The Committee on Health and Human Services was called to order at 2:15 p.m., on Wednesday, April 7, 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:

Assemblyman David Goldwater, District 10

STAFF MEMBERS PRESENT:

OTHERS PRESENT:

Assemblyman David Goldwater, representing District 10, stated he was attempting through A.B. 69 to get disproportionate share (DSH) hospitals the money to which they were entitled. It had been a difficult process to amend the bill. Work session document (EXHIBIT C), prepared by Marla Williams, Committee Policy Analyst, presented amendment 356 which had not quite accomplished what was intended. The amendment needed to state the amount of money the department might retain from the amount transferred to the department pursuant to subsection 1 must not exceed 10 percent of the amount of the disproportionate share payment received from the Federal Government. Additionally, there was a provision under proposed statute that required the state plan for Medicaid must allocate $4.8 million a year for fiscal year 1997-98 and $4.8 for fiscal year 1999-00. Because the effective date on the bill was changed statutory language must be retained for the current budgetary biennium.

Chairman Freeman said someone from Washoe County had expressed concern that it might adversely affect Washoe Medical Center, but she had been assured it would not.

Assemblywoman Leslie was still concerned with the Washoe County issue and believed the amendment should be more specific that Washoe Medical Center would be included.

Marla Williams, Committee Policy Analyst, stated in the new language Mr. Goldwater referred to amending the Nevada Revised Statutes (NRS) section 88, which would assure Washoe Medical Center was included.

Ms. Leslie said her concern was it would adversely affect the Medicaid budget and if it was sent to the Committee on Ways and Means, they could deal with that. However, she asked Mr. Goldwater, would there not be a hole in the Medicaid budget if the bill were passed.

Mr. Goldwater answered the effective date on the bill was not until the end of the current biennium, therefore, it would not leave any hole in the current budget. Medicaid had not been budgeted beyond fiscal year 2001, so there were neither revenues nor expenditures for those years. The bill would create the policy of disproportionate share money intended for hospitals go directly to hospitals. How that money would be made up was not known.

Ms. Leslie said that was the essence of her concern. She believed Medicaid was underfunded. Mr. Goldwater shared her concern, he had been advocating health care for a number of years. He questioned whether the money was being taken from Medicaid under false pretenses. It was bad budget practice to take DSH money to fund Medicaid. It was bad for Medicaid. It did not accurately reflect what was spent for Medicaid. That was money intended for hospitals being used for Medicaid. If it was kept in the hospitals then a better case could be made for Medicaid and illustrate it truly was underfunded.

Ms. Leslie said that case had been made for many years and still had not been addressed. She was willing to vote to send it on to the Committee on Ways and Means but was still concerned.

Mrs. Freeman asked if Mr. Goldwater was comfortable that having established a policy would really make a difference. Mr. Goldwater did feel comfortable and explained an interesting facet of Medicaid was that, "there was a nice crust of Medicaid and then there are a whole bunch of issues under that top crust. Whether this passes out of Ways and Means or makes it any further, these policy issues concerning this important health program need to be brought out and be discussed. These changes may not take effect right away but over time as we keep pushing, keep pushing, that is how good policy is made."

Mrs. Freeman appreciated his concern and said that Mr. Goldwater being on the Committee on Ways and Means helped move it along. It cost the state a lot of money not to face what its obligations had been in the past.

Assemblywoman Berman asked about the fiscal note. Mrs. Freeman said no one knew at that point what it would be, but the Committee on Ways and Means would discuss the policy. Mr. Goldwater clarified it would be a cost shifting. The fiscal note would not be any less dollars for health care, it would be less dollars for state Medicaid but more dollars for the hospitals. An estimate would be forthcoming of what it would cost state Medicaid if they lost hospital money from their budget.

Chairman Freeman asked for a motion to amend and rerefer to the Committee on Ways and Means.

ASSEMBLYMAN WILLIAMS MOVED TO AMEND AND DO PASS AND REREFER A.B. 69 TO THE COMMITTEE ON WAYS AND MEANS.

ASSEMBLYMAN MANENDO SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

Chairman Freeman opened the work session on A.B. 586.

Marla Williams explained the fiscal note (EXHIBIT D) had been jointly prepared by the Attorney General's Office and the Health Division. She also presented the compilation of proposed amendments to Assembly Bill 586 (EXHIBIT E), and explained it incorporated the amendments provided to the committee by Dan Geary and Tricia Hunter and the proposal of James Prosser. Mr. Prosser addressed two issues, only one of which had been included in view of the first set of amendments brought forward. Therefore, the amendment would be to amend subsection 2(a)2 of A. B. 586 to specify that an error in the administration of medication or a biological substance must result in harm or injury to the patient before it was required to be reported. The second amendment was provided in response to questions posed by Assemblywoman Von Tobel and included sanctioning provisions for a person who failed to report or falsified certain information, including a person who was in a position of responsibility for staffing in a medical facility. Further, the amendment specified sanctions if a pattern or practice of such violations could be proved. The final change was suggested by Chairman Freeman to indicate that in subsection 2 of section 2, items 1 through 4, that it be clear those conditions would only be reported while a patient was in the hospital.

Chairman Freeman explained the language had seemed unclear to her as to the timeline.

Assemblywoman Berman asked for an explanation of the wording at the bottom of page 3 of the fiscal note (EXHIBIT D) under the heading "Revenue." Ms. Williams stated if the bill was adopted, the Bureau of Licensure and Certification in order to administer or implement the bill would charge medical facilities fees. That would generate the revenue and fund the bureau's ability to enforce the bill.

Rick Panelli, Chief, Bureau of Licensure and Certification, explained the revenue was based on the total amount of money it would cost to set up a computerized system to track the requirements in the bill for staffing, to determine whether the facilities were providing adequate staff based on the acuity of the patients. The total amount in the first year was $675,000. Each additional year the cost was $314,000 to maintain the staff to handle the onsite investigations, to compile the data, and to handle the computer work or make any changes in the programming that would be necessary based on the findings obtained each year. The rationale was it would be more equitable to increase each additional bed fee, that way the larger hospitals would pay a proportionately larger share of the total expense. Currently the base licensing fee for each bed was $35. The number of hours to inspect a large facility was greater than a small facility so a facility like Washoe Medical Center with 500 beds would pay more than would the hospital in Yerington with 25 beds. Therefore a fee based on the number of hours required to inspect the facility was added to the base fee.

Assemblywoman Von Tobel asked Mr. Panelli if there would be a fiscal impact. Mr. Panelli said he did not believe the fiscal impact would be changed.

Chairman Freeman asked for a motion.

VICE CHAIRMAN KOIVISTO MOVED TO AMEND AND DO PASS AND REREFER A.B. 586 TO THE COMMITTEE ON WAYS AND MEANS.

ASSEMBLYMAN THOMAS SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

Mrs. Freeman asked Ms. Williams to discuss further business before the committee. Ms. Williams said three bills required action.

A.B. 190 had been heard and had little support. A similar bill in a better form had moved out of another committee.

Mrs. Freeman asked for a motion to indefinitely postpone A.B. 190.

VICE CHAIRMAN KOIVISTO MOVED TO INDEFINITELY POSTPONE A.B. 190.

ASSEMBLYWOMAN BUCKLEY SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

The next items were A.B. 301 and A.B. 354 which had been combined into A.B. 302.

Mrs. Freeman asked for a motion on A.B. 301.

ASSEMBLYWOMAN MOVED TO INDEFINITELY POSTPONE A.B. 301.

ASSEMBLYWOMAN LESLIE SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

ASSEMBLYWOMAN LESLIE MOVED TO INDEFINITELY POSTPONE A.B. 354.

VICE CHAIRMAN KOIVISTO SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

With no further business before the committee, the Chairman adjourned the meeting at 2:40 p.m.

RESPECTFULLY SUBMITTED:

Darlene Rubin,

Committee Secretary

APPROVED BY:

_____________________________________________

Assemblywoman Vivian Freeman, Chairman

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