The Committee on Health and Human Services was called to order at 1:45 p.m., on Wednesday, May 5, 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 Dennis Nolan, District 13

STAFF MEMBERS PRESENT:

OTHERS PRESENT:

Following roll call, Chairman Freeman commented on a concern expressed by legislators during the current session regarding lobbyists testimony that had not been entirely truthful. In some cases lobbyists had not provided the same information to both houses. The Nevada Revised Statutes labeled as a crime untruthful testimony to a legislative committee. Mrs. Freeman emphasized she was not making a specific accusation, rather serving notice untruthful testimony would not be tolerated.

The Chair then opened the hearing on S.B. 10. She noted the first three bills to be heard at the meeting had been recommended by the Interim Committee on Health Care. She invited Marla Williams to make the presentation.

Marla Williams, committee policy analyst, explained S.B. 10 had been recommended by the executive director of the Great Basin Primary Care Association during the interim. Essentially the bill put into statute that tribal health providers would be recognized providers for Native American children in Nevada Check-up. The bill also set up an advisory committee in the Nevada Indian Commission which was a statutory commission already set up in state law, and the bill designated the membership of that committee. During the interim there was testimony from some tribal representatives that indicated 4,153 children had applied to Nevada Check-up, of which 112 were Native American. Approximately 9,800 Native American children in Nevada were under the age of 19, and of that number about 2,200 received Medicaid services. The remaining 7,600 children received health care from the tribal health clinics in the state. Consequently, during the interim, a survey of tribal health clinic recipients conducted over a 2-month period by representatives of the Native American health community determined at least 1,854 tribal children might be eligible for Nevada Check-up.

Chairman Freeman recognized that although Dr. John Yacenda was now in a new position, he had recommended the legislation in the interim and thought he might like to address the issue.

Dr. John Yacenda, deputy director, Department of Human Resources, deferred to the individuals who had come specifically to speak to the issue.

Cassidy Williams, chairman for the Walker River Paiute Tribe, provided written testimony (Exhibit C) which stated in part:

• S.B. 10 would provide health care to low income families of Nevada.

• Enrolling Indian children in the Children’s Health Insurance Program (CHIP) would help all Indian tribes of Nevada as there had been large shortfalls in Indian health services for the past 10 years.

• The tribe supported S.B. 10 and the establishment of an advisory committee.

• The tribe was concerned the advisory committee was to provide advice and recommendations to the Nevada Indian Commission. The Walker River Tribe felt the Indian Commission was not responsive or representative of the tribes in the state.

• The tribe requested the advisory committee membership be structured to include tribal representation, such as someone from the service unit management team or tribes with health clinics.

• The Walker River Paiute Tribe would be willing to assume the cost of participation in the advisory committee.

Linda Sheldon, health director, Yerington Paiute Tribe, voiced support for S.B. 10 and for the comments made by Cassidy Williams. She reiterated the Indian Commission was not the vehicle to be used with the advisory committee. However, there needed to be a government to government relationship between the tribes and the state. Her tribe would also like to see representation from Inter-Tribal Council of Nevada and the Indian Urban Programs in the state. She suggested a 5-member board which would include the tribes from eastern Nevada, western Nevada, urban centers north and south, and one person from Inter-Tribal Council of Nevada.

Mrs. Freeman asked how that changed the membership composition in the bill. Ms. Sheldon said it went from four to representation by five entities. Currently the advisory committee was appointed by the Indian Commission. If there was representation from all over the state there would be much better input, and it would come from tribal people. Mrs. Freeman asked if Ms. Sheldon had an amendment. Ms. Sheldon said she did not have anything prepared; however, would be glad to create one. Mrs. Freeman asked her to give Marla Williams the amendment information, which she did.

Assemblywoman Leslie was not familiar with the Indian Commission and asked if someone was present to speak for them. She would be interested in specific details on the problems with the Indian Commission. Further, she did not feel changing the member composition of the advisory committee, who would still report to the Indian Commission, would be a solution.

Cassidy Williams responded they wanted to take it out of the Indian Commission arena, because the commission had not been responsive to the tribes in the past. The representation on the commission was not tribally-driven. There were Native Americans on the commission, but they were not in a leadership position for their tribe and therefore often out of touch with the needs of the reservations. Moreover, there were also non-Indians on the commission.

Ms. Leslie asked if by having the advisory committee made up of representatives from the five tribes around the state that would be enough to receive the responsiveness from the Indian Commission they desired.

Cassidy Williams felt the approach suggested here was a good one. The Schurz service unit represented primarily the western tribes and the service unit in eastern Nevada represented tribes in that area. Both groups held regular meetings, were up to date on all the issues regarding Indian health care, and in that respect would be a benefit. Also, the Inter-Tribal Council of Nevada whose meetings all tribal chairmen attended would be another benefit, along with bringing in the two urban groups. Some of the patients in those latter two groups did not belong to tribes in Nevada.

Assemblyman Manendo asked Mr. Williams if he had testified in the Senate. He had not.

Ken Richardson, tribal health director for the Walker River Tribe, expressed support for S.B. 10 and the views made by both Ms. Sheldon and Mr. Williams.

Assemblyman Williams asked if in addition to the changes already suggested should any changes with the commission be made. Mr. Richardson felt it would help. There had been a lot of frustration with the Indian Commission and consideration should be given to making changes. Mr. Williams asked to be apprised of those concerns and recommended changes in the near future. Mr. Richardson said he would be happy to do that.

Chairman Freeman asked if the commission was discussed in the bill. Marla Williams noted it was discussed in another section. Assemblyman Williams said he had not wanted to suggest that for the bill under consideration because it might have a negative impact but would like to explore other legislation where the concepts could be adapted.

Assemblywoman McClain noted the population of the state was heavily concentrated in the south and wanted to know if the Indian population the bill would address was more evenly dispersed throughout the state, and if the membership recommendations for the advisory committee reflected that.

Cassidy Williams responded that within the Schurz service unit, the Las Vegas Paiute tribe and the Moapa Paiute tribe were members. Ken Richardson added there were approximately 23,000 Indian people from McDermott to Las Vegas. There was an underserved population of about 12,000 Native Americans living in the Las Vegas area who were not receiving services from Indian Health Services.

Chairman Freeman asked where they received care. Mr. Richardson said the majority were Medicaid or private insurance. She queried if that was an issue they wanted to address as a statewide organization. Mr. Richardson said it was not an issue they had addressed with Indian Health Service because the majority of the 12,000 underserved were native Nevadans, but because Las Vegas did not have a direct care facility where those people could receive services. Mrs. Freeman suggested Assemblyman Williams might address that.

Kathy Bowen-Curley, health services director, Fallon Paiute Shoshone Tribe, spoke about NRS 638, Indian Self Determination, which stated Indian health care was free for American Indians, and she asked for a waiver for the premium for Nevada Check-up so more Indian families could participate.

Mrs. Freeman said a member of the Governor's staff was present and perhaps he would address that later.

Ms. Bowen-Curley suggested the "Nevada Indian Health Care Advisory Board" be established either in connection with the advisory board for the Indian Commission or as a separate advisory board and report directly to Governor Guinn.

Chairman Freeman noted in the letter (Exhibit C) from the Walker River Paiute Tribe they would be willing to assume the cost of participation in the advisory board, and asked if that would also be true for the Fallon Paiute Shoshone Tribe. Ms. Bowen-Curley said, "Yes."

Mrs. Freeman then asked how the committee felt about creating a second advisory board.

Assemblywoman Leslie voiced some confusion about the issue. She again asked if a member of the Indian Commission was present. No one came forward. The Chair said, "Where are they?" Cassidy Williams said that was exactly the problem the tribes had with the Indian Commission. He believed one of the commission's duties should be to advise the tribes of ongoing legislation, but that had never happened. The Chair asked who appointed the commission members. Mr. Williams said the governor made those appointments.

Dr. John Yacenda noted the Indian Commission was under the Department of Human Resources. There was no one present from the commission and he would not speak for them. However, when the governor spoke of a fundamental review of programs that meant all of the programs including the Indian Commission would be examined in terms of its functionality and whether it was meeting the needs intended or serving the people intended to serve. In regard to the recommendation to waive the premium for Check-up, there were problems. It would create a fiscal note for the bill, reducing the premiums coming into the Division of Health Care Financing and Policy thereby affecting their budget. However, there was discussion at the federal level about waiving all premiums for Indian children as a federal policy. Those issues were arising throughout the country on premiums for Indian children since the Indian Health Service was funded from the same source as the funding for CHIPs and there probably were inconsistencies at the federal policy level.

Mrs. Freeman felt it might be appropriate for the committee to either draft a resolution or send a letter to the Congress asking for approval. She asked where the issue was being discussed. Dr. Yacenda said they were at the level where Health Care Financing Administration (HCFA) and Indian Health Service were discussing the options, also national advocacy organizations for Indian people were discussing it. A lengthy discussion ensued. The state's congressional delegation was involved in that Senator Reid was a member of the Senate Select Committee on Indian Affairs. A letter from the committee to Senator Reid would be appropriate.

Assemblyman Williams asked if Dr. Yacenda was the "member of the Governor's staff" the Chair had referred to earlier. Dr. Yacenda said yes. Then Mr. Williams read from the Nevada Revised Statutes (NRS) which dealt with the Indian Commission, as follows:

"The executive director of the Indian Commission

shall compile for the commission's approval and

submission to the governor, a biennial report

regarding the work of the commission and such

other matters as he may consider desirable."

Mr. Williams said if the commission had been following the law they should have been presenting that report to the governor every 2 years detailing their work and outreach, and all the things they were designated to do on behalf of the Native American population in the state. There should be a record of those reports, and if appropriate the committee would like to examine them.

Dr. Yacenda said he would be happy to gather that information and report back within a week.

Mr. Williams asked the chair to be sensitive to that request. Mrs. Freeman asked it be submitted before May 14, 1999. Dr. Yacenda said he would be in Utah on May 10, attending a Governors Association meeting on Indian health issues. He would be prepared to make a report to the committee on May 12, 1999.

Chairman Freeman asked for a resolution or letters to the Congressional delegation regarding the waiver of premiums for the CHIPs program.

Assemblywoman Leslie asked who were the members and chairman of the Indian Commission, if they had reviewed the bill, and what was their position. Dr. Yacenda said the chairman of the commission contacted him and expressed support for the bill.

Mrs. Freeman asked the committee's opinion on the amendments brought forward thus far.

Assemblywoman McClain suggested looking into grant money at the federal level to pay those premiums rather than getting a waiver. Dr. Yacenda said the tribes were approaching the matter differently. His concern with a waiver was the fiscal note and in terms of the problems created for the bill would probably not be worth it. Ms. McClain agreed and believed other remedies might be found.

Dr. Yacenda noted the previous spokepersons for the tribes had done an excellent job in presenting the information. He added some clarification in regard to the suggested composition of the advisory board. There were two service management teams, one in the northeastern part of the state and one in southwestern. Those two bodies represented the tribes in those areas and they wanted a member from each team, along with a member from the urban programs in the north and the south, and one person from the Inter-tribal Council. The Inter-tribal Council was comprised of all the chairmen of the tribes collectively. The executive director of that body was in the audience. Dr. Yacenda felt those were excellent suggestions and would represent the varied interests.

Janice Wright, administrator, Division of Health Care Financing and Policy, informed the committee Title XXI was a grant and was the funding mechanism for the Nevada Check-up program or the Children's Health Insurance Program (CHIP). The title required a 35 percent state match, part of which was the premium payments. The remainder was a federal grant. The Nevada Check-up program had worked diligently with the tribal councils who had been extremely cooperative. Ms. Wright credited their energy and enthusiasm toward the program without which there would not be near the enrollment. She said also the division had an opportunity to improve its marketing and outreach and had benefited from the suggestions from the councils. The division would continue to work directly with the tribal councils in making sure the marketing and outreach efforts were successful.

In addition, if the committee was considering changes, Ms. Wright pointed out the particular language in the bill conflicted with A.B. 429 which would delete the sunset provision for the division. There were a number of areas in the bill where CHIP was referred to as a "public assistance program," which it was not, nor was it administered by the Welfare Division. Accordingly, there would need to be some conflict notices and resolution of that language. With respect to the fiscal impact, it would have an impact on the Indian Commission if it went forward as written. However, as Tribal Council chairman Cassidy Williams indicated, some of the tribes were willing to assume that responsibility.

Chairman Freeman asked the proponents to work on their amendments and present them in written form at the next meeting, and to discuss with Dr. Yacenda and Ms. Wright any other additions to the bill.

Assemblyman Manendo noted that students from Nate Mack School in Las Vegas had been in the audience and he wanted to acknowledge their presence and thank them for coming.

The Chair closed the hearing on S.B. 10 and opened the hearing on S.B. 163.

Richard Panelli, chief of the Bureau of Licensure and Certification, representing the Department of Human Resources, noted during the 1995 legislative session a statute was enacted which provided for the registration of homes that provided care for two or fewer individuals. The statute was seen as a way to allow for the good samaritan neighbor or friend to care for someone with whom they had a long-standing relationship. It was believed there were few homes in that classification. However, as of September 1998 there were 451 homes registered with the Health Division. The Health Division had only accepted registration of those facilities and not made routine onsite visits that would allow the division to attest to the quality of care provided. However, the Health Division had investigated numerous complaints concerning the quality of care provided but lacked the statutory authority for regulatory action. If the division found evidence of abuse, neglect, exploitation or isolation, it was reported to Aging Services Division or the local authorities, typically the district attorney's office. Registered homes seemed to attract heavy care cases, individuals one would normally find in a skilled nursing facility.

Mr. Panelli added there was a fiscal note to the Bureau of Licensure and Certification; however, it was neutralized by the fact the bureau would have to establish fees for the registered homes. Establishing regulations and carrying out the oversight of the homes would cost approximately $54,000 in the first year and $59,000 in successive years. One professional staff would be required to develop regulations, license the facilities, and investigate complaints.

The bureau recommended the costs be borne by the providers as other medical and dependent care facilities in the form of licensure fees.

Mr. Panelli said S.B. 163 would not affect the ability of individuals to provide care and shelter to persons related to them within the third degree of consanguinity or affinity.

Chairman Freeman asked what happened when a report of abuse was made to local authorities. Mr. Panelli said nothing happened unless there was actually a case where an individual could be convicted. Typically, the case was reported to the district attorney's office who made sure the individuals were either removed from the facility or protected in some way. Generally the district attorney did not see those cases as a priority and they got shelved. Mrs. Freeman found that interesting in light of all the bills passed by the Committee on Judiciary over the years concerning elder abuse, and then to learn the followup was not possible at the local level. Mr. Panelli believed the reason was those facilities did not have specific laws, statutes, or regulations. There were general abuse, neglect, and exploitation statutes but nothing specific to those facilities.

Assemblywoman Leslie clarified the homes were being moved from registration up to a licensure level. She also noted there had been four dissenting votes in the Senate and wondered what was the basis of their opposition. Mr. Panelli did not know. He had worked very hard to assure individuals that what was being done was a very limited regulation, there would not be the heavy facility type burdens such as sprinkler systems, and so on.

Mrs. Freeman asked how many ombudsmen there were at the state level. Mr. Panelli did not know; however, he said they would only report to the bureau if any facility was unlicensed or unregistered, and they knew there was a problem.

Vice Chairman Koivisto noted the homes cared for two or fewer individuals and asked what the range of cost would be. Mr. Panelli had heard anywhere from $700 to $2,500 a month. Ms. Koivisto then asked what care was provided. Mr. Panelli said all levels of care were provided. The homes they had visited on a complaint basis went up to skilled nursing care. The individuals they had seen were nonambulatory and had not fit into the group care setting. They had been placed there by family or friends to avoid placement in skilled nursing facilities at high levels of cost. Ms. Koivisto followed up by asking if the operators of the homes were capable of providing high levels of care. Mr. Panelli said they were not although they sometimes hired nurses to come in to provide care through home health agencies.

Chairman Freeman asked if the only registered homes were those that fell under the "good samaritan" category. Mr. Panelli explained the registered homes were those that provided care and supervision to two or fewer individuals who were not related to them. Mr. Panelli also provided his written testimony marked as Exhibit D.

Next to speak was Theresa Brushfield-Owens, president of Adult Care Association of Nevada, who supported S.B. 163. She did, however, propose an amendment. Ms. Owens expressed her belief registered homes served a purpose and gave the frail elderly a choice between an institution or a home in a neighborhood with familiar things that made their lives worth living. Many people in registered homes had a skilled nursing need which if they were living in their own home, the home health agency would provide, or would train a relative to do the care. Many people who had registered homes were either licensed administrators for residential facilities for groups or were registered nurses. Some of those nurses with registered homes testified at the Senate hearing of the bill.

Ms. Owens’ concern was licensing the registered home might open the door for some people to have 5 or 6 registered homes, bypassing licensure. She recommended placing a limit of one registered two person or less home. She explained she had opened a registered home because she had a resident who had insufficient money for a skilled facility, which was between $126 and $176 per day, and had not needed institutional care but rather custodial care. She was allowed to live for 3 years in a home in the neighborhood where she had activities and had not depleted her money. Had she gone to a skilled nursing facility her money would have been depleted in a couple of years then Medicaid and the State of Nevada would have had to pick up the difference. The two- person registered home was an asset to the state.

The other concern, Ms. Owens said, was the civil liability of $10,000 would be extremely high. In her research of the subject, she contacted 25 states and learned licensure in most states started with homes caring for three or more individuals. In two states a license was required to care for only one person. Two states had different levels of care; board and care, foster care, residential care, and assisted living. She believed Nevada needed to look at regulations of multi levels of care, because currently whether licensed for 3 or 60 the same regulations applied.

Sheila DeCastroverde, an adult homes referral service operator, voiced support for S.B. 163 with a few minimal changes as stated by the previous speaker.

Barbara Gunn, a lobbyist for the American Association of Retired Persons (AARP) and also a gerontologist who had done a great deal of work in the area of family caregiving and living arrangements for older adults. Her concern with S.B. 163 was that it put the one and two person home out of business. She agreed with Mr. Panelli that it was not so much a business as it was a care giving function by a friend or a neighbor. She recalled when as a university professor they offered a program called "Family Care Giving," recognizing most caregivers were family members. Ms. Gunn was surprised to discover many people who came to those sessions were nonfamily members but were caregivers, and in most cases they were paid. To frighten those individuals by going through too much regulation might not do anyone any favors. Most people would prefer to stay out of a skilled nursing home as long as possible, and if the care could be managed in an individual residential facility it was far preferable most times to going into a group home situation.

Ms. Gunn spoke neither in favor or opposition of the bill, she did caution about over-regulation of caregivers. If one called the bureau for information on obtaining a license they received 73 pages of regulations, cross referenced to other regulations, and if the person being cared for had Alzheimer's or a form of memory loss there were 13 more pages, plus an appendix, and all the fire regulations. And they also discovered they had to pay for it. For the person who wanted to help somebody in a one or two person caregiving situation, it should be emphasized there were minimal regulations. Many of the people with whom Ms. Gunn worked as family caregivers or who acted as substitute family would not understand what was involved, and in a rural area there was no place to go for an interpretation. They would be "scared to death" if they thought they might be fined $10,000 if they took in someone and had not gone through all the things they were required to do.

Vice Chairman Koivisto asked if an amendment was offered to the Senate and if so, what happened. Ms. DeCastroverde said they had and it was given to research. When it came back it did not contain what they suggested.

Chairman Freeman asked Mr. Panelli to respond.

Mr. Panelli said two issues needed to be addressed, one was the civil monetary penalty of $10,000 for unlicensed facilities. There was a full process described in statute and regulation for imposing any kind of a fine including several hearing and appeal processes. It would not be imposed if someone just started to care for another and was unlicensed and unaware of the law. It was intended for the chronic abuser of the law in which they continued to operate after notification or operated knowing they were in violation of the law. In the issue regarding the considerable amount of regulation that existed for some of the facilities currently licensed, like the group care homes, S.B. 163 specifically stated the State Board of Health would adopt minimum regulations. There was also a provision that any of the regulations would go back through the health care committee before adoption by the State Board of Health to insure they were of a minimal nature. It was absolutely not the intent of the bill to put anyone out of business. The bureau proposed to only inspect the facilities once when the home was licensed and not again for 3 years unless there was a complaint. The fee established to cover the cost would be approximately $100.

Last to speak was Misty Grimmer, representing Nevada Elderly Care Providers Coalition, who expressed support for S.B. 163. She was not expressing an opinion on the amendments until she spoke to her clients.

With no further testimony on the bill, Chairman Freeman closed the hearing on S.B. 163 and said the vote would be taken the following week. She asked the committee members who were considering the amendments to get in touch with her or with Marla Williams so they could be discussed on before the meeting.

Mrs. Freeman announced there were several bills already heard on which amendments had been drafted. First would be S.B. 197.

Marla Williams, committee policy analyst, explained S.B 197 had been heard on May 3, 1999. The proposed amendment (Exhibit E) responded to Assemblywoman Von Tobel's concerns and added an additional member to the advisory subcommittee on fetal alcohol syndrome to the advisory board on maternal and child health, increasing the membership from 11 to 12.

Vice Chairman Koivisto noted there was a fiscal note on the bill and queried if it went through Senate Finance. Ms. Williams said the first version of the bill had a fiscal note and when it was reprinted it no longer had a fiscal note.

The Chair asked Ms. Von Tobel to make a motion.

ASSEMBLYWOMAN VON TOBEL MOVED TO AMEND AND DO PASS S.B. 197.

ASSEMBLYWOMAN BUCKLEY SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

Next to be discussed was the amendment for S.B. 365.

Ms. Williams explained the first part of the amendment (Exhibit F) was a concern of the Nevada State Medical Association. It added a member to the emergency medical services committee that was appointed by a committee composed of two directors of the state's trauma centers and other physicians.

The second part of the amendment revised section 3, subsection 3(h) to read that the member was employed by a privately owned "facility;" however, that would be changed to "entity," that provided emergency medical services.

The bill's proponents had agreed to both amendments.

Ms. Koivisto asked if the bill had to go to the Committee on Ways and Means because of the fiscal note. Ms. Williams said the note was $16,000 for the first part and $13,000 for the second part, and although it was recorded she did not know if it was for the first version and would not apply to the reprint.

Dr. Yacenda advised the fiscal note had been erased because the State Office of Rural Health had pledged the money for the biennium. The Senate heard that testimony, accepted it, and passed the bill.

VICE CHAIRMAN KOIVISTO MOVED TO AMEND AND DO PASS

S.B. 365.

ASSEMBLYMAN MANENDO SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

Chairman Freeman opened the work session on S.B. 161.

Ms. Williams noted the bill had been heard on May 3, 1999, and it had been set aside for additional testimony. Also an amendment was presented (Exhibit G) which changed the definition of transitional housing to a "substance abuse halfway house" that provided "housing and a living environment for individuals recovering from" the abuse of alcohol or drugs, and so on.

Angel Robinson, speaking on behalf of Senator Titus, the bill's sponsor, reported Senator Titus was comfortable with the amendments and would urge the committee to amend and do pass.

Assemblywoman Leslie asked to have the Bureau of Alcohol and Drug Abuse (BADA) representatives come forward. She asked if Mr. Johnston had an opportunity to review the amendment. Also if he had a problem with substance abuse halfway houses that did not provide any treatment.

Robert Johnston, deputy chief, southern Nevada, Bureau of Alcohol and Drug Abuse (BADA), said he had reviewed it and understood BADA would work with the Bureau of Licensure and Certification on the development of the regulations related to the oversight of halfway houses. That would fall under BADA and not Licensure and Certification. Ms. Leslie was comfortable with that.

Mr. Johnston provided a letter (Exhibit H) indicating the understanding between BADA and the Bureau of Licensure and Certification regarding regulation of substance abuse halfway houses.

Assemblyman Manendo said he had earlier expressed a concern about the fine under the bill of not more than $1,000. He asked about affixing a minimum fine. Mr. Johnston responded he had received a list from licensure of their NAC 449.998 which described the various sanctions related to facilities. They began with the imposition of a plan of correction as directed by the bureau, the issuance of a provisional license, and so on. There were a number of different steps that could occur before a fine was imposed. The goal was to incorporate those steps and not put the operations out of business or create a fee structure that limited their ability to survive. Mr. Manendo remarked the bill sought to impose a penalty of $1,000 a day and that amount could conceivably put someone out of business.

Rick Panelli clarified the NAC 449 cited earlier established a minimum of some action, and it was then determined by the severity and scope; how many people did it affect, and what was the affect of the actual problem. From there a minimum penalty was determined and not necessarily a civil monetary penalty. It could place the facility on a restricted license. If BADA modeled its sanctions after that particular regulation there would always be at least a minimum sanction that had to occur.

Mr. Manendo noted page 2, line 11, of the bill stated "suspend or revoke and impose administrative fine of not more than $1,000;" however, he was still hoping to see some sort of minimum.

Dr. Yacenda believed establishing a minimum fine was appropriate, and suggested $100 to $200. Mr. Manendo felt a minimum of $100 was acceptable. He added it was a very important piece of legislation and intended to support it.

Chairman Freeman suggested Dr. Yacenda might want to provide a letter for the record. Dr. Yacenda responded, in the scope of oversight it was better to put in regulations a ladder of response to the severity of offense. If the committee wished to indicate to BADA that they do that it would probably be the most appropriate way to address Assemblyman Manendo's concern and keep the bill as amended so the committee could act on it.

Chairman Freeman suggested Mr. Johnston correspond with Mr. Manendo during the regulation process so he could be kept apprised. Mrs. Freeman asked if a letter of intent to BADA would be appropriate. Dr. Yacenda said it would be, and it was agreed Marla Williams, committee policy analyst, would prepare that. The Chair then asked for a motion on the bill.

ASSEMBLYMAN MANENDO MOVED TO AMEND AND DO PASS

S.B. 161 WITH A LETTER OF INTENT.

ASSEMBLYWOMAN LESLIE SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

The Chair then opened the hearing on S.C.R. 9.

Senate Concurrent Resolution 9: Urges Bureau of Licensure and Certification of Health Division of Department of Human Resources to make its published survey of certain long-term care facilities more accessible and easier to understand. (BDR R-484)

Rick Panelli, chief, Bureau of Licensure and Certification, appeared on behalf of the Department of Human Resources. He provided written testimony (Exhibit I) which stated in part as follows:

• The bureau was committed to developing a report that was meaningful and understandable to the consumer and general public.

• The bureau currently produced a "report card" of survey results for all nursing facilities and skilled nursing facilities licensed by the state.

• The current report was based on information from federal surveys and was updated and produced semi-annually in January and July.

• The information was distributed free of charge at health information forums and workshops, by ombudsmen, senior citizen centers, and so on. That information was included as part of Exhibit H.

• The committee was currently reviewing an example of a new "report card" that was based on the federal process and was used in Massachusetts.

• The bureau would continue to work with the industry to revise the context and format of the report.

Mr. Panelli noted the individuals who proposed the legislation, the Nevada Health Care Association, were not present. However, the issues they had with the report card was it was then only done on an annual basis so the information it contained was 12 months old, and there was no rating on the card higher than "satisfactory." If a consumer looked at the card to see how a facility was rated, the best they would see was satisfactory.

Chairman Freeman recalled a report published earlier that furnished information on the cost and noted that was not included in the new report. Mr. Panelli said it had been removed from the report at the recommendation of the facilities because the cost varied so significantly, and they also wanted the opportunity to discuss their costs at the time they were talking to potential residents. Mrs. Freeman said she had provided copies of those reports to some of her constituents, and they had found them very helpful. Mr. Panelli said the bureau would be happy to answer questions to accept suggestions for modification at any time. He said also the bureau was developing a similar report for all residential facilities for groups, which was expected to be ready for distribution around July 1, 1999.

There were no further questions on the resolution so Mrs. Freeman asked for a motion.

VICE CHAIRMAN KOIVISTO MOVED TO DO PASS S.C.R. 9.

ASSEMBLYMAN MANENDO SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

Chairman Freeman read into the record NRS 218.5345 which stated it was a misdemeanor "to knowingly misrepresent any fact when testifying or otherwise communicating to a legislator. The Chair had the authority to swear in witnesses appearing before the committee which makes such statements a gross misdemeanor."

With no further business before the committee, Chairman Freeman adjourned the meeting at 3:05 p.m.

RESPECTFULLY SUBMITTED:

Darlene Rubin,

Committee Secretary

APPROVED BY:

Assemblywoman Vivian Freeman, Chairman

DATE: