MINUTES OF THE
SENATE COMMITTEE ON HUMAN RESOURCES AND FACILITIES
Sixty-seventh Session
June 16, 1993
The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 2:50 p.m., on Wednesday, June 16, 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 Joseph M. Neal, Jr.
Senator Bob Coffin
Senator Diana M. Glomb
Senator Lori L. Brown
COMMITTEE MEMBERS ABSENT:
Senator Randolph J. Townsend
STAFF MEMBERS PRESENT:
Pepper Sturm, Research Analyst
Susan Henson, Committee Secretary
OTHERS PRESENT:
Dr. Jerry Zadny, Administrator, Mental Hygiene and Mental Retardation Division
Captain Randy L. Oaks, Lobbyist, Las Vegas Metropolitan Police Department (METRO)
Myla Florence, Administrator, State Welfare Division
Sheila Block, State of Nevada, Deputy Attorney General
Mary Ellen McCarthy, Senior Attorney, Nevada Legal Services
Mary Liveratti, Deputy Administrator, Division for Aging Services
Gary Crews, Legislative Auditor
May Shelton, Director, Washoe County Social Services
James L. Wadhams, Lobbyist, Nevada Hospital Association
Jan Lewellyn-Davidson, Lobbyist, University Medical Center
Teresa Rankin, Commissioner, State Department of Insurance
Robert R. Barengo, Lobbyist, Humana
Robert Gagnier Lobbyist, State of Nevada Employees Association (SNEA)
Chairman Rawson opened the hearing as a subcommittee on Senate Bill (S.B.) 533.
SENATE BILL 533: Makes various changes to provisions governing admission to and hospitalization in mental health facilities and hospitals. (BDR 39-1490)
Dr. Jerry Zadny, Administrator, Mental Hygiene and Mental Retardation Division, questioned whether there is a wrong that needs to be righted. He pointed out testimony taken at the previous hearing indicated individuals have legal actions pending. Those individuals sent material to the commissioner and the attorney general for review. The Commission on Mental Health and Retardation held lengthy hearings, and the Attorney General's Office looked at the affidavits and neither of those bodies found sufficient information to take action. Dr. Zadny reiterated those individuals indicated they are also pursing legal remedies in the courts. He stated he thinks maybe an additional remedy needs to be offered in the bill beyond the ones currently available.
Chairman Rawson commented the real concern is that if someone is retained against their will, even though voluntary at first, they should have the opportunity to make phone calls. He suggested allowing the individuals a call to the Office of Protection and Advocacy (OPA).
Dr. Zadny agreed that might be a solution, stating he does not feel the private hospitals, or the state system would have any objection to notifying OPA.
Chairman Rawson thought there should be some requirement in the bill to inform the patients of their right to contact other people and to institute proceedings for their release. He suggested advising the individuals of their rights at the time of admission, whether on a voluntary or involuntary basis.
Dr. Zadny stated they currently hand deliver a notification of client rights to all individuals upon admission.
Chairman Rawson suggested the hospitals post the client right's notices in restroom facilities, hallways, and day rooms. For those patients in isolation for 72 hours, a notice should be posted in their individual rooms. He maintained that if a patient makes a request to make a call or be released, that request should be honored within a certain period of time.
Dr. Zadny stated there is another area which should be considered. The commitment law was changed in a previous session to make for an expeditious judicial review of involuntary commitments. The net effect was to extend the time a person can be kept involuntarily before that review occurs. Dr. Zadny suggested Kevin Christensen, OPA, and a representative of the judiciary get together to discuss new language to remedy the problem which was created from this language. Chairman Rawson stated he would hold the bill for a couple of days in anticipation of receiving new language, at which time he would report back to the committee.
Chairman Rawson pointed out another issue of concern is the request for a second opinion for evaluation. The new language in the bill allows the patient to do basically anything they want to do. Dr. Zadny asserted the language in the existing bill is unnecessary to right the alleged wrong. Although the alleged wrongs are against private facilities, the language in the bill would prevent the state from collecting for public services. He indicated substituting the language previously discussed would be a sufficient remedy, as well as getting suggestions on how the involuntary commitment process could be speeded up.
Chairman Rawson referred Dr. Zadny to section 6, line 21, page 3 of the bill, and asked how this could be best handled. If a person is in a facility on a voluntary basis, should they sign a form giving the facility permission to keep them longer?
Dr. Zadny noted the difficulty arises when an individual enters a facility on a voluntary basis, they are evaluated as being a threat to themselves or others, and if they exercise their right to leave, the physician files an involuntary commitment, which they must do by law. A physician can be held liable for failing to confine an
individual. Dr. Zadny pointed out there are remedies for those individuals who feel they are held unreasonably.
