The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 9:30 a.m., on Monday, March 15, 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

GUEST LEGISLATORS PRESENT:

Senator Valerie Wiener, Clark County Senatorial District No. 3

Senator Terry John Care, Clark County Senatorial District No. 7

STAFF MEMBERS PRESENT:

Scott Young, Committee Policy Analyst

Kathryn Lawrence, Committee Secretary

OTHERS PRESENT:

Senator Valerie Wiener, Clark County Senatorial District No. 3, read her statement (Exhibit C) and stated she was in support of this bill. She submitted a packet of letters (Exhibit D), stating support of S.B. 357.

Steve McCauley, A.T., C., C.S.C.S., Sunrise Athletic Healthcare, stated there are 37 states that have a form of athletic training regulation. He submitted his budget to the committee (Exhibit E) and stated by passage of this bill, if an investigation does proceed against an athletic trainer, the board would be able to apply to the local authorities and seek charges against that person.

Senator Townsend temporarily closed the hearing on S.B. 357, and opened the hearing on S.B. 351.

Ed Allison, Lobbyist, Avis Incorporated, and Budget Rent A Car, stated the Nevada statute is not clear on whether the incidental sale of personal insurance on a rental motor vehicle should be licensed by the state. He explained this bill would clarify that the car rental companies who offer personal insurance products to their customers, in connection with the car rental transactions, shall obtain a limited license to sell such insurance. He stressed customers who have no vehicle insurance or have a limited insurance plan would benefit from this since it would offer potential liability coverage. Mr. Allison stated the insurance would be good especially for foreign people traveling to the United States in need of a car rental. He submitted his proposal to the committee (Exhibit F).

Robert A. Ostrovsky, Lobbyist, The Hertz Corporation, stated he desired voluntary regulation. He stated he was drafting some amendments to S.B. 351 that would require that the rental car company be licensed and there be a licensee on the premises at the time this product is sold to the public. He stated this would pertain to all car companies who may rent cars.

Alice A. Molasky-Arman, Commissioner, Division of Insurance, Department of Business and Industry, stated her office has been very firm and has indicated to everyone that the sale of any kind of insurance requires a license unless there is a specific exception under the law. She explained limited licenses are currently used for the sale of credit insurance and for banks in the sale of annuities.

Chairman Townsend closed the hearing on S.B. 351, opened the hearing on S.B. 354.

Senator Terry John Care, Clark County Senatorial District No. 7, introduced Lynn Maguire and Pamela Hogan.

Lynn Maguire, President-elect, Nevada Physical Therapy Association, stated in cases where treatment has been ordered by the injured worker’s treating physician and is denied by a non-medical claims person within 5 days of the request, the injured worker or the health care provider may request a medical opinion regarding the treatment ordered, to be determined within 5 days. She stressed if upon medical review it is determined the treatment is necessary to the recovery of the injured worker, the insurer shall ensure authorization of the treatment within 1 day after the physician makes his determination. She pointed out this would facilitate timely medical review and decision-making in cases where the treatment has been ordered by the injured worker’s treating physician and is withheld, not authorized, or denied by claims personnel without medical knowledge and experience. She expressed this would facilitate the injured worker’s return to the workforce without delay of treatment, care, and rehabilitation that is necessary to the recovery of the injured worker. She submitted a letter from the Nevada Coalition of Licensed Health Care Professionals (Exhibit G), in support of S.B. 354. She stated when treatment is ordered by the treating physician, the claim examiners are not authorizing or denying within 5 working days, which is the law. Ms. McGuire explained when there is a delay in care to the injured worker; it delays their recovery. She maintained non-medical, clerical claim examiners are making these decisions. She stated there needs to be a timely review of these denied claims, not 30 days as in many cases.

Pamela C. Hogan, President, Nevada Physical Therapy Association, stated the delay is occurring due to the paperwork delay to the proper individuals. Senator O’Connell agreed the primary health care provider grants the physical therapists six sessions with a patient, and when the physical therapists request further visits, there is a delay in the paperwork.

David Horton, Lobbyist, Nevada Homeopathic Medical Association, stated they support the rationale of this bill and suggested amending it by providing that homeopathic physicians would review homeopathic work. He suggested replacing the word "physician" with either "homeopathic" or "allopathic." He submitted a copy of the bill to the committee with his changes (Exhibit H).

Jack Kim, Lobbyist, Sierra Insurance Group, stated he had some concerns about the bill. He stated the bill did not only apply to physical therapists, but to various providers. He stressed the bill adds more days to the appeal process, and it requires a medical director to review all decisions, even decisions that are going to be authorized. He stated it is unnecessary in adding time to the appeals process, and is detrimental to the injured workers.

Lenard Ormsby, General Counsel, Employers Insurance Company of Nevada, stated he concurred with Mr. Kim’s comments. He stated the current system is working. He stated there are trained claim adjusters who have extensive training and adding physicians to every review is going to increase the cost astoundingly. He stated all of this would greatly increase the expense.

Mr. Ostrovsky stated he was concerned in section 1, paragraph (a), line 5 of the bill, with the language "within 5 working days"; he stated this may propose if the insurer does not have an answer on day 4, they may just deny it. He stressed this will probably lead to more denials, not less. He pointed out section 1, paragraph (b), line 11, is too negative. Mr. Ostrovsky stated in section 1, subsection 2, lines 12 and 13, the language would be subject to interpretation about what is necessary for recovery; and referring to line 18, page 2, did not feel the language of "1 day" was realistic.

Amy Halley Hill, Lobbyist, Nevada Self-Insurers Association, stated she would like to go on record as opposing this legislation.

Chairman Townsend closed the hearing on S.B. 354, and opened the hearing on S.B. 355.

Ms. Maguire stated if an employee’s physician determines that the injured employee requires medical services that the treating physician does not provide, and orders the provision of such treatment, the employee may select the provider of health care who provides such services, but is not a member of the managed care organization (MCO), providing the physician agrees to accept the terms of the MCO contract. She stressed this would allow the injured workers to go to providers for whom they have had previous positive treatment or care experience, and in whom they trust and have confidence. Ms. Hogan stated her association is also in support of this bill.

Mr. Ostrovsky stated he would like to go on record as being opposed. He questioned why have a restricted agreement with a certain number of physicians and seek treatment from providers not in that agreement. He stated it would be difficult to negotiate a reasonable deal in the future with anyone else. Mr. Kim concurred with Mr. Ostrovsky. Mr. Ormsby stated he is opposed to this bill and it does eliminate the credential impositions. He stressed workers’ compensation is not the same as the insurance medical group because the incentives are different. Ms. Hill stated, for the record, it seems that the issues proposed by the physical therapist during the interim meetings are still valid, but we would be more than happy to resolve some of these immediate issues.

Chairman Townsend closed the hearing on S.B. 355 and reopened the hearing on S.B. 357.

Mr. McCauley stated the athletic trainer delivers athletic health care to the entire spectrum of athletics and stated these services have been used for years. He stated traditionally, the high school athletic trainers have been hired sporadically or through a program funded by local universities. He explained some schools have sought services from volunteers who may be poorly trained or unqualified and this practice continues today. He explained the liability is stressful in the high schools, especially when the high school coach is forced to make uneducated decisions regarding the health care of the students. He stated the number of athletic trainers is expected to increase in the high schools rapidly, on a yearly basis. He pointed out a state licensure will give the public a level of protection by providing them legal recourse in not allowing those individuals who are untrained, uneducated, or act in a manner that will be harmful to the athlete’s health care to call or represent themselves as athletic trainers. He explained the competencies for many of these professions sometimes overlap and it is these duplications of services that lead to conflicts within these professions, such as the athletic trainer and the outpatient orthopedic physical therapist. He stated the professions share many of the same skills and treat their patients many times in the same manner. He expressed they have been working with the Nevada Physical Therapy Association and submitted the memo from Pam Hogan to the committee, expressing those concerns (Exhibit I).

Chairman Townsend suspended the hearing on S.B. 357.

Chairman Townsend introduced four bill draft requests (BDRs).

* * * * *

The Chairman reopened the hearing on S.B. 357.

Jerry Hughes, Executive Director, Nevada Interscholastic Activities Association, stated he was involved in implementing athletic trainers in Washoe County schools about 12 years ago. He stressed he is very supportive of this group and he felt it would increase the professionalism of athletic trainers and protect the student athletes. Mr. McCauley stated an individual could be a certified athletic trainer and provide inappropriate and unscrupulous activities to athletes. He emphasized the removal of licensure will give the employer the opportunity to determine if this person is licensed and what status his license is in. He noted licensure would also provide to the employers an immediate response as to the validity of the athletic trainer. He justified the licensure supercedes the certification on a legal basis and 37 states have licensure.

Chairman called a recess at 11:00 a.m.

Chairman reconvened the meeting at 6:05 p.m.

Harvey Whittemore, Lobbyist, Nevada Athletic Trainers Association, stated the draft of the bill (Exhibit J. Original is on file in Research Library.) supports some changes, which the physical therapists and the proponents of the bill have discussed. He stressed the words "athletic training" in the bill would be limited to a defined list of organized activities which would be high school, junior college, college and professional sports. He insisted the athletic trainers wanted to make it very clear they do not wish to go beyond their scope of practice. He stressed the proponents would accept the committee’s judgement as to whether or not they want an intern process delineated in the bill. Mr. Whittemore stated there would be no temporary license issued; only a license. He stated in establishing a new board, the committee needed to review if there exists potential harm to the citizens; if the proponents have presented a budget which is realistic; and he stated, if all are answered in the affirmative, then a board is appropriate. He acknowledged the proposed fee for licensed members is $200, which Mr. Whittemore agreed was reasonable.

John M. Vergiels, Lobbyist, Nevada Physical Therapists Association, stated Ms. Hogan had not had time to read the revised amendments. Chairman Townsend stated this bill does not state the schools are not obligated to hire the athletic trainers. Mr. McCauley stated the bill is not stating it is mandatory to hire an athletic trainer, but the bill does state if someone claims to be an athletic trainer, they must meet certain qualifications. Mr. Whittemore stated the schools are putting themselves in jeopardy by not hiring an athletic trainer who has met specific standards of training. Mr. McCauley stated, for the record, the goal, is, by the year 2004, to require all athletic trainers to have a bachelors degree at an accredited school. He explained at the present time, a person can come from a university program with an internship program where there is no accredited athletic program, but the trainer has taken courses sufficient enough to equal an accredited program. He pointed out the University of Nevada, Las Vegas, does have an accredited program. Chairman Townsend reminded Mr. McCauley that the board is there to protect the public, and not the licensee.

Chairman Townsend referred to the budget submitted by Mr. McCauley (Exhibit E), "Yearly costs," item 6, and expressed concern that $2,500 was not sufficient for operating costs.

Mr. Vergiels stated this bill does not have a clear delineation of duties. He also stated he would like to have the differences clarified between the national association versus a state board. Chairman Townsend stated one difference would be the board would issue the test to a perspective licensee as the same one offered by the National Association of Athletic Trainers. Mr. Whittemore stated for the record that is correct, and referred to section 24, paragraph (h) in the bill.

Mr. Vergiels questioned if an athletic trainer has to be employed for a team. He stated the bill clearly delineates institutions or schools, but there must be trainers employed by middle school programs. He asked if the athletic trainers employed by these schools would still have to be licensed by the board. Mr. Whittemore stated it is clear in the bill that there is a need to have a bachelor’s degree in a course of study approved by the board. He explained a bachelor’s degree does not delineate a particular type of institution, but it has to be the course of study. He declared individuals employed by institutions without licensure could volunteer to provide this type of expertise. He expressed they could not call themselves an athletic trainer without being certified and passing the test. He clarified the athletic trainer identified in this bill is clearly an individual employed by educational organizations or a professional team. He urged there could not be any crossover or expansion on the scope of activities from the Nevada Athletic Trainers Association.

Ms. Hogan stated she agreed with the justification for the licensure of athletic trainers in order to protect the public. She stated the association had concerns with the definition of athletic injury and athletic training being too broad. She mentioned the current definition could include the injured senior athlete, the Special Olympic athlete, or athletes with other significant disabilities. Ms. Hogan maintained there should be more information on athletes with medical conditions or diseases such as muscular dystrophy, multiple sclerosis, or arthritis. She stated the board needs to be self-sufficient and was concerned there may not be adequate funds for operating costs. She stressed if there are limited resources the athletic trainer board may not be able to carry out their assigned functions. She suggested the educational institutions be standardized so when an athletic trainer who may be licensed in another state relocates to Nevada, they will have the same knowledge background that our Nevada athletic trainers are required to have. Chairman Townsend suggested adding in section 24, subsection 1, paragraph (c), to be more specific than "approved by the board." He also stated in section 18, subsection 3, which states "National Athletic Trainers Association Board of Certification" to add "for continuing education," at the very minimum. Mr. Whittemore referred to section 18, subsection 3, suggested deleting "substantially equivalent" to read, "The requirements must at a minimum meet the requirements for continuing education." Chairman Townsend agreed and stated the committee desired the highest standards possible.

Bob Snellgrove, P.T., Department Coordinator, Rehabilitation Therapies, Saint Mary’s Regional Medical Center, stated all physical therapists licensed now in the State of Nevada have been educated outside of Nevada. He submitted his memo to the committee (Exhibit K).

Ms. Hogan stated she disagreed with the verbiage of "professional organized sport" since the trainers may be working with Special Olympics or neurological rehabilitation patients. She stated the scope of practice could be redefined. Mr. Whittemore stated the people with special needs are precluded under the definition because the bill addresses a sanctioned organized event sponsored by the high school, junior college, college or professional sports. He stated, "This is not the Special Olympics."

Mr. Vergiels stated the board needs a scope of practice. Ms. Hogan stated in section 18, subsection 2, "athletic trainer interns" will be removed and the association would welcome the opportunity to address their concerns with this bill.

There being no further discussion, Chairman Townsend adjourned the meeting at 7:25 p.m.

RESPECTFULLY SUBMITTED:

Kathryn Lawrence,

Committee Secretary

APPROVED BY:

Senator Randolph J. Townsend, Chairman

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