The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 1:45 p.m. on Wednesday, February 3, 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 Raymond D. Rawson, Chairman

Senator Maurice Washington, Vice Chairman

Senator Randolph J. Townsend

Senator Mark Amodei

Senator Bernice Mathews

Senator Michael Schneider

Senator Valerie Wiener

STAFF MEMBERS PRESENT:

Cynthia Cook, Committee Secretary

OTHERS PRESENT:

Chairman Rawson introduced members of the committee and briefly described the types of issues dealt with by the Senate Committee on Human Resources and Facilities.

Chairman Rawson presented the committee with a copy of Senate Committee on Human Resources and Facilities, Standing Rules, Seventieth Session-1999 (Exhibit C).

SENATOR WASHINGTON SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

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Chairman Rawson advised the committee that Vice Chairman Washington will be conducting some of the Senate Committee on Human Resources and Facilities meetings. Chairman Rawson requested committee members having an important issue scheduled for future meetings, to discuss it with the chairman in advance and, if possible, the chairman will have that member conduct the hearing when it is scheduled for discussion.

Chairman Rawson turned the meeting over to Vice Chairman Washington.

Vice Chairman Washington introduced Pepper Sturm, Committee Policy Analyst, Research Division, Legislative Counsel Bureau, to present his policy brief, Committee Policy Brief, Senate Committee on Human Resources and Facilities (Exhibit D. Original is on file in the Research Library.)

Mr. Sturm presented an overview of the policy brief, which provides background information and summaries of major education and health and human services issues that are pertinent to the Senate Committee on Human Resources and Facilities. A list of website addresses, a list of key education and health and human services officials, and interest groups are also included in the brief.

Mr. Sturm reported issues of concern to other states during this year are: regulation of managed care, efforts to fine tune the Childrens Health Insurance Program, medical record privacy laws, mental health parity legislation, and certificate-of-need laws. On the federal level, issues that may be considered include the tobacco settlement, managed care, patients’ bill of rights, and changes to Medicare Parts A and B.

Senator Schneider asked to which committee the recommendation concerning an insurance ombudsman mentioned on page 17 of the Committee Policy Brief would be assigned. Mr. Sturm replied that has not yet been determined. Senator Schneider said that a health care ombudsman bill would be ready to go the beginning of next week, and he thought it would be an insurance bill assigned to the Senate Committee on Commerce and Labor. Senator Townsend added he thinks the proposed bill to which Mr. Sturm referred is Assemblywoman Buckley’s (Assemblywoman Barbara E. Buckley, Clark County Assembly District No. 8) proposed bill regarding managed care. He surmised it would be referred to the Senate Committee on Human Resources and Facilities. He added if the bill were drafted differently, it would be an insurance bill similar to Senator Schneider’s, and be assigned to the Senate Committee on Commerce and Labor. Senator Schneider explained that his bill would create an ombudsman in the Division of Insurance and would address all health care issues.

Vice Chairman Washington solicited the cooperation of the members of the Senate Committee on Human Resources and Facilities while Chairman Rawson is recuperating from surgery. Senator Wiener requested agendas be prepared as far in advance as possible in order to schedule witnesses or a teleconference.

Charlotte Crawford, Director, Department of Human Resources, presented a report titled Overview Presentation to the Committee on Human Resources and Facilities February 3, 1999 (Exhibit E).

Ms. Crawford briefly reviewed the organization chart of the Department of Human Resources on page 1 of the exhibit. She pointed out page 2 of Exhibit E compares the 1998-1999 legislative approved budget to the year 2000-2001 Governor’s recommended budget.

Ms. Crawford explained two changes reflect the increase for the Aging Services Division. Homemaker Services and Elder Protective Services, formerly in the Division of Health Care Financing and Policy budget, were transferred to the Aging Services Division which was done in order to bring programs together that focus on seniors. She emphasized, in addition, some expansion of services in the Community Home-Based Initiatives Program (CHIP) were enacted.

Ms. Crawford stressed the Division of Child and Family Services provides child protective services outside Washoe and Clark counties. The services include family preservation, reunification, adoption, alternative services to juveniles who must be removed from their families permanently or temporarily, juvenile correction services, and mental health services for children across the state. She said a 56-bed inpatient facility, Desert Willow, opened last year in southern Nevada. The facility is designed to provide multiple levels of inpatient treatment for adolescents from residential treatment, to acute psychiatric care. The division also provides foster care and alternative care.

Ms. Crawford pointed out the Health Division is the public health arm of the department, providing immunization, pre-natal care, and direct services through special children clinics in both southern and northern Nevada. She explained the Bureau of Licensure and Certification survey and certify hospitals, long-term care facilities, and intermediate care facilities for the mentally retarded.

Ms. Crawford stated the Mental Hygiene and Mental Retardation Division provides direct services at the acute level, inpatient level, and outpatient level across the state for individuals who are mentally retarded or mentally ill. The program has expanded over the past several sessions in order to meet increasing needs. Ms. Crawford explained additional expansion is reflected in this budget because of continuing need. Funding for the construction of an inpatient facility located in Sparks, that was passed last session, has been delayed but it is anticipated the delay will be no more than 6 to 9 months.

Ms. Crawford testified the Welfare Division administers the Temporary Assistance to Needy Families (TANF) program (formerly known as Aid to Dependent Children), the Food Stamp Program, and the Child Support Enforcement Program. Efforts to reform welfare have resulted in a 46 percent decrease in caseload since 1995.

Ms. Crawford clarified the Division of Health Care Financing and Policy is responsible for Medicaid, and cost containment for hospitals and health care. The division has been involved in two major projects: to enroll the Medicaid population within the TANF program and the Child Health Assurance Program (CHAP) into mandatory managed care in southern Nevada, and the development of the Nevada Children’s Health Insurance Program which the Department of Human Resources has named "Nevada Check-Up." She pointed out the program provides health care coverage to low-income children in Nevada who are not eligible for Medicaid and is funded 65 percent by the federal government and 35 percent by the state. Nevada’s share is met by funds from the intergovernmental transfer fund.

The Department of Human Resources also administers the Office of the State Public Defender and the Nevada Indian Commission. Senator Mathews inquired why the department is responsible for the Office of the State Public Defender and the Nevada Indian Commission. Ms. Crawford replied this occurred several years ago when state government was reorganized.

Senator Wiener asked if a bill that passed last session tying child support and licensure has any impact on the collection of child support. She further inquired how many children are enrolled in the Nevada Check-Up program.

Ms. Crawford answered the agency is seeing increases in child support payments; however she does not have detailed information concerning the recoveries. Currently 4,100 children are enrolled in the Nevada Check-Up program.

Senator Washington said he spoke to Washoe County District Attorney Richard Gammick about the Nevada Operations Multi Automated Data Systems (NOMADS). Senator Washington pointed out that District Attorney Gammick is concerned about the implementation of NOMADS and the help it is going to provide for the collection of child support.

Ms. Crawford responded NOMADS has worked very closely with the all the district attorney offices in the state, and child support cases are now coming on at the district attorney level. Fears of the system seem to be resolved as NOMADS activates these cases. She said the cases are put in motion gradually, and staff is excited when they see NOMADS function. The automated financial portion is working very well. Forms are currently being worked out to meet the needs of the office of each district attorney.

Senator Washington inquired if there is a time line for implementation of NOMADS.

Ms. Crawford replied that NOMADS should have been completed almost a year ago, and the Department of Human Resources is now in a penalty phase with the federal government. Ms. Crawford clarified Myla Florence, Administrator, Welfare Division, Department of Human Resources will provide more exact information concerning the completion of the system to the committee at a later date.

Ms. Crawford continued the total of the Department of Human Resources budget on page 2 of Exhibit E compares the 1998-1999 legislative approved budget to the year 2000-2001 Governor’s recommended budget and reflects an increase of approximately 400 million dollars. She said the largest expansion is reflected in the Welfare Division budget, because child support enforcement payments now flow through the division. There are some modest increases in most of the divisions, and a reduction in some areas. The Department of Human Resources’ priority programs are being supported at a substantial level.

Vice Chairman Washington asked Ms. Crawford if the Governor’s budget would sustain the Department of Human Resources’ programs. Ms. Crawford said she believes every care has been taken to sustain the programs for the people of Nevada.

Vice Chairman Washington inquired about the Division of Child and Family Services’ budget and the bifurcated system for foster care. He stated in Washoe and Clark counties there is a major disparity in the allocation per child. Noting an increase of approximately 23 million dollars in the budget, he asked if any of the increase is designated for the per-child disparity between the county and the state payments for foster care. Ms. Crawford said there are no increases in foster care payments, it is caseload growth and staff expansion that accounts for the budget increase.

Vice Chairman Washington asked what is the current ratio of caseload worker to child. Ms. Crawford said she does not have the information with her but she will provide the data to the committee.

Vice Chairman Washington added District Court Judge Charles M. McGee, Department 2, Second Judicial District, will propose a bill to do an in-depth study of the bifurcated system in Nevada, and its impact on the judicial system.

Ms. Crawford explained under the bifurcated system, Child Protective Services are provided by the county in Clark and Washoe counties and by the State of Nevada for the balance of the state. The counties supply early services, and if there is no reunification within the family, the child comes into the custody of the Division of Child and Family Services. The result is a disruption of services.

Vice Chairman Washington asked Ms. Crawford if she had any thoughts about a concept to transfer $766,000 in staffing and administrative costs budgeted for the Division of Health Care Financing and Policy from the Nevada Checkup program and rolling these administrative functions into Nevada Medicaid staffing. He said this would enable eligibility for the CHAP program, the Nevada Checkup program, and other vital services to be handled by one division as opposed to two. There are 3,000 children currently enrolled in the Nevada Checkup program, and the Governor wants to cap the enrollment at 10,000.

Ms. Crawford said the current enrollment in the Nevada Checkup program is 4,100. She explained the eligibility process for Medicaid is lengthy and complex, whereas Nevada Checkup has a simple single page application. The department is always willing to discuss ideas to streamline the process. She pointed out the federal government requires clients who may be eligible for Medicaid to go through that process in order to continue to be eligible for Nevada Checkup. While going through the Medicaid process, a client can be enrolled in Nevada Checkup and receive services. A single eligibility form would delay the process.

Ms. Crawford described the Division of Health Care Financing and Policy total funds by stating Medicaid payments, the largest element in the Department of Human Resources budget, flow through the division’s budget. Ms. Crawford stressed page 3 of Exhibit E reflects staffing for each division, and a moderate overall increase of 1.6 percent.

Ms. Crawford stated page 4 of Exhibit E describes the source of funds. The column headed "Other" represents the transfer of federal funds between divisions. She explained using Medicaid as an example; federal funds are brought in through the Division of Health Care Financing and Policy, then transmitted to those divisions that provide Medicaid services.

Vice Chairman Washington asked if intergovernmental transfer accounts are included in "Other." Ms. Crawford replied she does not have the answer, and she will get that information to the committee.

Senator Wiener referred to the totals for the Division of Child and Family Services, and said they do not balance. Ms. Crawford thanked Senator Wiener for pointing out the discrepancy and said she will provide a revised report (Exhibit F) to the committee.

Ms. Crawford explained page 5 of Exhibit E compares funding to the full-time equivalency (FTE) for each division. Ms. Crawford emphasized the degree to which the department has been involved in maximizing federal funding.

Ms. Crawford spoke of Nevada’s Family Resource Center Project which will continue at the same level as in the past. She said however, the budget for the Family to Family Program is limited to approximately 45 percent of the original funding. She defined pages 6 through 12 (Exhibit E) are an overview of the programs.

Senator Wiener asked if the department has provisions for the receipt of gifts. Ms. Crawford answered yes, however the bulk of the contributions received by the department consists of in-kind donations, not money. Ms. Crawford said a report being prepared for the Legislature will detail the donations for both.

Vice Chairman Washington asked if the report will reflect a cost per person for the Family to Family program. Ms. Crawford responded that computation is difficult to do at this time, because of the front-end costs associated with new programs. She said the report being updated for the Legislature will reflect the types of services being provided in the program. Client reporting is voluntary, with an emphasis on not being intrusive to families. Vice Chairman Washington inquired if the report would reflect the types of services being utilized and if child abuse or child neglect has been reduced as a result of the programs. Ms. Crawford answered the department tracked both issues, and those results are not yet completed. Senator Washington wanted to know if immunizations have increased. Ms. Crawford said the department collects those numbers also.

Vice Chairman Washington adjourned the meeting at 3:25 p.m.

RESPECTFULLY SUBMITTED:

Cynthia Cook,

Committee Secretary

APPROVED BY:

Senator Raymond D. Rawson, Chairman

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