The Committee on Commerce and Labor was called to order at 1:45 p.m. on Friday, April 30, 1999. Chairman Barbara Buckley presided in Room 4100 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List. All Exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

COMMITTEE MEMBERS PRESENT:

Ms. Barbara Buckley, Chairman

Ms. Merle Berman

Mr. Joe Dini, Jr.

Mrs. Jan Evans

Ms. Chris Giunchigliani

Mr. David Goldwater

Mr. Lynn Hettrick

Mr. Dennis Nolan

Mr. David Parks

Mrs. Gene Segerblom

COMMITTEE MEMBERS ABSENT:

Mr. Morse Arberry

Mr. Bob Beers

Mr. David Humke

Mr. Richard Perkins (Vice-Chairman)

GUEST LEGISLATORS PRESENT:

Senator Raymond D. Rawson, Senate District 6

STAFF MEMBERS PRESENT:

OTHERS PRESENT:

Following roll call, Chairman Buckley apologized for the late start and explained some committee members were testifying in other committee meetings. She opened the hearing on Senate Bill 103.

Bruce Robb, Attorney at Law, Nevada State Board of Professional Engineers and Land Surveyors, stated there was nothing controversial about the bill. He pointed out that section 12 restricted the use of the word engineer. The state board recommended modifications on the use of the word to fully restrict "licensed, registered, and professional engineer." However, use of the word engineer as a professional or commercial identification was acceptable provided the individual engineer disclosed he was not licensed to practice professional engineering in the State of Nevada. Another issue referenced educational requirements of engineers and land surveyors in the State of Nevada. The trend was toward requiring a college education in both professions and the language agreed upon with the American Consulting Engineers Council, Nevada Association of Land Surveyors, State of Nevada Employees Association, and Nevada Department of Transportation was evidenced in section 17 of the bill and the following proposed amendment. Educational requirements for engineers would be effective July 1, 2010. Requirements for professional land surveyors were set forth in section 18 in the last three lines of the bill. Mr. Robb proposed an amendment to section 18, subsection 3, of the bill. The modification (Exhibit C) proposed that section 7 become effective July 1, 2010, if a land surveying curriculum of 4 years or more was approved by the board and offered by an institution of higher education located in Nevada. According to Mr. Robb, the bill was not drafted by the Legislative Counsel Bureau to reflect the agreement by proponents of the bill and Senator Carlton. Mr. Robb wrote to Senator Carlton and asked that she look at the language of the bill that was very close to what was agreed upon but not entirely accurate.

Ms. Segerblom sought clarification regarding the degree. Mr. Robb explained that engineering and surveying were two separate professions. There were professional land surveyors and professional engineers. It would be rare for a mechanical engineer to be involved with surveying.

Ms. Segerblom questioned whether surveying was taught. Mr. Robb responded classes were offered at University of Nevada, Las Vegas (UNLV). Classes were offered in California and other adjoining states that had an established a 4-year curriculum. With the passage of the bill the hope was UNLV could establish a 4-year curriculum for professional land surveying.

Chairman Buckley questioned what the current 4 year educational requirements were and why was it necessary to establish a law that would become effective in 10 years instead of waiting for the program to be in place and adjust the statutes in the future.

Mr. Robb testified under the current situation one could become licensed as a professional licensed engineer or professional land surveyor in the State of Nevada through graduation from an accredited curriculum or through an apprenticeship program that did not require a college education. National professional societies and the State of Nevada agreed with the new requirements because of the complexity of the two professions. The Nevada Department of Transportation currently had a program for individuals to take classes and qualify to take the exam without the formal college education. Experience demonstrated that members of both professions were more successful in passing the required exams and performed better professionally if they had a collegiate background.

Chairman Buckley reiterated that the approach requested became effective in 10 years after the Board of Regents approved a program and wondered if there was grandfathering in of current licensed engineers.

Mr. Robb noted the recommendation was an amendment to the bill that the land surveying educational requirements go into effect in the year 2010 if there was a 4-year curriculum offered by an institution of higher education in the State of Nevada. The requirement currently existed in the bill regarding professional engineers. The Senate committee’s opinion was that one should have a college education beginning in the year 2010. Section 18, subsection 2, related to engineers. Subsection 3 would have the requirement go into effect 10 years after a 4-year curriculum was established. The Nevada State Board of Professional Engineers and Land Surveyors suggested that it go into effect in 2010 if there was a 4-year curriculum with the hope it would encourage UNLV to establish a 4-year curriculum. Individuals who were presently licensed would be grandfathered, although that was not stated in the bill.

Chairman Buckley stated sometimes it was easier to have the information in the statutes so those who were not trained in law could read it clearly in the chapter. She invited members opposed to the bill to step forward to testify.

George Brizendine, Principal, Brizendine Engineering, was opposed to section 12 that dealt with title protection. He stated the change was not necessary at that time and, although restrictive, the current language of the law had served well for many years, and had been properly interpreted in the past by the board which used some discretion in enforcement of title protection. There was a case which used the title "domestic engineer" at a time when Mr. Brizendine served on the board. It was a cleaning service, which had no intention of misleading anyone but used a common household term. The board decided to restrict the use of the title, and he felt that was appropriate. The only time current language presented trouble was when individuals came to Nevada from out of state where the term "engineer" was not restricted. The terminology was used as a sales technique to suggest higher qualifications than were actually possessed. The computer industry did not subscribe to the limitation on the title "engineer" which they used freely for technicians. A computer company, Novell, took high school graduates that met certain background requirements and put them through a 6 week course and when completed they were Novell engineers. The purpose was to make the public believe the technicians were at a level of competence they really did not possess. The marketing department believed the title gave the company a competitive edge.

Chairman Buckley summarized earlier testimony that the Nevada State Board of Professional Engineers and Land Surveyors had used good judgment in the past with the existing language. She articulated if the language was changed would the board would use the same good judgment used in the past.

Mr. Brizendine voiced his belief that it did not cover partnerships, joint ventures, or limited liability companies but did apply to individuals and corporations. There was a defect in the proposed wording regarding a disclaimer to protect the general public.

Chairman Buckley stated S.B. 103 had been well covered by both sides but invited others to testify.

Rita Lumos, Vice Chairman of the Nevada State Board of Professional Engineers and Land Surveyors, commented she was in attendance to support the bill as printed with the amendment Mr. Robb offered.

Chairman Buckley closed the hearing on S.B. 103 and opened the hearing on S.B. 181.

Senator Raymond Rawson, Senate District 6, presented a letter he had received from Joel F. Glover, Doctor of Dental Surgery, Nevada Dental Association (Exhibit D). Exhibit E was a proposed amendment to Senate Bill 181. According to Senator Rawson, S. B. 181 accomplished some simple things. Upon graduation from an accredited dental school students took a national board examination which must be passed at a certain level to be entitled to take a state board examination. The state board examination consisted of two parts. The jurisprudence part was essentially Nevada law related to dentistry and a clinical examination to safeguard the public by demonstrating a student had the ability to perform according to the training he had received. A number of dental programs had been developed in the state which created a problem in recruiting nationally known faculty. There was a dental hygiene program in southern Nevada and a new hygiene program opened at Truckee Meadows.

A dental residency program was approved in 1997 and was just beginning to function. A dental school had been proposed. There were other residency programs developed in pedodontics, children’s dentistry, dental anesthesiology, endodontics, and several others had been discussed. For each position, one attempted to get the best director possible. Typically the candidate had 15 to 20 years experience, had taken a number of national and state board exams, was widely published, and known worldwide. When trying to recruit individuals of that stature to Nevada the first question they asked was whether or not a state board examination was required. They simply were not interested if they had to sit for that clinical examination. Those candidates wrote the textbooks from which most students learned, taught in clinics in the biggest schools in the world, and were willing to take only a limited number of exams which were expensive, time consuming, and not applicable to their work which did not include daily routine dentistry. Most applicants would not subject themselves to those requirements. The bill was written with the intention to keep a balanced control to safeguard the public and recruit nationally recognized faculty.

Section 1 allowed the board to issue a limited license to practice dentistry or dental hygiene without a clinical examination. The jurisprudence exam was still required, so they would know Nevada law if teaching in Nevada. To be qualified, the requirements included a valid license to practice elsewhere, fees paid, a full-time teaching contract or a full-time intern or resident with a contract with the University of Nevada. If there was a legitimate contract and other conditions were met a license could be issued. It could be called licensing by credential. The license would not be issued to anyone whose license had been revoked or suspended, who had been refused a license, or who was involved in a current disciplinary action. That would safeguard the public. The person with the license could practice only in certain areas and could not set up a competitive practice with a general practitioner. They could practice in the educational clinics or outpatient clinics associated with hospitals or those clinics associated with the University of Nevada System. The license would be granted for 1 year, was renewable and revocable.

The next five or six sections were technical changes that were added by bill drafters. The controversial part of the bill was section 7 regarding increased fees. There had not been a limited license in the past so a fee was added for the limited license, which was compatible with other license fees. The section also gave authority for the board to raise fees from $300 to $750 incrementally. Every 10 or 20 years the amount was legislatively adjusted. The legal requirement was that boards were self-sustaining and general funds were not used for the licensing procedure.

Because there was no facility in Nevada, the dental board in California must be used. It was expensive to travel there and rent the required facilities. Essentially the fees were added to maintain a cost-neutral position that did not require using general funds. Fees were added in other areas which had good public policy behind them. Currently a fee existed for general anesthesia in a dental office, but there were other dangerous procedures that should be licensed, such as conscious sedation of a patient which was being added. A reinstatement fee was being added to cover someone who had retired and then returned to work, or an individual who had been through a disciplinary action. A certificate of license fee was required because many hospitals required certification from the board and would not accept a copy of the license or correspondence.

The letter from the Nevada Dental Association, Washoe County Dental Association, and Clark County Dental Association, supported fee increases. They recognized it must be self-supporting and were willing to pay the fees. The Governor’s Office indicated the bill met its criteria, and they would not veto the bill.

Section 8 applied to the limited licensee and brought them under the same disciplinary actions as any other member. The limited licensee could be required to reimburse full payment to a patient if the patient disagreed with the work that had been done.

There was an amendment proposed to help with The Western Interstate Commission for Higher Education (WICHE) Program. The current requirement was that someone who had received help from the program was allowed to return to the state and receive credit provided they had 5 years experience. WICHE students who did not graduate from dental school did not have that kind of experience and, therefore, did not receive such credit. The amendment would change that and would allow the WICHE student 3 years. Individuals who failed their board and wanted to return and pay off their WICHE loans had no mechanism to do that. The university system would establish a remediation program in 1999 for those people who failed the board, so they could take continuing education, work on patients under supervision, and take the board test again.

Currently there was a dental residency program with a director not licensed to practice in Nevada. He was probably the very best person in the country that could be found to run the general practice residency program and allowance had been made in the law for the students under him. The graduate dentists could practice, but they did not have a director that was able to do the same thing. The amendment would change that.

Ted Twesme, President, Nevada State board of Dental Examiners, testified that the dental board was in complete support of Senator Rawson’s bill. The last time the board went before the legislature to raise fees was in 1988, 12 years ago and there had been considerable cost increases since that time. Because there was no dental school or site within the state where examinations could be done travel to California was necessary. The costs of travel, hotels, labs and rental at dental schools had increased significantly over the past 12 years. There were increased numbers of applicants for dental examinations that necessitated creation of an additional team of three examiners. The board was actually losing between $5,000 and $7,000 per examination. As a self-supporting entity of state government the increases were necessary to administer the board properly.

Other costs had risen as well, Mr. Twesme said. Rent rose from $850 per month to $2,200 per month. An additional part-time secretary was hired to handle the increased workload. The certificate fee applied to increased requirements for licensure requiring notary costs and certified mail costs sent to multiple locations. Approximately five were done a day and Nevada was the only state that did not charge for that certification fee. The fee was necessary to recover costs. Although the increased fee of $750 for an examination might seem like a large increase it was the board’s intention not to impose that fee but rather to recover their costs. A cost analysis allowed them to recover costs and not make a profit on the exam. Even if the cost was $750, Nevada would probably be the cheapest state board exam in the United States.

Ms. Giunchigliani expressed confusion between limited and restricted license in the amendment and wanted to know if they were now the same. Mr. Twesme clarified the restricted license was developed for student residents in the state. The amendment would remove 5 years, and the renewal would be changed from 1 year to 3 years.

Ms. Giunchigliani confirmed the limited license would apply to those coming from out-of-state but held a license in another state and met the same qualifications other than the 5-year clinical requirement. Under both restricted and limited license, neither would have to meet the 5 year requirement.

Mr. Twesme asserted there would never be a consideration for a faculty that did not have the experience and reputation.

Ms. Giunchigliani reiterated the bill gave the board flexibility.

Mr. Twesme remarked the main concern was there were people who wanted to pay off their loans that could not qualify, because they did not have the experience.

Ms. Giunchigliani referred to page 6 and inquired what constituted a disabled dentist. Mr. Twesme observed there had been some serious accidents involving dentists, and he had a friend that was now a quadriplegic. That could be very tragic for a dental practitioner who practiced that for many years. Some may want to maintain a license so that they could teach or do insurance claim forms or whatever they were capable of doing. The removal of the 5-year restriction for WICHE students had the intention of letting new graduates work off their debt immediately rather than 5 years later. The time allowed to accomplish that was increased to assist the student.

Ms. Giunchigliani questioned whether the wording on page 6 included dental hygienist since it did not say that. Mr. Twesme responded it was the intent to include dental hygienist.

Chairman Buckley asked why the license fees were being raised to a level they did not intend to utilize. Mr. Tweseme replied that would prevent the board from having to return to the legislature every 2 years.

Chairman Buckley asked if it was $300 now and raised to $500, that should last for a number of years. Mr. Twesme related the costs were actually close to $425 now so $500 would not last long in the current inflationary market in the dental field. Chairman Buckley replied sometimes there was a reluctance to a high increase.

Jeanette K. Belz, Director of Government Relations, Wadhams & Akridge on behalf of the Nevada Dental Association, appeared in support of S.B. 181.

Michael Rodolico, Executive Director, Health Access Washoe County (HAWC), Reno, Nevada, appeared in support of the bill. From a clinical perspective it was very important they had access to new dentists. HAWC had struggled for years with many barriers including those from Federal Government, which had directed them not to bill the dental clinic and not to use their funds to support dental programs. To get past that barrier they raised local funds and worked with the Nevada Dental Board that approved dental hygienists working independently in a medical clinic with dental supervision. HAWC had been providing that service for approximately 7 months and now served about 100 patients a week, all of which were children; 90 percent of them had never seen a dentist. HAWC had now been funded to have a dentist and were facing the hurdle of obtaining one in Reno. Dr. Rodolico reiterated they supported the bill and asked for support of the legislature.

Linda Sheldon, Health Director, Yerington Pauite Tribal Health Clinic, and a member of the Advisory Board for WICHE, introduced herself.

Stacy L. Stahl, a member of the Yerington Paiute Tribe and an elected tribal council member, spoke next. She read a prepared statement (Exhibit F). The Yerington Paiute Tribe supported S.B.181 with the amendment as proposed by Senator Rawson and one additional suggested amendment.

Assemblyman Dini questioned the witnesses regarding the program which was working but not sanctioned by the state dental board.

Ms. Sheldon replied they were on federal land and the state dental board had no jurisdiction over federal land. The site was chosen because the tribe agreed to be the test site to prove the program could work anywhere. Individuals served were eligible under a federal contract with an in-house service and specified by the tribal council as eligible for services. To do the program in a community center such as HAWC, Las Vegas, or any rural clinic other than an Indian reservation they needed parity with a limited licensure program as it stood with physicians. They were in the committee to share information of what was successful. The Yerington Paiute Tribe would like to see the program go out to others. It had been a wonderful experience since it began 6 months ago. An amendment was suggested to S.B. 181 that included parity in licensure (Exhibit G).

Chairman Buckley stated in the legal field through a Supreme Court rule, licensed lawyers from other states who agreed to work for legal services organizations could practice under the supervision of a licensed lawyer for a few years while awaiting licensure. Chairman Buckley revealed she was licensed in Arizona when she came to Nevada and began practicing law under that program. When there was so much need it could be an additional tool provided there were adequate controls for people who could not obtain help in any other way.

