The Assembly Committee on Ways and Means was called to order at 7:30 a.m., on Wednesday, March 17, 1999. Chairman Morse Arberry Jr. presided in Room 3137 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List.

COMMITTEE MEMBERS PRESENT:

Mr. Morse Arberry Jr., Chairman

Ms. Jan Evans, Vice-Chair

Mr. Bob Beers

Mrs. Barbara Cegavske

Mrs. Vonne Chowning

Mrs. Marcia de Braga

Mr. Joseph Dini, Jr.

Ms. Chris Giunchigliani

Mr. David Goldwater

Mr. Lynn Hettrick

Mr. John Marvel

Mr. David Parks

Mr. Richard Perkins

COMMITTEE MEMBERS ABSENT:

Mr. Robert Price (Excused)

STAFF MEMBERS PRESENT:

Chairman Arberry called the meeting to order and opened the hearing on A.B.330.

Vice-Chair Jan Evans stated she would defer in the interest of time to representatives from Washoe County. She requested Judge Charles McGee be allowed to speak first.

Judge Charles McGee, Chief Judge of the Second Judicial District Court in Washoe County explained he had been a juvenile judge for 20 years and chaired the Juvenile Justice Commission for several years. He was currently on a committee called The Work Study Group which for the past 2 years had been working on long range strategic planning in juvenile justice.

Judge McGee introduced Katy Simon, Washoe County Manager; Leonard Pugh, Director, Juvenile Services; and Ted Short, Vice Chairman, Washoe County Commission.

Judge McGee provided the global picture of juvenile justice for the committee. It was very simple yet very complex. It had taken Judge McGee many years to understand the process himself. He explained the responsibilities were bifurcated between counties and the state.

The county responsibilities included:

• Intervention;
• Detention; and
• Probation.

State responsibility was that of juvenile corrections. Unless those two systems could work synchronously with one another all placement decisions would be fiscal related. The county people would try to make the state bear the brunt of the costs and the state people would try to make the county bear the brunt of the costs.

Judge McGee said Assemblywoman Evans assisted the commission and the entities had tried to work together synchronously. To do that the state needed to buy into part of the county responsibility and vice versa. The Washoe County facility could probably be built without state assistance but the result would be a scaled down facility that did not work right for Washoe County. The "seed" money requested in Assembly Bill (A.B.) 330 would allow the commission to do some programming that would keep kids out of the Elko and Caliente state facilities.

Judge McGee explained Washoe County Sheriff Richard Kirkland, Adjutant General Drennen A. Clark, Joe Crowley and himself put together a fully funded program that would begin in the Summer of 1999 with about 35 kids called "Project Walkabout." The program called for a paramilitary but very positive, non-breakdown format for 60 days. After that, the juveniles went to the Boys and Girls Club for 120 days. In the previous year the program had achieved a 90 percent graduation and success rate. Judge McGee stated if he could divert the kids "on the bubble" that could mean as many as 30 kids who would not be sent to state facilities.

Judge McGee stated the commission wanted to make "Project Walkabout" permanent and locate it at the new detention facility as a dispositional alternative where families would be nearby and could work with the program too.

The commission was asking to create a partnership with funding of $3 million from the state on the promise by the commission that they would fulfill their part of the partnership. He said as a result, the legislature would not be called upon in the next couple of legislative sessions to build yet another $25 or $30 million facility like they were asked to do for Las Vegas in the 1997 Legislative Session.

Leonard Pugh stated the video to follow was a 2.5 minute news broadcast from Channel 4 in Reno that aired in February 1999. Ms. Simon played the video.

Leonard Pugh, Director, Washoe County Juvenile Services, pointed out the handouts provided to the committee:

• Presentation by Washoe County (Exhibit C);
• Blue Ribbon Committee Report submitted to the Washoe County Board of Commissioners (Exhibit D, on file at the Research Library, Legislative Counsel Bureau (LCB);
• Fact Sheet presented by county staff (Exhibit E); and
• A letter containing Mr. Pugh’s testimony (Exhibit F).

Mr. Pugh stated when Wittenberg Hall was built in 1961 it was equipped with 24 beds. Some additions to bed space were added and currently there were 68 beds in the facility. However, because 57 percent of those beds were located in dormitory rooms that housed 6 to 10 youth, the recommended maximum capacity was 44 beds.

In 1998, the average daily population was 69 juveniles. In April 1998 the hall averaged 85.5 juveniles for the month with a peak day of 100 residents.

Some of the reasons for the increases in the population was that juvenile offenders were more violent than in past decades. Between 1990 and 1998 Washoe County saw an 85 percent increase in arrests for person-related cases such as robbery, sexual assaults, assaults with a deadly weapon, batteries, and domestic violence. Drug-related offenses increased 280 percent in that same period of time. Because of those types of offenses juveniles were staying in detention longer. The average length of stay increased because it took longer to find appropriate treatment programs, intermediate sanctions in the community, or because they had to stay in detention until they were transferred to a correctional facility.

Mr. Pugh stated some of the conditions at Wittenberg Hall were hazardous and structurally inadequate. As mentioned 57 percent of the beds were in dormitories. That created particular problems because it was unsafe to mix certain types of offenders in those dorms such as opposing gang members, sexual offenders, or kids with violent outbursts.

Metal-framed beds resulted in more suicide attempts, sleeping rooms had keyed locks so anytime there was a fire it slowed down the evacuation process, and the holding and booking room area was inadequate. In 1998 4,334 juveniles were processed through one booking and one holding room. When kids were brought into the hall in groups, that also created very unsafe conditions for everyone involved. Routinely when there were too many kids they were placed in the shower room which did not have radio or camera monitoring, until their parents could pick them up or they could be transferred to the secure detention area.

The school facility could only hold 38 students at a time and as the committee could see from the numbers the facility was required to cut school days in half and provide two sessions each day.

Mr. Pugh testified several efforts had been made over the last few years to try to solve the overcrowding problem. Detention hearings had been increased from
3 days a week to 5 days a week. The detention-screening instrument was revised. All but the serious and chronic offenders were screened out. As a result, in 1985, 81 percent of juveniles admitted were detained, but in 1998 only 60 percent of admissions were detained. At the same time the daily population continued to increase.

The juvenile system had instituted a home monitoring house arrest program. The juvenile service also used alternative sanctions such as work and restitution programs, and was transferring more children than ever to the McGee Center, a shelter for status offenders. The juvenile service was also working on the development of other intermediate sanctions such as community outreach programs, a day reporting program, and with other community agencies in development of a boot camp.

The new proposed facility would be a "no frills," 99-bed facility on approximately 10 acres with room to grow. It would involve a detention area of 50,368 square feet and total square footage of 75,424 feet. It would include space for work programs, classrooms, a courtroom, a medical clinic, kitchen and dining area, traffic court, administration and probation offices, programs for substance abuse, training, and a boot camp. Mr. Pugh stated the estimated cost was $20 million. Washoe County Commissioners had allocated $200,000 to streamline the design and reduce construction costs. He stated the $20 million figure came from taking the design used in 1994 and building the inflationary index into it. The $200,000 from Washoe County would be used to reevaluate that design and to make cuts wherever possible without minimizing the safety and security of the facility. The county was going to use, sell, or trade land they possessed to offset the costs and pursue leasing agreements.

Katy Simon, County Manager, Washoe County explained the funding proposal started with an estimated project cost of $20 million but the county was working very hard to reduce that estimate in every way possible. The county anticipated selling the existing facility, which would return about $5 million in proceeds from the sale. If they received the requested $3 million in state funding as requested in A.B. 330, Washoe County would have to finance $12 million of debt. That would be an approximate debt payment of $1.5 million per year. The county was committed to finding those resources and Assemblywoman Evans had proposed in discussions that the county be given 4 years to find those matching funds. The county was confident they could do so.

Ms. Simon stated for the record, each $1 million contributed would reduce the annual debt payment by $125,000 per year over a 10-year period. The county intended to pursue foundations and grants wherever possible. Three million dollars from the state would provide "seed" money to raise the additional $12 to
$15 million needed. It was known that every dollar spent on prevention with juveniles in a quality detention facility was a component of a prevention program. Research showed that every dollar spent saved $4.74 in the cost of remedial education, welfare and crime. The state contribution would allow the county to free up the equivalent of those funds to keep six juvenile outreach or child protective workers out in the field, keep 20 acres of ball fields available to children, or keep 1,000 library books in circulation each year.

The county was aware that the debt service anticipated on the project would be paid in 10 years if only 60 youths a year were diverted from the adult system.

Ms. Simon stated a page of Exhibit C showed newspaper articles that illustrated the problem had been growing for a number of years. She stated voters defeated a ballot question in 1994 but Mr. Pugh had testified the county had worked very hard to address the concerns the voters had expressed. Voters had wanted to see a "no frills" facility, more alternatives to incarceration, and detention of only the most serious and chronic offenders and that was what was included in the proposal before the committee.

Judge McGee stated in conclusion, the county was not trying to build a fancy facility for the offenders, nor did they care if the offenders experienced some of the hard reality associated with being locked up while they were awaiting trial. But, it was not right to put 12-year olds in with 17-year olds with no place to counsel either one of them. Also, a little girl was lost several years ago and a tree had to be planted in the front yard for her to dismiss a lawsuit. He added the county was ripe for a lawsuit with the current facility. There had been several recent sexual assaults in Wittenberg Hall. He concluded the condition of the facility made a new facility nearly mandatory. Such conditions were subjects of consent decrees all over the country. The county wanted to take the initiative, work together with the state and build a long range plan on the promise that the county would not be back before the legislature asking for more funds for correctional facilities.

Assemblyman Marvel asked if a tuition or detention charge was required of the parents of children detained at Wittenberg. Mr. Pugh replied parents were charged $30 per day up until the time of the detention hearing and after detention became court-ordered there was no charge to parents. If parents refused custody of a child authorized for release the parents were charged an hourly rate until they picked up the child.

Assemblyman Marvel asked what annual income resulted from the custodial charges. Mr. Pugh responded Mary Ann Wooley; Assistant Director to Juvenile Services, in charge of corrections could answer the question. Ms. Wooley stated Juvenile Services collected approximately $30,000 in the previous year. The charge was based on the parents’ ability to pay. If parents could not pay they were not charged. When paroled youth were held the state and immigration paid a $50 per day contract fee. She added the facility no longer held "contract holds" because of the lack of space.

Assemblyman Marvel asked if Juvenile Services had explored the feasibility of using tents such as Sheriff Kirkland used for less violent offenders. Judge McGee replied if they received the 10-acre parcel of land they could do that type of thing in summer months. Assemblyman Marvel commented Sheriff Kirkland used tents year-round and some of them could be plumbed and heated. Mr. Pugh stated the tent concept could be considered once the youth had been adjudicated. However before that, certain obligations and standards were required in terms of square footage, the amount of program space, and the amount of daylight as well as other requirements. Those standards must be met to keep the county from exposure to liabilities. He could only envision tents being used to move a dormitory outside and the same problems of assaults and other offenses were present as they were in a dormitory. Mr. Pugh stated it was likely the sheriff’s office placed inmates who were serving longer sentences and had been evaluated in the tent facilities.

Assemblyman Marvel asked if Juvenile Services had any kind of work program. Mr. Pugh responded affirmatively. During school periods the work program was in place on Saturdays and Sundays and then 4 days a week during the summer. There were five crews of 10 to 12 youth that went out each of those days. Ms. Simon added the county was very committed to evaluating alternative construction opportunities such as tents and had used them successfully in the adult program of detention.

Assemblyman Marvel asked how the facility had gone so many years with individual locks and keys. He commented the state had a terrible time with state prisons being closed down because of fire marshal edicts. Mr. Pugh replied only through the grace of the fire department and the fact the windows in Wittenberg Hall were accessible by the "Jaws of Life." The county had on two occasions, funded projects to install electro/mechanical systems for the doors, but because of asbestos in the ceilings and other construction restraints in terms of the lack of wiring space and other problems the projects were shelved.

Vice-Chair Evans stated in addition to a detention center she understood Juvenile Services was planning an addiction center as part of the new facility. Judge McGee replied he had met on March 15, 1999 with Senator Raggio and Governor Guinn to promote a program built around drug courts. He commented he operated a family drug court and supervised a juvenile drug court. Judge Breen had an adult drug court with several hundred clients. He explained those courts were strength-based. Most of the juvenile justice system was deficit-based making people feel sub-human, reminding them of how bad, evil, or low they were. The drug courts were ideal models to get kids off drugs because they enhanced their strengths as well as holding them accountable. That was the type of program they wanted to place in the new juvenile facility. Others present on another bill operated such a facility called Sagewind and some of their expertise would be drawn on when working on some of the behaviors seen in youths using drugs and alcohol.

Mr. Pugh stated currently, because of the overcrowding, Juvenile Services was not able to accept youths into the hall on a dispositional basis. The law allowed youths on probation who violated that probation to be incarcerated up to 30 days in a juvenile detention facility. There were already youths incarcerated long-term and waiting for placement. It would be the intent to place the long-term residents in a 30-day program dealing with drug, alcohol, and tobacco use.

Assemblyman Marvel asked at what point in sentencing a youth was committed to Elko or Caliente. Judge McGee replied he hoped no youths were listening because the program ran like a "toothless tiger." There were work programs and as many intermediate programs as possible. Typically a youth offender was placed on probation, if they violated probation they were given a suspended commitment, with another violation transportation was deferred, and finally, the plug was pulled and they were sent to Elko or Caliente. Committing a young person to the state facilities was not an easy decision for a judge to make. The Elko facility was full of "gang-bangers" from Las Vegas and sometimes it did an injustice to a youth with a lesser offense to place them there. Assemblyman Marvel observed a number were sent to Caliente instead because of that. Judge McGee agreed and added they were trying to develop as many home-based programs as possible. That was why the county pledged to develop as many dispositional alternatives in connection with the new facility as possible.

Ted Short, Vice Chair, Washoe County Commission commented the testimony heard previously was just the "tip of the iceberg." He stated he had not been in the facility in approximately 25 years until recently and his impression from the tour was of deplorable conditions. Every broom closet had an office in it. Youths were standing around, could not be placed in school properly, very few programs could be offered and there was the situation of older, more violent youths placed with younger, lesser offenders.

Washoe County had the same problems as every government entity. They had lots of demands on their tax base but the new juvenile facility was an absolute must. The county had appropriated $200,000 to design a facility and excellent individuals were working on the program. If something was not done, the county would be in real trouble. He urged committee members to view the bill as an investment in Nevada. With the right facility youths could be kept out of state facilities.

Captain, Jim Nadeau, Washoe County Sheriff’s Office testified on behalf of Sheriff Richard Kirkland. He stated the sheriff’s office was solidly behind the effort to build a new juvenile facility in Washoe County and would do whatever they could to assist the effort.

Janice Pine testified representing herself. She explained her daughter was a juvenile probation officer for Washoe County and worked in Wittenberg Hall on a daily basis. She had asked her daughter what her main concerns about the facility were. The response had been absolutely, everyday the number one concern was one of safety for herself, fellow officers, and safety of the youth residents.

Ms. Pine urged the committee to pass A.B. 330 because as a parent and concerned citizen a new facility was definitely needed in Washoe County. Her brother and sister were some of the first people hauled into Wittenberg so it had been around a long time and she had also been there as a parent. The facility had deteriorated far beyond what should have been allowed to happen.

Louise Bayard-de-Volo, Nevada Women’s Lobby, testified in support of A.B.330. The early treatment, adequate facilities, and separation by age and offense that would be possible in the new facility were very important to the treatment of minors. The new facility would have great long-term savings in terms of social and economic issues.

Chairman Arberry closed the hearing on A.B. 330 with no action. He opened the hearing on A.B. 325.

Assemblywoman Sheila Leslie, Assembly District 27, presented A.B. 325. She noted previous speakers had presented the Blue Ribbon Report, Exhibit D, on file at the Research Library, LCB. She stated the first six recommendations dealt with Wittenberg Hall and she supported A.B. 330 as well. She stated anytime a person went to the hall and saw a 10-year old being taken in to mix with 16-year olds it was a known fact there would be problems. She stated one suicide was enough.

Assemblywoman Leslie stated she had participated as a member of the Blue Ribbon Committee and was in attendance to present A.B. 325 that addressed recommendation 7 in Exhibit D, on file at the Research Library, LCB. There was a lot of frustration that the county was not able to keep more youths out of the hall. The seventh recommendation grew out of that frustration. The whole Blue Ribbon Committee decided that prevention efforts needed to focus on children in grades 5 through 8. That was the age when a number of children were lost into the system.

Assemblywoman Leslie noted she had testified the previous day and the room was packed with adolescents who because of time constraints were not able to speak. She asked the committee to recall all those faces and said behind each face was a story. She stated she did not know those children in particular but she knew a lot of kids like them. She stated her belief that each one of those children who had been present would have said they first became involved with drugs or alcohol between grades 5 through 8.

In its final report the Blue Ribbon Committee recommended the state consider funding a pilot project for children in that age bracket that would address substance abuse, mental health and school issues for the next biennium. The Blue Ribbon Committee believed a pilot project would give a chance to prove early intervention could work. The youth would be tracked and valid data would be collected to present in the following legislative session.

Denise Everett, Chairwoman, Commission on Substance Abuse, Education, Enforcement, and Treatment stated she was also the Executive Director at Sagewind. She explained Sagewind was a drug and alcohol treatment center for adolescents in Reno. There was a huge unmet need in the state for substance abuse services for adolescents. While Nevada consistently ranked first or second in per capita consumption of alcohol and drugs, the state ranked forty-third in the amount of money the state spent on prevention, intervention and treatment.

A.B. 325 attempted to address a tiny part of the need through a pilot program in Washoe County. The project would target fourth through eighth graders whose counselors or teachers identified as being at risk for substance abuse, escalating behavioral problems and/or dropping out of school.

The $100,000 requested by the bill would allow a far less costly mode of providing services than incarceration or residential treatment down the road. She recalled earlier testimony that indicated there had been a 280 percent increase in youth drug arrests in the past 7 years in Washoe County. Intervention could hopefully save money and anguish up front, thereby reducing the volume of children that would need more intensive services later on.

Ms. Everett introduced Diane Freeman, Clinical Outreach Coordinator of Sagewind and asked her to explain the program.

Diane Freeman testified Sagewind was currently providing an early intervention pilot project. They were working in collaboration with the Sparks Family Resource Center, Agnes Risley Elementary School, Sparks Middle School, Washoe County Juvenile Services and Washoe County School District.

Ms. Freeman explained the difference between early intervention and prevention. Early intervention was a step above prevention. Prevention programs tended to be universal, educationally oriented, and activity oriented, and were applied to large groups.

Early intervention was a comprehensive individualized approach. It offered individual counseling sessions, group therapy sessions, and family counseling activities. Youth targeted were those identified by their teachers and school counselors as having high risk factors for developing problems with substance abuse. Ms. Freeman emphasized intervention was therapy, not just provision of information.

The current project provided to Agnes Risley and Sparks Middle Schools addressed fourth through eighth grade students. The program provided a minimum of 8 group therapy sessions, a minimum of 5 individual sessions, a minimum of 12 hours of family therapy, and provided, through Washoe County Juvenile Services, an opportunity to a Right of Passage (ROP) course project available through West Hills and Willow Springs.

Early intervention was a nationally recognized level of care according to American Society of Addiction Medicine so it was not a "fly by night" project. The Sagewind project was a pilot that had served 14 students to date. The project was in its first year. Of the 14 students, 13 had successfully completed the program.

Ms. Freeman related an anecdote regarding one of the students. At the beginning of the project the student’s citizenship grade was a D- and by the time he completed the program his grade was a B+. The program had observed successes in attendance, truancy problems had improved, and academic progress had greatly increased.

Referrals from the 2 participating schools for the second session stood at 25. That was well beyond what Sagewind could serve. Currently Sagewind was offering the intervention program for only $3.79 per student per hour.

Assemblyman Marvel asked if a budget had been developed for the Sagewind program and asked how the $100,000 appropriation requested in A.B. 325 would be used. Ms. Freeman replied they had a budget. She said the appropriation would be provided to the family resource centers that would, in turn, seek services from an agency such as Sagewind to provide counselors on site at the family resource centers. The services would be neighborhood-based, and culturally competent.

Sagewind’s project was currently being offered without any funding resources. The facility allocated other funds to the project and staff was working extra hours. The bill would allow the program to be provided throughout the entire school district instead of only through the Sparks Family Resource Center.

Assemblyman Marvel questioned whether Sagewind had a budget that would breakdown how the requested appropriation would be spent. Ms. Freeman replied the budget she had was for the current program.

Assemblyman Marvel noted the program was running without funding and asked if any grants were available. Ms. Freeman stated Sagewind had applied for several private foundation grants and were in the process of applying for some Bureau of Alcohol and Drug Abuse (BADA) funds but none of that had been secured to date.

Assemblywoman Cegavske stated in Las Vegas a program called Westcare provided services to juveniles. One of her concerns was that students could not be made to stay in the Westcare program. There were no mandates to require attendance for the entire program or any particular portion of it. She asked if Sagewind experienced the same problem. Ms. Freeman asked if Assemblywoman Cegavske was referring only to early intervention or other programs as well and Assemblywoman Cegavske clarified she was referring to any types of programs. She explained the Las Vegas program did not allow the facility to hold the kids for any reason. Ms. Freeman replied Sagewind also had no way to hold the kids in the program however, every single student in the first session stayed for the entire time. She noted the program was completely voluntary. The school district did work with Sagewind. Students were allowed to leave school an hour early to attend the services at the Agnes Risley School. Middle school students shared the same piece of property so they simply had to walk across the field.

Assemblywoman Cegavske stated in Las Vegas the program received a lot of the run away juveniles and that amount might make a difference. She referred to the $3.79 per pupil and asked if that included what it cost to help counsel the family. Ms. Freeman stated the cost was included. Assemblywoman Cegavske asked if the cost included the whole family meaning the siblings as well. Ms. Freeman stated it included all immediate family members.

Vice-Chair Evans asked how the youngsters were identified and what signals they displayed. Ms. Freeman replied the students were flagged by the staff at the school. The staff looked for disruptive behavior in the classroom, disruptive behavior on the playground, truancy problems, dropping grades, and if staff had knowledge of family situations, whether parents or older siblings were substance abusers. If the students themselves expressed interest in the program, they were also eligible.

Vice-Chair Evans asked if the program had experienced good response and cooperation of family members. Ms. Freeman replied approximately 50 percent of families participated in the first group and that was the most frustrating area for counselors. Sagewind was getting a better result with the second group. Staff had streamlined their process to make it easier for families to have access. They had also worked with other entities to move some of the family services to the Sparks Family Resource Center to be more in the neighborhood. Assemblywoman Evans applauded Sagewind’s work to date. She noted in all the juvenile justice literature it was becoming more and more evident that problems began much earlier than at first realized. Early intervention was important.

Assemblywoman Leslie told the committee a preliminary budget had been developed for the requested $100,000 appropriation and said she would provide it to the committee members.

Assemblywoman Leslie referred to Assemblywoman Cegavske’s question regarding the success of the program in the north. She stated perhaps the northern program was having such good success because they were targeting grades 5 through 8 when parents were more motivated. Assemblywoman Leslie said she was familiar with Westcare and that program was designed for a different group of juveniles.

Assemblywoman Leslie stated Sagewind had done a small pilot without funding but they could not continue doing so indefinitely. Thus the only chance to do a true pilot project and evaluate the results over a 2-year span of time was through
A.B. 325.

Ms. Freeman explained Sagewind had developed a fairly substantial follow-up process to track the students from the program. For the remainder of the academic year in which they participated in the program, Sagewind staff would have monthly contact with the student to reassess where they were academically, behaviorally, and with their family. Sagewind offered any case management services needed at that time. For 2 years following the completion of their program Sagewind would have contact with the child every 9 weeks or school quarter. The purpose of those contacts was again to reassess the student and offer any case management services needed. Sagewind also helped the families access any community services needed. The staff goal was to collect data leading to the program continuing through the years.

Marilyn Morrical testified on behalf of herself. She was a former director of Saint Mary’s McClain Center Programs and designed their adolescent and adult programs. She reinforced Assemblywoman Leslie’s remarks that most of the people coming through treatment started at an age of 10 or younger. Early intervention was a very effective method of keeping people out of treatment.

Ms. Morrical stated she was former Chief of the Bureau of Alcohol and Drug Abuse and addressed Ms. Freeman’s hope for funding from BADA. BADA received three-quarters of their funding from federal block grant money. Block grants had very specific criteria for use of federal funds. Twenty percent of funding must be directed to primary prevention activities and the other eighty percent went for treatment. That excluded use of those funds for intervention programs.

Ms. Morrical stated BADA received only $42,000 in state funding which was designated for after school latch key prevention programs. The remainder of funding to BADA covered operations and treatment thus there was no current funding source in BADA for an intervention program.

Louise Bayard-de-Volo, Nevada Women’s Lobby testified early intervention programs had been shown to be very effective in the long-term for very young children and the Nevada Women’s Lobby urged the committee to support
A.B. 325.

Leonard Pugh, Director, Washoe County Juvenile Services, testified that all too often children entered the detention system at age 14 or 15. In background data it was typically discovered problems started when children were in late elementary or middle school. The families often did not know where to access help so the problems went unattended for 2 or 3 years and then the child entered the detention system and the parents "have had it" and no longer want the responsibility.
Mr. Pugh strongly supported A.B. 325.

Katy Simon, Washoe County Manager, also urged strong support of the bill. Washoe County had been an active participant in the Blue Ribbon Committee that was the genesis of the recommendation. She noted the program would become a model for other communities and counties in the state.

Chairman Arberry closed the hearing on A.B. 325 with no action and opened the hearing on Budget Account 1011.

Victoria Soberinsky, Deputy Chief of Staff, Office of the Governor, read from prepared testimony found in Exhibit G.

Chairman Arberry stated the committee would listen to remaining testimony before offering their questions.

Don Hataway, Director, Budget Division stated the Washington Office budget was found in the first volume of The Executive Budget. He testified on the basis of the analysis that the Governor’s Office had made of Budget Account 1011, its activities and the direction of priorities the Governor felt the office should be taking, the Budget Division would be submitting a budget modification to the committee members for their consideration at closing.

On page Elected-9 the current Governor’s recommended expenditure level was $256,000 in the first year of the biennium and $264,000 in the second year. As part of Exhibit G the latest projected expenditure level for FY 2000 was $252,500 which was a reduction of $3,500 from The Executive Budget. The projection for FY 2001 was $259,300, which was a $4,700 reduction from the amount in the budget.

On the revenue side, the current entities that provided support for the Washington Office were the Commission on Tourism, Nevada Department of Transportation (NDOT), and the Commission on Economic Development (NCED). In addition, the Budget Division was recommending a change in level of funding from those three entities.

Looking at FY 2001 -- NDOT Tourism NCED

The Executive Budget $114,150 $ 49,950 $99,900

Budget Recommendation $129,650 $109,650 $20,000

Mr. Hataway stated because the NCED budget was a General Fund budget and the proposed changes would result in General Fund savings. The only expenditure line item was the contract for the office itself.

Tom Stephens, Director, NDOT referred to the recommended increase in fund allocations from NDOT, and explained whatever committees he spoke to he made the assumption the increased allocation would be levied. In Mr. Stephen’s opinion a lot more value was received through services of the Washington Office than was being requested in the budget.

Chairman Arberry stated the largest outcry regarding the Washington Office was measurement of the effectiveness of the office. He acknowledged Mr. Leo Penne had resigned but in the future someone had to supply the committee with accurate performance measurements. Ms. Soberinsky responded she appreciated the comment and the need for accountability but she could not speak for the prior administration. The proposed restructuring of the office would absolutely include accountability. The Governor was demanding accountability at all levels. In
2 years the office would provide accountability.

Chairman Arberry asked how the Governor’s office planned to provide accountability in 2 years. Ms. Soberinsky replied Mr. Stephens had some documentation from the past biennium and the plan was to follow along those lines. Chairman Arberry requested Mr. Stephens to explain how accountability would improve. Mr. Stephens stated one of the difficulties with the Washington Office in setting up performance indicators had been that they worked as a member of a team. The team included the Congressional delegation, the Washington NDOT consultant, and the various other representatives of the other local governmental entities. Thus the indicators would likely be more qualitative than quantitative.

In response to a request posed to NDOT by Debra King, Program Analyst, they had submitted 11 qualitative performance indicators to her. Mr. Stephens acknowledged NDOT would need to work with the Governor’s Office over the next 2 years to set appropriate indicators for transportation. Other agencies would need to assist where the office affected their needs.

Chairman Arberry asked if the performance indicator information Mr. Stephens had was for NDOT or the Washington Office. Mr. Stephens replied the information was for the transportation aspects of the Washington Office. The question posed had been, "What were the performance indicators for the Washington Office that NDOT would use to evaluate whether the contract was a benefit to the State of Nevada." He said the Governor’s Office obviously supervised the Washington Office but other agencies would have input to performance indicators as well.

Mr. Stephens read a few of the proposed indicators as examples:

1. Organize and coordinate a strategy for increasing federal transportation financing to include regular contact with the congressional delegation and staff.

He explained that was a qualitative indicator and perhaps to make it quantitative they could measure how many contacts the office had or how often they had meetings with the staff.

2. Provide staff support to the Governor in connection with the National Governor’s Association, the U.S. DOT, the White House, and the Office of Management and Budget (OMB).
3. Have regular contact and exchange of information with Nevada’s local government Washington representatives.

Mr. Stephens stated the Washington Office hosted meetings of all the local government Washington representatives to try to have some coordination in efforts on behalf of the State of Nevada. That was a very important function rather than having agencies proceed in contravention to each other or in too many directions at once.

Chairman Arberry asked if NDOT had its own agency representative or lobbyist in Washington, D.C. or was the Washington Office NDOT’s only representative in the capitol. Mr. Stephens replied NDOT had a Washington consultant who did not lobby, but provided technical expertise, information on how to complete a variety of applications or provided information such as what was the best approach to funding the Hoover Dam Bridge, how to gain a Public Lands grant, or who to contact at the Environmental Protection Agency or the Federal Highway Administration (FHWA) about an air quality conformity problem. The current consultant was a civil engineer and former administrator of the FHWA. The consultant also helped orient new staff at the offices of the congressional delegation. To some extent the NDOT efforts in Washington, D.C. were a supplement to congressional staff. There was currently only one staff person in transportation in all four delegates’ offices that was a carryover from the "TEA-21" reauthorization bill the previous year.

Chairman Arberry explained the reason for his question was he knew the Budget Division and the Governor’s Office would like to see the office stay open. He also knew NDOT’s recommendations for performance indicators were looking 2 years down the road. He directed those appearing on behalf of the office to provide some type of performance indicators before the budget was closed. The committee was not going to wait 2 years to find out what the office would do.

Ms. Soberinsky asked exactly what the committee wanted and Chairman Arberry replied that identifying appropriate performance indicators was the responsibility of the Governor’s Office. Ms. Soberinsky asked if the committee wanted performance indicators of what they had done over the past 2 years or what they had done since 1986. Chairman Arberry replied the committee desired whatever indicators the office felt were feasible to justify the office because every time the Washington Office budget came before the committee they heard the same old thing. Chairman Arberry stated his question to Mr. Stephens revealed NDOT, who paid the largest portion of the budget already had a consultant so the Washington Office didn’t appear to be doing anything for NDOT.

Ms. Soberinsky asked if the committee wanted to know future plans for the office or what the office had achieved in the past. Chairman Arberry replied the committee did not want to wait 2 years for the Governor’s Office to tell it what the functions of the office were.

Assemblyman Goldwater confirmed that Ms. Soberinsky testified funding the Washington Office was a priority of the Governor. He asked what exactly where in a list of priorities for funding, the Washington Office was placed. He commented in another hearing NCED had testified they did not get that much benefit from the Washington Office. Other functions Ms. Soberinsky had listed in her testimony also appeared duplicative. Every city and county and even certain state entities had contracted lobbyists in Washington, D.C.

Assemblyman Goldwater referred to the budget expenses listed in Exhibit G and questioned the need of $5,200 each year for telephones and $6,000 each year for travel and another $1,000 for local travel. The point of the Washington Office was to have someone in Washington, D.C. and he asked why so much travel funding was needed. Subscriptions were projected at $6,000 and Assemblyman Goldwater stated other agencies did not spend money in that manner.

Ms. Soberinsky prefaced her response by stating the numbers Assemblyman Goldwater was quoting were based on the previous administration. Mr. Goldwater commented the current administration had submitted the budget. Ms. Soberinsky stated the actual budget numbers reflected the fact that Washington, D.C. was far away. Mr. Penne in the past had traveled extensively with the National Governor’s Association and he also came back to the state to conduct office business. That was what drove up the travel costs.

Regarding telephones, in Ms. Soberinsky’s opinion $5,200 was not a wild request. There was obviously a great deal of long distance telephone calls. There had been three staff positions now being reduced to two.

Subscription costs not only included magazines, but also research materials, congressional directories, federal directories, and supported funding agencies in particular research material they needed.

Ms. Soberinsky alluded to the possible duplication of services and stated it was time to be proactive rather than myopic. Congresswoman Berkley recently appeared before the legislature and stated Nevada lawmakers had not done enough and were not doing enough to stop Yucca Mountain. The Governor wanted to do more on that issue.

Assemblyman Goldwater asked if Ms. Soberinsky expected the Washington Office to be dealing with the Federal Gaming Impact Study on behalf of the gaming industry. Ms. Soberinsky replied she expected the Washington Office to assist
Mr. Fahrenkopf’s office and the congressional delegation. Many other public entities with representation in Washington, D.C. obviously felt they needed the additional representation and the Governor’s office felt the state should be no different. Assemblyman Goldwater stated most were managing large delegations such as California with 50-some representatives while Nevada had only four.

Assemblyman Goldwater asked where on the Governor’s priority list the Washington Office. Ms. Soberinsky replied the Governor’s Office held the office to be a priority but it was not the number one priority.

Assemblywoman Chowning stated with all due respect there was only one leg of the "three-legged" stool of the team present. Ms. Soberinsky noted Mr. Robert Shriver, Director, NCED, and others were in attendance in support of the Washington Office. Assemblywoman Chowning commented when performance indicators were being discussed performance indicators should come from all three entities of the funding team. Ms. Soberinsky agreed that the performance indicators should reflect all three funding agencies and the Governor’s Office. When the performance indicators were submitted all four agencies would be reflected.

Chairman Arberry asked when the committee could expect to receive performance indicators and a mission statement for the Washington Office. Ms. Soberinsky replied they would have the information by week’s end or the beginning of the week following.

Chairman Arberry closed the hearing on Budget Account 1011 and opened the hearing on A.B. 171.

Assemblywoman Marcia de Braga, Assembly District 35, presented the bill. She testified A.B. 171 asked for an appropriation of $210,000 to assist White Pine County with astronomical costs incurred in a capital murder case. In 1996, Thomas Coleman, a state employee working at Ely State Prison tortured and murdered his 3-year old stepson Damean Stach. The case was filed in 1996 but it was filed after White Pine County’s budget had been submitted. To date the case had cost the county $223,000. The county was able to budget $70,000 in
FY 1997-98, which helped some.

The trial was held in June 1997 and most of the costs hit in June through August of that year. The case was very complex requiring many expert witnesses. The county couldn’t use the public defender because he had a conflict of interest. Therefore, they were forced to hire other attorneys.

Assemblywoman de Braga testified $210,000 did not sound like a significant amount of money given the millions the committee dealt with every day. That amount however, to a county on a very tight budget, largely dependent on mining, and which had repeatedly been faced with budget reductions due to unexpected Board of Equalization adjustments to mining property values, was very hard hit.

The cost of the case was far from over. The appeals process almost certainly would lead to even greater costs. An example of that was a murderer convicted in White Pine County in 1979, on death row since that time in Ely State Prison, was still appealing his conviction.

Assemblywoman de Braga introduced Donna Bath, White Pine County Clerk; Joe Petrelli, White Pine County Recorder/Auditor; and Cheryl Noriega, White Pine County Commissioner.

Donna Bath testified she had personal dealing with the Thomas Coleman trial. It impacted her office probably more than it did any other in the county. The office was very small with four full-time court clerks, two of whose services were required throughout the trial. Added to that were many cuts required for other reasons in the White Pine County budget.

Ms. Bath stated A.B. 171 requested an appropriation to cover some of the cost overrun experienced due to the murder trial. The county’s request for financial assistance started shortly after the county became aware of the magnitude of the case. Both of the Seventh Judicial District Court Judges spoke to representatives who advised the request must be presented to the legislature when it was in session and that was why county representatives were present at the hearing.

Ms. Bath said the county greatly appreciated the sponsorship A.B. 171 received from Assemblywoman de Braga. Due to some unfortunate financial circumstances in White Pine County the county was not prepared for the magnitude of the case. The timing was extremely bad. It occurred on June 4, 1996, right after the county budget had been submitted.

Assemblyman Marvel asked if the county had a contract with the state public defender’s office. Ms. Bath said the county had, but in the Coleman case, the state public defender’s office had a conflict of interest. Assemblyman Marvel noted several counties were giving various testimonies that indicated the public defender’s office would not assist due to conflicts of interest. It seemed if the county paid the public defender’s office it was their job to defend the contracted counties. Ms. Bath replied White Pine County felt the same way, but unfortunately, White Pine County could not use their own district attorney’s office because the person in that position was brand new and did not have the experience needed to try a capital murder case.

Ms. Bath stated the county was fortunate in obtaining the services of the Las Vegas District Attorney’s office. That office had two career prosecutors, extremely qualified women, who came from Las Vegas and did not charge a salary to White Pine County. The county only had to pay per diem, travel and room and board. Even with that, the county incurred exorbitant costs. The case required two defense attorneys that had to be death penalty certified and qualified.

Assemblyman Marvel stated he had no problem with the prosecutorial costs but it disturbed him that when the county contracted with the public defender, it was their job to assist the county. He noted a similar circumstance had occurred in Pershing County where a judge had ordered Pershing County to pay and Assemblyman Marvel had advised the county commissioners to refuse payment. Ms. Bath responded she wished White Pine County could have done that but they were presented with the bill and it was paid.

Ms. Bath continued, the county had paid the bill and were paying the bills but unfortunately, the county was on such a tight budget the costs were felt even worse.

The case was a very complex murder case involving the brutal beating, torture, and murder of a 3-year old infant named Damean Stach. Ms. Bath stated she had sat through the 6-week trial and it was an ordeal for everyone to experience.

The case turned many times on the testimony of expert witnesses on both sides. She added if an expert witness was presented by the prosecution, the defense was allowed an expert as well. One of the biggest issues in the case was the cause of death of the infant. Testimony was heard from pathologists on both sides who provided their expert opinions of cause of death. Testimony was heard from a number of forensic odentologists regarding bite-mark evidence. Many experts gave their opinions on what constituted child abuse. The experts came to Ely from Reno, Las Vegas, San Diego and Los Angeles. Those requirements and the remoteness of Ely increased travel costs related to the trial and the county had no control nor could they refuse to pay any one of those witnesses.

Joe Petrelli, White Pine County Recorder/Auditor, provided committee members with a summary of trial expenses (Exhibit H). Page H-4 detailed those expenses. To date the trial had cost $223,500. The attorney fees were $105,000, expert witnesses cost $29,400, investigations were $25,300, transcriber fees were $22,300 and miscellaneous fees which included jury, witnesses, lodging, per diem and others had reached $41,500.

Mr. Petrelli testified the timing of the expenses were crucial in the case. The FY 1996-97 budget had been submitted and in the same month the case was filed and trial was set for about 1 year out. In FY 1997-98 the county recognized the trial would start in June 1997 and budgeted $70,000 for the trial. The district court judges arrived at the $70,000 figure by consideration of all the factors. In June of 1997 the county incurred $81,300 of the expense, in July through September of FY 1997-98 the county incurred an additional $133,000 of expense.

In FY 1998-99 the county had through December 1998, incurred $9,200 in expenses. The county was able to use some re-appropriation and some appropriation of contingency funds to augment the budget and cover a portion of the costs.

In the Judicial budget for FY 1996-97 the county budgeted $321,350. Actual expense in that budget in the same year was $354,602, which result in variance. Variance from the original budget of $33,252. In FY 1997-98 the original budget was $280,215 and actual expenses were $397,460 with a variance from the original budget of $117,245 overspent. The county was able to revise the budget at the end of each year for the judicial category. In FY 1996-97 the budget was revised to $336,951, which left a revised variance of $17,651 overspent. In FY 1997-98 the county again revised its budget up to $353,200 leaving a variance deficit of $44,260.

The county was requesting an appropriation of $81,300 for FY 1996-97 as the county had been unable to budget any funds for the trial. In FY 1997-98 the county had budgeted $70,000 for the trial itself and was requesting the difference of $63,000 between the budget and the actual expense. For FY 1998-99 the county budgeted $9,200 and the expenses were the same amount so nothing was being requested for that fiscal year from the state.

Mr. Petrelli stated A.B. 171 was written with a request for $210,000 and the county had been able to offset a portion of that cost thus the county was actually requesting an appropriation of $144,300.

Assemblyman Goldwater stated in the school board budget hearing the committee had asked for a look at the county budget and expenditures and he was not aware if that had been received. Mr. Petrelli stated he was aware of the request and
Mr. Bob Hadfield, Nevada Association of Counties, had requested a copy of the budget which had been submitted and another copy had been submitted to
Paul Johnson of the school district. He was aware of the concern and desire to understand the county budget better. He acknowledged the county had a history of problems in certain areas of the budget. He testified in terms of the county budget over the past couple of years there had been no frivolous spending at all. The problems stemmed from the cost of the trial, which had pushed the county over the edge as far as budget and cash flow. Another problem was the county was coming off a pinnacle of construction economics for the reopening of the large copper mine in the county. The economy spiked up and then spiked down. Currently it had leveled off. The projections were not formulated correctly that resulted in a reduction in assessed value to the mine. That effect caused lower revenue to be realized than was budgeted. The one-half cent sales tax revenue came in at approximately 75 percent of projections as well.

Assemblyman Goldwater asked what the sales tax rate was in White Pine County. Mr. Petrelli replied White Pine County was at 6.75 percent sales tax. Mr. Petrelli stated the problem sprang from the shortfall of revenue coupled with the extra expense of the trial that had pushed the county over the edge. The county had done a lot to correct their debt deficiency prior to requesting the assistance of the state.

Assemblywoman de Braga asked if Mr. Petrelli had submitted a copy of the county budget to committee staff. Mr. Petrelli replied he had not but he would be glad to do so.

Assemblyman Marvel asked what the county paid for the public defender contract. Mr. Petrelli replied approximately $120,000 per year.

Ms. Bath testified she was aware that the county did not have a very good track record financially, however, in the past 4 years the county had tried to buckle down and pull together. It had taken the leadership of Mr. Petrelli who went to the Department of Taxation and requested technical assistance from them. It also took the cooperation of every department head and county commissioner to get as far as they had. In many instances staff paid their own travel expenses and bought supplies from personal funds in some cases. The county just needed some assistance to get back on their feet and under the present leadership the county would be all right. Vice-Chair Evans noted the committee appreciated the hard work and was aware of the situation.

Speaker Dini asked the county to explain to the committee what costs White Pine County had incurred by having the state penitentiary in their county and the impact on the courts. Ms. Bath stated she could not respond in actual dollar costs but as the court had two full-time district court judges as well as a juvenile court master. The clerk’s office had five positions. Her staff was in court nearly 5 days a week. The Ely state prison had a great impact on the office that had eased somewhat since the cases involving habeas corpus had been turned back to the courts of original jurisdiction. Everything done in White Pine County was done on an indigent basis. Thus everything from the Ely inmates was on a no-pay basis. She stated the cases typically heard included:

• Divorces;
• Name changes; and
• Lawsuits because they didn’t like something in the food menu.

A large number of jury trials were generated from the Ely prison as well.

Speaker Dini asked if there were two recording secretaries, one for each court. Ms. Bath replied that was correct, but they also had to work elections, county commission meetings and other office functions. Ms. Bath also worked as a recording secretary as needed.

Speaker Dini asked how many courtrooms the county had. Ms. Bath replied there were two courtrooms and usually Monday through Thursday they handled the Seventh Judicial Court business and Friday they did family court and juvenile matters.

Speaker Dini commented it sounded like the county had tripled its court workload with the opening of the prison. Ms. Bath stated that was very true, especially in the juvenile area. In 1993 there were 31 juvenile cases and in 1997 there were 105 juvenile cases.

Cheryl Noriega, White Pine County Commissioner testified she became a commissioner in January 1997 and it was quite an experience to go through the budget and make necessary cuts and then come back half-way through the year and try to find a way to cut an additional $1 million from the budget again. She reiterated what others had said that everyone was working very hard. In 1998 the roof was leaking in one of the courtrooms and the county had to get a grant to effect repairs. The courtrooms actually had buckets in them. Many people bought computers out of their own pockets and paid some of their own travel.
Ms. Noriega said A.B. 171 would really help and maybe some day they would "have the train back on the track."

Chairman Arberry closed the hearing on A.B.171 with no action. In the interest of time, the Chair opened the hearings on A.B.4, A.B.6, A.B. 139, and A.C.R. 9 for testimony all at the same time.

Assemblywoman Vivian Freeman, Assembly District 24, stated the series of four bills, A.B. 4, A.B. 6, A.B. 139, and A.C.R. 9 came out of the Standing Committee on Health Care chaired by Senator Rawson. Assemblywoman Buckley was also on the committee. Innumerable hearings were held and they all felt strongly enough about all the issues that they wanted to support the bills and even with budget shortfalls that somehow there had to be money found to fund the programs.

A.B. 6 provided health insurance for children and others, dealt with eligibility for Medicaid, and for care for the disabled.

A.B. 4 prohibited the Department of Human Services from considering the assets of children, pregnant women, or their families to determine eligibility for child health assurance. She urged serious consideration for the bill.

Assemblywoman Barbara Buckley, Assembly District 8, testified that in the legislative process, the Health and Human Services Committee debated and heard testimony about policy. The interim health committee met once a month for
8 hours over 1.5 years. The outcome was the programs that the committee felt were most important didn’t really get highlighted in the Ways and Means Committee. Policy was approved in the other committees with each typically having a price tag, and the Ways and Means committee members did not have the benefit of policy discussions. Fortunately, some of the long-term committee members were aware of some of the health care issues.

A.B. 4 was important because the asset test needed to be removed from Child Health Assurance Program (CHAP) qualifications. From a health care perspective, the importance lay in the fact the State of Nevada never had an asset test for CHAP until the budget cuts of 1992 and 1993. The asset test was placed as a barrier to keep people from getting health care insurance in tight fiscal times. If a family had a beat up old station wagon that got them back and forth to work they could lose their health insurance.

Nevada Checkup had started in the intervening years. Checkup had no asset test. Assemblywoman Buckley stated the result was that for a person making $12 per hour it did not matter if they had two cars, but those making $5 per hour, who had two cars and were on Medicaid, lost their insurance. It did not make sense with two heath care programs to have an asset test on one and not on the other. It also did not make sense to have no asset test for the program serving those of a higher income level.

Assemblywoman Buckley stated money and administration could be saved by eliminating the asset test. If a working mother making $9 per hour with three children wanted health insurance not offered by her employer she could apply for Nevada Checkup where she would complete an application (different from the one for CHAP). If the mother was accepted for Nevada Checkup, staff might look at the income level and suggest the mother apply for Medicaid. The mother would apply for Medicaid on yet another application, and if that application was not completed within 30 days the mother was cut off from Nevada Checkup. Interim testimony revealed the state was spending extra staff time to process two applications and the mother could still wind up disenrolled from Nevada Checkup.

The goal was to have one application and no disenrollment. One answer to that question in the interim had been, "One of the requirements of Medicaid was the asset test and that was why there had to be two bureaus and two applications." Assemblywoman Freeman had asked why the asset test was needed and never received a satisfactory response.

Assemblywoman Buckley stated the original fiscal note in her opinion was grossly inflated and assumed that anyone who had even thought of applying or had been eligible to apply in the past would apply if the asset test was removed. There was some impact but it had to be considered in the broader policy of having a simpler, less bureaucratic process.

Assemblywoman Buckley concluded she assumed it was the health care policy of the state to want to see more children insured. Nevada Checkup and CHAP were programs for kids to get health care insurance. The resources that were being wasted by having children in emergency rooms for earaches because they did not have insurance did not make sense.

Assemblywoman Buckley commented the committee would be hearing a number of health care bills during the session that needed funding, and would have very little money to provide. Some of the most important issues from a policy point of view were restoring the Medicaid Waiver funding approved in the 1997 Legislative Session, maximizing participation in the Nevada Checkup and CHAP programs, presumptive eligibility that would be presented in A.B. 5, allowing the disabled to return to work through A.B. 139, and enhancing the Personal Care Assistant (PCA) program. There were 4,300 children enrolled in Nevada Checkup and that was not good enough. A user-friendly system was needed to ensure people who needed a little help had it available.

Assemblywoman Freeman elaborated regarding the perceived inflation in the fiscal note. During the 1999 Legislative Session fiscal notes on bills in the Health and Human Services Committee were typically grossly over-inflated.

Assemblywoman Freeman stated A.B. 6 enhanced the eligibility program for children’s health care. In regards to marketing, an application for a grant from the Robert Woods Foundation was being requested.

Earlier in the session, several members of the legislature had heard from some of the Medicaid recipients who needed a PCA in their homes to continue being out in the community or return to the community as functioning citizens. Theirs was a compelling case. Those issues were covered in A.C.R. 9. She hoped funding would become available so the state could do what was smart rather than what was a "quick fix."

Assemblyman Hettrick stated the committee had heard testimony a few days previous regarding enrollees in Nevada Checkup that had revealed with 4,300 enrolled, Nevada was actually at a higher percentage rate than some of the other surrounding states over a much shorter period of time. He noted while arguably more could be done, he did not want the program perceived as not having any success. Assemblywoman Buckley stated Nevada could not conclude it was doing well by comparing itself to mediocrity. Lots of clever marketing techniques had been used in other states and she did not think the resources were being allocated to do creative marketing in Nevada. Resources did not only mean money, but the job could be done better if everyone were more focused. Assemblyman Hettrick stated obviously there were other good minds trying to work in other states and they were doing poorer than Nevada in terms of percentage penetration.

Chairman Arberry asked if there was anyone present to testify on bills A.B. 4, A.B. 6, A.B. 139, or A.C.R. 9. He requested witnesses to identify which bill they were testifying about. All four bills were being heard together due to the limited time available.

John Sasser, Washoe Legal Services, spoke to all four bills. He provided written testimony on A.B. 139, A.B. 4, and A.B. 6 which are included at Exhibits I, and J respectively.

Mr. Sasser had the honor of serving as a lay member of the Interim Committee on Health. The interim committee published a report that recommended 26 pieces of legislation. It was recognized in the tight budget cycle that not all 26 of those would be funded. Groups of advocates for the disabled community and the advocates for needs of women and children had tried to prioritize the needs.

The priorities were:

1. Restoration of the disabled Medicaid waiver (not before the committee at that hearing);
2. A.B. 139; and
3. A.C.R. 9.

The interim committee had meetings with Janice Wright, Deputy Administrator, Department of Human Resources, and had agreed, in light of the original fiscal notes, that A.B. 139 was not possible because the second year of the biennium called for appropriation of $189 million as the bill was currently written. Although he agreed the fiscal note was far out of line with reality, it would still cost something.

Mr. Sasser proposed an amendment found in Exhibit I for A.B. 139. The amendment read:

The amendment would allow the disabled to return to work but ask the state to develop a waiver that would focus solely on those people who were currently sitting at home, not working and drawing Medicaid. The disabled would cost money if they were sitting at home and they were going to cost money if they were in the workplace. In the long run the state would save money from the return to work. The disabled would buy-in to the Medicaid program either through premiums or through cost of care. In addition when people returned to work, they would ultimately re-qualify for insurance through their company’s private insurer.

Effectively through the amendment A.B. 139 was altered from a bill with high fiscal impact to a cost-neutral bill and would actually save money in the long run in terms of medical payments.

Mr. Sasser expected Ms. Wright to testify the agency would need some extra staff to develop the waiver and anytime something was done that affected the Nevada Operations Multi- Automated Data Systems (NOMADS) reprogramming costs were associated.

Mr. Sasser testified on A.C.R. 9 stating the interim standing committee had heard hours of testimony of practical problems with the PCA program. One thing that was certainly needed, but understood not to be available in the current legislative session, was an increase in compensation to PCAs. The interim committee was asking to amend the focus either by a letter of understanding or through the resolution that would ask the division to solve certain problems including backup PCA problems. Testimony had been heard from persons whose PCA did not show up and the patient sat at home in their own feces for hours or even days because the PCA program did not have a backup system.

Other problems included: recruitment of PCAs and a requirement for workman’s compensation for coverage of up-front costs. Mr. Sasser said they had agreed to back the money out of A.C.R. 9 and limit the focus to improvements in the program.

A.B. 4 was one of the highest priorities to eliminate the asset test in the Medicaid program, to make the program seamless with the Checkup program, and eliminate barriers to getting people enrolled.

The fiscal note on A.B. 4 was $1.5 million in the first year of the biennium and $1.7 million in the second year. The bulk of the fiscal note was built on the "woodwork" factor. The "woodwork" factor assumed that some 1,500 people who might have applied and been turned down over the past 7 or 8 years would suddenly reapply immediately in the first year of the biennium. There was no scientific basis for that. The fiscal note projections had not been discussed with the eligibility personnel of the Welfare Division.

The bill applied to both pregnant women and children. A pregnant woman who had applied 3 years previous would not likely be reapplying under the new guidelines. Mr. Sasser stated his belief that the "woodwork" factor would be an additional
175 applicants above the 175 annually that were denied coverage. That would make the fiscal note in state dollars $450,000 in the first year of the biennium as opposed to $1.5 million. Mr. Sasser asked the Chair to instruct staff to review his fiscal assumptions and the assumptions the division made in the initial fiscal note and come up with a figure more in line with reality to move the bill.

Mr. Sasser concluded those were the priorities established by the interim committee and explained how costs were backed out of the bills and asked the committee to move ahead with the bills and others that would follow.

Donny Loux, Chief, Office of Community-Based Services, testified the division provided personal assistance services, independent living services, housing, and traumatic brain injury and deaf services to people with disabilities.

Ms. Loux stated she wished to testify as a lay member of the Interim Standing Health Care Committee. She was in agreement with previous speakers that restoration of the Medicaid Waiver was the number one priority of the interim committee. Second was presumptive eligibility and the third priority was A.B. 139 as amended to be cost-effective through the Medicaid buy-in program. As a member of the interim committee it was at Ms. Loux’s request that the Medicaid buy-in system was brought forward. The buy-in was based on a Massachusetts program that had been in effect since 1988.

The Massachusetts program allowed access to everyone. Families and anyone eligible for Medicaid under an increased income was allowed in the program. In spite of that fact, throughout the intervening years since the program began, and with no income limit, the plan had only 3,596 people enrolled.

Ms. Loux said that was because the applicants were people with severe disabilities and the programs were not in place for additional services such as housing, personal assistance and other services. The "woodwork" effect would not be that great. However, the disability community had agreed to the limitation, which allowed existing Medicaid clients only to ensure there was no "woodworking factor."

Ms. Loux provided committee members with written testimony from which she read one paragraph that was an excerpt from the congressional report (Exhibit K).

Services that were absolutely necessary for people with severe disabilities to return to work included personal assistance and homemaker services, which were not allowable health care insurance expenses, even if a severely disabled person could qualify for a health care insurance program. Most of the people returned to work under the program would have some sort of health insurance through their employers and would only need the "wraparound" services unattainable through private health insurance.

Mary Jean Thomsen, Community Advocacy Coordinator, Northern Nevada Center for Independent Living testified on A.B. 139. She provided the committee with written testimony (Exhibit L). In February she had testified on A.B. 139 stating that her consumers wanted to work but they could not because of the "Catch 22" situation they were in with Medicaid.

Ms. Thomsen urged support of A.B. 139 and the people it represented. The bill created a glimmer of hope for those individuals that had a disability, required Medicaid to maintain their existence in the community, and who wished to be productive citizens in the state of Nevada.

Ms. Thomsen read from Exhibit L.

Paul Gowins, Disability Forum, testified the group was about 50-members strong and were known leaders in the state of Nevada. He spoke in support of the priorities that had been established by earlier witnesses. Mr. Marvel was known to get really angry over what he deemed was bad policy. It was hoped Mr. Marvel would feel equally as strong about the "good policy" bills currently being heard.

The two issues most important to people with disabilities were getting out of bed and maintaining themselves in the community, the number one priority, and secondly, once a disabled person got out in the community, they needed to maintain their health care coverage. A lot of anecdotal situations were heard but from the heart and in reality, if the disabled person went to work and increased their income they would lose their Medicaid eligibility. The buy-in program would solve that issue. Other states with long-standing buy-in programs had maintained cost neutrality.

Mr. Gowins reminded the committee when the Medicaid Waiver restoration was heard, the committee room was packed with severely disabled people. He noted some of those people had stayed up all night or begged and borrowed transportation just to make that appearance.

Two years of work had been done to get to the point of the bills currently being heard and the disabled community understood the fiscal restraints the legislature was working under. Prioritizing the waiver and the buy-in programs should help the legislature to come to decisions on those issues. Mr. Gowins acknowledged the agencies might testify regarding fiscal issues such as NOMADS and staffing and they would need to implement the priorities.

Assemblyman Marvel asked how many people would become eligible if A.B. 139 was passed. Mr. Gowins replied anyone with a physical disability who was currently receiving Medicaid services would potentially be eligible to go to work. He noted it sounded like a lot of people but he had spoken to the federal government and learned they were also attempting to address the issue. Once people get on the SSI roles they never left because they did not have the option to get health insurance they absolutely had to have. The bill was cost neutral, provided a better way of life, there could be long-term savings through the "wrap around," and the clients would contribute to the tax base. He stated he could not provide a specific number. Assemblyman Marvel asked if the probable number would be fairly significant and Mr. Gowins replied he did not think it would be. He said out of 10 disabled persons, perhaps 4 would apply.

Mr. Marvel commented in 1985, he was probably the only member of the Assembly Ways and Means Committee to push passage of the independent living bill and they had a fight on their hands. Mr. Gowins stated he understood that fight and the current situation was similar. The independent living program had done extremely well and was why there had been some complaints about A.C.R. 9. A lot of questions had to be answered before A.C.R. 9 had been able to move forward.

Chairman Arberry commented time was short and the hearing needed to move along.

Mary Jean Thomsen, Community Advocacy Coordinator, Northern Nevada Center for Independent Living, provided written testimony on A.C.R. 9 (Exhibit M). The Chair explained witnesses were supposed to have testified on A.B. 4, A.B. 6,
A.B. 139, and A.C.R. 9 at one time but allowed her further testimony.

Ms. Thomsen summarized her testimony that persons with disabilities did not know how to access the Medicaid system for personal care services. There were four different programs within Medicaid and consumers did not understand how to access those and which programs they actually qualified for.

Employment as a Personal Care Assistant was not an attractive position for employees in Nevada. The assistants had to pay up-front costs for workers compensation coverage, they received no health benefits, holiday, vacation or sick pay. They were considered independent contractors, and received $9.25 per hour before income taxes, workers compensation, social security or Medicare deductions.

Ms. Thomsen emphasized there was no backup system and insufficient recruitment strategies.

Ms. Thomsen requested the committee to eliminate the "Fear Factor" of being institutionalized, ask that Medicaid create the concrete backup system needed, and provide increased wages for PCAs because they would not stay around if the wage did not allow them to maintain the occupation.

Ms. Thomsen voiced her wish for Medicare to resolve the worker’s compensation barrier on personal care attendants and increase recruitment strategies.

Ms. Thomsen concluded with her own personal recommendation that Medicaid contract with an outside service as did the Office of Community-based Services with Accessible Space Incorporated. It would eliminate the consumer’s confusion, provide a backup system, provide PCAs with benefits, needed supervision, and desperately needed training for their employment. That would eliminate Medicaid as the Personal Care Attendant employer and eliminate the standing issues before the committee.

On behalf of individuals with disabilities that were unable to attend the hearing due to the lack of available PCAs at 4 a.m. she thanked the committee for listening to the recommendations and considering the requests.

Janice Gilbert, representing the Progressive Leadership Alliance of Nevada voiced her support of A.B. 139, A.B. 4, A.B. 6, and A.C.R. 9.

A.B. 139 was cost neutral or if a fiscal note was called for it would be a small amount for program changes to NOMADS. Passage of the bill seemed a "no brainer" because it was so cheap for the benefits it would provide.

Ms. Gilbert stated A.C.R . 9 was an urgent need because it had no fiscal note.

A.B. 6 had no fiscal note and Ms. Gilbert urged its passage. One application would streamline the process and encourage people to apply.

Ms. Gilbert stated A.B. 4 had a fiscal note but it was the key to making the program work. She reminded the committee that the Interim Health Care Committee was a non-partisan committee that Senator Rawson chaired.

Lisa Appelrouth Guzman, Director, Nevada Empowered Women’s Project read from prepared testimony (Exhibit N).

A 1994 study published in the 1997 Kids Count Data Book showed about 20 percent of Nevada’s children did not have health insurance, which was about
7 percent higher than the national average. The state should do whatever was needed to provide health care coverage to children.

When considering removal of the asset test for the CHAP program, families still needed to be "low-income" on a monthly basis to qualify for the program.

A.B. 6 would create a single application for the Medicaid and Nevada Checkup program and had her support. Ms. Appelrouth stated the current process could be very confusing. The form to apply for Nevada Checkup was one page on both the front and back however it contained information on the Medicaid program, which was confusing. If a client applied for Checkup and was really eligible for Medicaid, they were required to complete the second application for Medicaid, which was upwards of 15 pages long.

Louise Bayard-de-Volo, Nevada Women’s Lobby testified they had also been following the evolution of the four bills through the health care committee and wished to offer their support. It was very important to keep the "big picture" in mind. Removing some barriers might cause more people to enroll in Medicaid and Checkup but that was good. Good health care had long-term benefits for Nevada and for the quality of life of Nevadans.

The four bills would not only remove frustrating barriers to consumers (pregnant women and children) but could also save money in terms of staff time. Preventive care held cost savings for the state. The lobby wished to support A.C.R. 9, and A.B. 139 as amended.

Marla Williams, Senior Research Analyst, Legislative Counsel Bureau, stated she was the primary staff person on the legislative committee for health care and asked the committee to review the written comments provided from Senator Raymond Rawson for A.B. 139, A.B. 4, A.B. 6, and A.C.R. 9. That testimony is attached as Exhibits O, P, and Q. Ms. Williams offered to answer any questions the committee might have on the interim health care committee.

Janice Wright, Deputy Administrator, Division of Heath Care Financing and Policy testified all of the programs discussed in A.B. 139, A.B. 4, A.B. 6, and A.C.R. 9 were expansions of the existing Medicaid programs therefore all of them had a fiscal note. She stated she had presented information on the fiscal impact of each to committee staff. She shared with the committee that Director Charlotte Crawford had also worked with the interim committee. She had testified on numerous occasions that there would be fiscal impacts if the Medicaid program was expanded.

All the bills represented worthwhile goals. The division had no difficulty understanding the need for the requests but in a limited budget it would be difficult to fund the expansions.

Chairman Arberry asked Ms. Wright to briefly discuss the costs associated with A.B. 139. Ms. Wright replied that bill as amended would have a slight fiscal impact. Mr. Sasser had been very cooperative in working with the agency and the division would develop some language and opportunities and attempt to keep the bill revenue neutral if at all possible. There might be some up-front costs in the first year of the biennium that could possibly be offset by savings in the second year of the biennium.

Chairman Arberry asked when the revised fiscal note could be expected and
Ms. Wright replied in approximately 1 week. The Chair stated it was needed before that time. Ms. Wright replied the division would work with Mr. Sasser on language following the current hearing. Chairman Arberry requested the information be provided to staff by March 23, 1999. Ms. Wright agreed.

Vice-Chair Evans commented that according to her bill book there was no fiscal note on A.B. 6. She added a fiscal note was present but it showed no cost.
Ms. Wright stated that was the impact to the division for the original version of the bill. Through a subsequent amendment there was currently an additional fiscal note and most of that cost would be incurred by the Welfare Division relating to NOMADS and training for the eligibility rules.

Chairman Arberry closed the hearing on A.B. 139, A.B. 4, A.B. 6, and A.C.R. 9.

Chairman Arberry offered a bill draft for committee introduction.

BDR 17-1367 – Prospectively increases salary of legislators and provides for a communications allowance. (A.B. 600)

Chairman Arberry provided the next day’s committee schedule and asked members to be prepared to discuss planned budget closures.

There being no further business before the committee the meeting was adjourned at 10:45.

RESPECTFULLY SUBMITTED:

Cindy Clampitt,

Committee Secretary

APPROVED BY:

Assemblyman Morse Arberry Jr., Chairman

DATE: