MINUTES OF THE
SENATE COMMITTEE ON HUMAN RESOURCES AND FACILITIES
Sixty-seventh Session
April 14, 1993
The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 1:30 p.m., on Wednesday, April 14, 1993, in Room 226 of the Legislative Building, Carson City, Nevada. Exhibit A is the Meeting Agenda. Exhibit B is the Attendance Roster.
COMMITTEE MEMBERS PRESENT:
Senator Raymond D. Rawson, Chairman
Senator William R. O'Donnell, Vice Chairman
Senator Randolph J. Townsend
Senator Bob Coffin
Senator Diana M. Glomb
Senator Lori L. Brown
COMMITTEE MEMBERS ABSENT:
Senator Joseph M Neal, Jr.
GUEST LEGISLATORS PRESENT:
Assemblywoman, Vivian L. Freeman, District 24, Washoe County
STAFF MEMBERS PRESENT:
Pepper Sturm, Research Analyst
Susan Henson, Committee Secretary
Judy Alexander, Committee Secretary
OTHERS PRESENT:
Myla C. Florence, Administrator, Nevada State Welfare Division
Victor Knutzen, M.D., Vice Chairman, Maternal and Child Health Advisory Board
Gary L. Stagliano, Chief, Investigations, Nevada State Welfare Division
Jean Baecher-Brown, President, Nevada Dietetic Association
Lisa Fitzsimmons, Supervisor, Saint Mary's Health Promotion Center
Jerry Ash, Lobbyist, Nevada Hospital Association
Chairman Rawson opened the hearing on Assembly Concurrent Resolution (A.C.R.) 21.
ASSEMBLY CONCURRENT RESOLUTION 21: Directs Welfare Division of Department of Human Resources to shorten application for Medicaid and to make available application written in Spanish. (BDR R-1075)
Assemblywoman Vivian Freeman, District 24, Washoe County, advised this resolution came out of the 1991 interim study on welfare. The recommendation was made by people involved in the delivery of prenatal and infant care. Testimony received from the Washoe Prenatal Care Center at Washoe Medical Center indicated 40 percent of those persons using the facility are hispanic. Ms. Freeman introduced Myla Florence to speak further on the subject.
Myla C. Florence, Administrator, Nevada State Welfare Division, spoke in support of A.C.R. 21, as referenced in her summary (Exhibit C). Ms. Florence provided the committee with a copy of the Rhode Island Department of Human Services Statement of Need (Exhibit D. Original is on file in the Research Library.)
Ms. Florence stressed the division is supportive of both issues advanced by A.C.R. 21.
Chairman Rawson inquired if Ms. Florence brought a copy of the forms currently being used by the division. Ms. Florence stated she did not bring any forms with her, but remarked they are approximately 15 pages in length, and are for every program.
Chairman Rawson noted there appears to be a lot of good things in the Rhode Island application (Exhibit D), color coding, large spaces, etc., but expressed concern with its complexity.
Ms. Florence pointed out the division is sensitive to the issues and intends to involve people outside the agency in the development of the application. She explained many of the questions on the application are guided by federal rules and therefore must be included. The programs have become more complicated over the years and have frustrated the process.
Chairman Rawson expressed hope the division could keep the instructions simple and suggested english, followed by spanish, rather than printing two forms. Ms. Florence questioned if that would be possible, given the length and complexity of the questions, but would consider the suggestion.
Senator Glomb noted the state is in the process of setting up the Nevada Operations of Multi Automated Data Systems (NOMADS) which will help collect information and data regarding child support enforcement, Aid to Families with Dependent Children (AFDC) and food stamps. She expressed concern that due to budget cuts, the state had to pull back the appropriated money to begin the process of linking the state up with the Medicaid management information portion of the NOMADS system. The senator felt in order to be able to expedite applications, and to help clients, as well as the state, and to do long range, as well as short range planning, that is a key component. Ms. Florence agreed and said the Medicaid management information system is targeted more to payments, as well as information for policy issues, but integration with the eligibility side makes it desirable to have both systems under development at the same time. Senator Glomb asked if the application process for medical assistance would be hampered if the NOMADS system operated without the Medicaid management information. Ms. Florence replied that the eligibility side is separate from the reimbursement and provider issues, which the management information system would address, and did not feel there would be any impact on clients.
Senator Glomb stressed the importance of this program, pointing out if Nevada invests now it has the opportunity for a 90/10 match with the federal government. The senator stated in the long run, this is a cost saving measure, and by not implementing the program, the state could lose millions of dollars. Ms. Florence agreed, and wished to point out one client impact she had failed to mention. Providers would have the opportunity for instant verification of eligibility, and in that sense it would expedite service to clients.
Senator Brown referred to A.C.R. 21, line 10, and asked if changing the word "shorten" to "simplify" would change the intent of the resolution. Mrs. Freeman deferred the question to Ms. Florence and questioned if the application could be shortened.
Ms. Florence replied that by combining all the programs into one application, and meeting the federal requirements, in all likelihood the application would not be shorter.
Senator Coffin maintained it would be impossible to shorten the application, and felt the goal should be to make it more readable. The senator suggested one solution would be to spend more money to have additional personnel available to explain the questionnaire, which the state is not in a position to fund at this time. He agreed the structure of the application is long, but readable.
Ms. Florence hoped to modify the present system to follow that general format. She explained division workers go through the application process with an applicant and, pointed out, there are interpreters on staff to assist the spanish speaking clients.
Ms. Freeman remarked that during the course of the hearings, the committee heard the same request over and over again, making it easier for the patients to access the system. This resolution seems to be a step in the right direction.
Victor Knutzen, M.D., Vice Chairman, Maternal and Child Health (MCH) Advisory Board, spoke in favor of A.C.R. 21, as referenced in his summary (Exhibit E). Dr. Knutzen presented a copy of Florida's Medicaid one-page application form (Exhibit F). Dr. Knutzen pointed out he is a provider and the medical director of the Washoe Pregnancy Center, a high volume obstetric service in Washoe County, which deals predominately with Medicaid patients. Because of the complexity of dealing with the application process, Dr. Knutzen has hired bilingual staff and Medicaid eligibility workers. This facilitates the early entry of many of the Medicaid eligible patients into the program, which results in good prenatal outcome and decreased cost for the service. Any effort to shorten the application and facilitate early eligibility will result in more women receiving early prenatal care, which will produce healthier dollar saving babies. Dr. Knutzen pointed out the MCH Advisory Board acknowledges welfare's efforts to shorten the application and encourages passage of A.C.R. 21, which will strengthen those efforts and move the process forward.
Senator Glomb asked how the state of Florida can require only a one page application and questioned the general disparity among the states. Dr. Knutzen stated he did not know the answer to that and wondered if he could complete the Nevada application.
Ms. Florence suggested the one-page Florida form is merely a screening tool, and not the entire application. Although she has not had the opportunity to verify that fact, she reviewed the application and finds it does not comport to federal requirements.
Dr. Knutzen pointed out Nevada law applies a means test for eligibility, which makes any form more complicated. He suggested Florida employs more on-site eligibility workers which creates a face-to-face situation with the applicant and allows the worker to pick up the fraudulent applicant more quickly.
Senator Coffin asked if Florida did the form in spanish and french. Dr. Knutzen replied he was not certain, but did wish to stress that 35 percent of the clients at Washoe Pregnancy Clinic are spanish speaking.
Chairman Rawson closed the hearing on A.C.R. 21.
Chairman Rawson opened the hearing on Assembly Joint Resolution (A.J.R.) 17.
ASSEMBLY JOINT RESOLUTION 17:Urges Congress to enact legislation allowing states greater flexibility in carrying out coordinated programs of health care. (BDR R-785)
Ms. Freeman stressed A.J.R. 17 is not a new issue. This resolution means Nevada could have what is popularly called managed care in the state, and mandate that Medicaid recipients use this type of service, but stressed this cannot be done without a federal waiver. Ms. Freeman pointed out there is a bill before Congress to accomplish this, and asked if Pepper Sturm, Research Analyst, could make a determination as to the status of that bill. Ms. Freeman encouraged support of this resolution, and introduced Myla Florence for further testimony.
Ms. Florence provided the committee with two proposed amendments to A.J.R. 17 (Exhibit G). She said during testimony on the assembly side, it was indicated the resolution needed to fully address the issue of mandatory enrollment for comprehensive health care programs, as states have the option of developing coordinated programs of care. However, if they are going to do that on a mandatory basis, it requires a waiver and that is what needs to be simplified. Ms. Florence agreed with Ms. Freeman that there are indications from the Clinton administration the waiver process will be less difficult for states to pursue.
Ms. Florence went through the amendments with the committee (Exhibit G). She explained the states would require three different waivers to implement a mandatory program.
Chairman Rawson closed the hearing on A.J.R. 17.
The Chairman opened the hearing on Assembly Bill (A.B.) 245.
ASSEMBLY BILL 245: Prohibits unauthorized possession, transfer or use of card evidencing eligibility to receive Medicaid benefits. (BDR 38-753)
Gary L. Stagliano, Chief, Investigations, Nevada State Welfare Division, stated A.B. 245 was introduced by the welfare division seeking specific legislation to address the situation of unauthorized individuals using a Medicaid card. Over the past couple of years, individuals entitled to a Medicaid card are allowing unauthorized individuals to use the card. Mr. Stagliano cited an example in Las Vegas where an individual appeared at a local hospital in full labor and, during the interview, presented a Medicaid card as means of payment. The services were provided and Medicaid was billed. During the processing, it was discovered that particular individual had delivered a baby 5 months earlier. The current law entitles welfare to punish the unauthorized individual for obtaining money or services under false pretenses. However, there are no penalties for the individual authorized for the card. Mr. Stagliano pointed out A.B. 245 addresses that issue and he encouraged passage.
