The Assembly Ways and Means and Senate Finance Joint Sub-Committee on General Government was called to order at 8:00 AM, on Friday, February 12, 1999. Chairwoman Vonne Chowning presided in Room 3137 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List.

ASSEMBLY COMMITTEE MEMBERS PRESENT:

Mrs. Vonne Chowning, Chairwoman

Mr. Bob Beers

Mrs. Marcia de Braga

Ms. Chris Giunchigliani

Mr. David Goldwater

Senator William O’Donnell

Senator Lawrence Jacobsen

Senator Joe Neal

COMMITTEE MEMBERS ABSENT:

None

STAFF MEMBERS PRESENT:

Chairwoman Chowning announced because of the amount of interest shown by phone calls, mail and the public present the subcommittee would hear Budget Account 3266 Community Based Services first.

Chairwoman Chowning asked Maynard Yasmer, Administrator, Rehabilitation Division Department of Employment Training and Rehabilitation (DETR) to go through the budget first and then the committee would discuss Senate Bill (S.B.) 433 of the Sixty-ninth Legislative Session to explain perception versus reality.

Mr. Yasmer introduced Lori Bagwell, Budget Office; Donny Loux, Community Based Services Program; and Martin Ramirez, Deputy Chief Financial Officer.

Mr. Yasmer explained Budget Account 3266 represented a number of services and personal assistance in the areas of:

• Traumatic Brain Injury;
• Assistive Technology;
• Telecommunication Services for the Deaf;
• Independent Living Services; and
• Deaf Resource Centers.

Mr. Yasmer stated the services were designed to assist people in their ability to remain independent and productive.

Mr. Yasmer explained the area of greatest interest at the hearing seemed to be the issue of the Medicaid Waiver funding which was passed as S.B. 433 of the Sixty-ninth Legislative Session. The bill developed a special waiver for persons with disabilities to provide additional services that assured their ability to remain in the community and be as productive and independent as possible. The bill was intended to keep as many patients as possible living outside institutions or prevent them from having to enter institutions.

Chairwoman Chowning noted the bill allowed $500,000 to start the program and asked Mr. Yasmer to explain what happened after that point. Mr. Yasmer suggested they leap to the end of the situation and deferred to Lori Bagwell of the Budget Office.

Ms. Bagwell stated as everyone knew there was a terrible funding plight for
FY 1998 and funds had to be trimmed out of budgets to balance the budget. When the Budget Office reviewed budgets they came upon S.B. 433 of the Sixty-ninth Legislature funding $500,000 for the Medicaid Waiver program. The Budget Office ascertained that no funds had been expended for the waiver in
17 months of the program’s life.

In speaking with DETR and Human Resources at the time it was determined there was no way the program could be implemented in FY 1998 due to all the approval requirements for the waiver to occur. Therefore, the $500,000 was reserved for reversion to meet FY 1998’s funding needs.

DETR had requested $500,000 in the next biennium to fund the program, however, the Budget Office was unable to fund that request. There were simply not enough funds to go around for all the worthy programs. Since there was no approved plan from the Federal Government for implementation, and lack of funding for the program would not require any service cuts to existing clients it was decided to delete program funding.

The Chair clarified, there were no existing services that would be cut.
Ms. Bagwell agreed and stated the $500,000 would have funded additional services being requested. Chairwoman Chowning noted legislators had to wrestle with some very tough decisions and if some additional funding became available down the road then legislators would need Mr. Yasmer to explain what the division’s plans for additional services to those clients should be.

Assemblywoman Giunchigliani confirmed the Medicaid Waiver had never been requested. Ms. Bagwell responded a waiver had never been submitted to the federal government. DETR’s community based service group had worked hard in trying to put a plan together and had done an initial submission to the state’s Division of Health Care Financing and Policy Board (DHCFP). The division had done only an initial review to date.

Assemblywoman Giunchigliani asked why it had taken so long to get that initial piece of the project going. Mr. Yasmer deferred to Donny Loux, Chief of the Office of Community Based Services of the Rehabilitation Division to explain the process. Ms. Loux explained the original bill was requested by families who were finding they had no other options but to put their family members into institutional care. The request began in Las Vegas with families of autistic children and children with traumatic brain injuries and spread throughout the state to adult family members as well. The bill was crafted to assure that as the program was developed, input would be sought from family members, educators, providers, and people with disabilities and that there be a consensus for the services to be provided. The intent was to keep people from being placed in institutions and would provide the mix of services to stop the institutional process or in fact, remove people with disabilities from institutions. Several public hearings were held. Ms. Loux noted The Federal Government must be assured that for all the clients served in the program and living in the community, funding would not exceed the average cost of institutional care for those clients.

Ms. Loux stated Senator Rawson targeted the bill to the most severely disabled people. She explained it was always intended by those working on the plan that it would take a year or perhaps a little longer to develop the Medicaid Waiver. The waiver was developed, twice reviewed in a preliminary draft by the Health Care Financing Administration (HCFA) in Washington and had been sent to DHCFP for final submission. It was about that time when the budget shortfall cuts were first made.

Ms. Loux stated Senator Rawson had attended HCFA reviews and it had been hoped to get the program on a "fast track" so the program could begin on January or February 1, 1999, and encompass three years.

Assemblywoman Giunchigliani confirmed everything was in place for the program to proceed and asked if HCFA required funding to be in the budget for them to process the application. Ms. Loux responded she would find out the answer to the question and Ms. Giunchigliani stated her belief that regardless of whether the funding was present, the division must proceed with the waiver. There was an obligation to proceed and part of the legislature’s job would then be to find funding for the program. Ms. Loux noted the proposed services had not been previously available through any Medicaid source or through any general programs.

Chairwoman Chowning stated legislators must also have a clear overall idea of how many clients would be assisted, and what the true dollar figure would be. Someone must present a business plan because the legislature could not proceed in the dark even if they were able to proceed at all. She emphasized the program was not cut. It was an idea that was begun but not completed. The legislature could do nothing without solid numbers. Ms. Loux stated a business plan had been drawn and she could provide the figures from the waiver portion of the plan. She explained that section gave numbers, figures, actual services, and percentages of persons anticipated being removed from institutional care. Mrs. Chowning asked to whom that information had been previously presented. Ms. Loux replied the information was provided to Medicaid, the Budget Office, Senator Rawson and nearly everyone involved except the General Government Joint Subcommittee members. Chairwoman Chowning asked if the case management piece was also included and Ms. Loux replied it was.

Chairwoman Chowning asked Ms. Loux to estimate the ongoing annual costs. She explained one difficulty the subcommittee faced was that the DETR budget was only one piece of the puzzle and other portions were contained in other budgets. Ms. Loux offered to provide staff with complete figures from which to work. Mrs. Chowning replied that would be fine but asked for at least an estimate during the hearing. Ms. Loux reminded subcommittee members when applying for any Medicaid Waiver the applicant must assure the program was cost neutral, that it would not cost more to keep the person in the community than it would in an institution. The average annual cost was $38,524 for board and care in a nursing home and $83,351 for ancillary medical costs while a person was in a nursing home for a total of $121,875 for severely disabled people. Chairwoman Chowning asked how many clients Ms. Loux estimated the program would assist at $100,000 each. Ms. Loux stated the costs she had given were average costs and the waiver specified it would serve 48 people. Ms. Loux continued, the community cost to the waiver would be $18,875 and the ancillary costs if the person were in the community would be $37,397 for a total of $56,272. Chairwoman Chowning added part of the funds would be Medicaid funds and part would be state funds. She asked how much would have to be added to the budget to implement the program. She asked Ms. Loux to provide staff with the information as soon as possible.

