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

GUEST LEGISLATORS PRESENT:

Speaker Joe Dini, District 38

Senator Mark Amodei, Capital District

Senator Dina Titus, District 7

STAFF MEMBERS PRESENT:

OTHERS PRESENT:

Following roll call, Chairman Freeman opened the hearing on S.B. 161.

Senator Dina Titus, representing District 7, introduced her bill S.B. 161 which was related to other measures before the committee, namely S.B. 163, scheduled for an upcoming hearing, and a similar bill introduced by Assemblywoman Chris Giunchigliani in the 1997 session. The issue was transitional housing. She explained in some older neighborhoods in Las Vegas and Reno, properties were being bought and turned into halfway houses where several people lived with some supervision after release from a drug or alcohol abuse program, drug court, and so on. Little or no regulation existed for those facilities and other residents in the neighborhood were concerned about what was going on in those halfway houses. For that reason, Senator Titus introduced S.B. 161 in an effort to provide oversight through a licensing and/or inspection process.

There had been some debate on the best way to achieve the oversight provision, whether through the Bureau of Alcohol and Drug Abuse (BADA) or the Health Division (HD), and how to define transitional housing. Senator Titus did not feel extensive regulation would be necessary since halfway houses were not treatment facilities. The bill to be heard at an upcoming hearing, S.B. 163, asked for similar regulatory oversight for group homes, which also did not require the same regulation as nursing homes.

Chairman Freeman asked if private groups operated those halfway houses. Senator Titus confirmed that was true. Groups or individuals simply went into the business of operating halfway houses. She had contacted the city of Las Vegas to determine if the houses could be regulated through zoning, but that was not possible. The concept of halfway houses had been accepted as being good and necessary in the community. That did not mean, however, they should operate at will with no oversight. Mrs. Freeman asked what state or local agency would apply the regulations. Senator Titus said the original bill had been set up under BADA and she had tried to parallel the regulation with some of the organization that had come out of the Assembly, on which Assemblywoman Leslie had been working.

Assemblywoman Leslie believed Senator Titus' bill was excellent in terms of licensing transitional housing but was concerned it would not reach the halfway houses it intended to target. On page 3, line 10, the bill stated "transitional housing facility means a facility that provides a supportive living environment where persons receive treatment." Senator Titus said she shared Ms. Leslie's concern but that language had been used in the BADA definition, and that was the language drafted in her bill. However, amendments were being offered to change that definition.

Dr. John Yacenda, deputy director, Department of Human Resources, advised he had talked with Senator Titus about the bill and agreed with her intent. In its current language, however, S.B. 161 was not addressing the best means of accomplishing that intent without complicating other aspects of the licensing laws. Therefore, Rick Panelli, Licensure and Certification, and Barbara Caskey, BADA, had drafted language to amend the bill to be consistent with Senator Titus' intent and with Nevada Revised Statutes (NRS).

Senator Titus said she had read the proposed amendment and found it acceptable.

Rick Panelli, Bureau of Licensure and Certification, provided an overview of the amendment (Exhibit C) as follows:

• The present term "transitional housing facility" was amended to read "substance abuse halfway house" throughout the bill. The intent was to have a low level of oversight of facilities where people were in transition but not receiving treatment.

• A substance abuse halfway house was defined as a residence that provided housing and living environment to facilitate the individual's reintegration into the community. It would not provide substance abuse treatment as defined by the Bureau of Alcohol and Drug Abuse (BADA). The term did not include a facility for the treatment of abuse of alcohol or drugs as defined in NRS 449. Accordingly, it would not be regulated at the same level as alcohol and drug abuse facilities that provided treatment. Regulations would have to be developed specifically for that type of housing.

Assemblywoman Leslie asked for confirmation that Mr. Panelli did not see the need for a change in the language currently in the bill for transitional housing facility. Mr. Panelli said most of the language would remain as written. What would be changed was the terminology from transitional housing to substance abuse halfway house, which would continue to be certified by BADA and most of the rest of the language would remain unchanged. The philosophy in the proposed legislation would stay. Ms. Leslie asked if transition housing as stated in the bill was already covered in the existing law. Mr. Panelli said it was, and the Bureau of Licensure and Certification was working with BADA on a regulation to include transitional housing, which was the lowest level they would cover under NRS 449.

Assemblyman Manendo asked when the committee might review the amendment. Dr. Yacenda said he provided a copy to Marla Williams but had not made copies for members because Senator Titus had not approved it until a short while ago. Mr. Manendo asked about section 5 of S.B. 161 which indicated the bureau had the authority to impose fines of not to exceed $1,000 per day and wondered if there was a minimum fine.

Barbara Caskey, program specialist, Bureau of Alcohol and Drug Abuse, responded they had no authority previously to impose fines. Mr. Manendo felt the fine should be significant enough to encourage compliance while allowing the bureau to have some discretion in the matter. Ms. Caskey thanked Mr. Manendo for his suggestion and wanted to discuss the matter with Mr. Panelli and Senator Titus and return with a recommendation.

Chairman Freeman asked for an example of a violation. Ms. Caskey responded BADA needed to develop standards and regulations for halfway houses that it presently did not certify. From that base BADA could then determine what constituted violations. Mrs. Freeman cited language on page 3, line 25, of S.B. 161 which mentioned "intensive treatment for outpatients." Mr. Panelli said that entire definition would be removed and replaced with the new definition of a "substance abuse halfway house." Anything that dealt with intensive treatment would be covered in the current NRS 449 statutes and regulations.

Chairman Freeman then asked if there had been problems or simply expressions of concern from residents in neighborhoods with halfway houses. Senator Titus replied there had been concern from neighbors who had seen strangers in the area, more traffic in and out of the houses and a general feeling of uncertainty. Mrs. Freeman next asked what were the incentives for individuals who operated halfway houses. Senator Titus believed it was becoming fairly lucrative as those types of facilities became more widely used. Also when neighborhoods declined homes could often be purchased inexpensively and converted for that purpose. Mrs. Freeman asked if federal or state money was involved in funding those homes, but no one knew.

Barbara Caskey provided an answer to why people operated halfway houses. Historically with substance abuse recovery, people who were in recovery felt the need to stay with one another to offer support, stay sober, and continue working on their program. Halfway houses had been the patient's way of doing aftercare, which had never been a part of treatment. Halfway houses generally were not an entrepreneurial enterprise but a means for persons with a common desire for sobriety to stay with one another. Sometimes an individual simply owned a home and opened it up to others with whom they had been in recovery, and it could be a landlord-tenant relationship.

Vice Chair Koivisto asked if the amendment addressed the number of people who could reside in one house. Senator Titus said that would be left to the regulatory agency to determine. Regulations were discussed in an open meeting process with input from the community invited.

Assemblywoman McClain cited the penalty portion of the bill referenced on page 2, section 8, and elsewhere, and asked for what would the licensing bureau impose a fine. Also, would that be in addition to the misdemeanor charge also mentioned in the bill. Senator Titus reiterated the language had been lifted from existing statute for other kinds of facilities. Dr. Yacenda offered a blanket assurance that the bureaus (BADA and Licensure and Certification), as the experts in the matter, would develop model regulations that would embrace the principles of maintaining safe and effective facilities. The regulations for halfway houses would mirror those for treatment facilities or hospitals relative to the kind activity that took place, and there would be thorough protection for the provider-owner as well as the patients and residents in the community.

Mrs. Freeman acknowledged there was a great deal of interest from the committee in the bill and thought it would be best to continue with testimony and then schedule it for a work session.

Last to speak on S.B. 161 was Marilyn Morrical, a private citizen, who stated she had reviewed the definition of transitional housing and felt it was too limited. She believed the definition should include some provision for a "safe living environment while participating in an outpatient treatment program or immediately following a treatment process." She had given Senator Titus a draft of language to expand the definition; however, that draft was not provided for the minutes record.

There were no further questions or testimony and Chairman Freeman closed the hearing on S.B. 161 and opened the hearing on S.B. 365.

Senator Mark Amodei, representing the Capital District, Speaker Joseph Dini, representing District 38, and Steve Tognoli, district chief, Mason Valley Fire District, came forward to discuss S.B. 365.

Senator Amodei explained the bill had been introduced because of concerns Chief Tognoli had regarding rural emergency medical issues. The bill provided for the formation of a committee in the rural counties to advise the Health Division in order to focus and prioritize concerns. Clark County had been excluded from the bill because under state law its board of health was their overall health board authority. He stated there was no fiscal note, but there was an effect on state or industrial insurance by virtue of a grant from the Office of Rural Medicine at the University Medical Center who would handle the funding for the biennium.

Speaker Joseph Dini, representing Assembly District 38, expressed support for the bill on which Senator Amodei had worked so hard and which would benefit the eight ambulance services in his district. There had been a feeling among those all-volunteer groups of a lack of communication with the Health Division. They felt unable to present their problems or be assured of finding solutions. S.B. 365 would remedy that situation. He went on to explain the ambulance services provided a tremendous benefit to the people of Nevada. There were 3,000 volunteer fireman in the state and most of them were also in the ambulance service; without them the state's medical first response system would fall apart.

Mr. Dini added that Senator Amodei had succeeded in finding the funding to meet the expenses of establishing the advisory board and would also place additional training money in the budget. First response units throughout the state would benefit from the training, and they needed to be able to express their concerns to the Health Division that had jurisdiction over them. He added he had attended the convention of volunteer emergency groups and the primary issue they brought to his attention was the desire and need for more help in the emergency medical area.

Speaker Dini explained the composition of the advisory board included a doctor and a nurse. The emergency service group required the sponsorship of a doctor in order to operate. The sponsoring doctor enabled them to obtain the supplies and medications needed as well as onsite training.

Chairman Freeman commented she had asked for a study on the rural health system and felt the advisory board could be of help in that connection. Speaker Dini acknowledged everyone had concerns about being able to provide adequate medical attention to the rural areas. The greatest problem had been keeping hospitals open and being able to provide services. Chief Tognoli and others operated 24 hours a day in small towns, in fact a helicopter came to Yerington every day to pick up patients that had heart attacks or other serious health problems. The ambulance went to Carson City almost every day. It was an ongoing service and it was very difficult to get people to serve; some people were fireman and not emergency medical technicians (EMTs). Speaker Dini mentioned also he had once been with the fire department for 13 years and had been a Red Cross Instructor, a designation that no longer existed but at the time had been the highest category for an ambulance driver. Mrs. Freeman said her husband, too, had once been a Red Cross Instructor.

Mrs. Freeman asked about the communications systems in place.

Chief Tognoli, Mason Valley Fire District, responded they had come a long way from the "turf wars" of the past. There were 82 permitted services throughout the state and 28 medical directors. In rural areas the services helped each other between county lines, and he was not aware of any problems there. However, the establishment of an advisory board would enable the services to get together and communicate on a variety of issues.

Mrs. Freeman asked if the rural areas had the "911" system. Chief Tognoli said most areas had either "911" or "enhanced 911."

Assemblyman Manendo asked if there were any adverse affects anticipated from the advisory committee. Chief Tognoli felt there would be none; however, he could not predict there would be no problems. When the advisory committee was developed it was done through a combined effort, a task force, throughout the state. The task force met following a rural health conference; some concerns were brought up and there had been no way to address them. The idea was brought forth to form a committee to represent every part of the state, without having too many members that would make communication difficult. Clark County Health Board and Washoe County Health Board were a resource in an ex officio status.

Mrs. Freeman noted the money was in the bill for training and asked how it would be implemented. Chief Tognoli said several services provided training, but sometimes the people who needed the training could not get to the training site easily.

Chief Tognoli noted there were several changes coming from the Federal Government. The new Department of Transportation (DOT) curriculum for intermediate and advanced life support would be coming to the area and would affect many areas. It required 300 hours to train intermediates throughout the state. Volunteers had a very difficult time accomplishing 300 hours training so the committee needed to be involved and work with the new DOT guidelines to address those issues. Training could be done in many ways; any instructor could coordinate a course, as could any fire district or rescue squad, so long as there were proper instructors and the course was approved through the state. The problem was that not everyone understood how to coordinate the training so the committee needed to go out into the communities and advise them how to put together a continuing education program.

Mrs. Freeman asked for an elaboration of the funding mentioned on section 4, page 3, "entitled to receive per diem allowance and travel expenses which must be paid by the Health Division for money not allocated for another use." Senator Amodei responded that had been a concern on the Senate side and had been addressed through the Office of Rural Health, University School of Medicine, who obtained a grant from the Federal Government. If the legislation went through they were preparing to fund through the mechanism of interlocal agreement the per diem and meeting expenses for the next biennium. If the Health Division could not obtain the continuation it would be addressed in the budgetary cycle in the 2001 Legislative Session.

Senator Amodei added the legislation would not change the way the Health Division made decisions on emergency medical service issues presently. It would not remove any of their authority or add any authority. It would bring a priority in focus to those issues in the other 16 jurisdictions in the state to set up a mechanism whereby every community would have input through their local service providing agencies so that the Health Division had broad based information to make decisions.

Assemblyman Manendo noted page 3, section 5, of the bill detailing the responsibilities the advisory committee would have and asked for additional background on the genesis of the legislation. Senator Amodei believed the needs of emergency medical services in the other 16 jurisdictions had outgrown the resources of the Health Division. For that reason the bill provided a way to focus on and prioritize those needs.

Speaker Dini noted the division had worked closely with the jurisdictions; however, the hiring freeze and other things had happened beyond their control.

Regarding training, Speaker Dini said it had to be brought to the EMTs en masse, because if they had to travel to Reno or Carson to train then no one was in the jurisdiction to handle the emergency problem. If the instructor went to the smaller towns a group of 10 or 15 could be trained simultaneously.

Caroline Ford, assistant dean, University of Nevada School of Medicine, and director of the Nevada State Office of Rural Health, explained her office had worked with the task force group that was organized, prioritized the concern, and then introduced the legislation. Her office had been involved with emergency medical services (EMS) training and education for a number of years and had partnered with the people who delivered the services in the rural counties. That kind of legislation was a benchmark in bringing forward advocacy around the issues.

Ms. Ford presented a description of the Nevada Critical Access Hospital Program (Exhibit C) which had been accepted by Health Care Financing Administration to begin a program. The first wave of money coming from the Federal Government around technical assistance would be received soon.

Within the legislation one of the focuses would be EMS planning. The ultimate goal was integration and improvement of EMS systems around regional hospitals that participated in the program. Even if a facility decided they were not in a position to do a conversion to become a critical access hospital, technical assistance such as EMS planning could be provided to communities. One group of medical directors had already met in Yerington and the Rural Health Office would be supporting that group in their effort to examine protocols and other issues of concern.

Ms. Ford also provided a copy of her letter to Senator Rawson (page 2, Exhibit C) expressing support and commitment to the fiscal note on S.B. 365. She advised Chairman Freeman she would be glad to participate in the interim study and provide recommendations and assistance. In closing, she stated her office was partnered on the legislation and on ensuring that what was recommended by the committee could be supported in the communities.

Dr. John Yacenda expressed the strong support of the Health Division and the Division of Human Resources for the legislation and the ideals presented therein, particularly the activities of the advisory committee. Relative to the fiscal effect, a simple agreement between the Health Division and the university would provide for the movement of the funding to meet those needs.

Dr. Yacenda then introduced Fergus Laughridge, the new emergency medical services (EMS) supervisor, who would be working closely with the firefighters throughout Nevada.

Chairman Freeman asked Ms. Ford about the reference in her letter to Senator Rawson (page 2, Exhibit C) to telecommunications and how it would be used. Ms. Ford said in the context of her letter it was meant as support for the committee, because some of the individuals selected from rural communities might not always be able to travel and the university volunteered to use its compressed video system to connect them. She anticipated adding an EMS coordinator to the staff who would be located in Elko, and working with the Great Basin Community College to ensure the qualifications of that person would meet the criteria for instructor. The training agenda would be implemented and become available on compressed video so it could go out to the other communities.

Assemblywoman McClain expressed strong support for S.B. 365. In her experience with rural health issues in Clark County, she knew the Rural Summit and the rural health office at UNR had been seeking solutions to many problems and the legislation would be a wonderful first step.

Mrs. Freeman expressed support as well and remarked she was glad to see the Federal Government provide some funding. Regarding the interim committee, she was unsure who would be chosen; however, she hoped Ms. Ford would be available to help legislators on the Legislative Commission. Ms. Ford said she would be happy to do so.

Next to speak was Fergus Laughridge, representing the Emergency Medical Services, Health Division, Department of Human Resources, who expressed support for S.B. 365 on behalf of those agencies. He explained he was part of the task force before being appointed supervisor of the state's EMS system. He understood the feelings and problems of the rural providers and believed the legislation would give them an opportunity to come together as a group and work on the common goals. The combined efforts would enable the state's medical services to move into the next century.

Regarding the training issues, the state training coordinator was located in Tonopah, and there were representatives in Carson City, Reno, and Elko to serve the needs of the rural providers. The passage of S.B. 365 would open the lines of communication and be outstanding for the State of Nevada.

Mrs. Freeman was pleased to see Tonopah represented, because she knew from many committee meetings over the years that Tonopah was always among those areas that needed services. She was delighted also to see the cooperation and coordination between the various service agencies.

Ms. Ford informed the committee, in light of Mrs. Freeman's comment about Tonopah, that Tonopah would not be able to participate as a critical access hospital because it was defined as an urban area. Mrs. Freeman was quite surprised and felt that should be discussed at a later date. Ms. Ford said they were trying to work on that with Senator Bryan. Assemblywoman McClain said on other bills they had to define "urban" and the definition was any city over 10,000 population, which she felt was outrageous. Ms. Ford agreed and added according to the Office of Management and Budget (OMB) if it was in a county that was socially or economically integrated with an urban area it was pulled in. There were many definitions of "rural" and it could be interpreted in various ways. Currently the definition was under review. Ms. McClain asked about using the term "medically underserved." Ms. Ford said it was still in effect, but for the purposes of that specific HCFA program they chose the OMB definition which made no allowances for health care. She had tried to submit what was called the "Goldsmith Rural Modification" which would have allowed for rural parts of urban counties and situations like Nye County. Unfortunately in the midst of the plan review, Tonopah announced its bankruptcy so their plan was under close scrutiny and it did not pass. However, she said they were working through Senator Bryan's office for a waiver to the definition. Mrs. Freeman asked when it could be expected to reach the committee with recommendations. Ms. Ford believed it would be the fall of 2000 a new definition should be in place for medically underserved areas and health profession shortage areas, which were usually the markers for health care programs. Currently there were 38 programs tied to those definitions.

Mrs. Freeman invited Mr. Matheis to speak, whom she understood had an amendment to the bill.

Larry Matheis, executive director, Nevada State Medical Association, expressed support for the bill. The integration and long-term planning for emergency medical services particularly in rural and frontier areas was essential. At the hearing in the Senate, Dr. Myron Gomez, director of trauma services at Washoe Medical Center, was present. Afterwards he met with others in trauma centers around the state and suggested it would be useful for the Assembly Interim Committee and for the advisory committee to the Health Division to include a representative from the trauma centers. Accordingly, the amendment would be to add in the list of members in section 3, subsection 3 (j), "a physician who is a member of the American College of Surgeons, Nevada State Committee on Trauma." Further, the trauma centers needed to integrate better with the first responders.

Mrs. Freeman asked if he had discussed the amendment with the proponents of the bill. Mr. Matheis had only discussed it with the Health Division. Mrs. Freeman asked him to prepare his amendment and discuss it with those others who needed to know, and the committee would take action on the bill at the next hearing.

Next to speak was Scott Huntley, president of the Nevada Emergency Medical Association and chair of the Nevada EMS Task Force. He advised that at the recent statewide EMS conference of over 200 participants, all were very interested in the bill. The consensus of opinion had been the legislation would improve patient care. Further, the passage of the bill would improve communication around the state and the Nevada EMS Association was dedicated to keeping up that communication in the future.

Assemblyman Manendo commented the bill referred to "firemen" and since there would be an amendment to the bill perhaps it could include a change to the designation "firefighter."

Mr. Huntley said it has been originally presented in way and he thought it was a good idea; however, since all materials use the term "fireman" there would be a lot of things to correct. Nevertheless, his group supported the term "firefighter."

Mrs. Freeman said the committee would do some research in the next few days to see if the term could be changed. With no further testimony on S.B. 365, the Chair closed the hearing and opened the work session with S.B. 35.

Chairman Freeman referred committee members to the work session document (Exhibit D) prepared by Marla Williams, senior research analyst. There was an amendment (tab A, Exhibit D) to the bill that proposed to revise the definition of an "expedited service permit" and "person with a permanent disability."

Marla Williams stated the amendment generally rewrote the bill. The only significant changes were on page 1, lines 11 through 13, regarding the expedited service permit which entitled a person to an immediate, appropriate accommodation to avoid arduous standing or sitting in a waiting line. That same change was made on page 2, lines 43 to 46. Also, the definition of "expedited service permit" was again revised to incorporate portions of the language in the existing section 5 and into section 6.

Assemblywoman Buckley asked if the proposed amendment from the Department of Motor Vehicles was agreeable with the sponsor. She noted it was using that bill to fix another problem. Mrs. Freeman said they would hold off taking action until that had been cleared with the sponsor.

Angel Robinson, speaking on behalf of Senator Titus, said she was comfortable with the amendment. Accordingly, Mrs. Freeman asked for a motion to amend and do pass S.B 35.

ASSEMBLYWOMAN GIBBONS MOVED TO AMEND AND DO PASS S.B. 35.

ASSEMBLYMAN MANENDO SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

Mrs. Freeman moved to the next work session item, S.B. 73.

Marla Williams explained the measure had been sponsored by Senator Raggio; however, during the hearing on April 28, 1999, Senator Rawson testified on behalf of the bill. No amendments were proposed and no testimony heard in opposition.

Chairman Freeman advised she would hold the bill for a few days before taking any action. She then moved on to S.B. 197.

Ms. Williams noted the bill, presented by Senator Wiener, was heard on April 26, 1999. Mrs. Freeman noted there had been no opposition and no amendments offered. She asked if there was a fiscal note. Ms. Williams said initially there had been; however, the bill was redrafted and the sponsor was able to present it with no fiscal impact.

Assemblywoman Von Tobel noted the composition of the committee created by the bill did not include anyone from the Association for Retarded Citizens (ARC). She felt that would be important because so many individuals with fetal alcohol syndrome were in the ARC organization and received services.

Mrs. Freeman said Ms. Von Tobel could offer an amendment to that effect.

Ms. Williams noted on page 2, lines 41 to 43 stated there could be one member who "represents persons who operate community based programs for the prevention or treatment of substance abuse." Perhaps that would suffice.

Ms. Von Tobel said it would not cover someone from ARC. It would have to be more specific. She added ARC had made it part of its platform to examine the issue of fetal alcohol syndrome. She could offer an amendment, but did not know if the board could be expanded.

Mrs. Freeman suggested taking it back to Senator Wiener and ask her to amend accordingly. With no further discussion, Mrs. Freeman moved on to S.B. 288.

Ms. Williams noted Senator Washington's bill was heard on April 28, 1999. No amendments had been proposed and no testimony was heard in opposition.

VICE CHAIRMAN KOIVISTO MOVED DO PASS S.B. 288.

ASSEMBLYWOMAN ANGLE SECONDED THE MOTION.

MOTION CARRIED UNANIMOUSLY.

Ms. Williams noted the bill came through the Budget Division on behalf of the Welfare Division and was heard on April 26, 1999. No amendments had been proposed. Mrs. Freeman asked for a motion.

ASSEMBLYWOMAN LESLIE MOVED DO PASS S.B. 398.

ASSEMBLYWOMAN VON TOBEL SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

Ms. Williams advised the bill had been requested by the State Board of Pharmacy and was heard on April 26, 1999. Although no amendments had been proposed, committee members had various concerns.

Chairman Freeman was one who had problems and had asked Fred Hillerby to work on the bill in the interim and return to the committee in the 2001 session.

Fred Hillerby, representing the State Board of Pharmacy, said that related to the immunization portion, but the balance of the bill had been requested by other parties. One portion dealt with the euthanizing technicians licensed by the Veterinary Medicine Board and certified by the State Board of Pharmacy. There were new drugs being used other than sodium phenobarbital. The second provision on page 3 was at the request of the wildlife division who were using different drugs both in euthanizing and in tranquilizing wild animals so they could be transported. On page 4, section 4, the Visiting Nurses Association asked for the provision allowing them to carry certain emergency drugs when visiting patients in their homes, in order to respond to an emergency that might arise.

Mr. Hillerby suggested dropping the portion of the bill that dealt with the immunizations if the committee was not comfortable with it, and he would come back with additional information next session. He did urge consideration of the other portions rather than setting the entire bill aside.

Mrs. Freeman asked for clarification on the drugs for euthanasia and tranquilization of wild animals. Mr. Hillerby confirmed that was indeed what the drugs were used for; although occasionally an animal had to be euthanized, most of the time an animal that posed a danger to humans was relocated.

Assemblywoman McClain thought the Wildlife Division could already do that, and she had concerns about an animal control person carrying controlled substances.

Mrs. Freeman asked if they were licensed. Ms. McClain said that was what the bill would do, license them to carry drugs. Mr. Hillerby said it would not be just any controlled substance, it had to be very specific.

Mrs. Freeman next asked for further clarification on what the Visiting Nurses Association wanted to do. Mr. Hillerby responded section 4 of the bill would allow nurses employed by a home health agency authorized to provide emergency care to carry certain drugs for anaphylactic shock reaction and so on, as long as it was under the direction of the medical director who was a licensed Nevada physician. Mrs. Freeman asked what they had used previously. Mr. Hillerby said they had not had the authority before. Mrs. Freeman then asked what kinds of drugs they would carry. Mr. Hillerby did not have the names of the drugs but would get that information for her. Mrs. Freeman said she was uncomfortable processing the bill without that information.

Mrs. Freeman then asked the committee what action they wanted to take and when there appeared to be a lack of enthusiasm she asked Mr. Hillerby to take the bill back to the parties to come up with a new proposal in the next few days.

Assemblywoman McClain suggested specifying the drugs instead of controlled substances. Also, the immunization portion was equally broad and should be narrowed.

Mr. Hillerby noted that portion of the bill would be reworked and reintroduced in the 2001 session, at Chairman Freeman's request. He would still like to try to refine the other portions of the bill and would work with both the wildlife biologists on their portion and the Visiting Nurses Association on their portion.

Assemblywoman Von Tobel questioned the two-thirds majority required for passage on the original bill that was not required on the reprinted bill. She asked if fees had been taken out. Mr. Hillerby said the only thing amended was adding the physician licensed in Nevada to section 4, lines 24 and 25, and again on page 5, lines 38 and 39. He said perhaps in reprinting they realized a two-thirds majority was not required. Ms. Von Tobel said that if 19 senators felt strongly enough to pass the bill, the committee should give it consideration.

Mrs. Freeman said she asked Mr. Hillerby to bring something back and it would be considered; however, she was a little upset with the state agencies who were counting on Mr. Hillerby to carry the load for them. If they really wanted the bill they could show up to testify. Mr. Hillerby said if they saw him today, they would not put that kind of faith in him. He said he would try to bring additional information to ease the committee's concerns and meet the May 14 deadline.

Mr. Hillerby made a final comment about the euthanizing technician, discussed on page 3, lines 27 through 29, which made clear that the drugs were not for use by human beings. However, he would try to identify the drugs as requested. The problem was when drugs were named specifically, like sodium phenobarbital which had been the drug of use at one time but no longer was, it might then be necessary to return every 2 years with legislation to change it.

Chairman Freeman then moved on to the next work session item, S.C.R. 6.

Ms. Williams noted the measure was requested by the members of the Legislative Committee on Health Care. It had been heard on April 21, 1999. No amendments were proposed; however, testimony from the Division of Health Care Financing and Policy indicated it might be cost effective to combine the measure with other similar measures pending in the Assembly Committee on Elections, Procedures and Ethics, or the Senate Committee on Legislative Affairs and Operations.

Mrs. Freeman asked for a motion on the measure.

ASSEMBLYWOMAN VON TOBEL MOVED TO REREFER S.C.R. 6 TO

THE COMMITTEE ON ELECTIONS, PROCEDURES AND ETHICS.

SECONDED BY ASSEMBLYWOMAN LESLIE.

THE MOTION CARRIED UNANIMOUSLY.

The next measure for discussion was S.C.R. 8.

Ms. Williams stated the measure was also requested by the Legislative Committee on Health Care. No amendments were proposed; however, in the budget process the Division of Health Care Financing and Policy proposed a budget to increase certain waiver slots. The request was not carried forward in the governor's recommended budget. Other agencies that administered waivers included the Division of Mental Health and Mental Retardation and the Division for Aging Services of the Department of Human Resources. It was not a study bill.

Chairman Freeman asked Dr. Yacenda to enlighten the committee on the measure.

Dr. John Yacenda, deputy director, Department of Human Resources, advised there were four waivers that currently covered Medicaid beneficiaries: two in aging services, one in mental health, and one for persons with disabilities. He asked Janice Wright to present the fiscal aspects of those waivers.

Janice Wright, administrator, Division of Health Care Financing and Policy, said the intention had not been to eliminate the waivers but to eliminate the waiting list. The division requested a module in the agency budget, Module E855, for $1.8 million in the first year and $3.8 million in the second year and that would have deleted the waiting lists for all of the four waivers. The medical services for each of the waivers would be approximately $1.4 in the first year and $3 million in the second year of the biennium. The proposal was not produced as part of the executive budget due to limited resources. There were similarities between what was being examined here and what was being urged of DHR in the seven other study bills including one just recently rereferred to the Committee on Elections, Procedures and Ethics. If a comprehensive view of the issue and determinations were made as to where would be the best place for the dollars, then it would be possible to make an impact on the waiting lists.

Chairman Freeman wondered if it was worthwhile going forward with the measure. Ms. Wright said the problem with urging administration to do it was that if they did not have the staff or the money, then it was difficult for them to open up new slots. That was the issue as to why the agency went forward with agency requests and proposed the decision module. It was viewed as an enhancement. Mrs. Freeman noted the Senate had passed the measure and she found that confusing. Ms. Wright said there was discussion about combining it. If money was put into studying something, then why not put money into actually taking the action to remove people from the waiting list and open up those slots.

Mrs. Freeman felt it would be appropriate to rerefer it to the Committee on Elections, Procedures and Ethics, so it could be considered in that grouping.

Ms. Wright said it was very similar to S.C.R. 6 just rereferred, which examined the issue of providing the home and community based care for the elderly and the disabled. Many of those issues had to be decided; should they be studied or should they actually be acted upon. Those were the issues facing the committee in recognizing the limited resources.

Mrs. Freeman opined the best way to proceed would be referral with a letter of intent that the committee considered it important enough to be considered along with the other waivers. She asked Marla Williams to compose the letter of intent to accompany the referral to the Committee on Elections, Procedures and Ethics.

Assemblywoman McClain expressed concern that there were approximately 30 to 35 issues for study consideration currently and S.C.R. 8 did not appear to be one that required a whole interim study; either the process were streamlined or it was not. It was not that difficult. If a process were streamlined, resources would be reallocated. She voiced frustration that it always took more money to do everything. Mrs. Freeman concurred and did not anticipate the measure would be studied singularly but felt the point had to be made that at the time it was passed out of the Committee on Health Care it was considered important enough to have the measure drafted. She re-emphasized that simply urging the administration to do something made it too easy to be ignored.

Dr. Yacenda felt it was important to note the department supported the concept of eliminating waiting lists. It would like all the waiting lists to be eliminated and would continue to pursue that goal.

The Chair asked for a motion.

Assemblywoman Von Tobel said she would make the motion but commented as she had on an earlier resolution, it was frustrating to continue to urge state agencies to do something and not give them the money to do it.

ASSEMBLYWOMAN VON TOBEL MOVED TO REREFER S.C.R. 8 TO

THE COMMITTEE ON ELECTIONS, PROCEDURES AND ETHICS WITH

A LETTER OF INTENT THAT THE COMMITTEE CONSIDERED IT IMPORTANT AND SHOULD BE CONSIDERED.

ASSEMBLYWOMAN LESLIE SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

Chairman Freeman remarked to Ms. Von Tobel she shared her frustration. She then moved to the final item for consideration, S.C.R. 11.

Ms. Williams noted Senator O'Connell requested the measure. It was heard on April 28, 1999. No amendments were proposed; however, when testimony was taken members indicated they wanted to examine the funding needs of existing suicide hotlines in Nevada, among other things. Attachment B of Exhibit D included budgets of two entities presently answering suicide calls, one in Reno and one in Las Vegas. The Reno line handled about 2,400 suicide-related calls. Ms. Williams said she did not get similar numbers on the line that served Las Vegas and Clark County, but discovered substantial administrative and philosophical differences between the two hotlines. The hotline in northern Nevada handled additional duties including child abuse and elder abuse reports, as well as sexual assault. There were state mandates, and those were covered under tab C of Exhibit D. Included was a budget of one of the agencies that showed the overall amount required annually to meet the state mandates.

Ms. Williams noted it had been the consensus among members to make an allocation rather than simply a resolution. She invited Misty Allen to speak on the funding relationship between the state agencies and the suicide hotlines.

Misty Allen, director of the Crisis Call Center in Reno, welcomed questions from the committee.

Assemblywoman Leslie asked if the state provided any direct funding for the suicide prevention portion of the hotline. Ms. Allen said they received Victims of Crime Assistance (VOCA) funding, which was a federal program. However, it went primarily toward child abuse and neglect after hours; it was part of the 24-hour hotline which, as Ms. Williams noted, received 2,400 suicide-related calls but over 4,000 related to extreme emotional duress, which could lead to suicide prevention intervention. No direct funding was received for outreach and education. Ms. Leslie noted the VOCA money was probably not a stable source. Ms. Allen confirmed that and said it was a major concern, because they were in competition with other agencies. The money was not guaranteed, still they were mandated to provide the hotline for all of northern Nevada, parts of California, and all the rural counties. The only place they did not cover was Clark County.

Chairman Freeman asked who required the Crisis Call Center to do that. Ms. Allen said they had a collaborative agreement with the Child Protective Services and the rural counties, and the call center did receive a small amount of funding to do rural mental health services after hours. The majority of their funding came from grants, which was not guaranteed from year to year.

Mrs. Freeman noted Assemblywoman Leslie's interest in the issue and asked if she would like to work on it with Misty Allen and someone from Clark County to see if a funding source could be found. Ms. Leslie agreed and asked to include Assemblyman Manendo whose idea it was originally and whose district was in Clark County. Mrs. Freeman appointed a subcommittee comprised of Ms. Leslie and Mr. Manendo to return to the committee with a recommendation at the next meeting.

There was a brief discussion regarding S.B. 117 which had been listed on the agenda in error, but that bill would not be discussed at that time.

With no further business before the committee, Chairman Freeman adjourned the meeting at 3:20 p.m.

RESPECTFULLY SUBMITTED:

Darlene Rubin,

Committee Secretary

APPROVED BY:

Assemblywoman Vivian Freeman, Chairman