MINUTES OF THE meeting
of the
ASSEMBLY Committee on Health and Human Services
Seventy-First Session
March 26, 2001
The Committee on Health and Human Serviceswas called to order at 1:37 p.m., on Monday, March 26, 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. Dawn Gibbons
Ms. Sheila Leslie
Mr. Mark Manendo
Ms. Bonnie Parnell
Ms. Debbie Smith
Ms. Sandra Tiffany
Mr. Wendell Williams
COMMITTEE MEMBERS ABSENT:
Mrs. Vivian Freeman
GUEST LEGISLATORS PRESENT:
Assemblywoman Barbara Buckley, District 8
STAFF MEMBERS PRESENT:
Marla McDade Williams, Committee Policy Analyst
Darlene Rubin, Committee Secretary
OTHERS PRESENT:
Dr. John Ellerton, M.D., Las Vegas
Harriett Trudell, Political Director, Nevada State Democratic Party
Alicia Smalley, Legislative Chair, National Association of Social Workers
Julia Ratti, Human Services Consultant, Community Unity Coalition
Barbara Drake, Nevada Women’s Lobby
Louise Bayard-de-Volo, Nevada Women’s Lobby
Dorothy Pomin, Community Unity Coalition
Ed Fend, Capital City Task Force, AARP
Janice Ayres, Executive Director, Rural Counties Senior Volunteer Program
Tom Wood, State Government Affairs, PhRMA
Chairman Koivisto opened the hearing on A.B. 545 and announced the bill was the result of the hearings held in the interim by the Task Force for the Fund for a Healthy Nevada. She then asked Assemblywoman Buckley to present her testimony.
Assembly Bill 545: Directs development of optional subsidized program to provide prescription drugs and pharmaceutical services to senior citizens with low incomes. (BDR 40-826)
Assemblywoman Barbara Buckley, District 8, advised she had served as the co-chair of the Task Force for the Fund for a Healthy Nevada during the 1999-2000 interim. The Task Force was created by the legislature to oversee the tobacco settlement funds. Through the efforts of Attorney General Frankie Sue Del Papa, the state was fortunate to gain a share of the proceeds of the tobacco funds, in the amount of $48 million a year for 25 years. The legislature, and in particular the Assembly, fought for those proceeds to be dedicated toward health; senior programs and a prescription drug program. The Assembly fought for two other categories as well: children’s health needs and for the health care needs of individuals with disabilities.
Mrs. Buckley reported many other states had put the money into the general fund or devoted it to special projects. She felt proud the choices made for Nevada were all geared toward making sure the harm from tobacco products went to fund a majority of health care issues. The other fund was the Millennium Scholarship Fund. Mrs. Buckley acknowledged the many individuals, such as Ed Fend, American Association of Retired Persons (AARP), who joined the fight to make sure there was money for prescription drug programs and a program to keep seniors out of nursing homes and in independent living by having more services delivered to seniors.
Mrs. Buckley advised hearings had been conducted to assess the prescription drug needs of seniors and for the Department of Human Resources (DHR) to report on its efforts to provide prescription drug coverage for eligible seniors.
Mrs. Buckley noted that the Task Force applauded Governor Guinn and the insurance companies for taking the first critical steps to provide seniors a program to help with prescriptions. The Task Force believed the program could be improved and an alternative plan was proposed that was built on the foundation that Senior Rx had laid; assistance for low-income seniors who in many cases could not afford the drugs needed without help.
It was undisputed that the cost of prescription drugs was a critical issue facing seniors. Nationally, over one-third of those eligible for Medicare had no prescription drug coverage. In Nevada, in 1997, there were 218,000 Medicare enrollees and almost 70 percent of those were enrolled in Medicare’s fee for service option. Approximately 30 percent of Medicare beneficiaries did not have prescription drug coverage, which meant about 65,000 people in Nevada did not have that coverage. That did not mean that all those were unable to get coverage; some were probably eligible for Medicaid which covered prescription drugs. However, there was no doubt that many thousands of seniors needed help with prescription drug coverage.
Mrs. Buckley reported today’s prescription drugs offered an alternative to hospitalization for many seniors. A senior took as many as 29 different prescriptions a year. One report showed conservatively that based on 1999 drug costs, seniors would have to consume 14 percent of their Social Security benefits to afford the prescription drugs they needed. It was important to note, she said, that in addition to the high cost of prescription drugs, seniors also faced other critical issues; such as rising housing, food, and utility costs. It was very difficult for someone who had worked their entire life and never taken a handout, now to survive on their Social Security benefits.
In reference to Nevada’s Senior Prescription Drug Program, during the Task Force interim hearing, when a representative of the Governor’s Office asked the Task Force to initially release the funds for the program, there had been a hope that the basic plan would cost between $45 and $60 a month with a subsidy of approximately $40 a month. The program was expected to have copays from $5 to $20. The Governor’s representative envisioned that every major therapeutic class of drugs would be included. However, the request for proposal (RFP) put forth by DHR left the option open for formulary to be utilized. In response to the RFP bidders had the option of offering enhanced or optional plans over and above the basic plan, which might have had a higher premium that seniors could opt for. Unfortunately, the insurance companies that bid on the program did not meet those expectations. Senior Rx was the selected program. The terms of the program were:
Under the program the state could pay up to a maximum of $480 to help seniors. The exact amount paid depended upon a senior’s income. For example, if a senior earned between $19,000 and $21,000, they might receive a 10 percent premium subsidy, which amounted to a yearly subsidy from Senior Rx of $89 for the Blue option and $117 for the Silver option.
Mrs. Buckley said it seemed clear the program was not working. To date, despite the fact that thousands of seniors needed help, the latest numbers showed only 204 individuals had enrolled. The problem was, it was unaffordable. The premiums and the copays were major barriers for seniors. The plan design was complicated; it was very hard for a senior to know if the plan would really save them money in the course of a year. It was necessary to figure out in advance if the prescriptions were generic or not, preferred or not, and if not, what would 40 percent of the cost of the drug be. In fact, before Mrs. Buckley was called to testify in Congress on the problems facing seniors with prescription drug needs and to urge Congress to pass a prescription drug component as part of Medicare so every senior had it, she said she studied the formularies and plans and tried to figure out how much basic drugs would cost. Finally, she said, she had to e-mail the president of the company to assist.
The Governor had proposed legislation to pay the full amount of the premium for seniors who had an income under $12,700. However, they still had to have the copayment, which could be very expensive if they required a nongeneric drug. That was the first step; seniors needed help not only with premiums but also with copays and an alternative program that was more affordable for all.
Accordingly, the Task Force’s unanimous recommendation was A.B. 545.
The issue, Mrs. Buckley said, was more than simply unaffordability of premiums. Unaffordability of copayments could not be left out of the equation. If there were drugs a senior needed that cost more than $100, the program would require the senior to pay at least $50 for their preferred drug brands. Ultimately there was a cost saving from the retail price of the drugs, but getting a discount on drug prices would not help if the discount price was still more than could be afforded.
A.B. 545 proposed to give seniors an option to Senior Rx, a new program called Senior Option Prescription Care. The program would be available to the same age seniors with the same income levels. The bill provided a maximum annual application fee of $25; a copayment of $10 for generic drugs, including a requirement that a senior purchase a generic drug unless the senior’s doctor specifically prohibited the use of the generic drug due to interactions or physical condition. A maximum copay for nongenerics of $25 per prescription. In all other respects the bill was similar to Senior Rx; a maximum annual benefit of $5,000, a $100 deductible, and the convenience of filling prescriptions by mail.
Mrs. Buckley explained that under the measure, rebates from pharmaceutical manufacturers would be used to support the program, and the department might contract with a pharmacy benefits manager (PBM) to assist in the development and administration of the program. The rates negotiated by the department or by the PBM could not be more than the rates charged to the department for Medicaid. The measure specified how the senior accessed the program and the responsibility of the DHR to implement the program. Basically, Mrs. Buckley said, the program was designed to pay the difference between a senior’s copayment and the cost of the drug to the pharmacists. Nevada seniors would get a true drug benefit. It helped seniors’ needs in that it created a more affordable program, and was similar to programs offered in 15 other states. There was no other state that required a copayment be a percentage of the cost of the drug, because low-income seniors really could not afford that; they needed a low copayment and little or no premium that would be a barrier to them getting the drugs they needed.
Seniors who had an income between $12,000 and $21,000 a year only received $480 in assistance toward their annual premiums. Under the proposed program, seniors would get $5,000 in prescription drug assistance. For those individuals already on Senior Rx, it was important that the contract be allowed to continue without interruption. Mrs. Buckley also said she wanted the committee to keep in mind that although some people felt all that was needed was to pay more premium dollars under the Senior Rx program, the obligation to seniors went beyond that. It was not only the premiums, but also any other barriers seniors faced. Mrs. Buckley was also concerned that if more money was paid to the insurance companies fewer seniors could be served. Overpayment for something meant less money for someone else who was needy.
In closing, Assemblywoman Buckley said the goal needed to be that every senior citizen in Nevada would have access to affordable prescription drug coverage. She urged the committee’s support and passage of A.B. 545.
Assemblyman Manendo acknowledged Assemblywoman Buckley’s hard work last session and in the interim and commended her leadership on a very difficult issue that affected so many people, particularly as Nevada was becoming a retirement state. He also asked the seniors who would be testifying to let the committee know their feelings about the proposed legislation, or a program that would work with the current Senior Rx program.
Mrs. Buckley noted that Assemblywoman Freeman had planned to present the bill with her; however, she was ill and unable to do so. Mrs. Freeman had been the co-chair of the Task Force responsible for producing the bill.
Assemblywoman Leslie remarked how wonderful it was to see the committee room filled with so many people who had taken an interest in hearing and supporting the legislation. In that regard, she said it sounded as though the major difference was the middleman. By taking the insurance company out of the equation the funding could go directly to the seniors. She asked if the rebates given by the drug companies to the state, as a bulk purchaser, would be reinvested in the program. Also, who had received the rebates under the Senior Rx program.
Assemblywoman Buckley responded that currently the pharmaceutical companies gave rebates to the insurance companies and the state did not receive the benefit of those rebates. Under the proposed measure, the pharmaceutical companies would give the rebates to the state, and then more seniors could be helped. It was essentially a philosophical difference in how the bills operated.
Chairman Koivisto announced that Mr. David Wilson, who was to have made a presentation on Nevada’s Senior Prescription Drug Program, had been detained and would not be present.
Assemblywoman Buckley then illustrated her remarks with a visual aid presentation (Exhibit C) of a comparison of various drugs: Vioxx, Prilosec, Lipitor, Premarin, Singulaire, and Coumadin. She showed that the copay for Vioxx, for example, was $70.18 under Senior Rx Blue, the premium was $74.76, total $144.94 for one drug. Then, she said, if a second drug, like Prilosec, was needed, the cost would be approximately $260 a month for two drugs, and so on. She said there was a savings under Senior Rx but seniors needed to save more.
Under the Senior Rx Silver program, the copay for Vioxx was $40, the premium was $98.31, total $138.31. If Prilosec was added at $48.53, the cost would be $187.84 a month for the drugs. Under the Senior Option Program the cost would be $25 for each drug, after the $25 application fee. Moreover, the proposed program was much simpler to understand and determine the cost of the drugs.
Assemblywoman Smith remarked that the copay was alarming to her, as well as the sharply rising costs of the prescription drugs. Mrs. Buckley said the single largest increase in expenditure for health care was for prescription drugs. There was a raging debate as to why that was the case. Some attributed it to the manufacturers’ decision to advertise drugs on television. Some said the United States subsidized the cost of drugs in other countries, and in other countries the same drug could cost from 30 to 70 percent less. Congress was looking into those issues. In any case, the rising cost of drugs was a critical component, because there was no guarantee the copayments would not rise every year unless it was capped.
Mrs. Buckley reported an actuarial review of the proposed program had revealed that more of the costs for seniors could be covered, and all of the copays would be cheaper, than under the Senior Rx Program. The reason might be because there were three insurance companies involved in Senior Rx, all had to take an administrative fee and all had a profit margin to uphold.
Assemblywoman Gibbons commented that was what had been envisioned two years earlier with a prescription drug plan but it had not worked out. She felt confident about the proposed plan, in that seniors would know exactly what they were paying. She asked if the proposed plan would replace the one enacted in the last session. Also, she wanted to know about the fraud potential, and could the DHR go after someone who defrauded the program.
Mrs. Buckley believed it would be best to replace Senior Rx with the proposed program, but insure there was no gap in coverage to any of the seniors currently enrolled. She added that in speaking with the Governor prior to introducing the legislation, she believed the Governor, like herself, was committed to getting the best program for seniors. She felt he viewed the program favorably if it would be more affordable for seniors. The Governor contemplated whether Senior Rx should stay for a few more months then, if determined not to be working, automatically implement the proposed program. The manner in which the program would be implemented would be a good matter for debate by the committee and the entire legislature. Her own preference would be to have the affordable program on the books as quickly as possible. However, she recognized it might be January 1, 2002 before a program could be up and running. In that case, Senior Rx would continue for a period of time and a senior could go directly from that to the new program. Regarding the fraud issue, there was standard language utilized in other NRS sections for that purpose.
Assemblywoman Gibbons asked if individuals who could afford the prescriptions would also be allowed to purchase prescriptions under the program. Mrs. Buckley said there was a provision that allowed the drugs to be obtainable by anyone, similar to the other discount programs available, such as offered by AARP.
Mrs. Buckley remarked she was proud the Nevada Legislature and the Governor chose to act now rather than waiting for Congress to enact prescription drug coverage. She wished Congress would act now, so the money could be used to help seniors with utility bills, and so on.
Assemblywoman Parnell was very concerned that the Senior Rx Program had only 204 enrollees, and, further, like so many assistance programs, she had found it to be user-unfriendly. She asked if the Senior Option Program would be user-friendlier so that perhaps the number of enrollees would be increased. Mrs. Buckley said the primary difference was that it cost only $25 a year to enroll. Even if the cap was lifted under Senior Rx, it could still result in costing the senior a $50 a month premium, compared to $25 a year. Also, the program was limited to people with incomes under $21,000.
Next to speak, from Las Vegas, was Dr. John Ellerton, M.D. Dr. Ellerton voiced strong support for A.B. 545. He said he had personally called a group of physicians in the area to get their experiences and reactions to the Senior Rx Program. They asked him to convey that information to the committee. The provision of a drug benefit, especially for low-income seniors, had become an important need. A recent study by Project Hope showed the percentage of seniors covered by prescription plans was declining relatively rapidly as insurance companies and managed care organizations (MCOs) limited the pharmaceutical benefits or pulled out of the program completely. Those and other factors made the issue more critical. For many seniors the realization and enjoyment of a longer life span can only be accomplished with the assistance of life and function-preserving medications. Making those medications available and affordable was a challenge. Many factors had contributed to the crisis; one already discussed, was the rapid development of unique new therapeutic approaches and that trend would only escalate. None were free or inexpensive. The high cost of drugs was an issue that needed to be investigated; however, pharmaceuticals were expensive particularly in the United States. In Canada, for example, the price differences were remarkable for brand name drugs.
Dr. Ellerton suggested that although a federal plan was needed to solve the problem, in the absence of that plan, the state had to take action. Even if the federal government did do something the state might still have a role in administering or supplementing such a plan. He congratulated the Legislature and the Governor for their valiant attempt to provide a drug benefit for low-income seniors. The current program was a good first effort but the problems made it unworkable. It was much too confusing for everyone involved; the large formulary and confusing copays, and the way the drugs were listed made it very difficult to figure out exactly what to do. Dr. Ellerton pointed out that physicians dealt with formularies and managed care on a routine basis, but the Senior Rx Program ranked as one of the most confusing. Data indicated it benefited only a few select seniors. However, even with simple and inexpensive drugs or more complex therapeutic regimens, it was often the case that there was very little benefit to be gained by that program.
Dr. Ellerton noted that although the information and forms had been made available to physicians for distribution to their patients in a number of different ways, and many had tried to do so, the response had been minimal. None of the dozen or so physicians Dr. Ellerton polled could identify any patient in their practice who was on the plan, nor did Dr. Ellerton have any of his patients enrolled. Those same physicians found the formulary too confusing to have more than a cursory knowledge of it, and all were suspicious of any insurance company product. Dr. Ellerton said that having the experience of dealing with managed care, insurance company formularies, and pharmacy benefit managers could be a very frustrating experience. They were often driven only by cost, not by outcome measures, and often physicians had good ideas about how to keep patients, and particularly seniors, at home and away from the hospital with simple medications that were not available in formularies. Sometimes the insurance companies would see there was a better way to do something and change, but other times they would not. The point was, he said, that physicians had had so many negative experiences dealing with insurance companies that they were nervous about insurance company products. With all the exceptions, restrictions, and limits to length of prescriptions all had given the impression to the practicing physician that such plans made the care of the patient more complicated and less effective. Accordingly, from the physician’s point of view, it was not surprising that the Senior Rx Program had taken off slowly. It simply was not an effective plan. Dr. Ellerton believed the Governor and legislature had tried to do the right thing, but the program was such a mess the insurance companies should be embarrassed that it was the best they could present to the citizens of Nevada.
Dr. Ellerton felt A.B. 545 was a good option to expand the program and would expand it in many ways; the formulary was reasonable, and the Medicaid formulary was worthwhile. The program was one seniors could participate in easily. As a member of the Task Force for the Fund for a Healthy Nevada, Dr. Ellerton was proud and pleased to be involved in the discussions on the issues of senior prescription plans. A.B. 545 was not the complete answer, but it was a very good start to solving the problem for low-income and fixed-income seniors.
In closing, Dr. Ellerton said it was important to make sure the greed of the pharmaceutical companies and the apparent lack of interest of the insurance companies, was not compounded by inaction by elected representatives to destroy the enormous benefit of Medicare. He strongly urged the passage of the bill and the addition of the option to the Senior Rx Program.
Chairman Koivisto asked Dr. Ellerton to clarify his statement that as a physician he had informed patients about the program and there were no takers. Dr. Ellerton said that was correct. First, he said, the DHR had not done a good job of publicizing the program to physicians. He only had brochures because he had been on the task force. He understood the State Medical Society had made that information available to physicians so they might offer it to patients, and there had been other sources as well. Nevertheless, it was very difficult to describe to seniors.
Chairman Koivisto thanked Dr. Ellerton for his hard work on the task force.
Assemblywoman Leslie
noted Dr. Ellerton had mentioned that he thought the federal government should
deal with the problem but he did not want to wait for them to solve it. Mrs. Leslie said that Tom Wood, the PhRMA
representative who was supposed to testify but was unable to make it, also
believed the federal government should deal with it, but if they could not, he
did not feel the state should switch the program in mid-stream to a new
program. He felt Senior Rx should build
for awhile. Mrs. Leslie asked Dr.
Ellerton’s feeling about that. Dr.
Ellerton could not agree at all. He
expanded on the fact that when a senior prescription plan was offered that
would help low- and fixed-income people with expensive medications that did
work and did help, why had there not been an overwhelming response from people
to sign up. There should have
been boxes of applications and phone calls at DHR from people who wanted to be
enrolled. The reason was because it was
too expensive, it was not beneficial, and it was too confusing. The only way the insurance company could
make a profit was by limiting the benefits more and more, so that the premium
and the money from the state and the patients did not go to benefit the
patients, it went to maintain the business of the insurance company.
Harriett Trudell, Political Director, State Democratic Party, Las Vegas, urged immediate passage of A.B. 545. She commended the legislature and the Governor for using a portion of the tobacco funds for prescription drug assistance but felt it was obvious that the Senior Rx plan was simply not working. Out of the 10,000 to 11,000 people who should be eligible, only 205 seniors were currently enrolled. Only 2 percent were taking advantage of the program, nearly two years after it was enacted. Many say Senior Rx should be given more time, but Ms. Trudell disagreed. The proposed legislation held the promise of helping more people in a timely fashion.
Alicia Smalley, Legislative Chair of the Nevada Chapter of the National Association of Social Workers, spoke in favor of A.B. 545, which, she stated, had been developed by a bipartisan task force of legislators and experts in the area of prescription drugs. Her main concern with the present program was that it was run by an insurance company and included extremely high monthly premiums.
Julia Ratti, Steering Committee, Community Unity Coalition, advised her group was a coalition of people who worked on issues affecting mental health, disabilities, seniors, and children, and a variety of human services issues. The coalition was in strong support of A.B. 545 because it addressed some of the needs seen in the community on a daily basis and would help a significant part of the population they served.
Ms. Ratti related a personal experience to illustrate the need for the proposed legislation: She lived in an older section of Sparks, where many of her neighbors were seniors. Jan, her next-door neighbor in her 70s, was just getting by on her fixed income. With the great increase in utility bills Jan decided she had to give up her clothes dryer, so she now hung her clothes on the line. Last week her car would not start, add to that the cost of prescription drugs for a recent illness, and she had to start giving up even more things like her garden, because the cost of manure and seeds was beyond her budget. Ms. Ratti said it was not right to do that to a senior’s quality of life because they needed life-saving drugs.
Assemblywoman Leslie asked Ms. Ratti if her neighbor was on the Senior Rx program. Ms. Ratti did not know but said she would find out.
Next, Barbara Drake, representing Nevada Women’s Lobby and Community Unity Coalition, said she was retired and on Social Security. She commended the Governor and the Legislature for putting in a prescription drug law. She felt the program could be made better by being more affordable for more seniors. The issue should not be about political parties, or credit, or blame, only about helping seniors who had not much money to get the medicine they needed. She urged support and passage of A.B. 545.
Louise Bayard-de-Volo, representing the Nevada Women’s Lobby, also commended Governor Guinn for putting in a prescription drug program. However, it needed to be simplified and affordable. For that reason she supported A.B. 545. She related that she volunteered to do taxes for seniors and as a result saw in great detail what older people on fixed incomes lived on. It was lower than most people realized; the average income was between $8,000 and $20,000 for two people. It was also surprising to know how many seniors in their 70s and 80s had jobs, and those jobs were very low-paying, usually minimum wage. Ms. Bayard-de-Volo said she tried to tell the people whose taxes she calculated about the benefits they might qualify for. She tried to explain the Senior Rx plan to them but it was too difficult, and the premium was too high for anyone to consider.
Ms. Bayard-de-Volo expressed strong support for Sections 6 and 7 of the bill that discussed things that might be done by the DHR under the program. She stressed the importance of protecting confidentiality and cutting down on the administrative procedures and the amount of paperwork that had to be submitted by a senior. Additionally, forms needed to be designed so they could be used jointly by several departments and even by the counties.
Dorothy Pomin, a member of the steering committee for the Community Unity Coalition, strongly supported A.B. 545 and all issues that affected seniors. She commended Governor Guinn for the program established two years ago, however, having only 205 seniors on the plan was not acceptable. She urged the committee to do everything it could to make the plan more affordable, more accessible, less prohibitive, and get the seniors on the program.
Ed Fend, Capital City Task Force Member of American Association of Retired Persons (AARP), said that A.B. 545 was an excellent bill. He wanted to see the bill passed now so that it could be implemented by January 2002. He felt that if the Senior Rx Program did not gain a greater enrollment, then around October or November, 2001, A.B. 545 should be activated and all those who were signed up on the Rx program could be transferred and continue to get service. Mr. Fend disagreed with those who said the Senior Rx Program had not taken off. The problem was that the program had not been available until December 2000. However, the program was confusing and difficult to explain and for those reasons the proposed new legislation was so much better. He added there was a possibility neither program was suited to every person. Nevertheless, Mr. Fend had offered to go to the Minden AARP office to explain the Senior Rx Program. The most important point, he said, was to make sure no one got left out of the program.
Chairman Koivisto commented that with insurance companies there was usually an open enrollment period so that if one was covered already then they could be transferred to a new plan without losing any coverage, and it was hoped that would be the case with A.B. 545.
Assemblywoman Gibbons said the reason she was in favor of the proposed legislation was because it gave the amount of copayment for a generic drug and nongeneric. Her main concern was the subsidy and how much they would pay.
Mr. Fend responded that if someone ordered the inexpensive drug for 90 days it would cost $20. The problem with the Senior Rx Program was that if one had to use selected drugs as prescribed by a physician, as Dr. Ellerton, in Las Vegas, spoke of, then the cost was far greater. Mr. Fend digressed to speak about the increased cost of utilities, something he was working on, which was a significant factor in the budgets of so many seniors, and whether they could afford their needed medication. It was essential, he added, that some kind of program be made available to assist seniors with their medication as soon as possible.
Assemblywoman Buckley pointed out that under the provisions of the bill it would allow the department to begin planning immediately, but the effective date for implementation was January 1, 2002. That would allow an orderly transition. The Senior Rx contract expired December 31, 2001.
Janice Ayres, Executive Director of the 15 Rural Counties Retired and Senior Volunteer Program (RSVP), a position she had held for 23 years, said her job involved traveling the rural counties dealing with senior citizens, especially the homebound. She noticed in 1984 that Medicare dollars were often being spent prematurely to institutionalize seniors who could stay at home if they had help. She had put together the Home Companion Program and because there were no federal or state funds to fund it, the program utilized the senior population as volunteers to help other homebound seniors remain independent. She felt at the time that Congress should provide funds for prescription drugs and many other things that would allow seniors to stay at home longer. That was where prescription drug programs were needed. Without a program, many seniors had chosen to go into a home because they could not afford their medications, food, and utilities; something had to go.
Ms. Ayres spoke in support of A.B. 545 and felt it was much better than the current Senior Rx Program. She reported she held a meeting some months ago of all Seniorcorps project directors throughout the state, and the Governor’s chief of staff and other staff came to explain the Senior Rx Program. “We all went away shaking our heads,” she said, “because in a roomful of bright people no one could figure it out.
The increased enrollment had come from the rural areas only because Ms. Ayres brought people who could understand it well enough to be able to enroll some seniors. A.B. 545 was an excellent start, she said, but she felt it needed to be looked at further, and, she added “we should be on Congress constantly.” She felt the Medicaid money should be spent where it mattered, on keeping seniors in their own setting and independent.
Concerning the use of tobacco settlement funds, she had written a letter to the Governor telling him it would be wonderful if some of the money could go to seniors on the downside of their lives, to give them a better quality of life as they met the end. The Governor responded and came up with the dollars for independent living. Her program, RSVP, received a grant to help with the Home Companion Program, something they had never had before.
Assemblywoman Parnell, also a board member of RSVP, volunteered to help by explaining the program to seniors to get them enrolled.
Tom Wood, the Pharmaceutical Research and Manufacturers of America (PhRMA) representative, provided his written testimony (Exhibit D), in opposition to A.B. 545, for the following two main reasons:
Vice Chairman McClain asked Mr. Wood to explain his statement on page 2 of his written testimony that said “electronic claims for Medicaid passed four years ago. It has not been installed.”
Mr. Wood said nearly every other state had electronic claims in and operational, and he also noted Nevada did not even have a qualified medical management system (MMIS) required by federal law to be a part of the Medicaid system. Electronic claims was being worked on but had not been installed. The system, he explained, was one used by pharmacists to submit the claim electronically to the state and be reimbursed almost immediately.
Mrs. McClain asked how the claims were presently being processed. Mr. Wood said it was done manually.
Assemblywoman Gibbons said she felt the problem Mr. Wood had with A.B. 545 was that in the event Congress did implement a program Nevada would be stuck with it and lose the state resources. However, if they did it nationally could not Nevada take those resources and put them toward helping seniors pay for utility bills. Mr. Wood felt that was only one of the problems he had addressed in his testimony (Exhibit D). He felt that once a state–run health program was implemented it was difficult to overturn or change that program.
Assemblywoman Leslie asked if Congress did implement a prescription drug program would the state not have to end the Senior Rx Program anyway. Mr. Wood said he did not know. Mrs. Leslie then asked would the state not want to end the program. She reiterated the program was not working well and she would be glad to give that up and use the money for other great needs. Mr. Wood agreed with her.
Chairman Koivisto said it appeared the states were putting together different kinds of plans that might end up as a “patchwork” of plans with nothing that matched, however, until the federal government acted that would be the situation.
Vice Chairman McClain referred back to her question on the MMIS system and said her point was that the state needed to step up to the plate. She had just learned there was “one-shot” money to get the program underway, and she felt it was critical in any kind of prescription program that could be offered to seniors. She strongly supported implementing the computer system between the state and the pharmacies.
There was some discussion that Mark Stevens was in the audience and he might be able to comment about the one-shot allocation. Chairman Koivisto felt that although interesting it was not pertinent to the present bill, particularly as the Governor had requested one-shot funding for the MMIS system.
Assemblyman Williams felt the policy question was at the forefront for the committee. The bill would, of course, be reviewed by those who examined the fiscal aspects of it. Accordingly, Mr. Williams asked to make a motion.
ASSEMBLYMAN WILLIAMS MOVED TO DO PASS A.B. 545.
ASSEMBLYWOMAN GIBBONS SECONDED THE MOTION.
Assemblywoman Leslie supported the motion and felt that although Senior Rx was a good try, clearly all the testimony had shown the proposed legislation was much better. She felt there should not have been a delay in implementing the last program and the same logic applied here; if another concept appeared to have a better chance of working, it behooved the committee to lead the way and give the plan a try.
THE MOTION CARRIED WITH EIGHT VOTING YES AND ASSEMBLYWOMEN ANGLE AND TIFFANY VOTING NO.
Chairman Koivisto turned to A.B. 371 and called witnesses forward.
Assembly Bill 371: Makes appropriation to Department of Human Resources for increase in allowance for personal needs for residents of long-term care facilities who are eligible for Medicaid. (BDR S-1451)
Mrs. Koivisto commented the measure had been a subject of discussion for quite some time and most committee members had received letters, e-mails, and phone calls from residents in long-term care facilities who currently received an allowance of $35 a month. That small sum had to cover anything they wanted to buy. The bill was a committee introduction.
Mrs. Koivisto referred to the letter from Dottie Spinetta, a resident of Hearthstone Nursing Home, Sparks. The letter (Exhibit E) was made part of the record as follows:
To Whom It May Concern:
My name is Dottie Spinetta and I want you to get to know me a little. I have Familiar Spastic Paraplegia/Quadriplegia. The disease started showing itself in 1953 but I was able to stay out of a wheelchair until 1987. Since that time I have gone from an independent individual in my own home to a nursing home resident. I have lost a husband because he was unable to live with my disease. I have lost all use of my legs and now the disease is taking the use of my arms. As a nursing home resident I live on a very limited income. I receive Social Security disability and alimony, however the State of Nevada takes all but $35.00 of my income to pay for my “home” at Hearthstone. With this $35.00 I have to pay for all my personal expenses which include hair care, toiletries, clothing, birthday and Christmas gifts for my grandchildren and anything else I may need. My clothing needs are specialized in some areas such as breakaway pants and special underpants to accommodate both my ileostomy and catherization. One of these items alone costs $12 to $15, almost half my monthly allotment. I use many socks because I no longer am able to wear shoes. Some months I have to choose between sending one of my grandchildren a birthday card or buying a new pair of underwear. My shopping expeditions are limited to Dollar Stores and Savers so as to accommodate my budget.
When I first started using the local Paratransit service, Citi-Lift, all rides were free. Now the cost is up to $12.50 a book of ten rides. That means I am very limited on when and where I can ride. I attend 2 support groups a month, Muscular Dystrophy and Ileostomy, so that takes 4 tickets. I have various doctor appointments and do shopping. I would like to be able to attend my church but have not got enough money to buy the tickets necessary. When I buy a book of tickets it takes my monthly allotment down to $22.50. Not enough to allow anyone any sense of independence. I hope you will think about not just my life but the many lives of those of us caught in a situation not of our making. Without the ability to have some control over our own lives we have nothing. Please help by making our monthly allotments a more reasonable amount.
Sincerely, Dottie Spinetta
Vice Chair McClain spoke of a similar letter she had received last Christmas from a woman in a nursing home, who had to make a choice between having her hair done or buy her grandkids a present when they came to see her.
Assemblywoman Gibbons thanked the Chair for talking about Mrs. Spinetta, who had been a constituent of the late Assemblywoman Jan Evans. Mrs. Spinetta had needed a wheelchair and Mrs. Gibbons and Assemblyman Bernie Anderson helped raise the money to buy it. However, regulations would not allow Mrs. Spinetta to accept the wheelchair, so it had to be given to someone else and allow Mrs. Spinetta to use it. It had taken about a year and one-half to accomplish that. Mrs. Gibbons wanted the passage of the bill and its referral to the Committee on Ways and Means, to be done in honor of Mrs. Dottie Spinetta, a 62-year-old quadriplegic, and in memory of the committee’s colleague, Jan Evans.
VICE CHAIRMAN MCCLAIN MOVED TO DO PASS A.B. 371 IN HONOR OF MRS. DOTTIE SPINETTA AND IN MEMORY OF ASSEMBLYWOMAN JAN EVANS.
ASSEMBLYMAN MANENDO SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
With no further business before the committee, Chairman Koivisto adjourned the meeting at 3:21 p.m.
RESPECTFULLY SUBMITTED:
Darlene Rubin
Committee Secretary
APPROVED BY:
Assemblywoman Ellen Koivisto, Chairman
DATE: