MINUTES OF THE
SENATE COMMITTEE ON FINANCE
Sixty-seventh Session
February 23, 1993
The Senate Committee on Finance was called to order by Chairman William J. Raggio, at 8:02 a.m., on Tuesday, February 23, 1993, in Room 223 of the Legislative Building, Carson City, Nevada. Exhibit A is the Meeting Agenda. Exhibit B is the Attendance Roster.
COMMITTEE MEMBERS PRESENT:
Senator William J. Raggio, Chairman
Senator Raymond D. Rawson, Vice Chairman
Senator Lawrence E. Jacobsen
Senator Diana M. Glomb
Senator William R. O'Donnell
Senator Matthew Q. Callister
COMMITTEE MEMBERS ABSENT:
Senator Bob Coffin
STAFF MEMBERS PRESENT:
Daniel G. Miles, Fiscal Analyst
Robert Guernsey, Principal Deputy Fiscal Analyst
Larry L. Peri, Program Analyst
Joan McConnell, Committee Secretary
OTHERS PRESENT:
Stephen A. Shaw, Administrator, Rehabilitation Division, Department of Human Resources
Judy Matteucci, Director, Department of Administration
John R. Orr, Deputy Administrator, Rehabilitation Division, Department of Human Resources
Rochelle Summers, Principal Budget Analyst, Budget Division
John Chambers, Chairman, Governor's Planning Council on Developmental Disabilities
Elizabeth M. Breshears, Chief, Bureau of Alcohol and Drug Abuse, Rehabilitation Division, Department of Human Resources
Kevin Quint, President, Nevada Association of State Alcohol and Drug Abuse Programs, (NASADAP)
Senator Raggio referred to Exhibit C, a draft of a letter requested by the committee.
Senator Callister suggested on page one of the letter, the second paragraph, the second line, be changed to read as follows:
...consideration, heard testimony that such an investigation is already underway and that the whole...
Senator Rawson found the draft of the letter describes well the intent of the Senate Committee on Finance to encourage there be an investigation of the alleged misconduct related to the 1992 general election in Clark County. He stated he does not want to give up the right to go into this issue if it is not pursued.
Senator Raggio authorized the letter, with the changes, to be formally drafted and be directed to the chief judge of the Eighth Judicial District and also to the district attorney, the sheriff of the Metropolitan Police Department, and to the chairman of the county commission. The letter will be made public, and the media is invited to have a copy of the letter.
Vocational Rehabilitation - Page 1017
Stephen A. Shaw, Administrator, Rehabilitation Division, Department of Human Resources, stated the Rehabilitation Division directs services provided through the Bureau of Alcohol and Drug Abuse, the Bureau of Disability Adjudication, the Bureau of Services to the Blind, and the Bureau of Vocational Rehabilitation, and the Developmental Disabilities Program, as well as a number of related grant programs. They have very different systems, and in some of those programs state employees actually deliver the service. About half of the programs are privatized. There is every mix of funding, from 100 percent state to 100 percent federal.
The Governor's proposal for SIIS (State Industrial Insurance System) reform and government reorganization has significantly affected the budget request of the Rehabilitation Division. Specific detail will be addressed in the individual budget accounts. The three most significant changes include a transfer in the Bureau of Alcohol and Drug Abuse from the Rehabilitation Division to the Health Division. The second one is transferring the Rehabilitation Division from the Department of Human Resources to the new Department of Employment Training and Rehabilitation, with the attendant reorganization savings. The third major change is transferring the responsibility for the vocational rehabilitation of injured workers from SIIS to the Rehabilitation Division, and the assignment of resources necessary to accomplish this job.
The Governor's recommendation for state General Fund support to the programs of the Rehabilitation Division are approximately 22 percent less for the coming biennium than were appropriated by the legislature for the current biennium. That amounts to $2.8 million.
Mr. Shaw said they were able to increase the division's share of non-General Fund appropriation, approximately $2.4 million. He added it was not possible, with $2.8 million (across the entire budget) over the biennium, to maintain services at the current level.
Senator Rawson asked Mr. Shaw where the vocational rehabilitation
takes place.
Mr. Shaw stated there is a main office in Las Vegas, plus five outreach offices in different parts of Clark County, an office in Henderson, an office in Reno, and three outreach offices. Also, there is an extensive rural network based in Fallon, Winnemucca, Ely, Elko, Hawthorne, and Carson City. SIIS vocational rehabilitation acts independent of these locations.
Mr. Shaw mentioned Senate Bill (S.B.) 7 of the Sixty-sixth Session mandated Rehabilitation Division join a cooperative agreement with SIIS, which they did to cover the rural areas. The Governor's proposal for SIIS reform would have Rehabilitation Division performing all rehabilitation for injured workers, and workers with a disability not related to work.
SENATE BILL 7
OF THE SIXTY-SIXTH SESSION: Makes various changes relating to industrial insurance and other rights of employees.
Mr. Shaw said the Rehabilitation Division has always been the deliverer of services in the rural areas. SIIS does not have a rural delivery system. The responsibility for vocational rehabilitation will be in this budget. It is budgeted for 74 new positions, 47 new rehabilitation counselors, 23 rehabilitation technicians, four supervisors, and five accounting positions.
The Rehabilitation Division was asked to develop a budget to perform the rehabilitation duties currently functioned by SIIS. Rather than develop an entirely new and discrete program it was integrated with our existing program.
Senator Rawson mentioned 2,300 people have applied, and asked,
"When you take on the SIIS load, does that just double?"
Mr. Shaw replied:
Approximately. Our budget was based on 3,600 additional figures. The Performance Indicators were done quite a bit previous to the proposal for us to assume SIIS. None of the proposal's indicators are reflective of us assuming SIIS, and therefore are inaccurate.
Senator Raggio suggested the Performance Indicators be redone, to indicate the additional SIIS caseload and submitted to the committee.
Senator Rawson asked Mr. Shaw if he felt optimistic about the changes and about providing a dependable and good service.
Mr. Shaw said he did feel good about the changes, as they did originate from his division.
Senator Raggio asked, "If a worker is injured in Washoe County, under this program, who will undertake the responsibility for both the physical and vocational rehabilitation of that worker?"
Mr. Shaw stated SIIS would continue to be responsible for the physical portion of the rehabilitation, both in and out of the hospital. Given the referral up front, Vocational Rehabilitation
could begin treatment while the injured worker is in the hospital.
Senator Raggio expressed his concern about the possibility of providers fighting over the vocational rehabilitation of the injured worker. It is his desire to get the injured worker the needed physical and vocational rehabilitation as early as necessary, and the physical rehabilitation to cease when no longer necessary.
Senator Glomb asked how SIIS will be able to provide the physical rehabilitation aspect of their service, if so many of the rehab workers, nurses, etcetera, have gone to vocational rehabilitation? Where are they going to get the staff to follow the client through the physical rehabilitation?
Mr. Shaw replied, "Our proposal calls for 79 positions. If there are people at SIIS who meet our qualifications we would certainly hire them."
Judy Matteucci, Director, Department of Administration, commented:
In our proposal we had a very structured managed care proposal. Managed care is the medical portion of the rehabilitation as you're discussing now. If you are to go to a very strong managed care proposal, then the managed care proposal is going to take care of that individual through the medical necessities of rehabilitation. You do not need employees over at SIIS if you go to a very strict managed care proposal.
Ms. Matteucci agreed with Senator Glomb that the private sector would provide the actual physical rehabilitation, while SIIS's function would be more managerial and referral.
Senator Raggio asked if anyone has looked into the cost effectiveness, or potential of savings, as far as SIIS is concerned, if the Jean Hanna Clark Center were not operating.
Ms. Matteucci indicated she had not looked into it, but would.
Mr. Shaw stated the Rehabilitation Division was faced with a choice, at the time of budget cutbacks, of aggressively moving out in different directions, or pessimistically wringing their hands. The division is now pursuing third-party funding through revenue from their facilities, capturing federal dollars never captured before, and bringing in revenue through their SIIS contract.
A conscious effort was made to get involved in redistribution of federal dollars. There are more and more states unable to match their federal allocation, so the more money the division is able to match at the end of the year that is redistributed, the more is brought into the State of Nevada. Private insurance money is also being captured.
Mr. Shaw continued reviewing the budget, and stated:
The major features of this budget, in addition to the SIIS which we've been discussing this morning, lies on page 1018, decision item number 200. This calls for the additional service of the Laughlin [Nevada] area. Heretofore we were providing limited service to the Laughlin area, which is growing in population. It's demographically driven...This calls for a continual run from Las Vegas to the Laughlin area.
John R. Orr, Deputy Administrator, Rehabilitation Division, Department of Human Resources, commented the division has been working for the last 2 years with a consortium of agencies, including mental health, to identify ways of delivering services in Laughlin. What is developing is kind of a tri-state compact between California, Arizona and Nevada. The itinerate counselor would take advantage of permanent facilities being established either in Bullhead City, or Laughlin, by the tri-state group, probably Arizona. Mr. Orr continued:
The distribution of the resources connected with the Governor's proposal regarding SIIS is yet to be confirmed. We have convened six teams of our employees to study the resource distribution. It would not surprise me to learn that we would need a full-time presence to handle injured workers in Laughlin. In that event the resources are in the Governor's budget to hire one or two rehabilitation counselors, a rehabilitation technician to assist them and run the office, and to establish an office in Laughlin.
Senator Raggio reiterated, "What is this injured worker in Laughlin going to get from this service?"
Mr. Orr replied:
Vocational Rehabilitation, a state/federal program is authorized by federal law to provide a long list of 16 services, the 16th of which is any other rehabilitation service necessary to achieve employability for the disabled person. There are essentially no boundaries. The division I think you were searching for earlier, between the responsibility of SIIS as an insurance, and us as a return-to-work agent, is just that...any services necessary to return a worker to productive, competitive employment are available through our existing program.
A counselor in Laughlin...counselor is probably a misnomer, if fact the state personnel system describes that position as a rehabilitation coordinator as opposed to counselor. They are in large part masters-degreed, professional, vocational rehabilitation counselors, but counseling is not all they do. They coordinate that vast array of services, anything that is necessary to return that individual to work.
If a particular service, a particular training component, for example, was not available in Laughlin, then the counselor, or the coordinator, would make the arrangements necessary to send the injured worked to Las Vegas, or to Phoenix, or to wherever that training opportunity was most convenient.
Mr. Shaw assured a full-time presence of at least one rehabilitation coordinator, and one rehabilitation technician, in Laughlin, if the legislature and the Governor decide to give the responsibility for SIIS to the Rehabilitation Division.
Senator Raggio encouraged discussion on the Enhancements portion of the budget.
Mr. Shaw informed his division would like to handle the high school population statewide, known as the transition population. The schools currently have responsibility for them, and they are oftentimes handed over to the Rehabilitation Division at age 22. At age 18, or until age 22, they can stay in special education.
Mr. Orr said the division has identified 51 high schools in Nevada, which are being served on an itinerant basis. In 1992, 162 referrals were identified within the caseload as being elementary, or high school referrals. The numbers are expected to double, by doubling the presence of the division time-wise, in those 51 schools.
Senator Glomb wondered if the school provides the rehabilitation component for the disabled children of 16 and 17 years old.
Mr. Orr replied:
No, Senator. The school is required to do transition planning, to develop an ITP [Individualized Transition Plan]. That plan relies on the vocational rehabilitation agency to step in and pick up our responsibilities involved in that transition.
Senator Raggio referred to Item 702, Medical Contracts vs Medical Positions, where the agency will no longer have the half-time doctors and half-time nurses, and apparently physical exams are no longer required in every case, he asked, "Where is the funding you will have for those that do require?"
Mr. Shaw replied, "It's in our client's service budget."
Senator Raggio inquired, "Is that adequate?"
Mr. Shaw responded, "Yes. We found out we could do it cheaper and serve the client better."
Senator Raggio requested an update on the Performance Indicators in this budget.
Social Security Administration - Vocational Rehabilitation - Page 1024
Mr. Shaw stated the budget houses four programs, which are managed out of the administrator's office: The Social Security Reimbursement Program, the Client Assistance Program, the Drug Addicts and Alcoholics Referral and Monitoring Program (DA&A), and the In-Service Training Grant. Only the In-Service Training Grant contains state funds, a 90 percent federal and a 10 percent state match, equal to $10,000.
The Social Security Vocational Rehabilitation Reimbursement Program was created late in Fiscal Year 1990 to capture federal funds payable to the state agency for reimbursement for costs associated with returning Social Security Insurance and Social Security Disability Insurance. To date the program has brought in $311,000 at a total cost of $153,000. The profit of $157,000 has been used to provide necessary support for the PCA (Personal Care Attendant Program), the Deaf Resources Center Program, Vocational Rehabilitation Program, and support of relocations to the Reno District Office.
Changed federal regulations on the use of this money will limit future benefit to the rehabilitation programs in the Bureau of Service to the Blind and the Bureau of Vocational Rehabilitation.
The Client Assistance Program (CAP) assists and advocates for clients in various division programs. The CAP is entirely federally funded. Federal reports have recognized Nevada CAP as among the best in the nation.
The DA&A Program was created in 1993. If somebody should be getting Social Security benefits, as a result of cocaine or alcohol addiction it is a federal issue, but it is the agency's feeling he/she should be involved in a treatment program, or at least evaluated and referred for treatment.
Hearing Devices Program - Page 1029
Mr. Shaw stated this account is repository for the telephone line surcharges collected by the PSC (Public Service Commission) for the purpose of distributing TDDs (Telephone Devices for the Deaf) and operation of the statewide TDD relay system. The budget is subject to PSC (Public Service Commission) approval and will be presented to them in their April 1, 1993 meeting. There are no state dollars in this.
Senator Raggio asked who the individual is that actually supervises this program.
Mr. Shaw said the TDD distribution is done by the Deaf Resources Center in the north, a part of Nevada Center for Independent Living, and is funded through this program for this distribution. In the south it is the Nevada Association of the Handicapped. The TDD relay itself is a privatized matter. The contract was let on a competitive basis to Sprint, who operates and maintains the TDD relay system, which is almost in full compliance with the ADA (Americans with Disabilities Act). The only non-compliance is not having the capability of international calls.
Mr. Orr stated this Executive Budget portrayal does away with state support for the Deaf Resources Center. This budget anticipates some flow-through PSC support for the Deaf Resources Center. In 1992, prior to any reduction of state funding for the Deaf Resources Center, the Nevada Association for the Handicapped (NAH) received $63,120 of General Fund money, and $10,463 from the surcharge. Now, in 1993, following the elimination of the state support, NAH receives $34,308 from the surcharge, almost triple the amount, and another $9,700 is pending approval April 1, 1993, by PSC.
Senator Raggio requested a paper be presented on the effect on the Deaf Resources Center, what the change will be in their funding and the services that will be available.
Community Based Services - Page 1033
Mr. Shaw said this is another budget that is almost entirely privatized.
Senator Raggio asked, "In addition to the loss to the Deaf Resources Center, what other loss of services are reflected in this budget?"
Mr. Shaw replied, "There's a loss $60,000 to $70,000 on supportive employment, $60,000, which is all the state monies in supported employment follow-along. That aspect is passed on to community-based agencies."
Senator Raggio asked, "Is this a job coach's program?" Mr. Shaw replied it is. Senator Raggio added, "What are you indicating, that you're exploring natural support available to private sector employees as a substitute?"
Mr. Shaw responded, "Natural supports have never been allowed by the law with the re-authorization of the rehab act."
Senator Raggio asked, "What does that mean?"
Mr. Shaw said, "That means a relative. A relative can be a natural support. A coworker, a supervisor on the job can be a natural support."
Senator Raggio commented, "These are people who are so severely disabled that they are not, on their own, able to enter the job market. They've had a coach under this program to follow through for them. There will be no funding for that now?"
Mr. Shaw replied:
This is for the follow-along coach. There are two coaches. There's a supportive employment coach that works side by side with the person day in and day out. They're weaned off the program. When it gets to a certain point, the follow-along coach is no longer there. The initial one, and another one, is substituted to follow that client throughout life. They're on a much less intensive basis, but the employer has access to them in terms of handling any difficulties that come up. It's a real success for technology in my opinion for dealing with very severe disabilities.
Senator Raggio asked, "Was the $170,000 that's in the work program for that program. Is that what that was for part of it?"
Rochelle Summers, Principal Budget Analyst, Budget Division, replied:
Sixty thousand of that was for the supported employment follow-along coaches, and $110,000 was for the Deaf Resources Center. That was part of the General Fund dollars that were reserved as part of the budget reduction planned by this agency.
Ms. Summers added all of the General Fund money previously in this account is now out.
Senator Raggio said, "It seems to me a small amount of General Fund money, for two valuable programs that are being cut out of this budget. What was the reason for that? Do you consider these programs were of little value?"
Mr. Orr replied:
If you look at the revenue on detail sheets, and I don't believe you have that in front of you, you would see that the federal support for supported employment continues at $250,000 a year. Plus, we have a $350,000 a year supported employment-expansion grant. So, supported employment is not being ignored in this budget.
Senator Raggio asked if the $60,000 takes away the follow-along portion.
Mr. Orr commented:
Six years ago, when supported employment was first funded by the Rehabilitation Services Administration, as part of Title VI, Part C of the Rehabilitation Act, the requirement was to use any funds out of Title VI, Part C for the primary job coach. There was an absolute limitation on using any of that federal money for the secondary or follow-along job coach. The responsibility was on the state agency to identify resources to provide that follow-along. That's when we came to this body and asked for $60,000 to hire two follow-along job coaches.
Now the mood in Washington has changed, and they no longer require that cash support from states. Now they say there are alternatives. We would like to have the $60,000. We would like to have a lot of things. When we had to cut over $2.5 million we had to cut some programs that we are very proud of and hold very dear. But, our intention was to protect the core services. We could give up this $60,000 without putting the federal grant at risk, so that means we still have $600,000 a year of federal money in Nevada for supported employment.
Mr. Shaw emphasized the agency does not think any less of these programs. They cut virtually every program they had.
Services to the Blind - Page 1038
Mr. Shaw stated this account contains funding from various sources to support the Bureau of Services to the Blind program and vocational rehabilitation, providing social services, independent living, for both the general constituency and particular services for the elderly, a recreation and low vision clinic. He added:
When the budget was prepared, a 20 percent match requirement for the elderly blind grant was anticipated but not confirmed...By the time negotiations were entered into with the budget, the 20 percent figure was dropped entirely. Information available showed there was no match required. Subsequently, with the re-authorization of the rehabilitation act, a match requirement was put back in, equaling 10 percent.
Senator Rawson remarked, "We've struggled with the waiting list in this area in the past. Can you give me an idea what they are, and could we add that to the Performance Indicators?"
Mr. Orr said he could certainly add waiting list information to the Performance Indicators.
Senator Rawson noticed, in looking at the existing Performance Indicators, there is a general downturn, such as the number of clients diverted from institutional care.
Mr. Orr said:
In the case of Performance Indicator number 15, the bureau felt it was prudent to back off of their projection from '93, because '93 included $98,100 in state support for the elderly blind, which is not requested in this budget and would not be available in '94 or '95. The diversion from institutional care is a result of the activities, primarily of two programs, the elderly blind program and the Title XX program. In previous years we had only reported the Title XX successes, if you will, and now this merges both the successes realized in Title XX and in the elderly blind.
The reduction may be a safe number and not very challenging, but it also recognizes a reduction in state support.
...We would welcome the opportunity to revise these Performance Indicators, and we've told Ms. Matteucci exactly this, but we don't have the freedom to do so independent of the committee.
Senator Rawson stated:
I think one way to do that...I would be interested as you present a budget in the future that you talk specifically about some of these goals that have been set and where you are, and then talk to us in terms of we would recommend that there be a change, or adjustment. Because, as time goes you will be held more and more accountable to those things.
Senator Callister commented, "Maybe you can explain what is the recreation program as described in the budget? Apparently there's no continuing funding for the recreation program for the blind. Are you familiar with that?"
Mr. Orr stated the legislature has funded, for at least 10 years, an adaptive recreation program in Washoe County, which teaches someone who suffers a traumatic disability, opposed to a congenital one, to engage in leisure time activities and sports. In Washoe County, double amputees are taught to ski. Blind people are taught to wind surf. The Rehabilitation Division attempted to duplicate the Washoe County program in Las Vegas, but was unsuccessful for the past 3 years, and finally cut it from the budget this year.
John Chambers, Chairman, Governor's Planning Council on Developmental Disabilities, stated there was an attempt, a couple of times, to duplicate the program offered in Washoe County. Some of the problems with the program are a liability factor of snow skiing and wind surfing availability in Las Vegas. Las Vegas has offered a program, through the regular recreation program, as a mainstreaming program for the vocational rehabilitation clients in southern Nevada. There is one existing program through our Stewart Mohave Sports Center. It provides a fitness and wellness program for the vocational rehabilitation clients on a drop-in basis.
Senator Callister wondered why southern Nevada did not want to adopt an innovative program similar to the successful one in the north, rather than have a continuous wellness program. He asked, "Is a good program, a bad program, why don't you want to do it, why don't you want the money?"
Mr. Chambers replied:
We started an outreach program about 8 years ago. Our liability is cost prohibitive as a city being self-insured. We're seeking other avenues to try and grow in that program, but we are stagnant with the self-insurance of the City of Las Vegas.
Mr. Shaw stated the difference between southern Nevada and northern Nevada is in northern Nevada state employees deliver this service, the liability falls to the state.
Mr. Chambers said, "We have gone outside recently with the National Handicap Sports Association and have tried to fall under their umbrella insurance as a nonprofit agency to provide those services."
Developmental Disabilities - Page 1050
Mr. Chambers distributed a letter to the Senate Committee on Finance from John Chambers (Exhibit D), and a copy of the Nevada Times newspaper(Exhibit E. Original is on file in the Research Library), and discussion ensued.
Senator Glomb asked if the agency was not eligible for more federal money since the state is growing in population.
Mr. Chambers had requested more funds and was granted "the next notch up" from the minimum allotment with the new census in 1990.
Senator Glomb pointed out on the budget that Out-of-State Travel was not approved. Mr. Chambers agreed.
Senator Raggio asked if there are federal funds available for Out-of-State Travel.
Mr. Chambers commented, "This is entirely federally funded." Federal funds were not approved for Out-of-State Travel.
Ms. Summers responded, "The federal dollars were put towards the Developmental Disabilities Grants category rather than being used to fund additional Out-of-State Travel." To use funds for Out-of-State Travel, the amount would have to be reduced in the grants category.
Senator Raggio asked, "With that alternative what do you suggest?"
Mr. Chambers replied, "I'd like to have $5,471 in category 2 for Out-of-State Travel, out of the grants fund." Mr. Chambers added the out-of-state travel for the three trips he feels imperative to make, helps the grantees.
Senator Glomb stated she felt the agency should be able to manage the funds as they see fit, if they feel the out-of-state travel is necessary.
Blind Business Enterprise Program - Page 1044
Mr. Shaw stated this account supports the Bureau of Services to the Blind, whereby legally blind persons operate small businesses with the guidance and support of program staff. All activities are funded by program income. It is independent of federal support and state support. This budget portrays a culmination of 5 years of planning, whereby accumulated reserves will be invested in major developments in Las Vegas and Boulder City. There are no state funds and no new positions.
Senator Raggio asked, "In renegotiating these contracts, is the state anticipating taking a bigger percentage from these vendors than they have customarily?"
Mr. Shaw replied:
Yes. There is a proposal whereby we would take a higher percentage on the top end of the vendors that make a substantial amount of income...We are setting aside, to build new facilities, and get other blind vendors in it, I believe 50 percent of the revenue above a certain amount. And, we're proposing to move that up.
Senator Raggio did not feel it equitable to take 50 percent, and contemplate taking more, from the blind vendors.
Mr. Shaw stated there are two vendors operating the facilities on Boulder Dam currently grossing in excess of $200,000. Their net is somewhere around $200,000. The vast majority of vendors are earning $20,000 to $25,000 a year. It would be better to take a larger share on the high-end earners, refunnel it into the people not making as high a revenue, and offer them a retirement plan, or a medical plan.
Financial Assistance for Physically Disabled - Page 1055
Mr. Shaw stated the account contains state-funded support for the personal-care attendant program. Service is through privatized community-based providers. The increased payroll and insurance costs have deflated the purchasing power of the state funds, originally calculated to serve 100 persons per year. Even with the $140,000 in one-time supplementary funds from the division, the program will provide assistance to only 76 persons in Fiscal Year 1993. The request to augment the state support, by the amount of a one-time supplement, will nonetheless serve only 64 persons in each year of the biennium.
This is the one area in the budget we tried to protect, and we did protect at all costs. It was funded at $500,000 by the legislature. We were able to supplement it with $140,000 throughout the year by robbing virtually every program we had, so we could keep this program going as much as possible. We've had to cut virtually every other program in the budget but this one.
Senator Raggio said, "It looks like the number of personal-care attendants is decreasing from the budget. Is that indicative that area is being decreased?"
Mr. Orr commented, "Yes, that is correct. The number of attendants required for the program is a function of the number of recipients of the benefit."
Senator Raggio stated, "Even the number of clients has gone down from 93 to 64."
Mr. Orr replied, "Yes. That's our projection, because the request is for flat funding for this program."
Senator Raggio asked if there were any federal funds available for this type of program.
Mr. Shaw replied:
Not in this program operated by the Rehabilitation Division. There are federal funds available to the Medicaid program, and I understand there is a request from the Medicaid people to increase their waiver to allow 50 or 75 more recipients. That may relieve some of the burden to this.
Senator Raggio stated he thinks the program is taking a "beating."
Mr. Shaw stated there are some people on the program who would be eligible for the Medicaid program but are on a waiting list.
Mr. Orr commented there are 6,750 Nevadans in need of in-home attendant-care services. This agency is currently serving 76 people.
Senator Raggio asked how the agency determines who is chosen from the waiting list to participate in this program.
Mr. Shaw stated there is a first-come first-served basis in determining eligibility.
Senator Raggio felt there should be a better way to select, if someone is in more need than another on the waiting list.
Mr. Shaw mentioned this program was frozen immediately after the last legislative session, because there was not enough money to handle the people who were on it, much less try to deal with the waiting list.
Mr. Orr said:
At risk of publicly disagreeing with my boss, there is a prioritization for coming onto this program. The first priority is someone who is capable of leaving an institution through the provision of this care. Because there the savings are so obvious. And I believe the second priority is somebody that is prevented from requiring the institutional care.
Traumatic Head Injury Program - Page 1057
Mr. Shaw commented this is a program where there was a substantial amount of help and attention from the legislature last session to give the Traumatic Head Injury Program funding. The program was able to be funded in spite of the cuts. The first year of the biennium the program was frozen.
Senator Raggio stated, "We appropriated $300,000 a year. What are you able to do at this point with that funding, and what do you anticipate you will be able to do during the biennium with the same amount of funding?"
Mr. Shaw replied:
Actually in the next biennium we requested approximately 10 percent less...Through a contract with Accessible Space, and with the use of federal funds in addition to the state funds, we have created a 15-bed day-treatment facility. It has been very successful so far. They have also purchased an 8-bed four-plex that will provide the residential capacity for eight...brain injured.
We started the program in April with federal dollars again, because we postponed the state dollars. By July 1, it was 100 percent of capacity...We were saving the State of Nevada, through its Medicaid, and saving SIIS approximately $4,000 a day, by bringing people back and releasing them from more expensive programs.
Senator Raggio asked how much federal funding was available.
Mr. Shaw replied, "I believe there was about $188,000 in federal funds." Neither Accessible Space, nor the agency, has requested additional federal funds. The total state funds are being used with the Accessible Space program, which is looking to expand into northern Nevada.
Disability Adjudication - Page 1085
Mr. Shaw stated the Bureau of Disability Adjudication processes claims for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI), a part of Social Security Administration, which funds and regulates all bureau activities. A national problem, which is compounded in fast-growing states like Nevada, is that congress underfunds the state disability determination service. For example, in Fiscal Year 1992, the Bureau of Disability Adjudication was staffed and funded to process 8,300 claims, although the state received 11,756 claims. For this reason intolerable delays in processing occurred.
With two additional disability adjudicators in the first year, and an additional one in the second year, the caseload will be accommodated.
Senator Raggio asked why it takes so long to do an individual adjudication.
Mr. Shaw replied:
Again, it's federally regulated. They have to have medical documents. What documents that exist out there may not, and usually aren't sufficient for Social Security's purposes, so then we have to purchase medical exams from specialty doctors to make the decision. We make the decision, and half of our cases are audited by the feds.
Employment, Training and Rehabilitation Administration - Page 1090
Mr. Shaw remarked support for this budget came from assessments charged to other accounts within the division. As part of the Governor's reorganization plan, this account will become the administrative account for the director of the new Department of Employment Training and Rehabilitation.
The organization of the director's office and the source of funds support is only speculative at this time. With regards to the original request for the rehabilitation administration, the major features of this request include funds to purchase service from central data processing, the internal data processing staff will be transferred out. Additional accounting resources deal with the increased work load. Five accounting positions will be added from SIIS resources. And there will be funding for the attorney general.
There are no pure state funds in this budget.
Senator Glomb asked, "Where is the money resource that is not General Fund?"
Mr. Shaw replied, "It's in Administrative Assessment on each of the bureaus and each of the programs we operate."
Senator O'Donnell referenced the consolidation of the departments. "This particular budget item will go into the Department of Employment Training and Rehabilitation. Do we know today who is going to be the director of that department"
Mr. Shaw remarked, "To my knowledge we don't. From what I've read in the paper that's going to be decided in June or July by the Governor."
Senator O'Donnell asked, "Do we know if there is going to be any difficulty in combining these logistically, these budgets and these departments? And who do we ask to find out?"
Ms. Matteucci stated:
The Governor chose not to indicate who his department directors would be, depending the outcome of this legislative review...The appointments for the directors will not be made until June or July, until we have an idea which departments we are actually going to have.
Ms. Matteucci said it is proposed each director's office be given the duties and responsibilities, and they can establish the various divisions and the logistics of the new departments as they see fit, with interim finance approval.
Senator O'Donnell asked Ms. Matteucci, "Do you feel comfortable knowing there may be three different department heads deciding logistically what may happen in the combination of all three into one new division?"
Ms. Matteucci stated she does feel comfortable with the situation.
Senator Raggio remarked:
One question our staff has suggested to us is the reorganization savings indicate the consolidation with employment security, rehabilitation and job training, the personnel services are already established in the Employment Security Department, and they could be transferred intact to this Administrative Services Division, and they could assume personnel functions for the entire department. Has that been considered?
Ms. Summers replied:
That is one of the puzzles that is incorporated into the consolidation of the reorganization. You will not see those bodies actually transferring to this budget until after a director is named, and after you are through with your legislative review. But, in the course of that, part of the reorganization savings in this budget incorporates the savings equivalent to the personnel technician position in this budget.
Alcoholism and Drug Rehabilitation - Page 847
Elizabeth M. Breshears, Chief, Bureau of Alcohol and Drug Abuse, Rehabilitation Division, Department of Human Resources, commented:
BADA [Bureau of Alcohol and Drug Abuse] is an agency that provides no direct services. We have a staff of 18 with offices in Reno and Las Vegas. In the past 10 years, we've had roughly a 400 percent increase in budget, with only three additional employees. In 1982 we had a budget of $2 million, with 15 employees, and for every $2.5 million after that we have received one additional employee.
Since we provide no direct services, I think it's important to state what we do. We have accredited drug treatment programs similar to [an accredited hospital]. We provide training to professionals in the substance abuse field and technical assistance to treatment and prevention programs.
We certify alcohol and drug abuse counselors, and drug abuse program administrators, and we write and implement a state plan.
What I've talked about so far takes less than 10 percent of the funding to BADA. The bulk of our funding, over 90 percent, goes to direct services.
Ms. Breshears distributed a list of all of the programs funded by city (Exhibit F).
Senator Rawson was curious to know what happened after the last budget crunch. There were some enhancements. "We were concerned about both new programs and supplementing existing programs. Were we able to translate any of that through, or was it all lost?"
Ms. Breshears stated all is not lost. From resources in 91-92 actual in the amount of $3.2 million from state General Fund there was $598,352 lost out of the first year. Out of the current year of $3.1 million, reflected in the Reserve amount on page 848, $782,164 was reserved.
We do award funding on a competitive basis, and it's probably important to say that for every dollar we are able to fund we have to say no to three other dollars. That does mean that we do turn down some good requests, however we have an outside independent review committee. We prioritize grants based on a numerical score, and we go as far as the money takes us.
Mr. Shaw said after every round of funding there will be complaints from organizations in the area who competed for these funds and did not get funded.
Senator Raggio requested the committee be provided with the dollar amounts.
Ms. Breshears agreed to supply the information. She added:
We had two funding cycles. The base period, which is on a calendar year cycle, and that started in January. Programs applied last October. With the additional state funding we received in the last biennium, or if we receive an unexpected federal supplement, we have also, on occasion, had a mid-year fund cycle.
Two major sources of funding are the Alcohol Drug Abuse and Mental Health Services Block Grant, which we fund in January. We also receive a portion of the Drug-free Schools and Community Act funding, 30 percent of that, and those funds we award on a state fiscal year basis.
Senator Rawson asked, "If we wanted to develop an early out in prison drug rehab programs, is there federal money available for that, or would we have to take that from existing monies that are already coming in?"
Ms. Breshears stated federal monies are available to states funding prison treatment programs prior to 1991.
Mr. Shaw said there may be other research monies available but not on a continuing basis.
Ms. Breshears stated in 1992 the agency spent $150,000. Those funds, combined with roughly an equal amount from the prison system, were used to fund their DUI treatment center in Indian Springs.
Ms. Summers said, under Personnel, the value of one position out of the 18 positions was used to calculate reorganization savings in this budget.
Ms. Breshears commented there are several federal 3- to 5-year discretionary grants being phased out.
Mr. Shaw mentioned the agency has to show they have enforced the prohibition on selling tobacco to minors, or 40 percent of the block grant funds are in jeopardy. They are moving far afield from the treatment prevention area.
Senator Glomb requested clarification that 17 positions are going to be moved to the health department under the reorganization.
Ms. Breshears replied, "Yes. The budget, as a whole, will retain its whole flavor...and will move over and be administered by the Health Division under Health Services, under the Department of Human Resources."
Mr. Shaw remarked, "For this to remain in the Rehabilitation Division, if the Rehabilitation Division moves to the Department of Employment Training and Rehabilitation, does not make sense."
Ms. Breshears referred to Module 200 on page 848, saying those federal funds are already here, and were based on the authorization of the ADMS (Alcohol Drug Abuse Mental Health Services) Block Grant in congress last year. Those funds have already been awarded to agencies and not reflected in the work program budget although they are there. The additional funds began in October.
Senator Raggio requested Ms. Breshears provide a list identifying the grants, the amounts and how they were used.
Regarding Module 702 on page 850, Ms. Breshears said two positions previously were paid for out of some of the federal discretionary grants. "We asked those be continued and picked up out of state General Fund. The budget office's recommendation is that those be paid out of the ADMS Block Grant funds."
Alcohol Tax Program - Page 854
This program represents the tax collected on sales of liquor.
Ms. Breshears stated the Bureau of Alcohol and Drug Abuse received $.15 per gallon of liquor sold with alcoholic content above 22 percent. Over the last 5 years this revenue has averaged around $600,000. One hundred percent of the funds flow directly through to treatment programs.
Mr. Shaw mentioned there is a decrease in drinkers of hard liquor.
Kevin Quint, President, Nevada Association of State Alcohol and Drug Abuse Programs (NASADAP), distributed a brochure (Exhibit G), stated his organization would support BADA to be funded to do the job as BADA sees fit, in order to help NASADAP's programs provide the best quality services. He continued:
Our message to the legislature, and to the Senate Finance Committee today is, left untreated our client population has the capacity to bankrupt, and I want to underline the word bankrupt, some of our systems, such as criminal justice, health care especially, and social service systems...We would encourage the senate finance committee to look at the budget for treatment and consider an adequate funding level for our programs.
There being no further business before the committee, Senator Raggio adjourned the meeting at 10:42 a.m.
RESPECTFULLY SUBMITTED:
Joan McConnell,
Committee Secretary
APPROVED BY:
Senator William J. Raggio, Chairman
DATE:
??
Senate Committee on Finance
February 23, 1993
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