Assemblyman Dini said a medical doctor licensed in other states who did not have the 3-year residency required in Nevada could not practice. After working in rural areas for 5 years they were allowed to practice anywhere in the state. What was being sought was a similar program and some relief that if the test was failed one would not be prohibited from taking it again under those conditions.

Ms. Sheldon agreed. The suggestion offered was that the candidate had graduated from an accredited dental program recognized by the State of Nevada, successfully passed a regional dental examination, and held a license in one or more states as physicians did in under-served areas. That would be a great value to a large number of people. There were letters provided to be made a part of the record from Lona Katenay, Eloura Rogers, Margaret Mandeville, Doreen and Elwood Emm and Family, and Dr. David C. Buster (Exhibit H).

Roger Volker, Executive Director, Great Basin Primary Care Association, Carson City, presented a prepared letter from the association (Exhibit I). Great Basin represented providers of health care services to low income families throughout Nevada. Access to dental care was a major problem for children and families throughout the state. He encouraged the committee to support the bill and any amendment which would enhance the number of providers for the low income and under-served areas throughout the state.

Senator Rawson concluded his remarks by telling the committee in the past 4 or 5 years he had been exposed to the health care needs of the rural areas. All but two counties in the state were under-served and even major portions of Clark County were under-served. Douglas and Washoe Counties were at national averages for access to dentists, but the rest of the counties were in desperate straits. With an understanding of the situation he attempted to promote the idea of residency programs, a dental school, and some mechanism to allow WICHE students back into the state. The idea presented reflected a major shift in policy.

Continuing, Senator Rawson said the difference between dentistry and the other professions was that dentistry used engineering principles in a biological way. Almost every procedure performed by a dentist would involve an injection of anesthetic solution. There was high risk with some of the procedures performed. Great confidence was placed in a state board being able to create a high quality climate of dentistry in the state. When that was turned to a national board exam or a regional exam then the state had lost all control over quality. The only thing worse than no dentistry was bad dentistry or dangerous dentistry. In trying to get care for those who needed it, care must be taken not to degrade that care to a dangerous level for the patient. If one observed the exposés on television programs that showed anesthetic deaths in the dental office one would know that was to what he referred. In every case of disaster the track record of the dentist was the individual failed the board exam, didn’t do well in school, took extra time to get into practice, worked on Medicaid children, and patient deaths were the result. He did not want that to happen in Nevada. A year from now, he said, the public would hear that the things the committee considered mitigated all the problems in the rural areas. Qualified people could be placed in small towns that did not currently have access to a dentist. That would be a safer situation than opening the board. Senator Rawson requested that no fundamental, significant, basic changes be made without giving the dental community time to deal with them.

Chairman Buckley closed the public hearing on S.B. 181 and opened the hearing on Senate Bill 210.

Dorothy B. North, Chief Executive Officer, Vitality Center, representing National Association of Alcohol and Drug Abuse Counselors, Chapters in Northern and Southern Nevada (NAADAC), was the first to speak. The bill was the result of enormous effort put forth to elevate the profession of alcohol and drug abuse counselor. Nevada had certification by statute for over 20 years. The bill created licensure for individuals who held a masters degree and retained certification for individuals with a bachelor’s degree. The alcohol and drug treatment field had gone through a long evolutionary process. The bill raised the educational requirements while allowing internships for those working on their education. Ms. North asked that an amendment NAADAC recommended be introduced by Marilynn Morrical.

Marilynn Morrical, Certified Alcohol and Drug Abuse Counsel and Certified Program Administrator, testified there had been conversations with nursing board representatives, marriage and family therapists board, and social work boards because those disciplines overlapped with substance abuse counseling issues. In a discussion just prior to the meeting there were a few minor changes recommended. Social workers were concerned about an oversight that required the word clinical be put in front of the reference to social workers. That was specifically mentioned on page 2, line 36. The reason for inserting the word clinical in front of the word social worker was that social workers had a two-tiered system. One tier was comprised of individuals with a bachelor’s degree and the other tier had a master’s degree. It was the licensed clinical social worker referenced in that particular section. That word needed to be added also on page 6, line 8, for the same reason. Other amendments related to the issue that as the bill was written it would dictate requirements to other boards. For example, developing regulations regarding substance abuse would be dictated. Each board felt it was independent of the other and should not be dictating to another. To correct that, all references were deleted that would dictate anything to another board. Those specific areas began on page 6, lines 11 through 13, to delete the reference to nursing. Page 7, line 14, again delete the reference to nursing and replace with a generic statement that the degree would be in the field of social science approved by the board. Page 14, delete section 45; page 15, delete section 47; and on page 16, delete entirely section 49. That would accomplish the removal of cross-referencing the different board’s responsibilities. All boards agreed the changes were desired. In the field of substance abuse counseling the changes increased requirements for counselors and thereby increased the professionalism of the field.

Chairman Buckley questioned how alcohol and drug abuse counselors were currently regulated and asked if there were any certificate or educational requirements. She asked for justification for creating a new board because there were currently so many boards, how would that benefit the public and what would happen if the committee failed to act.

Ms. North responded Nevada currently had certification by statute. There had been a requirement that there be certification for alcohol and drug counselors for a long time. The certification process began with a high school education and allowed a person to become certified with 5 years of paid professional experience. It also allowed internships at that level. The bill increased the educational requirements and allowed certification only with a bachelor’s degree and licensure with a master’s degree. The bill allowed internships for individuals who had a high school diploma if they were enrolled in college working toward a degree. That was part of the evolutionary process of the alcohol and drug abuse counseling field as a profession. The field had been denigrated because it did not have the educational requirements of other licensed professionals. It also allowed for licensed people to directly bill insurance and offer third party payment for those that were licensed as alcohol and drug counselors. Alcohol and drug counseling was a separate professional counseling field.

Ms. North pointed out licensure bills had already passed in 14 other states. The bill would grandfather in those who were currently certified in the State of Nevada if they applied before January 1, 2001. The bill would not put currently certified people out of work. It was a necessary evolution to provide better services to the public and to ensure the individuals were qualified to do that work. A budget had been previously submitted indicating the board would be self-supporting through license fees, and Ms. North questioned whether it had accompanied the bill to the committee.

Chairman Buckley pronounced the budget had not been provided and requested a copy be made for Mr. Hughey (Exhibit J).

Assemblywoman Evans asked under the present arrangement for Bureau of Alcohol and Drug Abuse (BADA) certification, what were the other types of educational requirements that went with BADA certification.

Ms. Morrical testified that through BADA current requirements were like a teeter-totter. With a high school diploma one needed to have a minimum of 5 years supervised field experience. With a bachelor’s degree the requirement was 2 years of supervised experience and with a master’s degree 1 year of supervised experience was required. The requirement of supervised experience depended upon the level of formal education. The Bureau of Alcohol and Drug Abuse had a certification board, which acted in an advisory capacity. The creation of a board of examiners had more regulatory power, which resulted in the counseling field being perceived as more professional.

Assemblywoman Evans persisted in questioning what would happen to BADA certification, as it was currently known. Ms. Morrical replied that it would no longer be directly under BADA it would be an independent board. A two-tiered system was proposed under a new board rather than under BADA. It would be a bachelor’s level certification and a master’s level licensure. The new board would oversee it.

Chairman Buckley asked if there was anyone else that wished to testify.

Helen Foley, Lobbyist, representing Marriage and Family Therapists, said they supported the provisions of S.B.210 but drew the committee’s attention to page 6, line 8, regarding a social worker referred to 641A and said that should be 641B. On line 10, marriage and family therapist should be 641A and not 641B.

Kathy Apple, Executive Director, Nevada State Board of Nursing, declared the concerns were that the jurisdictions would not be confused and wanted to know the committee’s thinking about licensure based on a single educational background. For instance, a person could use a nursing license to be licensed by another board. The main thing was to ensure the jurisdictions were clean, clear and not confused.

Chairman Buckley observed she was going to schedule a time for everyone to get together before the amendment was submitted, and if they reached agreement they could indicate to the committee or conversely indicate any further concerns they had in writing. When the bill was brought back to committee work session everything would be clear. She indicated they were all welcome to return to the committee work session.

Rosalind Tuana, Executive Director, Board of Examiners for Social Workers, State of Nevada, declared as they understood the amendment they agreed with it. However, she stated they were not 641A but rather they were 641B.

Assemblyman Goldwater inquired whether the licensing for drug and alcohol counseling would result in the accusation that individuals were practicing outside the jurisdiction. He commented a lot of the people involved in that area, while not certified, had a good understanding of the experience and were effective in working with patients. They may not have had a formal education but were very effective in assisting the individuals counseled.

Ms. North responded that she did not expect that experience in the future.

Certification applied to advertising oneself as an alcohol and drug counselor and the same thing would be true with licensure. It would not prevent others from sharing their experience, strength, and hope with others who had the same problems.

Assemblywoman Giunchigliani questioned how many counselors were practicing now.

Ms. North felt there were approximately 800 certified counselors in Nevada operating as alcohol and drug counselors and the majority of them already had master’s degrees. Approximately 150 to 175 individuals had neither a bachelor’s degree nor a master’s degree and had been in the field for a very long time having risen through the ranks. Under the bill those individuals could make application to the board within a specified length of time and could be grandfathered in to licensure. They could still continue to practice.

Assemblywoman Giunchigliani queried why they did not hold certificates.

Ms. North revealed that the state had the latitude to hire individuals who did not have a license. As the administrator that put the Wings Program into Warm Springs Prison, Ms. North had a certified staff. However, that was not necessarily true throughout the system.

Assemblywoman Giunchigliani probed the requirements for the master’s degree. Ms. North reiterated it was in the field of social sciences and the board decided what fields in social sciences were appropriate.

Leigh Church, Intern Counselor, The Ridge House, read her prepared statement into the record (Exhibit K). Ms. Church was particularly concerned the potential costs associated with the bill would place treatment outside the possibility for many people. She was concerned about discounting the value of interns and apprentices in the process and felt that formal education was not a guarantee for quality care providers. The last point was that an artificial cap was placed on professional advancement based on educational and not proficiency standards.

Gary Short Meneley, Clinical Director, The Ridge House, presented the members with a letter (Exhibit L) which he did not read into the record. He related he came into the field when he was in his 40’s following an industrial accident in the construction industry and rehabilitation to a new career was required. He went through 2 years training in order to make a decent living. At that time he raised 2 children alone, paid child support, worked part-time, went to school full-time, and interned for a nonprofit agency simultaneously. If he had known at the beginning that a master’s degree was required to make a decent living in the field he would not have attempted to enter the field. He had been working for 7 years and considered himself highly proficient if not highly educated. He believed there could be a big difference between education and competency.

Mr. Meneley believed there was a real problem when individuals from social work, nursing, marriage and family therapists were allowed to practice in the alcohol and drug counseling field with 6 months of experience to qualify for licensure. Did that mean they saw one client once a week for 6 months and then were qualified to counsel drug addicts and alcoholics? Their education did not necessarily have one class in it that related to addiction. Yet, they were allowed to work in the field under supervision. To be certified, 4,000 hours of counseling experience was required. A social worker, marriage family counselor, and nurse would only be required to work under supervision for 6 months to qualify for licensure. Mr. Meneley stated that he had a 2-year degree, a history of personal recovery, and 7 years of experience working in the field. It took time to become an accomplished counselor. It was frightening to think that people with an education and no experience were allowed to counsel people. He worked with the incarcerated population, and they did not care what his degree was but wanted to know what he could do to help them. In fact, sometimes the counselors without a degree were very good at what they did because they could relate on an experiential level.

Mr. Meneley was of the opinion the bill was not needed. Currently there was a board, BADA, that certified counselors. Over 10,000 hours of experience and education were required to sit for the exam. The exam was not easy. Continuing education of 40 hours in substance specific classes were required following the exam. He avowed that a 2-year degree in addictions such as those offered at the University of Nevada or Truckee Meadows was much more reasonable and skill specific than a master’s degree in social science where no training in addiction was required.

A letter from Dr. John N. Chappel, Professor of Psychiatry (Exhibit M), one of the leading professionals on the field of addictions in the country, was presented. He made some of the same points. Even doctors were required to have a year of experience before they could be addiction specialists. Contrast that with the requirement to have social workers, nurses, registered social workers, and marriage and family counselors to have that privilege without the experience to perform the job effectively. Taxpayers were the ones who were going to pay for the increased costs of treatment under the bill. Drug abusers were indigents and had no insurance and no access to treatment other than what the nonprofit organizations provided.

Lynn Johnson of North Las Vegas Treatment Facility, a Division of Nevada Medical Systems, was an owner and program director of a medical clinic that treated heroin addiction. He provided exhibits for the committee (Exhibit N). The certification presently required by Nevada Revised Statutes (NRS) 458 and the Bureau of Alcohol and Drug Abuse allowed for those individuals who possessed a college degree. It also allowed someone with a high school diploma to work as an intern for 5 years and earn a BADA certification. That would be someone who was unable to attend college because of finances, geographical location, were a primary caregiver or must hold down a full-time job in order to live. Under S.B. 210, section 26, an intern was required to be enrolled in a program from which a degree was granted.

Mr. Johnson stated people who lived in small towns like Ely, Elko, Tonapah, or Mesquite had no chance of becoming a counselor unless they received a degree from an accredited college or university approved by the board. About 13 percent of Nevadans suffered from substance abuse. Based on the latest statistics available the population of Nevada as of November 1998 was more than 1,852,000. Thirteen percent would indicate that about 240,000 residents were considered addicts. In 1998 about 9,000 residents received treatment from publicly funded programs. There was a backlog of individuals who tried to get into the treatment programs. Research indicated more substance abuse treatment needed to be provided. Section 24, subsection 2(b), was in direct conflict with federal regulations when it stated a licensed counselor could diagnose or classify a person as an alcoholic or drug abuser. State law could be more but not less restrictive than federal law. Passing the bill gave counselors the authority to diagnose an alcohol and drug abuse addict. Counselors could not make final determinations, but they could serve as coordinators between staff and patients and suggest possible intervention. He continued his testimony by reading from the prepared text, concluding with the request the bill not be approved because it would hurt the people of Nevada.

Mr. Johnson questioned the discrepancy between the date the bill was proposed to go into effect October 1, 1999, and the date licensing commenced January 1, 2001, and wondered how the board was going to maintain itself during that period of time. The new law stated, except as provided in subsection 4, all expenses incurred by the bill must be paid from the money received. No salaries or expenses of the board may be paid out of the state general fund. Would taxpayers be required to meet those expenses.
Section 19, subsection 4, stated in part, if a hearing officer was authorized to take disciplinary action pursuant to subsection 3 the board shall deposit the money collected from the imposition of funds with the state treasurer or credit to the state general funds. It seemed to be saying the state was going to keep the money even through the fine was imposed by the board. Should someone be fined $5,000 and subsequently when the board was found to be in error, the state would keep the fine anyway. Since the fine was not authorized it seemed the money should be returned to the person who was fined.

Assemblyman Goldwater questioned whether there could be a different standard than licensing, certifying, or board regulating. He wondered if the standard could be something less than board regulation such as registering or monitoring. He wanted to know if that was a consideration or would be something palatable to individuals involved.

Mr. Johnson replied it was regulated now by BADA which required certification. It was against the law for a person to call himself or herself a counselor unless they were BADA certified. The present law met or exceeded federal standards.

Chairman Buckley closed the public hearing on S.B. 210 and opened the hearing on Senate Bill 218.

Helen Foley introduced two members of the Board of Examiners of Marriage and Family Therapists; the President, Stephen L. Sprinkel; Vice President, Richard Vande Voort; as well as Lee Derbyshire, Director of the Marriage and Family Association; Jack Caffey, Treasurer; Deborah Roberts, Legislative Chairwoman; and Roberta Vande Voort, Past President. The bill amended Nevada Revised Statute (NRS) chapter 641A. The association felt the chapter needed to be amended to address the question as to whether marriage and family therapists were allowed to diagnose. In section 49 of the law they were allowed to diagnose. On page 24 the term diagnosis was included. There were 570 marriage and family therapists in the State of Nevada which was the largest number of mental health providers. They worked in crisis intervention, police and firefighters stress intervention, addiction treatment, school counseling, home family services, divorce mediation, and many other areas.

Ms. Foley said when the bill came forward in the Assembly there was opposition by the Board of Psychological Examiners as well the psychology association. Compromise was reached to identify the areas they would and would not diagnose. The clinical social workers chapter discussed the ability to diagnose and treat mental and emotional conditions. Nursing practitioners talked about selected medical diagnosis and treatment. It was up to the board of nursing to determine what that field should be since it was not defined in state law. Because the term diagnosis needed to be in state law a major compromise was reached by Dr. Whittemore, Licensed Psychologist; Dr. Betsy Neighbors, Immediate Past- President, Nevada State Psychological Association; Dr. Amazaga, Nevada State Psychological Association; and Stephen L. Sprinkel, Chairman of Marriage and Family Therapists Board of Examiners (Exhibit O). The agreement reached was the term would not include the diagnosis or treatment of a psychotic disorder or the use of psychological or psychometric assessment tests to determine intelligence, personality, aptitude, interests, or addictions. Marriage and family therapists were diverse and to be able to reach agreement on the amendment was quite an accomplishment. Testimony in written form was made available (Exhibit P). Letters were presented from:

• Danny L. Thompson, Political Director, Nevada State AFL-CIO
• Torrey L. Slade, Clinical Director, Harmony Healthcare
• Jim Hippler, Senior Vice President of Administration, Boyd Gaming Corporation
• Kathy Olson, Health Plan Manager, Mirage Resorts Risk Management
• Rick Anderson, Director, Human Resources Department, City of Las Vegas
• Michael R. Adams, President and Chief Executive Officer, Behavioral Healthcare Options, Inc.
• Mark Fleischmann, Trustee, Las Vegas Fire Fighters Local 1285
• Vivian D’Arpa, Senior Child and Family Intervention Specialty,
• Department of Family and Youth Services, Psychological Services
• Ronald W. Lawrence, Community Counseling Center, Las Vegas, Nevada
• Steven L. Oster, Marriage and Family Therapist, University of Nevada Las Vegas
• Sandra Temeus, Marriage and Family Therapist, University of Nevada Las Vegas
• Susan M. Beglinger, Medical/Behavioral Health Care Coordinator, Health Management Center, Inc.
• William Stone, Secretary/Treasurer, Nevada Psychiatric Association, Board Certified Psychiatrist
• Mark Collins, Board Certified Adult Psychiatrist, Board Certified Child and Adolescent Psychiatrist
• Harold S. Orchow, Psychoanalysis and Psychiatry
• Terri Merz, Individual Marriage and Family Therapy
• Volmar A. Franz

Ms. Foley believed the most important form given to the legislators was the health insurance claims form (Exhibit Q). In order to receive payment from an insurance company a diagnosis, nature of illness, or injury must be identified. One of the requirements in completing the form was the use of a code. The important thing about the code was it had a few digits and was directly correlated to what the problem was. If the code was not filled out, payment was not rendered. Anyone who did not diagnose did not get paid. Marriage and family therapists had been licensed to practice for 26 years and had always diagnosed. That was not an issue until brought forward by the Board of Psychological Examiners. In the spirit of compromise, marriage and family therapists met the agreement although they desired to perform the duties in the same fashion as nurses with master’s degrees and clinical social workers who were licensed to practice. That fashion was to have their boards determine what could be diagnosed. Ms. Foley expected an amendment would be brought forward that the marriage and family therapists felt would be a breach of the agreement made in the Senate and requested the committee to pass the bill exactly as it was.

Dr. Louis F. Mortillaro, Psychologist, Chairperson of the Psychological Board of Examiners, stated the board had agreed to support S.B. 218 as amended. The board considered the bill a good start in the right direction; however, there was a technical matter not addressed in the agreed upon amendment language. They recognized it was late in the legislative session and it might not be the time or place to address their concerns. He had personally spoken to members of the marriage and family therapy board and all individuals named earlier. All of them agreed to work together in the 2-year interim before the next legislative session. They wanted to come before the committee to address the technical modifications that were necessary. Their goal was to develop mutual cooperation between the boards to maximize the provision of regulatory services that optimized the protection of the public. In fact, mutual invitations were being extended to visit other board meetings.

Stephen L. Sprinkel, President, Nevada Board of Examiners for Marriage and Family Therapists, commented the bill was the result of a collaborative effort and hard work between psychologists and marriage and family therapists. He felt it was a good bill and urged passage.

Chairman Buckley closed the public hearing on S.B. 218 and opened the hearing on S.B. 439.

Todd Russell introduced Randel E. Walker, Certified Public Account, President of Nevada Society of Certified Public Accountants, and David W. Turner, Certified Public Accountant and member of the board. The bill had no opposition in the Senate and was intended to bring Nevada law and the Uniform Accountancy Act (UAA) in alignment. The bill came about through a joint effort of the Nevada Society of Certified Public Accountants and the Nevada State Board of Accountants.

• Section 1 of the bill was merely a housekeeping aspect.
• Section 2 asked limited liability companies for consistency.
• Section 3 had a fingerprint requirement for applicants for a certificate for certified public accountant and allowed the board the discretion to deny licensure to a felon.
• Section 4 was a transition rule of new educational requirements to allow the individual who had already passed a portion of the CPA exam to continue without having to return and take those educational requirements.
• Section 5 was a housekeeping provision.
• Section 6 was to bring Nevada into line with the UAA equivalency and allowed people who were licensed in other states or countries to come to Nevada and be licensed provided they met the equivalency requirements of Nevada law that were in effect when they received their original certificate.
• Section 6.5 allowed for non-CPA ownership in various entities allowed to practice in Nevada or elsewhere in the United States (US) either in the form of corporations, partnerships, or limited liability companies. A licensed CPA ownership must maintain the majority interest in those entities. Those individuals who did not have a CPA license must be directly involved in the business.
• Sections 7, 8, 9, and 10 elaborated on the non-CPA ownership.
• Section 11 corrected an ambiguity in the law.
• Section 12 allowed the board to take disciplinary action against a CPA for making false or misleading statements in applying for a certificate.
• Section 12.5 allowed non-CPAs to issue certain financial statements and reports but must meet certain provisions.
• Section 13 provided for changes for those seeking registration with the secretary of state to protect the public against false advertising.
• Section 14 did the same thing for foreign corporations.
• Section 15 applied to nonprofit corporations.
• Section 16 applied to limited liability companies.
• Section 17 repealed Nevada Revised Statute (NRS) 628.382 that disallowed CPAs in the state to charge commissions. There were approximately 34 states that allowed commissions. The bill removed the prohibition and allowed CPAs to be governed by the American Institute of Certified Public Accountant’s standards. A lot of effort went into the bill over the past 2 years. An attempt was made to balance public safety and protection as well as expanding laws for licensure.

Chairman Buckley asked Mr. Russell to discuss the repealed section again.

Mr. Russell responded that Nevada was one of approximately 20 states that disallowed commissions to CPAs. CPAs were not allowed to receive any commission, and if they did they were in violation. They did intend to provide if any commission was received it must be disclosed to the client and that would be done by regulation in line with CPA rules.

Assemblyman Goldwater asked how many states currently allowed commissions for CPAs. Mr. Walker believed approximately 34 states currently allowed commissions, and there were other states in the legislative process of moving toward that position.

Assemblyman Goldwater asked if that was for any product that offered a commission. Mr. Russell was of the opinion a CPA would receive a commission for a referral to someone else who provided a service. It also allowed the CPA to provide other services in addition to accounting which they could not do under current law. He offered the example of a person who was both a stockbroker and CPA but did not necessarily perform tax functions which meant preparing financial statements for clients that went to banks. If he chose not to perform those types of services, then he could be a CPA and stockbroker and in his capacity of being a stockbroker be allowed to receive commissions for the sale of securities.

Assemblyman Goldwater interjected it was the conflict of interest that was at issue here. The question was whether or not a person should be paid a commission when giving financial advice. Would the board intend to get active on any type of complaints of those kind of conflicts of interest, Mr. Goldwater wanted to know.

Mr. Russell responded financial planners and others who were selling products were in competition with CPAs and they were allowed to receive commissions. The board had two restrictions in the commission area. The first one was the independence issue to make sure that if a CPA was involved in an audit, report, or financial statement with respect to that business or entity they were precluded from receiving a commission under the American Institute of Certified Public Accountants. The other primary preclusion was to require that if a commission was charged, it had to be disclosed in writing to the client. The intent was to provide that protection so individuals would not be charged a commission without knowing it.

Chairman Buckley closed the public hearing on S. B. 439 and opened the hearing on Senate Bill 462.

Dino Di Cianno, Deputy Executive Director, Department of Taxation, State of Nevada, asserted the bill was requested by the department to correct S. B. 246 passed during the 1997 legislative session. That bill changed the filing dates associated with the insurance premium tax from March 1 to March 15. However, it did not correspondingly change the filing date for the home office credit return. Mr. Di Cianno requested that the two dates correspond and the bill become effective upon passage and approval.

Assemblywoman Segerblom questioned to what kind of home office was referred.

Mr. Di Cianno informed the committee there were specific requirements in the statutes that mandated the insurer had phones, a building within the state, and at least 25 employees occupying that building.

Chairman Buckley closed the public hearing on S.B. 462 and opened the hearing on Senate Bill 465.

John P. Fowler, Attorney at Law, Marshall Hill Cassas & de Lipkau, Chairman of the Executive Committee of the Business Law Section of the State Bar of Nevada, noted S.B. 465 was a bill that modernized the chapter governing trust companies. The bill was prepared 2 years ago by the business law section of the executive committee in joint activity with financial institutions in the state government. The bill did not get through the 1997 session and was reintroduced and had passed the Senate side of the legislature. The bill was supported by the executive committee of the business law section and the board of governors of the state bar and by the Division of Financial Institutions. The bill gave basic powers to the Division of Financial Institutions to close down failing and broke trust companies. Currently that power did not exist under NRS. The chapter would allow limited liability companies as well as corporations to be trust companies. Banks were allowed to open stand-alone trust company offices. The bill made various other modernizing changes to bring it up to the 20^th century. Mr. Fowler provided a copy of the letter he had written to the Senate (Exhibit R) and detailed each change requested. Mr. Fowler asserted that the bill was needed.

Chairman Buckley inquired as to whether or not there was a fiscal note since none was attached to the bill. The two-thirds majority mentioned was separate from the fiscal note. She asked for questions from the committee and there were none. After thanking Mr. Fowler for his testimony Chairman Buckley closed the public hearing on S. B. 465.

Chairman Buckley adjourned the committee meeting at 4:00 p.m.

RESPECTFULLY SUBMITTED:

Cleone Bujalski,

Committee Secretary

APPROVED BY:

Assemblywoman Barbara Buckley, Chairman

DATE: