was a penalty assessed on hospitals who did not meet the mandated 6/10 of one percent free care to the indigent population.  The counties reallocate the penalties to local hospitals that provided a disproportionate share of indigent care.  However, no indigent penalties were collected last biennium.  Mr. Griepentrog-Carlin explained a new provider tax law could make this penalty obsolete.

 

PURCHASE OF SOCIAL SERVICES - PAGE 621

 

Scott Mayne, Department of Human Resources, Chief Accountant presented the budget.  Mr. Mayne explained the Purchase of Social Services account received grant awards equalling $13 million which were then distributed to the Divisions of the Department of Human Resources.  However two accounts did receive funds which were not divisions of the Department of Human Resources, the non-state agency account and the child abuse account.  Funds totaling approximately $600,000 were distributed through these two accounts by the Title XX Committee for social service welfare programs outside the state system.  The remaining $13.4 million is allocated to state agencies.

 

Chairman Arberry asked why costs were projected to remain flat over the next biennium.   Mr. Mayne explain the agency had attempted to maintain the 1992 expenditure level even though most of the programs had an increased funding need due to the increased population in the state.  Mr. Mayne stated the agency determined the major area of increase had occurred in the child welfare caseload therefore more funding was requested for this program.

 

Senator Raggio asked since Title XX federal funds were allocated based on the state population, why was there was a discrepancy between the agency and the Governor's projected need over the next biennium.  Mr. Mayne explained Title XX grant projection was comprised of the agency's best estimate of Congressional allocation.  Also the agency's budget was compiled in July and the Governor's Budget Office had received more recent information.  Mrs. Matteucci stated the Budget Office had received information from Federal Funds Information for States (Exhibit D) and the total Title XX federal allocation was $13,996 million in FY 94 and $14,407 million in FY 95.

 

Mrs. Evans inquired if the Title XX Committee would be expected to maintain its current level of service with a $72,000 decrease in funding.  Mr. Mayne stated the Title XX committee, like all state agencies during the budget crisis, would be held to the FY 92 actual expenditure level of $500,000. 

 

Senator O'Donnell asked for an explanation of the $260,125 reduction in child protection item.  Mr. Mayne explained the funds totaling $2,498,965 in FY 93 and $1,650,588 in FY 95 were reallocated to the child protection category, on page 621 of the Executive Budget, which was a substantial increase from the original work program amount.

 

Senator O'Donnell asked for an explanation of the discrepancy between the child protection line item in the maintenance budget and the child protection line item in the base budget.  Mr. Mayne stated the -$183,637 from the maintenance budget child protection line item was an amount gleaned from the other categories and added to the child protection line item in the base budget.  Mr. Mayne commented if all of the increased caseload funding had been budgeted in the same line item some confusion could have been avoided.  Senator O'Donnell commented this format did lead to confusion.

 

Senator Glomb asked if therapy services provided by social workers could be billed to Medicaid.  A brief overview of the Medicaid Managed Care program is provided in Exhibit C page 10.  Mr. Griepentrog-Carlin stated this prohibition was a cost control measure.  Mr. Griepentrog-Carlin explained a provision within Medicaid allowed public mental health clinic services to be billed to Medicaid.  However if social workers, who may be providing the same services outside the public mental health setting, were conceded billing privileges the entire private sector would also have to be provide access which would increase costs.

 

Senator Raggio asked if the non-state agencies line item in the expenditures category provided for payments to counties.  Mr. Mayne stated these were not payments to the counties.  Mr. Mayne explained the $500,000 was Title XX funding allocated by the Title XX committee to non-state agencies for social welfare programs.  Chairman Raggio asked the committee be provided a list of recipients and the amount granted to each of the non-state agencies for the current year.

 

Chairman Raggio asked how the non-state allocation of $500,000 was determined.  Mr. Mayne explained until the budget crisis the funding had increased as the federal grant award increased.

 

OFFICE OF STATE HEALTH OFFICER - PAGE 785

 

Yvonne Silva, Acting State Health Administrator read from prepared testimony.  She explained the budget provided for overall administration of the agency including business and grant management, accounting and personnel and health planning activities.  The budget included salaries and travel allowances for the seven member board of health.

 

Ms. Giunchigliani asked if the State Board of Health established guidelines for utilization review of Medicaid or managed care programs.  Mrs. Silva stated at this time they did not establish guidelines but it was a possibility.

 

Chairman Arberry asked what impact would the elimination of the Bureau Chief of Health Planning have on services.  Mrs. Silva stated the "value of" the Bureau Chief position had been reflected as reorganizational savings in the budget not the elimination of the position itself.  Mrs. Silva explained the Bureau Chief provided services to all bureaus within the Division and was responsible for developing and identifying outside funding resources, coordinating the Healthy Nevadans Year 2000 objectives reviewing all new health operations within the state, writing regulations impacting health maintenance organizations, serving as staff to the state health coordinating council, and the primary author of the state health plan.  Mrs. Silva stated the responsibilities of this position would have to be dispersed to other areas of the Division if the position was eliminated.  Chairman Arberry asked if this position was not deleted how would the Division meet the reorganization savings and budget targets.  Mrs. Silva explained the Division would be forced to seek outside federal funding or to consolidate bureaus within the Division which would result in layoffs to meet the budget targets. 

 

Senator Glomb stated the Legislature transferred the Bureau Chief of Health Planning into the Division to facilitate better coordination between divisions and bureaus and asked if this had been accomplished.  Mrs. Silva stated the health planning program had become an integral part of the operations of the State Health Division.  The Bureau Chief had become involved in the Maternal Child Health and has worked closely with the Maternal and Child Health Advisory Board.  The Division had truly made a concerted effort to integrate health planning into all other health programs and was the Health Planning section to develop demonstration grant requests to fund programs which meet the goals of the organization.  Senator Glomb asked how these functions were to be accomplished if the position was eliminated.  Mrs. Silva explained this was not the only health planning position within the organization and health planning functions would continue but at a more limited level.

 

Senator Rawson asked if these cuts would jeopardize public health.  Dr. Donald Kwalick, Administrative State Health Officer, explained if the flexibility to determine where the cuts would be made within a particular budget was given to the administrator then public health and safety would not be at risk.

 

Mrs. Williams asked how the work load of the Bureau Chief of Health Planning would be distributed and if other positions within the organization would need to be reclassified to perform the duties of the Bureau Chief.  Mrs. Silva stated she would provide the information to the committee.  Mrs. William commented none of the duties of this vital position should be curtailed.

 

Chairman Arberry asked what impact the elimination of the legislatively assigned computer analyst position would have on service.  Mrs. Silva stated the analyst position was being transferred to the Department of Data Processing's budget and Mrs. Silva assumed the position's location would remain within the Division.

 

Senator Glomb asked how the State Health Coordinating Council would function with a budget of $3,100.  Mrs. Silva stated the council would reduce the number of meetings and use teleconferencing to reduce costs.  Senator Glomb commented the rationale for these cuts was not readily apparent.

 

VITAL STATISTICS - PAGE 790

 

Mrs. Silva read from prepared testimony.  She explained the Bureau of Health Information and Data Management included the Office of Vital Records, which is the major entity of the Bureau.  NRS 440 provides the statutory authority for the registration of vital records for the state (births and deaths).  The Office of Vital Statistics also maintained an index of marriages and divorces.  In addition, a related function of this Bureau is the development of a data base to assist in analyzing health trends.  Mrs. Silva explained the reorganizational savings in the budget reflects the elimination of the bureau chief (Biostatistician), and in-state travel and operating expenses savings.

 

Mrs. Williams stated she was very disturbed with the proposal to eliminate the states only biostatistician.  Mrs. Matteucci stated the Budget Office viewed the position as a Bureau Chief and not its function as a biostatistician.  Mrs. Matteucci stated this was the rationale for the removal of the position.  Mrs. Williams asked Dr. Kwalick if the functions of the biostatistician would continue.  Dr. Kwalick stated he felt the functions of the biostatistician were vital and if budget allocations remained flexible the duties of this position would continue to be performed.

 

Mr. Price commented the Budget Director had not been affording Legislators the respect they were due.  Chairman Arberry stated he appreciated Mr. Price's comments, however the issue had been discussed with the Governor.

 

Mrs. Evans inquired how the functions of the biostatistician would continue if the position was eliminated.  Mrs. Silva commented it was very likely the maternal and child health block grant would increase as a result of the 1990 census which could be a source of funding for the biostatistician.  Mrs. Silva remarked the Department felt the position was vital to the overall operations of the programs. 

 

Mrs. Evans asked if statutorily established positions could be eliminated without legislative approval.  Senator Rawson stated if the positions such as these were not protected from budget cuts a public safety issue might be raised.  He stated the committee may wish to establish safeguards for legislatively endorsed positions.  Mrs. Silva stated the "value of" the position had been eliminated, not the position itself.  Senator Glomb requested statutory information from the legal department regarding legislatively established positions.

 

Senator Glomb asked the purpose of the $13 filing fee under demographics.  Mr. Lange explained NRS 440.700 set fees for birth certificates.

 

Senator Jacobsen asked if the $13 filing fees were consistent with other states.  Mrs. Silva stated the fees were on par with other states.

 

Mr. Humke asked if one new position would be adequate for processing 2,600 paternity filings per year.  Mrs. Silva stated one position would be adequate to deal with paternity filings caseload.  Mr. Humke asked how many people currently worked on these filings.  Mr. Lange replied the functions were absorbed by other members of the vital statistics bureau.

 

CANCER CONTROL REGISTRY - PAGE 795

 

Mrs. Silva read from written testimony.  She explained the Cancer Registry Program was initiated in 1979 by the Legislature and formally mandated by the 1983 session through NRS 457.250.  It is an information gathering program to identify the types and incidence of cancer in Nevada.  The goal of the Cancer Registry Program is to determine possible causes and identify common factors.  Data is obtained by abstracting information from patient records in the hospitals.

 

Mr. Evans stated the vacant Cancer Registrar position had caused some concern for hospitals.  Hospitals were mandated to pay an administrative fee for cancer abstractions by NRS 457.250 of the 62nd session.  Now an amendment to NRS 457.250, Assembly Bill 131 (AB 131), would allow either the Health Division or hospitals to perform cancer abstractions.  Mrs. Evans stated hospitals were concerned the new report produced would become an incidence report with less detail and require a higher fee.  Mrs. Evans observed hospitals would be willing to pay the higher fee if the position was restored and a more complete report was produced.  Mrs. Evans asked aside from the money committees was there another means of restoring the Cancer Registrar position.  Mrs. Silva responded she was aware of the hospitals concerns that follow up services would no longer be provided by the Cancer Registry function, however, NRS 457.250 of the 62nd session did not mandate a follow up study be conducted.  During the budget reductions of FY 92 non-mandated services were curtailed.  Mrs. Silva asserted the surveillance data collected by the Cancer Registry was much more than incidence reports and was widely utilized.  Mrs. Silva qualified AB 131 and stated the proposed legislation would allow those hospitals who performed cancer abstractions to be charged a lesser fee which was prohibited under NRS 457.250 of the 62nd session.

 

Ms. Giunchigliani asked how many hospitals currently performed cancer abstractions.  Mrs. Silva stated to her recollection Humana Sunrise and Veterans Administration were the two facilities which performed cancer abstractions.

 

Senator Jacobsen asked what service does the Cancer Registry provide the general public and how was the information distributed.  Dr. Kwalick stated the information gathered over the last 10 years indicated the condition of the state's health was declining.  For example the state was number one in lung cancer deaths in the country.  The general public received information through a newsletter published quarterly in conjunction with the American Cancer Society.

 

Mr. Perkins indicated the legislative audit found fees were not in compliance with Nevada Administrative Code.  Mr. Perkins asked the agency to explain the impact on cancer abstraction fees if AB 131 was approved.  Mrs. Silva stated AB 131 was introduced to correct these areas of non-compliance.  The agency, without statutory authority, had been charging a lesser fee to hospitals which performed their own cancer abstractions.

 

Mr. Perkins asked why the number of abstractions projected for the next biennium had dropped from 7,440 in FY 93 to 5,400 in FY 94 and 5,635 in FY 95.  Mrs. Silva stated the performance indicators for FY 93 included cancer abstractions performed by hospitals whereas the FY 94 and FY 95 numbers included only those abstractions projected to be performed by the Cancer Control Registry. 

 

Senator O'Donnell questioned why the hospitals were charged for performing their own cancer abstractions.  Mrs. Silva explained the total fee charged to hospitals, $3.50 per abstract, was a nominal fee to cover the agency's cost.  Mrs. Silva explained the data entry cost, in addition to staffing costs, to the Rocky Mountain Cancer Data System was $2.45 per abstract.

 

Senator Rawson commented cancer abstraction statistics provided vital information to the public and suggested performance indicators include the number and frequency of requests for access to the information.

 

HEALTH FACILITIES - PAGE 798

 

Mrs. Silva read from prepared testimony.  She explained the Health Facilities budget supported the state licensure of health and long term care facilities as mandated (such as hospitals, skilled nursing, intermediate care, alcohol and drug abuse, home health, laboratories, group care facilities and adult day care centers) by NRS 449 and appropriate Board of Health Regulations.  In addition, the Division is under contract with the Social Security Administration for the certification of health care facilities participating in the Federal Medicare and Medicaid Health Care Reimbursement Programs.  Agency staff are required to investigate all complaints (complaints have increased from 5 to 20 per week requiring extensive use of staff time).  The Division also inspects prisons and correctional centers semi-annually as required by NRS 209.382.  She noted a work load increase of 33 percent in the number of facilities since 1988.

 

Mr. Spitler asked what fiscal impact the new fee proposals would have on the prison system.  Mrs. Silva stated to her recollection the prison system was exempted from the fee schedule.  Mr. Spitler asked Mrs. Silva to research the potential impacts, if any, the new fee system would have on the prison system and whether the impact was accounted for in the prison budgets.

 

Mrs. Williams questioned which budget the mammography survey was included in.  Mrs. Silva answered it was included in the radiological health budget.

 

Speaker Dini asked what impact the new fee system would have on rural hospitals.  Mrs. Silva stated increased fees were assessed on initial openings of facilities, not on existing facilities.  Therefore, since most rural hospitals were established prior to the new fee schedule, most of them would not be impacted.

 

Chairman Raggio questioned if the Certified Laboratory Improvement Act (CLIA) and Occupational, Safety and Health Administration (OSHA) requirements for laboratories were mandated.  Mrs. Silva affirmed CLIA and OSHA were mandated and subsequent Education, Health and Human Services budgets would also include measures to meet these requirements.

 

Senator O'Donnell asked who would be performing the CLIA laboratory certifications.  Mrs. Silva replied a multi-disciplinary team, including a physician, would perform the certification for the state.  She added the team received annual training from Medicaid, Medicare, and the Social Security Administration to perform the investigations properly.  Senator O'Donnell observed the certification team was composed of state employees which would be responsible for certifying all state laboratories.  Mrs. Silva replied the team successfully completed certification on all state laboratories although with certification requirements under CLIA the review would be more extensive.

 

Senator Glomb stated the new fee schedule would generate approximately $300,000 in new revenue for the Department to offset the reduction in General Fund allocations.  Senator Glomb inquired about the $556,000 budgeted for agency transfers.  Mr. Lange explained the Department had contracted with the Health Care Finance Administration (HCFA) to perform Medicaid and Medicare health facilities licensure and certification.  This certification ensured facilities were eligible for Medicaid and Medicare reimbursement.  However, the Department did not derive Medicaid and Medicare funds to perform the certification directly from the HCFA.  Instead the funds were allocated to the primary agency, the state Welfare Division, and transferred to the Department under the agency transfers category.

 

Speaker Dini inquired if the CLIA certification requirements would impact individual physicians who performed in-house laboratory testing.  Mrs. Silva explained under the current CLIA certification requirements in-house laboratory tests would be subject to certification.  Mrs. Silva added this was a highly controversial issue which was currently under review in Washington. 

Senator Jacobsen inquired how often prison and long-term care facilities were inspected.  Mrs. Silva stated long-term care facilities were inspected annually and with every filed complaint.  Information on the frequency of prison system inspections would be submitted to the committee at a later date.

 

Mr. Spitler commented CLIA and other mandates only serve to increase health care costs to the consumer.

 

Chairman Arberry noted the next item was being heard out of order.

 

YOUTH ALTERNATIVE PLACEMENT - PAGE 981

 

Judge Robison thanked the committee for hearing him speak out of order in support of the China Springs center.  Judge Robison explained China Springs' present bed capacity was 40, and currently the camp had 37 residents and eight individuals waiting to be admitted.  The youth camp was funded by state and county matching funds, approximately 1/3 by the state and the remaining 2/3 from the counties.  Judge Robison boasted an 85 percent non-recidivism rate for the camp.  The mission of China Springs is to provide training and discipline to delinquent boys so they become productive members of society and avoid entrance into the adult penal system. 

 

Judge Robison stated the last four years had been lean budget years for China Springs and the state.  Judge Robison stated the $690,240 recommended by the Governor for combined state and county funding was not sufficient to maintain current services.  Judge Robison added the current cost to provide care for the camp was $1,438 per bed per month.  He pointed out when compared to the cost of camps such as Caliente and Elko at $2,000 per bed per month, China Springs was clear savings to the state.  Therefore the budget requests for $1,600 for FY 93 and $1,690 for FY 95 were not extravagant.

 

Judge Robison attempted to convince the committee the $50,000 psychologist position request was imperative to the boys' recovery.  He explained the service were no longer provided by the Mental Health Division because of the budget reductions. Judge Robison stated if the agency's request for psychological and health care services were included in the budget, total costs would increase to $839,065 for FY 93 and $884,745 for FY 95.

 

Judge Robison stated currently members of China Springs were not covered by catastrophic health care and the $21,000 request would eliminate the liability risk to the camp.  Currently if one of the members was critically injured the cost could devastate the current China Springs budget and would likely be transferred to the county.

 

Senator Glomb asked if any psychological assessments were performed on the members of China Springs before admittance.  Judge Robison stated before the budget reductions a treatment program for each member was provided by the Department of Mental Health.  However, only an initial admittance evaluation to determine the suitability of offenders for the program was performed at this time.

 

Senator Glomb asked who would be responsible for the placement of offenders under reorganization.  Judge Robison replied the individual counties placed offenders, excluding arson and sex offenders, through Family and District Court Judges.  Senator Glomb inquired if the camp used the rural clinics for psychological evaluations.  Judge Robison answered the clinics had been as helpful as their resources allowed which were sparse at this time.  Previously rural clinics had provided one on one, small group and large group sessions.  Judge Robison asserted the sessions had been a very important part of the program which was no longer performed.  Senator Glomb inquired how long this service had been neglected.  Judge Robison stated the assessments were abolished over the last biennium.

 

Mrs. Williams asked if Nevada had intermediate placement for girls.  Judge Robison stated Caliente, a high-risk placement center, was the only center for girls currently available.  Before the Home of the Good Shepherd was closed intermediate placement for girls was available.

 

Mrs. Williams asked what current the custody level was at China Springs.  Judge Robison stated the offenses committed by members of China Springs were less serious than those at Elko and in his opinion these offenders could be rehabilitated.

 

Senator O'Donnell asked for clarification on the source of the $13,172 in federal fund revenues recommended for each year.  Mrs. Matteucci, Budget Director, replied the funds were from Title IV-E eligible children through the alternative placement account which did not support China Springs.  China Springs funding came from the county/state match program, $436,000 from the counties and the balance from the state. 

 

Senator O'Donnell commented M-200 Demographics/Caseload Changes recommended $59,010 in FY 94 and $77,167 in FY 95 for an additional 117 bed days in FY 94 and 153 in FY 95.  Senator O'Donnell inquired which agency within the Division would place and supervise children in the Alternative Placement category since the youth parole staff was proposed to be eliminated.  Mrs. Matteucci replied the reorganization proposed the youth parole program be transferred back to the counties.  However, payment to the counties would be increased under Probation Subsidies budget.

 

Mrs. Evans requested information on the average occupancy rate of the China Springs facility.  Judge Robison replied the average occupancy level was 37 of 40 beds in FY 92.  Judge Robison commented a program with 85 percent non-recidivism rate and a relatively low cost per bed of $1,600, when compared to $2,000 per bed at Elko and Caliente, was an asset to the state.  Mrs. Evans asked for the cost allocation for each bed for the county and for the state.  Judge Robison replied 36.8 percent was funded by the state and 63.2 percent by the county with the exception of Clark County.

 

Senator Jacobsen inquired about the status of the new vocational arts building for which the 1991 legislature had approved $250,000.  He also inquired the number of offenders from each county at the China Springs facility.  Judge Robison stated the exterior of the vocational art building was completed however the interior work was not completed.  Mike Harper, Director of the China Springs Youth Camp, stated approximately $43,000 had been raised from private sources, through fundraising and charity. Approximately $70,000 is needed to complete construction.  The vocational arts building would include auto mechanics, wood working, metal, and welding classes.  Judge Robison stated 11 counties were represented of the county:  Washoe, 15; Lyon, 3; Carson City, 5; Churchill, 3; Douglas, 3; Humboldt, 3; Elko, 1; and Lander and Nye counties were presently processing 2 new members.

 

Senator Rawson asked if China Springs had received funding from the school districts for classes.  Mr. Harper stated Douglas County school district provided funding for all of the classes.  Mr. Harper explained the school district received direct federal funding for those residents participating in the average daily attendance (ADA) program.

 

Judge Robison stated in his closing remarks China Springs could not maintain the same level of service at the level of funding recommended by the Governor.  China Springs, without sufficient funding, would be compelled to reduce staff and consequently the program would suffer.

 

MATERNAL AND CHILD HEALTH SERVICES - PAGE 803

 

Mrs. Silva read from prepared testimony.  She explained the Bureau of Family Health Services was a cluster of programs that share a common goal of improving family health, with particular emphasis on services to children with special health care needs.  These services are provided in community-based environments that are uniquely family-centered and culturally sensitive.  Programs include primary preventive services to pregnant women and infants up to one year of age, children and adolescents, and family-centered services to children with special health care needs through community-based providers and the Special Children's Clinics located in Reno and Las Vegas.

 

Senator Callister asked what the total expenditure for the "Baby Your Baby" program was and which population would be targeted for the  outreach program.  Mrs. Silva answered three positions were recommended for the program totaling $144,000 in FY 94 and $166,000 in FY 95.  She asserted private sector funding totaling over $1 million was raised in support of the "Baby Your Baby" program.

 

These funds would be used for a multi-media campaign including public service announcements -- currently broadcast on Channel 3 and 4 in Las Vegas and Channel 4 in Reno, four 30 minute documentaries, the first of which was broadcast in Las Vegas immediately following Super Bowl 1992 -- radio spots, and newspaper articles.  Additionally an incentive program provided by the Kiwanis Club of Las Vegas was scheduled for pregnant women who seek prenatal care.  Mrs. Silva commented the program was designed to help not only low income women but all women who were pregnant or plan to become pregnant.

 

Senator Callister stated low income women statistically had a disproportionate number of babies with lifetime medical conditions which commonly had to be funded by the state.  Senator Callister asked how the "Baby Your Baby" program would target low income mothers.   Mrs. Silva replied the program would reach the low income population through the television campaign.  Further, the program had a high success rate in many states across the nation.  Utah, the state which developed the program, could show a dramatic reduction in Medicaid expenditures as a result of this program.  Mrs. Silva would provide program information from Utah to the committee.  The two year "Baby Your Baby" program planned to survey all women who called the hotline and to monitor the outcome of all of their pregnancies.  This information would be compiled into a published report indicating the total savings to Medicaid program.

 

Senator Callister asked for a brief description of the duties of three new positions.  Mrs. Silva stated the management analyst position would coordinate all media and sponsor relations.  She explained in northern Nevada Washoe Health System Incorporated had purchased all sponsorship rights and in southern Nevada Sierra Health Care Services, Sunrise Children's Hospital and Suma Corporation had purchased sponsorships.  The community health nurse would be responsible for answering health care questions from the hotline and for reviewing and analyzing the data collected for the program from a health care perspective.  The management assistant would perform support functions for the other members of the staff.

 

Senator O'Donnell asked Mrs. Silva to explain the rationale behind consolidating the Maternal and Child Health Care (MCH) Advisory Board with the State Board of Health.  He also asked who would be responsible for oversight of the "Baby Your Baby" program.  Mrs. Silva stated oversight was important not only for the "Baby Your Baby" program but for the entire maternal and child health care program.  She remarked some of the former members of the MCH Advisory Board had expressed interest in participating in an oversight capacity for the MCH program.  Therefore the Department was investigating the possibility of a volunteer advisory board.  However she was uncertain how the consolidation would impact the oversight of the "Baby Your Baby" program.

 

Senator Glomb commented in her opinion the Maternal and Child Health Services budget was a very important budget because the health care services provided were preventative.  She stated for the record, "I oppose the abolishment of the MCH Advisory Board and its consolidation with the State Board of Health."  Senator Glomb asked how the program would fund prenatal care and follow up to women without insurance who were not eligible for Medicaid if some presumptive eligibility requirements were not established.  Mrs. Silva stated for the last 18 months the Department had been working to ensure the funds would exist to provide funds for such women.

 

Further the board and staff members had conducted workshops and met with public and private community providers to develop resources.  Over the past six months providers in southern Nevada had agreed to provide prenatal care to women with or without reimbursement.  In northern Nevada Washoe Health Systems Incorporated agreed to provide prenatal care and designated a specific hotline for the program.

 

Senator Glomb asked if the media campaign presently included referrals to health care providers.  Mrs. Silva stated, once the program received approval from the Interim Finance Committee (IFC), the hotline would refer women to providers beginning July of 1993.  Currently the public service announcements do not include the hotline number.

 

Senator Rawson asked if any programs serving specific diseases or conditions had been eliminated due to the budget cuts.  Mrs. Silva replied in 1989 new recommendations were formalized for Children's Special Health Care Needs program.  They had been written to assure every child had the same opportunity to received services for specific conditions.  Mrs. Silva mentioned the program had operated for 52 years without formalized regulations.  The 1989 regulations established categories of care which would be covered and what services children would receive.  As a result of the streamlining effect of the 1989 regulations and the increase in Medicaid eligibility, the budget reductions totaling $800,000 were absorbed without major impact on services provided to the children of Nevada.

 

Senator Rawson asked if it would be possible to fund the Katie Beckate program through the Children's Special Services budget.  Mrs. Silva stated the funding sources and requirements for Katie Beckate were very different from those of the Children's Special Health Care Needs programs, however it could be adapted.  Senator Rawson asked if adapting the requirements would be beneficial in light of the reorganization.  Mrs. Silva stated she would like to meet with the Medicaid experts to discuss the possible implications of such a change before answering the question.

 

Mrs. Williams asked if the "Success by Six" program provided by the United Way had been networked with the "Baby Your Baby" program.  Mrs. Silva replied the Department did receive "Success by Six" United Way funding which was then passed to the Clark County District Health Department to develop a program named "Baby Find".  She explained "Baby Find" was a community based program target toward those women at the highest risk of bearing low birth weight babies.  "Baby Find" had been networked directly to the "Baby Your Baby".

 

Mrs. Evans commented any comparison between the Nevada and Utah "Baby Your Baby" programs must take into account the fact that Utah possessed sound clinical infrastructure funding before beginning its program.  She stated although Nevada's program had been a significant first step funding for the program was in no way comparable to the funding for Utah's program.

 

Mrs. Evans inquired what MCH Advisory Board's annual operating costs were.  Mrs. Silva stated the operating costs were $7600 annually for the MCH Advisory Board and its subcommittees.

 

Senator Callister remarked further study of the Utah program and its state clinical funding would be beneficial to the committee.

 

Senator Callister asked for an update on the sickle cell outreach/education program which had received a $20,000 appropriation during the 1991 session.  Mrs. Silva stated approximately $15,000 had been contracted to the Sickle Cell Foundation of Nevada for extended outreach to families with sickle cell trait and sickle cell anemia.  The foundation had also developed a 15 minute documentary on the disease.  The remaining $5,000 had been allocated to the State Health Division laboratory for low cost testing.  Over the next biennium funding would not allow for testing of sickle cell trait, however care for children with sickle cell disease would continue through the Children's Special Health Care Needs program.  Senator Callister asked if funding existed to distribute the documentary.  Mrs. Silva stated she believed funding was available and would provide the information to the committee at a later date.

 

Senator Glomb called attention to the decline in the number of children receiving diagnostic evaluations over the next biennium and asked for an explanation.  Mrs. Silva stated because the General Fund appropriation had decreased it was necessary to reduce monies in the medical payments category for FY 95.  Mrs. Silva explained by streamlining the Children's Special Needs program through the reorganization it could be possible to provide fewer services to more children.  However these numbers were merely projections and the performance indicators were currently under review.

 

Senator Glomb maintained as the states population increased the Children's Special Needs program should expand.  Mrs. Silva stressed early prenatal care programs such as "Baby Your Baby" should improve the outcome of pregnancy thereby decreasing the demand for long-term care programs like the Children's Special Needs program.

 

Senator Coffin asked for a brief explanation of the insurance recoveries category.  Mrs. Silva explained insurance recoveries were simply reverted funds from dual medical payments made by the Children's Special Needs Program and the individual's insurance company to providers.  For example, if a child's insurance company delayed payment to a provider, the Children's Special Needs Program would reimburse the provider.  However, if at a later date the insurance company rendered payment for the same set of services, the original payment would be reverted back to the Children's Special Needs account in the form of insurance recoveries.

 

Senator Coffin asked for an explanation of item 100 Inflation in the maintenance budget equalling $341,108 in FY 94 and $456,592 in FY 95.  Mrs. Matteucci explained the actual amount of inflation was $1,223 listed as "other funds" in the base budget.  The General Fund allocations for FY 94 and FY 95, $341,108 and $456,592 respectively, were due to increased insurance premiums and tort liability claims which had increased medical expenses by 13 percent in FY 94 and 6.5 percent in FY 95.

 

SPECIAL CHILDREN'S CLINICS - PAGE 808

 

Mrs. Silva read from prepared testimony.  She explained the Special Children's Clinics were community-based, family centered programs providing evaluation, diagnostic and early intervention services to children with special health care needs.  The clinics are located in Reno and Las Vegas and serve as regional centers for the screening, diagnosis, treatment and follow-up of children ages birth to three years with known or suspected developmental delays caused by mental and/or physical handicaps, neurological disability, and speech/language disabilities.  In 1991, Special Children's Clinics provided 2,454 children with multi-disciplinary evaluations and appropriate treatment services.  The clinics also provided a service delivery point for the Bureau of Family Health Services' specialty clinics, which offer medical review of children with identified conditions needing follow-up:  genetics, metabolic, and craniofacial disorders, and hemoglobinopathies.  Health Kids examinations for the Early Periodic Screening, Diagnosis and Treatment program (Medicaid EPSDT program) were provided in the Las Vegas clinic.  In addition, the Clinics provided periodic assessments and follow-up of newborns referred from hospital neonatal intensive care units.

 

Chairman Raggio asked if the Special Children's budget was approved as recommended by the Governor, which did not include the 5 additional positions requested by the agency to expedite the present backlog of 78 children in Las Vegas and 34 children in Reno, could the agency reduce the backlog.  Mrs. Silva stated the Department was in the process of standardizing care.  The concept behind standardization was to provide fewer services to more children.  Mrs. Silva stated the standards would determine essential services for children and would not include the services which would be provided if sufficient funding were available.  Senator Raggio requested Mrs. Silva provide specific information about the services which would be eliminated or reduced.  Mrs. Silva responded program levels would be reduced not eliminated.  For example, a child receiving three speech therapy sessions a week would be reduced to two sessions a week.  She stated she could not give specific information because the Department would perform a global reduction in all of the services.  In spring of 1993 the Department planned to meet with other agencies which provided services to the same population and establish a standardized set of services.  Chairman Raggio asked the committee be kept informed of the proposals.

 

Senator Callister asked if the reduction in standards of service for the Special Children's Clinic was the reason the Department could continue service with nine fewer positions.  Mrs. Silva replied she could not deny the level of service to children would decline with fewer positions.  However the agency would attempt to develop standards based on the latest information so the agency could provide the best possible service and remain within the budget.

 

Senator Callister commented agency heads, when discussing the proposed reorganization, seemed reluctant to simply say there were not enough funds to provide the same level of service.  Senator Callister stated he did not think this was a bad message to send the public and they were entitled to the information.

 

Mrs. Williams stated according to contemporary theory intervention as early as three months could substantially decrease the impacts of life-long disabilities.  She continued, it then became possible to mainstream children and to avoid the disabilities which could plague these children for a lifetime.  Mrs. Williams asserted when waiting lists for these children grew so did their disabilities.  Mrs. Williams commented the MH/MR subcommittee was highly concerned about the proposed reductions in services and would be discussing these issues in detail.

 

Mr. Heller cited a book titled Reinventing Government and stated when discussing the allocation of dollars the book suggested measuring output or the services received by taxpayers rather than rewarding failure.  Mr. Heller commented there had been a fundamental flaw in some of the discussions about the proposed reorganization because it failed to measure services received by taxpayers.  Mr. Heller continued policymakers should reward the successful use of funds.  Other states such as Arkansas and Illinois had implemented this policy and rewarded individual success.  An example in Arkansas was the reduction in lines at the Department of Motor Vehicles.  The Arkansas money committees based funding for the Department of Motor Vehicles and other agencies on the number of people served.  Mr. Heller suggested the committee implement the same policy and fund the Special Children's Clinics and other agencies based on the services provided.  Mr. Heller asked Mrs. Matteucci if this policy had been discussed during the proposed reorganization.  Mrs. Matteucci stated she appreciated Mr. Heller's comments because the impetus for the reorganization had been to implement this policy.  Mrs. Matteucci stated it would benefit the reorganization process if the committee would communicate its desired level of service for agencies to the Budget Office so they could establish priorities when building the Executive Budget.  She also advocated the empowering of agency directors to determine how to achieve budget goals and reward agencies which achieved the desired level of service.

 

Senator Coffin expressed interest in the cost to restore programs, under the proposed reorganization, to the level of service provided by the agency before the budget reductions.  Mrs. Matteucci stated budget construction for reorganization was a two step process.  First the Budget Office established target General Fund allocations for each agency.  Second the agency used the target budget allocation to determine which programs to curtail or eliminate.  However the Executive Budget did have two budgets which did not follow this process:  (1) welfare - because of federal mandates and (2) the distributive school account - because of mandates and growth in enrollment.  Senator Coffin remarked he agreed with Mr. Heller's comments there was a need for a new policy-making process.

 

COMMUNITY HEALTH SERVICES - PAGE 813

 

Mrs. Silva read from prepared testimony.  She explained this was a rural Community Health Nursing Program.  There are currently 21 nurses providing services from 16 primary locations and 30 satellite offices throughout all counties except Clark and Washoe.  The rural counties, through cooperative agreements with the Health Division, provide financial support equal to 40 to 50 percent of salaries, plus additional financial support through the provision of facilities and administrative support at no cost to the state.  There were 83,178 patient contacts in FY 92, an increase of 32 percent over four years.  The community health nurses also serve a vital role as central points of entry for many other state programs (such as Healthy Kids Screening for Welfare; WIC Nutrition Project for handicapped children and the joint project with medical schools geriatric program) as well as investigating communicable disease abstracts with other Health Division staff.

 

LABORATORY AND RESEARCH - PAGE 818

 

Mrs. Silva read from prepared testimony.  She explained NRS 439.240 required the State Health Division to maintain the State Hygienic Laboratory for public health activities.  The Laboratory provided for medical, environmental and food testing on a statewide basis.  The Reno Lab performed 223,992 chemistry and microbiology tests in FY 92.  The Las Vegas area is served by contractor (APL) which provides limited testing in areas of milk, food-borne outbreak testing for bacteria and water bacteriology.  The major tests were those to detect:  Tuberculosis, Venereal Disease (including Aids Antibody); and infectious viruses; chemical and bacteriological problems in domestic drinking water and milk; air pollution; and water pollution.  Proposed reoganizational savings would be achieved by eliminating the laboratory supervisor position and lowering operating costs.

 

Ms. Giunchigliani asked if the laboratory would be able to maintain certification if the "value of" the laboratory supervisor's position was removed from the budget.  Mrs. Silva stated this particular position spent 60-65 percent of the time on the bench or performing water and milk certification testing.  Therefore it would be difficult to spread the duties of this position over existing staff.  Mr. Lange added if the duties of the position were not completed by other staff members it could impact laboratory certification.  However, if the "value of" position had to be eliminated the agency would determine where the reduction could occur without jeopardizing the laboratory certification.

 

Ms. Giunchigliani asked if the laboratory director conducted any testing.  Mr. Lange explained the laboratory director was a doctor and did not conduct testing.  However, the duties of the laboratory supervisor were much different.  He performed tests, filled in during vacations, instructed the laboratory certification course under CLIA, and supervised the "bench" microbiologists.

 

Senator O'Donnell asked if the laboratory performed testing and certification on meat products.  Mrs. Silva stated only in the case of a food-borne outbreak did the laboratory perform routine testing on meat products.  The laboratory was conducting tests on the meat in the Jack-in-the Box restaurant chain. 

 

Senator O'Donnell observed the agency had requested $24,000 for laboratory equipment enhancements from the General Fund and the Governor had recommended the $24,000 come from other sources.  Senator O'Donnell asked for an explanation of the source of these funds.  Mr. Lange stated the laboratory building was not a state maintained building and when unanticipated equipment expenses occurred the funds had to come from the agency's budget.  Mr. Lange said he and the laboratory director had determined it would be possible to recover the $24,000 through the testing fees revenue.  Mr. Lange explained there would be no increase in fees however the laboratory hoped to generate the funds for the new equipment through increased work load.  This manner of procurement had risk because if the work load did not increase the laboratory would not purchase the necessary new equipment.  However, Mr. Lange was reasonably sure the work load would continue to increase at the current rate and the new equipment would be purchased.

 

SEXUALLY TRANSMITTED DISEASE CONTROL - PAGE 825

 

Mrs. Silva read from prepared testimony.  She explained the program was designed to monitor and reduce the incidence of sexually transmitted diseases which included AIDS.  It provides for screening, tracking, treating, and health education of known contacts as required by NRS 439 and 441.  In FY 92, there were 82,882 screening tests in Nevada, the incidence of the variety of STDs (excluding AIDS) in Nevada in FY 92 was 8,842.  There were 22,500 contact investigations and 9,801 cases of sexually transmitted diseases, excluding AIDS;  270 contact cases of AIDS in 1991.  As of 12/31/92 Nevada has had 1,175 confirmed cases of AIDS.  The incidence of AIDS in Nevada has increased by 42 percent over the last year and, while funding for the provision of treatment and home care for persons with HIV disease increased, prevention dollars have decreased.

 

Ms. Giunchigliani asked if the new communicable disease regulations required reporting HIV infected persons by name.  Dr. Kwalick replied the new communicable disease regulations require HIV positive patients be reported to the health authority by name.  However the health authority was required to maintain confidentiality at the local level.  Subsequent information provided to the Department would contain only the aggregate increase in HIV positive individuals in the state and would not include names.  Ms. Giunchigliani asserted it would be difficult to control confidentiality at the local level and she was opposed to including HIV positive names on any list.

 

Mrs. Chowning asked how Nevada ranked for incidence of HIV positive cases when compared to national levels.  Dr. Kwalick replied though the actual number of cases were low because of the state's small population, Nevada ranked in the top ten and as high as fifth for incidence of new HIV positive cases in the nation.  Mrs. Chowning asked if the state received federal grants based on these numbers.  Dr. Kwalick responded the Ryan White grant allocation was based on the total number of cases.  In areas of high incidence such as California, Florida, New York, and Texas, funds were received at a disproportionate level when compared to Nevada.  However, Nevada did receive a small amount of funding from this program.

 

FAMILY PLANNING PROJECT - PAGE 828

 

Mrs. Silva read from prepared testimony.  She explained the program was a federally funded program serving low-income clients in rural Nevada.  Clark and Washoe counties had separate grants.  Services were provided by rural community health nurses, family planning nurse practitioners and contract physicians.  The program had 13,129 patient visits during FY 92, eight percent of whom were below poverty level.

 

Mr. Heller asked if it would be possible to include the number of patients which were denied service in the performance indicators.  Mrs. Silva replied the program was funded completely by federal dollars and to her knowledge no women had been denied service.  Mr. Lange added low income women and teenagers were made aware of the program through schools and community services.  However, family planning was a voluntary decision and the agency did not actively recruit women for this service.

 

Mrs. Chowning asked if the number of bilingual families being served could be included in the performance indicators.  Mr. Lange stated this service was exclusive to the 15 rural areas.  Mrs. Chowning remarked the bilingual issue may be better addressed during subcommittee meetings.

 

Senator Glomb inquired how the family planning services were provided.  Mrs. Silva replied the services were provide to all women including adolescents through clinic sites in the 15 rural counties. 

 

COMMUNICABLE DISEASE CONTROL - PAGE 832

 

Mrs. Silva read from prepared testimony.  She explained the program provided clinic and treatment services to indigent individuals identified as having positive tuberculosis in accordance with NRS 443.  The program also includes services for individuals eligible under the federal refugee program.  However, the majority of refugee services were for tuberculosis.  NRS required indigent who were affected be cared for at public expense if they were unable to pay within limits of the budget.  The scope of service includes diagnosis and inpatient care within budget limitations.  TB has shown a gradual increase in the state.  There were 72 cases in FY 92 ending June 30, however, there were 54 cases from the period of July through December compared with 26 for the same period last year representing a 100 percent increase.

 

Ms. Giunchigliani asked for clarification on the medical inflation amounts since this amount plus base amounts recommended for total medical care costs were approximately $5,830 less than the recommended medical inflation increase for FY 94 and approximately $6,683 less than the recommended medical inflation increase in FY 95.  Mr. Lange responded he would gather the information and provide it to the committee at a later date. 

 

Ms. Giunchigliani asked what impact would the increase in the incidence of tuberculosis (TB) would have on the agency's prevention planning.  Dr. Kwalick stated the most important aspect of any prevention program was identification and treatment of the disease.  Dr. Kwalick commented the multi-drug resistant strain of TB was in a large part responsible for the increase in incidence of the disease.  For these cases a district health nurse was assigned to ensure the treatment program was followed by the patients.  Other forms of planning included community education, physician case reporting, follow up and prophylactic treatment. 

 

Mr. Spitler inquired if the Communicable Disease Control agency collected data on TB incidence in the prison system.  Dr. Kwalick replied any new cases, whether inside of outside of the prison system, would be reported to the agency.  Mr. Spitler requested the cost and number of cases of TB within the prison system be reported to the committee.  Dr. Kwalick stated the agency could get the information from the prison system.  Dr. Kwalick commented the number of multiple drug resistant cases had increased drastically statewide and there were presently 10-15 known cases.

 

Senator Raggio stated the Health Division requested $210,000 for FY 94, and $315,000 for FY 95 for medical care costs associated with the hospitalization of indigent patients.  The Division indicated the TB program denied paying hospitalization costs for ten indigent patients in FY 94 due to insufficient funding.  The Division projected 12 patients in FY 94 and 15 patients for FY 95 would require hospitalization.  Senator Raggio asked the agency to clarify who pays the hospitalization costs if the program was unable to.  Dr. Kwalick indicated if the patient was indigent county welfare or Medicaid would provide some funding to cover the costs.  The agency did provide some inpatient care with the small amount of funding the agency received.

 

Mr. Callister stated according to the performance indicators an enormous increase in the number of verified cases of TB, from 72 in FY 92 to 103 in FY 95, will occur.  However, the number of persons tested, diagnosed or treated for TB will remain relatively stagnant and the public awareness activities will decrease over the same period. Senator Callister asked for an explanation for the low number of public awareness activities.  Mrs. Silva stated she would report the answer back to the committee at a later date.

 

Mr. Heller asked the agency to provide an estimate of the required funding levels which would prevent a rise in TB.

 

Mr. Perkins called attention to the $1,203 TB elimination line item in the agency's budget and asked the purpose of these funds.  Mr. Lange stated the TB elimination was a special purpose federal grant.  The agency had recently received the grant award which amounted to $113,000 and would directly impact the work program.  The agency would be submitting an annualized budget request to the Budget Office this spring to account for the grant.

 

WIC FOOD SUPPLEMENT (WIC) - PAGE 836

 

Mrs. Silva read from prepared testimony.  She explained the WIC budget was 100 percent federally funded.  The WIC program provided nutrition counseling, education and supplemental food to pregnant, postpartum and breast feeding women, infants and children to age 5 who are income eligible and who have an identified nutritional risk.  Mrs. Silva explained the average WIC caseload was 15,439 participants per month in FY 92, and although the performance indicators projection increase to 18,597 in FY 94 and 20,000 in FY 95, however, it may be necessary to increase the performance indicators to reflect receipt of a USDA grant award in January 1993.  The case load could increase to 23,000 in FY 94 and 25,000 per month in FY 95.  Eligible participants received food vouchers based on their nutritional needs.  These food vouchers could be redeemed in exchange for specified foods only at contracting retail food stores.  The Nevada WIC program contracts with three local agencies for the operation of local programs in urban areas.  The Division planned to open the 4th clinic in Clark County with the District Health Department coming on board.  The Health Division operated local clinics in 12 sites serving all 15 rural counties.

 

Chairman Arberry asked for an explanation for the $7,000 reduction recommended by the Governor for the state cost recovery plan.  Mrs. Matteucci replied the reduction was a reflection of the statewide cost allocation plan.  The state cost recovery plan is an assessment placed on federal agencies which derive benefit from general fund functions such as the treasurers office, controllers office and the budget division. 

 

Senator Rawson asked what percentage of women eligible for the WIC program were being served.  Mrs. Silva replied in FY 94-95 the Department was projecting 62 percent of eligible women, infants and children in the state.  Senator Rawson asked how eligibility was determined.  Mrs. Silva stated eligibility was based on two indicators:  (1) the women must be under 185 percent of poverty and (2) nutritional risk.

 

Senator Callister asked the agency to provide the number of eligible women to be served for FY 93 and FY 95.  Senator Callister suggested this information would become a future performance indicator because it would show the how effective the agency was in providing needed care.  Mrs. Silva stated she would provide the information.

 

Senator Callister asked how many children were served by the one-shot appropriation of $600,000 provided by the 1991 session.  Mrs. Silva stated the appropriation provided funding for approximately 500-600 WIC recipients per month.  Senator Callister asked the agency to provide the percentage decrease in the number of WIC recipients due to the $600,000 reduction in funding.

 

Senator Callister asked if the food vouchers had been abused and if the agency had an enforcement policy.  Mrs. Silva stated the WIC program was one of the most heavily regulated federal programs and as a result the program has had very few problems with fraud. 

 

Senator Callister asked if the federal funding levels had fluctuated over time.  Mrs. Silva stated funding increased dramatically over the past year because Nevada was designated as a high growth state after the 1990 census data was released.

 

Senator Glomb commented the WIC program provided long-term cost savings to the state.

 

Ms. Giunchigliani asked if the $600,000 appropriation to the WIC program was one of the initial budget reductions.  Mr. Lange stated initially the funding level was recommended to be reduced, however the funding was protected because it was legislatively appropriated.

 

Ms. Giunchigliani asked where the allocation could be seen in the Executive Budget.  Mr. Lange stated the bulk of the allocation was under the transfer from prior years line item which was not included in the new Executive Budget format.  Mark Stevens, Fiscal Analyst, clarified in the expenditures category of the Executive Budget did include the line item state food support which budgeted the remainder, $599,511, of the one-shot appropriation.

 

Mrs. Chowning asked if bilingual services were provided to WIC recipients.  Mrs. Silva affirmed bilingual services were provided in all clinics.  Mrs. Chowning asked the agency to provide the total number of non-English speaking WIC recipients being served.

 

Senator Rawson asked for the yearly income of the average WIC recipient.  Mrs. Silva replied the agency would provide the committee with a poverty table.  Senator Rawson asked if the 62 percent of the eligible WIC families were prioritized according to nutritional need.  Mrs. Silva stated currently no waiting list existed for the program but if there were, the most needy would be served first according to nutritional risk.  Senator Rawson asked why a waiting list did not exist when only 62 percent of the eligible population was being served.  Mrs. Silva stated there were insufficient funds to serve the entire eligible population.  People were aware of this and simply did not come in to apply for the program.

 

Mrs. Williams suggested the actual number of non-repeat participants served be included as a performance indicator and asked the agency to provide that information to the committee.

 

Mrs. Evans commented during the last biennium funds in Washoe County for the WIC program were so low three, four, and five year old children were no longer eligible.  The subcommittee would need the agency to reconcile the discrepancies between the performance indicators in the Executive Budget and the caseload estimates provided in its expanded program narratives.

 

HEALTH AID TO COUNTIES - PAGE 841

 

Mrs. Silva read from prepared testimony.  She explained the budget identified flow-through funds to Clark and Washoe counties District Health Departments in return for those Districts providing full-time public health services to their citizens.  Funds were used to support such activities as nursing services, maternal and child health, emergency medical services, air pollution control, hospice, seniors' health, home health services, etc.  The projected per capita support was $1.10 in the 91-93 biennium but was reduced to 55 cents with the budget reductions.  Mrs. Silva instructed the committee to address any questions to David E. Rice, District Health Officer Washoe County, or David Rowles, Director, Administrative Services Clark County Health District.

 

Chairman Arberry asked for statements or comments from Mr. Rice and Mr. Rowles. 

 

Mr. Rowles delivered a memorandum, (Exhibit E), to committee members which identified the impact to the counties from the reduction in the Aid to Counties funding.  Mr. Rowles commented the Clark County Health District has provided public health to the citizens of Clark County, in cooperation with the state Health Division, for the past 30 years.  Mr. Rowles remarked the Clark County Health District served approximately 2/3 of Nevada's population.  Mr. Rowles stated Aid to Counties funding recognized that Clark County Health District provided important direct public health service to Nevada citizens which would otherwise be the responsibility of the state.  Mr. Rowles stated Exhibit E specifically depicted the impact of the approximate 50 percent reduction in the Aid to Counties funding, which equaled approximately $490,000, to the Clark County Health District.  The Legislature in recognition of local health needs had authorized a per capita funding level which until the last biennium had averaged $1.00 to $1.10 per capita.  The current proposal from the Governor recommends a decrease in funding for local public health.  Mr. Rowles asserted local public health needs were increasing with the population growth.  Mr. Rowles called attention to the requested 20-25 percent decrease in the Nevada Health Division budget from the Governor.  Mr. Rowles expressed concern the Clark County Health Division had been requested to take a larger share, 50 percent, of the requested budget reductions.  Mr. Rowles stated the two district health divisions were cognizant of the recent budget crisis and were willing participants in providing increased services when fewer funds were available.  However, the Clark County Health Division would request fair funding in order to provide services the legislature established as important to the state.  Mr. Rowles concluded although the two district health divisions participated as team players in today's environment of doing more with less, the sustained erosion of the past $1.10 per capita funding for Aid to Counties could cause dismal results when attempting to decrease local health risks and associated costs.  Mr. Rowles called attention to the incidence of the ecoli bacteria in Jack-in-the-Box restaurants.  He stated four of the 14 restaurants in the Las Vegas area had contaminated meat.  The investigation cost the county health district $15,000-$20,000 in additional staff time.  Mr. Rowles asserted if the county health district was not performing these investigations for the ecoli bacteria the state would have incurred the cost.

 

Ms. Giunchigliani asked for the rationale behind the 50 percent reduction in the Aid to Counties funding.  Mr. Lange stated the 50 percent reduction in Aid to Counties which equalled a 3-4 percent reduction to the county health districts overall budgets was not a major impact.  Previously the per capita General Fund allocation had no cap so as population grew the amount of funding grew proportionately.  Currently the projections for the next biennium were 55 cents per capita which equalled a decrease of $489,468 in the Aid to Counties budget.

 

Mr. Rice called attention to Washoe County District Health Department Annual Report, on file at the Research Library, and stated the Aid to Counties budget was a major part of the District's budget.  Mr. Rice stated Exhibit F provided an impact analysis of the Aid to Counties funding reduction to the District's overall budget.  Mr. Rice expressed concern that funding at the local level had decreased while the need for services had increase substantially due to population pressures.  Mr. Rice explained in FY 91-92 personnel and fringe benefit expenses consumed 82 percent of the District's budget.  As a result of the reduction, services to clients were decreased.  Mr. Rice emphasized the total reduction in the Aid to Counties would be more than 50 percent because in FY 94 the per capita allocation would be 53 cents and in FY 95 it would be reduced to 51 cents.  Mr. Rice asserted population increases had not been accounted for when the proposals were made.  Mr. Rice commented the reorganization's proposal to consolidate Consumer Health to Environmental Protection could jeopardize public health if assurances protecting public health were not specifically mandated.  Mr. Rice instructed the committee to read a benchmark publication titled The Future of Public Health by the Institute of Medicine.

 

Ms. Giunchigliani commented that the definition of the duties for the state and for county governments needed to be well defined.  Mr. Rowles replied the state mandated specific areas of public health such as immunization, sexually transmitted diseases, occupational and industrial administration to the counties through legislation.  Public health administration was then delegated to the local government health divisions.  Ms. Giunchigliani stated if the local governments were in fact more efficient administrators of public health programs, then it was the duty of the state to transfer sufficient funds to the local governments for these programs.  Mr. Rowles asserted the $500,000 decrease in Aid to Counties funding out of an $18 million budget was not a minuscule amount and the decrease would reduce direct services to the people not administrative overhead.

 

Mr. Humke asked if there were any positive impacts which reduced the number of immunizations provided by the Washoe County Health Department because of the opening of the two Saint Mary's clinics.  Mr. Rice stated the Department cooperated with Saint Mary's to provide immunizations at both clinics but the demand at the Health Department had not substantially decreased.

 

Senator Glomb asked if the analysis of the cost shift to counties caused by the reorganization, which had been requested at an earlier date, had been completed by the Budget Office.  Mrs. Matteucci stated the Budget Office was extremely busy and was making every effort to complete the study.

 

Senator Callister asked if there was a major economic impact to the food service industry as a result of the ecoli bacteria outbreak.  Mr. Rowles replied a $1,000 per day loss in sales at Jack-in-the-Box had been reported as well as decreased sales at other fast food restaurants and supermarkets in the area. 

 

IMMUNIZATION PROGRAM - PAGE 843

 

Mrs. Silva read from prepared testimony.  She explained the long-term goal of the program was the prevention, control and eventual eradication of all vaccine-preventable diseases among Nevadans of all ages.  To attain this goal, the Immunization Program supplied vaccines to public and private health care providers throughout the state.  Immunization levels for children entering school, licensed child care center enrollees, children two years old (statewide), and two year olds who access public health facilities for immunization services were assessed annually.  Consultation and direct intervention were also provided when vaccine-preventable disease (VPD) outbreaks occurred.  This program had expanded significantly during the last biennium with increased state funding and the with receipt of federal funding for peri-natal hepatitis and increased emphasis on vaccination for Hepatitis B.  A Federal Communicable Disease Officer (Ed Boes) is assigned to the state and does not appear in this budget.  He coordinates the statewide program, controls distribution of vaccines, conducts surveys and audits of Nevada schools for immunization compliance and provides education information to the medical community, schools and families.

 

Senator Jacobsen asked if the rural areas had ever experienced a shortage of flu vaccine.  Mr. Lange replied the amount of flu vaccine purchased for the rural areas was based on the previous year's demand.  Mr. Lange replied he was not aware of any critical shortages in the rural areas but if a minor shortage did exist the counties had the flexibility to exchange vaccines.

 

Ms. Giunchigliani asked which immunizations were required for school entrance.  Dr. Kwalick stated diphtheria, pertussis, tetanus, polio, measles, mumps and rubella were required for all school aged children.  Dr. Kwalick commented 250 cases of measles were detected in Clark County during 1990, however the number had decreased in recent years.  Ten percent of the one to five year old population were not immunized even through they were required to be immunized before entering the school system.  Ms. Giunchigliani asked if the Department had planned to target the one to five year old population.  Mrs. Silva replied target activities surrounded the coordination of the other programs and awareness of staff members to ask if younger members of the family had been immunized.  Ms. Giunchigliani asked if bilingual services were available.  Mrs. Silva stated bilingual services were available. 

 

Senator Callister asked if the $720,000 recommended increase in funding for the immunization program would be used to increase immunization levels in the two-year old age group.  Mrs. Silva affirmed the majority of the funds were targeted for this age group. Mrs. Silva commented it was every maternal and child health program's goal to reach this group of children.

 

Mrs. Chowning asked for an update on the Division's progress to date in implementing the Universal Infant Hepatitis B Immunization program.  Mrs. Chowning also asked for assurances from the Division that only the supplemental direct federal assistance award was used for Hepatitis B vaccines, not state support.  Dr. Kwalick affirmed only federal monies were used to support the Hepatitis B program.  Mrs. Silva added the Hepatitis B vaccine program for children had been implemented January 1, 1993 therefore it was not possible to measure the success of the program at this time.  Mrs. Chowning asked how much had been accomplished since January 1, 1993.  Ed Boes, Immunization Coordinator, stated monthly statistics were received from providers and January's statistics had not been received.  However, based on the amount of vaccine ordered by the providers the program appears to be a success.

 

Mr. Perkins noted a large discrepancy for budget account 200 demographics/caseload existed between the agency request of $858,887 and the Governor's recommendation of $193,028.  Mr. Lange indicated the discrepancy was a $685,000 error made by the agency.  When producing the budget requests the agency failed to reduce its demographics/caseload request by the amount included for this purpose in the base budget.

 

Mrs. Williams asked if the immunization schedule still recommended MMR booster shots be administered.  Mr. Boes answered the MMR booster shot was currently recommended and was being administered.  Additionally, the school districts required these vaccinations upon entrance to school and the agency had a 90 percent compliance rate.

 

EMERGENCY MEDICAL SERVICES - PAGE 1436

 

Mrs. Silva noted the next four budgets were proposed to be moved to other agencies under the proposed reorganization.  Mrs. Silva read from prepared testimony.  She explained Emergency Medical Services regulated the emergency medical service network in Nevada under the authority of NRS 450B and Board of Health regulations, found in Nevada Administrative Code, NAC 450B.  The program sets criteria and certifies emergency medical technicians, certifies training course instructors and licenses ambulance attendants, ambulance services, fireman attendants and fire fighting agencies.  EMS also issues permits for operating of all ambulance services, inspects ambulances and investigates complaints.  The Health Division, through this program and the State Board of Health, is responsible for the coordination of the statewide trauma network including setting of minimum criteria for trauma care, designation of trauma centers and data collection and analysis.  NRS required the publication of an annual trauma report based on data collected from Nevada hospitals.  This program is recommended to be transferred to the newly created Department of Public Safety.  This transfer would require statutory amendments to NRS.

 

Senator Jacobsen asked if the Emergency Medical Services (EMS) in the rural areas would receive adequate training under the reorganization.  Mrs. Silva answered the purpose of the reorganization was to economize services and the efficiency of the program would likely improve with the reorganization.

 

Senator O'Donnell asked for the total amount of the Emergency Medical Services for Children (EMSC) and when the funding would end for the program.  Mr. Lange replied in 1994 the grant was projected to be $250,000.  Mr. Lange added the program was funded with a specific time frame and could possibly be extended one year.  Mr. Lange indicated the grant would not impact the basic EMS budget.

 

Mrs. Chowning asked why the performance indicators projected such a high number of licenses to be issued over the next biennium.  Mrs. Silva stated she would research the discrepancy and report her findings back to the committee.

 

CONSUMER PROTECTION - PAGE 1522

 

Mrs. Silva read from prepared testimony.  The activities include assessing sanitation in food establishments, hotels and motels, institutions, schools, correction facilities, trailer parks, milk plants and dairies, and fires and wrecks involving food and drugs.  The Bureau provides for implementation of the federal public water supervision program, commonly referred to as the Safe Drinking Water Program, under contractual agreement with the federal Environmental Protection Agency.  This is a major program for which the state, through the Governor's office, has accepted primacy as opposed to having federal regulations implemented by EPA.  It is a program that is going to be very costly to many public water systems.  Under the 86 amendments to the Act, the agency must regulate 83 contaminant standards, implement a ban on lead material and participate in a new, more rigid enforcement program.  Activities also include plan review of commercial developments and sewage disposal systems.  Incidents of vector transmission of disease are investigated and reported to the State Health Officer.  The section is also involved with the enforcement of NRS 585 in the manufacture and licensing of drugs and cosmetics.  Services are provided throughout the state from seven locations:  Carson City, Elko, Ely, Las Vegas, Fallon, Winnemucca, and Tonopah.

 

Senator Glomb asked for the rationale behind the transfer of the entire Consumer Protection program to the proposed Department of Environmental Protection.  Mrs. Silva stated the environmental health programs within the state had been split between two agencies, Health Division and the Division of Environmental Protection.  The transfer would consolidate the programs and lead to a more efficient use of resources within the state.

 

Senator Glomb remarked the Safe Drinking Water Act (SDWA) would require a higher level of responsibility for the state.  She asked if these additional duties could be performed by the Public Health Engineer.  Mr. Lange replied the agency was currently in compliance with the SDWA legislation.  The new Public Health Engineer would perform specific duties related to the SDWA.

 

Ms. Giunchigliani inquired if the food inspections of the Health Division had decreased due to the loss of four positions during the recent budget reductions.  Mr. Lange answered the Health Division was required by statute to perform food establishment inspections twice yearly.  Before the budget reductions the Division attempted to perform these inspections on a quarterly basis, however over the next biennium only the required number of inspections would be performed.  Mr. Lange commented the SDWA program and the food-borne illness inspections would best serve the public if they were consolidated into one agency.  Ms. Giunchigliani asked if the SDWA would have precedence over food inspections if the proposed consolidation occurred.  Mr. Lange assured the committee the food inspection activities would not decrease if the proposed consolidation took place.

 

Ms. Giunchigliani asked if schools must have a permit to serve food.  Mr. Lange stated although the schools were inspected a food permit was not required.

 

Senator Jacobsen asked who would be responding to public inquiries about health related issues.  Mrs. Silva indicated the proposed Department of Environmental Protection would hold ultimate responsibility for health related decisions but the two major health departments in Clark and Washoe counties would answer inquiries at the local level. 

 

Speaker Dini asked if the Department of Environmental Protection was created, would the entire Consumer Health Division be transferred so no positions or functions would be lost.  Mrs. Silva answered the Department of Environmental Protection would assimilate the entire Consumer Health Division.  Speaker Dini asked what would happen to the Consumer Health Division if the consolidation did not take place.  Mr. Lange indicated if the Department of Environmental Protection was not created, it was possible for the Consumer Health Division to become a bureau of the current Environmental Protection within the state.  Currently developers and contractors have to apply to two separate agencies to acquire a permit.  The consolidation would prevent duplication.  Speaker Dini commented the duplicated services and excess fees cause undue stress on small business owners.

 

Senator Callister commented the modest reduction in food inspection activities could have a devastating effect on tourism, the states main industry.  Senator Callister advocated maintaining the highest possible standards for food service inspections.  He asserted the four food service inspector positions eliminated during the recent budget reductions could have extreme impacts on the state's food service industry as illustrated by the recent ecoli food-borne outbreak.  Senator Callister asked if the Department could maintain high sanitation standards with the reduction in staff.  Darrel Rasner, Chief for Bureau of Health Protection Services, stated the inspectors in the rural areas performed multiple tasks such as food service, sewer disposal facilities, and nuisance inspections.  The inspectors would decrease the number and frequency of all inspections except food service.

 

RADIOACTIVE MATERIAL DISPOSAL TRUST FUND - PAGE 1543

 

Mrs. Silva read from prepared testimony.  She explained the 1961 legislative session established the Radioactive Material Disposal fund for management and control of radioactive material disposal.  The budget recommendation is based on the site closing to low level radioactive waste as of 12/31/92, and continuing receipt of hazardous and toxic waste. 

 

Speaker Dini asked the agency to provide the net loss of revenue for closing the Beatty dumpsite.  Mr. Lange stated approximately 8 million in revenue was generated from July to December 1992.

 

RADIOLOGICAL HEALTH - PAGE 1538

 

Mrs. Silva read from prepared testimony.  She explained Radiological Health provides oversight of the operations of the low level radioactive waste site near Beatty.  This oversight will continue during the site closure period and for perpetual care of the site for the next 100 years.  The program also licenses radioactive material users, X-ray devices and oversees Department of Energy radiological activities at the Nevada Test Site.  A new program implemented as the result of legislative action last session and recent federal regulations relates to the certification and inspection of mammography operators and machines under an agreement with the federal agency (HCFA).

 

PRESENTATION - JUVENILE CORRECTIONS NEEDS ASSESSMENT -

  by National Council on Crime and Delinquency (NCCD)

 

John Sarb, Administrator, Division of Child and Family Services, stated the 1991 joint subcommittee on the Division of Child and Family Services recommended a $40,000 long-term study on the juvenile justice needs for the state.  The resulting study "A Juvenile Corrections Needs Assessment for the State of Nevada", on file at the Research Library, was presented to the committee by David Steinhart, Principal Investigator, National Council on Crime and Delinquency.  Mr. Steinhart explained his presentation would consist of 30 pages of highlights from the 175 page report.

 

Mr. Steinhart summarized the scope of work for the study.  He stated the principal objective of the assessment was to provide Nevada legislators and policymakers with accurate information on juvenile corrections needs from 1993 through the year 2001.  The assessment focused on state-committed juvenile offenders and on related policy, facility and program needs.  Some data was collected  and was reported on referrals of juveniles to probation departments and county operated camps.

 

Mr. Steinhart called attention to the major findings of the assessment as related to the state committed juvenile offenders.  Mr. Steinhart reported Nevada's juvenile offender incarceration rates were among the highest measured of any state.  The NCCD surveyed all juveniles released from state youth correctional facilities in 1991 and established a profile of the state referral population.  The profile included: (1) most juveniles committed to the State Youth Corrections agency were boys (83 percent) between 14 and 17 years of age; half of referred youth were White; one third were Black; and one-tenth were Hispanic; (2) most youth were committed for property offenses, misdemeanors and technical violations of parole (64 percent), while a much smaller share were committed for serious or violent felonies against persons (9 percent); (3) compared to four other Western states, Nevada's state training schools incarcerated a lower proportion of serious juvenile offenders and a higher share of misdemeanant and status offenders; (4) Nevada's average length of stay (ALOS) in state youth correctional facilities was 7.1 months, slightly higher than the national average of 6.6 months reported in the 1989 Children in Custody survey by the U.S. Department of Justice).

 

Mr. Steinhart reported counties had different rates of commitment to the state Youth Corrections agency.  Clark County had 61 percent of the state juvenile population but referred 80 percent of Nevada state juvenile commitments in 1991.  Washoe County had 20 percent of the state youth population and referred 11 percent of state commitments.  All other Nevada counties together represented 19 percent of the state youth population and were responsible for 10 percent of state committed juvenile offenders in 1991. 

 

Mr. Steinhart explained juvenile sex offenders (youth committed on the basis of a current sex offense) accounted for 12 of 463 referrals in the study sample of state committed youth (3 percent of referrals).  All were boys, with referral offenses of varying severity.  Twenty-six other youth in the sample were labeled as sex offenders based on prior sex offenses or allegations of past sexual misconduct.  The lack of a standard classification system for juvenile sex offenders, and lack of accurate historical data in each case, made it difficult to project future facility space needs for these youth.  Presently, juvenile sex offenders committed to the Nevada Youth Training Center at Elko or the Caliente Youth Center received little or no sex-offender specific treatment.  NCCD projected approximately 20 annual referrals of boys with current sex offenses to the Youth Corrections agency by the year 2001.

 

Mr. Steinhart stated juvenile offenders with mental health problems accounted for 26 of 463 referrals to state Youth Corrections in 1991 (6 percent).  Two thirds were boys; for all, criminal risk factors (severity of offence, gang affiliation)were moderate to low.  Accurate diagnostic information was unavailable in nearly all of these cases, making it difficult to classify these youths for present or future treatment and custody requirements.  These young people received little in the way of focused, professional mental health care while in state youth correctional custody.  There would be approximately 30 boys and girls referred to Youth Corrections with mental health treatment needs by the year 2001. 

 

Nevada has no youth correctional facility which is considered secure by accepted standards.  This created a problem in relation to the housing of serious and chronic juvenile offenders - those who were considered high risk for custody and public safety reasons.  When secure care is needed, Nevada sends these youth to an institution in Tennessee operated by Corrections Corporation of America.  NCCD determined that, among all 1991 referrals to Youth Corrections, 38 youths (all boys) met "serious and chronic" offender criteria developed for this needs assessment.  This number should grow to 56 youth needing 42 correctional beds by the year 2001.

 

Mr. Steinhart reported findings related to state juvenile corrections facilities.  Nevada has two state-run facilities for juvenile offenders - the Nevada Youth Training Center (NYTC) at Elko and the Caliente Youth Center (CYC) in Caliente.  Both facilities are overcrowded and are operating at an administrative cap of 110 percent of their design capacity of 300 youth. 

 

Mr. Steinhart asserted, in the last two years there had been backlogs in Washoe and Clark County detention centers of state committed youth for whom no state training school beds were available.  Nevada's at-risk youth population would increase by approximately 50 percent by the year 2001 over 1991 levels, based on forecasts from the 1990 census.  Nevada would have a shortage of 176 state youth corrections beds by the year 2001 if it made no changes in current commitment or length of stay policies.  The cost of building new correctional beds to meet this projected deficit is substantial.  The ten-year construction and operating cost of a single juvenile corrections bed approaches a half million dollars when adjusted for inflation.  Nevada needs to find safe and cost-effective alternatives to the construction of new juvenile corrections beds to meet the projected bed deficit.

 

Mr. Steinhart reported findings related to the county-level caseload of juvenile offenders.  Presently no statewide data was collected or available on juvenile arrests, referrals to probation, adjudications and dispositions.  Juvenile justice information was highly inconsistent from county to county.  In April and May of 1992, NCCD surveyed each Nevada Juvenile Probation Department and Juvenile Court Services Department to determine the statewide number of juveniles referred for law violations, with detail as to offense, pre-trial detention, court action, disposition, placement and state containment.  Incomplete and inconsistent information on these referrals was returned to NCCD, primarily because counties and probation departments did not track this information by any standard method, did not track it at all, or could not retrieve it from computers in Clark and Washoe Counties.  Based on the information received, there were 24,011 referrals of juveniles to Nevada probation departments for 30,616 law violations in 1991.

 

Mr. Steinhart reported findings related to the county operated juvenile camps.  NCCD analyzed two county facilities: the Spring Mountain Youth Camp in Clark County and the China Spring Youth Camp in Douglas County.  Spring Mountain (capacity 80) accepted male juvenile offenders directly form Clark County Juvenile Court.  China Spring (capacity 40) takes male juveniles from all Nevada Counties besides Clark.  Staff at each of these facilities completed NCCD surveys on all youth released in 1991.  Most youth were referred for felony property or misdemeanor offenses.  The ALOS was 6.2 months at Spring Mountain and 7.1 months at China Spring.  46 Spring Mountain youths in the 1991 exit survey were transferred to NYTC Elko for various violations; in many cases these youths spent substantially more time in custody than more serious juvenile offenders who were state committed in the first place.  If no changes in commitment policy or length of stay were made, Spring Mountain Youth Camp was projected to need 141 beds by 2001 (a shortage of 61 beds) and China Spring Youth Camp was projected to need 46 beds (6 bed deficit).

 

Mr. Steinhart reported recommendations to meet the projected state youth corrections bed deficit.  He stated the projected year 2001 deficit of 176 state juvenile corrections beds should be met by adjusting intake and length of stay policies, by building 60 new corrections beds for juvenile offenders with special treatment and custody requirements, and by developing a contract-care network of community-based placements.

 

Mr. Steinhart stated Nevada should immediately begin to implement a juvenile corrections bed savings plan.  This plan would sharply limit misdemeanor commitments to state training schools; would prohibit status offender commitments; would divert technical parole violators to halfway houses before they could be revoked into institutions; would control Spring Mountain transfers to NYTC; and would adjust lengths of stay at existing facilities.  These measures should go into effect in 1993.  By 2001, if fully implemented, the plan will eliminate the need for 86 juvenile corrections beds.

 

Mr. Steinhart stated Nevada should go forward with existing plans to build a mixed use facility in southern Nevada serving juvenile sex offenders and children with mental health treatment needs.  From a pool of juvenile offenders referred as sex offenders and minors with mental health problems, assessment teams should select those in need of specialized residential care in the new facility.  To meet corrections population reduction goals, 20 beds of the proposed 40 bed facility should be reserved for juvenile offenders.  The facility should come on line by 1996.

 

Mr. Steinhart recommended Nevada build a 40 bed "serious and chronic" juvenile offender facility to fill the void of secure juvenile corrections capacity in the state and to resolve custody and control problems that arise from commingling high-risk juvenile offenders with moderate and low risk youth at other facilities.  This facility should come on line in 1996.

 

Mr. Steinhart stated Nevada should end overcrowding and should reduce the populations at the Nevada Youth Training Center and Caliente Youth Center to their design capacities.  To make up the remaining deficit, Nevada should develop a network of contract beds for juvenile offenders, beginning in June of 1995.  By the year 2001, Nevada should plan to have at least 50 contract beds serving 100 annual referrals of state committed youth.

 

Mr. Steinhart warned if either policy savings or new facility plans were not realized, Nevada must make an aggressive and intensified commitment to the development of a contract care network of residential and non-residential programs for juvenile offenders, to compensate for the failure of the deficit reduction strategies.

 

Mr. Steinhart reported recommendations to meet the projected deficit of beds at county juvenile camps.  Spring Mountain and China Spring Youth Camps should reduce ALOS for the juvenile offenders in these facilities.  If ALOS were reduced to 4 months on average for felonies and 3 months on average for misdemeanant and technical violators, both facilities would be able to operate comfortably within their design capacity through the year 2001.

 

Mr. Steinhart made recommendations to reduce disparities in county rates of commitment to the state.  Juvenile Sentencing Guidelines should be applied by Juvenile Court Judges making dispositional decisions.  The goals of the guidelines would be to ensure that similar cases receive similar treatment regardless of county of origin and to reduce disparities in rates of commitment to state Youth Corrections.  The guidelines should be developed in unison with risk assessment protocols that would accurately identify the public safety and security risks of each adjudicated youth.  The guidelines would be advisory rather than mandatory and their application would be closely monitored to determine their effect.  The development of guidelines should begin with an education and consensus-building process, guided by a Task Force of affected parties.

 

Mr. Steinhart made recommendations to improve the level of information on juvenile corrections.  He stated Nevada's near complete lack of statewide juvenile justice information should be addressed with a two-step approach:  (1) Local agencies should be required to collect and report to the state basic information on juvenile arrests, referrals to probation, petition and adjudication status, and dispositions;  (2) To the extent it can afford to do so, Nevada should automate its juvenile justice data collection and reporting system.  Antiquated and eccentric computer systems serving Washoe and Clark County Juvenile Court Services Departments should be reprogrammed if possible and replaced with dedicated systems using standardized software.

 

Senator Glomb asked if a 506 bed deficit would exist if the state changed its incarceration policy.  Mr. Steinhart stated if NCCD's recommendations were implemented a bed deficit would not exist.  Mrs. Williams stated she was disturbed by the lack of data for juvenile corrections and stated a request for the compilation of the data had been requested during several past legislative sessions.

 

Mrs. Williams asked if Nevada needed a mid-level correctional facility for girls.  Mr. Steinhart recommended the state establish a diagnostic and assessment treatment facility to develop treatment plans for drug, pregnancy, alcohol, and health related problems young women experience.

 

Mrs. Williams commented she found it absolutely disgraceful status offenders were incarcerated in state correctional facilities.  Mrs. Williams asked whether other states incarcerated status offenders.  Mr. Steinhart stated the incarceration of status offenders violated federal juvenile justice policy.  Those states which received juvenile federal funds did not incarcerate status offenders.  Robert Cavakis, Director, Youth Corrections Services, stated since October 1, 1991 status offenders were protected by statute from incarceration within the state.

 

Mrs. Williams asked if the training appropriation for professionals within the facilities was utilized.  Tom Reilly, Deputy Administrator, Child and Family Services, stated the training allocation had been utilized.  Specific training information was provided in a "Report on the Status of Juvenile Sex Offenders in Nevada," (Exhibit G), which detailed the use of the training fund allocations of FY 1992.

 

Senator O'Donnell commented Home of the Good Shepherd could be reopened to avoid the cost of building a new facility.  Senator O'Donnell advocated a treatment center for girls which would allow for counseling and rehabilitation rather than incarceration.  Senator O'Donnell asked if the study had been presented to the executive branch.  Mr. Steinhart affirmed it had been presented to the Department of Human Resources and the Division of Child and Family Services in August of 1992. 

 

Ms. Giunchigliani recommended the committee form a task force or subcommittee for alternative sentencing for juveniles.

 

Senator Glomb asked if the study revealed any specific statute on the judicial system which channeled juvenile offenders into correctional facilities.  Mr. Steinhart answered the research was handicapped by the lack of source practice information, such as arrests, referrals to probation, adjudication and dispositions. The local data was so inconsistent it was difficult to assimilate into a general recommendation.  Mr. Steinhart emphasized the need for statewide juvenile justice information.

 

Mr. Perkins asked when developing the bed need projections for 2001 did the study account for the increasing trend toward crimes against persons.  Mr. Steinhart affirmed all the projections did account for current gang activity, behavior patterns, and the number of repeat or serious offenses. 

 

Mr. Perkins asked if statistics were used to support the national success of community based juvenile corrections programs.  Mr. Steinhart asserted the first statistics had been provided in NCCD's report.  The report provided state of the art projections on the outcomes under an alternate set of scenarios such as the bed savings plan and community based programming.  Massachusetts, Utah and Oklahoma had adopted aggressive community based models.  Cost savings and rehabilitation success rates had improved in states which have moved away from incarceration based models to community based models.

 

Mr. Perkins questioned if the recommendation for sentencing guidelines was developed to account for the varying demographic and geographical differences of the state.  Mr. Steinhart said the study did not develop the sentencing guidelines but did recommend they be developed with demographic and geographic difference taken into account.

 

Senator Jacobsen asked if NCCD visited the correctional facilities.  Mr. Steinhart stated NCCD did not visit the sites, however the data was collected locally by the employees at the facilities.  He stated he did meet with all of the probation officers.

 

Chairman Arberry commented the committee had deep concerns about the juvenile justice system and would form a subcommittee on the subject.

 

Public Comment

 

Robert Hadfield, Executive Director, Nevada Association of Counties (NACO), stated in 1985 NACO was instrumental in acquiring federal funds for a study on status offenders and the development of community based juvenile justice programs.  In 1988 the state created an advisory committee and took over the $225,000 federally funded program.  He stated NACO was pleased with the NCCD report and commented its findings clearly demonstrated a need for change in the current juvenile justice system.  The counties and the state needed to reach a financial agreement which would meet the mutually agreed upon goals for the juvenile justice system.  Mr. Hadfield advocated the Legislature, administration and counties work together during the interim to develop a plan for the juvenile justice system.  He also advocated the counties be granted the right to eliminate tax caps to allow for the generation of higher county revenue.  Mr. Hadfield concluded by stating the counties were available and willing to work with the state to develop this program.

 

Mr. Marvel asked if the counties were requesting a complete elimination of tax caps for all programs.  Mr. Hadfield stated the counties were advocating:  (1) to be a partner in the development of the juvenile justice program; and (2) to examine how revenue could be generated for community based programs.  Mr. Marvel asked if the tax caps were lifted would the counties receive opposition from community members.  Mr. Hadfield was confident little resistance would be encountered if a detailed program was developed which would benefit the communities.

 

Mr. Price asked if there had been any cooperation between cities and counties to develop revenues for the community based programs.  Mr. Hadfield stated the program should be developed before any proposal to increase the tax base was presented.  Otherwise the counties risked losing the public trust.

 

Rob Calderone, Director, Washoe County Juvenile Probation and Vice President of the Nevada Association of Chief Juvenile Probation Officers (NACJPO), distributed and read a memorandum to the committee, (Exhibit H).  The memorandum recommended the legislature adopt, in total, the study developed by NCCD.  The recommendations were as follows:  (1) NCCD's recommendations should be developed and adopted by the state and counties; (2) counties should assume total responsibility for all community based programs; (3) the state should take full responsibility for long-term correctional and treatment beds and services.

 

Carol Galantuomini, Vice Chairperson, Nevada Network on Juvenile Sex Offenders, stated the NCCD study under-reported the number of available treatment beds for juvenile sex offenders.  She pointed out Clark County was treating 18 sex offenders and Washoe County was treating 8 in outpatient centers.  Approximately 20 sex offenders were incarcerated in both Elko and Caliente.  The specialized adolescent treatment center in Las Vegas served 12 and 8 offenders were placed out of state.  She referred to Exhibit G, and stated a high number of sex offenders could be rehabilitated using community based outpatient centers. 

 

Sheila Leslie, Executive Director of the Children's Cabinet stated her organization endorsed the NCCD recommendations.

 

CHILD AND FAMILY ADMINISTRATION

 

John Sarb, Administrator, Child and Family Services explained this budget supports central office staff for the Division and staffing for family support services such as child welfare functions, protective services, foster care, adoptions, central intake, crisis intervention, and family intervention.  He continued the budget also included training funds for staff and contract funds for the sex offenders evaluations.  Staffing levels over the next biennium would maintain client/staff ratios at the 1992 level.  In Child Protective Services, the ratio was 22/1 for initial investigations and 35/1 for on going cases.  The Child Protective Services caseload was 3,195 in FY 92 and was estimated to be 3,373 in FY 94 and 3,609 in FY 95.  He stated the on-going cases averaged 408 per month in FY 92 and projections were 444 per month in 94 and 586 per month in 95. 

 

Mr. Sarb focused next on central intake and said the program had completed 658 assessments in FY 92 and was projected to complete 940 in FY 93 and 1,062 in each year of the coming biennium.  The Family Preservation Program was projected to serve 274 families in each year of the coming biennium.  Crisis intervention in Las Vegas would serve 144 families, including disruptive adoptions which was a new function for this program, over the next biennium. 

 

Mr. Sarb indicated budget reductions in FY 92 totaled $593,176 and included the elimination of 7 positions, the sex offender evaluation program and the AFCARS foster care and adoption data system.  In FY 93 the budget reductions totaled $353,666 and abolished four and one half positions. 

 

Mr. Sarb described the federal funds in the revenue section of the budget.  Title IV-B funds totaled $951,836 in FY 94 and $951,486 in FY 95.  Title XX funds totaled $3,781,692 in FY 94 and $3,806,772 in FY 95.  Title IV-E funds totaled $1,403,084 in FY 94 and $1,411,838 in FY 95.  The Dependant Care Grant totaled $52,143 in each year of the biennium.  He stated adoption fees totaling $96,523 in FY 94 and $99,093 in FY 95 were also included.  Building rent for the northern and southern Nevada Children's Home totaled $197,533 in the second year of the biennium.  The agency transfer from the Rehabilitation Division totaled $8,400 in FY 94 and $14,400 in FY 95 which would be used for office space rental at the Northern Nevada Children's Home. 

 

Mr. Sarb depicted the major changes in the base budget.  The operating category decreased approximately $270,000 due to cost allocation of the Attorney General fees across all budgets which use Attorney General services.  The training category included child welfare and a transfer from MH/MR for sex offender treatment training.  The automated processing item was a one-shot grant.  The juvenile correctional program appropriation of $39,172 was for the NCCD study presented by Mr. Steinhart.

 

Mr. Sarb reviewed the maintenance section of the budget.  Maintenance item 200 represented 8.25 FTE positions in FY 1994 and an additional 7.75 FTE positions in FY 1995.  Specifically 6 social workers, .75 supervisors and 1.50 management assistant I's in FY 94 and an additional 5 social workers, 1.25 supervisors and 1.50 management assistant I's in FY 95.  This was requested to meet the anticipated caseload increase over the next biennium. 

 

Senator Raggio commented the budget currently supported 176.50 existing positions and the budget recommended the transfer in of 15.50 positions.  Senator Raggio asked the agency to explain the origin of transferred positions.  Mr. Sarb explained the transfers were part of the reorganization and the reallocation of services.  Senator Raggio requested a memorandum specifying the originating agency for the transferred 15.50 positions.  Mrs. Williams requested information regarding the 11 eliminated positions be included in the memorandum requested by Senator Raggio.

 

Chairman Arberry asked if the agency truly needed all of the requested positions.  Mr. Sarb affirmed all of the requested positions were necessary to maintain the staffing ratio of FY 92.  He added the staffing ratios were higher than standard and to increase them could compromise the safety of the Division's clients.  Chairman Arberry asked for the agency's projections if the positions were not approved.  Mr. Sarb stated caseloads in foster care would increase to a ratio of 50/1.  This could invite lawsuits against the state which could result in federal intervention into the child welfare system.  Protective services investigations were currently operating at 22/1 ratio and if the ratio increased it would cause delayed services and compromise public safety.

 

Mr. Marvel commented the vacancy savings over the coming biennium totaling $601,263 was lofty.  Mr. Marvel asked if the agency could  maintain the desired service levels and still meet the vacancy savings figures.  Mr. Sarb commented the vacancy savings from the previous biennium were higher than the coming biennium therefore the agency would be able to maintain the desired service levels. 

 

Ms. Giunchigliani stated the budget recommended the transfer of the Victims of Domestic Violence account from MH/MR to the Children's Division.  This item also moved three federal grant programs to this account from MH/MR; U.S. Crime Victims, Indian Victims Assistance and Family Violence and proposed to transfer an existing MH/MR Program Manager into this account to administer the programs.  Ms. Giunchigliani asked the agency to explain the rationale behind these recommendations.  Mr. Sarb stated the majority of the services were performed by the Children's Division.  He added an amendment to the current statute may be required for the proposed Domestic Violence Program transfer. 

 

Mrs. Evans commented the Domestic Violence Program helped for parents of abused children, therefore it may be inappropriate to transfer the program into the Children's Division.  Mrs. Evans indicated this would be a topic of discussion for the MH/MR subcommittee.

 

Mrs. Williams shared Mrs. Evans' concerns with the transfer of the Domestic Violence Program to the Children's Division.  Mrs. Williams asserted the persons cared for by MH/MR for domestic violence would continue to request those services and deplete the resource of the department.  Jean Laird, Financial Officer, MH/MR, stated the administration of the federal grants accounted for approximately half of the program manager's time at MH/MR.  A discussion between the directors of MH/MR and Child and Family Services determined the administration of the program would be performed by the Children's Division.

 

Mr. Sarb noted maintenance item 501 data collection/foster care and adoption was a federally mandated data system for foster care and adoptions.  This item was part of the budget reductions of FY 92.  This reduction was possible because the federal government had not finalized regulations at that time.  Currently the regulations for the data system were in place and the Division was required to comply with the mandate. 

 

Mr. Sarb noted enhancement item 707 which would replace three vehicles.  The agency had requested $63,422 and the Governor recommended $37,637.

 

Chairman Arberry asked if the agency had estimated the cost of the requested 2 - 4x4 vehicles and 1 sedan.  Mr. Sarb stated the 4x4's were for the Elko and Ely areas and the sedan for the Carson City area.  Mr. Reilly stated the Division had estimated the cost of the vehicles based on information from the Department of Motor Vehicles.

 

YOUTH COMMUNITY SERVICES - PAGE 945

 

Mr. Sarb explained the budget's major components were emergency shelter care for children, continued services for families receiving protective services, care for neglected or abused children, the independent living program, adoption service for special needs children, adoption subsidies and foster and adoptive home recruitment.  In FY 92 the average daily census for youth in community services' custody was 2,861.  Projections for FY 94 are 3,128 and 3,254 in FY 95.  The substitute care and adoptions staffing costs were based on a client/staff ratio of 42/1.

 

Mrs. Williams asked about the status of the Single Parent Program.  Mr. Sarb stated the program was eliminated in the FY 92 budget reductions.  The program had provided some subsidies to pregnant women who were contemplating relinquishing babies for adoption.  Mr. Sarb indicated other sources of funds could be found for this service.

 

Ms. Giunchigliani asked if long-term foster care was provided by the agency.  Mr. Sarb answered long-term foster care was funded through the account. 

 

Ms. Giunchigliani commented that in the substitute foster care category a transfer from Education of $461,013 each year was suggested for the NRS 395 program that provides educational placements for children in the Division's custody who are autistic, severely/emotionally handicapped or suffering from traumatic brain injury.  Ms. Giunchigliani asked the agency to explain the reason for the transfer.  Mr. Sarb indicated the transfer accommodated the placement of 8 children over the last biennium.

 

Senator O'Donnell asked why the agency transfers category had increased from $461,013 in FY 92 actual to $1,081,853 in FY 94.  Mr. Sarb explained $620,000 of the total was from the children's trust account which previously was not shown in this account.  He stated the Division had used the trust accounts in the past and they did not appear in the Executive Budget.  The purpose of the new format for the Executive Budget was to give a more accurate picture of the cost of care for these children.

 

Senator O'Donnell asked why the General Fund allocation from the Governor was approximately $3 million higher than the agency's request.  Mr. Sarb explained the $3 million was the General Fund match for Medicaid which was not previously shown in this budget account.

 

Mr. Sarb pointed out maintenance item 200 demographics/caseload changes which recommended additional amounts for subsidized adoptions.  The agency anticipated continued growth in the number of new requests, non-recurring payment requests, as well as a continuation of ongoing cash payments.  Mr. Sarb explained adoption subsidies were payments to adoptive parents of special needs children.  The Division performed an annual audit to confirm the need for the continuation of the subsidy.  In most cases the subsidy was continued and the allocation of funds increased with each biennium.  The cost of a subsidized adoption was less than the Division's cost to maintain a child in long-term care facilities.  Substitute foster care was anticipated to increase due to caseload increases.

 

Chairman Arberry asked if payments to foster parents were scheduled to increase over the next biennium.  Mr. Sarb indicated there would be no increase in the payment amounts.

 

Mrs. Evans asked how many foster care homes were available in the state.  Mr. Sarb stated there were 646 licensed foster homes which could serve approximately 1,300-1,400 children.  Mrs. Evans queried what the anticipated need for foster care would be over the next biennium.  Mr. Reilly stated the total number of children were projected to increase by 200 in FY 94 and 281 in FY 95.  Mrs. Evans asked if the agency had anticipated the need for new foster homes.  Mr. Sarb stated foster homes would increase by 10 percent.  He pointed out that not all of the children could be placed in foster homes, some would need group homes and other residential treatment.

 

Mrs. Evans asked why the average length of time in custody for children in foster care seemed to be decreasing.  Mr. Sarb indicated children were being adopted more readily or returning to their own families.  He stated when children did remain in foster care for a prolonged period of time it was because they were poor or they were black.  Mr. Sarb indicated these reasons were not acceptable to the Division and solutions were being reviewed.  In Clark County all cases of children under 10 who have been in foster care for more than three years were under review.  The review would result in the children going back to their families or they would be placed in permanent homes.  Mr. Reilly interjected the One Church, One Child Program for special needs adoptions had been very successful in placing African-American children.

 

Mr. Marvel asked the agency if the transfer of the NRS 395 program from Education to the Children's Division had been successful.  Mr. Sarb stated the agency currently was providing out-of-state care to seven children.  The success of the program could be measured, in Mr. Sarb's opinion, by the number of children the state was now able to serve in state.  Mr. Marvel asked for the average cost of out-of-state placements.  Mr. Sarb indicated the cost of one child could be as much as $270,000 annually.  Mr. Marvel asked if at some time in the future the state would be capable of serving all of these children.  Mr. Sarb answered Nevada would inevitably have to send the most difficult cases out-of-state.

 

Mrs. Williams asked how many children were located at the Blasco Center in Las Vegas and how many of them were autistic.  Christa Peterson, Deputy Administrator, Child and Family Services, indicated the Blasco Center was serving four children and all have been diagnosed with autism.  None of the children currently placed were NRS 395 students, instead they were all voluntary parent placements.  Three NRS 395 autistic students were placed out-of-state.  Mrs. Williams asked if the Blasco Center was designed to hold four children.  Mrs. Peterson answered the building's capacity was 6, but the staffing levels did not allow for more than four autistic children. 

 

Mrs. Williams asked if the performance indicators suggested that the average number of changes in placements for a child would increase from 4.13 in FY 92 to 4.5 in FY 94 and FY 95.  Mr. Reilly stated these numbers were an average of the total number of placements for all children.  However these numbers did include emergency placements which were temporary placements for children before they were placed in regular foster care.  Mr. Sarb clarified the Division had a problem with the data collection in this area.  The Division was looking toward the Children's Resources Bureau's to more accurately depict the average length of stay for children in foster care.

 

CHILD ABUSE AND NEGLECT - PAGE 952

 

Mr. Sarb stated the budget was made up of two federal grants:  (1) the Basic State Grant - which was allocated to all states for technical assistance and consultation for protective service agencies and (2) Disabled Infant Grant - which provided direct assistance to children with life threatening disabilities.  Two positions were also supported in the account.

 

CHILD WELFARE TRUST - PAGE 955

 

Mr. Sarb explained the budget was composed of trust funds paid to the Division on behalf of children in the Division's custody.  Most of the funds came from Social Security, SSI, Veterans Administration or court ordered child support.

 

CHILDREN'S TRUST ACCOUNT - PAGE 957

 

Mr. Sarb explained the budget was funded by a $3 fee for birth and death certificates.  The funds were allocated to programs which prevent primary and secondary child abuse and neglect throughout the state.  There were 16 contracts awarded by the statutorily authorized committee in FY 92 and 17 were currently in progress for FY 94.

 

NORTHERN NEVADA CHILD AND ADOLESCENT SERVICES - PAGE 960

 

Mr. Sarb stated the budget offered a range of mental health services for children ages birth to 18.  The program's service area included Washoe County and its suburbs.  The program featured outpatient counseling, day treatment services and residential services.  The outpatient counseling has a capacity of 196 and was currently serving an average caseload of 251.  Day treatment has a capacity of 56 and was currently serving 74.  The community treatment homes have a 23 bed capacity and currently served an average caseload of 21.8.  The transition home has a capacity of 6 beds and had a current caseload of 5.7.  The adolescent treatment center has a capacity of 16 and a current caseload of 14.1.  All of the programs' caseload numbers were projected to remain constant over the biennium. 

 

Chairman Raggio asked the agency to explain why the increase in caseload for Northern Nevada Child and Adolescent Services had not been addressed as a maintenance item like Southern Nevada Child and Adolescent Services had been.  Mr. Sarb explained the Southern Nevada account had experienced a much larger budget reduction in the current biennium.  The maintenance item in the southern Nevada account was to bring the staffing levels back up to pre-budget reduction levels. 

 

Speaker Dini noted a $51,000 reduction in funding for the Desert Hills Sexual Offender Program.  He asked the agency to justify the reduction when a majority of these offenders were being institutionalized out of state at a much higher cost.  Mr. Sarb commented the offenders sent out of state were in a high risk category and could not have been placed in the Desert Hills Sexual Offenders Program.  He explained the budget reduction resulted because the program was not in operation.  The Division felt it was more appropriate to cut a non-operational program than to cut existing programs. 

 

Speaker Dini asked if the Severely Emotionally Disturbed contract beds budget reduction of $350,000 was related to the Sexual Offender Program.  Mr. Sarb stated the two programs were separate.  This program at its reduced funding level would continue to serve the non-Medicaid eligible clients at the Willow Springs Center.  The Medicaid eligible clients would continue to be served by the same facility.

 

Mrs. Chowning asked for an explanation of the high number of clients projected to be on waiting lists over the next biennium.  Mrs. Peterson stated the average waiting list, 73 clients for FY 92-93, was fairly standard for the program and was anticipated to continue.  The projected increase for FY 94 and FY 95 was based on the population increase for the state.

 

Mr. Heller suggested the performance indicators reveal the trends of the program's performance.  Mrs. Peterson commented staffing levels were directly related to the number of clients on the waiting lists.  She stated with no increase in current staffing levels the waiting lists would remain constant and would increase with the population.

 

Mrs. Evans asked if children's services were provided to the rural areas.  Mr. Sarb indicated the rural areas did not receive services and children had to be relocated to Clark and Washoe counties to receive services.  He commented the resulting influx of children receiving services from the rural areas was 186 for FY 91 which was high when compared to Clark (234) and Washoe (139) counties.

 

Mrs. Evans commented the Rural Clinics were largely impacted or eliminated due to budget reductions in the MH/MR budget.  She asserted this type of funding practice was discriminatory.  The subject would be discussed in detail during subcommittee hearings.

 

Mrs. Williams asked the agency to explain the decline in the number of clients on the waiting list for Early Childhood Services.  Mrs. Peterson explained an increase in federal Childcare Block Grant funding had occurred in FY 92-93.  However the new positions were not implemented until very late in the biennium and the resulting decrease in the waiting list was projected to occur in FY 94-95.

 

Senator Raggio noted E-709 Contract Meals recommended a reduction of approximately $41,000 in food costs as a result of a new food service contract.  Senator Raggio asked if the agency could produce savings of this kind in any other budgets.  Mr. Sarb stated the contract was developed by MH/MR.

 

SOUTHERN NEVADA CHILD AND ADOLESCENT SERVICES - PAGE 966

 

Mr. Sarb stated the budget provided many of the same services provided by northern Nevada Child and Adolescent Services.  The differences included:  (1) lack of an Adolescent Day Treatment Program in the southern Nevada center; (2) the southern Nevada program did have an adolescent residential program with a 12 bed capacity; and (3) a sex offender program with a 12 bed capacity.

 

Senator O'Donnell asked if the agency had requested funding for the 40 bed adolescent treatment facility recommended by the NCCD study.  Mr. Sarb indicated the treatment center had been the agency's number 1 recommendation.  However the Public Works Board did not approve the plans as part of the Capital Improvements list.

 

Mrs. Williams commented the Adolescent Sex Offenders Program was located in the adult unit on the mental health campus.  She asked if childcare funding was eliminated and if autistic children funding was listed in the Executive Budget.  Mrs. Peterson explained the child care block grant was shown as transfer from Human Resources.  She stated the funding for autistic children was part of the Treatment Home program and was included in the other line items throughout the budget.  The grant totaling $32,637 was allocated specifically for autistic children through a subgrant from the Division of Vocational Rehabilitation.  The grant was used to fund an independent living skills program for autistic children which included crisis services for children who were on the waiting list for the Blasco building.  The funding for this program would be discontinued in FY 94.

 

Mr. Humke asked if the Adolescent Treatment Program held one bed vacant for emergencies.  Mrs. Peterson stated 11 was the average monthly caseload for the facility which had a 12 bed capacity.  Mr. Humke asked if the average waiting list of 6-7 clients was accurate and what was done with the children while they waited.  Mrs. Peterson affirmed 6-7 clients was the standard number of children on the list.  She indicated the children were held at county detention centers, Elko and Caliente while they awaited treatment.

 

Mr. Humke asked if the children were categorized according to risk.  Mrs. Peterson confirmed the children were categorized according to the same guidelines (low - 68 percent, moderate - 11 percent and 12 percent high risk) given in the NCCD study.  The low - moderate sex offenders were served by the in-state facility.

 

Mr. Humke asked if a sex offender treatment center would ever be opened in the northern Nevada area.  Mrs. Peterson indicated a community based facility would be ideal for rehabilitation purposes and hoped there would be a facility sometime in the future.

 

CHILD CARE SERVICES - PAGE 972

 

Mr. Sarb indicated the budget supported licensing functions within the Division.  The licenses are required for child care facilities caring for 5 or more children and foster care homes.  Child Care Services licensed 119 child care facilities in FY 92 with an estimated 140 in FY 93 and a 10 percent increase in each year of the biennium.  The agency licensed 646 foster care homes in FY 92 and anticipated a 10 percent increase each year of the biennium.  The budget included an enhancement item which would fund fingerprint background checks.

 

YOUTH CORRECTIONS SERVICES - PAGE 977

 

Mr. Sarb explained the budget provided youth parole services and administered the interstate compact for juveniles.  The reorganization proposed youth parole services become the responsibility of the counties.  The remaining positions were funded by the administrative portion of the Office of Juvenile and Delinquency Prevention (OJDDP) grant.  The other portion of the budget included the funds necessary to administer the interstate compact for juveniles.

 

Speaker Dini asked if the counties would be able to finance Youth Parole Services.  Mr. Sarb stated the counties had requested the administration of Youth Parole Services in the past.  Mr. Sarb explained 25 of the states in the nation had parole and probation centralized in one level of government.  He stated budget constraints did contribute to the timing of the transfer.  He continued the current operation of Youth Parole was performed well.  The rural areas would receive better service at the local level.  The counties were given two choices for budget reductions, Youth Parole Services or Probation Subsidies.  Probation subsidies were increased to offset the cost of the transfer of youth parole services. 

 

Speaker Dini asked if the current quality of parole services would be maintained.  Mr. Sarb indicated he was confident the integrity of parole services would be maintained. 

 

Mr. Humke asked if Youth Parole personnel would be hired by other agencies.  Mr. Sarb indicated Washoe and Clark County Court Districts had expressed interest in hiring some of the personnel.  Mr. Sarb suggested a transition period be implemented into the proposed transfer.

 

Mr. Humke asked if policies for parole would be the same in all counties.  Mr. Sarb stated the establishment of sentencing guidelines recommended by the NCCD report should be instituted. 

 

Mr. Humke asked if county based agencies would have incentive to revoke the parole of juveniles in order to refer them to state correctional facilities.  Mr. Sarb explained in the state program these referrals were high.  He stated this was an area which needed to be discussed before the transfer took place.

 

Chairman Raggio asked where the recommendation to transfer Youth Parole to the counties originated.  Mr. Sarb stated it was a unilateral decision which was made in the course of the budget process.  He said the computations were made by determining the state's expense in parole placements.  This amount was allocated to the Probation Subsidies account.

 

Chairman Raggio commented the work program for the Youth Parole account was $1.5 million in FY 92 and the recommended funding level to the county was only $500,000.  Chairman Raggio commented a transfer of this kind should be a revenue neutral allocation.  The state should allocate to the counties the amount of funding which is necessary to support Youth Parole Services.  Chairman Raggio asserted this was an attempt by the state to balance its budget on the backs of the local entities.  He stated this was a classic case of the state mandating programs to the counties without proper funding.  Chairman Raggio mentioned he had asked the counties to provide the Senate Finance committee a cost estimate for the administration of the program.  He remarked actions of this kind should have been taken before the proposal was presented to the Legislature.

 

Mr. Price commented the Assembly Committee on Ways and Mean should be provided a copy of the county cost estimates as well. 

 

Senator O'Donnell commented he had similar concerns about the lack of planning and foresight for the transition of the Youth Parole duties to the counties.

 

Mr. Marvel commented the committee would benefit from the information requested by Chairman Raggio.

 

Mr. Spitler commented the counties could not operate the Spring Mountain Facility and the Youth Parole services with the current funding recommendation.  Mr. Spitler asked the agency to provide information about the cost to operate the Spring Mountain Facility along with the information requested by Chairman Raggio.

 

Public Comment

 

Sharon Spangler, lobbyist, State of Nevada Employees Association, stated if the 18-19 positions in Youth Parole were eliminated, there was no place in the state system for these employees to bump.  She commented the Department of Personnel was uncertain these employees could qualify for employment in other job categories.  She commented the program had qualified for a National Technical Assistance Grant because of the effectiveness of the program.  Each one of the parole workers had a caseload of 36 high risk juveniles.  The parole workers established relationships and began preparing the offender to reenter society while the person was incarcerated.  She advocated keeping the program funded until a replacement program was implemented.

 

YOUTH ALTERNATIVE PLACEMENT - PAGE 981

 

Mr. Sarb explained the budget funded out-of-home placements for parolees and for offenders who could not be incarcerated in Caliente or Elko such as children under the age of 12 and those who have special treatment needs.  Also included in the budget was the payment made to the China Spring Youth Camp and the payment for the out-of-state placement of chronic and violent offenders.

 

Chairman Raggio asked where female offenders who were previously placed in Home of the Good Shepherd were placed.  Robert Cavakis, Director, Youth Correctional Services, explained the counties had developed community based alternatives for female placements.  Mr. Cavakis stated the girls now had two stages rather than three stages of corrections, the county and Caliente.  Mr. Cavakis confirmed there was no longer an intermediate placement for girls.  However, because there were a smaller number of delinquent girls the communities had absorbed, through programs such as Westcare and Regina Hall, the girls who had been served by Home of the Good Shepherd. 

 

Chairman Raggio asked what the $147,000 enhancement item would be used for.  Mr. Sarb explained the funds were formerly used to fund youth placements at Home of the Good Shepherd and would be used for female placements in the coming biennium.  Chairman Raggio asked the committee be provided a detailed breakdown of the impacts of the budget reductions on these programs.  Chairman Raggio asked the Budget Division to prepare an alternative budget for Youth Parole Services which would assume the proposed transfer did not receive approval.

 

Mrs. Evans commented that during the interim, Judge Shearing testified on the Children's Division and stated there had been an impact felt in Clark County due to the closing of Home of the Good Shepherd.  Judge Shearing had advocated an intermediate placement center because she was concerned the girls were not receiving care or they were being sent to Caliente prematurely. 

 

Mrs. Williams commented virtually all funding for intermediate care facilities for girls had been eliminated with the $500,000 reduction.  Mrs. Williams asked what the $700,000 reserve for reversion was going to be used for.  Mrs. Williams expressed concern for the mixing of populations within the facilities.  Mrs. Williams asked for a specific listing of the beds available for intermediate placement for girls throughout the state.  Mr. Sarb stated the agency could provide the information requested.

 

The meeting was adjourned at 5:16 p.m.

 

 

            RESPECTFULLY SUBMITTED:

 

 

 

 

            Courtnay A. Berg

            Committee Secretary

??

 

 

 

 

 

 

 

Assembly Committee on Ways and Means

Senate Committee on Finance

February 9, 1993

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