The Committee on Health and Human Services was called to order at 1:40 p.m., on Monday, March 1, 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

GUEST LEGISLATORS PRESENT:

Assemblywoman Jan Evans, District 30

STAFF MEMBERS PRESENT:

OTHERS PRESENT:

Assemblywoman Jan Evans representing District 30, introduced Dr. Mary Guinan, State Health Officer, formerly with the Centers for Disease Control, and Dr. Colleen Morris, Associate Professor of Pediatrics, University of Nevada School of Medicine and Chief of Genetics Division, Department of Pediatrics, University of Nevada at Las Vegas (UNLV) School of Medicine.

Ms. Evans related prior to the birth of her children she had frequently been asked if she hoped for a girl or a boy. Her reply had been she hoped for an infant that had all of its parts, and all of its parts fully functioning. A birth defect meant life-altering consequences to a youngster and very special challenges for a family. Through the science of genetics and genetic testing birth defects could be detected early and through gene therapy some very effective interventions designed. A.B. 238 dealt with learning as much as possible about birth defects as early as possible, and designing interventions to alleviate the effects.

Dr. Colleen Morris identified herself as a physician employed by the University of Nevada School of Medicine. She daily treated children born with birth defects or mental retardation. For children born with birth defects, early intervention definitely had made a difference. A birth defect surveillance system would allow early identification and referral of children to health and education services that could improve their outcome. There had not been an organized population based data system to provide a means for those early referrals. Birth defects were quite common, affecting 4 percent of newborns in studies done across the country. However, many studies showed vital statistics (the records obtained from birth certificates) had not been completely accurate. Across the country those statistics accounted for one-fourth of the birth defects, due in part to the fact some birth defects were not obvious at birth, such as congenital heart disease or kidney abnormalities. Vital records from the State of Nevada in 1992 revealed 11 children had been born with Down's Syndrome, a common chromosome abnormality. However, that same year the University of Nevada at Las Vegas (UNLV) School of Medicine Genetics Clinic had seen 16 newborns with that diagnosis. The current system had not picked up all of the children with that easily recognizable condition.

Dr. Morris further stated, based on the number of children she had been seeing in the genetics clinic with fetal alcohol syndrome, fetal alcohol syndrome was an epidemic in the State of Nevada. The current system did not allow that to be tracked or to determine if intervention or prevention efforts had been successful.

The incidents of birth defects could be reduced. Women who took .004 milligrams of folic acid (a B vitamin) daily before and during pregnancy reduced the risk of a neural tube defect (spina bifida) by over 50 percent. The Division of Health had a campaign in place to promote folic acid use in pregnancy. The March of Dimes planned a similar campaign, but no data was available to determine if those campaigns were effective in the public health arena.

Some birth defects were genetic, others were due to problems in the environment to which the pregnant woman had been exposed. Most birth defects were due to a combination of genetic and environmental factors. In order to identify and investigate possible environmental causes, population based data was needed. The data was particularly vital in light of the discussions regarding the possibility of nuclear waste in Nevada and concerns about industrial waste that might be affecting the health of Nevada citizens.

Dr. Mary Guinan identified herself as the Nevada State Health Officer, Health Division, and testified on behalf of the Department of Human Resources. The State Health Division had received a 3-year grant from the Centers for Disease Control and Prevention to establish a birth defects registry. It had been stimulated by identification of the link between folic acid and neural tube defect. Identifying a preventable birth defect had been a very important milestone and generated the desire for birth registries so states could identify what birth defects were occurring in their state.

A.B. 238 allowed the Health Division and the School of Medicine to establish a statewide collection system for birth defects, stillbirths, and other birth-related conditions. It would require the analysis of collected information to examine possible causes and prevention strategies for such conditions. It would allow for identification of needed services for infants with such conditions. It would allow for linkages of data from the collection system to vital records. It strictly limited access to the information collected and provided for confidentiality of those records, as required by all health professionals who had access.

Dr. Guinan requested a change in A.B. 238 in defining a health facility or health care facility. Instead of "facilities that provide healthcare services" add "hospitals and obstetric centers as defined in NRS 449," because the proponents of the bill were only interested in facilities where babies were born. There were two facilities in Nevada.

Chairman Freeman asked if most states had registries. Dr. Guinan said many states had registries, she was not sure how many. Congress had appropriated money to the Centers for Disease Control for the establishment of registries in the states. Assemblywoman Jan Evans said the bill sponsors had obtained copies of legislation from those others states for use in drafting A.B. 238.

Mrs. Freeman asked about the fiscal note on the bill. Dr. Guinan said the Center for Disease Control had given a 3-year grant for $100,000 a year, first year renewable. It would be used to develop the software and hardware for the registry and to work out the various aspects of development. There had been no fiscal note from the state.

Mrs. Freeman asked who had access to the information. Dr. Guinan said authorized members of the Health Division and authorized members of the University of Nevada School of Medicine. Only persons authorized by those two entities had access to the data. For reasons of confidentiality anyone who had access would be required to declare they abided by the Health Division's strict confidentiality standards. The reason for allowing access was to encourage researchers to examine the data and find an appropriate prevention for birth defects in Nevada.

Chairman Freeman asked how the Health Division planned to disseminate educational materials, for example, on folic acid. Dr. Guinan said they had two programs ongoing to educate physicians and others about folic acid. But the Health Division had no baseline data on birth defects, no way to know what the level or the prevalence had been because there had been no data to evaluate the programs. For those reasons it was very important to have the data to be able to do that.

Assemblywoman Berman applauded the efforts the Health Division in obtaining the grant. Ms. Berman had been trying to get a tumor registry going without success and hoped Dr. Guinan would work with her in that regard.

Chairman Freeman called to speak those who opposed A.B. 238.

Kris Jensen representing Nevada Concerned Citizens said she had read through the bill and several areas concerned her.

• Page 2, Section 7, line 12: The Health Division shall in cooperation with the University establish and maintain a statewide system of collection." Would that create a new level of bureaucracy not previously there.

• Page 2, line 34: "patients diagnosed with the diagnosis of stillbirth." Would that mean the information became identifiable if information was released regarding the patient being discharged, not the child who was stillborn. Would that go into the area of divulging information upon that mother who had the stillbirth.

• Line 38: "The state health officer or representatives shall abstract from the records and lists required to be maintained." There would be the requirement of maintenance.

• Line 41: "from any source."

• Page 2, Section 9: Described the way information might be used, and on

• Page 3, line 8: "for other such purposes as may be approved by the state health officer or his representative." Ms. Jensen felt that had been a "red flag" that left it wide open for "other such purposes."

• Page 3, line 15: Described types of studies in which the information might be used; it might be research or insurance companies, which was a major area of concern when the information gleaned dealt with genetics.

She quoted from an article from the American Bar Association Journal, titled "Whose Genes Are They?" (EXHIBIT C) which stated:

Ms. Jensen's other concerns had been about privacy. Institutional interest in an individual's genetic information raised ghosts in a century that had witnessed too many ways genocide had been used for sterilization and stigmatization of entire groups of people based on their supposed genetic inferiority. Specific guidelines on the state level for legislators had been included in EXHIBIT C.

Ms. Jensen cited various additional sections of the bill that concerned her; all dealt with privacy issues or the transfer of data to unspecified but potentially damaging sources. She felt some sections of the bill would absolve people from the unlawful disclosure of information and thereby violated the confidentiality and the privacy of the individual and their genetic situation.

She related the details of her own child's defects not diagnosed at birth, but which had been later. Eventually she and her husband were referred by Clark County School District to genetic counseling. At that time the counselor told them they should not have any more children as they were at high risk to repeat the problem. She found that deeply offensive. Since that time she had two more children who both were gifted and academically talented.

In conclusion, Ms. Jensen asked the committee to provide provisions to address those concerns related to insurance and the privacy of genetic information.

Janine Hansen, President of Nevada Eagle Forum, said there had been universal concern about birth defects, but there had been some areas of concern in the way the problem had been handled. She referenced the article from the American Bar Association (EXHIBIT C) which offered suggestions on how to guard families and individuals with regard to any kind of genetic testing:

• Legislation should assure people had control over what genetic information would be generated about them. In A.B. 238 there did not appear to be any specific guarantee that people would be able to determine what kind of genetic information would be generated from tests or reports.

• Individuals should be able to control who had access to their genetic information. The bill provided for a lot of people in government agencies to have access to genetic information. Ms. Hansen hoped they all would be willing to comply with confidentiality. However, the more people who became involved in private health records the greater the potential for that information to be divulged, whether inadvertently or purposefully. There had been greater incidences in recent years of individuals losing their insurance benefits as a result of genetic testing.

• Discrimination against individuals based on genetic information should be prohibited.

Ms. Hansen stated there had been over 200 inherited conditions for which unborn babies could be tested. It had been a great blessing where there was a chance to cure the disease or to correct an abnormality, but for many conditions where a cure had not yet been found such testing would be like a "search and destroy mission." Pro-life people had to be aware genetic testing without the hope of a cure would be used for the purpose of recommending abortion. One of the Eagle Forum's concerns had been with a registry which proposed that kind of genetic information would become common place. There might be pressure on individuals who might have a genetic problem when it had been difficult to tell how far-reaching the problem had been. Prenatal testing had often been inaccurate. A family might have been encouraged to have an abortion to prevent a birth defect when as often as 50 percent of the time after the child was born the condition had not existed.

Moreover, the bill provided no guarantee that a woman whose information was obtained through the process could access her own records. Medical records that contained misinformation in genetic testing and resulted in loss of insurance or employment could be devastating to a family. Similar problems had occurred with credit reports and credit reporting bureaus; inaccurate information had been entered and had been impossible to remove. Ms. Hansen said if a cure for a birth defect had not been found the bill might place additional pressure to simply eliminate that baby in the future. Ms. Hansen cited articles in medical and Texas legal literature in which Margaret Shaw, lawyer and geneticist, had recommended states adopt policies to prevent the birth of children with genetic diseases. Would that mean if a couple had a genetic disease their child would be prevented from being born and an abortion forced as had been done in China.

Shaw suggested the prevention of genetic disease was so important that a couple who had decided to give birth to a child with a serious genetic disorder should be criminally guilty of child abuse. Ms. Hansen urged the committee to weigh carefully those potential problems.

Dr. Mary Guinan responded to some of the issues raised. A.B. 238 had not been about genetic testing, prenatal genetic testing, or birth genetic testing. The bill dealt with a registry of birth defects. The bill would not create a new bureaucracy. The Health Division presently collected data on newborn screening for seven metabolic or hemoglobin disorders and the bill would expand that particular area where both defects and metabolic problems would be registered. Regarding confidentiality, Dr. Guinan said access to records had not been allowed.

Regarding genetic testing, Dr. Guinan hoped a child with birth defects would be referred to services. If the physician felt genetic testing should be done, the physician would be required to get permission of the parent; so no genetic testing had been done without physician recommendation and parental permission.

Dr. Colleen Morris addressed the issue of genetic counseling and expressed regret about the bad experience related by Ms. Kris Jensen. In counseling parents, Dr. Morris and the UNLV clinic would not recommend anyone not have children. They were advocates; they treated individuals with genetic diseases and children born with birth defects and mental retardation. A. B. 238 would provide a means to track data. For example, a couple who already had a child with spina bifida had a 3 percent chance of having another child with a similar condition. But, if the woman took 10 times the normal dose of folic acid the risk decreased to 1.5 percent. She would do something positive in order to try to prevent the birth defect from occurring in a subsequent child. The results of the hopefully preventive measure would be gathered and the information would be available to others to allow them make the changes necessary to have a healthy child.

Assemblywoman Leslie said she had been concerned about the insurance question, but in reading through A.B. 238 had not seen where insurance companies would have access to the information gathered. Dr. Mary Guinan said there would be limited access to confidential data even with the Health Division. The confidentiality had never been breached. Insurance companies did not have access to the confidential data the State Health Division collected.

Assemblywoman Gibbons suggested the addition of certain language to page 2, Sec. 7.: The State Board of Health shall adopt regulations to insure that access to information contained in the system is limited to persons approved by the State Health Officer or his representative who are "AUTHORIZED AND." The addition might give some feeling of protection that not just anyone in the medical school would have access to the information. Dr. Mary Guinan agreed with the suggested addition.

Janice Pine representing St. Mary's Regional Medical Center questioned the language of A.B. 238 on page 2, lines 8, 24, and 34, in particular the wording "poor reproductive outcome" and "patients diagnosed with a diagnosis of stillbirth" had not been consistent in those three lines. She wanted to be sure the language in the bill would be consistent with that used by the hospitals. Also on page 2, lines 25 through 28, provided the hospital shall "maintain and make available a list." The section had not said anything about separate reporting, thus she felt the hospitals would not know what had been required of them in the bill. Some of those areas might be included in the regulations which the Board of Health would write, however, if the provision would be for a totally separate registry, like the cancer registry, the hospitals had been charged for it. She suggested there be an explanation about exactly what was expected of the hospitals and how they would handle it.

Assemblywoman Buckley commented a bill had been passed in 1997 that would specifically prohibit insurance companies from using genetic testing.

Chairman Freeman asked Assemblywoman Evans to advise the committee when she had the amendment for A.B. 238 ready. She then closed the work session on A.B. 238 and opened the work session on A.B. 178.

Assemblywoman Sheila Leslie representing Assembly District 27, in Reno, requested the legislation be drafted in response to a long identified problem in northern Nevada in terms of providing mental health care for children and youth. Over the past year the Community Unity Coalition (previously known as the Mental Health Coalition of Northern Nevada) had worked very closely with Senator Townsend and others to identify and prioritize the state's mental health resources and needs in the community. Coalition members included representatives from diverse groups such as the American Civil Liberties Union (ACLU), law enforcement, United Way, private nonprofit providers as well as state and county public agencies. Meetings had drawn 20 to 50 people and issues had been vigorously debated. The group tried to reach a consensus on solutions-based priorities that would improve the quality of life. During the last session the coalition had been successful in convincing the legislature to fund a new mental health facility on the grounds of the Nevada Mental Health Institute and significantly increase funding for community-based programs for adults. The coalition had not been as successful in addressing the needs of children and youth. A.B. 178 had a different approach to addressing a critical need.

A.B. 178 opened funding of mental health services to Medicaid-eligible clients by allowing licensed clinical social workers and licensed marriage and family therapists to provide mental health care to clients who would otherwise languish on waiting lists while waiting for mental health care through public agencies. It added to the provider list, it would not add a new service. Currently Nevada State Plan reserved the private sector privilege to licensed psychologists although many states had chosen the option of allowing other professionals to provide those types of service.

The bill had nothing to do with protecting the turf of any particular mental health profession. As a director of the Children's Cabinet, Ms. Leslie personally hired psychologists, licensed marriage and family therapists, licensed clinical social workers to work with families. All three professions had provided wonderful service. The needs of the child or adolescent were considered and matched with the best mental health professional available. However, the economic reality had been many psychologists had been able to accept a limited number of Medicaid clients because of the long reimbursement time and the low payment.

A.B. 178 had not been an attempt to bash the state agencies. There were wonderful people working at the mental health agencies who would be testifying and would explain how the waiting list worked and the realities faced with the limited resources. The children with the most severe needs had to move up the waiting list and be served first. However, the longer children remained on the waiting list the more severe their problems became. Many times children had to enter the juvenile justice system before they could receive mental health care.

Ms. Leslie described A.B. 178 as her "30 percent solution." The bill would only provide assistance to the 30 percent of children who had been on the list who were eligible for Medicaid. Those children could be served in the private sector by licensed clinical social workers and licensed marriage and family therapists if Nevada State Plan allowed them to provide services. If those two groups worked for the state or worked for the managed care providers in southern Nevada, they could be reimbursed for Medicaid. Only the private sector had been precluded. Even though Ms. Leslie described her bill as the "30 percent solution" it would be a 100 percent solution for the children and families it would help. She urged the committee to keep in mind the bill dealt with access to mental health care and quality of care, and both children and families deserved it.

Ms. Leslie said she had just received the fiscal note on the bill and felt it was extremely high. She would work with the state staff in Medicaid and in Health Care Financing and Policy to reach a more realistic number.

Assemblywoman Berman asked about the fiscal note. Ms. Leslie said it was $1.4 million for the 1999 fiscal year, and $1.5 million for the year 2000.

Janice Wright, Deputy Administrator, Health Care Financing and Policy, said she had met with Ms. Leslie and they would work together to develop a better idea of the population to be served. She had no information on the unmet need; Medicaid had not kept track of the number of people who had not received services. In southern Nevada, as Ms. Leslie stated, those services had been provided through the health maintenance organizations (HMOs), but in northern Nevada there had been a private sector and it had been the focus of A.B. 178.

Ms. Wright addressed two other issues. First, rates had not been set aside for that provider code. There would be no way to reimburse those providers. It would be necessary to do a State Plan amendment, the public notice, and the hearing process to establish rates. Second, to require Medicaid to include a service or provider type reduced the program flexibility.

Assemblywoman Berman asked if Health Care Financing and Policy would be creating a different pay scale for marriage and family therapists (MFTs) than the Ph.d. psychologists. Ms. Wright said the fiscal note would be determined based on the amount paid to psychologists. The issue of rates had not been included in A.B. 178 and would be addressed by a State Plan amendment.

Les Gruner identified himself as Program Manager, Children's Behavioral Services (CBS), in Reno. CBS had 330 children from newborns to age 17 on the waiting list for outpatient services.

• In the early childhood program, birth through age five, 63 of the 330 children waited an average of 109 days for service.
• In the 6 through 12 age group, 175 children waited an average of 191 days for service.
• In the adolescent program, 92 children waited an average of 198 days for service.

When a family called for services the procedure had been to do a clinical phone screening and attach a clinical triage rating determined by the seriousness of the problem. There were 9 counselors who provided services to 715 children in the last fiscal year. The average caseload had been between 30 to 35 clients per therapist.

Chairman Freeman asked if there had been a worsening of a child's condition as a result of a long wait for services. Mr. Gruner stated at the time of the initial phone screening the children with the most severe problems had been seen sooner. The children whose problems had not been severe were referred to other resources within the community.

Helen Foley, representing Nevada Association of Marriage and Family Therapists, introduced Mary Ann Potter, President of the Nevada Association of Marriage and Family Therapists (NAMFT). Ms. Foley stated there were 250 psychologists in the State of Nevada, 570 marriage and family therapists, and 450 clinical social workers. She found alarming Mr. Gruner's statement that children who had already been approved for Medicaid services had to wait up to 191 days. With therapy many problems could be corrected, without therapy problems could only escalate. Managed care had the authority in southern Nevada and, to the extent it had been utilized in Washoe County, to use marriage and family therapists as well as social workers. That had not been the case in rural Nevada where it had been almost impossible to find psychologists to take care of Medicaid needs, especially for children.

Mary Ann Potter identified herself as a licensed marriage and family therapist and president of NAMFT. She was employed by the Washoe Tribe of California and Nevada and treated court ordered victims and victims of abuse in Fallon and Gardnerville, and outlying rural areas such as Battle Mountain. There were licensed MFTs in Gardnerville, Winnemucca, Fallon, Incline Village, Birdeye, Elko, Ely, Stateline, Dayton, South Lake Tahoe, Zephyr Cove, and Carson City. Also Clark County had MFTs willing to serve in rural and southern counties including Indian Springs, Moapa, Overton, Pioche, Caliente, Panaca, Pahrump, and Mesquite had two therapists willing to go to Bunkerville.

Ms. Potter urged the committee to support reimbursement for marriage and family therapists and social workers willing to work in rural areas where there had been an identified need.

Alicia Smalley identified herself as president of the Nevada Chapter of the National Association of Social Workers. The group represented over 155,000 social workers nationwide and 650 in Nevada. She expressed support for A.B. 178 for Medicaid reimbursement for clinical social workers and marriage and family therapists. Both groups had been licensed by the State of Nevada to provide mental health services and should be allowed reimbursement to fill a need in the state and communities. Without proper assessment and treatment at an early age, federal, state, and local governments were forced to pay much higher costs for dysfunction when those youths became either a case in the juvenile justice system or participated in the adult mental health or corrections systems. Her written testimony was provided as EXHIBIT D, and included a letter of support from Robert P. Stuyvesant, M.S.W.

Helen Foley stated throughout the Nevada Revised Statutes (NRS) 433 which discussed mental health of adults and children, a person professionally qualified in the field of psychiatric mental health was defined as a:

• psychiatrist licensed to practice medicine in the state;
• psychologist licensed to practice;
• social worker who held a masters degree in social work and was licensed as a clinical social worker;
• registered nurse who practiced professionally and had a masters degree in the field of psychiatric and was employed by the division; and a
• marriage and family therapist licensed pursuant to Chapter 641A.

The only professionals in the field not included in receiving reimbursement from Medicaid had been the clinical social worker and the marriage and family therapist. It had been well documented in the law and reimbursement under A.B. 178 would simply be an extension of that law.

Chairman Freeman found that information interesting. She stated A.B. 178 would be put into subcommittee chaired by Assemblywoman Leslie. Assemblywomen Berman and Gibbons would also be on the subcommittee. Anyone who desired to testify before that subcommittee was invited to do so.

Mrs. Freeman closed the work session on A.B. 178 and opened the work session of A.B. 249.

Myla Florence identified herself as Administrator of the Welfare Division, Department of Human Resources (DHR). She stated A.B. 249 was a DHR requested bill that addressed two issues:

1. Changes to the Medicaid Estate Recovery Program.
2. Created a separate section in the law which addressed the ability of the Welfare Division to recover the amount of incorrectly paid benefits from recipients of public assistance.

Her written testimony, presented as EXHIBIT E, stated in part the Medicaid Estate Recovery Program had been approved by the 1993 Legislature and gave the Welfare Division authority to recover from the estate of Medicaid recipients. The program had been expanded by the 1995 legislature to permit imposition of liens that protected the ability of the state to recover Medicaid benefits paid for recipients. The program had received over 3,400 case referrals as of February 1, 1999, and had completed more than 2,600 cases. The program had recovered over $2.3 million since its inception. Those funds had been redeposited into the Medicaid budget and used to reduce expenses. Medicaid estate recoveries partially funded the medical needs of current and future Medicaid recipients.

Ms. Florence said a need existed to delineate in the Nevada Revised Statutes (NRS) between Medicaid estate recoveries and incorrectly paid benefits which encompassed Temporary Assistance to Needy Families (TANF), the Food Stamp program, and the Medicaid program. In 1998, $519,301 was recovered in incorrectly paid benefits. The addition of the separate statute would make it easier to collect incorrectly paid public assistance benefits.

The Welfare Division proposed amendments to A.B. 249 which stated in part:

• Section 1: Inclusion of the language "undivided estate" would be consistent with the current definition of estate as it related to the ability to recover correctly paid benefits from Medicaid recipients.

• Section 2: Sought conformity with optional federal definition of "estate" and clarified the ability of the Welfare Division to recover from property owned by the recipient immediately prior to death or at time of death. Included was property held in joint tenancy or other arrangements where title normally passed upon death of recipient.

• Section 3: Inclusion of the language "undivided estate" instead of merely "estate." The program would not seek recovery for benefits paid prior to October 1, 1993.

Charles Hilsabeck identified himself as a deputy attorney general representing the Welfare Division. One of the areas he handled was the collection of incorrectly paid benefits. There had been a number of problems in the area in the past, including conflicting interpretations of the statute of limitations presently in NRS 422.2935 which had been held on occasion to prelude the recovery of incorrectly paid benefits.

Assemblywoman Buckley asked if a 6 month statute of limitations would apply to TANF and other programs. Mr. Hilsabeck said in section 7 of NRS 422.2935, four events had to occur and then a 6 month window opened. In attempting to collect incorrectly paid benefits against a welfare recipient still living when the four conditions had not been satisfied, hearing officers had held that the incorrectly paid benefits could not be collected. The proposed amendment would change that. It was federal language that applied to Medicaid estate recoveries only and it was being applied to the collection of incorrectly paid benefits. Ms. Buckley said she was concerned mainly about good faith errors, the recipient being penalized and the children suffering.

Myla Florence stated there were provisions for waiving the recoupment by the welfare administrator. Ms. Buckley asked if they were in the law. Ms. Florence said the provisions were in the regulations. Ms. Buckley asked to see the provisions and regulations before a decision on the bill was reached.

Chairman Freeman agreed A.B. 249 should go into a future workshop. She closed the work session on A.B. 249 and opened the hearing on A.B. 250.

Mary Liveratti identified herself as Deputy Administrator, Division for Aging Services, Department of Human Resources (DHR). The DHR had requested a revision of NRS 427A.123 concerning the specialist for the rights of the elderly, also called the Elder Rights Attorney. The request resulted in A.B. 250. Ms. Liveratti provided written testimony (EXHIBIT F) which stated in part:

• The request was a housekeeping matter, a technical change to the statute that would not alter the substance of the work performed by the position.

• The position, created in 1989 to provide legal advocacy for Nevada seniors, was funded in part by federal monies.

• The statute provided certain powers to the specialist. What was lacking in the statute was a statement of duties that may be performed by the specialist, which occasionally had caused confusion among seniors who requested the specialist to represent them.

• The Department of Human Resources requested Section 2. (1)(a) be revised to read: "Provide advocacy and education relating to the rights of elderly persons and shall assist in the development of legal services to assist elderly persons in securing and maintaining their legal rights.

Bonnie Brand identified herself as Deputy Attorney General in the Human Resources Division, representing Adult Protective Services under Health Care Financing and Policy, which would soon be under the Division for Aging Services. She expressed support for A. B. 250 but wanted to clarify the Elder Rights Attorney would not be a criminal prosecutor or a legal representative, but would rather act to facilitate services within communities, at the senior centers, senior law centers, and so forth.

Ed Fend identified himself as Vice Chair of the State Legislative Committee for the American Association of Retired Persons (AARP) and voiced strong support for A.B. 250 which provided additional assistance to elderly citizens. He had no objections to the proposed amendment.

Assemblywoman Gibbons asked whether an amicus curiae had to be an attorney. Assemblywoman Buckley said the amicus organization itself did not have to be an attorney, so the Nevada Legislature could be an amicus, AARP could be an amicus, but the entity filing on behalf of the amicus had to be a lawyer licensed to practice to represent the organization.

Chairman Freeman asked for confirmation that no fiscal note had been attached to the bill. Ms. Liveratti confirmed it.

With no further business to come before the committee, Chairman Freeman adjourned the meeting at 3:00 p.m.

RESPECTFULLY SUBMITTED:

Darlene Rubin,

Committee Secretary

APPROVED BY:

Assemblywoman Vivian Freeman, Chairman

DATE: