The Senate Committee on Legislative Affairs and Operations was called to order by Chairman Jon C. Porter, at 3:37 p.m., on Tuesday, February 16, 1999, in Room 2144 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 Jon C. Porter, Chairman

Senator Mark A. James, Vice Chairman

Senator Raymond D. Rawson

Senator Dina Titus

Senator Maggie Carlton

COMMITTEE MEMBERS ABSENT:

Senator William J. Raggio (Excused)

Senator Bernice Mathews (Excused)

STAFF MEMBERS PRESENT:

Robert E. Erickson, Committee Policy Analyst

Scott G. Wasserman, Chief Committee Counsel

Emory L. Crews, Committee Secretary

Chairman Porter opened the work session on Senate Concurrent Resolution (S.C.R.) 1.

Chairman Porter provided a proposed amendment (Exhibit C) for the members of the committee. He said the amendment establishes that the committee conduct a study consisting of eight legislators to be appointed as follows: Three members of the Senate appointed by the majority leader of the Senate. One member of the Senate appointed by the minority leader of the Senate. Three members of the Assembly appointed by the speaker of the Assembly. One member of the Assembly appointed by the minority leader of the Assembly. The Legislative Commission shall appoint the chairman of the committee.

Chairman Porter asked for a motion of the proposed amendment to S.C.R. 1.

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Chairman Porter opened the hearing on Senate Bill (S.B.) 137.

Clark (Danny) Lee, Lobbyist, Nevada General Insurance Company, testified he was representing Nevada Physical Therapy Association (NPTA). Mr. Lee presented the committee a "Bill Analysis" (Exhibit D) of S.B. 137 prepared by Pamela Hogan, President of NPTA. He said an impact study is needed of anything that would affect health care providers expanding the scope of their practice. He said S.B. 137 is a self-explanatory bill.

Fred L. Hillerby, Lobbyist, Nevada Optometric Association, stated S.B. 137 is an unnecessary barrier when trying to obtain access to the Legislature during session. He said S.B. 137 would require professionals to meet with a health care committee about impact studies when they are trying to expand their scope of practice. Mr. Hillerby said when it comes to licensure of health care professionals the health care committee then would have the jurisdiction of a Senate commerce committee. He told the committee he did not understand why one set of policy issues would require the kind of pre-work outlined in S.B. 137 before anyone would have access to the Legislature during session. He stated he would not support S.B. 137, and asked that the committee not support it as well.

Robert R. Barengo, Lobbyist, Nevada State Board of Medical Examiners (NSBME), related he was concerned about S.B. 137, section 1, paragraph (b), which states, "Change the scope of practice of a group of providers of health care…." He said there is no definition in NSBME’s scope of practice; however it would certainly provide a burden for any other provider of health care. He said NSBME is not opposed to S.B. 137 if scope of practice is defined as any means or any municipality.

Chairman Porter closed the hearing on S.B. 137 and opened the hearing on S.C.R. 4.

Senator Rawson told the committee S.C.R. 4 is a result of the recommendation that was adopted by an interim committee on health care. He said the interim committee felt the issue of long-term health care needed a significant study during the next interim. He stated if long-term coverage were extended to state employees, it would cost approximately $235 a year per employee. He said the significance is that there are approximately 70,000 public employees in Nevada, and if the cities, counties, and state were included in this measure, there would be a "significant decrease on the Medicaid program 10 years from now." Senator Rawson said there is a pressing social need for dealing with this issue for the future.

Edwin C. (Ed) Fend, Lobbyist, American Association of Retired Citizens (AARP), West Regional Office, submitted AARP Nevada State Legislative Committee’s "Managed Care Position Paper 1999" (Exhibit E). He stated long-term care is becoming an increasingly complex issue because of the cost involved. He said Nevada residents who need long-term care and do not have sufficient income must go on Medicaid and are placed in nursing homes. He stated persons requiring long-term care frequently could go into residential care facilities; however the federal government under Medicaid would not fund this process. Mr. Fend said minor accommodating upgrades to homes of those persons requiring long-term care could be a possible solution.

Janice A. Wright, Deputy Administrator, Division of Health Care Financing and Policy, Department of Human Resources, said there was a bill recently heard in the Senate Committee on Government Affairs which addressed the fiscal impact of long-term care. She said testimony given at that time indicated there were insufficient staff and funds to finance a study. She suggested combining some of the proposed studies. Ms. Wright stated the Division of Health Care Financing and Policy stands ready to assist a study committee in any way possible, recognizing at this point there is insufficient staff to conduct the study.

Chairman Porter said there have been others who suggested combining these studies. He also stated for the record, the company where he is employed has filed to sell long-term care. He said he was not sure this would be a problem when it came time to vote on S.C.R. 4.

Chairman Porter closed the hearing on S.C.R. 4 and opened the hearing on S.C.R. 5.

Senator Rawson stated the study of Medicaid managed-care programs was another complex issue addressed during the past interim. He said the statutes do not specifically demand some of the information asked for in this bill; therefore the interim committee felt it was necessary to ask for a study.

Mr. Fend revealed he sat in on the interim health care committee meetings. He submitted for the record AARP’s "Managed Care Position Paper 1998" (Exhibit F). He said AARP supports the interim study proposed in S.C.R. 5. Mr. Fend cautioned that health maintenance organizations (HMOs) should not be driven away from Nevada. He stated HMO’s ability to pay physicians a livable wage should be studied to ensure physicians are not driven out of these programs.

Roberta Gang, Lobbyist, Nevada Women’s Lobby, and Planned Parenthood of Southern Nevada, said quality-of-care issues and provider issues have been discussed during the last session of the Legislature, and in the interim health care committee. She encouraged some resolution, and agreed with Mr. Fend’s comments. Ms. Gang stated that she would endorse a study.

Ms. Wright said S.C.R. 5 is a very complicated issue and warrants some study. She said the Division of Health Care Financing and Policy has contracts with HMOs that address the quality-of-care issues. She stated there are approximately 12 different areas on which her division is maintaining information since a portion of managed care went into effect this past December. She reported this information would be made available to an interim study committee.

Senator Rawson stated that the interim study committee suggested a need for continuous monitoring and reporting to the Legislature. He said statutes do not require the Department of Human Resources to report to the committee; however, the department has been very cooperative and helpful. He added the study would take it a step further and require their cooperation.

Senator Titus stated since the Department of Human Resources was already reporting, and since there already is a standing committee on health care the interim committee may not be necessary. She said the existing standing committee might be able to conduct the study.

Chairman Porter closed the hearing on S.C.R. 5 and adjourned the committee meeting at 4:10 p.m.

RESPECTFULLY SUBMITTED:

Emory L. Crews,

Committee Secretary

APPROVED BY:

Senator Jon C. Porter, Chairman

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