Chairman Rawson asked Dr. Zadny how to deal with keeping people against their will, which appears to be driven by the profit motive. He wondered if there should be a statement in the bill that a person shall not be kept in an institution solely on the basis of their ability to pay.
Dr. Zadny suggested putting language in the bill that if a facility keeps an individual who is not required to be in that facility, they are subject to civil or criminal penalties. He maintained that the licensure of the facility could be brought into question for such a violation.
Chairman Rawson remarked that if someone is kept against their will, without cause, it becomes an actionable item, as defined in the bill. Dr. Zadny commented this would allow a finder of fact the opportunity to listen to both sides and decide if containment was reasonable.
Chairman Rawson suggested language which would require notifying the bureau of health facilities regarding any disputed claim from a person held against their will, which would allow the bureau to document the cases. The chairman indicated he would review Dr. Zadny's proposed language and report it back to committee for further discussion.
Chairman Rawson closed the subcommittee on S.B. 533 and opened a subcommittee hearing on Assembly Bill (A.B.) 168:
ASSEMBLY BILL 168: Removes restriction on location at which certain medical examinations of allegedly mentally ill persons may be performed. (BDR 39-441)
Captain Randy L. Oaks, Lobbyist, Las Vegas Metropolitan Police Department (METRO), stated A.B. 168 was introduced by METRO in an attempt to remedy a couple of problems. First, the language of the current law does not allow METRO to conduct examinations within their own detention facility. In a county of 400,000, the law mandated a person must be examined in a hospital. Captain Oaks stressed this became awkward in that METRO had well qualified staff physicians in their own detention facility able to perform the examinations, and thus they are asking this provision of the law be removed. The proposed language would allow METRO to do the examination anywhere, if done by a licensed physician.
Dr. Zadny commended METRO for their attitude and cooperation in agreeing to workable language, and voiced the division's support of A.B. 168.
Chairman Rawson asked if there is any concern about having the examinations take place within a retention facility. Dr. Zadny stated in his opinion, it is a good idea.
In response to Senator O'Donnell's question, Captain Oaks explained the examination called for in the bill is to determine if the patient is reasonably healthy prior to transporting him to the mental health facility. The mental health facility will make the appropriate psychiatric evaluation.
There being no further discussion, Chairman Rawson closed the subcommittee hearing on A.B. 168 and opened the subcommittee hearing on A.B. 503.
ASSEMBLY BILL 503: Authorizes welfare division of department of human resources to recover benefits paid for assistance to medically indigent. (BDR 38-889)
Myla Florence, Administrator, State Welfare Division, explained A.B. 503 was initiated by the welfare division. She read from her prepared statement (Exhibit C) and encouraged the committee's passage of the bill.
Chairman Rawson asked if setting up the estate recovery program is built into the budget. Ms. Florence indicated it is not.
Chairman Rawson commented that Nevada requires individuals to deplete their resources before becoming eligible for Medicaid, which forces individuals to transfer or hide assets. Ms. Florence stated this usually applies to large Medicaid expenditures which are normally long term care facilities. Currently, the division does not have the authority to pursue reimbursement when there has been a transfer of assets.
In summary, Ms. Florence pointed out the division does not expect funding for a Medicaid estate recovery unit, as was originally proposed, recognizing the current budget crisis. She stressed the language in this bill is permissive and would enable the department to pursue cases where action would be warranted. In addition, Ms. Florence pointed out the bill establishes a legal responsibility for the recipient, or the person who signs the application on behalf of the recipient, to report required information. Currently, individuals applying for Medicaid on behalf of another may withhold known income or resource information, which affects Medicaid eligibility.
Ms. Florence drew attention to section 2, subsection 3, page 2 of the bill which provides the division with the ability to remedy recipient divestiture made for less than fair market value. Section 2, subsection 5, page 2 provides the welfare administrator discretion to waive the Medicaid recovery when such recovery would create an undue hardship. Ms. Florence referred the committee to section 3, page 2, which requires the division to put a notice in the application that the recipient may be responsible for repayment of benefits received.
Ms. Florence stressed A.B. 503 is an important piece of legislation and has been amended to satisfy any concerns evidenced by those in the legal community. It protects taxpayer's dollars to insure that they go to the most needy. Ms. Florence introduced Sheila Block, State of Nevada, Deputy Attorney General.
Ms. Block testified there is an increasing number of Medicaid applicants who are utilizing the spousal impoverishment laws to protect significant portions of their estate and their assets, and those assets are then exempt from consideration in Medicaid eligibility. This bill would make those assets recoverable upon the death of both spouses. In addition, recipients have assets which are considered excluded resources in determining eligibility, such as their home, vehicles, personal items of jewelry, etc. Often these assets are considerable and could be reached through the recovery process, which would not be commenced until the death of the surviving spouse.
Ms. Florence stated in view of the state's resources, she urged the bill be processed without funding, which would enable the division to have some experience with the bill using current resources. She stressed that eventually the program should become self-sustaining.
Chairman Rawson suggested, for budget purposes, figuring a 5 to 1 return on administrative dollars from the recovery program, which would allow the program time to get up and running. The program could be shown with $400,000 in revenue and $80,000 in expenditures. If the program was successful and the money started coming in, then staff could be hired to further service the program. Ms. Florence stated she did not anticipate any revenues in excess of expenditures the first year of the biennium, and suggested the second year might wash.
Chairman Rawson asserted there could be two available alternatives. First, after the division works some of the cases and develops monetary recovery, they could go to interim finance and ask to have staff added; or, the program could be put in the budget with $80,000 revenue and $80,000 expenditure.
Ms. Florence thought the first option might be desirable with some intent by the chair and the committee allowing the program to go to interim finance. She pointed out the staffing potentially associated with this issue would be in the welfare administration budget, which is not a capped budget.
Chairman Rawson suggested processing the bill with a letter of intent and implied it is to the state's advantage to get the bill up and going as soon as possible. If an individual has the ability to pay for services, the state should have the ability for recovery.
Senator O'Donnell questioned Ms. Florence about the transferability of assets, and in particular referred to section 2, subsection 3, page 2 which reads, "if a transfer of real or personal property by a recipient of assistance to the medically indigent is made for less than fair market value, the welfare division may pursue any remedy . . . ." The senator pointed out federal law allows a person to gift $10,000 a year to a spouse, tax free, which is dollar-for-dollar, and wondered why that would not be considered under this bill.
Chairman Rawson stated he thinks that law would apply under all circumstances, unless an individual would be applying to the federal government for support.
Ms. Block pointed out there are transfer rules under federal regulations which are imposed if it is discovered a person made gifts of property, which can make a person ineligible for assistance for up to 30 months. She stressed there are different sets of rules for transfers, gifting and diversion of assets.
Senator O'Donnell asked for an example of a person medically indigent, and on Medicaid, who would have assets.
Mary Ellen McCarthy, Senior Attorney, Nevada Legal Services, explained federal law governs how the Medicaid programs work. Federal law says if an individual gives something to someone other than their spouse, or a disabled or dependent child, and they do not get dollar-for-dollar fair market value, that is considered a transfer of assets. If an individual gives a child $10,000, there would be no problem with the Internal Revenue Service (IRS) in terms of gift taxes. If that person entered a nursing facility the next day and applied for Medicaid, there would be a problem as welfare would treat that as an invalid transfer of assets under both federal and state Medicaid laws, and thus the individual would be disqualified for a period of 2 months from receiving Medicaid. However, if the person gave his last $10,000 to his son to go to college, being in perfect health at the time, and the next day suffered a severe injury, he could apply to the administrator for relief. The general rule is a transfer for less than fair market value within a certain time period, subject to certain dollar limitations, will disqualify an individual for Medicaid for a period of time.
In response to Chairman Rawson's question, Ms. McCarthy stated fair market value is considered the price that a particular item will sell for on the open market at a given time. If the market is saturated, and an individual needs to sell his property at a discount because the value on the market at that time is less than the face value, it is a rebuttable presumption.
Ms. McCarthy, as Senior Attorney for Nevada Legal Services, stated she is involved in representing clients who have Medicaid claims. A.B. 503 is a result of negotiations, compromise and redrafting with her office and the welfare division, and is the bill which Nevada Legal Services can support in its present form. In the process of revising and amending the bill, certain amendments passed by Congressman Waxman's committee in the United States House of Representatives were taken into consideration. Ms. McCarthy stated she feels this bill is consistent with current federal law and meets their requirements, and the changes have been approved by the house and are being negotiated by the senate.
Chairman Rawson asked Ms. McCarthy to give the committee an example from Congressman Waxman's legislation. Ms. McCarthy stated one of the sections she and the welfare division debated was their ability to recover from the estate of the surviving spouse. Current federal law does not allow recovery from a surviving spouse, but only a recipient. The proposed Waxman amendment specifically allows for recovery against the estate of a surviving spouse. Ms. McCarthy commented this language would probably pass due to the current economic condition of the country. If A.B. 503 passes in Nevada, in a short period of time there will be comparable language on the federal level.
