The Joint Subcommittee on Human Resources/K-12 of the Senate Committee on Finance and the Assembly Committee on Ways and Means was called to order by Chairman Raymond D. Rawson, at 8:15 a.m., on Tuesday, February 9, 1999, in Room 3137 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.

SENATE COMMITTEE MEMBERS PRESENT:

Senator Raymond D. Rawson, Chairman

Senator William J. Raggio

Senator Bob Coffin

Senator Bernice Mathews

ASSEMBLY COMMITTEE MEMBERS PRESENT:

Ms. Jan Evans, Co-Chairman

Mr. Joseph E. Dini, Jr.

Mr. David E. Goldwater

Mr. Lynn Hettrick

Mr. David Parks

STAFF MEMBERS PRESENT:

Larry Peri, Senior Program Analyst

Birgit Baker, Program Analyst

Barbara Moss, Committee Secretary

OTHERS PRESENT:

Charlotte Crawford, Director, Department of Human Resources (DHR), referenced a document that was provided to the Interim Finance Committee (IFC) entitled "State of Nevada—Family to Family Connection Program—Report to the Budget Division and Interim Finance Committee—November 25, 1998" (Exhibit C. Original is on file in the Research Library.), and stated her intention to recap the Director’s Office budgets.

DHR Administration – Budget Page HR/DIR-1 (Volume 2)

Budget Account 101-3150

Ms. Crawford pointed out that budget account 101-3150 is the primary budget account for the Director’s Office and reflects "final housecleaning." She said all the "program-based programs" were moved and the administrative and oversight components remain. The primary function of the Director’s Office budget is to support the staff that provides direction, oversight, and coordination to the eight constituent entities within the DHR, Ms. Crawford stated.

HR, Purchase of Social Services – Budget Page HR/DIR-6 (Volume 2)

Budget Account 101-3237

Ms. Crawford indicated that funding at the federal level has continued to decline. She explained that federal authorization for Title XX of the Social Security Act (the Social Services Block Grant, or SSBG) has been reduced nationally, the impact of which will be seen in the coming biennium. She indicated adjustments were necessary to accommodate the approximately $2 million reduction throughout the funded entities within the DHR. However, the level of Title XX funding to non-state agencies remains the same as it has been for the last two years, representing an increase in the percentage of Title XX funding. Ms. Crawford noted that was the intention of the Legislature when it provided a letter of intent to that effect in 1995. She explained the percentage is approximately 7 percent of Title XX, which is not an increase in "absolute" dollars; however, it has been maintained while other agencies have experienced a reduction in Title XX funding.

HR, Family to Family Connection – Budget Page HR/DIR-15 (Volume 2)

Budget Account 101-3278

Ms. Crawford stated that the FFCP will be continued into the next biennium and reduced from what was appropriated for the last biennium. Ms. Crawford said the FFCP began the last biennium, became functional in July 1998, and saw 53 percent of newborn families in Nevada the last fiscal quarter. The FFCP has been extremely successful, Ms. Crawford remarked.

Continuing, Ms. Crawford indicated the budget situation created difficult decisions for Governor Guinn. She said the DHR was unable to retain the FFCP at its current level; however, it was retained at a level that would carry forward the basic structure of the program and provide necessary services to newborn families.

Answering Senator Rawson’s question, Ms. Crawford said the Community Connections Program is an organizational entity within the Director’s Office. Although it has no additional funding, it joins programs that are operated out of the Director’s Office, namely the Title XX Program, the Community Services Block Grant (CSBG) program, the FFCP, the Family Resource Centers (FRCs), and the administrative and quality assurance component of the early childhood program. Ms. Crawford indicated that the community-based programs were combined to achieve efficiency, focus upon pass-through funding, build community collaboratives, and provide support and expertise.

Referring to budget account 101-3276, currently in the Division of Child and Family Services (DCFS) budget, Ms. Crawford indicated a proposal was made to transfer the direct service components to the regionalized components within the DCFS, with the oversight, administrative, and quality assurance components transferred with that budget account to the Director’s Office.

Responding to a query from Senator Rawson, Ms. Crawford indicated that budget account 101-3276 is currently the early childhood, Chapter I, Special Education budget in the DCFS. The senator inquired whether the budget account contains the Home Activity Program for Parents and Youngsters Program (HAPPY). Ms. Crawford indicated the HAPPY program is one of the direct service components that will be retained in the division. To the degree that money comes from Chapter I, the oversight administrative component will be brought into the Director’s Office budget, Ms. Crawford stated.

Mark A. Roberts, Chief Financial Officer, Director’s Office, Department of Human Resources, indicated a Management Analyst IV position has been funded in this budget. He said the position will help with policy research and analysis, promote collaboration with private local executive and legislative partners, and develop strategies for consensus-making, conflict resolution, and negotiations of statutory language. Mr. Roberts indicated the position will also monitor proposed federal rules and regulations and assess the possible implications for the state.

Responding to a question from Senator Rawson, Ms. Crawford pointed out that the positions which were part of the hospital health care cost-containment area were dedicated primarily to that area and to Medicaid. The Director’s Office is seeking an individual who can monitor federal changes and other tasks which include writing and general research. Ms. Crawford said health care does not cover what is occurring federally and congressionally. She noted that the DHR must remain aware and proactive regarding federal changes.

In response to Senator Rawson‘s suggestion that consolidation may avoid duplication, Ms. Crawford opined there are no duplications. She indicated the Nevada Check-Up program came out of the Division of Health Care Financing and Policy (DHCFP) the last biennium and reflected the monitoring of congressional occurrences. She said there are very few research and analysis positions in that division or in the Director’s Office. Noting that the Director’s Office currently contains 9.75 full-time-equivalent (FTE) positions to oversee a department of approximately $2.5 billion and 4,000 FTEs, Ms. Crawford pointed out it is a lean administrative staff to oversee a department as complex and broad as the DHR. The requested Management Analyst IV position will be the only one that is not purely administrative and will provide research support in the Director’s Office, Ms.  Crawford remarked.

Senator Rawson inquired whether it would be to Ms. Crawford’s advantage to have the health policy and analysis coming out of the Director’s Office versus the creation of a separate entity. Ms. Crawford stated the health policy positions are in the DHCFP, whereas the Management Analyst IV position is much broader in scope. There are multiple divisions that monitor this particular area; however, there is no dedicated leadership position to review the congressional budget and the interfaces existing within it, Ms. Crawford continued.

Asked where the Management Analyst IV position would be assigned if DHCFP did not exist, Ms. Crawford answered the position would be in the Director’s Office because it requires a great deal of focus and attention from the DHR. She said over half the budget encompasses health care, which is an important issue that runs throughout the divisions and requires a high-level profile in the DHR.

Answering a question, Ms. Crawford pointed out the DHCFP has 166 employees, excluding those in Homemaking Services and Elder Protective Services. Senator Rawson asked Ms. Crawford to consider whether money could be saved and the same level of analysis and understanding maintained by consolidating and bringing the DHCFP into the Director’s Office. Ms. Crawford queried whether the subcommittee would entertain an investigation into the effectiveness of bringing Medicaid and the policy component into the Director’s Office. Senator Rawson answered yes, and Ms. Crawford indicated she would comply with the request.

Senator Rawson pointed out that the budget does not reveal the disposition of the executive function and, in addition, there is confusion regarding accountability performance indicators for this administrative area. He requested clarification of the performance indicators and asked how many agency heads have been evaluated, and how many agency heads have participated in some type of personal growth plan. In summary, Senator Rawson asked how the Legislature can evaluate the function and activities of the Director’s Office of the DHR when the two entities only connect a few times a year.

Ms. Crawford indicated the DHR is in the process of working on the performance indicators, most of which address the programs operated out of the Director’s Office. She agreed to share the data gleaned when the program components are separated from the administrative component. The performance indicators that are more reflective of the tasks anticipated by the DHR, as well as the reorientation within the department, will reflect the changing administrative and leadership role in the Director’s Office, Ms. Crawford stated.

Commenting further, Senator Rawson emphasized that during the 1999 Legislative Session the DHR budgets will not be closed until the performance indicators are understandable.

Mr. Roberts explained the final decision unit moves the Family Resource Centers program into new budget account 101-3289, and transfers the two positions into a new stand-alone budget.

Senator Rawson questioned moving the "developmentally delayed" programs into Children’s Mental Health and inquired whether there is agreement among the participants. Ms. Crawford responded that direct services functions are separated out of the Chapter I budget account. She said that currently, early childhood federal funding flows to the Division of Child and Family Services and the Health Division. In the past biennium the DHR developed a memorandum of understanding to assure direct services were not changed by moving the budget account, Ms. Crawford remarked.

Referring to federal reimbursement (Maximus) which showed $5.5 million for FY 1997-1998 actual, Ms. Evans inquired whether the funds were collected and reverted. Mr. Roberts indicated the $5.5 million was collected; however, during that fiscal year some of the money was balanced forward to fund the UNITY (Unified Nevada Information Technology for Youth) Project and a NOMADS (Nevada Operations Multi Automated Data System) quality assurance piece and none of the money was reverted to the General Fund. Mr. Roberts said the money was allocated for the two projects into the next fiscal year. Ms. Evans requested further clarification.

Mark Stevens, Assembly Fiscal Analyst, Fiscal Analysis Division, Legislative Counsel Bureau (LCB), indicated approximately $5.5 million has been earmarked to revert this fiscal year (FY 1999) in the Governor’s recommended $130 million reversion.

Ms. Crawford said the status of the Maximus contract has not yet been decided because she has not had an opportunity to discuss it with Governor Guinn. She indicated the decision will be made subsequent to an evaluation of Maximus’ performance as well as opportunities that might be provided in the future. Asked whether Maximus’ performance was considered successful, Ms. Crawford noted that revenues to date demonstrate its success. The counties received substantial benefits through the efforts of Maximus which are not reflected in the budget. Questioned whether she would recommend to the Governor that Maximus be continued, Ms. Crawford stated her recommendation is contingent upon the evaluation.

Ms. Evans declared performance indicators would help the subcommittee understand and measure the success of Maximus in bringing money back to the state. Ms. Crawford indicated the relationship with Maximus has been favorable in that the state, as well as the counties, have benefited from their work. Ms. Evans requested the subcommittee be provided: (1) the results of the evaluation, (2) the conclusion regarding continuation of the contract, and (3) the status of the process of making the evaluation final. Ms. Crawford said the evaluation is in the early stages and will be completed by the end of March 1999.

HR, Purchase of Social Services – Budget Page HR/DIR-6 (Volume 2)

Budget Account 101-3237

Mr. Roberts explained that the budget has a number of decision units which allow each state agency, as well as non-state agencies, to reach Title XX level. The budget also allows other General Fund entities, including Title IV-E and Medicaid revenue sources, to operate programs as they have done in previous years.

Mr. Roberts said module E-130 in enhancements is the main decision unit that takes the adjusted base and reduces it to the anticipated federal share for the state.

Mr. Roberts indicated module E-256 reflects a transfer of Temporary Assistance for Needy Families (TANF) revenue from the Welfare Division to the DCFS Child Welfare Trust Budget.

Mr. Roberts stated that when the original reduction was applied, the non-state agencies took a cut which was returned through module E-257 and restored to its current level of funding at $762,000 for each year of the biennium.

Mr. Roberts pointed out that module 352 in enhancements is one of the more complex decision units in the budget. He indicated that the budget office and the DCFS identified areas that would allow the DCFS to earn additional Title IV-E funds by transferring General Fund dollars in and moving Title XX dollars out to maximize federal money in the budget. The manipulation earned $400,000 more in Title IV-E funds for the division in those budgets, Mr. Roberts stated.

Mr. Roberts indicated that module E-904 assists in funding the proposed Homemaker Services transfer from DHCFP into the Aging Services Division. By adjusting some of the aforementioned decision units, this decision unit is funded entirely with Title XX funding.

Senator Rawson mentioned an early bill draft request (BDR) that will create an option for some counties (particularly Clark County) to organize their own health systems. Ms. Crawford acknowledged her awareness of several BDRs but confessed she was unfamiliar with one that addresses county-based health organizations. Senator Rawson indicated there might be a driving force behind the movement. He suggested the DHR peruse the overall subject from the standpoint of whether programs could be consolidated with a county-run organization, as well as whether consolidation would be "doable," and what the impact and effect would be of such a consolidation.

Ms. Crawford pointed out that the DHR works closely with the interim health care committee on proposals regarding county-based health organizations.

Answering a question, Mr. Roberts indicated that funding in the Purchase of Social Services budget is for Block Grant Commission (BGC) travel and meetings for the review of Title XX non-state agencies, as well as the allocation of funds and various informational meetings pertaining to RFPs and the manner in which they are distributed throughout the state. He said within the Family to Family Connections budget, money is allocated to review applications, budget changes, and potential RFPs for the Infant Support Districts (ISDs).

Asked whether an anticipated balance will be brought forward from 1999 to 2000, Mr. Roberts indicated no anticipated balance is brought forward in the Purchase of Social Services budget. He referenced a work program that was processed at the last IFC meeting which "adjusted the contract authority to the state authority to the anticipated federal revenues."

HR, Community Svcs Block Grant – Budget Page HR/DIR-12 (Volume 2)

Budget Account 101-4864

Mr. Roberts indicated the budget is straightforward and the grant award is held constant for the next two years. He said it is a pass-through budget in which 90 percent of the money brought in is given to non-state agencies, mostly counties statewide. There were no major decision units in this budget, Mr. Roberts remarked.

Senator Rawson queried whether CSBGs are followed up with to ascertain the disposition of the money, their accomplishments, and the manner in which waiting lists are affected. Mr. Roberts said each community or county submits:

• A budget on the services provided.
• Quarterly status and progress reports.

• An annual year-end report on the accomplishments and disposition of the block grant money.

Senator Rawson said the objective is not to create a heavy level of bureaucracy including useless and unnecessary reports. The senator suggested the issue be addressed during perusal of the performance indicators to ascertain what is occurring with the block grant funds.

Ms. Evans queried whether the distribution of funding is under the purview of the BGC, and asked how the disposition of funds is decided. Ms. Crawford answered that the CSBG is statutorily determined at the federal and state levels. The grant is based on a percentage of poverty distribution and the type of recipient is specified in federal and state statute. Ms. Crawford said the department and the BGC have very little discretion in distribution of the funds. Senator Rawson asserted there is still a need to know whether the funds are used well. Ms. Crawford noted that although the department has no discretion over distribution of the funds, the outcome is still scrutinized.

Ms. Evans requested the federal citation for specifications on the CSBG.

HR, Family to Family Connection – Budget Page HR/DIR-15 (Volume 2)

Budget Account 101-3278

Mr. Roberts pointed out that there is only one decision unit which continues the program at a 53 percent reduced rate. In continuing the program at this rate, 13 Infant Support Districts (ISDs) (6 in the south and 7 in the north) and 22 statewide baby centers will be maintained. The ISDs are given latitude to develop programs that meet the needs of their communities. The program is funded with an 82-18 split between the General Fund and the Childcare Development Block Grant, Mr. Roberts said.

Responding to a question from Senator Rawson, Ms. Crawford indicated the University of Nevada, Reno (UNR) was the contractor that developed the data evaluation system for the Family to Family Connection Program (FFCP). She mentioned a report that included the second quarter based on the university data system. Senator Rawson said a number of unanswered questions were brought forward from the 1997 Legislative Session. He indicated the program originally contained 50 people but was consolidated and reduced to a workable number; however, a number of items did not show up in the budget when final decisions were reached. Senator Rawson noted that $444,754 was expended on computers and requested information on their disposition.

In response, Ms. Crawford said the computers were state-purchased and provided the data system and computer base for all the FFCP offices. She indicated information regarding number, location, inventory, utilization, and the manner in which the computers interface with the data system is available.

Janelle Mulvenon, Acting Program Manager III, Community Connections, Department of Human Resources, distributed a document entitled "Business Plan, Department of Human Resources, Director’s Office, Family to Family Connection" (Exhibit D). She reported that effective February 1, 1999, computers purchased for the ISDs in the northern and southern regions of the state were located, tagged, and inventoried. In addition, UNR and the Department of Information Technology (DoIT) are working together to network the ISDs. Ms. Mulvenon indicated that two-thirds of the sites are networked and the information will be entered directly from the ISDs and new-baby centers into the server located at the Director’s Office. In addition, a family consumer survey conducted by UNR began in December 1998, and approximately 200 random families across the state will be interviewed and the information gathered will be made available, Ms. Mulvenon remarked.

Responding to a query by Senator Mathews in regard to combining the Family to Family programs with the family resource centers, Ms. Crawford explained that FRCs are specifically designated for and restricted to at-risk neighborhoods. She said it was also stipulated that FRCs are community-based, that local governing and advisory boards determine the necessary services in their neighborhoods, and that the provisions of those services are supported. On the other hand, the FFCP is broad-based and intended to reach all families of newborns in the state. Although they overlap, the FFCPs and FRCs are not a perfect match, Ms. Crawford stated.

Continuing, Ms. Crawford said competitive bids were received from each of the ISDs for community collaboration to ensure that the communities define and use available resources and combine them to form the services to be delivered. She explained that FRCs are required to participate if one FRC in the area chooses to be involved. A heavy emphasis is placed on the inclusion of FRCs; however, the promise made to them would be broken should they be mandated to provide a service not considered the most useful for their area. Ms. Crawford stated that for the most part FRCs are involved with FFCPs.

Senator Mathews expressed concern regarding duplication of money and effort and requested the number of underserved people using the FFCP as opposed to those who could use other resources. Ms. Crawford indicated the survey shows the demographics in terms of income, numbers, and location of people using the FFCP. She said the FFCP maintains confidentiality, is a voluntary organization, avoids a sense of intrusion into the family, and does not identify the person who provided the information. Ms. Crawford said there is a broad spectrum of FFCP users and the program is not restricted to low-income individuals.

Mr. Hettrick, noting the performance indicators showed the number of families actually served in FY 1998 was 382 and the projection for FY 1999 is 7,552, asked the current FY 1999 status. Ms. Mulvenon answered 1,888 families were served in the first quarter of FY 1999, 28 percent of which had newborns. In the second quarter of FY 1999, 3,587 families were served, of which 53 percent had newborns. Ms. Mulvenon reported the goal of 50 percent has been achieved and activity is increasing in the new-baby centers and ISDs.

Answering an inquiry, Ms. Crawford indicated the FFCP budget is approximately 45 percent of what was originally funded; consequently, to reach the 50 percent goal will require an extraordinary effort on the part of ISDs and existing collaborations. She said the program requires three types of services; therefore, the budget was designed for: (1) home and hospital visitation, (2) new-baby centers which are center-based services for families on a drop-in, voluntary basis, and (3) lending resource centers. In constructing the revised budget to meet what was allowable within available funds, the new-baby-center-based funding was used. Ms. Crawford said the types of services are not specified, rather the ISDs are allowed to utilize the services considered best for their districts and construct a contractual relationship with them to meet the goals. The effort will require greater contributions and collaboration from the private sector, Ms. Crawford remarked.

Mr. Hettrick said:

Ms. Crawford indicated an analysis would be provided.

Queried how the overall program will be affected considering the elimination of the hospital- and home-visit component, Ms. Crawford stated the component is not eliminated and explained that the FFCP does not dictate which of the three service components will be used by the ISDs. She said each Infant Support District (ISD) will be allowed to support the services that best match the needs in their area. Some of the ISDs determined hospital and home visitation to be most productive in their areas, while others preferred center-based services. Ms. Crawford said that to utilize reduced funding in the most productive way, the ISDs need flexibility to support the services, or a combination of services, that work best in their community.

Although indicating she understood Ms. Crawford’s comments, Ms. Evans wondered how the program would work considering the reduced resources and personnel. Ms. Crawford indicated difficult decisions must be made and reiterated that the budget did not allow support for all the currently existing programs.

On a different note, Ms. Evans referred to enhancement decision unit 351, Self Sufficiency Through Social Services, in the Family to Family Connection budget (page HR/DIR-16) and said $75,000 is budgeted for a public media contract. She asked whether the contract will continue, given the reduced scope of the budget. Ms. Crawford said $75,000 will not buy a "lot of media"; however, there is still a great need to provide family education. The media can publicize the program and spread the important message of early childhood stimulation, Ms. Crawford declared.

Ms. Evans pointed out that in the early stages, programs need a great deal of community outreach¾ in business terms, they must be "marketed." She asked, "What kind of media is being considered? What does the media plan entail? How will the $75,000 be spent?" Ms. Crawford indicated a firm plan is not in place; however, there is an outline explaining how the media plan will be developed with the community partners. She offered to share the outline with the subcommittee.

Senator Rawson indicated a number of legislators would be available to perform public service announcements.

Referring to the travel and per diem expenses for the Interagency Coordinating Committee (ICC) contained in the Regional Advisory Board expenditure category, Ms. Evans said the original request included funding for northern and southern regional boards, local advisory councils, and so on. She asked whether this aspect will be continued for the new biennium. In addition, Ms. Evans noted there are funds in the budget for the BGC, and a contract Block Grant Coordinator, versus in the Title XX Purchase of Social Services budget.

In response, Mr. Roberts indicated the ICCs and the regional committees were not renewed based upon the information outlined in Ms. Crawford’s earlier comments and the fact that much of the work in regard to education and training was in place. Hence, the request is for a facilitator to be a liaison between the BGC and the FFCP, Mr. Roberts remarked.

Asked the difference between a facilitator and a coordinator, Mr. Roberts confessed ignorance; however, he said, in this event the facilitator attends the meetings, and the coordinator has an expanded role beyond the meetings and interaction with the BGC. Ms. Evans indicated the definition needs further clarification.

Ms. Mulvenon indicated that the ICC furnished advisement and recommendation pursuant to the subgrants that were awarded to provide early intervention services to children who were eligible under the Individuals with Disabilities Education Act (IDEA). However, that line item will not be continued in the proposed FY 2000/2001 budget, Ms. Mulvenon stated.

Jan Gilbert, Lobbyist, Progressive Leadership Alliance of Nevada, distributed a document entitled "State of Nevada Department of Human Resources Block Grant Commission (BGC) Executive Summary¾ Calendar Year 1998" (Exhibit E) and indicated she is a member of the BGC, which is a volunteer organization. Ms. Gilbert said the BGC had tremendous input into the Family to Family Connection program (FFCP). She explained that the FFCP developed slowly and required the communities to coordinate activities and develop individual programs within a framework. Ms. Gilbert indicated the reduced budget will provide flexibility and the ability to create the best program for each community.

It was Ms. Gilbert’s opinion that the home visitation program is essential because it brings families into the new-baby center to learn how to care for their newborns. She praised the work accomplished by the DHR and community connections to facilitate the collaboration. She said that without the help of the state staff it would have been impossible to gather 10 groups together to agree on principles. Ms. Gilbert expressed concern that with less funding and staff the communities will be unable to put together a collaboration to create a new model.

Ms. Gilbert pointed out that Ms. Crawford requested the BGC to oversee the federal grants to include how the grants interact, how grant money is used, and how federal grant dollars are performing. She noted that the CSBGs are asked to submit reports to the BGC to clarify their outcome. The information will be utilized to avoid duplication when Title XX funds are provided, Ms. Gilbert said.

Ms. Evans expressed gratitude to Ms. Gilbert and the BGC for volunteering to develop good protocols when dealing with community agencies. She said her comfort level regarding the distribution of funds and accountability was raised from what it was several years ago. Ms. Evans indicated she had received excellent feedback in regard to the FFCP and noted that it is easier to be creative in larger communities because there are more resources. She asked how rural communities are impacted by fund reductions.

Ms. Gilbert indicated the rural counties experience more difficulties and require more assistance due to their lack of resources and services, as well as the travel required between communities. In addition, she said, audits for rural communities are expensive and many of the nonprofit organizations were never audited due to their small size.

Ms. Crawford noted the BGC did a tremendous amount of work for the people of Nevada and the DHR. She said the BGC took the FFCP to Title XX, broadened its scope, and brought accountability and integrity to the process of fund distribution. Ms. Crawford expressed appreciation for the work of the BGC and hope for their continued support.

HR, Family Resource Centers – Budget Page HR/DIR-18 (Volume 2)

Budget Account 101-3289

Mr. Roberts stated the Family Resource Center (FRC) program is made up of two local governing boards, north and south, and currently there are 41 FRCs statewide: 11 in Washoe County, 11 in the northern rural areas, and 19 in Clark County and the southern rural areas. He said the only decision unit of any note is module E-908 in enhancements, which transfers this budget account out of the Director’s Office into its own stand-alone budget account.

Senator Rawson speculated there is a wide variety of services provided by the various FRCs. Mr. Roberts said the communities direct their services based on at-risk neighborhoods, the makeup of their neighborhood council, and the clients living in their area.

Referring to performance indicator 3, Ms. Evans requested interpretation of the wide swing in the amount of cash match required. Mr. Roberts explained that the law requires each FRC to have a 10 percent cash match; therefore, in early projections of the indicators the 10 percent was included as a requirement. Upon conclusion, based on the success of the program, the cash contributions were actually well in excess of 10 percent, Mr. Roberts stated.

Regarding in-state travel, Ms. Evans inquired whether $7,195 is allocated for travel of one professional position. Mr. Roberts answered yes, explaining the funds are for the Statewide Coordinator who is housed in Las Vegas and travels to the rural areas. He indicated that trips to Reno and the rural areas, tours, and FRC visits are combined to obtain as much travel for the dollars as possible.

Asked whether the kinds of services provided are uniform among the FRCs, Mr. Roberts answered that specific guidelines must be followed for a neighborhood to be deemed at risk. The guidelines specify that a certain level of clientele be served and that the makeup of the board must represent the community. The report demonstrates that tailor-made themes are observed among FRCs, Ms. Crawford remarked.

Responding to the suggestion that the benefits of the program be included in the performance indicators, Ms. Crawford pointed out that governing boards in the northern and southern parts of the state clarify the evaluation of program benefits because the criteria are used to make funding decisions.

Mr. Goldwater requested the identity of the unfunded decision unit in the FRC budget that was not recommended. Ms. Crawford indicated the request was essentially "more dollars for more services"; consequently, the expansion was not funded.

Janine Hansen, Lobbyist, President, Nevada Eagle Forum, gave her oral testimony reflected in a document entitled "Governor Miller’s Family to Family Program Threatens Integrity of Family" (Exhibit F). Mrs. Hansen testified that government has become the greatest threat to the nurturing function and economic survival of the family. She stated that the Family to Family program creates a new social welfare voting block that recruits its constituency beginning with newborns and their parents in the hospital. In addition, the Family to Family program provides no safeguards protecting the privacy of families from government intrusion regarding medical, psychological, financial, and other, particularly with the new computer linkage of records in Nevada, Mrs. Hansen remarked.

Lynn Chapman, Lobbyist, Families for Freedom, stated that people need freedom from high taxes for programs that are either unneeded or duplicated. She also related the experience of a girl who was given a physical examination by the FRC at her school although it was not requested, nor were the parents informed of it. Citing another example, Ms. Chapman said an acquaintance worked at an FRC for five years as a volunteer bookkeeper. The bookkeeper informed Ms. Chapman that funding from the U.S. Department of Housing and Urban Development (HUD) was used in violation of HUD rules; money was given to families for house payments rather than for rent, documentation was falsely prepared for services provided, and people who were not clients were treated as clients.

In addition, Ms. Chapman continued, the bookkeeper said the FRC overstated client counts by counting families with five or six children as five or six families, and also falsified volunteer service-hour records. The bookkeeper further informed her that checks were written for items unrelated to the FRC. The books showed that a Girl Scout troop received services when, in reality, they used one of the rooms for their meetings. A prescription fund was set up with donations of $1,000 from a Reno women’s civic club and $2,000 from a northern Nevada foundation, but the bookkeeper never saw the checks. When the bookkeeper questioned the alleged nefarious activities and requested an audit, the FRC brought in its own auditor. The bookkeeper received threatening telephone calls and subsequently moved out of state. In conclusion, Ms. Chapman indicated she would confidentially divulge the name of the woman to the subcommittee should it be desired.

Senator Rawson indicated the first funding for FRCs was in 1996 and suggested the alleged entities could have been other community organizations or precursors to FRCs. Ms. Chapman said the volunteer bookkeeper worked at the FRC for a period of five years, during which time the questionable activities were conducted. Senator Rawson asked Ms. Crawford to investigate the accusations to assure the subcommittee that funds are correctly spent.

Michael Capello, MSW, Division Director, Children’s Services, Washoe County Department of Social Services, indicated the division supports both the FRCs and the FFCP. He distributed a statistical document entitled "Washoe County Department of Social Services Child Protective Services" (Exhibit  G). The document indicates the total number of reports received in FY 1994-1995 was 7,522, and this fiscal year it is projected that 5,782 will be received; this represents a 23 percent reduction in child neglect and abuse reports in Washoe County. Mr. Capello stated there has been an approximate 26 percent reduction in reported physical and sexual abuse and child neglect over the past five years.

Further, Mr. Capello pointed out, many services have come on-line in Washoe County to provide a continuum of prevention and family support services which enable families to access services before moving to more intrusive governmental intervention, such as child protective services. Mr. Capello said that in FY 1997-1998, 754 children were placed in protective custody, whereas this fiscal year only 600 children are anticipated to be placed in protective custody. He noted this means 154 fewer children will experience the trauma of separation from their parents when they are determined to be at imminent risk. In addition, he said, the services save money because the number of days of residential care that must be provided for children who are in out-of-home placement is reduced, and this is one of the most expensive parts of the program. A reduction in "bed days" is anticipated, from 34,805 in FY 1997-1998 to 27,788 in FY 1999-2000, Mr. Capello remarked.

In conclusion, Mr. Capello stated the FRCs and the FFCP are part of a continuum that improves the quality of life for children, while easing the job of the Division of Children’s Services by reducing the number of cases and enabling the division to offer more time to families referred to child protective services.

Ms. Evans congratulated Mr. Capello on keeping good data because "good data should drive policy." She indicated everyone is subject to his or her own experiences and anecdotal reporting; however, hard facts and figures tell the correct story. Ms.  Evans expressed a desire to see some hard facts regarding home visitation from Clark County. Mr. Capello indicated he would provide the requested information.

Senator Rawson requested Ms. Crawford to examine the FRCs’ privacy policy and submit it to the subcommittee.

AGING SERVICES DIVISION

HR, Aging Older Americans Act – Budget Page AGING-1 (Volume 2)

Budget Account 101-3151

Carla Sloan, Administrator, Aging Services Division, Department of Human Resources, distributed a document entitled "Division for Aging Services¾ Performance Indicators Outcome Statements" (Exhibit H), and explained the performance indicators were excerpted from the The Executive Budget. She indicated that in an effort to improve its goals for the coming biennium, the division reduced the number of goals from 13 to 4 and "tightened" the performance measures to demonstrate a "real" outcome to the public and senior citizens. Consequently, the actual and projected goals are for this biennium; however, the next biennium is changed. Hence the performance indicators in budget account 101-3151 are reflected on two pages, Ms. Sloan stated.

Continuing, Ms. Sloan pointed out that budget account 101-3151 contains the elder rights and community resource development units. She indicated the elder rights unit includes the Long-Term Care Ombudsman program, the Community Ombudsman Program, the Senior Ride Program, the new Medicare Information Counseling and Assistance program (ICA) (referred to as the State Health Insurance Assistance Program [SHIP]), federal grants administration, volunteer programming, and state transportation programs.

In terms of the decision units within budget account 101-3151, Ms. Sloan said in module E-125 under enhancements two positions are requested, one of which is a Management Analyst. She pointed out that the Management Analyst will manage budgeting and reporting requirements for the Elder Abuse and Homemaker programs, but it will not be exclusive to those programs. The Management Analyst will share time and be cost-allocated across other programs, as well as assist the fiscal services staff in reporting for federal, SHIP, or ICA grants, and any new initiatives that will occur during the coming biennium, Ms. Sloan stated.

Ms. Sloan indicated the second requested position is a Database Specialist to work with all databases within the division’s programs. She said an Information Systems Specialist has maintained the division’s technology requirements and set up local area networks (LANs) in the four regional offices. However, the expertise of the Information Systems Specialist is software and hardware, rather than database development. The Information Systems Specialist has overseen the database development but the task is too onerous for one person, noted Ms. Sloan.

Ms. Sloan noted there are 72 employees in the division at present and each person has a computer, but not all the computers are on the network. She said the older computers were assigned to the social workers and the new, more powerful computers were assigned to the fiscal services staff.

Ms. Sloan explained the division’s existing databases are for the Community Home-Based Initiative Program (CHIP), which has been under revision for the last year. She gave assurance that the database will be operable by the year 2000. Ms. Sloan said the programs recommended for transfer to the division have little automation and indicated that the Homemaker and Elder Protective Services programs are managed manually.

Ms. Sloan said that module E-126 addresses a transfer of funds in the budget from the Taxicab Authority program, which funds the Clark County Senior Ride Program. She said the Senior Ride Program, which is unique to Clark County, is funded entirely by revenue generated through the Taxicab Authority. Ms. Sloan indicated the program enables eligible senior citizens and disabled persons to purchase $20 worth of coupons for taxicab rides for $10. She stated it is statutorily determined that the Taxicab Authority fund reserve be maintained at a specified level in order to subsidize the program. It was Ms. Sloan’s understanding that the Taxicab Authority’s reserve has fallen below the statutory requirement, and therefore the Taxicab Authority’s contribution in the second year of the biennium was taken out of its base budget. Consequently, the contribution was also taken out of the division’s base. Ms. Sloan stated that module E-126 would restore the base funding.

Further, Ms. Sloan said the enhancement will not expand the program. She reported that sales in the base budget year included 16,000 coupon books, which will be authorized for sale in the next biennium as well.

Senator Rawson pointed out that the Taxicab Authority’s reserve has been used for other administrative purposes, which jeopardizes the Senior Ride Program. In response, Ms. Sloan confessed she was not conversant with the Taxicab Authority’s side of the budget process. Senator Rawson suggested that the full committee address this issue.

Birgit Baker, Program Analyst, Fiscal Analysis Division, LCB, referring to the Taxicab Authority budget account 245-4130, page B & I-224, said the reserve in the base budget in the second year dropped to $54,847. She noted that the statutory reserve must be $200,000 or more in order to fund the Senior Ride Program. Ms. Baker said decision unit E-126, page B & I-226, reverses the transfer to fund the Transportation Services Authority (TSA) which was approved during the current biennium. Reversal of the transfer returns the funding to the reserve which then provides sufficient money to fund the Senior Ride Program in the second year, Ms. Baker stated.

Continuing, Ms. Baker said the final component is in the TSA budget account 226-3922, page B & I-205, module E135, which recommends an increase in the Highway Fund level to offset the elimination of the transfer from the Taxicab Authority.

Senator Rawson directed the LCB staff to verify whether the draw on the Highway Fund is appropriate. The senator stressed the importance of the Senior Ride Program and said other subcommittees working on the issue should be informed that the program should not be eliminated.

Ms. Evans clarified that if the TSA were to be funded from the Highway Fund the 15-cents-per-trip contribution would be restored and the estimated income reserve would fund the Senior Ride Program. In response, Senator Rawson indicated the contribution could possibly fund the Senior Ride Program to the level of 20,000 coupon books. Asked whether there would be a demand for 20,000 coupon books, Ms. Sloan answered yes. She explained the reason only 16,000 coupon books were sold during the base year was that the coupons had an expiration date consistent with the state fiscal year and were sold on a quarterly basis. She said many seniors were reluctant to purchase the coupon books in April with a June 30 expiration date. Noting that the division plans to eliminate the expiration date, Ms. Sloan said she was optimistic that 20,000 coupon books could be sold with no difficulty.

Ms. Evans requested the LCB staff to keep the committee informed of the work of other subcommittees on this issue. On a technical note, Ms. Sloan said that module E-126 restores the base budget but does not take into consideration the sale of 20,000 coupon books. Ms. Evans noted that the Legislature would be required to change the budget to include the sale of 20,000 coupon books.

In response to a query, Ms. Sloan voiced the understanding that the fund would support 20,000 coupon book sales at 15 cents per taxicab ride with no impact on the state General Fund or other resources. Senator Rawson requested the LCB staff to make that a decision point in the final work session on the issue.

Ms. Sloan said that module E-128 addresses an increase for ombudsman travel. She said new facilities are coming on-line, many of which are in outlying areas. The Older Americans Act (OAA), under which the division receives federal funding, requires a long-term care ombudsman to be present in every facility at least once a year. Ms. Sloan said the ombudsman would make a courtesy visit to each facility to post residents’ rights material and make the residents aware of the existence of the Aging Services Division. The new facilities will require more than just a courtesy visit, Ms. Sloan remarked.

Ms. Sloan indicated that due to more complaints the workload of the existing ombudsman is steadily increasing. She said the division’s performance standards have been met without difficulty during the last biennium. The goal is to supplement the division’s workforce with students. Ms. Sloan mentioned that the division has experienced success with social work student placements in Las Vegas through the University of Nevada, Las Vegas (UNLV). She said the students have assisted in facility courtesy visits, performing in-service education at facilities, as well as community education. The students would not be authorized to make investigations; however, their activities would free the long-term care ombudsman to concentrate on the investigatory nature of the work. Ms.  Sloan said the division will prioritize its services to respond to the most urgent cases.

Ms. Sloan indicated that modules E-175 and E-176 address the moving of the division’s offices in Carson City and Elko. She said both offices are overcrowded and it is impossible to add additional staff authorized by the transfer of programs and the expansion of the Community Home-Based Initiative Program (CHIP).

Ms. Sloan indicated module E-352 provides for a $40,000 increase in transportation services, which is a direct increase at the local level. She said the division awards transportation funding based on a fixed fee and pays $2.10 per one-way ride; hence $40,000 will purchase 19,048 rides, which are provided by local service providers.

Ms. Evans expressed appreciation for the division’s detailed performance measures, commenting that too many budgets provide activity reports rather than performance indicators.

Ms. Sloan indicated older-volunteer programs received funding during the last biennium that enhanced their programs by approximately $250,000 a year. She said the funds were earmarked for three programs also receiving funding from the Corporation for National Service, which is the primary federal funding entity supporting the programs. The three programs are the Retired Senior Volunteer Program (RSVP), the Senior Companion Program (SCP), and the Foster Grandparents Program (FGP). Ms. Sloan said there are seven programs statewide: three RSVPs, two SCPs, and two FGPs.

Continuing, Ms. Sloan said there has been approximately $111,000 in the division’s base budget for some time. Commenting "the history goes back many years," Ms. Sloan indicated that at one time the FGPs, north and south, looked to the state to match an action grant. The state provided the match, which was approximately $36,000 per program. Ms. Sloan said that at one time the RSVP in Reno, currently located in the Sanford Center at UNR, was located in and administered by the Mental Hygiene and Mental Retardation Division. The FGP was then moved to Aging Services for one year, after which a determination was made to locate the program at the community level. In any event, the Aging Services budget continued to provide administrative support of approximately $18,000 for FGP, Ms.  Sloan remarked.

Further, Ms. Sloan reiterated, there is $111,000 in the base budget previously earmarked for two FGPs and one RSVP. After conferring with the state director of the Corporation for National Service, it was Ms. Sloan’s understanding that although the funds are well utilized they are no longer required for matching. Therefore, because funds are limited, an alternative is to open the $111,000 allocation for competition among the seven programs. The programs would apply to the Aging Services Division for funding through the same process currently followed in awarding federal grants, continued Ms. Sloan. There is an extensive review process including performance outcomes and a community resource development plan to ascertain the manner in which programs will be funded and sustained in the future. Ms. Sloan indicated the grant application process has been revised and review panels, including members from the Commission on Aging, perform an extensive review before decisions are made regarding the community’s greatest needs.

In response to a query regarding whose idea it was to change the plan, Ms. Sloan indicated that she made the suggestion during the Legislative Commission’s Budget Subcommittee hearings. Senator Rawson said the situation was either lose programs or find a way to share the funds. Ms. Sloan said that in either event there will be a loss in services. Responding to a comment that she was attempting to save existing programs rather than eliminate one, Ms. Sloan stated the current formula would disallow support for the Senior Companion Program, whereas the new plan will allow RSVP, the Foster Grandparents Program, and the Senior Companion Program to place their needs on the table. However, there will not be enough money to meet all the needs, Ms. Sloan remarked.

Ms. Evans commended Ms. Sloan for her creativity but expressed an ongoing concern for the growing elderly population and said she would like to see a maintenance of effort in this regard. Ms. Evans said that although she understood the competition for funds, the level of reduction versus the growing need is a setback for the Aging Services programs. She requested Ms. Sloan to report back to the committee on the progress of the new program.

HR, Senior Services Program – Budget Page AGING-10 (Volume 2)

Budget Account 101-3146

Ms. Sloan indicated this program is the community-based care unit. She referred to the performance indicators (Exhibit H) and the projected caseloads (Exhibit I). She said that budget account 101-3146 includes four programs:

• A small Title XX allocation that funds some services.
• The state Community Home-Based Initiative Program (CHIP).
• CHIP Medicaid, which is the primary Medicaid waiver, and
• The group care waiver.

Responding to a query regarding a waiting list for services, Ms. Sloan said the waiting list is fluid. She explained that "cases" do not necessarily represent people¾ they represent an opening or slot. At present 36 cases a month are closed due to turnover; therefore, to bring in 36 clients a month requires social workers to process considerably more than that number per month. Ms. Sloan indicated that approximately 100 people are processed each month who do not come into the program because they are ineligible, they choose not to accept "the requirement of payment of a patient liability," they enter a nursing home, or they move out of state.

Ms. Sloan further stated the only program that does not have a waiting list is the group care program. Other statewide programs have waiting lists due to the time involved in the processing. Ms. Sloan said there were 519 people on a waiting list at the end of January 1999, and the numbers vary from 300 to more depending upon the location of referrals from hospitals, social workers, and families.

Asked whether the list of 519 people anticipated a 5-month wait to get on the program, Ms. Sloan said in Clark County the wait could be as long as 6 months, and about 90 days in the northern part of the state. Ms. Sloan indicated there is a proposal to reduce the length of time on the waiting list for people who require the highest level of care. She said that as the program has grown, the waiver requires that services be provided for people who would be eligible for nursing home placement. The individuals must be at either intermediate care levels 1, 2, or 3, or skilled nursing levels 1, 2, or 3. Ms. Sloan pointed out that people who are extremely frail, have limitations on multiple activities of daily living, or are coming out of hospitals, are expedited immediately to the greatest extent possible.

Senator Rawson requested Ms. Sloan to prepare an explanation of action that could be taken to shorten the waiting list and submit it to the LCB staff to be evaluated by the committee.

Mr. Goldwater requested Ms. Sloan to identify what had not been recommended in the unfunded decision unit E-999 in budget account 101-3151. Ms. Sloan indicated the unfunded decision unit contained requests for ombudsman positions, and an initiative to obtain services at the local level for the senior centers for volunteer programs.

Mary Liveratti, Deputy Administrator, Aging Services Division, Department of Human Resources, clarified that separate waiting lists are maintained for the Medicaid and state-funded programs. She said people are put on the Medicaid program because there are openings; however, openings on the state-funded program only become available when a person vacates the program. No growth is anticipated on the state-funded program and it will maintain an average of 50 slots per month throughout the next two years of the biennium, Ms. Liveratti stated.

Questioned whether there was a way of blending the two programs, Ms. Liveratti said state clients are tracked, and should an individual "spend down" to become Medicaid-eligible that person will be processed as a Medicaid case. Senator Rawson recalled there was a state that received a waiver to develop a long-term care insurance policy with a limit, and when the limit was reached Medicaid automatically took over. The senator encouraged input from the division in regard to combining the programs and utilizing as much federal money as possible.

Ms. Liveratti indicated approximately 114 clients are on the waiting list for the state-funded program and the wait can be many months.

HR, Homemaker – Budget Page AGING-16 (Volume 2)

Budget Account 101-3252

Ms. Sloan indicated this is a new budget account within the Aging Services budget that would accommodate the transfer of the Elder Protective Program and the Homemaker Services program from the Division of Health Care Financing and Policy to the Aging Services Division. She said considerable discussion has taken place during the past year regarding the placement of these programs in Aging Services. Ms. Sloan indicated that Ms. Crawford, Director, Department of Human Resources, recommended the programs be transferred and the transfer request was supported by both division administrators. She stated that Aging Services, through its elder rights unit:

• Responds to elder abuse complaints in nursing facilities.

• Maintains the elder abuse registry represented by the "Nevada Elder Abuse Reporting System—SFY 98" (Exhibit J), and is the repository for the reports.
• Trains extensively with law enforcement. During the last year a trilogy of videos was completed and used for training in law enforcement and elder abuse.
• Conducts elder abuse investigations if the complaint is in the long-term care setting.
• Coordinates through the Community Home-Based Initiative Program (CHIP) for in-home care, including homemaker and attendants’ services.

Ms. Sloan noted the division’s expertise is such that it can offer efficiencies within the program management.

Interjecting, Senator Rawson suggested a cost benefit analysis will be required to address the issue. Noting that 15 positions are being transferred with three remaining, the senator said his initial impression was that unless the positions are justified the three remaining positions should be cut. In response, Ms. Sloan indicated the division had not prepared a cost benefit analysis and had attempted to follow the funding prescribed for the programs. She said it would require work with the budget office to prepare such a document. Senator Rawson requested that the information be provided within a few weeks in order to evaluate the issue.

In conclusion, Ms. Sloan said it was important to note that the program was not a "clean" program to transfer because of shared responsibilities and other aspects of the Medicaid program. She noted that employees with other responsibilities had been asked to perform elder protective and homemaker duties. An attempt was made in the transition meetings to overcome the difficulties of splitting employee responsibilities, Ms. Sloan remarked.

Senator Rawson expressed admiration for what he called the sensitive manner in which the division attempted to retain services in a "tough" budget year. He complimented the division on being "client-oriented" and promised that the committee will do all it can within its limitations to make the service work better.

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

RESPECTFULLY SUBMITTED:

Barbara Moss,

Committee Secretary

APPROVED BY:

_____________________________________________

Senator Raymond D. Rawson, Chairman

DATE:_______________________________________

APPROVED BY:

_____________________________________________

Assemblywoman Jan Evans, Co-Chairman

DATE:_______________________________________