The meeting was simultaneously videoconferenced in room 4401, Grant Sawyer State Office Building, 555 East Washington, Las Vegas, Nevada.

Assemblyman Greg Brower, representing Assembly District 37, introduced himself and his guests, Janet Van Gelder, R.N., Incline Village Health Center, and Gene Brockman, Member, Incline Village Committee. He introduced his bill, A.B. 533, and provided EXHIBIT C that included a bill synopsis, a copy of the bill, and an opinion letter from the Washoe County District Attorney's Office. A.B. 533 proposed to modify Nevada Revised Statutes (NRS) 450 by allowing the creation of a county hospital district for the purpose of contracting with an existing healthcare facility.

The proposed change to existing law was intended to allow remote communities such as Incline Village and other rural areas around the state to contract with an existing noncounty healthcare facility for services. The change would prevent the sudden termination of such services at Incline Village that had always loomed on the horizon. The Incline Village facility had undergone several ownership changes and was under threat of closing down. Current law did not allow for the creation of a hospital district for that limited purpose. The proposed change was simply another way for rural or isolated communities to ensure emergency care services.

Gene Brockman identified himself as full time resident of Incline Village who supported A.B. 533. His written testimony (EXHIBIT D) stated he represented the Incline Village Health Care Committee, a group of local physicians, health care providers, and interested local citizens. The situation in Incline Village was one of several similar situations in rural Nevada. The committee charter proposed to find and evaluate all integrated medical services and related facilities available to Incline Village residents and to assure they remained viable. In the event of a serious accident or a stroke it was imperative to have a hospital nearby for treatment. Complete and appropriate medical care was essential. The concept of the nearest and best treatment was more important than the nearest facility.

In Incline Village the total integrated medical care system included physicians, a highly skilled mobile intensive care paramedic units, a trauma center, six other hospitals in Reno, Truckee, and Carson City, and the Incline Village Health Center. Standard medical protocols and Nevada law mandated certain procedures be followed in the case of trauma, heart attack, stroke, or gastrointestinal bleeding, and those required the services of a certified trauma center. Washoe Medical Center in Reno was the only one in northern Nevada. A coronary intensive care unit with a catheter lab or stroke team might also be required, as might specialized surgery and blood availability. Currently those critical services were available only in Reno or Las Vegas.

The Incline Village Health Center (IVHC) was licensed as an eight-bed acute care hospital. It also had a 24-hour emergency room, outpatient surgery center, laboratory, radiology, and pharmacy units. It did not have such capabilities as general surgery, obstetrics, intensive care unit, Medical Resonance Imaging (MRI) or any of the other very sophisticated imaging systems, and other facilities found in larger hospitals; however it still played a very important role in the health care of the community. The emergency room, outpatient surgery center and support units were well utilized, while the eight-bed acute care unit averaged less than one patient per day and rarely had more than two patients at any one time. Current licensing required it be fully staffed 24-hours a day, 7 days a week. Local physicians did support the facility as best they could; however, the small inpatient load was a direct function of the small population. The population did not generate the patient load with the types of medical problems that could be treated in the local health center.

The IVHC was a unit of Tahoe Forest Hospital in Truckee, California. Tahoe Forest Hospital was owned and operated by a California tax district.

The IVHC had an approximate $400,000 annual operating loss. As a unit of the hospital supported by a California tax district, there was concern about long-term viability of the facility. The management of the health center had done all it could to increase efficiency and reduce operating costs. Ideas for ways to increase revenue included adding new services such as assisted living, hospice, respite care, or fund raising, either by a private effort or by forming a hospital district to own and operate or to contract to operate the facility.

Incline Village and Crystal Bay townships were a rural enclave about 45-minutes driving time, sometimes very hard driving, to the nearest full-blown hospital. There were 8,000 year round residents, increasing to about 11,000 during the summer. It was unlikely population would ever increase greatly because of terrain limitations or planning authority restrictions. The true market was also tempered by the number of residents who used physicians elsewhere than Incline. There were about 8,000 tax parcels in the townships. Current Nevada statutes did not permit a political entity smaller than a county to form a hospital district for anything smaller than a county hospital.

Mr. Brockman said his group had asked Assemblyman Brower to introduce the bill to enable problem communities in the state to form taxing districts to help fund the kind of facility that fit the unique health care needs of that community. They were also working diligently to find other solutions to their problem; however, if another way could not be found passage of A.B. 533 would give them the opportunity to form a hospital district to continue adequate health care facilities.

Assemblywoman Buckley asked to have clarified what the Incline community wanted was the ability to form a tax district to create a hospital or contract with an existing facility. Assemblyman Brower said that was correct, but most likely it would contract with an existing facility to ensure the facility stayed in operation. Ms. Buckley asked what would the taxing entity be. Mr. Brower said the Incline Village Crystal Bay community.

Mr. Brockman said his committee believed it would be the townships comprising Crystal Bay and Incline Village. Currently they were not allowed to form a hospital district unless it was a Washoe County hospital district for a county hospital. Ms. Buckley expressed confusion about the mechanism. She acknowledged rural communities had to create innovative ways to get health care when there was a great distance to a hospital. However, the way the proposed bill had been written, the board of trustees were allowed to levy a tax, accept donations, and determine medical indigence. Would that board be the Washoe County Commissioners or a board in a new tax district, and who would have the ability and authority to levy a tax. Mr. Brockman said his group visualized the board of trustees or commissioners would be formed for the purpose of managing the tax district and would have the power to levy a tax on the residents within the townships or communities involved.

Ms. Buckley asked if that would be in addition to the tax they paid to Washoe County to support Washoe County facilities.

Madelyn Shipman, Washoe County District Attorney's Office, offered to answer some of those questions. Washoe County did not have a county hospital (Washoe Medical Center was not a county hospital), so there was no separate tax to support a hospital other than the indigent levy. The appropriate taxing district was felt to be that which already existed for Incline-Crystal Bay, which was the Incline Village General Improvement District (IVGID). The intent was to have the residents control additional monies they might want to assess themselves to ensure the continuation of the facilities. Under existing Nevada Revised Statute (NRS) Chapter 450 there was an option provided to the creation of a hospital district. The board could be either the Board of County Commissioners or a separate elected board of trustees. That would be controlled by what the residents wanted to do, but it would first have to be approved by the county commissioners.

Chairman Freeman asked Mr. Brower if he had spoken to Washoe County Commissioners about that. Mr. Brower responded the commission voted unanimously to endorse the idea in view of the many factors discussed earlier, and the district attorney's opinion was it could not be done under current statute.

Assemblywoman Gibbons asked if the intention was to create the district under IVGID which made the decisions about the water board, was that legal under the cited chapter. Or, if it was created under the county commissioners it would be taxation without representation because there was only one commissioner who represented Incline and Crystal Bay.

Mr. Brower said he did not believe IVGID could do it and that would be what the change in the law would provide. The proposed bill would only change the purpose for which a district could be formed.

Chairman Freeman asked Lisa Gianioli, who represented Washoe County, to testify. Ms. Gianioli confirmed the county voted in favor of A.B. 533 for the options it would give the Incline Village area. On the IVGID issue, she said that was the area that would dictate the taxing district. IVGID would not actually form the hospital district, it would still have to go to the board of county commissioners who would form the district. In that process the district could decide if they wanted an elected body of trustees from the Incline Village area or if they wanted the board to act as their trustees.

Ms. Gibbons asked who would raise the tax. Ms. Gianioli said when the district was formed there was an inherent mechanism to set the tax rate that was allowed to be levied for that purpose. There would be involvement with the Department of Taxation and the district would become a taxing entity like any other taxing entity in the state. The tax rate would be determined based on assessed value and other formulas that dictated taxes. If a group in Incline was chosen to be the governing body, it would be the budgetary authority that established the budget and decided the rate within those limitations.

Ms. Gibbons asked if it would be a tax increase for Incline residents to create it. Mr. Brower said it could be, if the residents decided that an additional assessment was worth the services to be provided. They would tax themselves an amount they believed to be necessary to accomplish the goal. Ms. Gibbons wanted to know how the wishes of the community would be determined. Madelyn Shipman stepped in to straighten out the confusion. There were two options available. If the need coincided closely with a current election that would be the procedure the board would choose. If there were an emergent need the law authorizes the board to proceed by resolution which would be an open meeting and discussion. That would never be done without a popular request because it did require a petition to be filed.

A discussion ensued between Assemblywoman Buckley and Madelyn Shipman regarding applicability of existing law in which it was decided an amendment was necessary to accomplish the desired purpose.

Chairman Freeman suggested to Mr. Brower that he consider a preamble or letter that clearly stated legislative intent. There had been a great deal of concern in Washoe County about increased taxes and people felt they had no input in the process, and if he made it more clear, it might help his bill. She asked him to bring the letter or amended bill back to the Committee on Health and Human Services as soon as he had it. Mr. Brower agreed to do that.

Chairman Freeman closed the hearing on A.B. 533 and opened the hearing on A.B. 531.

Assemblyman Tom Collins, Assembly District 1, identified himself and provided proposed amendments to his bill, A.B. 531 (EXHIBIT E) as followed:

Nancy Ford Angres, Chief Deputy Attorney General, Division of Child and Family Services (DCFS), identified herself and stated DCFS was neutral but assisted in preparing the amendments to simplify the bill and to attempt to achieve what the Foster Care & Adoption Association of Nevada wanted.

From Las Vegas, Deanne Blazzard, President of the Foster Care & Adoption Association of Nevada, identified herself and stated the association was pleased with the amendments to A.B. 531. She believed the amendments were necessary in view of the national trend to hold parents responsible for their children's criminal actions. Because of additional influences on children who came into care they had more intense behavior problems. Foster care providers employed many behavior management techniques to help children change their behavior or keep behavior in line, unfortunately sometimes those children chose to break the law or commit a criminal act. Foster parents many times were unaware of the child's history and had no part in creating the problem so they should not be held liable for damages as a result of the child's actions. Ms. Blazzard provided written testimony marked as EXHIBIT F.

May Shelton, Director, Washoe County Social Services, identified herself and said to her knowledge there had not been a problem of foster parents being held liable for acts of children in their care. However, the department supported A.B. 531 because it made clear the fact that foster parents should not be held liable. It was difficult to recruit and retain foster parents and for that reason it was important to have the bill become part of statute.

ASSEMBLYWOMAN VON TOBEL AMEND AND DO PASS A.B. 531.

ASSEMBLYWOMAN GIBBONS SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

Chairman Freeman provided some background on A.B. 573 and A.B. 681 and opened the hearing on those bills.

In the 1997 session Assemblyman Close and Mrs. Freeman sponsored a bill that required background checks on people who worked in nursing homes. Since that time some people had lost their jobs because it seemed the 7 year period following a sentence being served had been too long. Assemblyman Humke had a constituent who experienced a problem and he and Mrs. Freeman therefore introduced A.B. 573.

Marla Williams, Committee Policy Analyst, introduced herself and stated A.B. 573 would reduce the length of time on certain crimes from 7 years to 3 years. A.B. 681 was an attempt to ensure that people, primarily nurses, who had already been given a professional license did not have to have a criminal background check if the background check was part of their application for a professional license. It also added "medical facilities" and "facilities for the dependent" which significantly broadened those personnel subject to criminal background checks. It also applied now to volunteers. Further, there had been a problem with "employees" with some facilities indicating they had no employees, rather they had only "independent contractors." Therefore, there was new language in the amendment to deal with people who might be considered independent contractors. Finally, the bill provided for background checks to be conducted every 5 years as opposed to a one-time background check.

Ms. Williams provided an amendment (EXHIBIT G) which returned the authority to the Health Division and continued to require termination of individuals with criminal convictions. It added another criminal conviction, being "abuse, exploitation, isolation, or neglect of a person who is aged or a person who is vulnerable." It also gave the Health Division the authority not to license a facility if they continued to employ a person who had any of those criminal convictions, or if the administrator of the facility had any of those convictions.

Richard Panelli, Chief, Bureau of Licensure and Certification, identified himself and stated he had no problem with the amendments as presented.

Assemblywoman Buckley asked for clarification of the two bills. Regarding A.B. 573 Chairman Freeman clarified the time limit was reduced from 7 years to 3 years, which she felt was not long enough and should have been 5 years. Ms. Buckley understood it would apply to crimes listed in NRS 449.188: murder, assault, sexual assault, abuse, drugs, fraud, theft, or felonies involving firearms. She asked why should individuals convicted of those crimes be allowed in nursing homes.

Mrs. Freeman took an informal poll the committee's thoughts on the matter and the members acquiesced with Ms. Buckley, and Assemblywoman McClain felt the time period should be increased.

Assemblywoman Leslie asked for the rationale behind the inclusion of a "volunteer" in the category of individuals requiring a background check. She also wondered if page 2, subsection 2 (a) would also cover people who were not providing treatment, care or services to clients of the facility, because Ms. Williams had asked the committee to review that section. Ms. Williams advised that language had been obtained from the Health Division and she did not know the justification for including volunteers, except there were many volunteers in those facilities.

In regard to the language on lines 38 and 39, that section made an exception for people who did not have to be fingerprinted. If the employee did not provide treatment, care or services, the language stated a criminal background check was not required.

Bill Welch, president of the Nevada Association of Hospitals and Health Care Systems identified himself and said his interpretation was A.B. 573 addressed existing regulations that required fingerprints of employees associated with the intermediate level care and nursing home services in the state. He was not clear what A.B. 681 addressed other than it now expanded the regulation to include all licensed health care facilities including acute care hospitals and others such as that. In surveying his member groups, he had identified more than 30,000 individuals who would be impacted by the legislation. The majority of his group's employees and personnel were already certified or licensed by some state agency. A.B. 681 would add one more burden in requiring fingerprinting. It required adding volunteers, "candy stripers," contract staff which included physicians in many cases, and if the bill were enacted as written would cost the industry at least $1.5 million at the outset. Every time the fingerprints had to be rechecked the costs would be incurred. Also, given the industry attrition rate of about 33 percent annually another half million dollars would be spent. Most of the facilities were already doing police background checks. Mr. Welch said he had spoken with Mr. Panelli to determine if it was an issue they needed to work to resolve, but Mr. Panelli felt it was not.

Ms. Williams clarified the bills further. There had been an additional concern that when the law was implemented people had to go through criminal background checks. Some of those people had already received a license from, for example, the Board of Nursing, but because of the convictions listed they still could not work in those facilities despite the fact they were licensed personnel. The bill would grant an administrator some flexibility in determining whether or not they wanted that person to continue to work for them as long as they had their professional license.

Mr. Welch said that provision would be more specific to the nursing home intermediate care industry rather than the acute care setting. He did not oppose the rationale just presented, however A.B. 681 went beyond that into requiring 30,000 plus individuals being fingerprinted. Mrs. Freeman asked how then could the flexibility be built in. Mr. Welch said there were facilities that already required finger-printing. In those facilities the regulations stated if a person had been convicted of specified crimes they must be terminated. If legislation could be enacted to address only those individuals who were regulated that would be best. He did not oppose what was being attempted only the expansion that included individuals who were already subject to fingerprinting as a part of licensure. Mrs. Freeman asked if Ms. Williams could explain the substance of what was desired to bill drafters. Ms. Williams said she believed it was simply a matter of removing the terms and returning it to the way it was, to only apply to skilled nursing facilities or residential facilities for groups.

Cathy Apple, Executive Director for the Board of Nursing, wanted to clarify they had not licensed or certified murderers or sex offenders. The constituent of Assemblyman Humke's was a nursing assistant who had a conviction of burglary. That had fallen into the categories outlined in the law. When the Board of Nursing reviewed the person's application they had looked at what was the offense, how long ago was it, was there evidence of rehabilitation. The young man in question had been able to demonstrate evidence of rehabilitation, he was certified but not given a clear certificate, rather he had been put on probation so that his practice could be monitored and action taken quickly if necessary.

Mrs. Freeman asked if the young man was back to work. Ms. Apple said because of that law he had been fired from the nursing home where he had been doing very well. Mrs. Freeman asked Ms. Williams to work with Mr. Welch and Ms. Apple and others to clean up the language so the bill could be passed out of committee.

Assemblywoman Buckley said she was still uncertain about supporting the bill. It was sad that someone who had been rehabilitated and certified had then been fired; however, was that cause to open it up to expose vulnerable individuals.

Jeff Artz, Supervisor, Records and Identification Services, Nevada Highway Patrol, identified himself and stated when he had reviewed the bill he felt language should be added that said "abuse, neglect, or abandonment of the elderly or disabled" because those were charges under statute.

Assemblywoman Berman asked Mr. Artz why background checks cost so much money and was there a "quick check" that could be done that would not be so costly. Mr. Artz responded his office charged $15 for a background check. That covered the complete cost of the personnel involved and the automated fingerprint identification system that searched not only Nevada records but six other states in the western United States. Mrs. Freeman commented when the interim committee had discussed background checks they were surprised it cost only $15. Mr. Artz said the problem was the FBI fee, which was $24 and drove the cost of the FBI-based background checks up to $39.

Mr. Artz questioned the background recheck time requirement and following a group discussion it was decided a recheck would be required every 5 years.

Mrs. Freeman suggested the new language "abuse, exploitation, isolation, neglect or abandonment of a person who is aged or vulnerable" be included in A.B. 573.

In discussing the amendment wording, Marla Williams clarified the language in A.B. 681 subsection (b) at line 40 on page 2, continuing to page 3, line 17 would be amended into A.B. 573. Basically A.B. 573 would be replaced with the new language. Committee members did not support changing the statutory limitation from 7 years to 3 years, therefore it would remain at 7 years.

ASSEMBLYWOMAN LESLIE MOVED TO AMEND AND DO PASS

A.B. 573

ASSEMBLYWOMAN BUCKLEY SECONDED THE MOTION

THE MOTION CARRIED UNANIMOUSLY.

Chairman Freeman suggested action be taken on the companion bill also and she asked for a motion to indefinitely postpone A.B. 681.

ASSEMBLYWOMAN VON TOBEL MOVED TO INDEFINITELY POSTPONE A.B. 681.

ASSEMBLYWOMAN LESLIE SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

Mrs. Freeman advised there were some items requiring action. First was A.B. 141. Marla Williams explained the bill had been one of three mental health bills addressed early in the session. It was recorded as "amend and do pass" however in rechecking the record a motion was not found.

Ms. Williams presented an amendment from the legal division dated March 30, 1999, EXHIBIT H, for the committee's review and to take another motion.

Assemblywoman Leslie asked if the Division of Mental Health had reviewed the amendment. Ms. Williams replied that Cynthia Pyzel and Dr. Brandenburg had worked on the amendment with the bill drafter, but they had not seen the final amendment. Ms. Leslie said she would have felt better if Dr. Brandenburg were present to comment on the amendment, because there had been some contentiousness at the earlier hearing from the advocacy side. Mrs. Freeman agreed the bill could be held for another meeting until Ms. Leslie could check with Dr. Brandenburg.

Mrs. Freeman remarked it was time in the session where bills had to be moved out and therefore some meetings would undoubtedly be held behind the bar in chambers to get things completed in a timely manner.

Mrs. Freeman then opened the hearing on A.B. 373.

Assemblywoman Chris Giunchigliani, representing Assembly District 9, identified herself and presented a suggested amendment (EXHIBIT I) prepared by Marla Williams. She tried to incorporate the testimony of Richard Panelli, Chief, Bureau of Licensure and Certification, Edward Fend, Committee Chair, American Association of Retired Persons (AARP), and her own comments into the amendment. The amendments proposed were summarized as followed:

A discussion ensued regarding the status of Senator Titus's bill, S.B. 161, and the inclusion of the "transitional housing" language into A.B. 373 which the Senator had requested. Senator Titus's bill was in process by the senate with an "amend and do pass," the "transitional housing" language being voted out of the bill.

Assemblywoman Von Tobel asked for clarification on whether the "transitional housing" language of Senator Titus was to be in A.B. 373.

Assemblywoman Giunchigliani and Chairman Freeman agreed it probably did not need to be included.

Theresa Brushfield Owens, owner of Adult Care Consultants in Las Vegas, identified herself and provided a proposed amendment, EXHIBIT J.

She stated she had only just received the amendment proposed by Assemblywoman Giunchigliani and had not had time to review it and prepare her response. Mrs. Freeman said because of the compressed session time was at a premium and asked if she could give her response at the time. Alternately, Mrs. Freeman asked Ms. Owens to give her prepared amendment to committee members for their review and a vote would be taken on the floor later. Ms. Owens chose to give an abbreviated version of her much lengthier planned testimony. She stated in part:

Assemblywoman Buckley asked who paid Ms. Owens fee and how much it was. Ms. Owens responded the facility paid the fee and it was 40 percent of the first month's rent. She placed approximately 11 people per month at an average $300 each. Ms. Buckley asked if the seniors were ever moved to another facility after initial placement. Ms. Owens said not by her, unless the senior requested it because they were unhappy there, and in that case the facility was not charged the fee. Or, if the senior went in at one level of care and was later determined to be another level of care not under the home's licensing, in that case they would be relocated. If the facility moved the senior she would not do business with the facility again. Ms. Buckley asked if Ms. Owens had explored charging the consumer the fee. Ms. Owens said in several states the law stated the consumer could not be charged and she had followed that example. Ms. Buckley pursued the fee situation and said that in the past doctors had been prohibited from referring patients to a specific facility for x-rays or physical therapy, for example, for consumer protection. Ms. Owens said her proposed amendment stated there could not be direct or indirect financial interest in any facility. Ms. Buckley asked for her comment on the referral of a senior by someone other than the Department for Aging Services, to a facility because of the facility's ability to pay rather than for its appropriateness. Ms. Owens said the Department for Aging Services was not allowed to refer individuals to a specific facility, they could only provide a list of facilities. The amount of fee should not dictate the facility rather the appropriateness of the service for the senior.

Ms. Buckley asked if referrals were ever made to facilities that did not pay a fee. Ms. Owens said, "Yes." Asked how often, Ms. Owens said, "about 5 to 6 percent."

Finally, Ms. Owens said her bill provided that a licensed facility could not also hold itself out as a "referral agency."

Last to speak on the measure was Sheila DeCastroverde, owner of Adult Homes Referral Service, and co-author with Ms. Owens of EXHIBIT J, who pointed out provisions in Ms. Giunchigliani's amendment with which she did not agree. First, that the senior pay the referral fee. Most seniors with whom they dealt did not have the money to pay a fee. The group homes should be responsible for payment. Next, their proposed bill asked for certain rules and regulations to improve the industry and protect the senior, such as requiring fingerprinting of referral agency operators, which would help to rid the industry of disreputable agency operators. She said she and Ms. Owens supported and agreed with much of A.B. 373 and because they were a part of the industry and had been for 10 years would like to be included in regulations regarding it.

Chairman Freeman announced the committee would not vote on the bill at the meeting and closed the hearing on A.B. 373.

Ms. Freeman asked Ms. Buckley if she had received the information requested from Charlotte Crawford, Director of the Department of Human Resources, regarding A.B. 429. Ms. Buckley said she had received it and asked to have the bill placed on the next agenda.

Ms. Freeman remarked Ms. Gibbons had given her information on the managed care reform act on which her husband, Congressman Jim Gibbons, had been working. She asked Ms. Gibbons to provide others on the committee with the same material.

With no further business before the committee, Chairman Freeman adjourned the meeting at 3:30 p.m.