The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 7:30 a.m., on Wednesday, March 10, 1999, in Room 2135 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

COMMITTEE MEMBERS PRESENT:

Senator Randolph J. Townsend, Chairman

Senator Ann O’Connell, Vice Chairman

Senator Mark Amodei

Senator Dean A. Rhoads

Senator Raymond C. Shaffer

Senator Michael A. (Mike) Schneider

Senator Maggie Carlton

STAFF MEMBERS PRESENT:

Scott Young, Committee Policy Analyst

John L. Meder, Committee Policy Analyst

Beverly Willis, Committee Secretary

OTHERS PRESENT:

Chairman Townsend opened the meeting today by presenting Bill Draft Request (BDR) 57-682.

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Senator Townsend advised the committee of a change in the agenda, noting although Senate Bill (S.B.) 95 had already been resolved in a previous committee session, a new amendment had been ignored. Senator Townsend asked for a motion to reconsider S.B. 95.

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Robert A. Ostrovsky, Lobbyist, American Toxicology Institute, and Nevadans for Affordable Health Care, presented an amendment to S.B. 95 (Exhibit C), to clarify certification requirements.

Chairman Townsend and Fred Hillerby, Lobbyist, Associated Pathologists Laboratories, and Hometown Health Plan, discussed whether or not a separate entity would deal with quality assurance as opposed to normal insurance issues regarding financial insolvency. Senator Townsend declared his concern stemmed from debate held pertaining to ombudsman jurisdictional issues that had been expressed concerning quality assurance versus insurance and financial solvency. Senator Townsend asserted these issues would need deliberation to determine the best course of action. Mr. Hillerby and Senator Townsend conferred on possible solutions to the possibility of an ombudsman being part of a state agency. Mr. Ostrovsky joined the discussion, noting efforts had been made to offer a consumer-friendly method to respond to concerns of the citizens who may have problems with insurance claims.

Mr. Hillerby, representing Associated Pathologists Laboratories, claimed the amendment presented by Mr. Ostrovsky might need adjustments in language to cover certain tests in toxicology. Senator Townsend, Mr. Hillerby and Mr. Ostrovsky perused standards for, and responsibilities of, laboratories conducting any kind of test pertaining to pre-employment drug testing or random drug testing.

Senator Townsend called for committee action pertaining to S.B. 95.

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Senator Townsend remarked on two proposed amendments to S.B. 210. Number one, a proposed amendment offered by Ron Johnson, Acting Chief, Bureau of Alcohol and Drug Abuse (BADA) (Exhibit D). Number two; an amendment presented by David Gibson, Clark County Drug Court Program (Exhibit E). Dorothy B. North, Lobbyist, National Association of Alcohol and Drug Abuse, stated she had spent time working with many of those concerned with this legislation. Ms. North offered changes to S.B. 210 (Exhibit F). Ms. North claimed her organization had incorporated all the changes BADA had recommended, and she had tried to incorporate changes of all those concerned. She claimed significant changes came from those within the field, noting some of those contacted were professionals in various fields.

Marilynn K. Morrical, Lobbyist, Certified Alcohol and Drug Abuse Counselor, presented Changes to S.B. 210 (Exhibit F). At the request of Chairman Townsend, Ms. North offered reasoning for this legislation and how it would benefit the public. Ms. North stated Nevada has had a certification process for alcohol and drug counselors for some time; with this legislation providing the means for licensure. She noted in 2001, S.B. 210 would necessitate a master’s degree to become a licensed alcohol/drug counselor. Ms. North maintained this would benefit the public since it would entitle all to have the assurance of competent help, noting a number of other states have licensure requirements. Senator O’Connell inquired if there were educational facilities in Nevada to accommodate those wishing to become counselors. Ms. North noted those who would become licensed need a master’s degree in some field of social science.

Ms. Morrical noted she had added sections covering definitions of "certification" and "certified counselor." Referring to Exhibit F, Ms. Morrical examined each of the 29 items listed, with her reasons for these changes. Senator Townsend requested a copy of the finished legislation with any changes, noting it would be too difficult to make a final decision from the notes in Exhibit F.

Senator O’Connell inquired about the fiscal note, commenting the committee did not have a fiscal note. Ms. North claimed this referred to fees collected, making any administration self-supporting. Senator Townsend and Senator O’Connell noted the data on the copy of S.B. 210 stated there would be an effect on local government, with Ms. North questioning this information. Senator O’Connell had other inquiries on how much money would be raised by the proposed budget, and whether or not these were actual costs being raised, with Ms. North claiming only fees for the continuation of business. Upon further questioning, Ms. North asserted a final budget had not, as yet, been completed. Senator Townsend pointed out this would be a determining factor that must be prepared before any legislation could be processed.

Rosalind Tuana, Executive Director, Board of Examiners for Social Workers, claimed she had received a request for a copy of the budget. Ms. North maintained she was not aware of any budget. Ms. Tuana offered to share with Ms. North and her associates. Senator O’Connell and Ms. North held further discussion regarding budget concerns, with Senator O’Connell referring to a possible limit on fees, etc., as noted in S.B. 210. Ms. North claimed her budget might possibly be similar to other agencies in related groups. Once again, Senator O’Connell emphasized budget limitations noted in S.B. 210. Senator Townsend reiterated concerns expressed by Senator O’Connell pertaining to budgetary matters. Senator Townsend cautioned Ms. North to be aware of all types of expenses that would need to be included in the budget.

Helen A. Foley, Lobbyist, Marriage and Family Therapists, and Humana Healthcare Inc., representing the Marriage and Family Therapists, stated she would be happy to help Ms. North with a fee schedule. Roberta A. Gang, Lobbyist, National Association of Social Workers, Nevada Chapter, joined Ms. Foley in the discussion with both agreeing if their associates are involved in an area of alcohol and drug abuse, they would need education, licensure and experience in these areas.

Gary Short Meneley, Clinical Director, The Ridge House, declared he was a certified drug and alcohol counselor, expressing his opinion that a great deal of experience was necessary in order to become really skillful in this line of work. Mr. Meneley maintained there should be a higher level of experience, in this field, with the educational requirement specific to substance abuse counseling.

Kathy Apple, R.N., H.S., Executive Director, State Board of Nursing, noted she had concerns about the educational requirements as they would apply to nurses. Ms. Apple stated she would be happy to help with budgetary problems.

Ms. Tuana stated she had concerns about the composition of the Board of Examiners for Alcohol and Drug Abuse Counselors, asserting there should be a public member. Senator Townsend agreed this would be very important. Referring to Exhibit F, it was determined to have a draft amendment to be presented at a later date.

Chairman Townsend closed the hearing on S.B. 210 and opened the hearing on S.B. 196.

Senator Schneider gave a few opening remarks pertaining to discussion/work by several different groups with concerns in the consumer health assistance area. Senator Schneider stated his goal would be to help the small-business person in particular. Senator Schneider and Senator O’Connell perused pitfalls and options available to help policyholders better understand the parameters of their insurance policies. It was suggested that at the time of the sale of a policy, better explanations should be available.

Senator Schneider maintained he would like to have an ombudsman-type person in the insurance commissioner’s office to deal with complaints and problems about health insurance. Senator Schneider asserted a $1 surcharge added to all health insurance policies would be needed, in order to establish this office. He did note, however, his reluctance to add the proposed fee, but felt it would be required.

Alice A. Molasky-Arman, Commissioner, Division of Insurance, Department of Business and Industry, answered questions posed by Chairman Townsend on any statistics that might be available on complaints, complaints resolved, or complaints under appeal. Ms. Molasky-Arman stated these types of figures were available and offered to bring updated material on these figures at a later date. Mr. Hillerby, Ms. Foley, Ms. Molasky-Arman and Senator Townsend examined how and when this report would be due and how the insurance division would handle these complaints. Senator Townsend and Ms. Molasky-Arman discussed the type of employee needed to fill this ombudsman-type position. Ms. Molasky-Arman maintained someone with a medical background, with Senator Townsend concurring. Senator Townsend reiterated his opinion an employee with a medical background would be desirable, as many situations could involve these types of questions/answers. Ms. Molasky-Arman and Senator Townsend continued their scrutiny of the source and conclusion of these inquiries. Senator Townsend maintained it would be necessary to know the source of these calls in order to make more resources available. In order to better service the needs of those with problems, he claimed, one priority would be to make sure the insurance division has the appropriate technology without taking away the human element. Senator Townsend emphasized educating consumers on how to purchase and how to read insurance policies would help in reducing the number of complaint/problem calls. He noted, however, it was the responsibility of the consumer to try to pay attention to any explanation when these policies are purchased.

Senator Schneider maintained a prime concern would be to help seniors as well as those who might have a language problem. Senator O’Connell suggested contacting a senior’s club that might have knowledgeable members to conduct seminars, and work groups, for an explanation of insurance policies. She proposed the possibility of a consumer guide to offer various types of information. Ms. Molasky-Arman noted this type of information was already available from her office. She explained for seniors in particular, the Information Counseling and Assistance (ICA) program was offered.

Mr. Ostrovsky asserted one goal of Nevadans for Affordable Health Care was to expand the number of those insured and help them understand, and how best to use, their health coverage. He considered other concerns pertaining to duties of the insurance commissioner and pointed out the enormous number of calls to other health care providers from those seeking information on insurance policies; i.e., coverage, provider doctors, medical information. Mr. Ostrovsky noted he had concerns over the possibility of a surcharge on health insurance policies to be used for an ombudsman. Ms. Foley, speaking for Humana Healthcare Inc., concurred with concerns voiced by Mr. Ostrovsky pertaining to the burden, especially to small business, that would be created by a $1 surcharge to fund the proposed ombudsman program. Senator Schneider stated he was sensitive to the concerns expressed by Mr. Ostrovsky and Ms. Foley.

Senator Townsend reiterated his emphasis on education about health insurance policies for consumers. He asserted focusing on teaching students in high school about insurance was of prime importance.

It was determined to send S.B. 196 to subcommittee. As there was no further business, the meeting was adjourned at 10:30 a.m.

RESPECTFULLY SUBMITTED:

Beverly Willis,

Committee Secretary

APPROVED BY:

Senator Randolph J. Townsend, Chairman

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