Assemblywoman Giunchigliani asked for clarification that 48 people would be served for the $500,000 and asked if there was a projected need. Ms. Loux replied there were 237 people who were institutionalized at the level of care that would make them eligible for the community program. It was unknown how many of those would be able to leave the institution. The agency was also working with county match programs, and the counties had committed recently to helping in identification of those who were eligible and presently on county assistance.

Assemblywoman Giunchigliani clarified the agency knew what the numbers were but not exactly who would benefit under the program. Ms. Loux agreed and added there were 200 people on the existing waiver list and many of those required services currently not covered. About 117 people were currently being served under another waiver program.

Assemblywoman Giunchigliani asked if there was any danger of losing the waiver under which the 117 were being served. Ms. Loux replied that waiver was provided for in the budget. Assemblywoman Giunchigliani asked the line number in the budget which contained that information. Ms. Loux replied that waiver was in the DHCFP Medicaid Office Budget.

Chairwoman Chowning clarified the agency was currently serving 117 clients but the waiting list contained 200 additional clients. She asked in what area the 48 clients to be served by a $500,000 appropriation fit. Ms. Loux replied there was an existing waiver that offered three services for less severely disabled clients. It offered case management, homemaker services, and emergency response systems. For that waiver there were approximately
200 clients on a waiting list. There was also mental retardation waiver and an aging waiver. The Medicaid waiver under discussion would offer 17 various services for the most severely disabled clients.

The Chair noted a lot of different numbers were being thrown out and the subcommittee needed to know what was county match, what was state match, and what numbers were actual. She asked if the $500,000 would assist only 48 clients would the remainder of the 200 clients be turned down for services. Ms. Loux stated clients could be turned down because a waiver could be capped at the amount of funding available and since the agency would only have $500,000, only 48 clients could be served. Remaining clients could be placed on a waiting list. The waiver was not an entitlement program.

Chairman Chowning added if the figure for each client served in the community was $100,000 only five people could be served. Ms. Loux replied the community-funding figure was $18,875 each on the waiver. The agency estimated medical costs of up to $37,397 would continue for clients living in the community. The Chair asked Ms. Loux to present the plan with specific costs and numbers of clients served and directed Ms. Loux to work with the Budget Office.

The Chair stated she would like to have a few people from the public be spokespersons for the group noting the subcommittee had only a limited amount time for the hearing.

Mary Jean Thomsen, Community Advocacy Coordinator, Northern Nevada Center for Independent Living, spoke from written testimony (Exhibit C). She added she had attached a letter at the end from Mary Evilsizer, Executive Director, Southern Nevada Center for Independent Living.

"In November 1998 I was sitting at the Interim Health Care Committee meeting and I asked Senator Rawson when the waiver would begin so that I could inform my consumers they could utilize the waiver. Right now there is no waiver, however, when Senator Rawson optimistically stated he was hoping for January 1999, the disabled community has reflected concern, as it is now February 1999 and nothing is in place. They were concerned with budget cuts as we all are. It is going to take away their money and the possible waiver that would provide the opportunity for them to live independently within their community. Individuals with physical disabilities in the State of Nevada have waited many years for this type of waiver. When the bill was passed in 1997 their anticipation started for the implementation of that waiver. I am here today along with other people asking that the $500,000 be returned to

the budget."

Ms. Thomsen showed a copy of the waiver and commented it was the most thorough waiver application she had ever read.

"In reading the waiver, the cost per individual living in the community cannot exceed the cost of the same individual living in a long-term care facility."

Ms. Thomsen referred the subcommittee to Exhibit C, page C-3 which was a chart summarizing the cost of the client in the community versus the cost in a skilled nursing facility.

The chart noted the figures represented a 50/50 Medicaid and state match dollars.

"The figures reflect a $65,603 difference in favor of a person in the community. In the waiver it also states 60 percent of the consumers, or 29 of the 48 consumers, served by the waiver will be those individuals in nursing homes. That reflects a savings of over $1.9 million per year for the state. I spoke with Ms. Janice Wright at the Medicaid office she informed me there is no documentation to substantiate the estimate
Mr. Comeaux’s office presented for estimated program costs of $2,500,000. I also called Ms. Donny Loux of Community Based Services to confirm the figures I refute in the waiver to be sure I was giving you the correct information. If your decision is solely based on money, it appears very clear in this waiver, with these financial documents, that allowing the waiver to move forward is the right financial decision for the state of Nevada. Your decision can not only maintain the cost effectiveness for the state of Nevada but also prolong the choice and independence of the 48 individuals served by the waiver."

Ms. Thomsen submitted a short letter from George Donham (Exhibit D) who was unable to attend the hearing. She explained Mr. Donham was in a nursing home in Reno. She stated Mr. Donham told her he did not belong there with a "bunch of old people" and he was looking for an apartment. Ms. Thomsen explained he was a 55-year old patient with a traumatic brain injury that happened about 26 years ago. He had lived with his mother until about 2 years ago when she became unable to care for him. His hopes were up.

Ms. Thomsen stated Mr. Ray Bottrell was at the witness table and would speak on his own behalf next but to see Ray Bottrell be forced to live in a nursing home was difficult. She added, Mr. Bottrell currently received basic Medicaid services. If Mr. Bottrell’s basic needs increased his only option would be to live in a nursing home. Ms. Thomsen stated:

"For Mr. Bottrell to be forced to live in a nursing home would be a detriment to all of us. His volunteerism, dedication and compassion for others were equal to none. Not only would Ray suffer, but the people who are motivated and inspired by him such as myself.

I am asking you to take this information and remind your colleagues that individuals with physical disabilities have the same rights as any other citizen. They have the same right in their community to enjoy the opportunities you and I have. Please maintain their right to choose where they live. Do not force them to live out the rest of their lives in a nursing home.

The waiver is ready for final approval from HCFA, the consumers are there waiting to access the waiver so they can leave the nursing homes, and also hope they do not enter the nursing homes. We are asking that the $500,000 be returned to where it was intended – the Independent Choices Waiver for individuals with physical disabilities. Please remember when voting on all the budget issues, people should be your first priority.

Last but not least, on behalf of Northern Nevada Center for Independent Living I would like to thank you for your time and consideration of this request. And thank you for listening to our pleas today."

Chairwoman Chowning wished to let everyone know she had received many, many phone calls and the legislators did take them seriously. She directed subcommittee members to page DETR-114 of The Executive Budget – Reserve for Reversion. Since the $500,000 had not been committed it was in the overall budget for reversion. That meant it went back into the general "pot" of money so that the budgets could be reviewed in total. The total was $546,000. $500,000 was set for reversion.

Ray Bottrell stated he was just a consumer. He stated he was a prime example of a client the waiver would assist. Mr. Bottrell said as a victim of Multiple Sclerosis who went out into the community 5 days a week or more assisting others, and trying to get them to do the same thing, and having been one of the people trying to get others out of nursing homes to physical therapy or out for some kind of therapy, even lunch or dinner was a very difficult thing.
Mr. Bottrell stated it scared him if he could not do the things he did.

Mr. Bottrell stated he did career counseling and facilitated three support groups and if he was stuck in a nursing home without the help of the waiver he would hate to see what his life would be. Mr. Bottrell said, "Getting stuck into a convalescent home is almost the last stop before you die anyway." Mr. Bottrell added the funding under discussion would assist him to stay in the community and to be more of an independent person and assist others.

Chairwoman Chowning thanked Mr. Bottrell for his appearance and his dedication to others in need in the community. The subcommittee very much appreciated his service. She commented Mr. Bottrell’s assistance came at a very low cost overall.

Bob Hogan, Director of the Nevada Community Enrichment Program Accessible Space’s Disabled Housing Operations spoke from prepared testimony (Exhibit E)

"I am on the Board of Director’s of Nevada’s Head Injury Association, serve on Brain Injury Subcommittees for the National Brain Injury Association, the American Congress of Rehabilitation Medicine, am a founding member of the National Association of State Head Injury Administrators and serve on Nevada’s Statewide Council on Traumatic Brain Injury. I have worked for over 20 years in both the private and public sector. Not long ago, it was my great pleasure to be part of the coalition that worked long and hard to see S.B. 433 of the Sixty-ninth Legislature become a reality. I come before you today because I am deeply concerned that this reality and the services it could provide will vanish and we in Nevada, will lose the opportunity to bring forward a sensible, responsible, cost effective addition of services available to persons with brain injuries and other disabilities.

Senator Rawson, a man I respect and admire for his commitment to both Nevada and its persons with disabilities had, I believe, a simple goal in mind. He wanted people who were in institutions but did not have to be there, returned to their homes and community. He wanted those who were likely bound for institutions, especially many of our young disabled folks to be given the same opportunity we have, to be part of their own community.

Without support, some young folks go to nursing homes, a place reserved for the old and the feeble. Without support, many adults like you and I are institutionalized, not because its where they need, or want to be, but because we do not yet have the systems in place to support them in our community at large. ‘Too expensive they say!’ I say my experience tells me not. I have worked with hundreds of people, who with support can live more normally, independently, and respectfully in the community rather than removed from it, and at less cost. ‘How can that be!’ they say. ‘A nursing home costs less than $100 per day.’ I say, that’s only the beginning and I’ll tell you why.

Let me share information I have gathered from several sources, the most recent being a January article in The Journal of American Congress of Rehabilitation Medicine. Relative to the general population, persons with disabilities have higher rates of re-hospitalization and institutionalization. Injury related disability has many costs, but I quote here ‘Re- hospitalization is one of the major contributors to this expense.’"

Mr. Hogan explained re-hospitalization was one of the ancillary costs referred to by Ms. Loux.

"One in five individuals with brain injuries are hospitalized at least once a year for the first three years after a brain injury. Persons with spinal cord injury are hospitalized twice as often as those with brain injury.

Persons with brain injury are hospitalized for uncontrolled seizures resulting from mismanaged medications; for infections and disease resultant from poor nutrition, self-care and a weakened immune system; for depression, anxiety and substance abuse resultant from adjustment problems. Those with spinal cord injuries are most often hospitalized for urinary tract infections, serious skin breakdown, depression, anxiety and substance abuse resulting from similar adjustment problems. All of these conditions, with proper care and support are very preventable, and believe me, being in a nursing home increases, not decreases, the likelihood of many of these problems existing.

Do all these people need 24-hour a day care in the community to avoid these problems. Of course not, the community very often contains family and friends, that with, and I would emphasis, with support, assistance, training and respite, can provide much of the care needed to help their loved ones stay healthy both in body and mind.

‘How can you demonstrate that all this is not just theory, but practical reality,’ they ask. I say, a parallel can be drawn between these needed waiver services and our current Life Skills Training Program (LST) that Medicaid uses with the majority of people we treat in Nevada’s Brain Injury Program at Nevada Community Enrichment Program. A former visionary of Medicaid, Diane Hooley, understood that support in the community was a critical factor and helped to build that support into the model of care we established. Our post discharge clients receive from 5 to 20 hours per week of Life Skills Training and assistance doing some of the very things S.B. 433 of the Sixty-ninth Session would provide for some of the more severely disabled persons. For more than 7 years we have provided this ongoing service at home and in the community helping them to shore up and maintain their mostly functional lifestyles with some pretty remarkable results. Remember the statistics stated earlier; one in five individuals are re-hospitalized every year for 3 years following their injury. Additionally survivors of brain injury are three times as likely to receive a head injury than the general population. What has been seen with clients receiving community support. We have, in 7 years, had no hospitalizations for infection, disease, nutrition, medication, or skin breakdown. We have seen only two hospitalizations for uncontrolled seizures (neither related to mismanaged medications) and one hospitalization for substance abuse as a result of adjustment problems. This flies in the face of statistics, but does not surprise me. Support in the community works and I feel the need to shout that fact from one end of this legislature to the other. None of our LST program clients have been re-injured, defying the national statistics in a major way. And it is inexpensive, averaging less than $250 per week.

Yes, S.B. 433 of the Sixty-ninth Legislature is aimed at persons with more severe disabilities, but many of the issues are identical and the model is applicable.

I could introduce you today, to a 19 year-old man in a Las Vegas nursing home who resides there only because S.B. 433,of the Sixty-ninth Legislature Independent Choices, is not available to him. He is a courageous young man, but he hates living in a nursing home, and so would I, so would you, so will we. I hate to say it, but its almost a certainty that one or more of us in this room will be where he is before we reach the age of 60. With two daughters, I shudder to think that one or more of us will certainly find ourselves in the predicament of having a son or daughter suffering a major traumatic injury. This would result in our having to decide how much we can, or cannot do for them, finding ourselves without the supports we would need to keep them home and out of a nursing home. What a nightmare.

Community models of care work. Case management, family training, respite and personal assistance allows us to keep clients, patients, friends and loved ones in the community, where they belong. It is possible for us to do.

In closing, I can tell you that some of the most courageous families I know are those who give their lives to their disabled family members. They are also some of the sickest and most worn out folks I know. The personal, physical, and emotional toll is enormous. Without support, this is more than most of us could give.

I cannot speak for the disabled, though I know many who agree with me. I would, knowing what I know, seeing what I’ve seen in my 20 years in this field, rather end my life than live it out in an institution. I can hardly imagine a worse form of slow demise.

I strongly encourage you to support S.B. 433 of the Sixty-ninth Legislature, not just to save money, time and even lives, but to save life itself. The kind of life we mean where we think of living not just existing."

Chairwoman Chowning reminded those present that S.B. 433 was a bill of the Sixty-Ninth Legislative Session so the bill was not under discussion, but the concept of re-funding the Medicaid Waiver was.

John Sasser, Washoe Legal Services, stated he was present because he sat on the Interim Committee on Health chaired by Senator Rawson. He had also served with former Assemblyman Jack Close on the Subcommittee for the Disabled that served the interim committee. He told the subcommittee the stories currently being presented were just the tip of the iceberg regarding independence in the community and the assistance the Medicaid Waiver would provide.

Mr. Sasser said he had also served with Ms. Loux on several task forces in development of the waiver and assured the subcommittee a lot of hard work had gone into the document.

Mr. Sasser stated his strong support for returning the $500,000 funding to the Medicaid Waiver Program. He introduced Jan Gilbert, Progressive Leadership Alliance, who had asked him to express her support for returning the funds.

Mr. Sasser clarified some of the technical confusion around the issue. If a person was outside an institution in the state of Nevada, for that person to qualify for Medicaid services, a disabled person must be a recipient of Supplemental Security Income (SSI) and income for a single individual must be $500 per month or less. A disabled person residing in an institution could have a monthly income of up to $1500 and receive the services. The waiver would set aside the maximum income requirement for a disabled person living in the community. It also provided additional services not available in the basic Medicaid package.

Thus, a client who could come out of an institution to live in the community would not cost the state an extra penny and in fact would cost less in terms of the overall cost to the state in the Medicaid budget and in Community Based Services.

Mr. Sasser said the extra costs had always been a speculative matter of how many people had incomes between $500 per month and $1500 per month and somehow managed to survive in the community without the waiver and were currently being supported by families. He explained those folks were termed as the "woodwork" factor. How many of those people would now apply for the waiver that otherwise would not be served.

He stated his understanding that some of the people would have ended up in an institution anyway so only about 40 percent would actually come out into the community. He recommended the Chair have a meeting with Assemblywoman Evans and Senator Rawson about how to compare the two budgets and see what funds could be moved that would ultimately create a budget savings. The amount needed was likely well less than the $2.5 million suggested by the Budget Office and probably less than the $500,000 originally funded as well because of the subsequent savings in Medicaid.

Chairwoman Chowning reminded Mr. Sasser that the Senate Chair of the General Government Subcommittee, Senator O’Donnell should also be included in any meeting. She added staff would be looking at the business plan and putting the pieces together to provide the subcommittee with accurate information.

Senator Neal asked Mr. Sasser why in his judgement the provisions of S.B. 433 of the Sixty-ninth Legislature were not working. Mr. Sasser replied the waiver was in the final stages of development and in the fall of 1998 when the budget crisis struck it was put on hold and not allowed to move forward.

Senator Neal said he was concerned that if the actual cost for a disabled person to live in a community was less than that for the same individual to live in a nursing home and asked if the state was faced with further privatization of Community Based Services. Mr. Sasser replied he was not aware of any such move.

Senator Neal asked if individuals were being forced to live in nursing homes or institutions. Mr. Sasser replied he would not impugn any ill intent on anyone’s part but the unfortunate consequence was that there were people who were in nursing homes who could be treated more cheaply and the quality of their lives could be greatly improved if they were given the opportunity.

Senator Neal asked what the current legislative session needed to do to solve the problem. Mr. Sasser said the funding to proceed with the waiver would solve the dilemma. Senator Neal further questioned that the funding had been provided and not been spent. Mr. Sasser said obviously the money needed to be there for the project to keep going. The full $500,000 was needed for the biennium.

Assemblywoman Giunchigliani said the Senator stated a consternation they all felt but that after hearing the testimony she was more comfortable that the program was not stalled. The true culprit was the amount and complexity of work needed to draft the waiver. She was also pleased the entire community was involved in development of the waiver.

Assemblywoman Giunchigliani added she was disturbed that a price was placed on the quality of peoples’ lives and that in an alleged budget crunch the $500,000 was reverted that would affect quality of life. She said one subcommittee recommendation might be to use unfunded decision units and place them in the "999" category to fund the waiver.

Assemblywoman Giunchigliani stated she had worked with AARP when they drafted the language to authorize the long-term care study and unfortunately it did not get to the depth of study hoped for. She stated the key was looking at what assisted living programs were available, what facilities were available, and what other federal dollars could be captured. She stated the whole aging population needed to be addressed.

Chairwoman Chowning pointed out that S.B. 433 of the Sixty-ninth Legislature, page 2, section 7, subsection 2 read, "any remaining balance of the appropriation" which in that case was the entire amount, "must not be committed for expenditure after June 30, 1999." She added the bill was to sunset at that time. That date had not yet been reached and yet the funding was being pulled back to cover budget shortfalls.

Senator Neal suggested a bill draft request (BDR) be initiated to lift the sunset. After discussion Chairwoman Chowning replied that could be placed on the table for consideration but first the business plan and accurate figures from the agency were needed. The request for a BDR would be placed in the record but to act responsibly, staff would be allowed time to complete their study of all facets of the budget issue.

Jim Boscacci read from prepared testimony (Exhibit F). He explained he had been a quadriplegic for 38 years. He considered himself a very lucky man. For 25 years his mother and father provided for his special personal needs. When his parents were no longer physically able to provide those services, he was confined to a bed for 2 years during which time he landed in the Washoe Rehabilitation Hospital. After 6 weeks he recovered sufficiently to sit in his chair again and be released to his home. Again he was faced with the same problem.

Mr. Boscacci was fortunate enough to be accepted on the Nevada Medicaid Waiver program and considered himself very lucky because he had his own home and his own wheelchair-accessible van. He could go into the community and into the work force.

Mr. Boscacci stated he was concerned for people who were not as fortunate as him. The provisions in the Medicaid Waiver would allow him and others like him to remain at home. He added one benefit of his independence was that he was able to work with the fire departments in developing a plan for emergency response to wheel chair bound patients.

Mr. Boscacci told the subcommittee that it was frightening to think that without his home and van and assistance of friends he might be placed in an institution and not be able to serve the community as he did. He gave one example of clients like himself who needed a bowel and bladder program which took
1.5 hours of care each day. He said a nurse in a nursing home might have
8 clients and not have enough time to perform such care.

Chairwoman Chowning noted the program had been called the "Freedom Bill" and the name was accurate because it gave people the freedom of choice to stay home or return home. The program appeared to offer a cost-savings of $65,000 per client and the ability to give people their freedom. She thanked those who presented testimony and provided their services to the community.

The Chair asked everyone else present who supported the waiver program to raise their hands and state their names for the record. They were:

Robert Desruisseaux, Advocate Northern Nevada Center for Independent Living

Reggie Barr, Advocate, Southern Nevada Independent Living

Jill Stanley

Mack Johnson, Artist

Gene Machado, Volunteer, Northern Nevada Center for Independent Living

Russ Rougeau, United Cerebral Palsy

Michael Goodwin, Personal Care Manager, Accessible Space

Jill Smith, National Disabilities Advocacy and Legal Center

Joe Bohl, Director, Northern Nevada Center for Independent Living

Mark Duvall, and

Leagh Lamoureaux.

