MINUTES OF THE meeting

of the

ASSEMBLY Committee on Ways and Means

 

Seventy-First Session

April 18, 2001

 

 

The Committee on Ways and Meanswas called to order at 7:37 a.m. on Wednesday, April 18, 2001.  Chairman Morse Arberry Jr. presided in Room 3137 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:

 

Mr.                     Morse Arberry Jr., Chairman

Ms.                     Chris Giunchigliani, Vice Chairwoman

Mr.                     Bob Beers

Mrs.                     Barbara Cegavske

Mrs.                     Vonne Chowning

Mrs.                     Marcia de Braga

Mr.                     Joseph Dini, Jr.

Mr.                     David Goldwater

Mr.                     Lynn Hettrick

Ms.                     Sheila Leslie

Mr.                     John Marvel

Mr.                     David Parks

Mr.                     Richard D. Perkins

Ms.                     Sandra Tiffany

 

COMMITTEE MEMBERS ABSENT:

 

None

 

STAFF MEMBERS PRESENT:

 

Mark Stevens, Fiscal Analyst

Steve Abba, Principal Deputy Fiscal Analyst

Lila Clark, Committee Secretary

Linda Smith, Committee Secretary

 

Senate Bill 248:  Makes supplemental appropriation to Department of Museums,             Library and Arts for unanticipated additional utility costs, personnel costs and purchasing assessments. (BDR S-1255)

 

Mr. Scott Sisco, Interim Director of the Department of Museums, Library and Arts, introduced himself and thanked the committee.  Mr. Sisco provided the committee with Exhibit C, which was a supplemental request that had been included in The Executive Budget.  It provided primarily for utilities for the various museums in the Department of Museums, Library and Arts as well as some personnel costs in the director’s office budget, State Purchasing assessment costs in the director’s office budget and utilities for the director’s office budget, utility costs for the division administrator, the Boulder City Railroad project, utility costs for the Nevada Historical Society, utility costs for the Las Vegas Museum, utility costs for the Nevada State Museum and the Lost City Museum in the total amount of $35,791. 

 

Chairman Arberry asked if the amounts were still correct.  Mr. Sisco said the projections had been based on an estimated 20 percent increase in the cost of electricity and a 35 percent increase in the cost of natural gas.  Those numbers were provided by the Public Utilities Commission and the utility companies.  He said the requested amount would pay the utilities to the end of the fiscal year.  Mr. Sisco added that the department was currently paying some of the utility bills out of other categories in order to avoid accruing late charges.  He said he would appreciate anything the committee could do to expedite the process. 

 

There being no additional testimony on S.B. 248, the hearing on S.B. 248 was closed and the hearing on A.B. 374 was opened. 

 

Assembly Bill 374:  Revises provisions relating to school textbooks. (BDR 34-            851)

 

Assemblywoman Kathy McClain, Assembly District 15, introduced herself and explained A.B. 374.  She said that in the Seventieth Session of the Legislature A.B. 241 was passed that called for an audit and analysis of the instructional costs and materials used in the school districts throughout the state.  Ms. McClain said there were disturbing findings in the report that had been prepared.  Because of that audit, she felt obligated to follow up and offer some suggestions to remedy the findings.  She said she had two goals in mind with the proposed legislation.  The first goal was to ensure that there were enough textbooks in any class, where it was appropriate that a textbook be used, for each student enrolled in the class to have his own book.  The second goal was to require within a school district that the same textbook be used for all core subjects that were offered district wide, especially at the high school level.  In order to ensure that there were enough textbooks, A.B. 374 mandated that the Department of Education determine the amount of money that each school district must spend on books.  The amount would be expressed in an amount per pupil and she would prefer that it be stated in a percentage of the per pupil allocation by the state.  In addition to the specified amount, the school districts would be required to spend no less than the average preceding three-years’ expenditures on books.  School districts would be required to report to the Department of Education the actual expenditures on textbooks in their financial reports. 

 

Ms. McClain said that one of the problems she had heard from constituents was a lack of consistency among high schools for textbooks that were provided if there were textbooks available.  A student could transfer or be transferred because of zone changes, be enrolled in the same class and have an entirely different textbook.  If the state was going to require proficiency exams, at the very least there should be a consistent teaching method, especially in regard to teaching materials such as a textbook.  That would enable the students to have stable, consistent instruction in the areas that would be tested.  Ms. McClain said to her that meant the same curriculum and the same textbooks for all core subjects.  She said she appreciated the committee’s time and consideration of A.B. 374. 

 

Ms. Giunchigliani said she had some concerns.  Conceptually, she agreed that students that needed the textbooks should have them available.  She said one of the problems not addressed in the bill was that the state did not fund inflation costs for textbooks.  Ms. Giunchigliani brought some textbooks to the hearing that she showed the other committee members.  She also shared with the committee some catalogs for ordering textbooks and said the cost of one textbook was $50 to $70.  If inflation was not built into the costs, she did not know how schools could afford to buy books.  According to Ms Giunchigliani, another issue was that of readability.  Some books looked very attractive to teachers but were not readable by students.  She said that there had been no training given on how to select a book correctly and she believed the bill might address that problem at least at the high school level.  She suggested there might be some changes that could be made in the bill.  Ms. Giunchigliani said she did not have a good understanding of how each of the districts purchased textbooks.  She asked how the books were selected at the school sites or at the various districts.

 

Ms. McClain explained that the audit concerned numbers, the number of textbooks available, it did not go into readability factors or inflation costs.  The audit was an accounting of who had books and who did not have books.  The other part of the audit pertained to instructional materials and supplies. 

 

Ms. Giunchigliani asked if Ms. McClain would object to the committee trying to get a better understanding of why districts bought books.  She said she did not want districts to purchase something they were “stuck with” and then wound up never being used because they were at a 12^th grade readability level and the students were reading at a 4^th grade level.  That was a waste of money. 

 

Ms. Giunchigliani asked if the audit considered the collection of fines from students who got a book and did not return it.

 

Ms. McClain said the collection of fines of unreturned books was not part of the audit but she agreed that it should be considered.  She said she had come to Las Vegas from Colorado many years before where she had worked for a school district for 15 years.  That school district was very successful in collecting fines by withholding report cards and diplomas until the fines were paid.  She said the system was kept going year after year instead of having to start from scratch all the time.  If a book was lost or destroyed, a fine had to be paid so that it could be replaced. 

 

Ms. Giunchigliani said the State Department of Education approved a list of textbooks that were appropriate and could be used but after the list got to the district she was unsure what occurred.  She believed that in her district a group got together and told the schools what three or four books the school could select from and those might not be appropriate for that particular school.  That was where the waste occurred. 

 

Mrs. Cegavske thanked Ms. McClain and said she understood that the intent of the bill was to make sure that every student had a book.  One area looked at through the textbook audit was that the special education area did not appear to be given textbooks for their particular needs.  She wanted to make sure there was funding for the special education classrooms.

 

Mrs. Cegavske said she had received information on book fines.  It seemed that schools all had their own policy and there was no suggested statewide or district-wide policy.  She related that she had some information from one of the Las Vegas high schools that had done a very good job.  As of last year, they had $60,000 in unpaid fines and loss of textbooks. 

 

Mrs. Cegavske asked Ms. McClain if she was opposed to including supplemental materials that could be taken home such as compact discs (CDs) to the bill.  She said that technology was advancing and materials other than books might need to be included.  She expressed concern on the procedure for books to be selected and added to the approved list of textbooks.  She commented about the agreements that the districts had with the publishing companies.  If there were errors in the books the contract provisions were not enforced. 

 

Ms. McClain further testified that the bill could be looked at as a vehicle to get a result that everyone could agree on.  The bottom line was that if there was a classroom for which a textbook or whatever supplemental information needed to be with it was appropriate, every student should have one.  Students should be able to take the material home so their parents could help them. 

 

Ms. McClain said that another problem reported to her was that teachers were the ones responsible for taking care of the books.  If there was a system in place where the book was checked out to the student, at the end of the year if the book was destroyed or lost, the student would be responsible for it and the pressure would be removed from the teacher. 

 

Mrs. Cegavske reported that she had a group of parents in her district that met with her several weeks ago and their suggestion was that there should be a book deposit that could be applied to the next book as it was needed.  Some of the parents said they believed the books should be available for sale similar to what was done in colleges.  In some school districts across the nation students had to purchase the books. 

 

Ms. McClain said she thought the first priority was to be certain there were enough books available for students and she agreed with Mrs. Cegavske that a book deposit was a very good idea. 

 

Mr. Beers said that he was astonished that there was a fiscal note involved with purchasing a minimum level of books.  He asked Ms. McClain if she knew how the fiscal note had been developed.

 

Ms. McClain said she had not seen the fiscal note and did not know how it had been developed.  Mr. Beers said the fiscal note calculated the cost to be $1 per student in Clark County and Washoe County reported a cost that was four or five times higher. 

 

Mr. Beers asked if there would be some input from school personnel on how the fiscal note was developed. 

 

Ms. Tiffany remarked that she also sponsored a book bill that had an appropriation built into it.  She asked Ms. McClain if A.B. 374 would change the Distributive School Account (DSA) for the line item on textbooks. 

 

Ms. McClain answered Ms. Tiffany’s question by stating, “Not in specifics, fortunately that was the Ways & Means Committee’s purview.”

 

Ms. Tiffany said it seemed to her that the text of the bill was written in that way.  If it took $1 to put a textbook in every student’s hand the DSA must be adjusted to make sure that amount was spent.  She also asked why it should be put into legislation that the same textbook should be used for each core subject throughout the district.  She wanted to know what the resistance was to that in the 17 school districts. 

 

Ms. McClain said she was unsure what the resistance was among the school districts to using the same textbook district-wide.  She advised that she had many parents talk to her about that issue.  If their student was transferred, especially at the high school level, they could be enrolled in the same course but a totally different textbook could be utilized.  Sometimes a student would be transferred because of zoning issues and would be enrolled in a class with an entirely different textbook. 

 

Ms. Tiffany asked Ms. McClain if the bill referred only to Clark County students or the other 16 school districts as well. 

 

Ms. McClain said the bill would affect all 17 school districts but the crisis was in Clark County because of the growth and the movement of the population within the county.

 

Ms. Giunchigliani commented that the content of the book was important, not the book.  She believed that it must be recognized that the same curricular content should be covered from school to school.  Mandating one text would cause opposition from teachers.  The content and readability must be appropriate and the book must be accurate.  If that was accomplished then it would make sense to have a pool of books to choose from.  Ms. Giunchigliani said that was the point that should be taken into consideration. 

 

Ms. Giunchigliani said she appreciated that Mrs. Cegavske brought up the issue of special education.  She offered an example from her experience as a special education teacher in Clark County.  She said she continued to “fight” with the school administrators at the local site because special education students were funded on a per pupil basis and that each school got funding for textbooks.  The special education students were to be funded out of that dollar amount.  She said she did not want to take the textbook money out of her classroom supply money that in her case was $613.  With $350 she could only purchase ten books.  Some teachers were teaching 2 and 3 subjects and there were generally 15 to 18 special education students in the classroom.  That would not provide a textbook per student.  Ms. Giunchigliani said part of the problem was how the funding was actually allocated to the school site and then the segregation of the funds between English as a Second Language (ESL), special education, and general education populations. 

 

Ms. Giunchigliani asked Ms. McClain to discuss the inconsistencies between school districts regarding fine collections and deposits.

 

Ms. McClain said that was not part of the audit but she understood it to be a problem from conversations with many people.  There was at least one school where they were actually tracking the fines.

 

Ms. Giunchigliani believed deposits were not a bad idea but there had to be a provision for lower income students who might not have money for deposits.  She suggested there might be other structures that could be used.  Ms. Giunchigliani offered to work with Ms. McClain to develop a workable plan. 

 

Assemblyman Bernie Anderson, District 31, testified on the importance of textbooks to teachers.  He said he was a social studies teacher and he usually had the same textbook for a relatively long period of time.  He said it was important to use updated U.S. History and Government textbooks in the classroom.  Several years ago, Mr. Anderson recognized that he could no longer end his curriculum at the end of the Korean war, that he had to include the Vietnam war.  He said that might not sound like a large step for those who were younger than 40 years of age, but for those who were over 40 it was current history.  He said it was an enormous reality to him that some of the textbooks did not do a good job on the later time periods.  Mr. Anderson said many times teachers utilized various supplements in an attempt to keep current.  The other reality of life was that because of the technological changes that had taken place in the classrooms the traditional textbook was not being utilized.  “Software available” often meant that a traditional textbook would not need to be supplied.  Mr. Anderson said he taught at the largest high school in Washoe County and the idea of having a textbook for use in the classroom and a textbook at each student’s home had been discussed.  Students’ backpacks could weigh 80 pounds filled with books.  The large backpacks presented a problem with the concern for security in schools. 

 

Mr. Anderson said in looking at the bill the committee needed to be very aware of how much books cost and the opportunity to keep students aware of what was happening in the new, changing society.  He asked the committee not to hamper his ability as a classroom teacher to provide students with the most up-to-date information.  He said that might not be with a textbook. 

 

Mr. Al Bellister, representing the Nevada State Education Association, introduced himself.  His organization was concerned about A.B. 374 for two reasons.  The first was the state’s obligation to adequately fund the Distributive School Account (DSA).  The budget proposal did not include an adjustment for inflation.  That was a critical element in helping to resolve the shortage of textbooks that was revealed by the Legislative Counsel Bureau (LCB) audit.  The audit showed some interesting information.  School districts spent more than was allocated to them over the five-year period studied than was allocated to them through the Distributive School Account.  Despite their best efforts over and above the allocations through the state there was still a shortfall of $6 million.  The school districts contributed $6 million more than was allocated to them and there was still a textbook shortage in the state.  He said the other key piece was that teachers on average were spending $500 out of their own pockets to supplement funding for textbooks and instructional supplies.  That also should be taken into consideration.  The bottom line was that more money should be going into the Distributive School Account for textbooks, supplies, and instructional materials. 

 

Mr. Bellister said his second concern was about Section 5 of the bill that required one textbook to be used in the district.  Teachers needed to have the flexibility to select textbooks that were consistent with the standards and adopted curriculum but also met the needs of their students.  In most school districts there was an approved list that teachers could choose from but the approved list was designed to meet the approved standards and curriculum.  Everyone would be going in the same direction but teachers would have the flexibility to choose the vehicle to meet the goal. 

 

Ms. Giunchigliani asked if it was Mr. Bellister’s understanding that each of the school districts used the State Department of Education’s approved list of books and then created their own approved lists.

 

Mr. Bellister confirmed that that was his understanding of how books were selected. 

 

Ms. Giunchigliani asked where most of the textbooks came from.  She said it seemed to be done by regions.  There had been criticism that many of the books had not appropriately reflected minorities, women, or other groups. 

 

Ms. Martha Tittle, representing the Clark County School District, introduced herself.  She said that when the district went through a textbook adoption process within the district, requests for proposals (RFPs) were submitted to all the vendors.  Those vendors responded as to whether or not they wanted to participate in the process of book selection.  There were committees formed that included teachers, parents, and administrators who reviewed the books that were submitted for consideration.  In the Clark County School District there was a maximum of three different books that were selected for adoption.  She pointed out that in the Clark County School District for elementary schools that meant three vendors for the reading, language, arts program, three for the mathematics program, etc.  Schools could choose from those on the list. 

 

According to Ms. Tittle, at the high school level books were adopted for courses.  She said that was part of her concern with the language in the bill.  For example, in 9^th grade mathematics there were many different courses and books were selected for the courses.  Once those titles were selected by the local committees there was a process where the proposals went to a textbook commission which was made up of representatives from the district and community.  The meetings were advertised so that the local community had an opportunity to review the proposed textbooks.  The selected textbooks were then recommended to the State Board of Education and the state board did the final approval of those that were proposed.  Those then went on the state approved list.  In actuality, the selection started at the local level and moved to the state level rather than from the state level to the local level. 

 

Ms. Tittle addressed the committee regarding Sections 1 and 5 of A.B. 374.  She said she appreciated the focus of the bill on the importance of funding for textbooks.  The concerns she had in Section 1 that would require the Department of Education to prescribe a minimum amount of money the district should spend for textbooks in the succeeding school year was that the provision transferred budgetary responsibility from the local school boards to the Department of Education.  The Clark County School District was in the process of building a large number of schools and when new schools were built the DSA allocation for the purchase of textbooks was supplemented with bond funds.  The bill would cause a significant variation in the number of books needing to be purchased from year to year.  The amount that needed to be spent from year to year as was proposed in the bill could cause the district to have to spend money on textbooks when those monies may or may not need to be spent.  For example, in the 2000-01 school year in Clark County eight new elementary schools and two middle schools would be opened.  In 2001-02, seven elementary schools, five middle schools, and three high schools would be opened.  With the growth, it would be very difficult to base the funding on a three-year average.  The basic problem was that additional funding was needed for the books.  Ms. Tittle said she did not disagree that every student should have a book in class and a book to take home but she was not convinced that A.B. 374 provided the appropriate way to fund the purchase of the books and how to allocate the monies. 

 

Ms. Tittle went on to say that the Clark County School District supported Section 4, subsection 1(d) regarding the report for actual expenditures for textbooks.  The district would have no problem providing the information. 

 

Ms. Tittle reported that because books were selected for the various courses at the high school level, the district had a problem with the language in the bill that would suggest that one textbook be selected for the core subjects at the high school. 

 

Mr. Steve Williams, representing the Washoe County School District, introduced himself.  He said “ditto” to the testimony of Ms. Tittle.  The Washoe County School District also would be building additional high schools.  In 2002, they would open two new high schools and two elementary schools.  In 2003, another elementary school and another high school would be opened.  The opening of the new schools would skew the yearly average spent on books.  That was a problematic feature of any averaging technique and he did not have an answer for how to solve that problem.  The Washoe County School District also agreed that having textbooks was important and that the textbooks needed to be readable, comprehensible, and suitable to the subject. 

 

Mr. Williams said that his daughter had participated in the “We the People Program” in her senior year in high school, which counted as the American Government class.  There were many different ways of teaching a subject that should be tailored to the teacher and the type of instruction presented.  The Federalist Papers, the United States Constitution, Newsweek magazine, and local newspapers were all part of the instructional materials in his daughter’s class.  Specifying a textbook would not have been appropriate in that case.  He said that the students who completed the “We the People Program” benefited greatly from the experience, much more so than if they had been forced to use one particular textbook. 

 

Mr. Williams concurred with Mr. Bellister’s testimony regarding the need for the additional funding of the DSA for textbooks.  He said there were many bills that “tiptoed around the real issue” that there was inadequate funding at the per pupil level in the DSA.  S.B. 417, introduced by Senator Schneider in the Senate Human Resources and Facilities Committee, was the first bill that addressed the issue directly requiring that the state fund the DSA at a per pupil level equal to the national average.  He indicated his support for that bill. 

 

Ms. Giunchigliani asked if anyone who had testified knew what would need to be built into the DSA for inflation on textbooks. 

 

Mr. Bellister commented that the Bureau of Labor Statistics had an inflation measure, the Consumer Price Index (CPI), that was a little over 3 percent.  There was another source in Washington, D.C. that he could not recall the name of that had a school inflation index.  Mr. Bellister said he would provide the information to the committee. 

 

Ms. Giunchigliani said the issue was that all costs such as insurance, books, and supplies went up and the inflation cost was never built into the budget. 

 

Mr. Bellister said that the Department of Education in its budget proposal had an overall adjustment of 3 percent throughout operating items for inflation that was not built into the budget. 

 

Mr. Don Hataway, of the Budget Division, clarified for the committee some of the statements that had been made in previous testimony.  He said the DSA budget had been built based upon the actual expenditures that occurred in the preceding year including salaries, textbooks, and other expenses.  Money was not allocated for textbooks; money was allocated on a per pupil basis and it was up to the individual districts to make the decision as to how the funds would be spent.  He said he remembered one year during that last decade where inflation was built in for books and as he recalled, the districts did not spend all of that money.  He said he appreciated their decision-making process; they did not buy books on a uniform basis and they had other expenditure demands. 

 

Mr. Hataway further explained that the bill addressed the General Fund expenditures and if the district used bond funds, Title I funds, or other federal funds for the purchase of books for specialty purposes that should not be taken into consideration.  It would be the General Fund acquisitions that they reported in their audit reports to the state. 

 

Mr. Hataway reported that regarding inflation it all boiled down to money.  The most pressing need now was the inflationary increases that had been built in for energy.  He was not certain that the amounts were adequate but it was a matter of priorities in relation to the amount of money available. 

 

Ms. Giunchigliani commented that education usually got what was left, not what was right.  She asked if the budget took into account when districts supplemented the purchase of textbooks out of their local funds. 

 

Mr. Hataway explained that all the General Fund revenues were taken into consideration in the preparation of the budget.  He said that for all practical purposes the local districts had no control over their revenue stream.  There were some tuition dollars they collected but even the revenue that was inside the DSA, basically the 50-cent property tax and the Governmental Services Tax (formerly known as the Motor Vehicle Privilege Tax), was controlled by the state.  He reiterated that all General Fund revenues were considered when the budget was constructed. 

 

There being no further testimony on A.B. 374, Vice Chairwoman Giunchigliani closed the hearing on A.B. 374 and opened the hearing on A.B. 378. 

 

Assembly Bill 378:  Provides for establishment of program to promote             profession of nursing. (BDR 34-852)

 

Assemblywoman Vivian Freeman, District 24, introduced herself and explained that for many years there had not been enough nurses being trained and that Nevada was one of the worst states in training and educating nurses to be available to provide care to the people of the state not only in a hospital setting but in other areas as well.  The bill had been heard in the Committee on Education and she had been asked why people were not entering the nursing profession any longer.  She said there were a number of reasons for that but the result was that there was a terrible shortage of nurses in Nevada.  Any hospital administrator could confirm that they were importing nurses from every state in the nation, and hospitals were using nursing agencies that supplied nurses from out of state.  Ms. Freeman said she had met with Mr. Bill Welch from the Nevada Hospital Association and they had worked together on the bill.  Ms. Freeman reminded the committee that the Millennium Scholarship Program was created from the tobacco settlement funds coming to the state of Nevada.  One of the agreements with the Governor was that 40 percent of the tobacco settlement funds would be utilized to finance Millennium scholarships.  The bill that established the program provided that the students who would be eligible for Millennium scholarships must have graduated from high school on or after June 2000.  That restricted the scholarships to students who had recently graduated from high school.  The majority of students that went into nursing were, for the most part, older students.  Ms. Freeman said she had met with Dr. Jane Nichols, Chancellor, and others involved in the University System, to determine how many students were going into health-related courses of study.  The University System should be encouraged to do outreach to students interested in health-related courses of study. 

 

Ms. Freeman said she was a former nurse and saw nurses as the most critical professional in the delivery of health care.  The bill asked that the department work in consultation with an advisory committee and provided $250,000 from the trust fund for public health to be utilized by the University System to provide the outreach into the communities and schools to encourage students to go into the field of nursing.  The bill also allowed anyone who graduated from high school after 1985 to be eligible for the Millennium Scholarship Program and that would allow the University System the flexibility to provide this benefit to older students. 

 

Ms. Freeman said she had been told by a university instructor that allowing only  younger students to go into the University System for nursing training did not work out well.  Many of the students were burned out and did not want to take organic chemistry right after graduating from high school.  Many of them failed and dropped out. 

 

Ms. Freeman said tracking the success of students in the nursing program that received the Millennium scholarships was not possible because many freshmen had not yet declared a major.  The information was not available yet. 

 

Ms. Freeman thanked the members of the committee who had signed on as co-sponsors of the bill.

 

Mr. Bill Welch, President/CEO of the Nevada Hospital Association, introduced himself.  He said the association felt very strongly about A.B. 378 and believed it addressed a very important issue facing Nevada.  According to Mr. Welch, the nursing shortage in Nevada was a public health crisis.  Mr. Welch presented Exhibit D that was a summary of presentations that had been made in the past.  He said Exhibit D included the slides that had been presented and copies of letters from five of the six nursing programs in the state of Nevada that had indicated they would have the ability to expand their nursing programs in fall 2001 if A.B. 378 was passed. 

 

Mr. Welch said the Bureau of Health Manpower Statistics indicated that there was a shortage of 300,000 nurses in the nation.  By 2010 that shortage would expand to 750,000 nurses.  Nurses in Nevada, as well as across the country, represented 67 percent of the work force in the hospital setting.  He said it should also be noted that with respect to 67 percent of the nurses working in the hospital environment, there were still not sufficient nurses to meet the demand.  Forty-seven percent of the nursing payroll last year was overtime payroll so that the patient demands placed on the hospitals could be accommodated.  That indicated the severity of the shortage in the state. 

 

Mr. Welch went on to say that while the population in the nursing programs grew, it did not keep pace with the rate of general population growth.  In the rest of the country the rate of the registered nurse programs grew in proportion to the population growth.  Nevada fell behind because of the rapid population growth experienced in Nevada and it appeared that the population growth would continue. 

 

Mr. Welch said that the Health Resources and Services Administration (HRSA) measured nurses per 100,000 population.  Nevada was ranked last in the nation.  There were 520 nurses per 100,000 population.  That had decreased 10 percent in the last four years.  Four years ago there were 582 registered nurses per 100,000 population.  The national average was 782 nurses per 100,000 population.  The next state closest to us was California.  California ranked 49^th in the nation and was also experiencing a severe nursing shortage.  They were estimated to have a shortage of 17,000 nurses by the year 2006.  California was one of Nevada’s greatest competitors for recruitment of nurses.  Nevada should expect great competition from California as well as other parts of the country. 

 

Next, Mr. Welch discussed the average age of the registered nurse.  In 1980, 30 percent of the registered nurses were under the age of 30 and in 1996 the statistic had dropped to less than 10 percent under the age of 30.  The average age of RNs today was 42.  Mr. Welch said his organization had done a survey of the RNs in the hospital setting and for the hospital setting alone the average age was 44.5 years.  Mr. Welch discussed the average age of RNs at graduation.  In 1975 the average age of the graduate of the associate degree program was 28 years and the average age now was 34 years.  For a diploma nurse it was 23 years and today it was 31.  For a baccalaureate degree program it was 23 years and today it was 28.  Those figures indicated that the individuals choosing to pursue nursing were making the choices much later in life than they had in the past. 

 

Mr. Welch said there would be a great expansion of the elderly population in our country as the baby boomers hit the health care system.  Nevada had been the fastest growing state in the growth of the elderly population and was expected to continue in that position for the next 30 years.  That population sector was the biggest user of the health care services system. 

 

Mr. Welch informed the committee that the Nevada Department of Employment, Training, and Rehabilitation reported that the current need for nurses on an annual basis was 662 and that rate was projected to go through at least 2008.  Mr. Welch clarified that 75 percent of that growth was based specifically and solely on the growth of the state.  Those were new positions, not replacement positions.  Twenty-five percent of that growth could be attributed to attrition, for retirement, or individuals choosing other career paths. 

 

Mr. Welch said in the last graduation year the University and Community College System of Nevada produced 262 nurses.  According to the forecast, that would grow, if nothing changed, to 385 in the year 2008 graduating class.  If you compared that number to the 662 nurses needed annually, it fell far short of the demand.  Based on data collected on most of Nevada’s large hospitals and some of the small hospitals, Mr. Welch projected there were currently 982 vacant positions in the hospitals. 

 

Mr. Welch stressed that the nursing programs in the state were very good.  The issue was not the quality of the graduate; the issue was the number of graduates that the system produced.  Nationally, the American Association of Colleges of Nursing suggested that if the state experienced an 8 percent shortage of nurses that was a crisis.  National statistics showed that the national vacancy rate for RNs was 9.7 percent.  Nevada was at 13 percent.  This represented a very serious problem. 

 

Ms. Leslie congratulated Mr. Welch for an excellent presentation.  She asked if there would be a requirement that the students affected by the bill would stay and work in Nevada for a certain number of years. 

 

Mr. Welch said that idea had been considered but had not been incorporated into the legislation. 

 

Ms. Leslie said she would like to see that added to the bill because she did not want to train nurses in Nevada and have them go to California when Nevada had a critical shortage.  She asked for more detail on how the $250,000 designated for outreach would be spent.  She commented that she would rather put that money into the loan program.

 

Mr. Welch said the reason the $250,000 was designated for a public relations campaign with respect to nursing was because there had been a decline in individuals choosing to pursue a nursing education.  There were statistics to demonstrate that and he believed that was affecting the average age of the graduate nurses.  The proposal would develop a coordinated promotion program within grades K through 12.  He believed that the nursing profession needed to be promoted starting with kindergarten students.  There were many ways to do that through such tools as coloring books focusing on the importance of nurses.  Mr. Welch reported that his organization was looking at creating a structured, organized mentoring program in the K through 12 educational system with the entire health care system.  The two forces would be brought together so that student counselors were oriented to the opportunities of the nursing profession in a very structured way with the health care industry.  The concern was that if the nursing program was doubled, in two or three years would the system continue to be able to sustain that volume of nurse graduates.  If nothing was done to change the image of the nursing profession, Mr. Welch did not believe the program could be sustained.  That was why Nevada needed to start immediately on the promotion of the nursing profession and why the funding was included in the bill. 

 

Ms. Freeman said that the question of requiring nursing graduates to stay in Nevada was a very good one that had been considered.  There was also a proposal made that some of the funds be used for the Western Interstate Commission for Higher Education (WICHE).  She said she had no problem with adding that to the bill.  She talked about the difficulties in encouraging students to go into the nursing field and said that when she was a child, the image of a nurse was a white uniform and cap.  She believed that some type of marketing tool was necessary to encourage students to go into nursing and she thought the $250,000 would be money very well spent. 

 

Ms. Leslie said she had been working with the Hospital Association on the working conditions issue because that was part of the image problem that should be addressed.  She said that the committee needed to look carefully at the budget.  Some money for outreach was appropriate but she believed more students could be attracted by giving them loans and requiring them to stay for a period of years in Nevada. 

 

Mrs. de Braga said part of the problem was that more of the nurses were women and there were many other job opportunities for women than in the past.  She asked if pay, working conditions, staffing levels, or the inability of students to be admitted to a nursing program was the biggest problem to be addressed.  She asked if the problem was worsened by the amount of profit desired by the health maintenance organizations (HMOs) and those types of systems.  She said there was denial on that level but it seemed to her that nurses were required to tend to a larger number of patients either because there were fewer of them or because of the profit motive.  She said that she believed the major causes of the problem should be addressed.

 

Mr. Welch said Mrs. de Braga had asked a good question and there was not a simple answer as the issue was very complex.  Nevada was a very fast growing state so just the growth alone contributed to the shortage problem.  However, it was beyond just a state issue.  Nursing was a 24-hour, 7-day, 365-days-a-year job.  There were many other opportunities now for young women and the nursing field had been predominantly a female profession and that continued to be the case.  Things needed to be done to change that and there were efforts to do that around the country that Nevada could use for a model.  The work environment needed to be addressed.  The patients in the hospitals were sicker, stayed in the hospital shorter periods of time, with nurses taking care of more patients than they used to.  Economics had had an impact on care.  It was not known whether that was driven solely by the profitability that certain health systems felt they needed to make or if it was driven by managed care and the effects that it had on the health care delivery system.  Mr. Welch suggested that it was probably a little bit of both. 

 

Mr. Welch went on to talk about the opportunities available for women now that were not available in the past.  He said that over one-half of the students in the legal schools in the country were female.  The same thing was true for the medical schools.  He said that the nursing profession needed to be revitalized.  In the 1960s and 1970s there were not a lot of opportunities for women other than pursuing education or nursing.  The X-generation came to the software world and could potentially make millions of dollars quickly and it took time for them to find out that it was a very small percentage of the population that would be that successful.  That was why the age of the students had increased as they found out they could fall back on those stable professions to sustain themselves. 

 

According to Mr. Welch, the Hospital Association created a task force last year to review issues regarding the workplace image.  The task force included representatives from the State Board of Nursing, the Bureau of Licensure and Certification, the Nevada Nurses’ Association, the educational system, the hospitals, etc., and the task force had studied the issues carefully.  It would continue that effort.  For example, they had hired a registered nurse to bring a specific focus from the Hospital Association on addressing the nursing shortage, including the work environment.  They were surveying all the hospitals as they had done last year.  The association asked the hospitals to review their exit interview surveys and then they published the findings.  He said the association knew it had an image problem with the staff that needed to be addressed.  According to Mr. Welch, the association was trying to step forward to deal with the issues.  In March 2000, a forum was held to which every licensed nurse in the state was invited, over 20,000 invitations were issued, and 300 people attended.  From that came many subcommittees that would address issues such as the workplace environment in hospitals and other locations.  They talked about education and other issues.  Mr. Welch said the association had taken a broad approach to addressing the issues so that long-term solutions could be identified. 

 

Mrs. de Braga asked if it was easy to get admitted to the nursing programs.  She said she had heard that it was very difficult and there was a waiting list. 

 

Mr. Welch said there were varying opinions on Mrs. de Braga’s question.  He said the Hospital Association had tried to study the question for the last several years.  Sometimes he heard there were waiting lists and other times he heard there were no waiting lists.  He believed that would vary depending on when the question was asked.  He said that currently there was a waiting list in at least five of the six nursing programs in the state.  Mr. Welch said he had been the hospital CEO in Elko for many years and chaired the nurse advisory committee for many years.  Each year he had more students than slots available.  He had been gone from Elko for ten years and was unsure what the status was now.  Mr. Welch said that nursing was a tough, educational career path to follow.  There were prerequisites that were required before the student could be admitted to a nursing program. 

 

Mrs. de Braga said that if students were solicited but there was no program for them to go into they were defeating the purpose. 

 

Mr. Welch said that was the reason they were asking for the nursing programs to be expanded.  If the image of the profession was improved and the other issues were addressed there still would be no program for the potential students to enroll in.  If the campaign to attract more students was successful the students would not have the opportunity to pursue the education unless the nursing programs were expanded.  Mr. Welch said that Nevada was not the only state in the nation that was addressing the issue.  Texas, for example, was looking at doubling its programs and investing over $30 million into it.  California was looking at investing over $100 million into programs.  Mr. Welch said he was asking the committee to invest $11 million into the program for the first biennium and approximately $9 to $10 million in later years. 

 

Ms. Giunchigliani asked why a bill was needed to tell the universities to expand its programs.  Also, she said that many of the traditional problems had been mentioned and they were the same as those affecting teachers.  She said poor working conditions, lousy salary, recruitment that had been done for Caucasian women, had to be looked at in the nursing and teaching professions.  Men were very welcome and much needed to expand the work force.  Ms. Giunchigliani said she believed the committee should look at a loan program, use the Millennium scholarship dollars, and require work in a hospital for a certain amount of time to encourage students to make a commitment to the state.  Ms. Giunchigliani asked if the Hospital Association had funds for those employees who might want to return to school to change their careers. 

 

Mr. Welch said the Hospital Association did not have such a program.  However, he said many of the larger hospitals had those types of programs.  Two of the hospitals were funding the expansion of nursing programs at Western Nevada Community College and at the University of Nevada, Las Vegas nursing program.  Several of the hospitals had mentoring programs and scholarship programs.  Unfortunately, there had been no coordination of the programs and that was the reason that the association hired a staff person to better coordinate the programs that were available. 

 

Ms. Freeman said she believed the bill took a comprehensive, serious look at the issues and she appreciated all the suggestions offered.  She said that she believed the question of why it would require legislation for the University System to expand nursing programs was a good one.  One of the biggest problems up to the present was that everyone thought someone else would take care of the problem.  It was time for everyone to get involved, the University System, the legislature, and the Governor.  It was a crisis in the state and professional care in the hospitals was a necessity.  Ms. Freeman thanked the committee for its help. 

 

Ms. Neena Laxalt, representing the Nevada Nurses Association, said the key points she intended to cover in her presentation had all been covered by Mr. Welch and Ms. Freeman.  The concern that the nurses had was that the issue of retention be followed as closely as the issue of recruitment and she commended Ms. Freeman for the bill and offered her support.

 

Ms. Robin Keith, President of the Nevada Rural Hospital Project, a consortium of Nevada’s small, rural, public and not-for-profit hospitals, introduced herself.  She said that testimony regarding the extent of the shortage had already been given so she would not repeat it but she did want to tell the committee that the Nevada Rural Hospital Project stood firmly in support of the project.  The nursing shortage was a huge problem for all of the rural hospitals.  She said that the smaller hospitals often had scholarship programs and were instrumental in the early 1990s in bringing federal funding into a distance learning program and equipping a number of the rural sites with video classroom capability.  That was another option that she hoped could be revived. 

 

Ms. Kathy Apple, R.N., M.S., Executive Director of the State Board of Nursing, introduced herself.  She said that as the body charged by the legislature to protect the public through the process of licensure, she was very concerned about the consequences of the current shortage based on the demand for nurses in the state.  She was more concerned about the shortage that would be coming that had been described in previous testimony.  Nevada was on the downhill slide of losing one-half of the nurse population.  When the statistics of actively licensed nurses in the state were reviewed, fully over one-half were over the age of 45 years.  The State Board of Nursing was in full support of the bill and believed it was a very complex issue that would need very complex solutions, of which this was only one. 

 

Ms. Giunchigliani said that part of the concern was that Section 5 of the bill would open the scholarships up to more than just the high school students and others would be encouraged into the profession. 

 

Dr. Joe Crowley, representing the University and Community College System of Nevada (UCCSN), introduced himself.  He said that the bill had a significant fiscal note and Vice Chairwoman Giunchigliani had asked why a bill was necessary to expand the nursing programs.  He said that he assumed that meant that Vice Chairwoman Giunchigliani believed that the cost of the expansion could be taken from current funding.  He said he wished that were the case.  Dr. Crowley said that a few years ago the system did a significant review of health care education needs in Nevada.  The story of nursing shortages was replicated across the spectrum of health care.  Nevada might not be ranked 50^th in the nation in the availability of physicians, but in the Las Vegas metropolitan area the state lagged well behind.  Dr. Crowley said Nevada was close to the bottom of the nation in the presence of pharmacists, dentists, and other health care professionals.  Dr. Crowley stated that the UCCSN was not able to produce the money to educate the students to meet all of the health care needs.  He said that typically dollars in the institutions followed enrollment demands or other pressures from the community and they were asked to expend larger sums of money in engineering and the sciences to promote economic development and diversification.  They were asked to spend more money to educate more teachers to meet the growing need for teachers in the state of Nevada and that had been done. 

 

Dr. Crowley said that just as Mr. Welch had indicated, there were differences of opinion of the degree to which there was a demand for slots in the nursing programs.  Dr. Harter, who was the coordinator for health care education programs at UCCSN, could testify that they were able to find waiting lists at only two of the six institutions.  Those two were the University of Nevada, Reno and Great Basin College.  He said he assumed there would be an overwhelming need for more nurses in southern Nevada but he had no data that suggested there was a waiting list at UNLV or CCSN.  Dr. Crowley said the requested appropriation was not part of the system’s enhancement request in The Executive Budget.  The University System submitted a modest request for approximately $15 million of which approximately half would be used for meeting the health care needs including dentistry, pharmacy, physicians, and others.  Within the institutions it would typically be the case that where there was demand and there were dollars to help meet it, dollars would flow in that direction.  It could be anticipated that at the UNR, because there was a significant waiting list, some assistance would be found within the budget that the state had provided for the upcoming biennium.  Since the UNR was now a growth institution there might be dollars that could help in that direction.  Dr. Crowley said the system was cognizant of the need for the state to step forward when it could to help meet the nursing shortage.  He believed that the idea of promotion of the profession was an excellent idea for all the reasons Mr. Welch put forward.  There was a need to depict the nursing profession as a desirable place to work and there were problems with that at the current time.  The notion of financial assistance for nurses was also a worthy goal and he noted that in the bill provision was made for an advisory committee with places for UCCSN representatives.  He endorsed that plan and would be pleased to cooperate. 

 

Dr. Crowley said that Section 8 of the bill provided for a doubling of the size of the programs.  The language was a little vague as to when that was supposed to occur but that did represent a significant amount of money that the system simply did not possess.  Dr. Harter had been asked to work with the deans and directors of nursing programs and the relevant academic officers to determine what the costs would be of doubling the size of the programs whether that would occur beginning in the fall or whenever it might occur.  He provided Exhibit E showing the costs of doubling the nursing enrollment in the system and said Dr. Harter would explain them. 

 

Dr. Michael Harter, Coordinator of the Health Care Education Programs for the University and Community College System of Nevada, introduced himself.  He said that Ms. Freeman and the Nevada Hospital Association had documented very clearly the shortage of registered nurses in the state of Nevada.  Because of that, he planned to focus his testimony on Section 8 of A.B. 378. 

 

Dr. Harter said that in Section 8 the Board of Regents was directed to take such action as was necessary to double the capacity of the programs of nursing from its capacity in school year 2000-01.  He referred to Exhibit E as a summary of costs that had been assembled by the individual schools of nursing.  The costs related to faculty salaries and fringe benefits to support staff, and facilities costs.  For example, there were insufficient nursing skill labs and classrooms to accommodate twice as many students, and offices for faculty would need to be provided on most campuses.  In the area of equipment, Dr. Harter said that mannequins for registered nursing students cost $7,000 each.  If the enrollment in the system was doubled there would be a significant number of mannequins that would have to be purchased along with additional beds.  Dr. Harter said that nursing had become a high technology profession and there was a need for computers and technical equipment in the nursing programs to help prepare nursing graduates to function in modern settings.  In the area of operations and supplies, the skill labs needed supplies ranging from bed sheets to replacement and upgrades on software for the computer systems, and books.  Doubling the size of the faculty would also require significant continuing education for those faculty members.

 

Dr. Harter said the first year costs were estimated to be $7,133,266 and the costs for year two would be $4,529,976, totaling $11,663,242 for the biennium.  The ongoing costs after the first two years were estimated to be approximately $5,369,355.  By year 2003-04 there would be a doubling of the enrollment across the system for a total of 1,246 nursing students enrolled in RN programs.

 

Dr. Harter pointed out that the Board of Regents had not had an opportunity to authorize any doubling of enrollment and that would have to follow any action that the legislature might take. 

 

Vice Chairwoman Giunchigliani pointed out that the system was a state university and part of a university’s program ought to be to evaluate the needs within the state.  Programs had been added and not necessarily appropriately funded.  She used teaching as an example and said that Speaker Perkins had brought forth the issue of the Henderson College and she wondered why the system had not recognized there was a need and then reacted to it.  The same thing went for the nursing shortage.  There were other needs in other professions that should be reviewed by a state university.  She believed that was where some of the concerns came from and why there were several pieces of legislation dealing with those issues. 

 

Dr. Harter asserted that in southern Nevada, where 60 percent of the nurses were produced, CCSN and UNLV did significantly increase their capacity.  The UNLV was graduating close to 70 percent more RNs than it did seven years ago. 

 

Vice Chairwoman Giunchigliani asked how many nurses were represented by 70 percent.  Dr. Harter said the graduating number currently was around 70.  Ms. Giunchigliani said that percentage figures could mislead, number of nurses was what needed to be considered. 

 

Vice Chairwoman Giunchigliani asked if the system had considered tapping the resources of those already in the profession, doing an urbanized-type program where graduates were licensed or certified to instruct.  That would broaden the base without having to go to the university for courses.  She said a teacher did not necessarily need to be a professor.  Many of the teachers in the University System were not licensed in many cases and she questioned why other resources could not be utilized. 

 

Dr. Harter said the faculty that taught nursing students had to be master’s prepared registered nurses.  He said that some RNs would qualify to teach and the schools did utilize them to augment their teaching force. 

 

Vice Chairwoman Giunchigliani said she believed there were some possibilities that were not being utilized as resources.  Perhaps they could be called an adjunct and paid a stipend.  They would not have to be a university faculty member but they could impart the knowledge that they were very well aware of.  That would expand the base very quickly and could be done at a hospital site.  She said she believed that sometimes the university needed to be more urbanized as far as looking at what they brought to the state’s two urban areas and then helping in the rural areas based on what the needs were. 

 

Vice Chairwoman Giunchigliani asked how many students had qualified for the Millennium scholarship to date for the health care professions.

 

Dr. Harter answered that the information was not known.  There was a problematic factor having to do with the students in the four-year institutions.  They would not actually enter the clinical education program until their junior year and because the Millennium scholarship program had been available to students for less than a year the impact had not been possible to estimate. 

 

Vice Chairwoman Giunchigliani asked if there had been any effort to remove the barriers that were there either for the scholarship, how the program was set up, or how one moved forward in the course work. 

 

Dr. Harter said the questions regarding barriers being removed was a constant area of evaluation for the faculty in the nursing programs.  They had a set of standards for admission that had been promulgated over many years and there was a correlation between the standards and the success of the students admitted to the program.  Dr. Harter said that it was a concern that was constantly reviewed by the faculty.

 

Mr. Perkins said that assuming the legislature was able to move forward with the current budget and there was some form of a state college in the state, he asked if that would help relieve some of the burden that had been described relative to the bill. 

 

Dr. Harter said there would have to be adequate funding for the new college to be able to hire nursing faculty and educate nurses and that cost was not insignificant.  If the plan was to include nursing and to fund it properly, certainly the new college could have an impact on the shortage.  The other factor was that it was necessary to constantly work at recruiting qualified students into the programs.  Dr. Harter said if “we can get our act together as a state” and help make nursing the outstanding career choice that students thought it was a couple of decades ago, and there were a sufficient number of students to apply to the six programs and Nevada State College, it could alleviate the nursing shortage. 

 

Mr. Perkins said that the legislature was counting on the system to do the outreach, the marketing, and building the profession at least at the academic level. 

 

Ms. Marybel Batjer, Chief of Staff, Office of the Governor, introduced herself.  She said she appeared before the committee rather reluctantly because she was aware there was a terrible shortage of nurses in Nevada and throughout the nation and she believed that every state was grappling with the very serious issue and the answers for it.  Ms. Batjer said that the Governor opposed a section of the bill although the Governor supported the intent and the concern that was behind the bill.  Section 5 of A.B. 378 would open up the Millennium scholarship in a way the Governor opposed.  The Governor supported the original intent, purpose and implementation of the Millennium scholarships and that intent was to bring about scholarships among high school students in the state of Nevada and to ensure that there was a method for students who maintained a B average or above to enter the University System of the state of Nevada with the hope and intent that those students would graduate from Nevada’s school systems and the University System and return to help build and assist in the betterment of the state.  Unfortunately, the bill had a provision to open up the entitlement to the scholarships in a way the Governor could not support. 

 

Vice Chairwoman Giunchigliani asked how many Millennium scholarships had been provided and what fields the students had chosen to go into. 

 

Ms. Batjer said the information on the number of scholarships taken could be provided but she could not provide information on the students’ majors because most freshmen had not selected a major.  Ms. Batjer said the State Treasurer’s office had the information on the number of scholarships issued and she would provide it to the committee. 

 

Mr. Hataway, of the Budget Division, pointed out a technical issue with Sections 6 and 7 of the bill.  The current statutes prohibited the use of the principal in the trust fund for public health.  Only the interest that was earned on the trust fund could be allocated and he believed that all of that was currently recommended for allocation in The Executive Budget to other purposes in the Department of Human Resources.  If the interest from the corpus of the trust was used there would be a potential conflict as to where the funds would come from. 

 

There being no further testimony on A.B. 378, Vice Chairwoman Giunchigliani closed the hearing on A.B. 378 and turned the hearing over to Chairman Arberry. 

 

Chairman Arberry opened the hearing on A.B. 603. 

 

Assembly Bill 603:  Creates Nevada health account for uninsured families in             state general fund. (BDR 31-1408)

 

Marybel Batjer, Chief of Staff, Office of the Governor, testified in support of A.B. 603 that created a Nevada health account for uninsured families in the state from the General Fund.  When the Governor built The Executive Budget, he solicited from the legislature and community leaders ideas and proposals that he could consider as he built the budget.  At the time, he considered monies for single appropriations into the health care area.  As he solicited suggestions from legislators, community leaders, and community-based organizations, one of the proposals that came was a proposal for an appropriation for an account that would be established for uninsured families in Nevada.  The Governor asked for an appropriation of $5 million for the effort and believed it would be a pilot project that would utilize some of the information that had been gathered from the Children’s Health Insurance Program (CHIP) and the Nevada Check Up Program in order to better understand the population and the needs of the population. 

 

Chairman Arberry asked how the amount of money needed for the program was determined. 

 

Mr. Charles Duarte, Medicaid Administrator of the Division of Health Care Financing and Policy of the Department of Human Resources, introduced himself.  He said he was unsure how the amount of $5 million needed for the program was developed.  He said his office was requested to develop alternatives for the $5 million that could be used for coverage of low-income families in Nevada.  As a part of that, the division tried to maximize federal revenue and take advantage of ideas other states were using to develop programs using Title XXI or the Children’s Health Insurance Program funds to expand health coverage. 

 

Mr. Duarte explained to the committee that the division proposed at least two alternatives for the use of the money.  Two types of programs could be considered.  The first would provide health insurance coverage to parents of low-income families and the second would be to establish a premium assistance program to cover the cost of employer-based health insurance for dependents of low-income workers currently employed at a business that offered dependent coverage as an optional benefit.  There were over 17,000 children currently enrolled in the Nevada Check Up Program.  The division knew there were probably 5,000 parents of those children who would qualify for insurance.  National statistics indicated that when parents were insured the odds of a child getting insured were even higher and so states had used those options to expand coverage to parents in an effort to get more children enrolled.  The other option available was to look at a premium assistance program to pay the costs of dependent coverage for qualified low-income workers.  They would have to work very closely with the employer community in order to establish that program.  Both of the alternatives would be established as pilot programs.  Federal law allowed that to be done under Section 1115 of the Social Security Act that allowed states to establish research and demonstration projects.  The division would probably seek that type of waiver, at least for the first option Mr. Duarte discussed.

 

Mr. Duarte said they would work with the advocacy community and seek counsel from tribal entities to develop a program for the use of the funds and the evaluation tools that would be needed to ensure that the services were being provided effectively for the coverage of low-income families. 

 

Chairman Arberry asked how long it would take to get the federal government’s approval under Section 1115.

 

Mr. Duarte answered that it would take considerable effort.  The federal government had shortened its time frames for evaluating those programs to 90 days.  It could extend longer given the back and forth exchange of information between the state and the federal government. 

 

Chairman Arberry asked Mr. Duarte when he anticipated having an approval.

 

Mr. Duarte said the division would only seek approval if they knew the funding was available.  The effort to develop a waiver under Section 1115 would be made once the funds became available. 

 

Chairman Arberry asked how long it would take after the funding was approved to get the federal approval.

 

Mr. Duarte said he was unable to give a definite answer.  It would probably take no less than three months.

 

Chairman Arberry asked Mr. Duarte when he would be able to give a definite answer.  He wondered if that would be before the legislature adjourned.  Chairman Arberry asked Mr. Duarte to look at the issue from the committee’s perspective.  If the money was allocated and the federal waiver not received, the division would have the money.  He asked Mr. Duarte to provide the information to the committee. 

 

Mr. Duarte said that he would be glad to provide additional information to the committee. 

 

Ms. Tiffany said she was a little confused regarding the low-income parents being covered.  She asked if that would be an expansion of Medicaid or providing private insurance.  She said she assumed it would be Medicaid since it involved a waiver. 

 

Mr. Duarte said the division was looking to expand the Title XXI program that was the children’s health insurance program called Nevada Check Up. 

 

Ms. Tiffany said that Mr. Duarte had also discussed the premium supplement and she wondered if the division would choose between the two options or do both programs. 

 

Mr. Duarte said the division could potentially do both but they would work with the community and probably pick a program option that would be most effective to pursue. 

 

Ms. Tiffany asked what the criteria was for picking the options.

 

Mr. Duarte reported that the current available data seemed to suggest that premium subsidy programs were not as effective in covering low-income parents and their children as other alternatives.  Mr. Duarte felt that after consideration the division would probably arrive at the conclusion that an expansion program to parents of low-income children would probably be the most effective. 

 

Ms. Leslie said the bill came as a recommendation from the Task Force that S.B. 556 of the Seventieth Session of the Legislature established.  She said the figure was selected by the Task Force because it was sufficient to try some new approaches.  She said she was a little concerned that the bill was vague and did not include a third option.  The third option was Ms. Freeman’s idea of dedicating $1 million to the safety net provider so the insurance system was bypassed and low-income families would be served directly.  She said she wanted to look at that proposal later.  Ms. Leslie said her biggest concern was Mr. Duarte’s statement about working with the community.  The department had not had a good track record in recent years in working with the community.  She wanted to see more detail in the bill or a plan as she was not comfortable with a simple statement that the department would work with the community.  Ms. Leslie said there should be some legislative oversight because programs such as the Senior Rx Program had not worked well.  She said that did not mean it could not work or be improved upon.  The private insurance plan made Ms. Leslie very nervous but she felt that expanding the Nevada Check Up Program might be a viable alternative.  She said that it was very complicated to get the waiver and it would take time but might be an idea worth pursuing.  Ms. Leslie said she would like to see the legislature be creative in using the funds and, perhaps, try several things.  It would require legislative input and real community input. 

 

Ms. Batjer pledged the Governor’s Office and the department to work with the legislature and the community.  She said that Mr. Duarte had been a strong, professional addition to the department and she was certain that he would work well with the community in developing further ideas.  She said that the program was not intended to be a private insurance-based program. 

 

Ms. Tiffany asked “What is the community?”  She said she worked on Welfare to Work and some of the mothers had coverage and some did not have coverage.  She wanted to know who the targeted community would be for the low-income parents. 

 

Mr. Duarte said that Ms. Tiffany had asked the most important public health question there was and that was to define the community.  It was a very difficult task and he said he was not a public health expert.  The population that he believed should be served were individuals from low-income families who had children who were either covered with Medicaid or with the State Children’s Health Insurance Program (SCHIP) and who themselves were working in employer situations where group coverage was not offered. 

 

Ms. Tiffany asked if the division planned on accessing the parents through the children. 

 

Mr. Duarte said the answer was “Yes.”  Some of the outreach efforts that some states had undertaken had gone through the children to get to the parents in order to provide the program coverage. 

 

Ms. Tiffany asked who signed up the participants.  She believed it was a noble effort that should be done but it was wrought with difficult issues.  That had been demonstrated with the Nevada Check Up Program.  Some low-income people were resistant to the establishment, the organization, and the system.  She believed it would be very difficult to identify the community and to access them. 

 

Chairman Arberry requested that Mr. John Yacenda address the committee.  He asked Mr. Yacenda to discuss the program as someone who had been involved in the program in the past. 

 

John Yacenda, formerly the Chief of the Nevada Check Up Program, introduced himself.  He said that he had been the architect of the idea of how to expand the use of $5 million to leverage Title XXI dollars. He thought some of the information that had been presented was accurate and some other information was a little bit inaccurate.  Mr. Yacenda said that if the committee was to choose the option to use Title XXI as a vehicle, the $5 million appropriation could be leveraged to $14.3 million of value in buying insurance.  That was, of course, the biggest benefit of doing it.  As well, based on the way the legislation was written, A.B. 603 would allow the money to continue to be rolled over biennium to biennium and that would, under Title XXI law, allow money to be matched as time went on and it would give it an extensive life.  Perhaps the one-shot appropriation could be spent for five to seven years in that particular program.  Mr. Yacenda cautioned the committee that there were certain restrictions on applying for a waiver and currently Nevada was not eligible to apply for a waiver to cover parents under Title XXI.  At least three of five requirements must be met and currently the state officially met one of the five requirements and provisionally met a second one of the five.  That was a mail-in application that was a joint application from Medicaid and Nevada Check Up.  The state did have an application now on-line on the Nevada Check Up Web site that served as a joint application and he believed that it could be approved because it could be downloaded, sent in, and processed. 

 

Mr. Yacenda said the third element under consideration of the committee was the removal of the asset test for the Medicaid for the Child Health Assurance Program (CHAP).  If that was approved that would satisfy the third requirement and make the state eligible to apply for the Section 1115 waiver, the CHIP waiver. 

 

Mr. Yacenda said that Mr. Duarte had mentioned that the eligible population might be approximately 5,000 parents.  He said that was not exactly accurate; the eligible population that could be funded was approximately 1,940 parents projected over five years because of the cost of the program.  There were requirements that the program be cost-effective, in other words, you could not just buy coverage for parents.  You could buy coverage for parents of CHIP children if the cost of covering the parents did not exceed the cost of covering the CHIP children, so the division would have to work with employers and there would have to be a combination of resources to come up with that neutrality in cost.  If the division chose to use the CHIP waiver that would not be official until June 18, 2001; CHIP parents could be covered without a cost-effectiveness requirement but Medicaid parents would also have to be covered at that time as well.  There was a provision that a state could not cover a parent of higher income than another low-income parent whose children were covered by a health insurance program.  Mr. Yacenda said there were some technicalities that were very difficult. 

 

Mr. Yacenda believed that the premium assistance program was a much more viable program.  If that plan were to be pursued, it would require a state plan amendment but would not require a waiver.  It would be easier to implement and would require working directly with employers of wage earners but the employers must offer health insurance coverage to dependents.  CHIP could not be the health insurance coverage for those employers.  They must have a package currently offered and the premium assistance would be worked out to determine how to cover the children and the adults for the same cost as if only the children were covered.  For example, if an employer offered a family package for $400 per month to cover the parents and three children, if the program came in and spent $336 per month for the three children, and the employer then paid the additional $64 per month, the entire family could be covered for $336.  That was how the program would work.  It would be viable if the program could work with employers and a statewide program could be created. 

 

Mr. Yacenda informed the committee that those were just the options that were being discussed.  He personally believed there were other options that were very viable and could be highly productive.  One would be to create a cost-effective community-based health care delivery system that would be much more innovative at the local level.  That could be done through federally qualified health centers, rural hospitals and other hospitals.  It would require a waiver but it offered tremendous opportunity to do community-based health care delivery that was currently not being done to uninsured, low-income families. 

 

Mr. Yacenda said another option would be to create a sub-grant program with community-based organizations to actually do outreach and eligibility determination.  He felt certain that with the experience the department had had that the enrollment could be done as well.  The whole nature of how the program was done could be changed and the money could be placed with the people who were working on the front-line with low-income individuals and families. 

 

Another option would be to expand dental services and activity through the program, which was allowed under the federal law. 

 

Mr. Yacenda told the committee that another option was to create a pilot program of presumptive eligibility for Nevada Check Up with the funds.  It used to be that if you made some mistakes in the eligibility determination the state would pay for the mistake.  That was not true anymore. The federal government, assuming the rules stayed intact, would pick up the cost if there were wrong determinations made.  You would change the nature of how the service was provided but you would make immediate medical services available to low-income children throughout the state. 

 

Chairman Arberry asked how long it would take to get the federal dollars approved.

 

Mr. Yacenda stated that some versions of a state plan amendment could go into effect upon submission.  Usually there was a rapid approval of state plan amendments.  Waivers took 90 days for approval. 

 

Chairman Arberry asked if Mr. Yacenda was referring to a 1115 waiver.  Mr. Yacenda replied in the affirmative and said there was also a 1115 SCHIP waiver as well as a 1115 Medicaid waiver.  They operated similarly in terms of time frames.  They required public hearings and testimony.  They also required objectives for what was being studied and an evaluation plan for how those objectives would be measured. 

 

Chairman Arberry asked Mr. Yacenda how long that would take.  Mr. Yacenda answered that with hearings to be held it would probably take two months and the waiver would take another three months, or five months total. 

 

Mr. Stevens asked how long the current 1115 waiver took to receive approval from the time it was submitted until the federal government approved it as he thought it was much longer than 90 days. 

 

Mr. Yacenda said that he was unable to answer the question.  He said there was an expedited effort for the waivers under CHIP because the CHIP program was so much different from the Medicaid Program in terms of requirements.  The creativity was with the state.  With Medicaid it was much more difficult for the state to express creativity. 

 

Mr. Stevens asked how long the current Section 1115 waiver from the federal government took from the time it was submitted to ultimate approval.

 

Mr. Yacenda said he was unable to answer and the question was referred to Steve Abba of the Legislative Counsel Bureau.

 

Mr. Steve Abba asked Mr. Yacenda how long it took to get the Nevada Check Up Program approved through the federal process. 

 

Mr. Yacenda said the original plan for Nevada Check Up went through several versions but the major submission in March got approved in August of the same year.  That was a state plan for an entire program including all of the eligibility, qualifications and income.  That was much more elaborate than a waiver and was targeted in a very different kind of way. 

 

Chairman Arberry thanked Mr. Yacenda for his help.

 

Mr. Roger Volker, Director of the Great Basin Primary Care Association, said his organization represented all of Nevada’s federally qualified health centers.  He said that he had appeared before the committee regarding the need to support the safety net providers and reduce Nevada’s uninsured population because it was creating a health care crisis.  Mr. Volker said he supported A.B. 603 and the Governor’s initiative, at least in concept, as they were engaged in working out details.  He saw it as a partial answer to dealing with the health care crisis in Nevada.  Mr. Volker said he had two pieces of information to add.  The first was that the association was in the process of updating the study of Nevada’s uninsured population that was published last year and he expected the formal data to be available in May but preliminary reports indicated that the number of uninsured in Nevada was growing at a rate greater than the population increase.  He said that was a great concern.  The second item Mr. Volker wanted to share with the committee was that his organization managed a Volunteers in Service to America (VISTA) program in which there were 15 full-time VISTA volunteers working in community clinics and nonprofit agencies throughout Nevada.  They were engaged in outreach and enrollment to Medicaid and Nevada Check Up populations and they were doing a wonderful job in increasing the number of people that had become enrolled in the programs.  In an informal survey of those VISTA health advocates, they indicated that approximately 60 to 70 percent of all the parents they engaged in the process of working to get the children enrolled, at least one member of that family would be interested in becoming enrolled in a program similar to Nevada Check Up that would be extended to parents.  Mr. Volker believed that the numbers would be significantly higher than the department was forecasting but certainly there would be great interest in the state doing the program. 

 

Mr. Jon Sasser, representing Washoe Legal Services, provided Exhibit F that was written testimony in support of A.B. 603.  He said that in addition to representing Washoe Legal Services he was also Co-Chair of the Nevada Statewide Covering Kids Coalition that worked in partnership with the state to try to make sure that all uninsured children and their parents received health insurance which was appropriate to them.  That might be Nevada Check Up, Medicaid, or private health insurance.  Mr. Sasser thanked the Governor for setting aside $5 million to address a very strong need.  There were still many children who were eligible for the Nevada Check Up Program who remained uninsured and their parents remained uninsured.  It was important to set aside money that could be rolled over into various years to take advantage of ideas that might come forward to deal with the population.  Mr. Sasser reiterated that it was possible to run the $5 million through Title XXI, the Nevada Check Up Program, and Nevada could pick up an enhanced federal match of 65 cents in federal money for each 35 cents in state money.  The $5 million could be turned into $14.3 million.  The Section 1115 waivers to cover parents were for premium assistance and in order for Nevada to be able to apply for the waiver the assets test in CHAP would have to be eliminated. 

 

Mr. Sasser discussed the time it took to obtain a federal waiver.  He said it would take 90 days by federal rules.  The reason it took so much longer than 90 days was because the federal government could call time-out.  In the middle of the 90-day period the federal government could ask the state for more information.  While the state was submitting the information and the federal government was evaluating it, there was a time-out and the clock was not running on the 90 days.  That meant that it could take many months longer than the 90 days.  There was no way to concretely answer the question as to how long the waiver would take because it was not known how many time-outs the federal government would call during the 90-day process and what information they might seek from the state for clarification. 

 

Mr. Sasser pointed out that the bill itself did not indicate how the money would be used and there were many ideas on how to use the money other than the two waivers that had been suggested.  Mr. Sasser liked the flexibility of that so that Nevada could “get the most bang for the buck.”  On the other hand, he understood why the legislature might be unwilling to issue a blank check for $5 million and not know how the money would be spent.  Mr. Sasser suggested that if the legislation was to move forward there should be some level of oversight and reporting so that the legislature could feel confident that the plans developed were sound in detail as well as in concept. 

 

There being no further testimony on A.B. 603, the Chair closed the hearing on A.B. 603 and opened the hearing on A.B. 505. 

 

Assembly Bill 505:  Makes appropriation to State Department of Conservation          and Natural Resources for replacement equipment for Division of State             Parks. (BDR S-1390)

 

Mr. Steve Weaver, Chief of Planning and Development with the Division of State Parks, introduced himself.  He referred to Exhibit G as a comprehensive package that explained A.B. 505, A.B. 506, and A.B. 507.  He started by pointing out that there should be a correction on the dollar figure stated in A.B. 505.  It originally included the communications package that had been incorporated into A.B. 507 and that accounted for most of the $207,000 discrepancy.  The correct figure for A.B. 505 was $335,410. 

 

Mr. Weaver said that A.B. 505 included two decision units.  E-710 involved the replacement of essential equipment necessary for management of park resources and facilities.  The department’s priority list for state parks included six replacement vehicles, a used motor grader, one dump truck, six personal computers, ten printers, one laptop computer, and miscellaneous small equipment.  Vehicles were the department’s top priority for a reason.  The fleet currently consisted of 141 vehicles with an average age of 13 years.  Twenty of the vehicles had over 150,000 miles on the odometer.  By comparison, the State Motor Pool replacement standards were three years of age or 85,000 miles. 

 

Decision unit E-720 involved the purchase of one new equipment item, a Cisco router that was needed for the Region 2 office to provide access to a T-1 line in order to implement the Integrated Financial System (IFS). 

 

Mr. Beers asked where the IFS access would be located.

 

Mr. Weaver said the division office was located in Carson City as well as the Region 2 office that was located in a different location in Carson City.  The Region 2 office needed to be tied directly into the state’s system.  That office did not presently have the means to input the data that was necessary to implement the system. 

 

There being no further testimony on A.B. 505, the hearing on A.B. 505 was closed and the hearing on A.B. 506 was opened. 

 

Assembly Bill 506:  Makes appropriation to State Department of Conservation          and Natural Resources for maintenance projects at state parks. (BDR S-            1391)

 

Mr. Weaver described A.B. 506 as a request for funding of park maintenance projects totaling $716,603.  He said there had been concerns by various legislators regarding the allocation of $118,000 to one project in the Floyd Lamb State Park.  The funds would provide field staff with materials and labor to complete the highest priority items identified for the maintenance of buildings and grounds throughout the state.  Of the total, $122,675 would be funded by the Commission on Tourism through the room tax.  The remaining $593,928 in the bill was a one-time General Fund appropriation.  Of the $593,000, $477,724 was attributed to category 07 for maintenance projects not related to park ranger residences.  There was, however, another $116,204, known as category 08, that was intended for ranger residences. 

 

Ms. Tiffany said that Assemblyman Roy Neighbors submitted a bill for the restoration of the courthouse in Belmont, Nevada.  She asked if it would be possible to have the restoration of the foundation of the courthouse on a priority list in the division’s budget.  She said that she and Mr. Neighbors felt that the fiscal note on the project was exorbitant and she wanted to know how the division had determined the cost to repair the foundation. 

 

Mr. Weaver said that two to three years ago the division gave a list of projects to the Public Works Board for the Capital Improvement Program (CIP) bond program and asked them to have a structural engineer look at the courthouse.  The Public Works Board provided a report to the division with an estimate of approximately $400,000 to stabilize the foundation.  It was in deplorable condition and that concerned Mr. Weaver.  He said it was requested in the CIP but it did not make the funding cut for the coming biennium.  The division did not specifically request it in their budget as it was felt that it would be better to try to obtain the funds through the CIP.  Mr. Weaver said there was a request in the capital improvements budget request for funds for the rear wall of the building, which was ready to tumble down.  That wall needed to be stabilized to keep it from deteriorating any further.  However, that would not take care of the main building foundation. 

 

Ms. Tiffany said she remembered in the meeting held with Tule Springs, there was a community group that wanted to repair one of the buildings and the division said that no one except the state could do repairs.  She asked if it was the same for the Belmont Courthouse.  Ms. Tiffany said there was a community there that would like to have the foundation repaired and she wondered how they could get authorization to do the repairs. 

 

Mr. Weaver said the Belmont Courthouse was a substantial building and he believed the state would be undertaking substantial liability if the work was performed by people other than qualified engineers and contractors.  It was not a job that could be done by amateurs and volunteers.  That would be a very dangerous situation. 

 

Ms. Tiffany said she was talking about engineers, however, they would not be state employees who were employed by the Division of State Parks.  She asked if that was ever allowed. 

 

Mr. Weaver said it was not the intent of the division to attempt to do the repairs with state employees.  They had fully intended to have Public Works hire a consulting structural engineer to do all the necessary plans and then contract the job out to a private contractor. 

 

Ms. Tiffany asked if it could be done for less if there was another bid that met the division’s qualifications. 

 

Mr. Weaver said he had his doubts about completing the job for less than had been budgeted.  He suggested that Public Works might be able to supply more information. 

 

Ms. Tiffany asked how much money had been included in the budget for the stabilization of the rear wall. 

 

Mr. Weaver said the division had asked for a total of $141,000, some of which was for public facilities.  There was no restroom and a sum was included for a restroom, a few picnic tables, and gravel for the parking lot.  He said he could provide the actual amount that was set aside for the wall to Ms. Tiffany at a later time.

 

There being no further testimony on A.B. 506, Chairman Arberry closed the hearing on A.B. 506 and opened the hearing on A.B. 507. 

 

Assembly Bill 507:  Makes appropriation to State Department of Conservation          and Natural Resources for radio connection between Nevada State Park             System and Department of Motor Vehicles and Public Safety. (BDR S-            1393)

 

Mr. Weaver said A.B. 507 would provide a one-shot appropriation to purchase radio equipment to allow continued access to Nevada Highway Patrol statewide dispatch services beginning on October 1, 2001.  The $193,323 General Fund request in FY2002 was for 36 mobile radios, 42 portable radios, 1 programming module, 1 test component, and 1 set of manuals.  The Division of State Parks had 36 commissioned peace officers who had no reliable dispatch services for routine law enforcement matters.  That could cause a dangerous situation for routine traffic stops.  Most law enforcement officers had the ability to contact their dispatch officer to find out if the vehicle that was stopped was a stolen vehicle and they should be on guard.  The division had looked into using the Nevada Division of Forestry, who had a dispatch service, but it was not set up for public safety and during the fire season the park rangers were literally shut out from having any dispatch services.  It was also hit or miss with local sheriffs as well as the Nevada Division of Wildlife.  The request contained in decision unit E-888 offered full compatibility with the Nevada Highway Patrol on a full-time basis.  The division would then have reliable, 24-hour dispatch service available to all 36 of its officers and that was the intent of the bill. 

 

There being no further testimony on A.B. 507, the hearing was closed on A.B. 507 and Chairman Arberry opened the hearing on A.B. 508. 

 

Assembly Bill 508:  Makes appropriation to State Department of Conservation          and Natural Resources for new and replacement equipment for Division of        Water Resources. (BDR S-1394)

 

Mr. Hugh Ricci, P.E., State Engineer, introduced himself.  He said A.B. 508, as introduced, would have provided replacement and new equipment for the Division of Water Resources through the Department of Conservation and Natural Resources, Budget Account 4150.  After the bill was introduced there was information provided by the Budget Division to the Legislative Counsel Bureau that the original amount as specified in Section 1 was to be amended to $202,644.  After that number was amended there was some additional discussion as to some additional money that was needed for the Channel Clearance Fund that was reimbursed through the Contingency Fund.  Mr. Ricci said it had been discussed that the funds should be obtained from the Interim Finance Committee (IFC).  However, he had been informed that the Contingency Fund was somewhat low and it would probably take time to access that fund.  Therefore, a request for $100,000 was being added as an amendment to A.B. 508.  Mr. Ricci said that it was imperative that the department receive additional funds for the channel clearance process because the fund that was allocated to the department under Nevada Revised Statutes (NRS) 532 had been totally committed and was in need of some additional money and there had already been a written request for an additional $60,000 from the fund. 

 

There being no further testimony on A.B. 508, Chairman Arberry closed the hearing on A.B. 508 and opened the hearing on A.B. 517.

 

Senate Bill 517:  Makes appropriation to restore and increase balance in reserve             for statutory contingency account. (BDR S-1512)

 

Mr. Stevens said that Mr. Don Hataway of the Budget Division was scheduled to present testimony on S.B. 517 but was unavailable to testify. 

 

There being no further business to come before the committee, Chairman Arberry adjourned the meeting at 10:07 a.m.

 

 

RESPECTFULLY SUBMITTED:

 

 

 

Lila Clark

Committee Secretary

 

 

APPROVED BY:

 

 

 

                       

Assemblyman Morse Arberry Jr., Chairman

 

 

DATE: