MINUTES OF THE JOINT SUBCOMMITTEE MEETING OF
SENATE COMMITTEE ON COMMERCE AND LABOR
AND
ASSEMBLY COMMITTEE ON LABOR AND MANAGEMENT
Sixty-seventh Session
June 25, 1993
The joint subcommittee meeting of the Senate Committee on Commerce and Labor and the Assembly Committee on Labor and Management was called to order by Chairman Christina R. Giunchigliani, at 10:10 a.m., on Friday, June 25, 1993, in Room 321 of the Legislative Building, Carson City, Nevada. There was no Meeting Agenda or Attendance Roster.
COMMITTEE MEMBERS PRESENT:
Senator Randolph J. Townsend, Chairman
Senator Leonard V. Nevin
Senator Suzanne Lowden
Assemblyman Christina R. Giunchigliani, Chairman
Assemblyman Bernard Anderson
Assemblyman Douglas A. Bache
GUEST LEGISLATORS PRESENT:
Senator Lori Lipman Brown, Senate District 7
STAFF MEMBERS PRESENT:
Denise Pinnock, Committee Secretary
Jan Needham, Senate Bill Drafting Advisor
Kim Morgan, Assembly Bill Drafting Advisor
Brian Davie, Senior Research Analyst
Frank Krajewski, Senior Research Analyst
Don Williams, Senior Research Analyst
OTHERS PRESENT:
Scott Craigie, Chief of Staff, Governor's Office, State of Nevada
Helen Foley, Lobbyist, Nevada Nurses Association
John McGlamery, Attorney, Director's Office, Department of Industrial Relations, State of Nevada
Bob Ostrovsky, Lobbyist, Consensus Group
Larry Zimmerman, Lobbyist, Consensus Group
Scott Young, General Counsel, Nevada State Industrial Insurance System
The subcommittee was formed to address Bill Draft Request (BDR) 53-2157 (Exhibit A), the trailer bill to Senate Bill (S.B.) 316.
BILL DRAFT REQUEST 53-2157: Makes various changes to provisions of S.B. 316 of this session.
SENATE BILL 316: Makes various changes to provisions governing industrial insurance.
Chairman Giunchigliani called the meeting to order and turned the meeting over to Senator Townsend. Senator Townsend submitted documents titled List of Items Approved for Consideration in the Bill as of Noon, June 23, 1993 (Exhibit B), and Technical Amendments to S.B. 316, June 21, 1993 - From Assembly (Exhibit C). The first item Senator Townsend opened discussion on was item 2 of Exhibit B, "Page 7, section 20, subparagraph 3(b), lines 44 and 45: Delete lines 44 and 45 and insert '(b)The primary cause of the injury was an event that arose during his employment; and'." This item is addressed to page 3, section 3 of Exhibit A. Ms. Giunchigliani said:
It was my understanding that the concern here was the issue of the place of employment, but in talking with staff, if you're in a truck, and that's where you're driving to, that's your place of employment. I think, also, that it's repetitive to say again "that arose out of and during the course of" because that's what's up in the primary section 1. My concern is this, if Mr. [Scott] Craigie [Chief of Staff, Governor's Office, State of Nevada] wants to address it, last Friday when we were doing the final signoff on the language, I stated I was not making any more changes on the stress language. I agreed to take out the term 'physical.' I don't think it's necessary to change this language again, and I'd like to know why this is coming back again to revisit us.
Mr. Craigie stated:
First of all, this is language that we wrote as a result of an issue that was brought by Senator Nevin. The statement that you made I will confirm, that is what you told me on the stress language, but we helped draft the language as we sat with [the Senate Committee on] Commerce and Labor to respond to a question that Mr. Nevin asked, and so I'll leave it....I don't know if anyone else wants to speak on that.
Ms. Giunchigliani remarked:
In my talking with staff they said that there is no problem with the terminology 'at his place of employment.'
Mr. Craigie explained:
I think the issue was just to make it clear and you're right about the truck example. That is the example that was used. They just wanted to make it absolutely certain that it was in the course of employment. Actually, the language that you agreed to could be construed as being more constrictive than the language that has been added.
Ms. Giunchigliani wondered how that could be. Mr. Craigie asked whether Ms. Giunchigliani was suggesting to remove all of subsection 3(b) or to leave it as it is. She suggested leaving it as it is if it is not a problem with interpretation. Mr. Craigie said the interpretation was that maybe that was too constraining.
He stated the italicized language was slightly broader than the language that was removed in the first line.
Jan Needham, Senate Bill Drafting Advisor, agreed with Mr. Craigie. She said "conditions at his place of employment" is more narrow than "some event that arose out of or during the course of his employment."
Ms. Giunchigliani questioned the value of repeating the phrase. Ms. Needham asserted the intent is to say the primary cause of injury is connected to his employment.
The next item was section 1 of the BDR. Ms. Giunchigliani said she and Helen Foley, Lobbyist, Nevada Nurses Association, had gone back and forth about this issue. She wanted to clarify the intent is to make sure the advanced practitioner of nursing (APN) could be reimbursed for service they provide, especially in the rural counties where, from time to time, there will not be a managed care organization (MCO) physician. Ms. Foley agreed, but explained it was not only intended for rural areas. Ms. Giunchigliani expressed concern the language would increase the scope of the APNs by equalizing them with the treating physician or chiropractor. Ms. Foley was afraid the nurse practitioner would be treating patients and the doctor would be signing the forms.
Ms. Foley clarified that APNs are not only on duty in emergency rooms. She said they treat within their scope on a regular basis.
Ms. Giunchigliani pointed out the APN is not going to be on a provider list from which patients are allowed to choose. Ms. Foley stated whether you choose to call them primary care providers or not, they are the first person a patient sees, in many cases.
Mr. Craigie stated the Governor's Office originally felt strongly the language should be removed, as Ms. Giunchigliani had been saying. The emergency or first visit situations have changed their perspective on the issue. He said that if the committees intended to keep the technical amendments bill confined to technical amendments, they should not be dealing with issues about which there were still arguments.
Ms. Foley said there is currently an advisory opinion from the Department of Industrial Relations (DIR) dating back to 1986 that says APNs can provide these services and be reimbursed for their services. She reiterated her concern that APNs would not be paid for their services. Ms. Foley stated the APNs do not want their scope increased.
Ms. Giunchigliani suggested the DIR handle the issue with regulation. John McGlamery, Attorney, Director's Office, Department of Industrial Relations, State of Nevada, said the advisory opinion binds the agency, and since the agency handles all the billing disputes, the situation is under control.
Mr. Craigie said it still looked to him as if the matter needed to be addressed in statute. He agreed with the principle Ms. Foley put forward and urged the research analysts to come up with language to resolve the conflict. Mr. Craigie suggested including a short section allowing DIR to adopt regulations that would define who in the MCOs can do the billing.
Senator Townsend stated the next issue was section 4 of BDR 53-2157, which would revise section 21.3 of S.B. 316. Ms. Giunchigliani objected to the new language saying it would mandate vocational rehabilitation start too early. Mr. Craigie said it seems to him the patient would have to be stable and rateable before the process could possibly begin. He said the intent of the language is to cut down the interim time between the patient becoming stable and rateable, and the rehabilitation evaluation taking place. Ms. Giunchigliani insisted the language would "start the clock" on rehabilitation before the patient was ready.
Senator Townsend pointed out the treating physician would still have control over the patient's care. He said the new language would allow the process to go more smoothly.
Ms. Giunchigliani wondered if there is currently any language to prohibit the vocational rehabilitation from starting earlier than 90 days in cases where the patient is ready. Bob Ostrovsky, Lobbyist, Consensus Group, called section 4, paragraph 5, to the committee's attention. He suggested the new language covered those patients who are not expected to ever return to work, who would benefit from earlier intervention.
Ms. Giunchigliani said her concerns had been addressed. Mr. Anderson also voiced concerns over the timetable, saying he does not want to discount the ability of an individual to be more successful in his rate of recovery than the protocol might mandate. Mr. Craigie assured him that would not be the case.
The next item is the addition of the injured employee's employer to the group with whom the counselor will work. Ms. Giunchigliani said she does not believe the employer belongs in this section because the employer, at that point, would have already decided the employee would not be going back to their place of business. Senator Townsend asked Ms. Needham if she thought the language was improperly placed. Ms. Needham agreed with Ms. Giunchigliani.
Mr. Craigie pointed out that remaining in touch with the employer would be an important part of the program because there might come a time when the employer would be willing to take the employee back.
Ms. Giunchigliani spoke to the deletion of possibly challengeable language in that section. She claimed that not considering an employee's age, sex and physical condition for the purpose of rehabilitation could be construed as reverse discrimination. Senator Townsend agreed to leave the language in the section.
The next item was section 7, paragraph 4. Mr. Craigie said his office agrees to the suggested change. The original language stated an employer in an on-the-job training program must continue to employ the injured employee for at least 1 year. BDR 53-2157 would change that time period to 30 days. Ms. Giunchigliani objected to the new time frame on the grounds it does not show a real commitment to the worker. Mr. Craigie asked if there was a time frame with which she would be comfortable. Ms. Giunchigliani replied, "6 months." Mr. Craigie countered with a suggestion of 3 months. Ms. Giunchigliani refused that suggestion. Senator Townsend pointed out 6 months might be a dissuading factor to the employer.
Larry Zimmerman, Lobbyist, Consensus Group, explained from an administrator's point of view it is very hard to find jobs for injured workers who cannot return to their former jobs. He said without a great incentive for employers to take the worker on, it is very difficult to place the injured worker. From the perspective of the small employer, he would not have taken any of the injured workers on had he not been reimbursed 100 percent of their wages. Mr. Zimmerman stated if he were required to keep that injured employee on for any length of time he would not even participate in the program.
Ms. Giunchigliani argued the section did not mandate the employer had to keep the worker. She said the intent was for the employer to get 50 percent of the employees wage on a wage subsidization program. If the employer chooses to retain the worker for a period of time the employer would be paid another 50 percent of the original wage. Mr. Zimmerman stated he completely understands the program, and maintained his position that the additional hoops are a great disincentive to employers.
Scott Young, General Counsel, Nevada State Industrial Insurance System, said he thought the point Mr. Zimmerman was trying to make is the employer would not even hire the injured worker to begin with if the language requiring retention of the worker is not deleted.
Mr. Craigie added that, in the casino industry, normal probationary time is 60 to 90 days, so the employer would have to make that person a permanent employee in order to meet the time-frame criteria of the program.
Ms. Giunchigliani reiterated her suggestion of 3 months. Mr. Craigie accepted her suggestion. Senator Townsend said it would be worded as 90 days.
Senator Brown objected, saying the change the subcommittee was discussing was substantive, rather than technical.
Senator Townsend reminded Mr. Craigie of the agreement they had reached stating any disagreement would result in no change being made.
The assembly members of the subcommittee were called to the floor at this point, but they agreed to recess the meeting at 11:15 a.m. and reconvene the meeting later in the day. Due to conflicting schedules, the meeting was not reconvened.
RESPECTFULLY SUBMITTED:
Denise Pinnock,
Committee Secretary
APPROVED BY:
Senator Randolph J. Townsend, Chairman
DATE:
Assemblyman Chris R. Giunchigliani, Chairman
DATE:
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Senate Committee on Commerce and Labor
Assembly Committee on Labor and Management
June 25, 1993
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