Don Hataway, Deputy Director Budget Office clarified the reversion date of June 30, 1999 only referred to the funding amount. The program was in place and thus the only question would be funding for the coming biennium so a BDR should not be needed.

Mr. Hataway emphasized the Budget Office was in the throes of developing a balanced budget for the 1999-2001 biennium while at the same time ending the current fiscal year with a balanced budget also statutorily required. The Budget Office discussed the waiver program with Chris Thompson, the former Administrator, DHCFP who indicated the draft he received was preliminary and he had some questions and concerns but based upon what he saw the net cost to the state would be $2.5 million. The Budget Office did not attempt to verify the funding need estimates and his office took no stand on the goodness of the program. The Budget Office would be happy to make an attempt to verify the figures.

Chairwoman Chowning stated she understood a bill was not needed to lift the sunset but felt a bill would be needed to fund the appropriation during the next biennium. Mr. Hataway replied the legislature must also end with a balanced budget and one of the projections from the Budget Office was a $10 million savings from the employment freeze. That was still under review.
Mr. Hataway commented if the legislature made a decision to go forward with the program and it was possible to begin before July 1, 1999, the Budget Office would cooperate and release funds from the reserve. When Chris Thompson outlined the steps involved including his division’s final review, the HCFA final review, IFC’s approval, and the development of the business plan, the feeling prevailed that it would be virtually impossible to get the program in place during FY 1998.

Senator Neal referred to section 32 of S.B. 433 of the Sixty-ninth Legislature which talked about funds appropriated in section 9 in the amount of $2 million and asked if the $546,000 reversion was a part of the $2 million appropriation. Mr. Hataway replied he did not have the bill in front of him. Senator Neal explained his belief a bill was needed to continue funding beyond the sunset date. Mr. Hataway stated that was not correct to which Mr. Neal took exception based on his tenure in the legislature. Mr. Hataway explained the funding for the startup of the Medicaid Waiver had a reversion date of
June 30, 1999. That funding was for that specific fiscal year. Any further funding would have to be incorporated into the next biennium’s budget. Senator Neal stated if the funds were not spent they reverted back to the General Fund. The Chair stated Senator Neal was looking at an earlier draft of the bill and after many amendments the final version was stated differently.

Assemblywoman Giunchigliani noted more importantly the Budget Office needed to provide justification for the $2.5 million cost of the program.
Mr. Hataway replied that information came from the Division of Health Care, Financing and Policy. The Budget Office did not do an in depth analysis of the figure. He added the legislature had the ability to amend the budget and adopt it in the way they wanted.

Correspondence was presented by Jim Boscacci from Sally Richardson, Director, HCFA, dated May 28, 1998 (Exhibit G) which outlined HCFA’s efforts on behalf of state Medicaid offices and clients. It stressed a focus on community- based care with emphasis on consumer directed services.

Continuing with the Rehabilitation Division’s budget presentation, Mr. Yasmer stated Budget Account 3266, Community-Based Services, represented a grouping of independent living and assisted living services provided to individuals to help them become or remain independent.

Decision unit M-200 increased funds for the telephone surcharge program of the Public Utilities Commission through the surcharge on access lines in the state of Nevada. He did not believe there would be an increase in rates but a major portion of the funding went to support the relay system contract. The Request for Proposal (RFP) for contract renewal was presently under review.

Assemblywoman Giunchigliani asked the status of the RFP. Mr. Yasmer replied the RFP had been sent out, responses returned, and review was currently being done. At present it appeared the current contractor would be chosen again with an approximate 1-cent per-minute cost increase. That would affect the cost per-minute of the relay service but should have no budget impact because of the growth of access line numbers and the revenues appeared to be holding.

Assemblywoman Giunchigliani referred to unit M-525 and asked why the funding was split between M-200 and M-525. Mr. Yasmer replied the shift in funding M-525 was made because of the lack of state funding. Anything regarding the telephone surcharge program must be approved by the Public Utilities Commission (PUC). Assemblywoman Giunchigliani asked what happened if the PUC did not approve the funding shift and what the impact on the budget would be. Mr. Yasmer responded the impact would be whether the Deaf Coordinator who happened to be deaf would have the ability to communicate with persons who were not deaf.

Assemblywoman Giunchigliani asserted the General Fund would pick up funding if PUC did not approve and asked when the matter was scheduled for a hearing. Mr. Yasmer replied the proposals were submitted by April each year so a response could be expected by the end of the legislative session.

Chairwoman Chowning noted $500,000 was scheduled for reversion from Budget Account 3266 for the Medicaid Waiver and the remaining reversion of $46,000 included $26,000 from the traumatic brain injury program and $20,000 from the deaf resource centers. Ms. Loux agreed $26,000 came from the Nevada Community Enrichment Center and the additional funding came from the Developmental Disabilities Council’s housing program. The Chair asked how that would affect those groups. Ms. Loux replied the Director of the Nevada Community Enrichment Center was present but she believed it meant they would be cutting their vocational counselors. The Chair understood the Governor’s recommendations had restored those funds.

Additional correspondence was submitted for review by the subcommittee from Mark Puig de Vall, Jerry Leeper, Maribeth Segale, Terry Hardy, Andrew Laubert, and Russ Rougeau and are included as Exhibit H.

Maynard Yasmer, Rehabilitation Division, stated Director Carol Jackson was unable to attend the hearing because of minor surgery. The Chair extended best wishes to her.

Mr. Yasmer stated the division was responsible for programs and services for the disabled community. The Administrative Office was responsible for all the bureaus and programs in the division. Those included the Bureaus of: Vocational Rehabilitation, Services to the Blind and Visually Impaired, Disability Adjudication, Alcohol and Drug Abuse, and Vocational Assessment Centers. All the programs provided services to restore people back to the mainstream.

Chairwoman Chowning asked Mr. Yasmer to review the new performance indicators for Budget Account 3268 and to specify who would be responsible for needs assessment and the employer satisfaction surveys. Mr. Yasmer replied those functions were done by the Department’s Information Development and Processing Division, Bureau of Research and Analysis.

Chairwoman Chowning asked for particulars of the assessment, primarily the size of the survey, accuracy of the data and who would be included. Mr. Yasmer replied the sampling was drawn from the clients of the Bureaus of Vocational Rehabilitation and Services to the Blind and Visually Impaired. Specifically targeted would be clients whose cases were closed either successfully or unsuccessfully. He added the study was statistically significant.

Decision unit E-913 reflected a transfer of funds from Budget Account 3258, which was being reduced in order to consolidate the Title I federal funding under the Rehabilitation Act into two budget accounts. The transfer in E-913 involved a staff member functioning as a training technician who would serve a broader component of the program as part of the administrative budget.

Senator Neal asked for an explanation of the difference between the reserve and the reserve contingency funds. Mr. Yasmer replied E-126 was solely included if the legislature and the Governor recommended a pay increase for state employees. The funds were accounted for in E-126 so if that occurred the funding would not have to be cost-allocated to each of the bureaus and programs again. Senator Neal asked why one was called a contingency and one was called a reserve. Marty Ramirez, Deputy Chief Financial Officer, DETR, replied, the two types of reserves were separated because they had two unique functions. The category 86 reserve was for other unmet needs such as to provide an additional $1,000 in operating costs that could be transferred to category 04 without changing cost allocations for all the various programs.

Senator Neal asked how DETR arrived at the amounts in both categories.
Mr. Ramirez replied the contingency reserve in E-126 for salaries was based on the current-year raise of 3 percent. Lori Bagwell, Budget Office added the reason the funds were separated was because the normal reserves could "balance forward" for future use and the contingency reserve could not "balance forward." If no pay raise was approved decision unit E-126 would be deleted.

Chairwoman Chowning stated a training officer position was transferred out of Budget Account 3268 in the last biennium to expand the department’s training efforts and the current budget proposal asked for a training position to be placed into the division’s training activities. She asked what the difference was. Mr. Yasmer replied Department of Employment Training and Rehabilitation centralized and established a training office that would facilitate training department-wide. The earlier transfer was of a professional level staff person. The current request was for a training technician who prior to and after reorganization of DETR continued to be funded from Title I, the Rehabilitation Act. That funding required the position be used solely for the federal reporting requirements of staff training of the Vocational Rehabilitation employees. The staff person continued to serve that function but had additional time to provide training support to the other bureaus outside the federal program. To avoid a conflict with federal rules and audit exceptions Mr. Yasmer had placed the position into the administrative budget.

Senator Neal asked why the cost allocation for attorney general services was so high. Mr. Yasmer replied he used that person a lot. He added a large area of the rehabilitation program activities required legal advice. Mr. Yasmer said, on an ongoing basis the attorney general’s office had served DETR very well with legal advice on major program issues.

Mr. Yasmer stated disability adjudication was tightly controlled by the federal Social Security Administration. He explained it was the program to which people applied for social security disability insurance benefits. The program also did the adjudication for supplemental security income disability issues. Mr. Yasmer explained the program was 100 percent funded by the federal Social Security Administration and was tightly controlled.

Chairwoman Chowning asked Mr. Yasmer to address a request by Senator Raggio on January 25, 1999. Mr. Yasmer stated a report on the mean processing time had been provided reflecting performance indicators 2 and 3. The statement would describe a measurement of time from the time an application for benefits got to the Bureau of Disability Adjudication to the point where the application was sent on to the federal government for its final actions. The only variable was how quickly the staff could do their work. The kinds of tasks performed within the program did not vary. There was some difficulty in the current year because of staff turnovers.

Chairwoman Chowning asked if that was why projections indicated turnaround time would be reduced from 83 days to 75 days. Mr. Yasmer agreed.

The Chair asked how Nevada compared to surrounding states. Mr. Yasmer replied Nevada was not the best in "mean processing time" meaning they were somewhere in the middle, but Nevada was the highest in the region in accuracy.

Chairwoman Chowning asked Mr. Yasmer and the Budget Office to explain
E-125 because if the state employees were not getting cost of living raises it appeared contract staff would. She also asked the representatives from the Budget Office if there was an overall policy concerning salary of contract employees.

Mr. Yasmer explained the sole reason for decision unit E-125 was that if the state employees received a pay increase DETR would like to provide a cost of living (COLA) increase for the medical provider contractors. If state employees did not receive an increase, E-125 would not be funded. Mr. Yasmer addressed the question of why medical contractors were given a COLA stating a number of doctors were needed to perform medical reviews and they were needed in a number of specialties. He added the necessary staff were difficult to get because doctors were busy. The bureau had a tradition that the doctors "won’t play if DETR did not pay." They were treated on an equal basis with state employees. He emphasized the decision unit would not be implemented at all, similar to the salary reserve in the Rehabilitation Administration budget if state employees did not receive a COLA.

The Chair asked Ms. Bagwell if all the other budgets would appear with the same type of contingency decision units. Ms. Bagwell replied a policy had not been set. It depended upon the need and justification that each budget authority submitted. She approved the decision in Budget Account 3269 because the funding needed to be there. Mr. Yasmer stated such a contingency was not included in budgets that did not require some type of advance authority.

Assemblywoman Giunchigliani confirmed that the budget was pretty much flat and asked what happened if there were any kinds of salary increases. Where would those offsets appear and would services have to be cut. Ms. Bagwell replied the agency would request a federal augmentation. Ms. Giunchigliani noted it would work in that particular budget because of its federal funding but asked what would happen when it was an account funded through the General Fund. Ms. Bagwell replied salary adjustment money would be used created by legislation. Assemblywoman Giunchigliani requested a list of budgets that would be impacted by that issue to see what potential cuts would be made.
Ms. Bagwell stated it would depend on what salary increases were proposed. Assemblywoman Giunchigliani concluded for each 1 percent recommended as a salary increase there would be a commensurate lowering of caseload service and that would mean it could potentially create a budget cut.

Mr. Yasmer indicated the Rehabilitation Administration had set a contingency because it was cost-allocated. Disability Adjudication was no problem because it was 100 percent federally funded.

Senator Jacobsen referred to decision unit E-710 and asked if the agency ever used any furniture made by Prison Industries. Mr. Yasmer replied they did.

Mr. Yasmer stated Budget Account 3265 represented the federal funding from the Rehabilitation Act of 1973, as amended and was supported by 21.3 percent state funding, matching federal funds of 78.7 percent.

He noted any pay raise that could occur would not be a problem in that budget because there was a substantial amount of federal funds to bring into Nevada as long as the match requirements were met.

Chairwoman Chowning told Mr. Yasmer the subcommittee was very please that the percentage of people Vocational Rehabilitation had been able to put to work had increased by 10 percent.

The Chair asked why so many people succeeded in placement, a definition of successful employment, and why the projections had leveled off if such great strides were made in the current biennium. Mr. Yasmer responded the projections were leveled off somewhat because of funding availability. If they received approval for M-200 that would provide three more rehabilitation coordinators in the state and the projections might increase slightly.

Rick Schneckloth, Bureau Chief, Vocational Rehabilitation, stated there were a number of factors contributing to the successful outcomes including hard work. Bureau staff worked closely with other community providers to develop systematic approaches to employment and they had benefited by the unemployment rate.

Chairwoman Chowning asked if Mr. Schneckloth agreed with Mr. Yasmer that they could only increase slightly in the future due to funding. Mr. Schneckloth agreed that given the fiscal resources it would be optimistic to increase slightly. Mr. Yasmer interjected that the 935 projected in FY2001 on performance indicator 6 could really be 957 because of the staff component in M-200.

Chairwoman Chowning asked how Nevada compared with surrounding states or a national average. Mr. Schneckloth replied it was difficult to compare Nevada with surrounding states because the federal performance indicators were not based on the same formula of eligibility determinations and successful outcomes. The federal performance indicators measured successful and unsuccessful closures into the formula. Mrs. Chowning stated the subcommittee would like to be proud of Nevadans being put to work in Nevada in comparison with other states. Chairwoman Chowning asked if DETR could include the federal performance indicators with their budget performance indicators and Mr. Yasmer said they could.

Senator Neal asked what was happening with the $369,339, balance forward of federal funds in the work program for FY 1998-99. Ms. Bagwell explained that figure was a "balance forward" figure so it represented a balance of federal funds from the end of FY 1997-98 forward for expenditure within the
FY 1998-99 work program year. The agency did not complete the expenditure of those federal dollars in FY 1998 so it came forward for use in FY 1999.

Assemblywoman Giunchigliani stated it appeared when looking at The Executive Budget for the Section 110 state/federal General Fund match that there was a

2 percent decrease in the second year of the biennium. She had thought the trends were higher than that. Mr. Yasmer stated the problem was due to matching funds. The agency was bringing in everything they could on the match ratio but the state funding side was not available. Assemblywoman Giunchigliani said her concern was that the state funds recommended by the Governor in the first year of the biennium would not support all the federal funds and that would directly impact the second year. Mr. Yasmer agreed.
Ms. Giunchigliani asked what service cuts could be anticipated in the second year of the biennium. Mr. Yasmer replied he did not believe there would be cuts but there would be a lack of increase in availability of case services which would show in the future in performance indicator 6, clients achieving successful employment and performance indicator 5, numbers determined eligible. The impact would probably occur visibly the year after the coming biennium.

Assemblywoman Giunchigliani asked if she could say that budget was not adequately funded in terms of dealing with the trend and needs of the client base. Mr. Yasmer said he thought the Budget Office was doing the best it could with the funds available. If more funds became available to use for match that would be good. He added the Rehabilitation Division’s top priority if funds became available was for the Medicaid Waiver and an increase to affect the federal match would be second.

Assemblywoman Giunchigliani stated the state/federal match only increased
2 percent in the second year of the biennium and was less than the "trend" and asked what the trend was. Mr. Marty Ramirez, Deputy Chief Financial Officer, DETR, stated based on the increase their department had experienced in the Section 110 grant which was 5.9 percent, they had calculated some numbers which showed there was about $530,000 of federal money that would not be made available in the first year of the biennium and about $850,000 in the second year. Each of those amounts required a 21.3 percent match. The first year approximately $145,000 in state funds would be needed and about $230,000 in the second year. Cumulatively if the state match increased, it would infuse $677,000 in FY 2000 and a little over $1 million in FY 2001.

Chairwoman Chowning noted M-200 asked for six new positions and on page DETR-79 the funding for case services were very flat. She asked how the six more positions could affect more cases if the funding was not there.

Mr. Yasmer replied the current staff load of counselors in the bureau was maxed out. They were running over 100 clients per counselor at any given time. There was no waiting list but there was an internal slow-down on progress of clients through the system. By adding more staff they would be able to accelerate that. The agency also needed to work more in the communities with minorities.

Mr. Yasmer went on to explain if they had instead an additional amount of case service money but not enough staff they would not be able to move ahead at all, so it was a choice of the better of two alternatives. Chairwoman Chowning verified Mr. Yasmer was saying the agency would be able to handle more of the people on the waiting list if they were given the additional positions.
Mr. Yasmer replied they did not have a waiting list per se, but they did have a number getting into the system who were not being attended to very quickly.

The Chair indicated the number of clients served was 5,112 excluding rural clients, yet the performance indicator only reflected 2,256 clients were determined eligible. She asked how many rural clients were served. Mr. Schneckloth responded the 2,256 figure indicated the number of clients determined eligible and "cases served" included all the clients in the caseload at the beginning of the year and all the new intakes. The total served including rural clients was 5,957. Chairwoman Chowning said that figured out to be around 800 clients served in the rural areas and Mr. Schneckloth agreed.

Mr. Yasmer stated Budget Account 3254 represented a group of three services for the blind and visually impaired: 1) Vocational Rehabilitation to assist blind people get to work; 2) Life Skills Training which had a decision unit to replace federal Title 20 funds with state General Fund; and 3) the Older Blind Independent Living program which was a federal/state ratio program.

Chairwoman Chowning referred to The Executive Budget on page DETR-99 which indicated nearly $710,000 for case services in the base year, yet the Governor recommendation for the following biennium was $100,000 to $200,000 less. She asked where the obvious cuts in service would occur.
Mr. Yasmer responded if there was more state funding available more federal funding could be leveraged. The Chair asked what the agency’s plan was.
Mr. Yasmer replied they would get as creative as they could and added, one positive impact was decision units E-125 and E-126 which included a new position of an Assistive Technology Specialist. Those services were currently provided to the blind through client services monies going to community sources. With the proposed new position the funds in the client services category could be reallocated to other client services. The new Employment Specialist position would assist in job development and consultation. The agency worked closely with the employment services office.

Chairwoman Chowning stated she had been provided a packet of information concerning one-stop centers by Mr. Harry Bradley, Deputy Director, DETR, and asked why there had to be a separate job developer just for the blind and visually impaired population. Mr. Yasmer replied the Rehabilitation Division focused on employment for the disabled and was a resource for Employment Security. The standard client who came to a one-stop center or employment office was job-ready but the clients of the Rehabilitation Division needed a great deal of intervention to become job-ready. The specialist was needed to compliment, not duplicate services.

The Chair agreed the subcommittee liked the term "no duplication of services." She asked if the agency envisioned the one-stop centers not assisting disabled clients. Mr. Yasmer replied negatively. The one-stop centers worked together with the Rehabilitation Division and the division facilitated the service by providing availability to a variety of resources. He noted people were unemployed for a variety of reasons. The new position would be doing intervention with employers and would also work with employment service people.

Mr. Yasmer stated Budget Account 3253, the Blind Business Enterprise Account represented a program under the Randolph Sheppard Act Vending Program in federal law, to provide opportunities for blind persons to become independent as proprietors in vending operations at public facilities.

Chairwoman Chowning referred to performance indicator 6, which indicated the number of blind vendors achieving Substantial Gainful Activity earnings and asked what that measured. Mr. Yasmer introduced Mike Becker, Chief, Bureau of the Blind and Visually Impaired. Mr. Becker explained Substantial Gainful Activity was defined by the Social Security Administration for blind individuals as an income of $1,100 per month. The agency felt that was a minimal level of achievement and the majority of Nevada vendors would earn at or above that level. The agency projected a 90 percent achievement rate. The agency was aware of two vendors who chose not to expand their businesses beyond a certain level.

Chairwoman Chowning asked if an agreement had been reached with the Bureau of Reclamation concerning the Hoover Dam project and would the project be complete prior to the end of the FY 1998-99. Mr. Becker replied the agency was negotiating a permit with the Bureau of Reclamation at present. The agency issued a rough draft and the Bureau of Reclamation responded with a draft that was currently being reviewed by the agency’s senior deputy attorney general for completeness and compliance. Mr. Becker had seen nothing in the permit that would be a deal-killer at the present time. The project would not be complete in FY 1998-99 but they hoped to break ground by June 1999. Some of the funds would be expended for development of the plans. The plans required approval from the Bureau of Reclamation before the agency could continue. Mr. Becker had just received word that the Bureau of Reclamation wanted the agency to hire the engineer who worked on the original parking structure as a consultant. The project was a two-level facility and some of the supports had to be connected with existing supports or be modified with the existing plans.

Chairwoman Chowning asked if the agency was working with the Budget Office because it appeared there were some budget adjustments needed. Mr. Becker replied the only adjustments to be made were through IFC because there were no state or federal funds in the program.

Senator Jacobsen asked the agency for a brief report on the success of the vendor in the Caucus Deli housed in the legislative building. Mr. Becker replied it was a very successful operation when the legislature was in session, but it was a little grim between sessions. The agency made up some of the difference by bringing in their own vending machines rather than contracting with private vendors.

Mr. Yasmer asked if the subcommittee felt the operation was a success. Senator Jacobsen replied it seemed to do well at peak times and asked if the agency or the vendor had advertised in other facilities in the surrounding area. Mr. Becker replied the operators were free to advertise wherever they chose. The operators in the Blasdel and Kincaid buildings did advertise in other buildings in the Capitol Complex. He noted if the Caucus Deli advertised, the level of service would need to increase slightly, which was risky because more food must be purchased and prepared and would be a waste if the clientele did not increase.

Mr. Yasmer stated Budget Account 3170, Bureau of Alcohol and Drug Abuse (BADA) provided funding to local treatment facilities throughout the state. No direct services were provided. The bureau was responsible for the state plan and coordinated state and federal funding. The bureau also developed standards for certification of facilities and personnel. They were pleased with the performance in the past year. The bureau was striving for better outcome measures, looking at more follow-up studies, and more data being tracked.

Chairwoman Chowning noted the bureau proposed a series of new performance indicators and asked if they were currently tracking the data to develop a
base-line. Mr. Yasmer replied he could provide some baseline data and introduced Robert Johnston, Acting Chief of the BADA.

Mr. Johnston stated in performance indicator 1, the percentage of patients with no substance abuse at 3-month follow-up, the projection was 67 percent but actual was 75 percent. The outcome study results did not come in until November 1998, after the budget process. That was not a performance indicator in FY200-01 although the data would still be tracked internally.

Performance indicator 2, in terms of a 6-month follow-up, the actual for
FY 1998 was 59 percent, and the bureau was expanding the treatment outcome study to gather data at 1 year out. Mr. Yasmer stated the projection of 45 percent in 2000-01 was based on the FY 1998 actuals.

Performance indicator 3 related to the percentage of patients unemployed at time of entry into treatment. Mr. Johnston said currently at admission
38 percent or 3,420 were unemployed upon entry. At 3-month follow-up
21 percent were unemployed and at 6-month follow-up it dropped to 14 percent unemployed.

Performance indicator 4 would generate the same data at 1 year out of treatment.

Chairwoman Chowning asked Mr. Johnston to submit the data to subcommittee members in writing due to time constraints.

Chairwoman Chowning asked the agency to discuss decision unit M-200 and explain how much of the $2 million would be available for program enhancements or new programs. Mr. Yasmer replied the affect of M-200 currently was to continue what was created by the IFC for the current state fiscal year. It would bring in the authority for the federal funds similar to the authority brought in for the current year. The impact of the funding would be felt now, not 2 years down the road.

Mr. Yasmer stated the monies funded not only current programs but allowed them to add a few because of the net affect of the enlargement of the federal grant. He offered to provide the subcommittee with information on the newly funded programs and the Chair agreed.

Chairwoman Chowning asked the agency to discuss any future changes in the budget concerning state and federal fund requirements and tracking systems, performance measurements, and fees for service. Mr. Yasmer replied the agency was striving for better outcome measures. The agency had moved into a "performance-based" grant situation where they required the treatment facilities to provide the same performance indicators the agency operated under.

Mr. Yasmer said the agency was trying to streamline the RFP and flow-through granting process so it was not so labor intensive. The Chair asked when the agency was going to start, and Mr. Yasmer replied they had already started in some areas. He noted some of the data provided by Mr. Johnston was derived from that effort. The agency wanted to monitor the programs by outcomes rather than by regulation.

Chairwoman Chowning referred to decision unit E-350 and asked for confirmation that the amount of funding each year would be $280,000 to dedicated to alcohol and drug prevention to target youth at risk. She noted that request for funding was in response to issues raised during the interim and stated that was an excellent enhancement. Mr. Yasmer replied that was the Governor’s recommendation.

Chairwoman Chowning noted Budget Account 3154 was basically a flat budget with no additional funding. The Chair commented she had seen the program in Washington D.C. and that performance indicators indicated up to 25 people would be able to purchase their own home. She asked how the program would occur and with the depressed budget how people could accomplish the purchase of their homes. Mr. Yasmer gave a special recognition to Donny Loux, Chief, Office of Community Based Services, Rehabilitation Division, because she had done more for disabled persons in the state of Nevada than anyone he had ever known.

Donny Loux responded to the question from the Chair stating that the legislature had approved a one-shot appropriation several years ago and another appropriation in the Sixty-ninth Session. The agency used those funds to bring in $20 million in non-state revenue to construct three assisted living apartment complexes, and another three were scheduled to be built. The funds from the previous session were used to establish a non-profit organization in Reno and Las Vegas as a Community Development Housing Organization (CHDO). Two wonderful staff had been hired who used the funds to leverage county and state dollars and brought in an additional $325,000 to assist people in buying down their mortgages. The expectation was that the positive outcomes would only increase.

Ms. Loux stated another part of the state appropriations were recently used to collaborate with Clark County to apply jointly for a grant from Housing and Urban Development (HUD) that generated $600,000 in vouchers for people with disabilities to live wherever they liked. The Chair asked for a written report on the program. Ms. Loux stated she would provide it and told the subcommittee that Mack Johnson who was at the meeting earlier was an artist who painted with his mouth and had two children who previously had to sleep on the couch. He was one of the new homebuyers. Chairwoman Chowning asked if the program was a Fannie Mae project and Ms. Loux replied affirmatively.

The Chair asked how the agency was going to continue to pay for the dental services. Ms. Loux explained there had been difficulty in starting the program and just in the last few days Senator Rawson had intervened and she received an offer of assistance from the Blue Cross, Blue Shield Foundation in Las Vegas. A plan had been worked out that the agency would take a small portion of their federal funding for the next two years and Blue Cross, Blue Shield would match that funding at $60,000 to $90,000 to provide the dental services not only for the disabled but for all children.

Ms. Loux credited Mike Goodwin of the Personal Assistance Program in Reno with wearing a beeper making himself available 24 hours a-day and a person who literally dug people out of the snow in winter and did whatever it took to provide services. The Chair asked for written testimony concerning the Personal Assistance Program which can be found in Exhibit H.

There being no further business, the meeting was adjourned at 11:00 a.m.

RESPECTFULLY SUBMITTED:

Cindy Clampitt,

Committee Secretary

APPROVED BY:

Assemblywoman Vonne Chowning, Chairman

DATE:_______________________________________

_____________________________________________

William O’Donnell, Chairman

DATE: