The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 1:30 p.m., on Wednesday, February 24, 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:

Helen A. Foley, Lobbyist, Marriage and Family Therapists

Brent Begley, M.A., Licensed Marriage and Family Therapist

Chairman Rawson opened the hearing on SENATE BILL (S.B.) 10.

Janice Wright, Deputy Administrator, Division of Health Care Financing and Policy, Department of Human Resources, testified the division is currently working with the 27 tribes in Nevada, the Nevada Indian Commission, and all Indian Health Services tribal clinics to assist in eligibility and enrollment of Indian (Native American) children in the Nevada Check Up Program. Additionally, she said staff has given presentations to tribal councils to inform and educate them about the Nevada Check Up Program. Indian children who are tribal eligible can access other services at no cost. Therefore, there is little incentive to enroll in the Nevada Check Up Program, which requires a premium. Division of Health Care Financing and Policy (DHCFP) has worked with clinics in the Indian Health Services program, Great Basin Primary Care Association Inc., and the Robert Wood Johnson Foundation. Medicaid currently has contracts with 10 of the 11 Indian Health Service clinics and the hospital in Owyhee. Ms. Wright concluded the creation of an advisory committee specified in section 15 of S.B. 10 is the only concept not currently in force.

Chairman Rawson opened the work session on S.B. 21.

Pepper Sturm, Committee Policy Analyst, Research Division, Legislative Counsel Bureau, stated S.B. 21 has two proposed amendments. The first proposed amendment, outlined on attachment A, page 3 of "Work Session" (Exhibit C) is a proposal by Nevada Concerned Citizens. The amendment would make tests available 3 weeks following their administration to the public for viewing.

Senator Wiener asked if questions used in proficiency examinations were "recycled;" that is, used again in subsequent years. Chairman Rawson replied they probably are used again.

Mr. Sturm explained the second proposed amendment, attachment B, page 4 (Exhibit C) is by the Washoe County School District. It would tighten up the language of the bill to make test accommodations fairly standard statewide.

SENATOR SCHNEIDER MOVED TO AMEND AND DO PASS S.B. 21 WITH SECOND AMENDMENT (ATTACHMENT B) OF EXHIBIT C.

SENATOR MATTHEWS SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

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Chairman Rawson opened the work session on S.B. 58.

Mr. Sturm said S.B. 58 would change the current fall testing date to spring. Chairman Rawson commented approximately 80 to 90 percent of the districts test in the fall, using the results to analyze what to teach during the school year. Washoe County is testing in spring. If the change were effective January 1, 2001, schools would be able to honor their current contracts with the test vendors.

Senator Wiener asked if the tests look at comparative scores. She recalled the districts do an analysis, and discovered with two testing periods one will show performance, and the other helps with corrective action. She asked if the test looked at a period of time in order to help with comparative scores. Chairman Rawson answered affirmatively.

Chairman Rawson clarified S.B. 58 would change the testing to spring. Currently most testing is done in the fall. Senator Amodei said he misunderstood the motion and would withdraw his second.

SENATOR AMODEI WITHDREW HIS SECOND TO THE MOTION.

Chairman Rawson requested another second.

SENATOR WIENER SECONDED THE MOTION.

Senator Townsend said he misinterpreted some of the testimony and some of the materials that have been presented.

Chairman Rawson asked if the committee would object to holding the issue for another work session. The committee agreed that the bill be tabled for the time being.

THERE WAS NO VOTE ON THE MOTION.

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Chairman Rawson opened the work session on S.B. 104.

Mr. Sturm explained S.B. 104 would delay the test dates for the new proficiency examinations, which are linked to the new academic standards.

SENATOR TOWNSEND SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

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Chairman Rawson opened the work session on S.B. 72.

SENATOR TOWNSEND MOVED TO INDEFINITELY POSTPONE S.B. 72.

SENATOR WIENER SECONDED THE MOTION.

Senator Washington stated he would like to further research the issue and requested the motion be tabled. Senator Amodei said the bill was designed to cut down on fraud, but testimony presented earlier indicated there was no evidence that attempting to obtain benefits using a false identity is a problem in Nevada.

Chairman Rawson called for a vote on Senator Washington’s request to table the issue with committee rejection of the request.

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Chairman Rawson opened the work session on S.B. 89.

Mr. Sturm told the committee S.B. 89 has three proposed amendments described on page 7 of Exhibit C. Senator Townsend requested Jon L. Sasser, Lobbyist, Washoe Legal Services, to clarify the third proposed amendment which states, "Further, add that the percentage would increase from 10 percent to 50 percent, by the 2001-2003 biennium." Mr. Sasser explained it is his understanding there is approximately $500,000 per year attributable to utilities that comes into the indigent fund. Ten percent would generate $50,000 per year, not a great deal of help to assist indigent persons with their heating and cooling utility bills. Increasing the percentage for the 2001-2003 biennium to 50 percent, potentially $250,000 a year, would have a greater impact on the problem.

SENATOR WIENER MOVED TO AMEND AND DO PASS S.B. 89.

SENATOR TOWNSEND SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

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Chairman Rawson opened the work session on S.B. 117.

SENATOR MATTHEWS SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

*****

Chairman Rawson opened hearings on S.B. 73.

Carlos E. Brandenburg, Ph.D., Administrator, Mental Hygiene and Mental Retardation Division, Department of Human Resources, read prepared testimony (Exhibit D) verbatim. Chairman Rawson asked Dr. Brandenburg if S.B. 73 were processed as written would it eliminate the final approval of a psychiatrist under an emergency situation required under Nevada Revised Statutes (NRS) 433A.115 subsection 5 (Nevada Revised Statutes (NRS) 433A.160, subsection 5). Dr. Brandenburg answered the bill would not eliminate that provision. However, the bill would create dual standards; that is a physician would be able to conduct a second evaluation and not be able to do the emergency admission. He stated there are some inconsistencies between emergency and second evaluations. As it stands right now, a physician must seek and secure a psychiatrist. Chairman Rawson clarified S.B. 73 would change this.

Senator Townsend requested information about the purpose of the bill. Dr. Brandenburg stated he believes it applies to private psychiatric facilities, not state-operated facilities. State facilities use staff members to conduct evaluations. A concern is physicians may not have the proper training to conduct evaluations.

H. Jill Smith, Advocacy Director, Nevada Disability Advocacy and Law Center, Inc., testified she agrees with the previous testimony. The expertise required to evaluate a mental disorder is an important part of due process. A dermatologist or urologist for example, would not be the appropriate physician to determine mental status.

Chairman Rawson closed the hearing on S.B. 73, and returned to the hearing on S.B. 10.

Chairman Rawson explained the background of S.B.10. The concept came from the Legislative Committee on Health Care and was prompted by development of the Nevada Check-Up Program. There is a federal requirement that the state reach out to the Native American community, and attempt to bring children into the program.

C. Edwin (Ed) Fend, Lobbyist, American Association of Retired Persons, Western Regional Office, stated he was a member of the Legislative Committee on Health Care. He stated if the enrollment fee were not affordable, it could be waived. The lack of access to register seems to be the biggest reason for low enrollment by the Native American community. Mr. Fend supports S.B. 10 as a method to increase enrollment.

Chairman Rawson made the point that if a child is eligible for certain services under Medicaid, there is no assurance the child is receiving those services. Studies have shown that approximately 40,000 children are eligible for dental services under Medicaid, but access is scarce and not many dental offices will accept Medicaid. With the existence of Indian Health Services and other programs for the Indian (Native American) community, the committee might feel as though there is not a problem, but the health of this population does indicate more needs to be done.

Chairman Rawson closed the hearing on S.B. 10 and opened the hearing on S.B. 97.

Senator Wiener read her prepared testimony (Exhibit E) to the committee. Senator Wiener then presented Helen A. Foley, Lobbyist, Marriage and Family Therapists. Ms. Foley summarized her handout "Marriage and Family Therapists" (Exhibit F), and introduced Brent Begley, M.A., Licensed Marriage and Family Therapist. Ms. Foley commented that Mr. Begley is also an attorney, a rather unusual combination.

Mr. Begley provided copies of NRS 433.209 (Exhibit G), which defines persons professionally qualified in the field of psychiatric mental health. The current composition of the commission on mental health and mental retardation includes four of the five persons qualified under the section. A licensed marriage and family therapist is not included on the commission.

Mary Jean Thompsen, Community Advocacy Coordinator, Northern Nevada Center for Independent Living, made the recommendation a consumer be a member of the commission. Senator Wiener responded that the current framework of the commission includes a representative of the general public who has a special interest in the field of mental health, and a representative of the general public who has a special interest in the field of mental retardation; these members represent the consumer.

Chairman Rawson closed the hearing on S.B. 97 and opened the hearing on SENATE CONCURRENT RESOLUTION (S.C.R.) 8.

Senator Rawson explained to the committee S.C.R. 8 came from the Legislative Committee on Health Care. The State of Nevada currently has four separate home- and community-based waivers that have the same general purpose of allowing for a greater degree of independence for individuals who might otherwise be in nursing facilities. He described them as follows: one for the physically disabled to allow them to live in the community; another for the elderly, which is similar to the one for the disabled; a third for the elderly and disabled both to live in group care homes as an alternative to nursing facilities; and one specific to individuals who would otherwise be in an intermediate care facility for the mentally retarded (ICFMR).

Mr. Sasser testified during the interim he served on the Legislative Committee on Health Care. One of the issues studied was that of those waiting for Medicaid waiver services. He stated at that time there were 107 individuals on the waiver for persons with physical disabilities; an additional 162 have expressed interest in being on the waiver. The Community Home-Based Initiative Program (CHIP) waiver for the elderly had approximately 745 individuals on the program with a waiting list of approximately 598. He pointed out regarding group care waivers, there are 55 individuals on the waiver with no waiting list. Of the waiver for persons with mental retardation (MR) and related conditions, there are 694 individuals on the program with a waiting list of approximately 101 people. He stated under federal regulations, the waivers are capped, and the number of slots is stated in the waivers themselves. Changes in the Medicaid state plan would be required in order to implement an increase in the number of slots.

Ms. Thompsen read from her presentation (Exhibit H) which emphasizes the savings to the state under a waiver to allow individuals with disabilities to live independently compared to living in a nursing facility. Ms. Thompsen encouraged the committee to return $500,000 that was allocated when S.B. 433 of the Sixty-ninth Session was passed.

Senator Rawson said the decision to return $500,000 to the budget for the waiver program would come from the finance committee. He urged Ms. Thompsen to remain in contact with staff in order to testify before the finance committee when the issue comes before them for a hearing.

Edward R. Guthrie, Executive Director, Opportunity Village Association for Retarded Citizens, reported Opportunity Village was established in 1954. The association has a 45-year history of advocating for persons with mental retardation and related conditions. Mr. Guthrie provided the committee a presentation by David Braddock, Ph.D., to the United States Senate Select Committee on Aging (Exhibit I). Mr. Guthrie added currently there are 167 residents in state-operated ICFMRs and 89 residents in private facilities. Additionally, 559 residents are in facilities that are waiver funded. The cost of services in ICFMRs is $175 to $250 per patient day. The Governor’s budget proposes adding 54 people to ICFMRs and 205 people to be served through waiver funded programs. Mr. Guthrie stated according to the Mental Hygiene and Mental Retardation Division (MHMR) the Governor’s budget would leave 162 persons on the waiting list to receive residential services. Under Medicaid regulations, requests for Medicaid services must be provided in a reasonable amount of time. Mr. Guthrie added the majority of people with developmental disabilities reside with family caregivers. Many caregivers are retiring to Nevada, and are aged 60 or older. As the caregivers age, supervised arrangements outside the home must be established for their dependent relatives. Additionally, people with developmental disabilities are living longer. In 1993 when the most recent survey was done, the average life span of a Down’s syndrome person was 55 years of age. In conclusion, Mr. Guthrie noted that while Nevada is proposing the expansion of expensive ICFMRs, other states are expanding home- and community-based waivers, and closing institutions.

Brian L. Lahren, Ph.D., Lobbyist, Executive Director, Washoe Association for Retarded Citizens Inc., testified:

Donny Loux, Concerned Citizen, read a paper titled "What Are They Doing for Services Now" (Exhibit J).

Mary Liveratti, Deputy Administrator, Aging Services Division, Department of Human Resources, read prepared testimony verbatim (Exhibit K). Chairman Rawson asked Ms. Liveratti if any agencies in the department were adverse to S.C.R. 8. She replied the agencies are neutral on the bill.

Martin Bibb, Lobbyist, Retired Public Employees of Nevada, testified in support of S.C.R. 8 on behalf of the organization.

Ms. Smith stated she supported the testimony of Dr. Lahren and Mr. Guthrie. She alerted the committee of a decision by the attorney general to join as a leader in the states’ amicus curiae brief in support of the petitioner’s request for certiorari in L. C. and E. W. v. Olmstead. The action of the attorney general’s office undermines public policy and runs counter to the joint efforts of the disability community and state policy officials. The ruling will determine whether Nevada and other states can continue to segregate people in institutions. Chairman Rawson asked why the attorney general is taking this position as it would seem to thwart the efforts the state has made promoting the rights of persons with disabilities to be included in their communities. Ms. Smith replied the Office of the Attorney General made the decision without consulting with key disability policy makers in the state. Ms. Smith said the rationale for joining the brief is; the state wants to pursue community-based services, and the state does not wish to be forced to do so. Chairman Rawson stated he would instruct staff to communicate with the attorney general’s office concerning this brief.

Winthrop S. Cashdollar, Lobbyist, Nevada Health Care Association, testified the association supports S.C.R. 8. All those needing long-term care should have appropriate care. It is the position of Nevada Health Care Association the entire continuum of long-term care is in need of further study, and is underfunded in Nevada. Nursing facilities currently restrict admissions based on their ability to staff properly. It is Mr. Cashdollar’s understanding that the budget would eliminate the annual adjustments in nursing facility rates. Senator Wiener requested clarification of a statement made by Mr. Cashdollar, that home- and community-based services extend the need for long-term care. Mr. Cashdollar answered although home- and community-based waivers save money for some long-term care clients, they increase overall government spending. While some people may move from institutional care to home care, an additional population who would never have been in institutional care would come into home- and community-based care.

Chairman Rawson closed the hearing on S.C. R. 8.

Chairman Rawson asked Senator Wiener for a motion on S.B. 97.

Cynthia Cook,

Committee Secretary

APPROVED BY:

Senator Raymond D. Rawson, Chairman

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