The Committee on Health and Human Services was called to order at 1:35 p.m., on Monday, March 8, 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. Merle Berman

Ms. Barbara Buckley

Ms. Dawn Gibbons

Ms. Sheila Leslie

Mr. Mark Manendo

Ms. Kathy McClain

Mr. Kelly Thomas

Ms. Kathy Von Tobel

COMMITTEE MEMBERS ABSENT:

Ms. Sharron Angle

Mr. Wendell Williams

GUEST LEGISLATORS PRESENT:

Assemblyman Lynn Hettrick, Assembly District 39

STAFF MEMBERS PRESENT:

OTHERS PRESENT:

Following roll call, Chairman Freeman made the following committee introductions:

• BDR S-1643: Provides for model program for guardians ad litem for children who are abused and neglected (Assembly Bill 430.)

MOTION TO INTRODUCE BDR S-1643 BY ASSEMBLYMAN MANENDO.

MOTION SECONDED BY ASSEMBLYWOMAN GIBBONS.

MOTION CARRIED UNANIMOUSLY.

• BDR 38-635: Eliminates sunset concerning continuation of the Division of Health Care Financing and Policy.

MOTION TO INTRODUCE BDR 38-635 BY ASSEMBLYWOMAN KOIVISTO.

MOTION SECONDED BY ASSEMBLYMAN MANENDO.

MOTION CARRIED UNANIMOUSLY.

Chairman Freeman opened the hearing on Assembly Bill 167.

Assemblyman Lynn Hettrick, Assembly District 39, addressed A.B. 167. He said A.B. 167 was actually introduced in the 69^th Session by Assemblywoman Guinchigliani and had a great deal more in it than the present bill. When Ms. Guinchigliani's bill reached the Senate in the session, it was not released. Ms. Guinchigliani included her bill from the 69^th session in another bill she planned to introduce in the present session. However, both she and Mr. Hettrick were concerned her new bill would meet the same fate.

Judge David R. Gamble, Ninth Judicial District Court, testified in favor of A.B. 167. Judge Gamble explained for the past 8 years, he and his wife had taken into their homes and then into a private nonprofit building called City of Refuge, pregnant and homeless or nearly homeless women. There was no charge, no one was paid, and the entire operation was voluntary. Currently, pregnant women were included in A.B. 167 among people controlled by the "group home" statutory scheme, which required substantial administration by the state and substantial expense by whichever organization gave support to those women. Mr. Gamble continued his group came to the conclusion that pregnant women were not disabled by virtue of their pregnancy and so should probably not be included in the group of people protected by the statutes in question. In the 1997 session, the point addressed by Mr. Gamble was included in Ms. Guinchigliani’s bill to spread out group homes in metropolitan areas. While the issue of pregnant women did not receive opposition at that time, it was decided to submit the question separately in the current session.

Mr. Gamble continued he had not canvassed agencies to determine if they were of the same mind as 2 years ago. At that time everyone from the state had no opposition to the idea of pregnant woman being removed from the category of people protected by the group home statute.

Chairman Freeman asked if the City of Refuge was required to be licensed. Mr. Gamble stated currently there was a requirement to be licensed and a severe limitation on the number of women per facility. There was a requirement for a full-time administrator and various other expenses, which could not be met if the organization was to remain free-of-charge. The City of Refuge was not licensed. The requirement to be licensed would cause them to close their doors. Anticipating what might happen with the bill seemed to make the state not really interested in checking the facility, even though they had been invited.

Chairman Freeman asked what kind of oversight was in place. Mr. Gamble explained the oversight consisted of himself and his wife, another couple on the board of trustees, and a few other people who assisted.

Chairman Freeman asked where the City of Refuge was located. Mr. Gamble said it was 7 miles east of Highway 395 and south of Gardnerville. He stated his group received referrals from judges, the Family Support Council in Gardnerville, probation departments (both adult and juvenile), public health nurses, and private referrals from pregnancy crisis centers. He added the bill would affect a few other places in Nevada, including Casa De Vita in Reno.

Assemblywoman Leslie wondered if Step 2 had testified in the hearing during the 69^th session. Mr. Gamble was not sure he recalled that. Step 2 was one of the organizations to whom City of Refuge referred women with drug and alcohol involvement. There was a great deal of parenting training and birth preparation at City of Refuge. Family Support Council in Douglas helped with those programs. One girl graduated from high school while with the program, and there were other success stories as well.

Assemblywoman Koivisto asked what kind of supervision pregnant women needed. Mr. Gamble responded assistance was needed in learning about the birthing process, G.E.D. or continuing education credits, computer training, cooking, and so forth. So maybe the better word would be training, rather than supervision.

Chairman Freeman asked what the funding was for City of Refuge. Mr. Gamble said the City of Refuge was a blatantly Christian organization. They were not connected with any particular church, but received donations from churches, from people on both sides of the abortion issue, and from a few foundations through private grants. No government money was involved at all. The exception was the mothers were allowed to become Medicaid qualified so doctors could be paid. There were also two OB-GYN doctors who took women through from beginning to end if they did not qualify for Medicaid. The mothers or their families did not donate anything.

Chairman Freeman commented City of Refuge must have a fine reputation in the community to be able to ask for such aid with no oversight at all. Mr. Gamble replied Douglas County people had a reputation of standing up to support endeavors such as the one in question.

Chairman Freeman closed the hearing on A.B. 167, and opened the hearing on A. B. 251.

Speaking in support of A. B. 251 was Donald Haight, Director, Contract Management, University Medical Center (UMC). Mr. Haight told the committee the purpose of A. B. 251 was to clarify the provisions available and purchasing powers of county hospitals to allow them to join into purchasing groups. Joining such groups would allow economy of scales, to get the lowest possible price for a given item. The purchasing group in which UMC was interested in joining had about 78 members, with a combined purchasing power of up to $22 billion a year. The purpose and intent of the Local Government Purchasing Act was to allow competitive bidding to insure the taxpayers saved money.

Mr. Haight pointed out A. B. 251 went one step further because the purchasing group engaged in competitive bidding, and because of its buying power was able to get most favored nation agreements from suppliers. That provision meant those suppliers would give the purchasing group their lowest prices. If they ever gave someone else a lower price, that price must be made available to the group. Through such means the purchasing group expected to realize up to a five- percent savings on medical supplies. Those purchases were highly specialized and used only national suppliers. Therefore local suppliers would not be affected. Mainly the purchases were for medical and surgical supplies, medical instruments, and pharmaceuticals.

Chairman Freeman thought the issue A. B. 251 addressed had been determined in a previous session. Her recollection was the previous bill had a requirement to comply with the Local Government Purchasing Act. She asked what the difference was in A. B. 251.

Mr. Haight responded there was an act some time ago limited to management groups that came into hospitals, and the hospitals contracted with those groups, who in turn joined purchasing agreements. A. B. 251 would expand that to allow county hospitals to do so directly.

Chairman Freeman wondered what the opinion was of the Clark County Board of Commissioners. Mr. Haight responded that board was also the hospital board of trustees, so they were in favor of the bill.

Ms. Koivisto wished to clarify Section 3, paragraph 1, where it stated "the purchasing group would purchase through a process of competitive bidding", but Page 3, line 28 to 29 said "without complying with competitive bidding." She asked Mr. Haight to explain.

Mr. Haight elucidated what was meant was transferring competitive bidding from individual hospitals to the purchasing group as a whole. So the group as a whole would have national advertising and competitive bidding on a nation-wide basis. Based on those bids, the individual hospital would be able to purchase. The hospital itself would not have advertised and solicited bids.

Chairman Freeman then asked where those purchasing groups were. Mr. Haight responded there were a number of different purchasing groups throughout the country. The biggest one at present was a group called Novation, which was a combination of the University Health System Committee (UHC) and Veteran’s Hospital Administration (VHA). There were 100 members in UHC and VHA had 1300 members. There was a huge economy of scale when that purchasing power was so great.

Chairman Freeman stated she had been a nurse for years and was very concerned about quality of medical supplies. She asked whether Mr. Haight was satisfied the purchasing group would go for quality products. Mr. Haight explained each member of the group was entitled to sit on the purchasing committees and had input into specifications, quality, and requirements for every item being bid. Because of the vast economic bargaining power of the groups, they were able to get assurances of quality from manufacturers.

Assemblyman Berman expressed concern about quality. She asked for an estimate of what the 5-percent savings amounted to in actual cash dollars. She wondered whether the purchasing group received payment for their services.

Mr. Haight answered joining did not require the hospital to buy through he group. If the hospital were not satisfied with the quality of the merchandise being provided by the group, they would be able to contract elsewhere. They would also have input into those quality measures to make sure they had the highest quality and the products met all of the needs of the health care professionals. He did not have a dollar amount for the savings, but he would be able to provide those reports at a future date. The hospitals already in the group experienced between 2-to-5 percent savings. The purchasing group received membership fees from members. Even with fees factored in, the hospitals still experienced those savings.

Chairman Freeman asked for the charges of the purchasing group to be included in the upcoming report of dollar figures from Mr. Haight. She said the committee would review the testimony at a future workshop and asked Mr. Haight if he could have the requested information available for presentation at that time.

Assemblywoman Koivisto wanted to know that if pharmaceuticals were included, since not all Health Maintenance Organizations and so forth used the same formula, how A. B. 251 proposed to deal with that issue. Mr. Haight commented the chief of UMC would be on the purchasing committee, so he knew each member hospital had input from their chief of pharmacy.

Chairman Freeman responded the use of generic products was an issue for a lot of people, whether on Medicaid, Medicare, or anything else. She asked Mr. Haight to include that information as well on his next report to the committee.

Assemblywoman Von Tobel said new studies were done on the TMR Laser heart machine, and asked if Mr. Haight would use the purchasing power to get that machine as a group. She understood the machine was rather expensive. Mr. Haight responded the purpose of the group was to get the best pricing for individual member hospitals. The group did not purchase equipment to be utilized among various members.

Chairman Freeman closed the hearing on A. B. 251, and opened the hearing on A.B. 146.

Chairman Freeman explained A.B. 146 came out of an interim committee on health care. Assemblyman Close chaired a subcommittee on long-term care. One recommendation was to appropriate funds for a study on quality of care. There was an appropriation of $100,000, so A.B. 146 would go to the Assembly Committee on Ways and Means. It was the job of the Committee on Health and Human Services to determine if it was good policy to contract with an independent organization for the study.

Assemblywoman Buckley told the committee she had been on the subcommittee with Assemblyman Close. The legislature had decided some years ago to have all Medicaid recipients of Aid to Dependent Children or the Children's Health Assurance Program enroll in mandatory managed care. That decision was made a few sessions ago, but implementation was delayed. During the interim, the division indicated they were ready to actually implement the enrollment. After great discussion that took place. At that point, a managed care organization suggested those people not in mandatory managed care were mostly the disabled and the aged. Those groups were the largest expenditures of Medicaid dollars and warranted study.

Assemblywoman Buckley said she knew individuals from the disability community were very much against mandatory managed care for the disabled population who because of their chronic conditions needed to see specialists.

Chairman Freeman asked for a motion on A.B. 146.

ASSEMBLYWOMAN GIBBONS MOVED TO DO PASS A.B. 146.

ASSEMBLYWOMAN LESLIE SECONDED THE MOTION.

Lois McDonald,

Committee Secretary

APPROVED BY:

Assemblywoman Vivian Freeman, Chairman

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