ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES

MINUTES OF THE meeting

of the

ASSEMBLY Committee on Health and Human Services

Seventy-First Session

May 21, 2001

The Committee on Health and Human Serviceswas called to order at 1:30 p.m., on Monday, May 21, 2001. Chairman Ellen Koivisto presided in Room 3138 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

COMMITTEE MEMBERS PRESENT:

Mrs. Ellen Koivisto, Chairman

Ms. Kathy McClain, Vice Chairman

Mrs. Sharron Angle

Ms. Merle Berman

Mrs. Vivian Freeman

Mrs. Dawn Gibbons

Ms. Sheila Leslie

Mr. Mark Manendo

Ms. Bonnie Parnell

Mrs. Debbie Smith

Ms. Sandra Tiffany

Mr. Wendell Williams

GUEST LEGISLATORS PRESENT:

Senator Valerie Wiener, Senate District 3

Assemblywoman Barbara Buckley, Assembly District 8

STAFF MEMBERS PRESENT:

Marla McDade Williams, Committee Policy Analyst

Darlene Rubin, Committee Secretary

OTHERS PRESENT:

Robin Lecuyer, Resident, Carson City, Nevada

Alfredo Alonso, Lionel, Sawyer & Collins

Gale Thomssen, Director, Carson Advocates for Cancer Care

Carl Cahill, Division Director, Environmental Health Services Division, Washoe County District Health Department

Darin Winkelman, Public Health Director, Carson City Environmental Health Department

Helen Foley, Lobbyist, Clark County Health District

Alex Haartz, Deputy Administrator, Nevada State Health Division

Charles Duarte, Administrator, Nevada Division of Health Care Financing and Policy

Christopher Thompson, Consultant, Health Care Financing and Policy

Robert Ostrovsky, Lobbyist, Lake Mead Hospital

William Moore, Chief Executive Officer, Lake Mead Hospital

Denell Hahn, Lobbyist, Sunrise Hospital

Sue Pacult, Program Administrator, Clark County

Mike Alastuey, Assistant County Manager, Clark County

Danny Thompson, Executive Director, Nevada State AFL-CIO

May Shelton, Consultant, Washoe County

Robin Keith, President, Nevada Rural Housing Project

Jon Sasser, Attorney at Law, Washoe Legal Services

Marcia Holmberg, Assistant Administrator, Intergovernmental Services, University Medical Center

Steven Smith, Chief Executive Officer, Carson-Tahoe Hospital; Nevada Rural Health Project

Peter Livermore, Carson City Board of Supervisors; Trustee, Carson-Tahoe Hospital

Fred Hillerby, Lobbyist, Washoe Medical Center

Cynthia Pyzell, Senior Deputy Attorney General, Department of Mental Health and Developmental Services

Carlos Brandenburg, Ph.D., Administrator, Department of Mental Health and Developmental Services

Frankie Sue Del Papa, Attorney General

Michael Willden, Administrator, Welfare Division

Michael Hillerby, Deputy Chief of Staff, Governor’s Office

Robert Barengo, Lobbyist, Sunrise Hospital

Chairman Koivisto opened the hearing on S.B. 352.

Senate Bill 352: Revises provisions regarding regulation of food establishments. (BDR 40-1489)

Assemblywoman Bonnie Parnell, District 40, thanked the Chairman and the committee for revisiting S.B. 352, and she explained recent developments had prompted a proposed amendment.

Ms. Parnell referenced the proposed amendment (Exhibit C) and explained it would allow a licensing exemption to those who took meals to someone who was ill or in bereavement. All those who had performed that act of kindness probably had assumed they were not breaking the law or that they didn’t need a license; however, when it came to light recently that Robin Lecuyer, also known as “The Soup Lady,” had been taking soup to cancer patients, the Health Department informed her she needed to be licensed.

Continuing, Ms. Parnell said the incident pointed out an inconsistency in current statute. Accordingly, the amendment intended to clarify the status of someone who wanted to be involved in compassionate service to others in need.

Testifying on behalf of the amended bill, Robin Lecuyer, a Carson City resident, said she had become involved in taking soup to cancer patients because she wanted to give back to the community that supported her following the death of her husband. She had seen the idea on the “Oprah” show about two years ago and recently offered, through Carson Advocates for Cancer Care, to do something for people going through radiation and chemotherapy.

Alfredo Alonso, representing the California-Nevada Soft Drink Association, stated he was honored to have that amendment attached to S.B. 352 which he believed made it a superior bill. He explained that the amendment exempted food prepared in a private home and distributed free of charge and would impact Nevada Revised Statutes (NRS) 446.870.

Continuing, Mr. Alonso said the bill’s sponsors had discussed subsection 5 that dealt with religious and charitable organizations, and he believed that was covered in NRS 446.020 and would be redundant. He had no problem with that subsection being removed.

Assemblywoman Leslie posed a hypothetical situation in which someone made soup in their home, delivered it to someone else, and then that person became ill from it. Could that person sue? Would the Health Department not become involved? Mr. Alonso said that was correct. Ms. Leslie asked if the Health Department was agreeable to that, to which Ms. Parnell responded a representative would speak to that.

Gale Thomssen, Program Director, Carson Advocates for Cancer Care, stated acts of kindness that took place in the community and the state should perpetuated and honored. She urged support of the proposed amendment.

Chairman Koivisto remarked that almost everyone was surprised to hear that a law was necessary to take homemade soup to someone in need.

Carl Cahill, Division Director, Environmental Health Services Division, Washoe County District Health Department, thanked the committee for providing the time needed to work on the amendment to S.B. 352. In regard to subsection 5, in Washoe County where there were so many special events, such as air races, nonprofit organizations were not required to get a permit. They did not allow home-cooked food to be served to the public, and he agreed with Mr. Alonso that subsection 5 should be removed from the amendment, as it was already covered in NRS 446.020.

Darin Winkelman, Public Health Director, Carson City Environmental Health Department, said he had initiated the issue regarding Ms. Lecuyer, and that he supported the bill as amended, including the deletion of subsection 5.

Helen Foley, Lobbyist, representing Clark County Health District, supported the proposed amendment including the deletion of subsection 5.

Alex Haartz, Deputy Administrator, Nevada State Health Division, echoed the support of the preceding witnesses and endorsed the deletion of subsection 5.

There being no further questions or testimony, the Chairman asked the committee’s wishes.

ASSEMBLYWOMAN PARNELL MOVED TO AMEND AND DO PASS S.B. 352 WITH THE PROPOSED AMENDMENT AND THE DELETION OF SUBSECTION 5 ON PAGE 3, AS SUBMITTED BY ASSEMBLYWOMAN PARNELL.

ASSEMBLYWOMAN SMITH SECONDED THE MOTION.

Assemblywoman Angle asked for clarification that if subsection 5 was removed, could a church or charitable organization have a bake sale without obtaining a health permit. Assemblywoman Parnell responded that the reason for the deletion of subsection 5 was that it currently existed in statute.

Marla McDade Williams, Committee Policy Analyst, clarified the subsection was included to make it clearer how that exemption in existing law worked, and, therefore, did not believe it should be taken out. She believed bill drafters understood what everyone’s intent was in regard to that section.

Assemblywoman Leslie said the Legal Division had just sent an e-mail that it was not that simple to delete that subsection. They wanted an opportunity to work with the parties to develop language that met the desired intent. Ms. Leslie was comfortable with the motion, as long as the intent was to leave the nonprofit organizations covered.

Chairman Koivisto asked Ms. Parnell to restate her motion. Ms. Parnell said she found it perplexing that the local and state health departments and others who had interpreted the statute felt comfortable with the deletion. She asked for their input.

Mr. Winkelman said he was comfortable with removing subsection 5; however, it might be an issue that Washoe County Health District could better address. Nevertheless, with subsection 5 left in place, he felt the door would be open to food-borne illness, a subject about which he was very concerned. He explained that when food was prepared at home and taken to special large events, and there happened to be a large food-borne illness outbreak, it created major problems. By striking that subsection, it would allow the interpretation he needed while still allowing the church and similar organizations to have bake sales. He felt it was important to strike that subsection.

Chairman Koivisto understood Mr. Winkelman’s concerns, as well as those of Ms. Parnell. Mrs. Koivisto felt it had to be assumed that bill drafting, aware of the intent, would create an amendment to address those concerns. She asked if Mr. Winkelman preferred to have the Legal Division address the issue before the end of the meeting. Ms. Parnell asked to have the Legal Division clarify the matter before passing the amended bill out of committee.

Chairman Koivisto then opened the work session on S.B. 112 and asked Ms. McDade Williams, Committee Policy Analyst, to clarify information for her.

Senate Bill 112: Revises certain provisions concerning amelioration of causes of poverty to conform to changes in federal law. (BDR 38-535)

Marla McDade Williams reported the bill had been heard by the committee on April 25. It revised certain provisions concerning the amelioration of the causes of poverty to conform to changes in federal law. The Chairman had received a response from Janelle Mulvenon, with Community Connections, that identified the federal law that required changes in state law. There were no amendments proposed for the bill.

ASSEMBLYWOMAN LESLIE MOVED TO DO PASS S. B. 112.

VICE CHAIRMAN MCCLAIN SECONDED THE MOTION.

THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT.

Chairman Koivisto then opened the work session on S.B. 337.

Senate Bill 337: Provides for regulation of boilers, elevators, pressure vessels, boiler inspectors and elevator mechanics. (BDR 40-1033)

Chairman Koivisto reported the bill, sponsored by Senator Care, was heard previously. There were some individuals who wanted an amendment, but that amendment had since been withdrawn. Originally the mechanical contractors had supported the bill; however, they had since withdrawn their support. Senator Care was not aware of the amendment when he presented the bill. Mrs. Koivisto said it was a safety bill and could be passed out the way it had been presented.

VICE CHAIRMAN MCCLAIN MOVED TO DO PASS S. B. 337.

ASSEMBLYWOMAN LESLIE SECONDED THE MOTION.

THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT,

WITH ASSEMBLYWOMAN PARNELL ABSTAINING.

Chairman Koivisto closed the work session on S.B. 337 and opened the hearing on S.B. 377. She announced that due to time constraints, testimony would be limited to 20 minutes on each side.

Senate Bill 377: Revises provisions governing payment of hospitals for treating disproportionate share of Medicaid patients, indigent patients or other low-income patients. (BDR 38-316)

Charles Duarte,Administrator, Division of Health Care Financing and Policy, Department of Human Resources, was accompanied by Christopher Thompson, a consultant for the Division on disproportionate share (DSH) policy issues. Mr. Duarte explained the bill dealt with Nevada’s disproportionate share and inter-governmental transfer program. He provided his written testimony (Exhibit D), highlights of which were as follows:

Since its 1919 inception, the program had brought in nearly $400 million in additional federal funds which had been used to support the Medicaid and Nevada Check Up programs and to make $200 million in direct payments to hospitals;

The Department of Human Resources created an interim study committee to review the disproportionate share and intergovernmental transfer program;

The first reprint of S.B. 377 reflected the recommendations of the Disproportionate Share Study Committee, June 2000 report (Exhibit E);

The committee wanted rural hospitals to receive an additional amount as a result of any increase in allowable DSH payment to the state. They wanted to provide benefit to private hospitals, but not reduce the benefit for any hospitals currently receiving DSH. Federal legislation passed at the end of 2000 increased Nevada’s DSH allotment, therefore, S.B. 377 was able to accomplish all those goals;

The bill provided rural hospitals currently receiving DSH would get an increase of $25,000 per year in net benefit from the program;

The bill provided that three rural hospitals that had been excluded from DSH because of federal law would receive $50,000 each per year;

The bill also provided DSH payments up to $200 per uncompensated day to any private hospital in a county with a public hospital that had a Medicaid utilization above the statewide average for all hospitals; and

Finally, the department would conduct an interim study of various programs used in the state for the provision of indigent care. The study would be funded out of the net benefit the state received from the increased DSH allotment.

Concluding, Mr. Duarte stated that prior to the Senate hearing on the bill, the Division was informed that Carson-Tahoe Hospital intended to become a private hospital. Under current law and with the bill as proposed, the hospital would have its DSH payments cut from $5.3 million to $2 million, and Carson City would become liable for an intergovernmental transfer of $1.5 million. As a public hospital Carson-Tahoe currently made a $3.9 million transfer. The Division proposed an amendment that would set the DSH payment for Carson-Tahoe at $4 million and the transfer from Carson City at $3 million. The amendment also would allow Carson City to impose a tax on the hospital in order to raise the funds necessary to make the transfer payment. The proposed amendment (Exhibit F) was provided.

Christopher Thompson, former administrator, Division of Health Care Financing and Policy, and current consultant for the Division, provided “Senate Bill 377 First Reprint Explanation of Changes” (Exhibit G), and summarized the key sections 1 through 5.

Responding to a question from Vice Chairman McClain, Mr. Thompson explained Medicaid utilization percentage was the percentage of the total inpatient days that a hospital served that were Medicaid related. For example, a hospital with 1,000 total inpatient days and 100 of those being for Medicaid patients, the Medicaid utilization percentage would be 10 percent.

Chairman Koivisto asked if “Medicaid days” were patient days that were being reimbursed by Medicaid. Mr. Thompson said they were patient days that were being provided to Medicaid patients whether they were paid directly by the state or by health maintenance organizations providing services for Medicaid. He added that the definition of an “uncompensated day” was a day for which the hospital did not have a third party source of payment, and for which they did not receive more than 25 percent of the cost of care from a patient who was making some attempt to pay, but unable to pay the full bill.

Vice Chairman McClain asked if those uncompensated days were for indigent patients. Mr. Thompson stated the term “uncompensated day” was used instead of “indigent,” because indigent care generally referred to individuals below a certain set income level. “Uncompensated day” was a broader term and included people who had a higher income level, but still were unable to pay the bill.

Continuing in his explanation of the bill sections, he mentioned, as Mr. Duarte had done, the interim study referred to in Section 5. Chairman Koivisto had recalled that DHR had done a study in the last interim but was unable to get the parties to agree to anything; therefore, what would be the point of repeating that study.

Mr. Duarte responded that the Department had been directed to conduct a study, a committee was formed, and recommendations were made. The only outstanding issue was the way in which to get funds to private hospitals in Clark County. The general recommendation had been that private hospitals should receive some DSH benefit. The committee had made recommendations for rural facilities as well as Clark County, but provided several alternatives for Clark County. The intent of the bill was to provide a reasonable middle ground to get new federal dollars to those private facilities.

Chairman Koivisto asked what a continuing study would accomplish. Mr. Duarte responded it would continue to look at issues of equity and payment policy for the DSH program. A number of issues pertained to counties with a private hospital and no public hospital. Equity issues with respect to those areas needed to be examined. Further, he felt it was important to maintain ongoing review of the concerns raised in the process at private hospitals in counties with a public hospital to see how they were paid.

Robert Ostrovsky, representing Lake Mead Hospital, voiced support for S.B. 377 and presented an amendment (Exhibit H) for consideration. He concurred with the comments made by Christopher Thompson that it was an important bill for many hospitals across the state. However, he reminded the committee that DSH programs were enacted by Congress as a necessary response to a dangerously high number of emergency room closures and other problems related to hospital staffing. That situation was a result of a disproportionately high volume of uncompensated care to low-income patients across the nation. It had become a critical component of the Safety Net nationwide. In conclusion, Mr. Ostrovsky asked consideration for an amendment changing the definition of who should receive the additional funds for private hospitals in Clark County. He introduced Mr. Moore to continue the discussion.

William P. Moore, II, Chief Executive Officer, Lake Mead Hospital Medical Center (LMHMC), stated LMHMC was an “anomaly.” It was the only private hospital that currently qualified in Clark County for payment of DSH funding, a requirement of the federal government. There were two federal guidelines set up by the federal government that defined DSH hospitals:

Twenty-five percent or more of the patients treated were low income; and,
Comparison of the Medicaid utilization rate with its peers.

An inordinately large number of Medicaid patients did not necessarily meet the definition of DSH; however, if a hospital treated one standard deviation above the mean for the state, or significantly more than the average for the state, it would be defined as a DSH hospital. Currently there were only two hospitals in the state that met both federal requirements: University Medical Center (UMC), Las Vegas, and Lake Mead Hospital, North Las Vegas. Mr. Moore stated there might be two other hospitals that also qualified: William Bee Ririe in Ely and Humboldt General in Winnemucca.

Continuing, Mr. Moore stated it was his intention with the proposed changes that no hospitals that currently received funding would be affected in any way. It was his desire that those hospitals that truly treated a disproportionately large share of low income or had a high percentage of low-income utilization, received some relief. His primary concern was the viability of Lake Mead Hospital and, if current trends continued, the hospital would definitely be closed in the next 18 to 24 months. His prediction was based on the fact that they continued to see a higher utilization of low-income patients, including Medicaid clients, the homeless, or individuals without any type of reimbursement.

Mr. Moore then referred to an analysis of Medicaid utilization among Nevada hospitals (Exhibit I) that he explained as follows:

The “gray bar” area showed the current distribution per Medicaid day where the lowest amount next to Lake Mead Hospital was UMC. Currently LMHMC was being paid less than $10 per day. The only reason Lake Mead Hospital was getting any funding was because the federal government mandated the state pay the hospital something, since it met both criteria.
In the next column, “Proposed Distribution” per S.B. 377, showed Lake Mead rising from $8.61 to $63.09 per day.
Under the additional proposed amendment, a threshold would be set; the Medicaid utilization rate in Clark County would have to be 20 percent or greater to qualify. None of the rurals would be affected in a negative manner, nor any of the hospitals that currently qualified for DSH. Accordingly, the Proposed Distribution per S.B. 377a, in the last column, would be $150 per hospital.

Assemblywoman Leslie found the amendments extremely confusing to the committee and felt it unfair to ask the members to process the very difficult subject on the last day in the session on which bills could be voted. She asked if the amendments presented by Mr. Thompson worked in conjunction with Mr. Moore’s.

Mr. Ostrovsky responded stating Mr. Thompson’s amendment was completely independent of that presented by Mr. Ostrovsky and Mr. Moore. It could be processed with or without their amendment for the protection of Carson-Tahoe Hospital. Page 3, Section 3 of the bill proposed to replace in its entirety the language in 2(c), which dealt with Medicaid utilization, with the language in the proposed amendment. In paragraph 4(b), the definition of “uncompensated day” was removed because by making the change in (c) above, the term “uncompensated day” was removed from the statute.

Continuing, Mr. Ostrovsky asked for a review based on what the standard should be. If his amendment was accepted, the “bar was raised” and Lake Mead Hospital received a much larger payment. If S.B. 377 passed as currently written, both Lake Mead and Sunrise Hospital would receive compensation, with Sunrise receiving more than Lake Mead. The other option, he added, was an amendment to protect Carson-Tahoe Hospital.

Assemblywoman Leslie thanked Mr. Ostrovsky for clarifying the issue. She asked his rationale for the committee accepting his amendment that allowed Lake Mead to receive more money. Mr. Moore responded that Lake Mead Hospital currently treated a disproportionate share of indigent low-income patients. It would increase payment from $63.09 to $150 per day, and it was not greed on Lake Mead’s part, but rather an attempt to try to remain viable. If they were looking for a higher reimbursement, he would have proposed being reimbursed in a similar manner to that of hospitals in Washoe County, Elko, or any of the other hospitals that currently qualified. Alternatively, Mr. Moore suggested, they would have asked for a flat amount or to be reimbursed based on their uncompensated costs, which were in excess of $4 million. Instead, they were looking for a smaller amount, to be in line with the money that had been made available to the state. They would not try to exceed that amount, because it would not be supported by the Department of Human Resources.

Mr. Ostrovsky added that Lake Mead Hospital was a smaller hospital with a very large share, 37 percent, of uncompensated care. Sunrise was a very large hospital that also had a great deal of uncompensated care; however, it was smaller in terms of the percentage of their total number of patient days.

Chairman Koivisto asked if their amendment, in part, changed from a specific dollar amount to a percentage. Mr. Ostrovsky answered that the bill provided for a percentage amount. His amendment would raise it to a fixed number, greater than 20 percent of care. The standard was different and they believed more appropriate because it looked for those hospitals that had the greatest number of Medicaid utilization days.

Assemblywoman Tiffany asked if they had presented that proposal on the Senate side. Mr. Moore responded that they had presented S.B. 333, in a form very similar to the current, modified version. S.B. 377 and S.B. 333 were very similar bills, but S.B. 333 was not voted on. Ms. Tiffany asked if they had proposed an amendment to S.B. 377. Mr. Ostrovsky stated that during the work session one bill was killed, and the other one was processed. He added they had not been in the room when that occurred; if they had been they would have made a proposal.

Ms. Tiffany then asked who proposed the two bills. Mr. Ostrovsky said Lake Mead Hospital proposed S.B. 333, and Sunrise Hospital had proposed S.B. 377. He noted that Lake Mead Hospital had been receiving a very small amount of money for a number of years, and Sunrise Hospital had received no money. In both cases, the hospitals felt they were being treated unfairly. Ms. Tiffany agreed they were.

The next witness was Denell Hahn, who, along with Robert Barengo, represented Sunrise Hospital. She considered the state’s proposal to be very fair. They had spent a great deal of time in the interim with a diverse committee of public and private hospital representatives, the Department, and representatives from the Nevada Association of Counties (NACO). The recommendations were embodied in the amendments to the bill that had been furnished by the Department of Human Resources. Everyone felt they should have received more money, which Ms. Hahn said indicated it was “a pretty fair split.”

Assemblywoman Tiffany asked if Ms. Hahn supported the amendment proposed by Mr. Ostrovsky. Ms. Hahn said they did not, however, they appreciated the fact that Carson-Tahoe Hospital needed an amendment to include that hospital. Ms. Tiffany then asked what they did not like about the amendment. Ms. Hahn stated it only included Lake Mead Hospital, and while they did see 7,000 Medicaid days per year, that was only about one-third of what Sunrise Hospital had. She added the time had come when all hospitals should be treated equitably. Concluding, Ms. Hahn said their desire was for a “level playing field.”

Next to speak was Sue Pacult, Program Administrator with Clark County Social Services. Her intent was to support a fair DSH funding mechanism that enabled area hospitals to continue to provide care for the most needy citizens. As such, she believed that funding should follow the actual demand and actual cost expenditures to service that indigent population. She was also concerned that the viability of Safety Net providers be maintained. She expressed support for Mr. Ostrovsky’s proposed amendment.

Michael Alastuey, Assistant County Manager of Clark County, echoed Ms. Pacult’s comments. They supported the amendment offered by Lake Mead, but pointed out one grave concern. The financial analysis provided by the Department of Human Resources to examine the expected impact of the bill, as amended, had an additional $1 million intergovernmental transfer from Clark County, or UMC, or another Clark County source. He pointed out that in the past, intergovernmental transfer had resulted in a return of approximately $4 for every $3 paid in. In that particular case, there was $1 million paid in and only about $200,000 net benefit back to the county to help provide health care. Mr. Alastuey implored the committee to examine the distribution of the payments. If the amendment by Lake Mead was adopted, he believed the numbers should be rerun and the county’s contribution under that scenario be reduced or eliminated.

Vice Chairman McClain commented that she did not see how anyone could be opposed to the 20 percent. It seemed the fair way to do it; however, she agreed that the numbers should be rerun.

Danny Thompson, Executive Director, Nevada State AFL-CIO, opposed the bill as written; however, if the bill were amended to protect Carson-Tahoe Hospital he would support it. He supported the amendment by Mr. Ostrovsky.

Mr. Thompson referred to one item in his handout, “Data Submitted to the Disproportionate Share Committee” (Exhibit J). The bottom line, the total profit/cost, indicated which hospital was making money. DSH money should compensate hospitals that suffered financially by taking care of those patients.

Mr. Thompson also pointed out that Lake Mead Hospital had 12,000 Medicaid patient days last year. The interim DSH committee had spent six months reviewing the issue, yet made no clear recommendation about Clark County. In a letter from Charlotte Crawford, Director of the Department of Human Resources, dated July 3, 2000, included as part of Exhibit J, Ms. Crawford stated “the Department believes the allocation of DSH benefits in Clark County is a local issue which should be addressed by local policymakers.”

May Shelton, representing Washoe County, expressed support for S.B. 377, as well as the amendments proposed by the Department of Human Resources. She proposed one additional amendment to Section 5 regarding the interim study. Ms. Shelton noted that the issues in question were very complicated and technical, and for the Department of Human Resources to take on the subject again might place the hospitals at odds again. She suggested that the interim Health Care Committee take on the study because it represented a level of authority to which the hospitals would listen.

Robin Keith, President of Nevada Rural Hospital Project (NRHP), stated the issue was very important as S.B. 377 represented about $1.2 million in benefit to the rural facilities, including those three hospitals that did not currently qualify under the program. She said DSH helped offset a good deal of uncompensated care. The rural DSH hospitals were providing about $11.6 million in uncompensated care. DSH reimbursed the hospitals for about $2.7 million of that amount, leaving about $8.9 million balance of uncompensated care. She added there were many reasons why the committee had decided to recommend against doing anything that would diminish DSH payments to rural facilities. In fact, the committee recommended that new federal DSH money that was coming into the state be shared in such a way that rural hospitals would benefit. She expressed NRHPs appreciation to the committee for its commitment that the rurals remain whole, including the $50,000 benefit to the hospitals that did not currently qualify.

Jon Sasser, Attorney at Law, Washoe Legal Services, commented the bill was extremely important for rural hospitals and for Carson-Tahoe Hospital, and he urged that it be passed as outlined by the division. He remarked that he usually did not like to get involved in competition between hospitals because his clients had to rely on them all; however, in listening to the testimony, one principle occurred to him that might cause him to lean more toward Mr. Ostrovsky’s amendment. That was the definition in the current bill of “uncompensated care.” He believed that the DSH program was set up to recognize hospitals that were representing a disproportionate share of low-income people. Uncompensated care did not necessarily reflect services to low-income people; it reflected services to persons who did not pay their bills. Therefore, a reliance on the bill’s definition of “uncompensated care” caused him concern.

Marcia Holmberg, Assistant Administrator, Intergovernmental Services, University Medical Center, expressed support for Mr. Ostrovsky’s amendment to the bill. Regarding the concept of disproportionate share, the Institute of Medicine conducted a study of Safety Net providers who provided the vast majority of uncompensated care throughout the country. She noted that the formulas were calculated based on the Medicaid rate. One of the things that was happening was that some private hospitals in the past were unwilling to treat Medicaid patients. Because of the change in the medical industry, they were currently willing and seeking to treat Medicaid patients, because some Medicaid services were very highly reimbursed. Although a private hospital may have a high level of Medicaid patients for which they were being reimbursed, hospitals such as UMC and others, like Lake Mead, had high rates of uncompensated care. She added that she hoped that fact would not be lost in the discussion.

Steven Smith, CEO, Carson-Tahoe Hospital, noted there was $74 million at issue, and only about three people in the state who understood the matter. He said in his other role as chairman of the Nevada Rural Hospital Project, he supported the bill and felt it benefited the rural hospitals. He added that all the testimony thus far had indicated support for the rurals getting the minor amount of money the bill would give them.

Speaking as the CEO of Carson-Tahoe Hospital, with the amendment (Exhibit F), presented by Charles Duarte, Mr. Smith said Carson-Tahoe would lose $400,000 from what it had previously received. The reason for that was Carson-Tahoe sought to become a 501(c)(3) private hospital and would lose the funding it received as a county hospital. More importantly, if the amendment was not passed, Carson City would pay the state $1.5 million. At best, the hospital might get $2 million, but the hospital could not give back any portion of that to the city. He added that was one of the primary reasons he wanted to testify: “the hospital wanted to make the city whole.”

Peter Livermore, a member of the Carson City Board of Supervisors and a trustee of Carson-Tahoe Hospital, urged support for S.B. 377 and the Carson-Tahoe amendment, to ensure the long-term health care of the citizens of Carson City and the entire region.

Fred Hillerby, representing Washoe Medical Center, urged passage of S.B. 377. He explained that Section 4 was the mechanism that implemented the system that had been in place for some time. Without that, there was not a system to distribute the DSH dollars to Washoe Medical Center and some of the other hospitals.

Chairman Koivisto asked what effect the amendments would have on Washoe County. Mr. Hillerby said there was none.

Assemblywoman Tiffany asked Mr. Ostrovsky if his amendment was passed, would it change the way the formula worked in Section 4. Mr. Ostrovsky said that was correct. Anyone who reached that 20 percent threshold would become eligible for payment. Ms. Tiffany noted that out of the formula change, Lake Mead and Sunrise Hospitals would be vying for the differences in money. Mr. Ostrovsky said the only two hospitals in Clark County that he believed currently qualified were Lake Mead Hospital and University Medical Center. They had the “greater than 20 percent” utilization factor. The rurals were covered in another section of the bill, and he did not believe it changed that, nor was it the intention to change it. The appropriate language had been added to make sure they were “grandfathered in.” If his amendment was dropped, bill drafting should be very careful that it did not affect any of the rurals or the other counties, nor negatively impact the Carson-Tahoe amendment.

Ms. Tiffany then asked Mr. Ostrovsky about the handout (Exhibit I) presented by Mr. Moore. He said the numbers were hard to grasp and hard to define, so a definition was selected which everyone knew how to evaluate. He felt $8.61 was an inappropriate rate for Lake Mead Hospital, but that was the way the system had been “broken” for a long time. Ms. Tiffany said they were “trying to protect Carson-Tahoe,” but Lake Mead Hospital appeared to need protection even more, based on those numbers. Mr. Ostrovsky felt that was the reason the DHR proposed that an interim study be done, to try to determine the appropriate way to make those distributions.

Mr. Moore interjected that in fairness, other hospitals that had been in a similar situation as Carson-Tahoe had been “grandfathered in;” namely, Washoe, Elko, and Nye Regional, and the amendment allowed Carson-Tahoe Hospital to be handled that way also. What Carson-Tahoe presented was not an unfair distribution. For Lake Mead to be increased from $8.61 to $150, although still less than half the next lowest hospital, was more palatable than what they currently received.

Mr. Duarte stated he had just received a copy of Mr. Ostrovsky’s proposed amendment and would like to examine it to determine if it could be approved under federal law.

Chairman Koivisto closed the hearing on S.B. 377 and said she would bring it back before the end of the meeting for a vote.

Regarding S.B. 352, Chairman Koivisto noted a quorum was present and asked Assemblywoman Parnell to explain her amendment.

Ms. Parnell thanked everyone who worked so quickly to get the amendment completed. She referred to page 3, subsection 5, and stated the following would be added: “…if the sale occurs on the premises of the organization. If the sale occurs off the premises of the organization, a permit is required unless an exemption is issued pursuant to subsection 2.” That added religious, charitable, and other nonprofits to NRS 446.870, which references exemptions. Currently it was only in NRS 446.030, and legal staff recommended to double-reference it and make sure it was cited in exemptions. It would also allow the Division of Health to require permitting when appropriate. It did not apply to the “Soup Lady” situation because no sale of goods was taking place, and that addition only applied to the sale of goods. She added the amendment had been agreed upon by all parties, and she urged the committee’s support.

Chairman Koivisto asked Ms. Parnell to make the motion.

ASSEMBLYWOMAN BONNIE PARNELL MOVED TO AMEND AND DO PASS S.B. 352 WITH THE ABOVE AMENDMENT.

ASSEMBLYWOMAN SMITH SECONDED THE MOTION.

THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT.

Chairman Koivisto opened the hearing on S.B. 116.

Senate Bill 116: Revises provisions governing use of restraints and interventions on persons with disabilities. (BDR 39-346)

Marla McDade Williams, Committee Policy Analyst, referred to the proposed amendment for S.B. 116 (Exhibit K), submitted by Assemblywoman Barbara Buckley, and stated the purpose of the amendment was:

· To define “forensic facility” as a facility for mentally disordered offenders and defendants who were ordered to the facility by a court. That would include Lake’s Crossing Center, in Reno.

· To revise the definition of “mechanical restraint” to include handcuffs, belly chains, and four-point restraints which were used by forensic facilities to ensure the security of the facility and clients.

· To prescribe the additional circumstances under which a “forensic facility” may use mechanical restraint on a person with a disability who was a client of the facility; and

· To clarify that a parent or legal guardian of a pupil with a disability and the pupil’s individualized education program team were entitled to receive certain reports regarding the use of restraints and interventions on the pupil by public and private schools, and were allowed to participate in a hearing or meeting to determine whether a violation of the pupil’s rights had occurred. That would apply to pupils with disabilities in public and private schools.

Continuing, Ms. McDade Williams said the amendment had been worked out by representatives of the Division of Mental Health and Developmental Services, as well as by Assemblywoman Buckley.

Cynthia Pyzell, Senior Deputy Attorney General, Division of Mental Health and Developmental Services, stated she had worked on the bill and on some of the changes. The Division had worked with the Legislative Counsel Bureau to try to clarify some of the language as it pertained to “forensic facility.” The bill was originally brought about because of A.B. 280 of the Seventieth Session, which dealt with aversive interventions and restraints used in facilities. Ms. Pyzell advised that Lake’s Crossing Center was a forensic facility that had some “strong difficulty in adhering to the letter of the law,” as was brought forward in the interim Legislative Committee on Health Care, that was checking on the implementation of that bill. For that reason, Lake’s Crossing was exempted.

Continuing, Ms. Pyzell said she had no idea where subparagraph 4, page 1 of the amendment, came from, as she had never discussed anything having to do with educational facilities; however, with respect to clarifying how the proposed amendment applied to Lake’s Crossing Center, it differentiated and provided for a different type of procedure for that facility, which she supported.

Assemblywoman Tiffany asked Ms. McDade Williams to explain how the subparagraph referenced above fit into the bill. Ms. McDade Williams said that it was “clean up” language from A.B. 280 of the Seventieth Session, which was the reason the Division came forward to amend it.

Assemblywoman Parnell offered additional clarification for Ms. Tiffany, clarifying that when A.B. 280 of the Seventieth Session was passed, many special education teachers in the state had classes with students who needed to be restrained. The way the bill was written, every time they restrained a student, they would have had to immediately fill out a report on the need for the restraint, what process had been used, and so on. That caused a “great furor” within the special education units, particularly with some of the more profoundly mentally and physically challenged students. That subparagraph, therefore, was a response to the problem.

Assemblywoman Angle wanted clarification on who recommended the section about a pupil’s rights. She was concerned that there had been no testimony from parties who might be involved in that issue. Chairman Koivisto responded that A.B. 280 from the Seventieth Session had dealt with aversive techniques. Part of that bill was about restraints, and it caused great difficulty for special education teachers, and it was being corrected under S.B. 116. Mrs. Angle said she understood the impetus, but not why the use of restraints in public or private schools would come under the bill that concerned a forensic facility’s restraints. She felt that should be dealt with in the Education Committee, and she asked again who offered that part of the amendment.

Chairman Koivisto stated that A.B. 280 of the Seventieth Session had been a very broad bill that had been heard and passed out of the Assembly Health and Human Services Committee. That was the reason S.B. 116 had come back to the committee for certain issues to be readdressed and corrected.

Ms. McDade Williams reported she had received an indication from the bill drafting staff that the parts about education in the bill were “cleanup” language from the aversive therapy bill from last session.

Assemblywoman Berman said she had a difficult time accepting Section 3 on page 13 of Exhibit K as “cleanup” language, and she asked Dr. Brandenburg to review that section.

Dr. Carlos Brandenburg, Administrator, Division of Mental Health and Developmental Services (MHDS), determined that language applied strictly to the administrator of a private school; it did not apply to MHDS.

Chairman Koivisto stated the bill would be brought back to committee to await an explanation from the bill maker of A.B. 280. She stated, however, the “aversive techniques” bill that passed out of committee last session had dealt with schools as well as Dr. Brandenburg’s area, and that was the reason Section 3 had been included in S.B. 116.

Chairman Koivisto opened the hearing on S.B. 367.

Senate Bill 367: Provides for administration of certain activities to prevent or delay early sexual activity and reduce rate of pregnancies among unmarried teenage girls in Nevada. (BDR S-26)

Senator Valerie Wiener, District 3, explained S.B. 367 dealt with delaying the early sexual activities of teenagers and others younger, to reduce the rate of teen pregnancies. Nevada had dropped from number 1 to number 4 in out-of-wedlock pregnancies for teenagers. Senator Wiener provided her written testimony (Exhibit L) and urged support and passage of the important bill. Some highlights of Senator Wiener’s testimony were as follows:

Thirty-nine percent of ninth graders had engaged in sex;
Sixty-five percent of 12^th graders had engaged in sex;
One in three teens opted for no birth control; and
Twenty-five percent of American girls have been pregnant at least once by the age of 20.

Despite those statistics, an Associated Press report dated August 9, 2000, revealed:

Teenagers were having babies at the lowest rate in at least 60 years. Nationally, that translated into about 50 births per thousand teenage girls; a reduction by almost half since 1957, when the rate was 96 births per 1,000; and

Nevada had dropped from number one to number four in births for 15-to-19-year-olds, a reduction of 20 percent since 1995. That translated to 75 births per 1,000 girls ages 15 to 19.

Continuing, Senator Wiener said young people surveyed had attributed their sharpened awareness to advertising campaigns and community-based and faith-based programs. Also, seeing their friends having children had a chilling effect, sometimes resulting in teens forgoing sexual activities altogether. Nevertheless, any teen pregnancies, especially out-of-wedlock pregnancies, were too many. Even at fourth place, Nevada still had to deal with the reality that too many high school and younger students engaged in sexual activity, some before the age of 13. Further, Senator Wiener said that the risk of becoming involved in sexual situations was compounded by the use of drugs and alcohol, and in Nevada more than one in four sexually active students drank alcohol or used drugs before they had sexual intercourse the last time.

Continuing, Senator Wiener noted what S.B. 367 would accomplish:

Section 1 created a state partnership comprised of the Health Division Administrator and other key representatives to carry out activities designed to raise public awareness.

The partnership would meet regularly until 2005, and, to ensure accountability, would submit regular reports of their activities to the legislature.

The Health Division would be able to accept gifts, grants, and donations from public and private sources to help the partnership carry out its duties.

The partnership would promote efforts to delay early sexual activity and reduce the rate of pregnancies among unmarried teenage girls; establish and promote “Teen Pregnancy Prevention Month”; and a campaign to target adult and adolescent males, because more than 70 percent of the fathers of babies born to teenage mothers in Nevada were adults over 19.

Concluding, Senator Wiener said Section 8 of the bill provided for an inter-agency agreement between the Health Division and the Welfare Division, enabling the Welfare Division to transfer TANF (Temporary Aid to Needy Families) money to the Health Division to carry out provisions of the legislation. The cooperative agreement would utilize S.B. 367 to accomplish a federally mandated goal to reduce out-of-wedlock pregnancies in Nevada.

Attorney General Frankie Sue Del Papa, also representing the National Campaign to Prevent Teen Pregnancy of which she was a board member, echoed Senator Wiener’s concern about the high teen pregnancy rate. She reported that nationwide, four out of every ten girls would become pregnant before the age of 20. She believed S.B. 367 was a big step in the right direction. Experts reminded adults to focus on kids, to involve key players, and to make it happen, and S.B. 367 did all three in a coordinated manner. She strongly urged the committee’s favorable consideration of S.B. 367. For additional information, Ms. Del Papa stated the Web site www.teenpregnancy.org would provide information in English and Spanish, and information on what efforts would be continued in Nevada.

Chairman Koivisto noted there was a fiscal note for state and local tax impact and asked if the bill needed to go to the Assembly Committee on Ways and Means. Senator Wiener replied the bill had already been through the Senate Committee on Finance, and Mr. Willden, of the Welfare Division, could respond on how it would be funded.

Michael Willden, State Welfare Administrator, stated the TANF budget was closed with $1 million for two of the Governor’s objectives. One was to provide funding for the type of activities covered by S.B. 367, and the second was to provide funding for projects related to family formation. Although $2 million was requested, the $1 million would allow support for Senator Wiener’s bill. The fiscal note associated with the bill was just under $500,000, and most would go to direct grants, some for the education advertising campaigns, and a small amount, under $2,000, for administration.

Responding to a question by Assemblywoman Tiffany, Senator Wiener said the money would go for two social marketing programs, and local community-based organizations would apply through the RFP (request for proposal) process. The focus would be on reaching the adolescent and adult males and also populations with a high rate of teen pregnancy.

Ms. Tiffany then asked Mr. Willden if the Welfare Division could refer young mothers with babies who were on welfare to an education program. Mr. Willden said “absolutely.” He added that a minor who was pregnant or had a child was required to live with her own parents, unless she got an exemption. Social workers worked with those teens in the “Stars” program, and they could be required to participate in that kind of program as part of their personal responsibility plans.

Alex Haartz, Deputy Administrator, Nevada State Health Division, expressed support for S.B. 367.

Chairman Koivisto asked the committee’s wishes.

VICE CHAIRMAN MCCLAIN MOVED TO DO PASS S.B. 367.

ASSEMBLYMAN MANENDO SECONDED THE MOTION.

THE MOTION WAS CARRIED UNANIMOUSLY BY THOSE

PRESENT.

Chairman Koivisto opened the hearing on S.B. 539.

Senate Bill 539: Makes various changes concerning fund for a healthy Nevada and program to provide prescription drugs and pharmaceutical services to senior citizens with low incomes under certain circumstances. (BDR 40-536)

Assemblywoman Barbara Buckley, District 8, noted there had been competing prescription drug proposals before the committee. The Governor’s Office and Ms. Buckley, Assemblywoman Freeman, and many others had been working on the varying proposals over the last several months. She was pleased to report that they had reached a compromise, which she felt was in the best interest of the seniors. Mrs. Buckley outlined her proposed amendment, for which she provided written testimony (Exhibit M). The key elements of the bill were as follows:

The Senior Rx Plan would provide a 100 percent subsidy for persons with incomes below $21,500.

The copayments for prescription drugs would be set at $10 for generics/preferred and $25 for brand names.

The formulary covered by the Senior Rx Plan would be reviewed and adjusted to ensure that it covered drugs that seniors generally required.

The last section of the proposed amendment dealt with the Task Force itself.

Michael Hillerby, Deputy Chief of Staff for Governor Guinn, reported the Governor was very pleased at the collective improvements proposed for the Senior Rx Program. He thanked Mrs. Buckley, the committee, and particularly the seniors who had talked to Mr. Hillerby’s staff about their ideas for developing a plan that was simple, affordable, and easy to administer. He also thanked Senator Rawson and his committee, Human Resources and Facilities, who added the language for sharing the chairmanship of the Task Force. Many good ideas emerged from the committee regarding how the administrative caps would operate and how the funds would be spent; specifically, 2 percent was available to the Treasurer, and up to 3 percent would be available in each of the program areas to administer those programs.

Continuing, Mr. Hillerby said he would report to the legislative body about work programs and budgets and how the money would be spent, while keeping as much money as possible in the program areas.

Assemblywoman Vivian Freeman stated that as co-chair of the Task Force with Assemblywoman Buckley, and as a long time health care professional and legislator, she felt the work on the program had been a learning experience for everyone. The bill that was passed last session had many mistakes, all in good faith; however, during hearings, everyone was watching because Nevada was the first state in the nation attempting such a program. The bill finally moved forward in a bipartisan way, and everyone worked together to remedy the problems in order “to keep faith with the seniors.” The language evolved into an understandable bill that covered the poorest seniors.

Concluding, Mrs. Freeman felt a “wonderful” bill had resulted, and she thanked everyone who contributed to it, particularly Michael Hillerby, who had worked with the Task Force on the details.

ASSEMBLYWOMAN FREEMAN MOVED TO AMEND AND DO PASS

S.B. 539.

ASSEMBLYWOMAN PARNELL SECONDED THE MOTION.

Assemblywoman Leslie stated she was pleased a compromise had resulted. Everyone had the same goals, and the result was excellent. She wished there had been money to do both programs simultaneously, so seniors would have had a choice right away, because she was unconvinced that the insurance model was the best model. As she understood the bill, there would be a year and one-half to try out the insurance model. If the enrollment did not reach 3,500 seniors, the non-insurance model would be implemented. She then asked Ms. Buckley about staffing, specifically for the Department of Human Resources. What would the (DHR) staff be doing when it stated, “will continue to provide assistance” versus what the Legislative Counsel Bureau (LCB) staff would do. Ms. Buckley responded the Task Force was unique in that regard. During the last interim, DHR provided staff support. Initially they had no staff, so LCB had done all of the work. In the end it was a balanced approached; DHR performed the executive functions of administering the grants, releasing the RFPs, collecting them, and making recommendations. The LCB staff set up meetings, received requests from legislators, and provided legal counsel. The biggest concern had been who would provide legal counsel, the Attorney General’s office or LCB. Finally, it was agreed that LCB would serve as legal counsel in consultation with the Attorney General. When the final amendment was drafted, all parties would review it to make sure it met the committee’s wishes.

Chairman Koivisto asked Assemblywoman Buckley if she was amenable to “upon passage and approval.” Ms. Buckley said she was.

Mr. Hillerby said there had been a very strong commitment from the Governor, from Ms. Buckley, and from everyone involved in the compromise to wholeheartedly support and actively pursue Senior Rx to try to make it a success. If the numbers in Section 3 of the proposed amendment were triggered, then support would go fully toward the new program.

Chairman Koivisto was glad to hear they were going to take another look at the formulary and perhaps remove birth control pills. Mr. Hillerby responded they had checked into it, and there was a requirement that if a prescription drug benefits plan was offered, it was required to include birth control pills; however, since they were not used, there would be no expense.

THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT.

Returning to S.B. 116, Chairman Koivisto asked Ms. Buckley to explain why an education component was included in the amendment. Ms. Buckley responded that between the time the bill was heard and the present date, she had received a communication from Washoe County that there was a concern about whether or not the board of trustees had to review and consider reports of aversive techniques on students, and whether or not that information should be kept confidential. She had e-mailed all of those concerns to Kim Morgan, Chief Deputy Legislative Counsel. She reminded members that last session the goal had been to ensure that the use of those techniques was kept confidential. The individuals involved in the issue felt it would be helpful to clarify in the existing statute the intent last session. She had shared that amendment with Assemblywoman Giunchigliani, experienced in special education, to make sure the confidential sections were correct, and she indicated they were. Therefore, it represented a further clarification of a question that arose regarding intent, and since it was the same bill, the Legal Division thought it was appropriate to clarify the language of the bill.

ASSEMBLYWOMAN LESLIE MOVED TO AMEND AND DO

PASS S. B. 116.

ASSEMBLYWOMAN GIBBONS SECONDED THE MOTION.

THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT.

Chairman Koivisto reopened S.B. 377.

Charles Duarte, Administrator for the Division of Health Care Financing and Policy, stated he had met with Mr. Ostrovsky and between Mr. Thomson and himself, they had agreed that the amendment was acceptable. The only exception was the last sentence that read, “all current participants regardless of whether or not they meet this definition are held harmless and grandfathered into this program.” Mr. Duarte said they did not believe that language was necessary. The rural facilities and others were covered in other sections of the bill and, therefore, he suggested removing that language. Mr. Ostrovsky said he was in total agreement, and, by not putting that in statute, it could be revisited every two years, which was appropriate.

Chairman Koivisto asked if the issue would be discussed again in two years. Mr. Ostrovsky said the DSH payments had to be authorized every two years.

Assemblywoman Smith wanted assurance that with the change, all the parties “were on the same page.” Mr. Ostrovsky said Sunrise Hospital, which was covered in the current S.B. 377, would not be eligible under the definition in his proposed amendment.

Assemblywoman Parnell asked if the bill was passed with both amendments, who would be the “big loser” and by how much. Mr. Ostrovsky explained that Sunrise Hospital did not currently receive a distribution. It was a loser because it would not receive a benefit from the bill as drafted on the Senate side. Lake Mead Hospital, which received a small benefit because it was federally qualified, received a larger benefit under the proposal. The county gained a small amount also.

Robert Barengo, representing Sunrise Hospital, stated the bill as written was crafted by the Senate, with the help of the state, to divide the money the way the DSH study committee had recommended it. The bill, as initially introduced by Sunrise Hospital, was to designed to create more money for the rurals, including Lake Mead Hospital and Sunrise Hospital, and to try to modify one of the study committee recommendations that was not universally accepted. The state modified that that, but Lake Mead had modified it again to remove Sunrise Hospital. Consequently, Sunrise would not be receiving any benefit under the bill.

Christopher Thompson, representing State Health Care Financing and Policy, stated he had been working on the estimated numbers based upon what he had been presented at the hearing. Compared with the figures on the “Disproportionate Share/Intergovernmental Transfer (Exhibit N), which showed the net benefit by hospital, the effect would be that the benefit for Carson-Tahoe Hospital would be adjusted from $1.5 million down to $1 million for fiscal year 2003. The net benefit per year would be approximately $380,000 less. Lake Mead Hospital would go from $550,000 in net benefit up to approximately $1.3 million; Sunrise Hospital would go to zero. The only other significant change was that University Medical Center’s (UMC) net benefit would increase to roughly $16 million, which would net out at approximately a $900,000 payment as opposed to the $1 million shown for Clark County. Therefore, the net benefit for UMC/Clark County would be adjusted upward from $14.5 million to $15.1 million.

Concluding, Mr. Thompson said the effect of the amendment would be that Lake Mead Hospital and UMC would increase, and Sunrise Hospital would decrease.

In response to an earlier question, Mr. Duarte said the state supported the Carson-Tahoe amendment. The state did not support the amendment by Mr. Ostrovsky, although they had worked out concerns with them.

Vice Chairman McClain asked why the state would have an opinion one way or the other; it was an agency, not a lobbying group. Mr. Duarte replied that the Department of Human Resources had proposed S.B. 377 as drafted in the first reprint. That represented the Department’s position, but understood it was the committee’s prerogative to decide against it. Nevertheless, he believed it was a fair distribution of funds.

Ms. McClain commented that if the study had to be done again, perhaps it should be under the direction of the Legislative Committee on Health Care

VICE CHAIRMAN MCCLAIN MOVED TO AMEND S.B. 377 BY INCLUDING THE CARSON-TAHOE AMENDMENT AND THE AMENDMENT PROPOSED BY MR. OSTROVSKY, MINUS THE LAST

SENTENCE, AND TO CHANGE THE STUDY FROM DHR TO THE LEGISLATIVE COMMITTEE ON HEALTH CARE.

ASSEMBLYWOMAN LESLIE SECONDED THE MOTION.

Assemblywoman Freeman said she approved the amendment for Carson-Tahoe Hospital, but she was unsure about the Lake Mead Hospital amendment. She tended to think it was such a complicated issue that she was not ready to make a decision. She wanted the bill to pass, but she could not approve the Lake Mead amendment. She would wait to hear what the interim Legislative Committee on Health Care said about it.

THE MOTION CARRIED WITH 7 IN FAVOR AND ASSEMBLYWOMEN

FREEMAN AND ANGLE OPPOSED.

There being no further business before the committee, the Chairman adjourned the meeting at 4:20 p.m.

RESPECTFULLY SUBMITTED:

Darlene Rubin

Committee Secretary

APPROVED BY:

Assemblywoman Ellen Koivisto, Chairman

DATE: