MINUTES OF THE meeting
of the
ASSEMBLY Committee on Health and Human Services
Seventy-First Session
March 14, 2001
The Committee on Health and Human Serviceswas called to order at 1:30 p.m., on Wednesday, March 14, 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
Ms. Sharron Angle
Ms. Merle Berman
Ms. Sheila Leslie
Mr. Mark Manendo
Ms. Bonnie Parnell
Ms. Debbie Smith
Ms. Sandra Tiffany
Mr. Wendell Williams
COMMITTEE MEMBERS ABSENT:
Mrs. Vivian Freeman
Ms. Dawn Gibbons
GUEST LEGISLATORS PRESENT:
None
STAFF MEMBERS PRESENT:
Marla McDade Williams, Committee Policy Analyst
Darlene Rubin, Committee Secretary
OTHERS PRESENT:
Brian McAnallen, Director of Government Relations, American Cancer Society
Danielle Dratzer, American Cancer Society
Yvonne Sylva, State Health Administrator, State Health Division
Charles Duarte, Administrator, Health Care Financing and Policy
Gale Thomssen, Carson Advocates for Cancer Care
Larry Matheis, Executive Director, Nevada State Medical Association
Sally DeLipkau, Volunteer, American Cancer Society
Linda Sheldon, Outreach and Enrollment Coordinator, Great Basin Primary Care Association
Nancy Wall, League of Women Voters
Ann Proffitt, Cancer Resource Center Coordinator, Carson-Tahoe Hospital
Mary Liveratti, Administrator, Division for Aging Services
Chairman Koivisto opened the hearing on A.B. 75.
Assembly Bill 75: Requires adoption of state cancer plan and mandates administrative action necessary to provide Medicaid coverage to certain patients with breast or cervical cancer. (BDR 40-277)
Assemblywoman Merle Berman, District 2, introduced A.B. 75 and explained the bill contained two major provisions relating to cancer. First, the measure required the adoption of a state cancer plan. Second, it mandated the administrative action necessary to provide Medicaid coverage to certain women with breast or cervical cancer. Both parts of the measure related to the Breast and Cervical Cancer Prevention and Treatment Act of 2000 (Exhibit C) as passed by Congress.
Ms. Berman reported approximately 8,300 new cases of cancer would be diagnosed in Nevada in 2001. Of that amount, 3,800 cancer deaths would occur. The average annual age-adjusted mortality rate for cancer deaths per 100,000 in Nevada was 183.5, compared to the national rate of 170. Nevada ranked 8th highest overall in cancer mortality rates among the 50 states and Washington, D.C. Some Nevada lifestyle choices contributed to those statistics, but individuals who had cancer faced tremendous financial burdens. If they had health insurance they might still find themselves owing thousands of dollars to health care practitioners and facilities. Individuals without health insurance faced an additional burden of not being treated adequately for their disease because of their lack of insurance.
Health care costs affected government and people. Ms. Berman explained she was intimately involved because of the Women’s Health Connection and they were always trying to obtain free health care for women diagnosed with breast cancer; it was not an easy task.
Allowing Nevada to adopt a cancer plan allowed the state to direct its limited financial resources toward the prevention of all types of cancer. Furthermore, policymakers could use the plan to develop short- and long-term goals for funding. It would eliminate duplication that sometimes occurred among agencies and would allow the state to direct resources where they were needed. Rather than being compelled to devote funding based on a political environment, a strategic plan was necessary in moving policymakers toward objective decision making in the states.
Ms. Berman stated the first part of A.B. 75 set up the state cancer plan, and the second part addressed the treatment of breast and cervical cancer.
According to the American Cancer Society, breast cancer ranked second among cancer deaths in women. The number of women who died of breast cancer in 2000 was 40,800. Although the number seemed high, statistics indicated that breast cancer mortality rates had declined significantly since the period from 1992 to 1996. The decrease was attributed to early detection and the improved treatment of breast cancer. Early detection of breast cancer greatly improved treatment options, chances for successful treatment, and survival. More than 95 percent of women diagnosed at the earliest stage survived the disease. Mammography was the single most effective method of early detection since it could identify cancer several years before the actual physical symptoms developed. Cervical cancer was the cause of death for 4,600 women in 2000. Like breast cancer, the mortality rates for cervical cancer had significantly declined over the 1992 to 1995 period. Cervical cancer deaths dropped by 74 percent. The number of cervical cancer deaths continued to decline at a rate of 2.1 percent per year. The decrease may be attributed to the increased use of a pap test to find cervical cancer in the early stages. When detected early, invasive cervical cancer was one of the most successfully treated cancers.
Ms. Berman noted that all women could not afford to have a routine mammogram or pap test. Therefore, in 2000, the Federal Breast and Cervical Cancer Prevention and Treatment Act was signed into law. The act permitted states to provide medical assistance through Medicaid to eligible women who were screened for and found to have breast or cervical cancer. That also included precancerous conditions. The screening must be conducted through the National Breast and Cervical Cancer Early Detection Program that in Nevada was administered by the Health Division (HD) of the Department of Human Resources (DHR). Under the federal act, states would receive an enhanced federal match equal to the federal match received for the state’s Children’s Health Insurance Program (CHIP). For Nevada it was 62.25 percent. The fiscal year would begin October 1. Payments would be made for medical assistance provided during the presumptive eligibility period.
Among other provisions, A.B. 75 appropriated $685,000 for each year of the biennium to pay for Nevada’s share of the coverage. That total was reached by calculating that 70 women would require cancer treatment and would be eligible for the program. The average cost for each woman was $15,000. The coverage would include the breast and cervical cancer treatment, and also if the woman became ill with something else she would also be covered for the same period as covered under the bill.
Ms. Berman added A.B. 75 would insure that the state of Nevada had a plan to combat some of the most devastating diseases of the generation. She emphasized that having a comprehensive cancer plan might enable the detection and identification of cancer clusters, such as the tragic incidences in Fallon.
In conclusion, Ms. Berman noted that passage of A.B. 75 would enable women who were unable to obtain medical treatment for breast or cervical cancer to increase their chances for survival. She urged the committee to vote on A.B. 75 and stated the bill had been fully funded in both the cancer plan side and the breast and cervical act.
Brian McAnallen, Director of Government Relations, American Cancer Society, advised that he represented the southwest division in three states; Nevada, New Mexico and Arizona. He reported working on a similar bill in all three states, and the American Cancer Society had been working on similar legislation in all the other 47 states. He reported waging a struggle nationally to secure the funding stream from the United States Congress for a long time, and had pushed the United States Government to allocate its share of dollars to the states so it was not a burden on the backs of the states. Finally, in October of 2000, success was achieved which assured that Nevada will receive the federal share, and the state had to come up with its portion to “draw down” the federal dollars. Mr. McAnallen emphasized the urgency to act upon that important legislation.
Danielle Dratzer, Interim Vice President of Cancer Prevention and Control for the southwest division of the American Cancer Society, informed she had been working with the HD since before Nevada began its screening program and had seen the program grow and develop. The lack of the treatment component was a huge barrier to reaching out to the numbers of women that could be reached with the program. Many women were reluctant to enter the program at all, because they asked the question: “What’s going to happen if I am diagnosed?” Previously the answer had been that an attempt would be made to get help and physicians and hospitals to donate services, but there was no guarantee that would happen. A.B. 75 would provide the critical opportunity to say to those women diagnosed through the program, there would be help for them. The number of women being screened would be increased, as well as the number of cancers detected at their earliest and most treatable stages.
Additionally, Ms. Dratzer said the burden would be lifted off the case managers who worked on the program, keeping them from using their limited resources to try to secure treatment thus enabling them to follow up on abnormalities and other problems going through the screening process. She urged support and passage of A.B. 75.
Assemblywoman Angle asked, of the women who had been diagnosed, how many had not been able to receive treatment. Ms. Dratzer said they had been 100 percent successful in obtaining some kind of treatment. There were some women who had refused treatment, but not for her lack of ability to provide them with something. The timeliness of getting them into that treatment program was delayed because of the efforts they had to make to get them treatment. Also, a huge burden was being placed on providers in the program by asking them to donate the level of services that were needed.
Mr. McAnallen stated only been two or three of those women Ms. Dratzer referred to had been unable to get treatment and he believed they were tested through the program but before they were able to move into the treatment phase, they either left the state or moved out of the system. It was not because the pro bono services were not found.
Ms. Angle asked if those who had received treatment had been affected by the delayed time in getting them into treatment. Mr. McAnallen said he had a statistical overview from September 27, 1997 through September 30, 2000, however it did not necessarily have the answer to her question. He thought Ms. Sylva from the Health Division might be able to answer that.
Chairman Koivisto asked Mr. McAnallen to furnish the document referenced to Marla McDade Williams, Committee Policy Analyst, which he did. (See Exhibit D).
Assemblywoman Berman said although she did not have statistics, what would happen was the care became more expensive as time went on. It became harder to obtain free care. The bill would allow women to get treatment immediately, which was the most important factor.
Assemblywoman Tiffany asked if among the three states Mr. McAnallen covered, had any started with just the state plan and not the Medicaid portion. Mr. McAnallen responded that New Mexico was in the process of doing a comprehensive state plan separate from the Medicaid portion. They were looking at cancer overall, and developing a plan that would include everyone. They were pursuing the funding through the budgetary process and through separate legislation, which was very similar to A.B. 75.
Ms. Tiffany asked about the anticipated cost of doing just the cancer plan. Ms. Berman said there was a cancer plan the HD had worked on and they were going to present what they would do, but there would be no extra cost to A.B. 75 for that; it was ongoing and would come out of their budget.
Ms. Tiffany asked if the plan was in process now. Ms. Berman said it would be. They had statistics that had to be formulated into numbers that could be worked with to regulate a plan that would work for either five to ten years in the future.
Ms. Tiffany asked if the bill needed to be passed for direction to the Health Department to make sure that they had the indicators they would like. Ms. Berman said “yes.” Ms. Tiffany said the strategic plan and that component of it would be very helpful to have passed. Again, Ms. Berman said “yes.” Ms. Tiffany felt that would be very good but was afraid it would not survive the Committee on Ways and Means. Ms. Berman said the entire bill as it was presented was taken care of financially. Everything was paid for.
Chairman Koivisto assumed the screening and treatment was for low-income Medicaid women. Ms. Berman said no, that it was for low income working women without insurance, they would not have to sell their home or anything else to get treatment for breast or cervical cancer needs. The women would apply and be processed and receive coverage. In the past it was a 50-50 split; now with the federal money it was a 65-35 split, saving the state 15 percent. It also saved the people who would be covered from having to go on welfare. Mrs. Koivisto wanted to clarify that the women who would be covered were not Medicaid-eligible people, but the treatment would be paid for by Medicaid dollars. Ms. Berman said that was correct. Ms. Koivisto asked about Ms. Berman’s earlier mention of presumptive eligibility, and wondered if that was presuming passage of the current presumptive eligibility legislation. Ms. Berman said it was not.
Ms. Dratzer, American Cancer Society, stated, in terms of the screening and diagnostic portion, the program currently served women in Nevada who were not otherwise eligible for Medicaid or Medicare, who did not have other insurance coverage, and had an income up to 250 percent of the federal poverty level. The program attempted to identify and address the needs of women who fell between the cracks. It would cover those women who might be working but not making enough to purchase health insurance and who did not have benefits coverage through their employer, but were out there trying to make a living. The program was an attempt to assist them from a health perspective in being healthy and maintaining their independence.
Assemblywoman Leslie expressed some confusion about whether the women would be on Medicaid. Ms. Berman said they would not be on Medicaid. Ms. Leslie asked if the dollars for the specialized cancer treatment would partially come from Medicaid and from the state. Ms. Berman said “yes,” and from the federal government. Also, Ms. Leslie asked if that was the same money the Governor was talking about in his State of the State Address. Ms. Berman said it was. Ms. Leslie said “assuming we pass the budget, then the money is there. If we don’t pass it then it’s not.”
Vice Chairman McClain asked if a waiver was needed since it was not Medicaid but Medicaid money. Chairman Koivisto deferred to Ms. Sylva and Mr. Duarte who would speak next to answer that question.
Yvonne Sylva, Administrator, Health Division, reported that she, Charles Duarte, Administrator, Health Care Financing and Policy, and Charlotte Crawford, Director, Human Resources, met with Assemblywoman Berman in early March to address the concerns they had with A.B. 75, most of which were related to the appropriations included in the bill. First, the Breast and Cervical Cancer Treatment Act and the options available to Medicaid were included in the Governor-recommended budget so that appropriation was not necessary in the bill. The Centers for Disease Control (CDC) and Prevention and the direction they were taking with their cancer prevention program, such as the Breast and Cervical Cancer Program in Nevada, more commonly referred to as “Women’s Health Connection,” was to mandate that Nevada develop a statewide plan to address cancer. The state of Nevada had developed a cancer plan in 1998 but had not enforced it because of the effort to develop the Women’s Health Connection and make sure women received early treatment.
Ms. Sylva said, in answer to Assemblywoman Angle’s question about what costs might have been saved, she did not know. She did know that the amount of effort and the pro bono care provided in Nevada was tremendous and all of the effort that went into that would be able to be redirected into getting women services earlier than in the past. Ms. Sylva said the HD would do a cancer plan whether or not A.B. 75 passed, so that they would have something that was data-driven rather than simply focused on breast and cervical cancer. She added that the way a woman would enter into services would be that they must have been screened through the Women’s Health Connection program.
Charles Duarte, Administrator, Health Care Financing and Policy (HCFP) reported that with respect to where Medicaid picked up, Medicaid would provide the treatment services needed for women diagnosed through the Women’s Health Connection with breast or cervical cancer. Those and other Medicaid state plan medical services would be provided to those women. It was a Medicaid state plan option, which meant that they were considered Medicaid recipients once they were screened through the Women’s Health Connection and diagnosed for breast or cervical cancer.
In terms of funding, Mr. Duarte said HCFP had about $6 million for the fiscal biennium, $3.2 million in the first year and $3 million in the second year. In terms of General Fund that worked out to about $1.23 million over the fiscal biennium for those services. His numbers might differ from those numbers presented in the bill primarily because many of the estimates developed for the bill were based on the delivery of a great deal of charity care, and the bill would reduce the stress put on the providers to provide free care to women diagnosed with breast and cervical cancer and those resources could then be focused in other directions.
Vice Chairman McClain was unclear how women automatically qualified for Medicaid simply because they went through the screening process. Was there an assets test. Mr. Duarte said the Breast and Cervical Cancer Treatment Act of 2000 allowed states to select that option and there was no asset screening required for the women. If they qualified for the CDC Grant program, Women’s Health Connection, they presumptively qualified for treatment under Medicaid. They would still need to put in an application but the criteria would be different.
Assemblywoman Tiffany said the numbers were not adding up. Chairman Koivisto suggested that the numbers be left to the Committee on Ways and Means and the committee focus on establishing the policy. Ms. Tiffany pressed for an answer; Mrs. Koivisto agreed she could continue if it was relevant. Mr. Duarte explained the total funding requirement for the program was $3.2 million in fiscal year 2002, and $3.1 million approximately in 2003. The state match was $1.153 million in 2002 and $1.078 million in 2003, based on the 35-65 match. There were also some additional costs needed for systems changes in the eligibility system in the first year of about $151,000. The numbers differ from those in bill, Mr. Duarte explained again, because they used information based on terms of disease incidence rates and costs in order to project those figures. He would be glad to work with staff to resolve any discrepancies.
Ms. Tiffany pressed on to determine if the bill as represented was correct as to the fiscal numbers. Ms. Sylva referenced a handout (Exhibit E) and stated the dollars included in the bill initially were no longer relevant; they were removing all the dollars from the bill. She then went through the amendment to describe those changes:
Page 2, line 40 Section 4 would be deleted. In its place it would say: The Health Division in consultation with the State Board of Health shall take such action as may be necessary to carry out the provisions of Section 1 of this act.
Number 2 in Section 4 would be deleted as well. Section 5 would be deleted, and that includes the $685,000. Number 2 in Section 5 would also be deleted. Section 6 would become Section 5 and would be reworded to say: The Health Division of the Department of Human Resources shall publish and submit to the Seventy-Second Legislature the state cancer plan pursuant to Section 1 of this act.
Ms. Sylva added that the dollars would be taken care of elsewhere within the Governor-recommended budget.
Assemblywoman Leslie asked about the first section of the bill; were those the items the division felt should be in the state cancer plan. Ms. Sylva said they found no problem with the language there, and that would be included in the cancer plan along with some other things as well. Mrs. Leslie asked if anything was missing that should be in statute. Ms. Sylva said “no.” Mrs. Leslie asked if it was customary to put into statute what should be in a plan, since it might change over time. Ms. Sylva agreed it would change over time. The language as now stood would not be prohibitive for the HD; they would not normally include all of that however. Chairman Koivisto noted the bill stated to “revise the plan at least once every five years.”
Mrs. Leslie asked if some language should be added to the bill so that it was not limited to those things listed. Chairman Koivisto asked Ms. Sylva if she could work with that. Ms. Sylva responded that she would add “not limited to.”
Next to speak was Gale Thomssen, representing Cancer Advocates for Cancer Care, voiced support for A.B. 75. Ms. Thomssen provided a written copy of her testimony (Exhibit F), which outlined why it was good legislation. Among other reasons, the National Cancer Institute, Washington, D.C., and other cancer research facilities were doing tremendous research. Nevada needed to be ready to take advantage of the results. She stated that what was being done on the local level would mean the difference between life and death for Nevada’s women. Further, with the Women’s Health Connection for Breast and Cervical Cancer Early Detection program, once cancer was detected there needed to be treatment and follow through. A.B. 75 was the means for that to happen. The National Cancer Institute had $9 million available for rural and underserved populations. Nevada could tap into those grant monies to educate and reach individuals with cancer in rural areas. In closing, she said that silence was approval of the current system. She urged support and passage for A.B. 75.
Assemblywoman Parnell commented it was not often as legislators they received calls from people outside of Carson City who praised the accomplishments of Gale Thomssen’s group. However, she had recently received a call from a woman in Gardnerville who commended the emotional and financial support given by the Cancer Advocates for Cancer Care. Ms. Parnell thanked Ms. Thomssen for her efforts.
Larry Matheis, Executive Director, Nevada State Medical Association, expressed support for A.B. 75. He understood some “fine tuning” might be required, however addressing the growing reality of cancer as a Nevada problem needed to be done. It was a problem that was different for women than for men, for different races, and for the different parts of the state, access to treatment and support mechanisms, and understanding what options were available. Mr. Matheis felt the bill took an important step in the right direction both in terms of directly dealing with breast and cervical cancer and in committing the state to take a longer view of what cancer was doing to Nevada, and what Nevadans could do to address it. He offered assistance to the committee in whatever might be needed, and hoped the bill would not only pass but also result in a meaningful implementation.
Sally DeLipkau, a volunteer with the American Cancer Society for more than 20 years, and a three-time cancer survivor, explained she had breast cancer twice, at age 18 and 21, both detected early, and she did have adequate insurance at that time. The third cancer was acute lymphocyitic leukemia, which she noted was the “Fallon cancer,” though she had never lived in Fallon. She also had over a year of chemotherapy and radiation and knew well the devastation of treatment as well as the financial burden.
Ms. DeLipkau related that as a volunteer she worked primarily with breast cancer patients and also made presentations on the early detection of breast and cervical cancer. She always asked the women in those presentation groups if they had an annual breast exam, pap smear, and mammogram, as well as regular breast self-exams. Often the women confessed they did not because they were afraid they would find something. They feared what it would do to their lives, their families’ lives, and how they would deal with it without insurance. Often someone asked about putting off the exam. Ms. DeLipkau’s cancer was found at an early stage and she only needed surgery; at that time there was only mastectomy but now there was the option of a lumpectomy, a relatively easy surgery and recovery. Sometimes no follow-up chemotherapy or radiation was necessary if caught early enough. However, once the lump exceeded two centimeters, six months of chemotherapy and six weeks of radiation were needed.
Ms. DeLipkau noted when she was asked to help on the “Race for the Cure,” she and others involved said they would help if they could have the money to help women financially. Consequently, the “Race for the Cure” had been very successful and in the past year they had been able to grant over $100,000 to agencies to help with the financial needs of women. However, they were only able to help out with expenses during the period they were off work, namely rent, childcare, utilities, food, and also transportation and lodging, if they came from the rural areas for treatment. She emphasized that no one had treatment money.
In her position as the cancer information representative at Washoe Medical Center, most of the calls she received were from women who had just been diagnosed with cancer but had no insurance and wanted to know what could be done for them. Ms. DeLipkau felt A.B. 75 was a wonderful step in helping women with breast and cervical cancer. She hoped the next time she received one of those phone calls she would be able to say there was something she could do for them.
Chairman Koivisto thanked Ms. DeLipkau for her testimony, followed by Assemblywoman Leslie who thanked her for all her good work over the years. She noted Ms. DeLipkau’s photograph was often in the newspaper advertising her availability to help victims of cancer. Mrs. Leslie said she had often sent people to her and Ms. DeLipkau also went into the hospital to talk to patients and reassure them. She added that the committee would try to do its part to give her the needed resources.
Next to speak was Linda Sheldon, Great Basin Primary Care Association, who represented the community health centers, tribal clinics, and other safety net providers in the state. Early breast and cervical cancer detection was such an important issue for all of them, and they strongly supported A.B. 75. She added it would be of great assistance to the uninsured and underserved women in the state who were being served by the Women’s Health Connection.
Nancy Wall, representing the League of Women Voters, expressed strong support for A.B. 75.
Next, Ann Proffitt, Cancer Resource Center Coordinator, Carson-Tahoe Cancer Services, supported A.B. 75 as a nine-year breast cancer survivor. When she was diagnosed nine years ago she had insurance and no need for financial assistance, nevertheless, she incurred several thousand dollars of medical debt that had not been covered. It took five years to pay off that debt. The stress of the diagnosis was bad enough, she recalled, but also worrying about her ability to survive and the extra financial burden was very difficult. Because of her experience, Ms. Proffitt pressed to start a resource center in Carson City and she succeeded with the help of several people in doing that. Ms. Proffitt said she worked with cancer patients every day and heard some very tragic stories. Many of the women were single parents, had no insurance, or their income was badly needed in a two-income family.
Ms. Proffitt said the person she worried most about was the person who had decided to put off surgery or treatment, not knowing what was available to them or if they qualified financially. By the time they found out where and if they could get help they had waited too long. They either did not survive or they shortened their lives considerably. In closing, Ms. Proffitt urged passage of A.B. 75.
Vice Chairman McClain said she was unaware of the federal legislation, and felt there must be many thousands of women in Nevada who were also unaware. She asked how to get word out to everyone if A.B. 75 was passed. Also, what was to prevent those people who had insurance but knew it would not cover everything from taking advantage of the new program provided by A.B. 75, in view of the fact there was presumptive eligibility and no assets test.
Assemblywoman Berman said that it was not likely Mrs. McClain would have known because the bill had just been passed in December 2000. Next, the applicant would have to go through the Health Department in order to be referred to the program. The Women’s Health Center did the screenings for mammograms and pap smears. That was where most underserved women went to obtain their medical assistance and that was where the referrals would be made.
Mrs. McClain stated the program really needed to be publicized in order to reach the women who needed it.
Gale Thomssen remarked that in the more than ten years she had worked with cancer patients she had never seen an abuse of the system; there was not that much energy. Further, with the public-private partnership the word would get out through agencies like Carson Advocates for Cancer Care, Great Basin Primary Care Association, and others, all of whom were geared up and ready to go.
Chairman Koivisto noted, too, that as a survivor she could attest to what Ms. Thomssen said. When in that situation one was living under such overwhelming fear that it was the only power in one’s life. Mrs. Koivisto then asked the committee’s wishes.
Assemblywoman Smith felt the committee was clear on what the amendment would contain, accordingly,
ASSEMBLYWOMAN SMITH MOVED TO AMEND AND DO PASS A.B. 75.
ASSEMBLYWOMAN PARNELL SECONDED THE MOTION.
Marla McDade Williams, Committee Policy Analyst, explained the amendment would incorporate the document that was submitted by Ms. Sylva to delete Sections 4 and 5 of the bill, and renumber the following sections and insert a new Section 4 which stated: “The Health Division in consultation with the State Board of Health shall take such action as may be necessary to carry out the provisions of Section 1 of the act.” Further, one qualifying statement would be added that the Health Division would not be limited to those items that were specified in the bill for the cancer plan.
Chairman Koivisto called for a vote.
THE MOTION CARRIED UNANIMOUSLY.
Assemblywoman Berman thanked the committee for their approval.
Mrs. Koivisto closed the hearing on A.B. 75 and opened the hearing on A.B. 195.
Assembly Bill 195: Authorizes Nevada silver haired legislative forum to operate independently of aging services division of department of human resources. (BDR 38-534)
The Chair explained the bill was to move the Silver-Haired Legislative Forum out of the Department of Human Resources.
First to speak was Mary Liveratti, Administrator, Division for Aging Services (DAS). She explained A.B. 195 was a bill requested by the Department of Human Resources (DHR) on behalf of the DAS. The Silver-Haired Legislative Forum was established by the 1997 legislature. The Governor appointed 21 senior citizens to represent the state senatorial districts on a nonpartisan basis. As part of the fundamental review of government, the division recommended that the Silver-Haired Legislative Forum be allowed to operate independently. Currently the Silver-Haired Legislative Forum operated without any state funding. However, the DAS was the fiscal agent for the forum. When the forum wished to spend any of the funds that they had raised themselves, they had to submit a claim through the DAS. The division then processed the claim through the state accounting system. The entire process could take several weeks. A.B. 195 would allow the Silver-Haired Legislative Forum control and direct access to their funds. The forum would be able to make payments more expediently, for example, timely reimbursement of travel expenses to members.
Chairman Koivisto asked for representatives from the Silver-Haired Legislative Form to come forward. There was no one present. The Chair asked if anyone had input on the measure. Ms. Liveratti said essentially the forum was never under the DAS, they had been an independent body, and all the bill asked for was that the forum have direct access to their funds. She had spoken to the members and they had no problem with the bill. Their main concern had been raising enough funds to support their efforts.
Mrs. Koivisto presumed the forum received no General Fund money, only contributions. Ms. Liveratti confirmed that.
Assemblywoman Angle said she was on the Governor’s Commission for Aging and supported A.B. 195.
Assemblywoman Leslie asked if Virginia Cain was still on the forum. Ms. Liveratti said she had resigned as president, which was part of the problem because they did not have an operating president. Ms. Liveratti had spoken to her recently and explained she resigned because of so many other commitments. However, she was on the Commission for Aging. Mrs. Leslie asked if the forum still issued their annual booklet. Ms. Liveratti responded they were allowed to present a report to the Governor every two years, per statute, so much of what they did was going out as a grass roots effort in their own communities to look at the issues for seniors. They were presently in a reorganizational period.
Chairman Koivisto asked if making them independent would hurt their organization. Ms. Liveratti felt they would be able to operate as they had in the past, they could go out and raise funds, and in fact it might offer more opportunities for the forum to obtain grant funding. Basically, however, the passage of the bill would make things more convenient for them. Presently, it might take three weeks for members to be reimbursed for their travel expenses. They did have a treasurer who could write a check immediately and it would give them direct control over their funds, which Ms. Liveratti felt was fair since they were the fundraisers.
Assemblywoman Smith asked if the forum had funds in an account at present that would be transferred to a new account with bill passage. Ms. Liveratti said they did, and if the bill passed they would have to establish their own bank account. The money they had raised would go directly into that account. They had less than $2,000 at present.
Assemblywoman Leslie asked if the forum was a nonprofit 501(c)(3) tax- exempt entity under Internal Revenue Service. Ms. Liveratti was uncertain. Mrs. Leslie said that would make a difference to her; she was inclined to feel as Chairman Koivisto did, that this transition might not help them if they did not have a structure in place. She then asked what their official relationship was to the state. Ms. Liveratti said they were totally independent and operated independently. The DAS was simply their fiscal agent, held their money and gave it back as needed. Mrs. Leslie asked if anything was mentioned in statute about the forum. Ms. Liveratti said there was statutory authority for the Silver-Haired Legislative Forum. Mrs. Leslie asked for staff to report what that citation was so it could be reviewed before voting. Ms. Liveratti said it was NRS 427A.
Chairman Koivisto pointed out it was a national program that existed in every state. Mrs. Leslie was concerned about a lack of structure and she felt, with no disrespect for their present treasurer, that sometimes problems developed with private nonprofits and she wanted to make sure the bill passage would not expose the state to undue liability. Ms. Liveratti believed that under the 501(c)(3) there was a threshold of $25,000 before filing an income tax return. Mrs. Leslie still wanted to make sure there were financial policies in place. Ms. Liveratti assured the committee that if it went forward DAS would provide technical assistance to help the transition.
Assemblywoman Smith noted another issue with the 501(c)(3) status was if they were going to be doing their own fundraising then they would need to be 501(c)(3) so that their donors could have the tax deductible ability. Ms. Liveratti said they had been given $5,000 to start by the in 1997 legislature, but that money ended in 1999. Since then they had received no other state funds and had to raise their own funds. Mrs. Smith pointed out that if they had their money in a state account then it could have been under different authority so that they and their contributors would be in a safe position. That would be important to know.
Chairman Koivisto closed the hearing on A.B. 195 and said the bill would be held over for a work session so the questions could be answered.
The final item to come before the committee was a BDR to make an appropriation for an increase in the allowance for personal needs for residents of long-term care facilities.
ASSEMBLYMAN WILLIAMS MOVED FOR COMMITTEE INTRODUCTION
OF BDR S-1451.
ASSEMBLYMAN MANENDO SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
Chairman Koivisto said it could be introduced March 15, 2001. With no further business before the committee, the meeting was adjourned at 2:49 p.m.
RESPECTFULLY SUBMITTED:
Darlene Rubin
Committee Secretary
APPROVED BY:
Assemblywoman Ellen Koivisto, Chairman
DATE: