The Committee on Health and Human Services was called to order at 1:40 p.m., on Wednesday, February 3, 1999. Chairman Vivian Freeman presided in Room 3138 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:

Mrs. Vivian Freeman, Chairman

Mrs. Ellen Koivisto, Vice Chairman

Ms. Sharron Angle

Ms. Merle Berman

Ms. Barbara Buckley

Ms. Dawn Gibbons

Ms. Sheila Leslie

Mr. Mark Manendo

Ms. Kathy McClain

Mr. Kelly Thomas

Ms. Kathy Von Tobel

Mr. Wendell Williams

COMMITTEE MEMBERS ABSENT:

None

GUEST LEGISLATORS PRESENT:

None

STAFF MEMBERS PRESENT:

OTHERS PRESENT:

Charlotte Crawford, Director, Nevada Department of Human Resources

Dave Hill; Rose/Glen, Dental Hygienists

May Shelton, Washoe County

Following roll call and staff introductions, Chairman Freeman discussed the Standing Rules (Exhibit C). She called attention to rule number six, indicating that definite action on a bill or resolution would require that a majority of seven members be present to vote, and an affirmative vote of a majority of seven members was required to take action on a measure. Under rule number eight, a two-thirds majority (8) of the entire committee was required to reconsider an action. With regard to rule number 14, Chairman Freeman emphasized that the committee member notify her before a vote was taken on a bill or amendment on the floor of the Assembly if the committee member intended to vote differently than he/she voted on the bill or amendment in committee.

ASSEMBLYWOMAN BERMAN MOVED TO ACCEPT THE STANDING RULES (EXHIBIT C) SUBMITTED BY THE CHAIRMAN.

ASSEMBLYWOMAN BUCKLEY SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

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Chairman Freeman called for approval of BDR’s, which had come from the Standing Committee on Health Care and an Interim Committee on Mental Health.

• BDR R-1133 - Encourages the Department of Human Resources to contract

ASSEMBLYWOMAN BUCKLEY MOVED FOR COMMITTEE INTRODUCTION OF BDR R-1133.

ASSEMBLYMAN WILLIAMS SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

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• BDR R-483 - Urges Bureau of Licensure and Certification of Health Division of the Department of Human Resources to use continuous quality improvement approach to monitor quality of care provided to residents of certain facilities for long term care.

ASSEMBLYMAN WILLIAMS MOVED FOR COMMITTEE INTRODUCTION

OF BDR R-483.

ASSEMBLYWOMAN BUCKLEY SECONDED THE MOTION.

MOTION CARRIED UNANIMOUSLY.

**********

ASSEMBLYMAN MANENDO.MOVED FOR COMMITTEE INTRODUCTION

OF BDR 39-169.

ASSEMBLYMAN WILLIAMS SECONDED THE MOTION.

MOTION CARRIED UNANIMOUSLY.

[NOTE: MOTION FOR INTRODUCTION WAS ACTUALLY MADE BY ASSEMBLYWOMAN BERMAN, AND SECONDED BY ASSEMBLYMAN MANENDO.

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• BDR 39-171 - Clarifies provisions governing testimony that may be

ASSEMBLYMAN MANENDO MOVED FOR COMMITTEE INTRODUCTION

OF BDR 39-171.

ASSEMBLYMAN WILLIAMS SECONDED THE MOTION.

MOTION CARRIED UNANIMOUSLY.

**********

• BDR R-170 - Directs Legislative Commission to appoint interim committee to continue to review an evaluation of services and treatment provided to mentally ill persons in this state. (A.C.R. 11)

VICE-CHAIRMAN KOIVISTO MOVED FOR COMMITTEE INTRODUCTION

OF B.D.R. R-170.

ASSEMBLYWOMAN LESLIE SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

**********

ASSEMBLYWOMAN GIBBONS MOVED FOR COMMITTEE INTRODUCTION OF BDR R-1134.

VICE-CHAIRMAN KOIVISTO SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

ASSEMBLYWOMAN BUCKLEY MOVED FOR COMMITTEE INTRODUCTION OF BDR 38-1128.

ASSEMBLYMAN WILLIAMS SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

**********

VICE-CHAIRMAN KOIVISTO MOVED FOR COMMITTEE INTRODUCTION

OF BDR R-1125.

ASSEMBLYWOMAN BERMAN SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

ASSEMBLYWOMAN BERMAN MOVED FOR COMMITTEE INTRODUCTION

OF BDR R-1137.

VICE-CHAIRMAN KOIVISTO SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

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BDR R-1132 - Urges the Department of Human Resources to comply with the federal law requiring staff to be available at certain health care facilities.

ASSEMBLYWOMAN LESLIE MOVED FOR COMMITTEE INTRODUCTION

OF BDR R-1132.

ASSEMBLYMAN MANENDO SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

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Chairman Freeman introduced Charlotte Crawford, Director, Nevada Department of Human Resources (DHR), who made a presentation on behalf of her agency (Exhibit D). Ms. Crawford provided an overview of her department, noting the Department of Human Resources was composed of six major divisions and two smaller entities which dealt with most of the health and human services within the State of Nevada. They were the:

• Welfare division, governing the TANF program, child support enforcement, food stamps, and eligibility determinations for those programs as well as for the medicaid program.

• Aging division, which provided services to seniors, Meals on Wheels programs, general social services, and the ombudsman-type programs.

• Child and Family Services, which provided child protective services for the balance of the state outside of Clark County and Washoe County. As well as foster care, group care placements, family preservation, reuniting of families, and permanent placement [adoption services]. They also provided mental health services for children.

• Health division, covered public health services, such as immunization, pre-natal care, quality and health care issues, and provided direct services through special children’s clinics.

• Mental Hygiene and Mental Retardation provided both in-patient and out-patient direct services.

• Health Care Finance and Policy division, created in the last legislative session, primarily governed the Medicaid program, along with health care cost containment and hospital oversight programs.

• Public Defender’s Office

• Indian Commission.

• Community Connections, a newly-formed group, oversaw the administrative and quality assurance of free-standing programs within existing services with a focus on direct community services. Programs included Community Services Block grant-Title XX, the Family-to-Family program, Family Resource Center programs, and the Early Childhood Program-Part C.

Ms. Crawford provided a breakdown of the DHR budget (Exhibit D, pages 3, 4, 5, and 6), by division, and a comparison between the 98-99 legislatively approved budget and the governor’s recommended budget for 00-01. She stated the largest amount was for Health Care Finance and Policy (HCFP), which represented primarily the medicaid budget of slightly over $1 billion for the biennium. DHR Staffing, Exhibit D, page 4, represented how the staffing was broken down. Ms. Crawford pointed out that staffing and dollars were not necessarily related. For example, in HCFP there were substantially fewer staff than in some of the other divisions even though it had the largest budget. Further, a reduction in staffing in HCFP from 203 to 166, was due primarily to the transfer of homemaker service and elder protective services to the aging division, in order to focus the services for seniors in a single agency where they were more involved in advocacy program provision.

Chairman Freeman noted that the aging services budget had increased by 51 percent and asked if that accounted for the explanation just given. Ms Crawford responded affirmatively.

Ms. Crawford further pointed out the total DHR staff in the governor’s recommended budget numbered 3,798, a slight increase over the 3,646 in the last biennium. The majority of changes in the budget and bills presented did not require staff increases. There were, however, substantial increases in the expenditure of federal dollars of almost $400 million from the last biennium.

Ms. Crawford noted that Exhibit D, page 5, indicated how the revenues were broken down within the DHR. The single largest area was federal dollars, followed by state and "other." The "Other" category reflected the passage of federal monies from one division to another, such as mental health and retardation. Such transfer of funds would explain the apparent, although erroneous, suggestion of a substantial increase in DHR fees.

Further, Ms. Crawford stated that breakdown reflected the degree to which the DHR was involved with federal regulation, federal law, and federal as well as state programs. The Medicaid, welfare, child and family services, and aging services programs all had significant federal requirements, had their basis in federal law, and had substantial federal funding.

Ms. Crawford pointed out the landscape in social service legislation at the federal level had changed dramatically over the last six years. Welfare reform had been the major area of change, from an individual open-ended entitlement program to a state block grant program. There had been nearly a 46 percent decrease in the welfare caseloads. Additionally, the DHR showed substantial success helping families move from assistance to independence in working.

Ms. Crawford related that funds to support child care assistance to low-income families had been a major area in the welfare budget. There had been a substantial increase from an approximate $16 million in the last biennium to slightly over $21 million, however, it was doubtful that would serve all of the child care assistance needs.

Chairman Freeman asked what percentage of those dollars related to the welfare reform act. Ms. Crawford responded there had been no change in the way those funds were used. What had been three different funding streams at the federal level were incorporated into a single funding stream of primarily federal dollars, although there were some state-matched dollars included. She indicated this issue was an area for further discussion in the committee. In order to earmark those funds to support the welfare-to-work effort, the DHR needed to assist low-income families so they did not have to become dependent on an assistance program. The parameters, however, had not been changed; they were available to all low-income families with 75 percent of the median income or less. While there was no time limit established to receive that assistance, it was on a first-come first-served basis, with some prioritizing for foster families.

Assemblywoman Buckley asked whether, in addition to the plans to increase child care subsidies, there had been a plan for the remainder of those dollars and she wondered what those federal restrictions were in terms of the categories, job readiness and other substantive areas? Ms. Crawford responded that what looked like a major increase was primarily the pass-through of child support enforcement dollars not previously shown in the budget. She added future presentations would be made as to what funds remained in the TANF grant , what were available in child care funds, and where DHR was still trying to retain reserves.

Ms. Crawford stated the children’s health insurance program—"Nevada Check-up,"—became available after last session’s adjournment, and was moving forward. Almost 4,200 children had been enrolled in HMO’s and were receiving benefits. Further, there had been mandatory managed care for the TANF and CHAPS populations in southern Nevada, with voluntary managed care in northern Nevada, because there had been only one provider in the HMO network systems that DHR could contract with.

Chairman Freeman asked if she had been referring to "Nevada Care?" Ms. Crawford responded that Nevada Care had been the provider in the north and also one of three providers in southern Nevada.

Assemblywoman Leslie asked if the eight positions lost out of Community Connections were Family-to-Family positions? Ms. Crawford answered that there were seven positions lost out of Family-to-Family and one out of IDEA.

Ms. Leslie also asked if the hiring freeze had an impact on programs in the DHR that were either partially or fully funded by federal funds, and if Nevada was in danger of losing those funds due to the hiring freeze? Ms. Crawford stated she had not been aware of any area where funds were jeopardized, and that DHR had been trying hard to ensure that did not happen. The intent of the hiring freeze had been to preserve state general fund dollars, and there had been a process in place to look at positions that were necessary where funding was not from the state general fund. Ms. Leslie asked specifically about Family Preservation. Ms. Crawford responded they were not jeopardized. In the first instance of freezes, some positions were exempted, and in the second phase, many of those exemptions in the Human Services area were removed and it was now necessary to go through the justification process. Ms. Leslie emphasized that her concern was in having to return federal funds for the Family Preservation program. Ms. Crawford stated DHR did not want to return any federal funds. She indicated she would look into the matter and get back to Ms. Leslie.

Assemblyman Manendo asked for an explanation of the procedure for getting more children onto the Nevada Check-up program. Ms. Crawford responded that DHR had a variety of plans, among which were another round with the schools, milk carton advertising, public announcements, and more. HCFP and the Check-up program had made an aggressive effort to reach out in that area and would detail those efforts in future discussions with the committee. She stated further that they were tracking how outreach was working geographically, by ethnic base, in order to tailor outreach efforts.

Assemblywoman Buckley stated they were all very concerned about the outreach efforts primarily because it was a "Herculean effort to capture the money and to get the program in place and we are thrilled with that, and now the work really begins in doing more outreach." She noted the creative efforts in this outreach by other states, and stated the need to get the word out because the program was only as good as the number of people being helped. Ms. Crawford responded that DHR intended to pay a lot of attention to outreach.

Chairman Freeman commented that during the interim she sent Senator Rawson a suggestion that the legislature consider going to a marketing firm to do the PR, because, "we cannot allow this program to fail."

Chairman Freeman asked about the governor’s budget in relation to Nevada Check-up, and how many children the budget planned for in the future compared to those who had already been enrolled. Ms. Crawford responded that the governor’s budget was constructed at an enrollment level of 10,000 children in the early stages. The enrollment did not come in as quickly or at the level anticipated. There had been difficulty in determining how many uninsured children were in Nevada, and the numbers both in Nevada and at the federal level had been adjusted downward several times in the interim from what was initially projected. A UNLV study done for the Interim Health Committee came in with a number of uninsured children in Nevada that was lower than DHR’s experience would have suggested.

Chairman Freeman asked if funding had been increased for foster care. Ms. Crawford said she did not know the actual rate, though she did not believe there had been an increase in the individual foster care rate, it varied depending upon the category of child. She stated she would get that information for Chairman Freeman.

Ms. Crawford stated that the committee had been provided with information on the Family Resource Centers and on the Family-to-Family project (Please refer to Exhibit D, pages 6-9). The Family Resource Centers was an initiative brought about four years ago. It had since been doubled and had been very successful largely due to the efforts of Assemblywoman Leslie. The program was targeted at high-risk neighborhoods. At present, there were 41 FRC's across Nevada. The FRC Programs were defined at the local level and tailored to services desired at that level. That program continued in the current budget at the same level as previously in order to continue to support existing efforts.

Ms. Crawford stated that the Family-to-Family program:

• Targeted 50 percent of the newborns in Nevada.

• Established 13 Infant Support Districts (ISD’s)

• Provided block grants to each local district.

• Encouraged collaborations to provide three services in each district--home and hospital visitation, new baby centers, and resource lending libraries.

• Targeted families with children newly born and under the age of 12 months.

Ms. Crawford reported that in the first quarter of operation, the Infant Support District’s (ISD) saw 28 percent of newborns. In the second quarter, ending in December, 1998, they saw 53 percent of the newborns in Nevada. She added the program had not been continued at its current funding level, but at about 45 percent of the level. The state staff had been cut in half, down to seven, to provide the minimum level of quality assurance

Assemblyman Manendo thanked Assemblywoman Leslie for a wonderful job and her hard efforts in regard to this program. He noted that a caravan, comprised of Ms. Leslie, Assemblywoman Chowning, and Mr. Manendo, toured some of the FRC’s in southern Nevada. He added they had seen just a small part of what those programs provided but he was very impressed.

Chairman Freeman queried Ms. Crawford regarding the income level of the families in the Family-to-Family program. Ms. Crawford replied that families of all income levels were using the program. Despite the success of the program, however, funding had been reduced by 55 percent.

Chairman Freeman asked if, when the report of the Economic Forum came in, more funds were available, would funding be restored to the previous level? Ms. Crawford responded that she was thankful the program was continuing at all, in view of the many difficult choices that had to be made in crafting the budget, and that if funds should become available in the future, there were many worthwhile causes lined up.

Assemblywoman Leslie asked if, with the Family-to-Family program decreased by 55 percent, the structure would remain the same with 13 ISD's and the money directed toward the new baby centers, with home visitation being cut, or would it be determined within each ISD. Ms. Crawford answered that it was the intent of each ISD to designate which services they wished to provide, because what was successful varied within each ISD.

For the benefit of new committee members, Chairman Freeman detailed the background of the Family Resource Centers, the first of which started in Reno eight years earlier at a low-income, high-risk school. The FRC began with a coalition of community people, including UNR School of Medicine, School of Nursing, County Public Health. Senator Matthews and Mrs. Freeman were on that committee, where it had been decided to begin at the school level, because that was where the children and the families were. Mrs. Freeman introduced a bill to ask for funding for one year to hire a director, but the bill did not get through the Ways and Means Committee. However, last session Governor Miller introduced a bill that had since been funded. Mrs. Freeman said Assemblywoman Leslie worked with the state to coordinate the centers, and they had been enormously successful.

Assemblyman Manendo stated he had been working with the Combach Family Resource Center, in Henderson, which recently expanded a feeding center into his district for the Cunningham Elementary School. It has been very successful.

Assemblyman Manendo asked to publicly recognize Linda Chase, a teacher in his district, who recently got funding approval to start a Family Resource Center.

Further, Mr. Manendo commented that Assemblywoman Leslie offered to take committee members to an FRC. Assemblywoman Leslie reported that there was a wonderful FRC in Carson City, located on the grounds of the Children's Home, and she would be happy to take a group there. Alternately, she would let committee members know the location of an FRC in their districts.

Chairman Freeman prefaced her introduction of Commissioner of Insurance, Alice A. Molasky-Arman by commenting that as a result of her bill of last session, Assembly Bill 30 , she and Commissioner Molasky-Arman, and several lobbyists, had worked together to develop the NEVADA HEALTH INSURANCE GUIDE (please see Exhibit E) to let the consumer know what health insurance was and what it provided.

Chairman Freeman introduced Alice A. Molasky-Arman, Commissioner of Insurance, Department of Business & Industry, Division of Insurance. Ms. Molasky-Arman, in turn, introduced her associates, Jim Jeppson, Chief Insurance Assistant, and Guy Perkins, Supervisor of Life and Health Section, Division of Insurance, without whom, she stated, the "Guide" would not have evolved.

Ms. Molasky-Arman was asked to give a presentation regarding Assembly Bill 30 (please see Exhibit F), enacted in 1997 as a result of the committee's efforts. That legislation required the commissioner to establish an advisory committee on health care and insurance. The advisory committee, which had been formed in 1995 was expanded in 1997 in order to provide membership from the representative segments of the public, as required by the bill.

(Exhibit F, page 2.) The advisory committee and its special subcommittees (Exhibit F, page 3) held 12 meetings during the past 18 months, to address many of the health care and insurance issues, primarily A.B. 30 and A.B.156.

Ms. Molasky-Arman advised that A.B. 30 required a report to be delivered to the Legislature on January 31, 1999 (a Sunday). The report (Exhibit G) was delivered on Monday, February 1,1999. She indicated that report would also be delivered to all legislative committees so they could see what had been accomplished as a result of A.B. 30.

Ms. Molasky-Arman stated the report (Exhibit G) described health insurance demographics (Exhibit G, exhibit 1), included the market share and the kinds of insurance available and provided to the consumer (Exhibit G, exhibit 2). She added the primary insurance population base came from the 31 percent who were under traditional insurance. Included in that category were HMO's and other managed care organizations. Twenty-eight percent of insureds in the state were under self-insured or ERISA-exempt plans. She emphasized that even though those insureds and employers were presumably beyond the reach of the Division of Insurance, they work hand-in-hand with the Department of Labor. They had established a good rapport with many of the self-insured employers and their administrators, who were licensed by the Division of Insurance. Additionally, the National Association of Insurance Commissioners lobbied in the congress to affect higher authority over self-insured plans by the states' regulatory body.

Ms. Molasky-Arman added the demographics also included 23 percent of our population who were under federal and state health plans, such as Medicare, Medicaid, CHAMPUS, and Federal Employees.

Ms. Molasky-Arman further stated the report described the Division's consumer specialist activities, how contacts were made, and how the commissioner's office assisted consumers in referrals to the appropriate agencies for handling their inquiries or complaints. The nature of the complaints received were described in Exhibit G, exhibit 3, and the NAIC Standard Complaint Data form was provided as exhibit 4 of Exhibit G. In 1997, the consumer officers of the Division of Insurance referred 42 cases to the enforcement section for disciplinary action; 32 cases were referred in 1998. Also in accordance with A.B. 30, a toll-free number had been established in November 1997, and that number had been printed on all insurance company forms. Upon closure of a consumer complaint, a pre-paid post card had been sent to the consumer to elicit satisfaction comments.

Ms. Molasky-Arman stated the report also detailed what the Division had done to satisfy consumers' problems. One situation, involving GEM Insurance Company, impacted thousands of people throughout the state, but through the Division's efforts they achieved $6 million in payments and claims, and premium refunds of approximately $700,000. More importantly, they succeeded in placing the 8,000 people remaining in the plan with another insurer.

In conclusion, Ms. Molasky-Arman detailed the distribution of the Nevada Health Insurance Guide (Exhibit E) including:

• Nevada Association Hospital System
• Health Underwriters Association
• Health insurance agents
• American Cancer Society
• Information Counseling and Assistance (Aging Services)
• Other commissioners

The "Guide" also had been delivered to the Legislative Council Bureau (LCB) with copies to every legislator.

Regarding A.B. 156, Ms. Molasky-Arman reported a second subcommittee had been formed to address its requirements and to develop the regulation required under that bill. A third subcommittee had been formed to develop regulations related to the health insurance reportability and accountability act. The fourth subcommittee had been established in response to the L & H administrator's problem in connection with prompt claims payments.

In closing, Ms. Molasky-Arman stated they had difficulty in finding consumers to be represented on the advisory committee, and encouraged the public, members of the industry, and other interested parties to attend the meetings. Meeting notices were published on the web site as well as notices under open meeting law.

Chairman Freeman thanked Ms. Molasky-Arman and her staff for their efforts.

She emphasized that one of the biggest problems was in getting information out to the public.

Assemblywoman Buckley congratulated Ms. Molasky-Arman and her staff, and the members of the industry for their efforts in regard to the Nevada Health Insurance Guide. She stated she had heard from providers and a hospital who indicated they would like to put copies in their waiting rooms to begin better educating consumers. She added a further note of thanks for the bulletins which had been issued on the timely payments and the unfair and deceptive trade practices, and for trying to help those individuals who fell within the self-funded plans.

Ms. Molasky-Arman responded that copies of the "Guide" were provided to the Nevada State Medical Association to distribute to member's offices throughout the state.

Chairman Freeman stated that she had recently delivered 100 copies of the "Guide" to an American Association of Retired Persons (AARP) meeting in Reno, and it had been very well received.

Chairman Freeman next called Marla McDade Williams, Senior Research Analyst, Research Division, Legislative Council Bureau (LCB) to report on what had taken place in the 1997 Legislative Session.

Ms. Williams provided the committee members with a Committee Policy Brief (Exhibit H), which highlighted some of the relevant health and human services issues that were addressed by the committee during the 69^th Session, and by other committees of the Legislature. Page 1 of Exhibit H described the jurisdiction of the committee and the measures that came before it. On pages 2 through 6 of Exhibit H, significant policy issues from the 1997 session were detailed, specifically:

• Children's Health Insurance Program (aka "Nevada Check-up")

• Do-not-resuscitate Legislation. Ms. Williams indicated another measure would be coming forward to address that issue.

• Health Care Practitioners, in medically under-served areas, and dental licensure.

• Long-term Care Facilities, addressed last session by two bills: A.B.11 requiring residential care facilities to post surety bonds as a condition of their licensure. A.B. 155, requiring criminal history checks of employees of agencies that provide nursing in the home, facilities for intermediate care, skilled nursing, and residential facilities for groups. The latter measure was significant in causing some turnover in nursing home facilities throughout the state, and had incurred awareness on behalf of people who operate nursing home facilities.

• Managed Care Legislation, covered under A.B. 13, A.B. 26, A.B.30, and A.B. 156.

• Mental Health Bills

• Program for Persons with Physical Disabilities, a measure which did not come before the committee, was covered under Senate Bill 433, and a discussion had been provided as to where that issue now stood.

• Public Assistance Legislation, including Medicaid and Welfare. A.B. 401 adopted the Temporary Assistance for Needy Families (TANF) program, and A.B. 460 and A.C.R. 25, which worked in conjunction with the welfare reform effort

Ms. Williams reported (page 7 of Exhibit H) that the Legislative Committee on Health Care, had issued a report detailing a number of recommendations which generated a 26 Bill Draft Requests (BDR's) that would be handled by the Senate as well as the Assembly committees.

On page 8 through 10 of Exhibit H, Ms. Williams reported on possible issues that might come before the Legislature, among which were the County Organized Health System and Child Care Issues.

Ms. Williams stated that the Health Policy Tracking Service (HPTS) had a web site that monitored legislation throughout the United States (pages 10 and 11 of Exhibit H). On pages 12 through 15 of Exhibit H, Ms. Williams reported on significant federal issues, such as Managed Care, Medicare, the Tobacco Settlement, including web site information for monitoring tobacco settlement issues, and Medicaid Coverage of Viagra. The balance of Ms. Williams brief included other published reports available in connection with Nevada's health concerns, web site addresses for locating current information about health and human services topics, and a contact list for state, county and other agencies.

Ms. Williams concluded by stating she would make herself available to all committee members to provide whatever help or assistance they needed.

Chairman Freeman advised new committee members to work with Ms. Williams if they intended adding an amendment to a bill.

Assemblywoman Angle introduced her father, Mr. Jess Ott, Fallon, Nevada.

With no further business before the committee, Chairman Freeman adjourned the meeting at 3:06 p.m.

RESPECTFULLY SUBMITTED:

Darlene Rubin,

Committee Secretary

APPROVED BY:

Assemblywoman Vivian Freeman, Chairman

DATE: