MINUTES OF THE
ASSEMBLY COMMITTEE ON WAYS AND MEANS
Sixty-seventh Session
May 17, 1993
The Assembly Committee on Ways and Means was called to order by Chairman Morse Arberry, Jr., at 7:40 a.m., on Monday, May 17, 1993, in Room 352 of the Legislative Building, Carson City, Nevada. Exhibit A is the Meeting Agenda. Exhibit B is the Attendance Roster.
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
COMMITTEE MEMBERS ABSENT:
None
STAFF MEMBERS PRESENT:
Mark Stevens, Fiscal Analyst
Gary Ghiggeri, Deputy Fiscal Analyst
ASSEMBLY BILL 193- Revises provisions regarding medical and other related facilities.
Ms. Mary Liveratti, Division for Aging Services, testified the Division for Aging Services had requested this bill with the intent of requiring licensure for all non-relatives receiving compensation for caring for one or more individuals. The Division's position was receipt of payment for care by non-family members constituted a business relationship which should be subject to licensure and review.
Ms. Liveratti noted group care facilities were a vital part of group care, provided the level of care was appropriate and safe. A loophole in the current statute allowed group care providers to avoid licensure by shuttling clients between homes. AB 193 would close this loophole and improve enforcement capabilities.
Dr. Jerry Zadny, Administrator, Mental Hygiene and Mental Retardation Division, stated during the 1991 legislative session there had been an attempt to exclude administrators of intermediate care facilities for the mentally retarded regulated by the Mental Hygiene and Mental Retardation Division of the Human Resources Department from the requirement that they hold nursing home licenses. In the process, all group homes were exempted from licensure inadvertently. AB 193 would correct that error.
Ms. Sharon Ezell, Chief, Health Division Bureau of Licensure and Certification, indicated she was appearing in support of AB 193. She explained it was the responsibility of the Bureau of Licensure and Certification to license a variety of medical facilities, including group residential facilities. Presently the bureau licensed homes caring for three or more disabled adults. Homes providing similar services for two or less disabled adults were not currently required to be licensed. AB 193 would provide for the licensure of all persons providing care for the elderly and disabled and would allow the Board of Health to establish regulations to exempt certain short-term care homes. She stated the bureau had submitted a fiscal note to accompany AB 193 predicated on the understanding that if new licenses required by this legislation exceeded 20, the bureau would require additional staff support. She noted the bureau would be charging fees for licenses.
Ms. Giunchigliani asked for clarification of Section 3 of the bill. Ms. Ezell explained the intent of the bill was to allow the Board of Health to waive licensing requirements in certain instances, such as a "good samaritan" caring for a neighbor on a short-term basis.
Ms. Giunchigliani asked why the limit on the number of clients in a residential facility was changed from 3 to 2. Ms. Ezell said she did not know the reason for the change.
Mr. Spitler asked if a caregiver would have to apply for a waiver. Ms. Ezell responded affirmatively. Mr. Spitler asked what the application procedure entailed. Ms. Ezell said the regulation had not yet been drafted. She explained the current application procedure was fairly simple. She noted application fees could be returned to caregivers who were granted a waiver.
Mr. Spitler asked if there would be a penalty for not applying for a waiver. Ms. Ezell responded the current penalty for operating a group care facility without a license was possible conviction of a misdemeanor. This legislation proposed no other penalty.
Mr. Spitler asked if caregivers could be charged with a misdemeanor for failing to apply for a waiver. Ms. Ezell responded they could be charged under the current statute. Mr. Spitler noted the statute might discourage someone from acting as a good samaritan.
Mr. Spitler questioned whether insurance liability was considered in the bill. Ms. Ezell replied caregivers were required to maintain liability insurance in order to become licensed. Insurance was not required if the license was waived.
Mr. Spitler asked how many unlicensed facilities would have to become licensed under the proposed legislation. Ms. Ezell said the number was estimated at between 5 and 135. She noted those unlicensed facilities would probably be identified through reports from current licensees or from complaints received by the bureau.
Mr. Spitler inquired about the care being provided in homes for two or less. Ms. Ezell said her office had no authority over those facilities. Ms. Liveratti stated level of care was brought to the attention of the Division of Aging Services by reports from law enforcement or home health agencies.
Mr. Humke asked for further clarification of the waiver provisions. Mr. Ezell responded the intent of the legislation was to exempt people caring for neighbors or friends in their home for a period of nine months or less.
Mr. Humke inquired whether those people would be required to apply for licensure and then prove they should be exempted. Ms. Ezell responded affirmatively. She noted licensing fees would be returned to applicants who were exempted.
Mr. Humke asked if the exempted care givers could receive fees for their services. Ms. Ezell replied the exempted care givers could receive compensation.
Mr. Humke asked how many serious situations had been discovered in unlicensed homes. Ms. Liveratti said she did not know the exact number but could provide the information at a later time. She said the trend appeared to be toward an increase in numbers of problem situations as well as severity of problems. She noted over 2,000 complaints had been investigated in the past year.
Ms. Giunchigliani noted an operator was operating two unlicensed homes in her neighborhood. This was only discovered when neighbors investigated business licensing requirements.
Ms. Giunchigliani stated this regulation was needed to protect senior citizens.
SENATE BILL 79 - Eliminates requirement that adoptive parents of child with special needs have limited financial resources to receive financial assistance.
Chairman Arberry announced SB 79 would be heard out of order.
Senator Diana Glomb, Washoe County Senatorial District 1, testified SB 79 was one of a series of bills recommended by the Study Committee on the Reorganization of Child and Family Services. SB 79 would eliminate the financial means test for the subsidy program in order to encourage adoptions of special needs children, i.e., children with disabilities, older children or sibling groups.
Senator Glomb said the Division of Child and Family Services estimated the cost of foster care for special needs children awaiting adoption at $862 per month per child. If those children could be placed in adoptive homes and the adoptive parents subsidized for their care, the children could be maintained in the permanent placements for a cost of $302 per month per child. The estimated savings to the General Fund was approximately $838,000 per year.
Mrs. Evans noted she had served on the interim study committee with Senator Glomb. Adoptive parents and potential adoptive parents had testified to the importance of removing the financial means test. Adoptive parents faced a great unknown when assuming the responsibility of raising a special needs child. Adopting a special needs child could represent a substantial financial burden for the average family.
Senator Glomb added frequently it was unknown what emotional and physical problems might be manifested in special needs children at some later time.
Mrs. Williams said she wholeheartedly supported this bill. She noted people willing to adopt special needs children were an incredible group who needed all the support the state could provide. She agreed with Senator Glomb it was time to spend a little up front rather than spend a lot at the back end.
Mr. John Sarb, Administrator, Division of Child and Family Services, explained the foregoing comments summed up the Division's position. He expressed support for SB 79. Passage of SB 79 would enable the Division to place an additional 30 special needs children per year in adoptive homes.
Mr. Humke asked how many children were currently adopted annually through the Division of Child and Family Services. Mr. Sarb responded approximately 135 special needs children were adopted.
Mrs. Evans asked how the cost estimates were calculated. Mr. Sarb replied $302 was an average cost per child for foster care. Mrs. Evans asked if actual costs would be evaluated on a case-by-case basis. Mr. Sarb said costs would be evaluated for each case.
Senator Glomb noted fiscal staff had prepared a memo outlining technical changes which would be required in the budget if this bill was passed.
Chairman Arberry called for public testimony.
Ms. Bobbie Gang of the Nevada Women's Lobby and the National Association of Social Workers appeared in support of SB 79. She said it was important to encourage adoption of all children, especially those who were difficult to adopt. She expressed the opinion spending dollars up front for savings in the future was the only fiscally prudent way to go.
ASSEMBLY BILL 277- Expands eligibility for coverage pursuant to state plan for assistance to medically indigent.
Ms. Myla Florence, Administrator, Welfare Division, explained AB 277 related to presumptive eligibility for prenatal care. The bill was introduced at the recommendation of the Interim Study Committee on Welfare.
Mr. Florence noted presumptive eligibility was part of an overall program designed to promote early entry into and continuous prenatal care for low-income, pregnant women. She said early and continuous care was correlated with lower incidences of poor birth outcomes such as low birthweights, neonatal deaths, birth anomalies and birth complications for the mother. Barriers to receiving prenatal care included lack of financial resources, knowledge of importance of prenatal care, knowledge of public prenatal care programs and the ability to access public programs. Other states have implemented higher income limits for Medicaid eligibility, outreach programs, case management programs, public clinics and presumptive eligibility to address those barriers.
Ms. Florence explained Nevada was proposing to implement or expand outreach and case management programs through the Baby Your Baby program and the MOMS program of the Welfare Division. Presumptive eligibility would be another component of the overall program to promote early and continuous care and would address the barrier of access to public programs, specifically Medicaid. The need for presumptive eligibility was based upon the assumption that the Medicaid application process represented a barrier to early prenatal care. Women might lack the ability to complete application forms, application sites might be inconveniently located and delays in determining eligibility might delay prenatal care. Medicaid providers would be more willing to accept pregnant women as clients if there was a guaranteed payment source rather than a possible payment source while patient eligibility was pending.
Ms. Florence said under presumptive eligibility certain trained Medicaid providers could make a presumptive determination of client eligibility for Medicaid. Providers would have to meet several qualifications in order to be allowed to make the determinations. Single practitioners and clinics not already providing care or programs for low-income persons would not meet the qualifications. Qualified providers would assist clients in filling out Medicaid applications. A client would have to apply for Medicaid by the last day of the next month after she was determined presumptive eligible or she would lose her eligibility. Medicaid eligibility would continue until a determination of eligibility was made. Medicaid would pay for pregnancy-related services provided during the period of presumptive eligibility.
Ms. Florence pointed out research had shown low birthweight infants were 40 times more likely to die in their first few months of life. Seven percent of newborns had low birthweight and 60 percent of infant deaths occurred among low birthweight babies. Survivors were two to three times more likely to experience respiratory problems, hearing deficits and learning disabilities. Additionally, the average low birthweight baby cost $21,000 in the neonatal period. It was estimated 15 percent of very low birthweight neonates would have learning and developmental disabilities which would require long-term, specialized health care services.
Ms. Florence noted the percentage of low birthweight babies in Nevada for the years 1984 through 1988 was higher than the national percentage. Women who received late or no prenatal care were over 43 percent more likely to have a low birthweight baby than women who had received prenatal care during all three trimesters.
Ms. Florence said the tremendous advantage to the child and society at large for the child to be born healthy and free of handicaps could not be denied. A decision needed to be made to determine whether this program would be effective in reaching that goal and if the immediate monetary investment could be offset. A recent study by the Health Division showed a correlation between women who became eligible for Medicaid and entry into prenatal care. The results of the study indicated a presumptive eligibility program would assist in promoting early entry into prenatal care. The costs of implementing a presumptive eligibility program have been reviewed. Other states have not been able to identify the costs associated with presumptive eligibility programs because those programs had been implemented contemporaneously with other programs. Those states reported, however, the number of pregnant women on Medicaid programs had increased significantly.
Ms. Florence stated a major unknown factor was the number of pregnant women there were in Nevada with incomes below 133 percent of poverty who were not currently eligible for Medicaid. Thus, it was only possible to project the cost of presumptive eligibility within the range of $907,722 to $4.5 million in fiscal year 1993-94 and $959,112 to $6 million in fiscal year 1994-95. The low estimates assumed current clients would become eligible earlier and CHAP cases which were denied in fiscal year 1990-91 would initially be found presumptive eligible. High estimates assumed the same plus eligibility of the CHAP cases which were denied and eligibility of children born to eligible mothers for the first year of life.
Ms. Tiffany asked how clients presented themselves for assistance. Ms. Florence responded women might present at a district office of the Welfare Division or public clinics. They would be referred from those agencies to apply for Medicaid.
Ms. Tiffany said it appeared there were multiple programs and multiple eligibility requirements. She asked how clients were channeled into the most appropriate programs. Ms. Florence replied clinics had trained eligibility workers on-site to make appropriate referrals. Under presumptive eligibility the provider would have to be trained to determine eligibility requirements and assist clients with applications.
Ms. Tiffany said it was difficult for her to make a decision based on such a nebulous fiscal note. Ms. Florence said the Welfare Division staff and the Health Division staff had worked diligently to narrow the range of projected costs but it was an impossible task given the unknown factors. She noted savings had been incorporated within the Medicaid budget to offset costs based on the MOMS program and welfare reform. It was not believed any additional savings could be projected from presumptive eligibility.
Mrs. Williams asked what the base year for calculating 133 percent of poverty was. Ms. Florence said the base year was 1990.
Dr. Nancy Rody, Chairman, Presumptive Eligibility Subcommittee of the Governor's Maternal and Child Health Advisory Board, testified Nevada ranked 32 in the nation for infant low birthweight. Between 1985 and 1990 low birthweight rates in Nevada increased 5 percent.
Dr. Rody said early prenatal care was the best means of reducing low birthweight. Research had shown 28 percent of pregnant women in Nevada did not receive prenatal care in their first three months of pregnancy, the most important time for detecting and dealing with medical problems in pregnancy and for educating pregnant women about alcohol and drug use, smoking and nutrition.
Dr. Rody explained in 1991 Medicaid was billed nearly $25 million for newborns with problems associated with low birthweight. Medicaid charges for all normal newborns in 1991 was $2 million. She noted Medicaid savings resulting from early prenatal care programs would be realized within one year.
Chairman Arberry called for public testimony.
Assemblyman Vivian Freeman, District 24, said this bill represented a long-term solution to health care problems and should be seriously considered.
Dr. Trudy Larson of the Maternal Child Health Coalition of Northern Nevada testified presumptive eligibility was a priority item for the coalition. She expressed strong support for the bill because it represented a cost-saving measure. She suggested actual savings would be far greater than could be estimated.
Ms. Bobbie Gang strongly encouraged the committee to seriously consider funding this program.
ASSEMBLY BILL 431- Makes various changes concerning mental illness and retardation.
Dr. Zadny explained AB 431 was a housekeeping measure to revise the current statute. AB 431 would exempt state mental health hospitals from the provisions of the federal Patient Self-Determination Act requiring notification to patients of the availability of durable powers of attorney and living wills. He explained clients were not mentally competent to deal with the information provided and the application of the law was inappropriate in this instance. The bill would narrow the definition of "client" to someone who has been accepted to a mental facility and not discharged and rename the facilities to conform with current usage. The position title "Associate Administration for Mental Retardation" would be deleted pursuant to the recommendations of Legislative Counsel Bureau auditors. In addition, contractors would be required to be Board Certified.
Dr. Zadny went on to explain patients were physically restrained when they were taken outside the mental facility for medical treatment or other reasons. Currently the facility was required to file a denial of rights each time a patient was restrained. The bill proposed allowing the director of the forensic facility to order physical restraints.
Dr. Zadny said the bill also proposed strengthening the provisions of the current statute regarding client abuse and neglect and exempt clients from those provisions. He said it did not make sense to place people who were not responsible for their actions in a locked facility but then hold them responsible under the law for their actions. He noted abuse reports were required to be filed with local police every time one client struck another. Further, the bill would increase abuse of clients by staff members to a felony rather than a misdemeanor.
Dr. Zadny noted the current statute required the state to provide for all the client's needs. The bill would limit the requirement to the provision of treatment and care of clients in accordance with the policy of the facility. The bill would also make clients responsible for the cost of their care where possible.
Dr. Zadny listed several other proposed revisions to the current statute, including revisions recommended by legislative auditors and deletion of NRS Chapter 436, which contemplated development of a community mental health program funded by the counties but was never funded or implemented, and restructuring of the regional placement fund.
Ms. Giunchigliani asked who had requested the bill. Dr. Zadny replied the bill was requested by the Mental Hygiene and Mental Retardation Division to bring the statute in line with current practices. He explained the bill had received Commission approval.
Ms. Giunchigliani asked for clarification about the exemption from providing information about living wills. Dr. Zadny said state mental in-patient facilities were required to inform patients about durable powers of attorney and living wills. The bill would exercise an allowable exemption from that requirement. Ms. Giunchigliani inquired whether the patients' rights to enter into living wills would be jeopardized. Dr. Zadny responded patients would still have the right to draft durable powers of attorney or living wills.
Ms. Giunchigliani questioned why the federal law imposed this requirement on mental facilities. Dr. Zadny replied the federal law was an effort to educate people entering hospitals for physical care of some provisions they might wish to make in the event they did not survive the hospital stay. In most cases, mental patients survived their hospital stay. Additionally, they were not mentally competent at the time of admittance to make determinations about durable powers of attorney or living wills.
Ms. Giunchigliani asked why the director of the forensic facility was not currently allowed to order physical restraints. Dr. Zadny responded under current law, restraints could only be ordered by a physician in the name of treatment. In the subject instances restraints were not being used as treatment and, typically, the director of the forensic facility was not a physician. Ms. Giunchigliani said she could foresee abuses. Dr. Zadny responded the committee would have to have faith in the director's ability to exercise this authority wisely and in the client's best interest.
Ms. Giunchigliani asked why the physician did not consider restraints part of treatment. Dr. Zadny said the physician at Lake's Crossing had taken the position this was a public safety issue rather than a treatment issue and declined to authorize restraints.
Ms. Giunchigliani asked how "unjustified infliction" was defined. Dr. Zadny explained unjustified infliction referred to harming clients for no reasonable purpose.
Ms. Giunchigliani asked if someone could determine the infliction of pain, injury or mental anguish was justified. Dr. Zadny answered the language of the bill was tied to standard of care in the industry. If people were acting outside normal standards of care and were harming patients, their behavior could be construed as abuse for which they could be terminated and/or prosecuted under the law.
Ms. Giunchigliani inquired about neglect of clients who did not consent to treatment. Dr. Zadny said in cases where clients did not consent to treatment, treatment was prescribed according to the terms of the court-ordered commitment. The facility would continue to treat the patient without his or her consent.
Ms. Giunchigliani asked if treatment included nutrition, clothing and health care. Dr. Zadny responded treatment did not include nutrition, clothing and health care and the division was not funded to provide those things. He stated, as an example, the current statute required the division to furnish nutrition, clothing and health care for out-patients. Even in in-patient settings, the division was not funded to provide clothing for patients. He noted facility policy for treatment and care would encompass the needs of patients in treatment. He pointed out the statute applied to in-patient treatment rather than out-patient treatment. Ms. Giunchigliani suggested drafting sections in the statute for both in-patient treatment and out-patient treatment. She expressed the proposed revision could create a loophole allowing the facility to provide inadequate treatment. Dr. Zadny said that was a reasonable concern but it was not the intent of the bill. He pointed out the Division policy had been to pursue cases of abuse or neglect very aggressively.
Ms. Giunchigliani asked what kind of training mental health technicians were required to have. Dr. Zadny answered the Division trained and certified mental health technicians.
Ms. Giunchigliani questioned why technicians should be exempted from being charged with patient neglect if that was the area where abuses were occurring. Dr. Zadny said the intent of the bill was to define a realm of acceptable treatment, including the knowledge, skills and practices of professionals as well as people trained to be technicians. Behavior outside that realm could be considered abuse or neglect.
Ms. Giunchigliani inquired if technicians could then be charged with abuse under the statute. Dr. Zadny responded affirmatively.
Mr. Dini asked if the intent of the bill was to revert money that would go to community training centers. Dr. Zadny responded funding for the training centers was budgeted at fixed daily rates and payment was made as services were rendered. The current statute required ending balances to be distributed to the training centers on a pro rata basis. Practice in prior years had been not to make those pro rata distributions and it was the Division's position the centers should not receive money which they had not earned. The bill would delete the requirement from the statute. He noted the legislative auditors recommended the deletion.
Mr. Dini asked if the training centers relied on the money. Dr. Zadny responded the ending balance payments did not represent substantial amounts. Last year's balance was approximately $5,000.
Mr. Humke asked for clarification about how the bill would affect client-on-client abuse. Dr. Zadny replied the proposal was to omit client-on-client actions as grounds for abuse or neglect. Clients would still have the right to press charges against other clients. Under the current statute the Division was required to file reports with the police and the Office of Protection and Advocacy each time a client hit someone.
Mr. Humke questioned the need to change the current statute. It served to protect people. Dr. Zadny said clients who were confined because they represented a danger to others should not be held responsible for their dangerous behavior once confined. The statute also imposed a substantial burden on local police, who were reluctant to make the reports on cases which were frequently not prosecuted.
Mr. Humke asked if the bill was intended to revise the law because the law was unenforceable. Dr. Zadny said that was basically the intent. Mr. Humke said he was unsure if he agreed with Dr. Zadny's position.
Mr. Humke inquired whether the industry standard of practice was defined by the state facilities. Dr. Zadny said the Division did not support the original statute, which restricted standard of practice to the behavior of prudent medical personnel. He explained the Division staff consisted of people other than medical personnel. The revised statute would include non-medical personnel within the realm of staff members who were required to adhere to standards of practice.
Mr. Humke said he agreed with the current standard because it implied several levels of authority, each ultimately lying with a medical doctor. He said, as a practical matter, standard of practice was defined by the practice of the state facilities. Dr. Zadny said the language "persons professionally qualified" was intended to define people who were qualified to deliver services in state facilities. He said he was willing to negotiate alternate language.
Mr. Humke said he did not have a problem with the reference in the bill to trained technicians since the word "trained" placed liability on the Division to train staff and ensure they were working within the scope of their ability. He did have a problem, however, with the totality of the changes proposed.
Mr. Humke inquired whether NRS Chapter 436 had ever been implemented. Dr. Zadny replied to his knowledge it had not. He said the statute had envisioned the creation of a county system of care. The program had not been funded, however, and the legislation had never been used.
Mr. Humke questioned whether Dr. Zadny was proposing to delete Chapter 436. Dr. Zadny said the proposal was to repeal Chapter 436. Mr. Humke said he violently disagreed with deleting the chapter.
Mr. Price asked how long Dr. Zadny had been in his current position. Dr. Zadny replied he was appointed Administrator on July 2, 1992.
Mr. Price noted the Division was currently operating well but that had not always been the case. He suggested it was improper to set procedural law based on the people who happen to be operating any agency at any given time. The Legislature's job was to set long-range policy intended to function forever.
Mr. Price asked what procedures were used to develop or change institutional policy. Dr. Zadny said policy changes were made in-house. Mr. Price inquired whether changes in policy were subject to public hearings. Dr. Zadny said it was not industry practice to hold public hearings. Policy changes were subject to Commission approval, at which time public hearings were held.
Mr. Price said the bill appeared to be taking away patient rights in order to alleviate paperwork on the part of the agency staff. Dr. Zadny said he was committed to protecting client rights and most of the proposed changes to the statute would strengthen client rights. The current statute was in many ways unenforceable and reduced felonious conduct to misdemeanors. He said, as an administrator, he felt it was incumbent on him to try to revise procedures which were time consuming, did not make sense and were of no major consequence. Mr. Price stated the major consequence of an action was often revealed only after several years.
Chairman Arberry stated the committee had limited time in which to deal with this issue. He suggested this bill be assigned to the Mental Hygiene and Mental Retardation Subcommittee for further discussion.
Mrs. Williams pointed out some of the provisions of the current law which Dr. Zadny found difficult were provisions which had been added by the Legislature over the past few years.
Mr. Perkins noted clients were already exempted from criminal statutes if they were of unsound mind, and once clients recovered to the point of again being of sound mind, he would not want to see them exempted from the criminal statutes.
Mr. Perkins noted appropriate staff conduct could sometimes be misconstrued as "verbal harassment."
Chairman Arberry called for public testimony. There was none.
ASSEMBLY BILL 432- Makes various changes regarding administration of state welfare programs.
Ms. Nancy Angres, Chief Deputy Attorney General, Department of Human Resources, explained AB 432 was intended to update NRS Chapter 422, pertaining to administration of the Welfare Division, by deleting various outdated sections and adding new ones as appropriate.
Ms. Angres informed the committee an accompanying bill requested the transfer of several sections of the chapter to statutes which specifically governed the Division of Child and Family Services.
Ms. Angres stated AB 432 would add program definitions for food stamps, low-income home energy assistance, weatherization and the Child Support Enforcement Program. The definition of services to the aged, blind and disabled would be deleted since those services were no longer provided solely by the Welfare Division. The bill added a generic definition of "state plan" which would eliminate the need to define each program plan separately.
Chairman Arberry asked that this bill be submitted to the Welfare, Children and Aging Subcommittee for review.
ASSEMBLY BILL 554- Makes appropriation to department of human resources for grants to organizations that provide prenatal care to low-income women.
Assemblyman Vivian Freeman, District 25, reported AB 554 had been recommended by the Interim Study Committee on Welfare. The committee had discovered funding was required for prenatal care facilities providing care to women who would not otherwise receive it. She urged the committee to seriously consider supporting this bill.
Chairman Arberry called for public testimony.
Dr. Trudy Larson urged support of AB 554 primarily because it addressed support of organizations which provided prenatal care and would allow women to more easily access prenatal care. She pointed out educational campaigns such as "Baby Your Baby" were creating a need for additional prenatal services. AB 554 would assist organizations in providing prenatal care.
Ms. Bobbie Gang expressed support for AB 554. She noted this was a preventative measure which, hopefully, could avoid future crises.
ASSEMBLY BILL 557- Establishes minimum rates of compensation for provision of clothing to foster child.
Chairman Arberry rescheduled the hearing on this bill to a later time.
SENATE BILL 274 - Transfers responsibility for administration of account for aid for victims of domestic violence.
Mr. Sarb explained SB 274 would transfer the account for victims of domestic violence from the Division of Mental Hygiene and Mental Retardation to the Division of Child and Family Services. He noted the administrative staff had previously been transferred from the Division of Mental Hygiene and Mental Retardation to the Division of Child and Family Services. He pointed out the Division of Child and Family Services worked very closely with the family courts in Las Vegas and Reno and was a more appropriate location for this account.
Mrs. Evans asked for clarification of the mechanism for allocating funds which would be used by the Division of Child and Family Services. She noted allocation of funds from the Division of Mental Hygiene and Mental Retardation was subject to Board review.
Mr. Sarb explained the Mental Health Commission would retain oversight responsibility over allocation of funds.
Mrs. Evans inquired whether the Mental Health Commission had agreed to maintain that responsibility. Mr. Sarb stated the oversight responsibility of the Mental Health Commission extended to all mental health services, both public and private, and it was appropriate for the Commission to continue that role.
Mr. Dini noted allocations were based on populations. He explained rural counties had the same problems per capita as larger counties. He asked what services were provided to the small counties. Dr. Zadny replied many of the small counties formed consortiums. He noted the original legislation had set population limits at 13,000. The law was changed inadvertently to increase the number to 25,000. SB 274 would revise the number to 14,000 to recapture the legislative intent.
Mr. Dini asked who handled Storey County domestic violence cases. Mr. Sarb said Carson City handled Storey County cases.
Chairman Arberry called for public testimony.
Ms. Sue Mueschke, Executive Director, Nevada Network Against Domestic Violence, testified the population number was the figure which was in effect in 1989, before the Legislature conducted a census which changed several population formulas throughout the statutes. The Nevada Network Against Domestic Violence as well as the agency was unaware of the change, which effectively cut the budgets of three programs in half. SB 274 would reverse the effect of the census. She expressed support for SB 274.
CRIME PREVENTION - PAGE 30
Ms. Brooke Nielsen, Assistant Attorney General, said she was appearing at the request of the committee to answer some questions regarding the missing children coordinator position in the Attorney General's Office. The question posed by the committee was, "Why was the state performing crime prevention work when the counties were conducting similar programs?" She explained the position was established in 1983 to perform a strictly crime prevention function using federal funding for the McGruff program. Those federal funds had been withdrawn and the program had not been operating in several years. Counties were now primarily responsible for crime prevention programs in the form of D.A.R.E. programs. She explained the position in the Attorney General's Office now served as a missing children coordinator and performed crime prevention only in the context of missing children. The state was not duplicating the services provided by the counties.
Chairman Arberry asked if the position was still needed. Ms. Nielsen reiterated services were not being duplicated. She stated without this position the Attorney General's Office would not be able to perform a missing children clearing house function. She noted the function was mandated by statute.
Mr. Perkins agreed the missing children clearing house did not represent a duplication of services. He expressed concern about the title of the account, which seemed to be misleading.
Mr. Perkins asked how much of the position was devoted to the missing children clearing house function. Ms. Nielsen responded the coordinator had reported 95 percent of her time was devoted to the missing children clearing house. She agreed the title "crime prevention" did not accurately apply to the function of the office.
Mr. Marvel inquired how many children had been located through the efforts of this program. Ms. Nielsen answered 10 children were located in 1991. She explained approximately 10,000 children were reported missing in Nevada annually. Approximately 95 percent of those children were runaways. Approximately 200 children were victims of abduction--for the most part parental abduction--per year. The office currently listed over 200 open cases. She noted the missing children clearing house coordinator had assisted in the return of 10 to 15 children in 1992.
Mr. Marvel asked if Model Dairy was voluntarily printing photos of missing children on milk cartons. Ms. Nielsen responded affirmatively. She noted the missing children coordinator had also made arrangements with a theater chain to run photos of missing children in its advertising programs.
Mr. Humke noted the program description in the Executive Budget appeared to be outdated and there were no performance indicators.
Mr. Humke asked if most children were abducted in conjunction with custody battles between their parents. Ms. Nielsen said that was correct. There were very few abductions committed by strangers.
Mr. Humke questioned whether this program had outlived its usefulness. He pointed out in custody battles each party was represented by counsel. He inquired whether this was a matter more properly handled by the courts. Ms. Nielsen responded the courts played a large parts in settling the disputes; however, the courts were not in a position to locate abducted children. That was the function which the missing children coordinator performed. She said the position was still needed. In fact, the need was increasing.
Mr. Humke noted at the outset of the missing children program there was a public perception that there were hordes of child molesters abducting children when, in fact, children were being abducted by their parents. Ms. Nielsen said there was now a clearer public perception about the nature of abductions than there was initially.
Ms. Giunchigliani asked if local entities collected information about missing children or if this was solely a state responsibility. Ms. Nielsen answered this was a shared responsibility. She explained law enforcement agencies were required to transmit information regarding missing children to the clearing house as well as a national data base. The clearing house was the only office which networked with other states.
Ms. Giunchigliani inquired what efforts were made to coordinate with schools. Ms. Nielsen said the missing children coordinator had provided training programs for school police. Ms. Giunchigliani stated school police would not be the group she would target for training regarding missing children because they had limited contact with students. She asked what kind of training teachers had received. Ms. Nielsen stated the coordinator wanted to provide training to teachers as well.
Mrs. Williams asked if the coordinator position was filled by an attorney. Ms. Nielsen said it was not.
Mrs. Williams said this was an area of special interest for her. She expressed concern about situations where non-custodial parents violated Nevada law by abducting their child then going to another state and receiving a court order for custody from the other state. She asked if the Attorney General's Office did anything to fight for Nevada law and the integrity of a Nevada court decision that had been circumvented by another state. Ms. Nielsen stated the coordinator had worked with district attorneys and custodial parents to have warrants issued against the felony abduction.
Mrs. Williams inquired whether the Attorney General's Office would institute any legal action to protect Nevada statutes and court decisions in such instances. Ms. Nielsen said the Attorney General did not have the authority to institute an action. She noted a package of legislation was currently being proposed to strengthen the ability of one state to extradite the abductor and strengthen the uniform child custody laws. If that legislation passed, the Attorney General could serve as a greater resource to the parent from whom the child was abducted.
EMERGENCY MANAGEMENT - PAGE 1461
Mr. Jim Hawke, Director, Division of Emergency Management, distributed copies of a chart showing the organizational structure of the Division of Emergency Management (Exhibit C). The Governor proposed combining the Division of Emergency Management (DEM) with the State Emergency Response Commission (SERC) in order to improve efficiency.
Mr. Hawke explained he had been in his current position only 30 days. He said he was impressed with the interaction among DEM, SERC, the Highway Patrol, the Public Service Commission, Division of Environmental Protection, the Environmental Protection Agency and other agencies. He pointed out there was some duplication of service between DEM and SERC, however, and the Governor's proposal to provide administrative support to SERC using the current staff of the DEM was on target.
Mr. Hawke reported the DEM responded to 104 emergency incidents during the month of April 1993, 86 of which were hazardous materials spills. He noted there was no funding for hazardous materials spills in the DEM budget.
Mr. Hawke stated $103,000 was currently budgeted for administration of the SERC office. The Governor proposed transferring $177,000 from the SERC budget to DEM. As a result SERC would suffer a loss of approximately $74,000 which could be used for grants to local emergency planning councils (LEPCs). He said he would prefer not to diminish funding to the LEPCs; however, the DEM was issuing similar grants to the same LEPCs and he would like to see the DEM more fully support them. Under the Governor's proposal that would happen.
Mr. Hawke noted SERC had anticipated receiving $300,000 revenue annually from the Beatty site. The Executive Budget contemplated revenue of $150,000 in fiscal year 1993-94 and $300,000 in fiscal year 1994-95. Based on fee revenue currently being received, it was reasonable to project revenue of $300,000 in each year of the biennium.
Mr. Hawke stated transferring revenue from SERC to DEM would allow DEM to better coordinate funding to the LEPCs and provide funding for a 50 percent federally-funded hazards mitigation officer position to assist with earthquake preparedness. He explained legislation was pending which would create a seismic safety council. Staff for the seismic safety council would be funded by a federal matching grant. SERC revenue would allow DEM to provide the match.
Mr. Dini noted the 1991 Legislature had increased fees for hazardous waste in order to provide funding for the LEPCs and SERC. Now the Governor proposed using those funds for administrative costs and the DEM. He pointed out the LEPCs were relying on those funds to purchase first responder equipment and reducing that funding would be detrimental to providing good emergency response.
Mr. Hawke said he was reluctant to take money away from the LEPCs. He noted his background was in administering grants to local governments. He explained administration of some of the LEPC grants had been lax in the past. He would like to see grant funds spent in accordance with a more comprehensive and efficient plan.
Mr. Dini inquired whether the Governor proposed reducing the SERC board. Mr. Hawke replied the Executive Budget did not propose reducing SERC. He suggested reducing the board could realize a cost savings.
Mr. Dini asked how SERC would function under the Governor's proposal. Mr. Hawke stated the Executive Budget did not change SERC's responsibilities. It only changed the administrative support structure, which would come from the DEM. A portion of the salaries for the support positions would be paid from the SERC budget.
Mr. Dini questioned how great a fee increase would be required to return the $74,000 to the SERC budget. Mr. Hawke said he had not reviewed that possibility. That would be a decision for SERC to make. He noted grants to LEPCs had increased from $1,000 to $2,000 for a total cost of $30,000. He said he would like to maintain strong support for the LEPCs. It could be possible, with DEM administering the program, to locate other sources of federal revenue.
Ms. Janet Johnson, Principal Budget Analyst, Budget Division, noted the Governor had drafted legislation to reduce the size of the SERC commission.
Mr. Dini asked how debts to the counties would be repaid. Mr. Hawke said those audit problems would be corrected within a few months.
Mr. Dini questioned whether a portion of the deficit in the DEM budget was due to funding for Oasis. Mr. Hawke said all state agencies were strained by reductions in staffing levels and growth in the state. He noted DEM had been without an administrator for some time and the problem was lack of leadership. He explained the Oasis emergency operation center worked very well. He invited the committee to visit the facility.
BUDGET CLOSINGS
HIGHER EDUCATION
Chairman Arberry presented the report of the Higher Education Subcommittee. He explained the funding recommended in the Executive Budget was insufficient to meet the anticipated increase in student enrollment during the coming biennium. However, revenue was not available to provide the additional funding necessary to adequately support the projected growth in enrollment.
Chairman Arberry explained the Executive Budget recommended $388 million in General Fund support for the University and Community College System during the coming biennium. That was less than the amount appropriated by the 1991 Legislature for the current biennium.
Chairman Arberry said the instructional component of each budget was normally fully-funded for each budget and non-instructional support services components were funded at less than 100 percent of the amount generated by the various formulas. The lack of resources projected in the coming biennium had resulted in the Executive Budget not providing funding in the traditional method. The Executive Budget provided a base amount and then recommended a maintenance budget to fund projected enrollment growth. However, in most instances the maintenance budget was insufficient to fully fund instructional costs based on projected increases in student enrollment. The percentage of General Fund spending recommended for higher education in the Executive Budget dropped from 20 percent in 1991-93 to 18.2 percent in 1993-95.
Chairman Arberry reported the subcommittee recommended several adjustments to the Executive Budget. He thanked the subcommittee members for their hard work and the time spent in developing the revised budget.
Chairman Arberry noted the University and Community College System's Unemployment Compensation Fund had not been funded since fiscal year 1987-88 and had been operating on reserves. Reserves were no longer adequate to pay unemployment compensation claims during the coming biennium. The Executive Budget recommended an assessment of .22 percent of payroll during each year of the biennium to fund unemployment compensation claims for state agencies, but the University and Community College System budget was not funded for this assessment. The subcommittee recommended the .22 percent assessment be included in all University System accounts, requiring additional General Fund dollars totalling $354,950 in fiscal year 1993-94 and $364,871 in fiscal year 1994-95.
The University System Administration budget provided for the Board of Regents staff, including the Chancellor. Since fiscal year 1983-84, Regents Discretionary Funds totalling $69,429 per year had been utilized to partially fund the Chancellor's Office budget. The Executive Budget did not recommend utilizing this funding source during the coming biennium and recommended funding the budget 100 percent from the General Fund. The subcommittee recommended continuing to partially fund the Chancellor's Office budget from Regents Discretionary Funds in the amount of $69,429 each year.
Chairman Arberry noted the K-12 Subcommittee had revised the Student Incentive Grant funding provided by the University System. The corresponding adjustments to the special projects account would increase funding provided to the Student Inventive Grant Program by $2,822 in fiscal year 1993-94 and reduce funding by $3,816 in fiscal year 1994-95.
Chairman Arberry reported the subcommittee had heard public testimony regarding a proposed 9 percent student fee increase at the School of Medicine in each year of the biennium to offset program reductions which had been instituted as a result of budget reductions in the current biennium. The fee increase was estimated to generate an additional $104,793 in fiscal year 1993-94 and $223,570 in fiscal year 1994-95.
Finally, the Executive Budget did not provide funding to continue the Weather Modification Project in the coming biennium. In the past, the money committees had written a letter of intent to allow the Desert Research Institute to approach the Interim Finance Committee if conditions warranted continuation of the program in each year of the coming biennium. The subcommittee recommended that the Desert Research Institute be given a letter of intent allowing it to approach the Interim Finance Committee during the interim if funding for the program was required.
Chairman Arberry explained the subcommittee's recommendations would increase General Fund appropriations to the University and Community College System by $285,521 in fiscal year and $295,442 in fiscal year 1994-95 over amounts recommended in the Executive Budget.
Ms. Giunchigliani asked if the subcommittee was recommending adoption of the Executive Budget except for the adjustments delineated in the subcommittee report. Chairman Arberry said Ms. Giunchigliani was correct.
Ms. Giunchigliani asked what the subcommittee's rationale was for not funding growth in student enrollment. Chairman Arberry stated funds were not available. Ms. Giunchigliani pointed out the Executive Budget was not balanced when it was presented to the Legislature and at some point in time the Legislature had an obligation to properly fund the services expected by the public. She expressed concern about closing budgets without dealing with revenue issues.
Mrs. Evans stated she was a university employee and would be abstaining from voting on these budgets. Mr. Humke said he was also a university employee and would not be voting on these budgets.
Mr. Price asked if all of the Regents Discretionary Fund had supported the Chancellor's Office. Mr. Stevens said $69,429 per year had been used each year for the past 10 years to partially fund the system administration budget. The Regents had discretionary funds available over and above that amount to fund various other activities as they saw fit.
Ms. Tiffany expressed concern about the shortfall in the university's budget in the second year of the biennium. Chairman Arberry reiterated there was limited revenue to fund the budgets. He explained the committee would try to find some solutions to the problem before the end of the session.
Ms. Tiffany encouraged all the members of the committee to look at what must be done during the interim in order to properly fund the University System in 1995. Chairman Arberry said he was hopeful additional funding for the University System could be located before the end of this session.
Mr. Dini noted a 1986 study of higher education had resulted in a program for the future development of the University System. He said this budget represented a step backward for that program. He noted, however, unless taxes were raised, the state would have limited revenue. In the meantime, the budgets had to be closed based on revenue projections.
Mrs. Williams said this had been a very painful decision for each member of the subcommittee. Each one had strong feelings about higher education. She pointed out this committee had no authority to raise taxes, however. Its authority was limited to the appropriation of available funds. She said she supported the recommendation of the subcommittee.
Ms. Giunchigliani said, for clarification, she was aware this committee did not vote on taxes; however, the budget presented to the committee required the committee to vote on taxes one way or another. She added the committee had always taken the position of funding programs and allowing the Taxation Committee to provide funding. Now the committee was closing budgets based on insufficient revenue and further compounding the unbalanced budget. She said she would not support the higher education budgets in this way. She pointed out it was difficult for the committee to argue the need for taxes if it did not have the courage to fund the programs.
MR. MARVEL MOVED TO CLOSE THE HIGHER EDUCATION BUDGETS PURSUANT TO THE RECOMMENDATIONS OF THE SUBCOMMITTEE.
MRS. WILLIAMS SECONDED THE MOTION.
THE MOTION CARRIED. MS. GIUNCHIGLIANI WAS OPPOSED. MRS. CHOWNING WAS ABSENT. MRS. EVANS AND MR. HUMKE ABSTAINED.
BUDGETS CLOSED.
Chairman Arberry asked Budget Division staff to provide the committee with a written statement outlining the Governor's proposal regarding internal auditor positions. Mr. Thorne said he would deliver the request to the Budget Director.
Chairman Arberry asked for a committee introduction of a bill relating to venture capital delaying the expiration of certain provisions concerning the establishment of a program for the investment of new enterprises.
MR. MARVEL MOVED FOR COMMITTEE INTRODUCTION.
MR. SPITLER SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY. MRS. CHOWNING WAS ABSENT.
There being no further business, the meeting was adjourned at 10:32 a.m.
RESPECTFULLY SUBMITTED:
_________________________
C. Dale Gray
Committee Secretary
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Assembly Committee on Ways and Means
May 17, 1993
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