MINUTES OF THE

      SENATE COMMITTEE ON COMMERCE AND LABOR

 

      Sixty-seventh Session

      June 24, 1993

 

 

 

The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 9:30 a.m., on Thursday, June 24, 1993, in Room 227 of the Legislative Building, Carson City, Nevada.  Exhibit A is the Meeting Agenda.  Exhibit B is the Attendance Roster.

 

 

COMMITTEE MEMBERS PRESENT:

 

Senator Randolph J. Townsend, Chairman

Senator Sue Lowden, Vice Chairman

Senator Ann O'Connell

Senator Mike McGinness

Senator Raymond C. Shaffer

Senator Leonard V. Nevin

Senator Lori L. Brown

 

 

STAFF MEMBERS PRESENT:

 

Brian Davie, Senior Research Analyst

Sheri Asay, Committee Secretary

 

 

OTHERS PRESENT:

            

Joan Clements, Administrator, Manufactured Housing Division

Joe Guild, Attorney

Marolyn Mann, Executive Director, Nevada Mobilehome Park Owners Association

Jack Vergiels, Lobbyist, Nevada Association of Physical Therapists

Marsha Berkbigler, Lobbyist, Nevada State Medical Association

Ray Bacon, Lobbyist, Nevada Manufactured Housing

Tim Terry, Deputy Attorney General, Medicaid Fraud Control Unit, State of Nevada

Terry Rankin, Commissioner of Insurance, Department of Insurance, State of Nevada

 

 

Chairman Townsend opened the meeting and announced that a discussion of the trailer bill to Senate Bill (S.B.) 316 would take place at 2:30 p.m. today.

 

SENATE BILL 316:  Makes various changes to provisions governing industrial insurance.

 

Senator Townsend opened the hearing on Amendment No. 997 to Senate Bill 532.

 

SENATE BILL 532:  Allows conversion of master-metered water system in mobile home park or company town to individual water meters with approval of tenants or occupants of park or town.

 

Senator Brown stated, "The sections that are deleted are all the sections of the bill that had any changes at all, so it makes it an entirely new bill."

 

Joan Clements, Administrator, Manufacturing Housing Division, provided a definition of "company town."

 

Joe Guild, Attorney, elaborated on the definition.

 

There was general discussion on what constitutes a "company town."

 

Senator Brown explained the changes in Amendment No. 997. She stated:

 

      Page 2 is the part that would keep the owner from passing it through to the residents, in subsection g, and the terminology used is exactly the same as that that was used on that $12 fee, not to pass it through. I did notice that it didn't say "or rent increase" as a pass-through vehicle, but I was told that the intent, even on the $12 language, which is the same as this, was that it wouldn't be passed through in any way, shape or form. I'd like that to be in the minutes.

 

Senator Brown noted that the homeowner representatives had agreed to this amendment in front of the committee. She added, "It was agreed to by these guys, too."

 

      SENATOR O'CONNELL MOVED TO AMEND AND DO PASS S.B. 532 WITH AMENDMENT NO. 997.

 

      SENATOR BROWN SECONDED THE MOTION.

 

Marolyn Mann, Executive Director, Nevada Mobilehome Park Owners Association, addressed the committee in support of S.B. 532 with Amendment No. 997.

 

Ms. Clements stated that the only concern the mobile homeowners have is "that no charges be passed through."

 

      THE MOTION CARRIED UNANIMOUSLY.

 

 

      * * * * *

 

Senator Townsend opened the hearing on Amendment No. 991 to Senate Bill 488.

 

SENATE BILL 488:  Clarifies circumstances when compensation by physical therapist for referral of patient is ground for disciplinary action.

 

Jack Vergiels, Lobbyist, Nevada Association of Physical Therapists, addressed the committee on Amendment No. 991. He stated that the amendment grandfathers-in physician-owned physical therapy practices that were in business prior to July 1, 1988, and prohibits them from expanding beyond their present staffing.

 

Senator Shaffer asked, "As far as not extending their business, Jack [Vergiels], is this restrictive trade of any kind, is there any problem with the fair trade practices, or anything?"

 

Mr. Vergiels said there would be no such problem.

 

Senator Shaffer wondered if there would be a constitutional problem with a business not being allowed to expand. Mr. Vergiels said that attorneys have scrutinized this legislation thoroughly and found no problems of that nature.

 

Senator Nevin expressed a concern about page 2, subsection b, which restricts the number of personnel allowed. Mr. Vergiels explained that this is a compromise, because the physical therapists want a situation in which someone quitting would not be replaced, and the business would eventually phase out. He said that is not very realistic.

 

There was further discussion of subsection b, page 2. There was also general discussion on physician self-referral, as it is covered in S.B. 316. 

 

Mr. Vergiels stated, "Basically, what the physical therapy association is trying to do, is just like ophthalmologists cannot own optometrists, statutorily, they don't want physicians to own, or be able to hire, physical therapists." He explained that S.B. 316 is "purposefully full of holes, in terms of self-referral."

 

Senator Lowden said, "I think I'm pretty much on the record on how I feel about physician self-referral...I've been grateful that physicians bought equipment, and laid their money on the line when there were needs." She said she thinks they are now being told, "it's too bad, the competition is too tough, you've got to get rid of your stuff..."

 

Mr. Vergiels responded, "...This bill is specific only to physical therapists...."

 

There was further discussion on physician self-referral.

 

Senator Townsend expressed concern over a specific date being put in the bill, but he said he thought he could resolve that problem, and "bring it back to the committee."

 

Senator McGinness asked whether the number of personnel in practices in rural Nevada would be restricted. Mr. Vergiels responded, "This is only relative to physical therapy, and right now, you don't have any physician-owned physical therapy units in rural Nevada."

 

There was general discussion on how the bill would affect practices in rural Nevada.

 

In response to a question of Senator Brown regarding grandfathering people in, Mr. Vergiels reponded, "...We were thinking of putting

a 3-year disvestiture provision in there. The Governor had recommended 3 years at one time. However, the session meets again 2 years from now, and you ought to be able to evaluate those physician-owned units 2 years from now, and if it looks like they're gouging, because they're physician-owned, then in 2 years you'd have the opportunity to say that they have to get out in 1 year...."

 

Discussion ensued on how the physician-owned units will be monitored.

 

Marsha Berkbigler, Lobbyist, Nevada State Medical Association, testified that S.B. 488 "sets up a situation where physicians could not even employ, in their private practice, a physical therapist."

She said this could be a problem if carried to the extreme, i.e., a physician could not employ a lab technician, and a patient would have to be sent to a laboratory for blood tests. Ms. Berkbigler said it is ludicrous to compare physical therapists who are employed in a physician's office, or in a rural setting, with an optometrist. "It's like apples and oranges, it's not even the same thing," she remarked.

 

Ms. Berkbigler stressed, "We just want to make sure that we're on record, that we do have a very strong concern about a physician being told who he can employ in his office."

 

Senator Townsend thanked Ms. Berkbigler for her input.

 

Senator Townsend referred to a request by the Nevada State Board of Cosmetology to allow the board discretion in offering licenses to people who "dress differently than most people who practice cosmetology."

 

Senator Nevin stated he thinks this is an issue that should be handled by the city and the county.

 

Senator Lowden said, "As someone from southern Nevada, who has a constituency who is very upset about what's going on, I would like to see us move on this."

 

In response to a question by Senator O'Connell, Senator Townsend replied that the Nevada State Board of Cosmetology has not had a bill this year, "per my request from last year."

 

It was decided to attach this legislation to a current bill.

 

Senator Townsend opened discussion on Bill Draft Request (BDR) 53-2157 (Exhibit C). He explained the first section, which deals with the advanced practitioner of nursing.

 

There was discussion on section 3, regarding stress language. Senator Townsend noted that the goal of defining "stressful situation" has been realized.

 

There was general discussion on sections 4, 5 and 6 of Exhibit C.

 

Senator Townsend read section 7, subsection 4 to the committee. Senator Brown expressed her concern that "employers will just hire these people for a month and that's it." 

 

Ray Bacon, Lobbyist, Nevada Manufacturers Association, responded, "That's the one that had been discussed that all the intent was to do the 30 day thing. And then Jan [Needham, Bill Drafting Advisor] at the last minute asked Scott [Craigie], and Scott's the one that threw in the 1 year and readily fessed up that he did it without talking with anybody...and the intent had been 30 days, or some relatively short period of time, not an extended period of time."

 

Senator Brown said she favored 1 year, and reiterated her concern that an employer would hire someone for a month, and then let them go.

 

Senator Townsend referred to section 8, which changes the language from "claimant" to "person." He read subsection 2, which he claimed makes provision for offsetting the fraud investigation costs.

 

Senator Townsend discussed section 9, subsection 3 (Exhibit C), which deals with managed care organizations (MCOs). He questioned the manager's ability to offer a "certificate of authority." Senator Townsend read subsections 4(a) and 4(d), and commented that the language in 4(d) is not clear with regard to what constitutes "adjacent county."

 

There was general discussion on to what "adjacent county" refers. Mr. Bacon said his understanding is that "it is going to be based upon the location of work."

 

Senator Townsend asked Senator McGinness to assist in developing clearer language for section 9, subsection 4(d).

 

Section 10 was discussed, specifically the time interval for utilization reviews. Mr. Bacon remarked, "I believe what you will find the manager will actually do, is they will be doing an on-going independent utilization review of all the organizations, and it's going to be some sort of case-selected basis...."

 

Senator Lowden stressed, "...This committee wants an outside utilization review, and I think once every 2 years is at least what we want."

 

There was further discussion on the time interval for utilization reviews.

 

Senator Townsend explained section 11 as, "anyone who is in an MCO situation must go through that internal process, before they are allowed to go outside to appeal..."

 

Referring to section 12, Senator Nevin remarked that the hearings and appeals provision should not have been put back into the bill, because the original purpose was to streamline the process. He said, "It should be a mediation process so we can get that person out of the system."

 

In subsection 2 of section 12, Senator Townsend clarified, "...You have, many times, medium size employers who don't have a third party administrator, because they're not self-insured, but they don't want to do the claims themselves, so they hire somebody."

 

Senator Townsend referred to sections 14, 15, 16, 18 and 19 of Exhibit C. There was general discussion on subsection 2 of section 19, regarding the assessment for funding the fraud unit.

 

Tim Terry, Deputy Attorney General, Medicaid Fraud Control Unit, State of Nevada, commented, "...I've been in the joint money committee meeting this morning, and there has been a serious issue raised about the 90/10 split...there has been some serious questions about the fiscal note from the Attorney General's Office on the number of staff positions involved." Mr. Terry asked for the committee's support for the staffing increase.

 

There was general discussion on section 20, subsection 7.

 

Ms. Berkbigler referred back to section 18, and said, "...One of the things we intended to include was a private practice of a physician. In other words, if you had...an x-ray machine, you would not have to send the patient out." She concluded her remarks by noting, "The interesting thing about what this language does, is it protects an outside physical therapy unit or an outside x-ray unit, but it doesn't protect a single independent physician who is using it just for his patients."

 

Ms. Rankin referred to changes in section 21, subsection 1 (Exhibit C). She said that this language "amends S.B. 316, and it adds back in section 178, with the "p and a" [passage and approval] language."

 

There was further discussion of section 21, subsection 1.

 

There being no further business, Senator Townsend adjourned the meeting at 10:44 a.m.

 

                                    RESPECTFULLY SUBMITTED:

 

 

 

                                                            

                                    Sheri Asay,

                                    Committee Secretary

 

 

 

APPROVED BY:

 

 

 

 

                                     

Senator Randolph J. Townsend, Chairman

 

 

DATE:                                

 

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Senate Committee on Commerce and Labor

June 24, 1993

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