Senator O'Donnell inquired if this is a rampant problem. Mr. Stagliano stated it is not currently a big problem, maybe 1 dozen cases last year, but did add it is a difficult problem to detect.
Senator Coffin inquired if the division had considered putting photographs on the cards. Mr. Stagliano replied the division had discussed this, but has not done anything due to the cost. Currently, if a person receives Aid to Dependent Children (ADC), the Medicaid card is attached to their check, and if they only receive Medicaid, those are mailed monthly to the recipient, as Medicaid requires month-to-month eligibility.
Senator Brown asked if identification is required when the cards are presented by the recipient. Mr. Stagliano stated some providers require identification, and in some cases welfare has refused Medicaid billings when providers did not do any type of identification. He pointed out there is no mandate requiring identification.
Chairman Rawson closed the hearing on A.B. 245.
The chairman opened the hearing on Assembly Concurrent Resolution (A.C.R.) 20.
ASSEMBLY CONCURRENT RESOLUTION 20: Encourages employers to establish programs to promote employee wellness, physical fitness and prevention of disease and accidents. (BDR-R 1084)
Chairman Rawson welcomed those individuals with the hospital association.
Jean Baecher-Brown, President, Nevada Dietetic Association, spoke in support of A.C.R. 20, as referenced in her summary (Exhibit H).
Senator O'Donnell voiced concern at the high percentage of overweight children and questioned whether the cause is heredity or diet. Ms. Baecher-Brown commented that overweight is a combination of both factors, coupled with a sedentary lifestyle brought on by an excess of television, computer age technology, video games, and our latchkey society. Ms. Baecher-Brown called attention to the lack of physical education in the school system. In her opinion, prevention is a better approach to weight control than dieting.
Lisa Fitzsimmons, Supervisor, Saint Mary's Health Promotion Center, spoke in support of A.C.R. 20, and presented a packet to the committee (Exhibit I). Ms. Fitzsimmons called attention to the report relative to the cholesterol screening done at the legislature March 31st, commenting that the statistics reflect an extremely healthy population.
Senator Coffin spoke of Senate Bill (S.B.) 71 which mandates employers provide wellness programs of a different nature, drug awareness programs, etc. for employees, and noted A.C.R. 20 does not speak to those issues.
SENATE BILL 71: Requires certain entities who receive money from state to establish policy to ensure workplace is free of illegally used drugs and alcohol. (BDR 40-911)
He questioned if language regarding substance abuse should be added to the bill.
Ms. Fitzsimmons agreed that was an important component of the wellness program. It is something that is included in programs Saint Mary's Health Promotion Center offers to employers. There is a company assistance work place drug free program wherein they will educate the employers on how to implement those kinds of policies and programs. She stressed the drug free environment is an important part of the work place, and felt the bill could be changed to include that language.
Senator Coffin asked Ms. Fitzsimmons if she knew of a vehicle to get the programs to employers. Ms. Fitzsimmons agreed this is a problem, but suggested it could be done through the health care institutions.
Chairman Rawson remarked that when he was in Washington, D.C. for the briefing on President Clinton's health care plan, he noticed a great deal of emphasis on prevention. He spoke of the interim health care committee which sponsored a wellness program as part of the university system. This was a small pilot project done in a facility with 100 to 150 employees. A surprising number participated in the project and did everything from increasing their walking to other active things, as well as eating better. The cholesterol levels went down significantly as a group. This project came about after a legislative session which gave incentives to hospitals to develop these programs.
Chairman Rawson closed the hearing on A.C.R. 20.
The chairman suggested the committee process the bills.
SENATOR O'DONNELL MOVED TO DO PASS A.B. 245.
SENATOR COFFIN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR NEAL WAS ABSENT FOR THE VOTE.)
* * * * *
SENATOR COFFIN MOVED TO AMEND AND ADOPT A.C.R. 21.
SENATOR O'DONNELL SECONDED THE MOTION.
A discussion ensued among the committee members.
SENATOR BROWN MOVED TO AMEND THE WORD "SHORTEN" TO "SIMPLIFY," APPEARING IN LINE 10.
SENATOR GLOMB SECONDED THE MOTION.
THE MOTION TO AMEND CARRIED. (SENATOR NEAL WAS ABSENT FOR THE VOTE.)
THE MOTION TO AMEND AND ADOPT A.C.R. 21 CARRIED. (SENATOR NEAL WAS ABSENT FOR THE VOTE.)
* * * * *
SENATOR O'DONNELL MOVED TO ADOPT A.C.R. 20.
SENATOR TOWNSEND SECONDED THE MOTION.
A discussion ensued among the committee members. Senator Coffin questioned if the chairman would entertain an amendment to add in some precautionary substance abuse language. Senator Brown expressed concern about this resolution having very general language, and should the committee list specific things, the bill might not seem as all-inclusive.
Chairman Rawson suggested the committee act on this resolution today, but agreed to delay taking it to the floor for a couple of days. If there is an amendment, it could be considered on the floor.
Senator Townsend pointed out some specific statistics on why the committee is addressing this issue through A.C.R. 20. Sixty percent of those persons who enter hospital emergency rooms in Nevada are there because of lifestyle choices. Nevada is constantly under attack internally, and outside the state, for having some of the highest hospital and medical care costs. This 60 percent figure includes alcohol and drugs, as well as not using a seat belt, job prevention, and sitting in front of the television. In 1990 there was $680 million of hospitalization charges attributable to tobacco use in Nevada. The senator noted even though this is a general resolution, it has a strong foundation.
Chairman Rawson asked Pepper Sturm, Research Analyst, to check and see what other types of bill drafts or bills are in this session dealing with these issues. The chairman suggested the committee may wish to create some specific programs, such as smoking, etc., which deal with teenagers.
Senator Townsend also addressed utilizing the body of knowledge through providers and practitioners, and working with the school system to provide a curriculum to help kids understand lifestyle choices.
Senator Brown asserted some of the programs regarding alcohol seem to be having a good effect as consumption is down among teenagers, which she feels is a direct result of the educational process.
THE MOTION CARRIED. (SENATOR NEAL WAS ABSENT FOR THE VOTE.)
Chairman Rawson reiterated he would delay delivering the bill to the floor for a couple of days.
* * * * *
SENATOR GLOMB MOVED TO AMEND AND DO PASS A.J.R. 17.
SENATOR COFFIN SECONDED THE MOTION.
Chairman Rawson reminded the committee of the amendments presented by Myla Florence regarding this resolution.
THE MOTION CARRIED. (SENATOR NEAL WAS ABSENT FOR THE VOTE.)
* * * * *
Chairman Rawson opened a work session on S.B. 104.
SENATE BILL 104: Revises the definition of a "county of residence" for purpose of determining eligibility of indigent person for benefits from county. (BDR 38-1284)
The chairman advised that each of the counties confirmed this bill would not add a fiscal note to the state, and each voiced their support for passage of the bill.
Chairman Rawson had talked earlier with Verlia Davis, Deputy Director of Clark County Social Services regarding S.B. 104. She commented that the department supports this bill. She stated, "The statute being amended affects (primarily) nursing home residents in rural counties."
Chairman Rawson stated May Shelton, Director of Washoe County Social Services, felt this measure is a cleanup bill and expressed support for the measure. In addition, the Nevada Association of Counties voiced their support. That organization felt the measure would bring Nevada into compliance with acceptable constitutional definitions of residency.
SENATOR GLOMB MOVED TO DO PASS S.B. 104.
SENATOR O'DONNELL SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR NEAL WAS ABSENT FOR THE VOTE.)
* * * * *
Chairman Rawson asked the committee to consider A.C.R. 18.
ASSEMBLY CONCURRENT RESOLUTION 18: Urges the county school district boards of trustees to adopt daily class schedules for public elementary schools which include a fixed period of uninterrupted teaching time during each school day.
The committee decided to think about the resolution further and took no action.
SENATE BILL 62: Makes various changes regarding emergency admissions to mental health facilities. (BDR 39-661)
Chairman Rawson noted the committee has taken no action on S.B. 62, stating the parties in favor and opposition to the bill have not been able to agree on amendments. Senator Townsend asked if there was a subcommittee to encourage the parties to reach a resolution. The chairman suggested Senator Townsend might be able to assist in resolving the issue with the parties. He pointed out possible alternatives for consideration: (1) request a motion to "indefinitely postpone" the measure; (2) take a vote on the bill based upon its merits; (3) hold the bill until late in the session to see if the parties involved wish to change their positions; or (4) hold the measure for use as a vehicle for other legislation. Chairman Rawson asked Senator Townsend to take a further look at the bill.
Chairman Rawson asked for comments from the Nevada Hospital Association. Jerry Ash, Lobbyist, Nevada Hospital Association, replied they appreciated the opportunity to visit the session.
There being no further business, Chairman Rawson adjourned the meeting at 2:40 p.m.
RESPECTFULLY SUBMITTED:
Susan Henson,
Committee Secretary
APPROVED BY:
Senator Raymond D. Rawson, Chairman
DATE:
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Senate Committee on Human Resources and Facilities
April 14, 1993
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