Chairman Rawson pointed out whether Nevada wants to pursue a spouse would be a policy decision, as the state does not want to create a destitute situation for a remaining family member. Ms. McCarthy stressed recovery is only against the estate of the surviving spouse, and in a hardship case, the administrator could waive the recovery.
Chairman Rawson noted for the record that upon the arrival of Senator Glomb a quorum was present and the meeting was continued as a full hearing.
SENATOR NEAL MOVED TO RATIFY ACTION TAKEN BY SUBCOMMITTEE UP TO THIS POINT.
SENATOR O'DONNELL SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS TOWNSEND, BROWN AND COFFIN WERE ABSENT FOR THE VOTE.)
Senator O'Donnell posed a hypothetical question to Ms. McCarthy. As a married man he became ill and, without assets, was forced to incur a large Medicaid bill prior to passing away. Shortly thereafter, his surviving spouse married a wealthy gentleman. The senator wondered if the Medicaid indebtedness of the estate would be passed to the newly married couple, and would welfare attempt recovery against their assets.
Ms. McCarthy noted with this legislation it would be difficult to shelter assets, but feasibly something could be done with a prenuptial agreement. She did agree the above scenario could in fact happen.
Chairman Rawson pointed out this legislation may force some individuals to live at a lower standard than if they remarried.
Ms. Block testified she and Ms. McCarthy worked together drafting this legislation. She addressed the above scenario and stated one of the first things the division would look at is how much the deceased spouse left the surviving spouse in the way of assets and attempt to trace the proceeds. There may be sufficient assets available to pay the indebtedness. Ms. Block stressed the new spouse would not be responsible for the payment of medical bills incurred prior to the marriage. However, the surviving spouse would be responsible if she had adequate assets from the estate to pay the indebtedness. If there were no assets, the surviving spouse obviously could not pay the bill.
A discussion ensued among the committee members in an attempt to understand the changes presented in this bill.
Ms. McCarthy clarified that the claim is against the estate of the surviving spouse. In response to the above scenario, she pointed out the wealthy second husband would come into the marriage with separate property. It would remain separate property until gifted to the surviving spouse so as to make it either community property or her separate property. At that time, the division could pursue her portion of the community property or her separate property to the extent that Medicaid benefits were paid. Ms. McCarthy commented the division would in all likelihood be going after the surviving spouse who has a significant asset that is worth their time and investment of money to pursue.
Ms. Block drew attention to the fact that the Medicaid program in the state of Nevada provided a benefit to an individual who was in institutional care, and stressed the division would be seeking recovery from the surviving spouse's estate only if there were assets.
Senator O'Donnell wondered if, at the time of the first spouse's death, the division could put a value on the married couple's assets, and that amount would be the amount the division would pursue at the time of the surviving spouse's death. Ms. McCarthy pointed out there is a statutory duty to provide spouse for spouse and parent for child in the state of Nevada, and thus the debt incurred by a spouse during marriage is the surviving spouse's debt.
Senator Brown reminded the committee if the debt were incurred in a private hospital, the spouse would be liable, and the standard should not be different because it is a state institution. Ms. Block confirmed that the division considers the spouse's assets when determining Medicaid eligibility, and currently there is no recovery program for the state of Nevada.
Ms. McCarthy, in response to the spousal issue, stated there may be some clarification from the federal government if they pass the spousal recovery act. Ms. McCarthy emphasized Nevada Legal Services originally opposed the spousal recovery provision. However, because of Congressman Waxman's federal legislation, and the current budget crisis in Washington, D.C., recovery is an issue. She stressed it has become more of an concern because of the spousal impoverishment provision which now allows the spouse of a nursing home recipient to keep a minimum of $14,148 and a maximum of over $70,000. Ms. McCarthy pointed out if A.B. 503 is not passed this session, more than likely the division will be back before the legislators during next session saying there is a federal law on the books and the state law must be amended to bring it into conformity.
Ms. Block summarized that the Medicaid program is intended to serve those truly needy individuals, and the state recovery bill will enable the division to recover monies from estates where there are assets to sufficiently support and reimburse the state for benefits received.
Ms. Florence stated the general accounting office puts out a report on Medicaid and state recovery programs nationally. Thirty-six states have recovery programs in the interest of the increasing Medicaid budgets. She stressed this is a resource to provide additional funds for those who are most needy. There is language within the bill to protect those special circumstance cases. Ms. Florence concluded the recovery program is in the state's best interests.
Mary Liveratti, Deputy Administrator, Division for Aging Services, testified her division is neutral on A.B. 503, and read her comments into the record (Exhibit D).
Senator Neal suggested the premise of this measure is based upon the spouse having money to pay for services. It was his thought if the spouse had money, they would not seek Medicaid.
Ms. Liveratti pointed out seniors are typically "cash poor" and "brick rich." They may have a home that is paid for, but it is difficult to convert that into cash to pay for medical expenses, in essence they do not have liquid resources available. When both spouses are deceased, the estate has the home, which was exempt during Medicaid eligibility, to be sold to generate cash. The home can be passed to a surviving child, if the child qualifies.
Senator Brown drew attention to language in the bill which says "may, when circumstances allow" making the bill permissive. The senator also questioned if notification and appeal could be handled through regulations. Ms. Liveratti remarked that it could be handled through regulation.
Ms. Florence stated notification is already part of the division's process. She pointed out the division is not capable at this time of itemizing costs on an annual basis, nor will this be possible until such time as the division has a Medicaid management information system available. Ms. Florence declared the state has 75,000 Medicaid recipients. The bill provides that the
notification be placed on the application form when the Medicaid estate recovery program becomes effective.
Ms. Liveratti noted in order to recover costs, there would have to be an accounting, and asked Ms. Florence how the division would come up with an amount. In response to Ms. Liveratti's question, Ms. Florence replied that as a practical matter, the division would only pursue estate recovery when the state has incurred a large expense.
Senator Glomb asked if anyone has done an estimate as to how much money would be recovered through the program. Ms. Florence reiterated that page 3 of her statement (Exhibit C) indicates what expected recovery costs could be with full time staff dedicated to the program. However, due to the budget crisis, the division does not anticipate having full time staff. Ms. Florence remarked that as a general measure, states have experienced for every $1 invested there has been an average return of $14.
Senator Glomb questioned how it would be determined that the person signing the application on behalf of the patient has failed to disclose full information, and how can the division hold that person liable for another person's debts when they were acting as a good will ambassador. Ms. Florence indicated this was the subject of debate in the assembly, and the new language reflects what the attorneys believe would withstand a review of intent to defraud, someone who knowingly fails to report.
Ms. Block stated when a claim is filed in probate court, the division must provide the court with a cost accounting.
Ms. McCarthy responded to Senator Glomb's question, which she pointed out was the subject of extensive debate on the assembly side, section 2, line 15, page 1, which says, "Failed to report any required information to the welfare division which he knew at the time he signed the application." The new language should protect someone who inadvertently failed to disclose information, and should take care of those concerns which the prior language did not address.
Gary Crews, Legislative Auditor, spoke in favor of A.B. 503 and explained it came out the audit report on the Medicaid program issued last fall to the audit subcommittee and the legislative commission. The purpose of the bill is to treat all individuals in an equitable matter. For example, those who have cash, or stocks and bonds must pay for their care, while a person with a house is exempted from having to pay back from his estate for the cost of his care during a prolonged hospitalization. Mr. Crews drew attention to the 1988 general accounting office (GAO) report which indicated 21 states were using the recovery program, and since that time more states have started using the program. Due to severe budgetary constraints, the state must look to all avenues for recovering the costs of care. Mr. Crews stated the audit report also identified that the state of Oregon was recovering at the rate of approximately $10 for every $1 spent. At the time of the audit report, Oregon's Medicaid recovery was approximately $6 million and Nevada's Medicaid recovery was approximately one-third of that figure. A recommendation was made in the audit report that the welfare division establish and pursue an estate recovery program.
May Shelton, Director, Washoe County Social Services, spoke in favor of A.B. 503. She stated Washoe County has had the ability to seek and accept reimbursement for services rendered. She directed the committee to section 2, subsection 6, page 2 of the bill which states any recovery of money goes first to pay for the costs of recovering the money, and any remaining money must be divided among the federal government, the department and the county. Ms. Shelton noted the county is listed above as they have a 300 percent county match program for people who have incomes between $714 and currently $1,302. The county picks up one-half of the cost of care, which in Washoe came to about $1.3 million this year, and next year will be about $2.2 million, and stressed any recovery would be beneficial to the county.
As there were no further comments, Chairman Rawson closed the hearing on A.B. 503 and opened the hearing on A.B. 553.
ASSEMBLY BILL 553: Increases compensation of certain hospital trustees. (BDR 40-2001)
James Wadhams, Lobbyist, Nevada Hospital Association, reported this bill increases the compensation of certain hospital trustees, basically for the rural hospitals. He referred the committee to section 1, subsection 1 of the bill, which refers to counties with a population of less than 100,000, and thus would exclude Washoe County and Clark County. Subsection 2 of the bill refers to counties whose population is 100,000 or more, and explained currently no one falls into that bracket. Washoe Medical Center (WMC) would have fallen into that section, but dealt with this issue in a separate law in 1987 or 1989, and Clark County is addressed in subsection 5, where the county commissioners themselves sit as the board of that hospital.
Mr. Wadhams pointed out this law has been on the books for 25 years and needs to be updated as the compensation for sitting on the board is low. A monthly maximum has been established, even though the trustees may attend more than two board meetings per month. Mr. Wadhams stressed the fiscal impact does not apply to county government, but would apply to the hospital. He noted for the committee that the act becomes effective July 1, 1993 which would coincide with the county hospital's standard fiscal year so they could adjust their budgets accordingly.
Chairman Rawson asked Mr. Wadhams if the compensation should be tied to some figure that is updated periodically. In response to the chairman's question, Mr. Wadhams felt the precedent is to do it in a fixed dollar amount and adjust it accordingly. He stressed the purpose is to develop a setting in the rural hospital to encourage more people to participate and declared the updated statute is worthy of adjustment.
Chairman Rawson closed the hearing on A.B. 553 and opened the hearing on A.B. 655.
ASSEMBLY BILL 655: Revises provisions relating to state lien on recovery of proceeds from person liable for illness or injury of recipient of assistance to medically indigent. (BDR 38-746)
Ms. Block testified that A.B. 655 will assist the welfare division in obtaining reimbursement for benefits paid on behalf of a Medicaid recipient from a responsible third party. Ms. Block read verbatim from her prepared testimony (Exhibit E).
As there was no further testimony or discussion, Chairman Rawson closed the hearing on A.B. 655.
Prior to taking a vote, Chairman Rawson clarified A.B. 168 allows police departments in the major counties to do examinations of individuals within their detention facilities.
SENATOR NEAL MOVED TO DO PASS A.B. 168.
SENATOR GLOMB SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS O'DONNELL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
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SENATOR BROWN MOVED TO DO PASS A.B. 503.
SENATOR COFFIN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR NEAL VOTED NO. SENATORS O'DONNELL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
* * * * *
SENATOR COFFIN MOVED TO DO PASS A.B. 553.
SENATOR BROWN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS O'DONNELL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
* * * * *
SENATOR BROWN MOVED TO DO PASS A.B. 655.
SENATOR GLOMB SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS O'DONNELL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
* * * * *
Chairman Rawson presented a bill draft provided by a physician, and subject to committee introduction. This bill prohibits a homeopathic physician from using devices for electrodiagnosis if they are not in compliance with the federal food, drug and cosmetic act. A discussion ensued and it was decided to refer the bill draft to the committee for commerce and labor for introduction.
Chairman Rawson opened the work session on S.B. 311.
SENATE BILL 311: Clarified that a private hospital may provide for the examination of persons alleged to be mentally ill; eliminates the requirement that county hospital provide a room for the detention of such persons. (BDR 40-482)
Chairman Rawson reviewed the assembly's Amendment No. 674 to the bill, shown on page 2 of the work session document (Exhibit F).
Jan Lewellyn-Davidson, Lobbyist, University Medical Center (UMC), remarked that an amendment was passed out of assembly with the key words, "custodial supervision." She stated Mr. Carpenter requested this amendment to S.B. 311 in order to insure that there would be continued cooperation between the rural hospitals and the police departments who were doing the transporting. She voiced her support of the amendment.
SENATOR GLOMB MOVED TO CONCUR ON S.B. 311.
SENATOR BROWN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS O'DONNELL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
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Chairman Rawson introduced Senate Concurrent Resolution (S.C.R.) 17.
SENATE CONCURRENT RESOLUTION 17: Supports personal assistance services to persons with disabilities. (BDR R-955)
Chairman Rawson briefly outlined the assembly amendment, and noted they deleted the word "programs" and inserted "a national program." He read for the committee, "Resolved, that the members of the Nevada Legislature support all efforts to develop programs which would provide personal assistance services," and pointed out the amendment would change the wording to all national programs, which might be reasonable in light of the state's financial condition.
He continued reading, "Resolved, that the Nevada Legislature urged the Governor to establish a task force to examine the problem;
Resolved that the Governor appoint the following persons to the task force, persons to serve without reimbursement, persons with disability, administrators of programs, representatives of state agencies, members of the legislature, and any other interested persons."
Senator Coffin voiced his concern with the amendment, and a general discussion ensued among committee members.
SENATOR GLOMB MOVED TO NOT CONCUR ON S.C.R. 17.
SENATOR BROWN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS O'DONNELL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
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Chairman Rawson presented the proposed amendments to S.B. 93 (Exhibit G).
SENATE BILL 93: Creates board to regulate cost of health care. (BDR 40-224)
Pepper Sturm, Research Analyst, briefly summarized the proposed amendments to the bill, as outlined in Exhibit G.
Teresa Rankin, Commissioner, State Department of Insurance, stated that sections 1 through 4 of the amendment were contained in S.B. 359.
SENATE BILL 359: Makes various changes relating to cost of health care. (BDR 57-1725)
She pointed out the bounty to be paid to the patient, which was objected to in the senate finance hearing, has been deleted.
Chairman Rawson questioned section 1, subsection 1, which imposes a $1,000 fine for each violation. It was his feeling this is a relatively big fine for the offense. Senator Brown pointed out the language states, "not more than $1,000."
Ms. Rankin noted this fine is similar to the insurance company fines which can range from $5 up to $2,000 per incident. She clarified the executive director is an arbitrator/mediator, and as it would be inappropriate for them to be the finer also, they make a recommendation and the commissioner adjudicates the fine.
Chairman Rawson noted for the committee that S.B. 93 could be handled a number of ways, amend, do pass and re-refer, consider a hearing, or hear it at Friday's work session.
Senator Glomb asked Ms. Rankin if the department is taking a position on this bill. Ms. Rankin stated as it relates to S.B. 359, she would support the bill, however, she remarked she has some concerns about section 5, page 4, of the amendments (Exhibit G).
Senator Brown asked about the fiscal impact of the bill. Chairman Rawson replied he would have Pepper Sturm get some estimates and present them at the next work session. It was agreed to handle S.B. 93 at the hearing scheduled for this Friday.
Chairman Rawson introduced the proposed amendment to S.B. 418.
SENATE BILL 418: Requires establishment of primary health care network for improving health status of mothers and children.
Mr. Sturm reviewed the work session document regarding the fiscal note for S.B. 418, page 3, attachment B (Exhibit F). He advised the committee had been waiting for a revised fiscal note as the original fiscal note did not include the cost to the University of Nevada. Mr. Sturm cited the new totals, $226,074 for fiscal year (FY) 1993-94 and $217,620 for FY 1994-95.
Senator Glomb pointed out there was testimony from Robert Barengo that this bill might have an effect on the provider tax.
Robert Barengo, Lobbyist, Humana, stated there is an agreement that there would be no attempt by the state, or anyone else, to direct patients, which would create open competition.
Chairman Rawson asserted there was a proposal by the executive branch to do a managed care program in Medicaid, and as part of the context of that they were not going to try and influence the flow of patients. Mr. Barengo agreed with the chairman's statement. He said it is his understanding there would be no managed care program on the Medicaid population. Chairman Rawson maintained that is not his understanding. Senator O'Donnell commented this appears to be a steering bill.
Senator Coffin stated it was his impression from the hearing that the committee was going to agree to strike everything after section 4, which would have taken care of the steering action.
Mr. Sturm referred the committee to page 7 (Exhibit F). He pointed out this amendment was proposed by the university to address concerns expressed by Mr. Barengo. Mr. Barengo replied he has not had the opportunity to express his concerns directly to the university.
Chairman Rawson read the amendment, "Develop a plan to provide access to clinical services to mothers and children disadvantaged due to their geographical location or socioeconomic status."
Mr. Barengo stated that there is a risk for the hospitals to accept the provider tax, and by allowing competition the hospital can feasibly get more business to cover the payment being made.
Based on the above discussions, Chairman Rawson decided to put S.B. 418 into subcommittee in an attempt to get the parties together to revisit this issue.
Chairman Rawson opened the hearing on S.B. 526.
SENATE BILL 526: Revises manner in which interest must be paid to individual accounts in trust funds for child welfare. (BDR 38-2027)
Mr. Sturm reminded the committee this bill had been heard recently and was not acted on due to the lack of a quorum. He stated the division of child and family services recommends deleting subsection 5 of section 1, page 2, of the bill. Chairman Rawson clarified this language allows court ordered child care benefits to produce the child care.
SENATOR O'DONNELL MOVED TO AMEND AND DO PASS S.B. 526.
SENATOR GLOMB SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS NEAL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
* * * * *
ASSEMBLY CONCURRENT RESOLUTION 37: Urges State Welfare Administrator to develop program to encourage certain recipients of Medicaid to participate in educational program on family planning. (BDR R-1430)
A discussion ensued among the committee members as to the definition of family planning. Ms. Florence pointed out the federal government currently provides enhanced federal participation for family planning activities. She clarified they define family planning as education to male and female patients of child bearing age who are on Medicaid, to insure that any pregnancy is an intended pregnancy, advising them of their sexuality, contraception, abstinence, and the consequences of engaging in sexual behavior. This bill requires providers to furnish information on family planning to all individuals of child bearing age.
Senator Brown noted that planning talks about before conception and in her opinion abortion is not part of family planning.
Senator O'Donnell stated this came out of an interim study and he recalled that the clergy testified against the resolution. Ms. Florence reminded the committee the original resolution dealt with restricting benefits if the recipient did not participate in family planning, and emphasized this has been changed substantially with the new language.
SENATOR GLOMB MOVED TO DO PASS A.C.R. 37.
SENATOR BROWN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS NEAL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
* * * * *
Chairman Rawson opened the hearing on S.B. 447.
SENATE BILL 447: Prohibits under certain circumstances surveillance on the grounds of a public school or a state facility or on a campus of the University of Nevada System. (BDR 34-1668)
The chairman stated he would be excusing himself and leaving the gavel with Vice Chairman O'Donnell due to a potential conflict of interest. A discussion ensued among committee members as to those who felt their employment might also represent a conflict.
Senator Coffin pointed out the rules allow action unless a pecuniary interest has been created. Chairman Rawson agreed and stated he would go ahead and administer the bill.
Senator Coffin explained he proposed S.B. 447 in response to issues relating to electronic surveillance in the university system, and the state employees who found they were being observed without their knowledge, in an area where they had a reasonable expectation to privacy. He reminded the committee of the testimony taken during the last hearing, with the primary resistance coming from law enforcement. Senator Coffin stated he worked with law enforcement, the state employees and the teachers in drafting amendments to meet their needs. The senator referred the committee to the work session document (Exhibit F), commencing on page 8, which sets out the new amendments, and is essentially a new bill.
Senator Coffin stated the school district is proposing a new amendment, as shown on page 11 (Exhibit F), which would meet the needs of all those concerned. He proceeded to review the amendments with the committee.
Chairman Rawson asked if surveillance cameras in the hallways, which are public thoroughfares, would be outlawed. Senator Coffin referred the chairman to Nevada Revised Statutes (NRS) 331, which relates to public buildings in general.
Pepper Sturm recalled from previous testimony that having surveillance cameras in hallways is usually with the knowledge of people traveling in a public thoroughfare, and in his opinion there is nothing in the proposed amendments which would change that interpretation.
Chairman Rawson asked if the amendment addresses surreptitious surveillance or just surveillance. Senator Coffin noted the amendment merely states any kind of electronic surveillance without the knowledge of the person being observed.
Senator O'Donnell expressed concern that those persons using a camera off the school grounds to film an activity on school grounds might be in violation under this bill. Chairman Rawson suggested adding language which reads, "is necessary as part of a system of security used to protect and insure the safety of persons on the grounds of the school." Senator Coffin asked Robert Gagnier to step forward and render an opinion on this language.
Robert Gagnier Lobbyist, State of Nevada Employees Association (SNEA) testified they did not intend to limit the use of security cameras. Chairman Rawson maintained the whole issue is surreptitious surveillance. Mr. Gagnier stated there is no intent to eliminate cameras, such as in the hallways, or to stop the filming of situations such as the Rodney King beating. Mr. Gagnier suggested Senator O'Donnell's concern is well taken, but he is not sure of a resolution.
Senator O'Donnell questioned if the word "surveillance" is defined in the statute. He suggested inserting the language "surreptitious surveillance," into the bill, which may clarify the intent. Mr. Gagnier suggested "surreptitious" or "clandestine" as language which may assist in clarification of the bill.
Senator Coffin thought the legal division could select some wording that would address the concerns of the committee.
There was general discussion among the committee members about the amendments and the bill.
SENATOR GLOMB MOVED TO AMEND AND DO PASS S.B. 447.
SENATOR BROWN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR RAWSON ABSTAINED FROM THE VOTE. SENATOR TOWNSEND WAS ABSENT FOR THE VOTE.)
There being no further business, the meeting was adjourned at 5:12 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
June 16, 1993
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