MINUTES OF THE meeting

of the

ASSEMBLY Committee on Ways and Means

 

Seventy-First Session

May 15, 2001

 

 

The Committee on Ways and Meanswas called to order at 7:40 a.m. on Tuesday, May 15, 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

Michael J. Chapman, Program Analyst

Georgia J. Rohrs, Program Analyst

Rick Combs, Program Analyst

Linda Smith, Committee Secretary

Kathryn Fosnaugh, Committee Secretary

 

 

Senate Bill 144:  Revises provision relating to payment of certain transitional             expenses for governor-elect. (BDR 18-391)

 

Don Hataway, Deputy Director, Budget Division, Department of Administration, said S.B. 144 dealt with the transition expenses of a governor coming into office.  He explained the section to be revised had originally been passed in 1969 and was amended in 1973, and since that time had been as the current statutes outlined.  Governor Guinn's transition costs had been just under $15,000, and when an audit was done on the Governor's budget an issue had been raised as to whether the costs were in violation of the section of the statute that dealt with the $5,000 budget item.  Mr. Hataway said the proposal was to eliminate the $5,000 reference and insert a reasonable amount to pay for transitional expenses for the Governor-elect. 

 

Ms. Giunchigliani asked what would be a reasonable expense and Mr. Hataway said he was not sure what all the expenses were.  He said in the FY2003 the amount budgeted was listed as $5,000 and the department had eliminated the amount that was spent in the Governor's office as a one-time cost.  Mr. Hataway said, obviously, if the current Governor was reelected there would not be any transitional costs for the next election.  He added, since 1973, inflation alone would have driven the cost up, and it was not thought that the Governor's expenses of $15,000 were unreasonable, but it had a potential conflict with the statute.  Ms. Giunchigliani said that the issue was the cost might have gone beyond the $5,000 limit, but there should be a means for tracking.  Mr. Hataway said he had a list of the Governor's costs, but did not have it with him.   

 

Being no further testimony, Chairman Arberry closed the hearing on S.B. 144.

 

 

Senate Bill 480:  Extends date for submittal of biennial budgets proposed by       state agencies. (BDR 31-1441)

 

Mr. Hataway said S.B. 480, although different from the original proposal, was currently pretty straightforward.  He said the bill changed the date in which agencies had to file their agency's budget request from August 15 to the more traditional date of September 1. 

 

Being no further testimony, Chairman Arberry closed the hearing on S.B. 480.

 

 

Assembly Bill 513:  Makes appropriation to Department of Human Resources for             development of long-term strategic plan concerning health care needs of             citizens of Nevada. (BDR S-1407)

 

Charlotte Crawford, Director, Department of Human Resources (DHR), said A.B. 513 was a request in the Governor's budget for $1.8 million to do comprehensive strategic health care planning.  She referred the committee to a handout (Exhibit C), which provided an overview of the six major areas to be studied and the business plans that would go with each study.  She explained there were three major areas the department felt needed strategic long-term planning to help the Executive Branch with its budget construction, policy development, and with legislators.  The three areas were as follows: 

 

• Senior health care and independence services.
• Individuals with disabilities health care and independence services.
• Uninsured individuals of Nevada.

 

Ms. Crawford said good fundamental data was lacking in many of the areas to assess exactly how many seniors Nevada had, what the projected need for seniors was, what the seniors' insurance status was, how seniors were distributed, what the seniors' support systems were, and what the seniors' future needs would be. 

 

Ms. Crawford noted she had become more keenly aware, as she was aging and approaching the point of senior status, that future seniors might be looking at long-term care services and that Nevada needed to develop long-term planning to be prepared for its seniors.  She stated there was a need to look at areas for development including alternatives to nursing care that could fit the needs of seniors.  She said a term currently in use was "to age in place," which meant for seniors to be able to be as independent as possible and to only use the services that would be needed.  To do that, the state needed to craft some different methods of delivering services, as well as evaluate and develop a long-term strategic plan. 

 

Ms. Crawford said what had been proposed in A.B. 513 was, for each of the three areas, the department would contract with a facilitator who would work very closely with consumer advocacy groups, providers, payors, decision makers, and draw on any information that would currently be available to construct a broad array of comprehensive information that would identify where gaps in service were and where additional resources were needed.  A model would then be developed that the state would like to move toward and a strategic plan would be developed to achieve that model. 

 

Ms. Crawford explained, in addition to seniors in need of services, there were also individuals with disabilities that had needs.  The goal was to give those individuals the highest level of independence possible.  She said there were a lot of services and resources already in place for people with disabilities, but there had not been a comprehensive plan that would move the state toward an array of services and a model of delivery that the department would like to see achieved in Nevada.  She stated that to achieve that goal the department would work with consumer groups, advocacy groups, insurers, payors, and with providers to try and develop a model and a strategic plan.  In each case mentioned the goal was to provide a blueprint that would guide the Executive Branch in its policy and its budget planning, and to assist the legislature and its planning, so that all involved could come together, determine where it was they all wanted to go, and then move strategically in that direction. 

 

Ms. Crawford continued and said those without health insurance had been a dilemma for sometime.  She explained the Interim Health Care Committee, during the interim, had contracted with the university for a study to assess the uninsured; Great Basin Primary Care Association (GBPCA) had done a study to assess information on the uninsured, and the census had provided information regarding the uninsured.  Much of the information gathered had been conflicting and there was not a solid base of information at who the uninsured were, or how long they were uninsured, to enable the department to develop a plan, in a strategic way, to address the problem. 

 

Ms. Crawford said in each of the above-mentioned areas there was a lack of services to address the needs and issues that were dealt with by the department every day.  She stated the Governor had been greatly concerned about Nevada being first or last, depending on what the wrong end of the scale was, for providing services to its citizens and the department wanted to move forward to improve Nevada's status. 

 

Ms. Crawford said another area of concern was rural health services.  She explained that many of Nevada's rural health care areas were designated as underserved.  Providers in that area were "at-risk individuals" and had a great deal of difficulty at being able to access or offer a complete array of services.  She said there was a need to determine, in a strategic way, what was needed to make sure the state sustained critical rural health care services. 

 

Ms. Crawford stated another area that was in need of a strategic plan was rate setting.  She said the issue had been a continuous concern each legislative session.  The question was how to develop rates and add rate increases to ensure essential providers would be available, and able to do business.  What the department was proposing was to develop a sound methodology and to develop a structure so that when budgets were submitted to the legislature it would be understood that the rates had been developed with a sound basis, with an understanding of the market and with what it would take to support the services. 

 

Ms. Crawford explained the last major concern was the area of domestic violence.  She said domestic violence was an area where the department had been losing ground and the Governor wanted to support programs that could improve and reduce the incidents of domestic violence. 

 

In summary, Ms. Crawford said each area discussed would require strategic planning and involvement from consumers and advocates.  The department proposed to bring together a strategic plan to be a blueprint for Nevada to move toward. 

 

Chairman Arberry said he felt the bill was a great concept, but he questioned how long it would take to put together the plan and then how long after the plan was made would it take to be implemented and what would happen to people with service needs in between the planning and the implementing stages.  Ms. Crawford said in each business plan there was a time frame set out and each area would be done separately.  The intent had been to begin contracting out immediately to start the process and then bring back the strategic plan prior to constructing the next budget.  Implementing the plan would not be a single step, rather a multi-step process that would be done over several years involving the Executive and Legislative Branches in the decision making process.  Chairman Arberry asked if there were any dates set, because a plan could be made but once a Request for Proposal was sent out the process could be delayed.  Ms. Crawford referred the committee to Exhibit C and said there were projected time lines for each of the plan areas.  Chairman Arberry asked what would take place before a plan was implemented, in regard to the people that were currently falling through the cracks.  Ms. Crawford said the department had tried to take care of the immediate needs, but that concept did not encourage a long-ranged vision.  She explained what was being proposed was a long-range strategic plan; resources would be developed each biennium to increasingly work towards the goals of the strategic plan.  She said the department was not suggesting having individuals go without their needs being met, rather the object was to assess its resources, determine where the gaps were and what delivery model to move towards.  The department would strategically move toward the goals set for them in the plan to ensure individuals did not fall through the gaps and that the department would become more effective in delivering comprehensive services to all areas concerned. 

 

Ms. Giunchigliani said she did not have a comfort level with the proposed appropriation for the strategic plan.  She said the budget indicated the cost would be $1.8 million, but the cost, in actuality was $2.4 million, when the federal dollars were taken into account.  Ms. Giunchigliani said she also was concerned that the stakeholders had not been involved and that although the comments "were there," she did not feel that past practice had "been there," and this had developed a level of mistrust.  She said every one of the goals seemed to state, "implement zero base budgeting and develop ongoing revenue forecast," which sounded nice but was paper-intensive and in actuality the programs were starting from zero, as they had not been funded in the first place. 

 

Ms. Giunchigliani stated there was legislation coming out of the Senate that might be heard by the Assembly soon, regarding individuals with disabilities, that appeared to be more cost-effective, and would impact those in the field almost immediately.

 

Ms. Giunchigliani said, in regard to the area of domestic violence, the task force had presented a plan that had already been completed, but just needed to be implemented.  She asked why do study after study, when there was no need. 

 

Ms. Giunchigliani agreed that the uninsured might be an area that needed review, but asked what about the underinsured.  She said there might not be a need for a senior prescription program and other supplemental programs if the underinsured population was being dealt with, as well as the uninsured.  She said she didn't see anything regarding the issue of the underinsured in the department's plan.  Ms. Giunchigliani added that she had not seen anything about the Special Children's Clinic.  She said she appreciated that some of the issues needed to be studied, but she had a problem with the study being done by the department, but felt some short-term plans could be put together with a plan to implement them, and then the implementation could be done the next session.  She said she had "not bought into" A.B. 513 in its current form or an amended version at the current time. 

 

Ms. Crawford replied the department would not be developing the plan, and it was, in fact, oriented toward facilitating the exact process Ms. Giunchigliani advocated and the department supported bringing together advocacy groups and consumers.  She added she believed there were many different ideas "out there," but unfortunately they had not been fashioned into a strategic long-term comprehensive plan, and they would need all the partners to do that, which was what had been proposed through A.B. 513.  Ms. Crawford said she assumed the bill mentioned by Ms. Giunchigliani that was coming out of the Senate was the rate setting bill which was intended specifically for just a couple of rate areas in the developmental disability area.  There were many different rates that were much broader than that particular bill addressed and should be addressed because there were individuals with a variety of needs that needed to be certain that services were there.  A.B. 513 offered a much broader proposal than the Senate bill.

 

Ms. Crawford said the Special Children's Clinic tended to serve infants and very young children with disabilities, but A.B. 513 had a component for individuals with disabilities to cover all ages.  She said what people tended to do was look at individuals with disabilities not as a continuum through all ages and there was a need to be sure and provide those supports and services as the individuals matured into adults to maximize independence.  She agreed that the department did not have a blueprint that could be implemented.  She said the department's goal was to have a blueprint created that they could move toward so that the department would not have to come to session each year, trying to debate what should be funded and how, rather to come together, agree on the goal, and then strategically move in those directions.  Ms. Crawford said the department had tried to identify other revenue sources and they would continue to do so, so that they could apply more funds toward the effort.  She said the department had identified several grants in the areas in question and had pursued them and would continue to do so. 

 

Mrs. Chowning said she had the same type of concerns as Ms. Giunchigliani and was focusing on the area of domestic violence.  She said the state, for many years, had funded a domestic violence task force through the Attorney General's Office which had resulted in funding, a plan, and interaction, etc., and almost everything said by Ms. Crawford had been said a few years previous when discussing Family to Family and the family resource centers.  She said currently the family resource centers were in desperate trouble in regard to funding.  Mrs. Chowning stated the coordination between the churches, nonprofit organizations, and good work that had been taking place a few years ago had gone away.  She said a lot of the information that was being requested was already "out there" with Safe Nest and a lot of the nonprofit organizations, and the Attorney General's Office was already doing much of what was being requested by the department.  Mrs. Chowning said she did not understand where the department was going, whether it was to coordinate efforts, or if it was a duplication of what had already been done.  She was concerned that, although what they wanted sounded really good, what might happen as did with the family resource centers and the Family to Family program, a few years later and saying "Well, we're not going to do that anymore," and come up with a different plan.  She stated that did not mean the need was not there, because in regard to domestic violence, in the Victims Crime budget the committee was trying, in every single area, to focus on the area of domestic violence and to hopefully do away with the problem, as it was a problem that touched all families in some way or another.  Mrs. Chowning said she was just concerned about the duplication of services. 

 

Ms. Crawford responded, saying the department had worked on the issue of domestic violence with people in the field and there was a plan that had been brought to her attention by the Nevada Domestic Violence Prevention Council.  What was included in the bill was a result of a suggestion that the council had brought forth, which was to fund supervised visitation in exchange centers because there was a strategic plan in place in regard to visitation.  She explained the exchange centers were currently only available in Washoe County but the plan was to expand and add more centers.  She said the council had pointed out that they had a plan and the department had acknowledged the plan.  She said the department did not want to duplicate where there were existing resources or plans. 

 

Chairman Arberry asked if the amount requested in the bill had to be reduced, could Ms. Crawford provide information to legislative staff on how the department could implement their plan with less funding.  Ms. Crawford answered she would be glad to do that and asked for an estimate of how much less the Chairman was asking for, and Chairman Arberry said about half.  Ms. Crawford agreed to provide a plan.

 

Paula Berkley, representing Nevada Network Against Domestic Violence, and Educare, a developmental disability provider, said the Department of Human Resources had contacted the Network and asked for suggestions because the department had been unaware at first that there had been a state plan already implemented.  She said the Network was trying to emphasize more prevention and most of the dollars spent in Nevada for domestic violence were reactionary, after a person had already been "beat up."  She said the state had been reacting to the issue through the courts, police, and shelters, and the department had requested suggestions for prevention.  The visitation centers had been something the Network had been looking at as something it would like to implement.  The purpose of the visitation centers was to provide a safe place so that families could continue to interact, after separation, allowing the continuation of the bond the family had.  Without a safe place the bond had to be disconnected and that was not good for the children involved.  Ms. Berkley said the network provided details on the centers and had offered to assist the department with the implementation of the plan, or with a study.  She said the Domestic Violence Council with the Attorney General's Office had the full range of people involved with domestic violence, including the courts, judges, prosecutors, district attorneys, public advocates, etc., so there had been a good group of individuals who had been working successfully together for the past five years.  She explained A.B. 513 would provide information that would be run through the council to make sure that it would work through the whole system. 

 

Ms. Berkley said, speaking in regard to the developmental disability issue, before the current legislative session had started she had been unaware that the department would be recommending the planning efforts.  She explained the DHR had depended on the budget to be the planning document in the past and the providers had felt that was not a good approach.  Providers had wanted a planning process for the disability community that mirrored the Olmstead Act, because of the federal funding available, and a process that required task force to develop planning for developmental disabilities.  She explained the reason the task force would be extremely important was everyone who would be affected would be coming up with solutions.  Ms. Berkley stated it was easy for providers to always say "The department didn't do this, or the department didn't do that," but if the providers had the opportunity to plan, where they were at the table taking the responsibility, the state could then say, "Okay, providers, we gave you this opportunity to create solutions and develop that plan so why isn't it working." 

 

Ms. Berkley opined everyone needed to do the planning together and to that effort legislation had been introduced the previous day, S.B. 486, which would create a task force for community-based services for persons with disabilities.  Ms. Berkley stated that S.B. 486, at $350,000, was less costly than A.B. 513.  She said her agency was currently in the process, with the legislative staff, reviewing ways to reduce the cost of S.B. 486.  She added the advantage of having the guidelines that had been developed by the Health Care Financing Administration (HCFA) was the Supreme Court and the Ninth Circuit Court had said the states were vulnerable if they were not providing adequate services, unless they had a planning document in place that had been worked on with everyone included, which allowed for protection against litigation.  The Supreme Court had said it understood the state did not have a "whole bucket of money" that could be put toward people with disabilities but there had to be a reasonable plan to avoid litigation against the state.  Ms. Berkley explained the providers had felt S.B. 486 would give the state protection by using the focus that the HCFA and the federal government had designated. 

 

Ms. Berkley agreed that there was another bill being discussed regarding rates, and said S.B. 486 was more narrowly focused than A.B. 513 because it was only directed toward mental illness, developmental disabilities, and physical disabilities.  She explained the larger study, that would be initiated if A.B. 513 was passed, included hospitals and long-term care and quite often providers were "at the bottom of the pile" and felt their focus would be lost.  Setting up a permanent form of commission as described in S.B. 486 would get an effort out to standardize care and rates so that the care the providers offered would be systematic.  Ms. Berkley explained that although providers were not against other legislation currently in discussion, such as A.B. 513 and S.C.R. 32, which would direct the Legislative Commission to conduct an interim study concerning Nevada’s program for providing services to persons with disabilities, they favored S.B. 486.  The reason it was favored more was because it was much more participatory and the emphasis was on the task force orientation, rather than having someone coming in from the outside and producing a report.  The providers preferred to have a "hands on " approach.  She said it was not that the providers were against the other bills, but they just liked S.B. 486 better. 

 

Ms. Giunchigliani said if S.B. 486 had a cost of $350,000 and then anticipated another $200,000 for the federal match it really carried a cost of $550,000.  Ms. Berkley explained that the providers had not assumed the federal match would be received because they knew the DHR would have to apply for it and it had not been known if or when it would be received, so they did not guess.  She said if funds were received from the federal government it would lower the General Fund impact and she believed that when the bill had been reviewed the day before an additional $100,000 had been removed, making it closer to $250,000, but it had not been evaluated by legislative staff as yet. 

 

Ms. Giunchigliani said it was mostly known what was wrong with the system, but not how to fix the problem, and she did not want to restudy again having someone else from the outside who would have to "get up to speed" to even understand what Nevada's proposals and programs were, which would waste necessary time.  She said a task force was there for a period of time and then it was done.  Ms. Giunchigliani said the task force could be monitored for a while, but the purpose was not to go on indefinitely. 

 

Ms. Giunchigliani asked which plans the committee had received during the current hearing that Ms. Berkley had been a part of and Ms. Berkley said she had been a part of the domestic violence plan (Exhibit C).  Ms. Giunchigliani said she appreciated that the DHR had to come up with some kind of plan, but the plan was not new and had been discussed since January.  She was concerned the plan was developed without any of the providers' input, or the input of any groups that would be recipients or potential recipients, to say what they thought of the plan or what it should encompass. 

 

Ms. Giunchigliani said, in review, as far as the domestic violence issue, things were basically completed; it just needed to be determined how to implement the plan.  She said it sounded like the individuals with disabilities category had one or two issues that needed to be reviewed.  Ms. Giunchigliani stated she had reviewed S.C.R. 32, sponsored by Senator Titus, and added, if S.B. 486 passed she would like to see it changed to another format so that it would not extend over the interim, and then the other issues seen in A.B. 513 should be reviewed.  She felt there were pieces missing, which was her main concern.  Ms. Berkley said that was the providers' concern as well.

 

In opposition to A.B. 513, Mary Bryant, Associate Director, Washoe Association for Retarded Citizens (WARC), said she was mainly addressing her concerns as a parent with a child who had Down's syndrome.  She explained since 1977 Nevada had "ranked 51^st in overall services" to people with developmental disabilities, evidence that a good system was needed.  She added it was not good enough to have just any planning process and, as a parent, and someone who talked to a lot of parents, the disability community was not confident in having the DHR be the one responsible for the planning process.  The department's plan was to use outside consultants but the state already had a lot of experts that could participate.  Ms. Bryant opined, most importantly, to have an effective planning process it was necessary to listen and respond to people's needs, and the DHR had a history of not listening to people.  She added that was the opinion of many of the people in the disability community.  In the year prior to the current legislative session, the disability community had spent much time and energy communicating their needs to the department, which included the dire need for rate increases that the providers needed in order to be able to serve people with disabilities well.  When the disabled community had come before the joint finance committee it was heard that the department had talked to the providers and had been advised no rate increase was needed.  Ms. Bryant said that was hard to hear.  On a personal level, Ms. Bryant explained when she had tried to get services for her child no one at the department would listen to her.  She added that she had been having problems getting services, until she testified before the legislature, and then someone from the DHR called her.  Ms. Bryant stated having the DHR be responsible for the planning process could only be compared to having the fox guard the hen house.  At the end of the planning process they would have a system that "suited the fox just fine, but left the hens out in the cold."  She declared S.B. 486 and S.C.R. 32 were more cost-effective and would take the planning process to the people who needed and used the services and to the providers who provided those services. 

 

Speaking in opposition to A.B. 513, Bev Kling-Hesse, a disability rights advocate with Northern Nevada Center for Independent Living, said to the extent that A.B. 513 purported to study disability issues, the center opposed it.  She explained during the spring of 2001, 11 public forums had been held around the state, asking people with both physical and mental disabilities how they wanted the state to conduct the study of people with disabilities.  Ms. Kling-Hesse said she had participated in many of the forums and almost without exception the people with disabilities, their advocates, and their families said they wanted the study to be done by the legislature.  Those people believed almost unanimously that the best hope they had for objectivity and fairness, and for putting their issues forth, was with their legislators.  Not one voice was raised in favor of a study being done by a state agency and only a handful thought that another commission or task force would be a good idea.  Ms. Kling-Hesse stated the consensus of families, through their previous experience, was if the legislature did the study what the people with disabilities and their families had to say would come out the way it had been said, not hidden, changed, or ignored.  She added there was not a lot of faith or trust in state agencies.  She concluded by stating the Disability Forum, the Centers for Independent Living, the State Developmental Disabilities Council, Nevadans for Equal Access, and many other disability organizations had pledged support for S.C.R. 32 and that would give responsibility for the study to a special committee of the legislature, and they hoped the Ways and Means Committee would give support as well, in lieu of A.B. 513. 

 

Speaking in favor of A.B. 513, Robin Keith, President, Nevada Rural Hospital Project (NRHP), said the NRHP was 14 years old and was a successful collaboration of 11 independent entities.  Through joint effort, pooled human and financial resources, and shared vision the NRHP had been able to do what none of its neighbors had done alone.  She said she mentioned that because, like all successful efforts, their results came about because it was planned that way.  Organizational forces that had the power to cause change were able to bring that change about when they had a clear vision of the future, and then develop the procedures and operations to achieve that future.  In any venture, without a shared vision, resources were often dissipated in disjointed efforts and activities that were narrowly focused on the crisis of the day without regard for the larger picture.  Ms. Keith stated it cost money to develop a comprehensive agreement about what health care in Nevada should be, but in the long run it cost far more to operate without it.  Business understood that concept well and made the corresponding investment.  The NRHP believed the state should do likewise because in the end it would result in the better use of resources.  Ms. Keith opined Nevada had some unique characteristics that affected health care delivery that included small, rural population centers separated by vast geography, high wages, a relatively high cost of living, severe shortages of health care professionals, high rates of uninsured and underinsured residents, under funded social service programs, unstable rural economies, inadequate community planning, and notoriously poor health care outcomes.  She said the health care industry, as a whole, was a very difficult field, but those factors made health care delivery in Nevada especially difficult.  The effective assessment of needs and the coordination of resources were therefore, all the more important. 

 

Ms. Keith said, in addition to Nevada's problems, there were important strengths.  Being a small state, it was not just possible, but common, for those interested in rural health care to work collaboratively to effect change, including communities, counties, numerous organizations, the industry, and state government, cooperatively bringing human and financial resources to bear on an issue.  She said the NRHP had a history of working together, and had a lot of the pieces of information and planning that would ultimately be built into an integrated statewide approach to the health care issues to be addressed in A.B. 513.  Ms. Keith said the NRHP had been responsible for bringing into the state several million dollars through grant money and the Office of Rural Health, through the university, was responsible for bringing in tens of millions of dollars.  She explained the NRHP saw A.B. 513 as the opportunity to bring what they already had in existence together into a comprehensive and fully integrated statewide plan for rural health that could strengthen the state's success. 

 

Ms. Giunchigliani asked what part of A.B. 513 would accomplish what Ms. Keith had stated.  Ms. Keith answered what she saw A.B. 513 doing was to provide the facilitation and opportunity for numerous groups around the state to come together to talk about what had already been done, what needs had already been identified, and what was available in terms of resources, take that information and establish priorities.  The information would then be taken to the Executive and Legislative Branches advising them that a consensus had been accomplished in regard to priorities, and advise the Branches what was being proposed to address the priorities.  Ms. Giunchigliani said the plan's goal, as recommended to the committee, was to develop incentives to encourage economic development, implement zero base budgeting, incentives for departments to operate more efficiently, eliminate duplication, maximize the use of the Internet, improve pupil achievement in elementary and secondary school, foster government services to the level closest to the people, and then she asked Ms. Keith if that had anything to do with rural health.  Ms. Keith said she had not seen the document Ms. Giunchigliani was addressing.  Ms. Giunchigliani thanked Ms. Keith for proving her point. 

 

Mrs. de Braga said she did not agree that the goals were good, but saw that a lot of the goals outlined in A.B. 513 would take away services rather than enhance services.  She said the bottom line was the NRHP could use the money part of the bill, but that was it.  She added the state needed to build on what problems had already been identified and the needs of the people who were the targets of the type of legislation such as A.B. 513.  Mrs. de Braga said she was not saying a long-term plan wasn't a good idea; she was saying the bill requested a lot of money and took off in a million different directions and did not focus or prioritize on the needs of the people. 

 

Ms. Crawford said she felt the department was being "unfairly characterized" for following the legislature's directions.  She said in a business plan it was required to give goals and the goals listed were the goals in the Governor's strategic plan.  She referred to Exhibit C and said specific goals for the rural areas were listed under the section titled "Strategic Plan for Health Care Services to Persons in Rural Nevada."  She explained the reason the plans were listed the way they were in Exhibit C was because that was the way it was required for a business plan.  She said under the rural section the detailed business plan included the following plan:

 

• Researching and compiling data.

 

• Coordinating and facilitating public hearings to obtain input.

 

• Researching and documenting alternative models of providing services.

 

• Identifying costs and payment sources.

 

• Writing progress reports.

 

• Developing a preliminary implementation plan.

 

 

She said what had been cited during the meeting was a requirement of the business plan and had to do with the Governor's strategic plan, and each section presented had its own goals and an outline specific to its own area.

 

Speaking in favor of A.B. 513, Carolyn Ford, Assistant Dean, University of Nevada School of Medicine, said a broad-based approach in health planning had been needed in Nevada for a long time to establish short- and long-term goals, not just for state agencies, but for other organizations in the state that chose to partner on many projects with the state.  She said if there was not a common direction determined for some of the collaborative relationships things would be "helter-skelter" and a lot of different initiatives would be going in different directions.  Ms. Ford believed it was important in the process to establish benchmarks that would look at a breakout between urban, rural, and frontier areas of the state and to be able to measure how resources would be allocated and how well the state was doing with the resources in the program areas and in geographic areas.  She stated the legislative body had the authority to mandate partnerships with stakeholders and make sure there was collaboration in setting and defining what particular content areas would be studied. 

 

Ms. Ford noted her office had met with Ms. Crawford's office in looking at augmenting some of the planning approaches through the critical access hospital program by looking at selected communities and at a particular health plan in process that would "pretty much" bridge the gap between public health and long-term care.  She said, specifically in the planning process referred to in A.B. 513, the goal was to look at issues that affected facilities, not just from the financing standpoint, but the physical construction and remodeling, etc., as they specifically affected facilities and services in rural communities. 

 

Ms. Ford pointed out one of the things she would like to see in both urban and rural planning was a specialized look at some of the issues that were pertinent to those areas and to highlight the transport of nuclear waste and storage in the state.  She said the state needed to get a handle on the emergency medical response and how well people were prepared to deal with a transportation accident as well as issues associated with the fact that there were storage facilities in the state that also had an impact on public health.  She said those issues needed some attention and focus in the type of planning document being discussed. 

 

Ms. Ford added, her office would be ready to provide any kind of assistance to the department to make sure they could bring together interested parties to comment and be engaged in the planning process, and make sure that it met established deadlines.  She concluded by saying she was not necessarily convinced she could follow a zero-based budgeting approach.  She said when resource needs were discussed, and issues were reviewed, you could start with a zero-based budget, but you would have to go the full range to determine what it would cost to put some attention on the problem.  Ms. Ford added that some unusual things had come across her desk, for example, one application received from an ambulance company was for a well to be sunk at their ambulance bay facility because there was no drinking water and the company had to go eight miles to get water to sanitize equipment.  She said those kind of issues needed close review when the Tobacco Fund monies were being distributed. 

 

Being no further testimony, Chairman Arberry declared the hearing on A.B. 513 closed. 

 

 

Assembly Bill 630:  Revises provisions regarding system for reporting of             information on cancer that is maintained by state health officer. (BDR 40-            1456)

 

Assemblyman Marcia de Braga, Assembly District 35, said A.B. 630 was a Natural Resources, Agriculture, and Mining sponsored bill that evolved from hearings on the possible environmental causes of the leukemia cluster in Fallon.  She said testimony received during the hearings indicated that Nevada was one of the few states that charged hospitals to input data into the cancer registry, which did not provide an incentive for hospitals to report the information in a timely manner.  For that, and other reasons, Nevada's registry was approximately two years behind.  During the course of the hearings the Health Division was asked how soon would they have found out about the cancer cluster if they had gone through regular channels and individuals and other sources had not brought the issue to their attention.  The answer was that it would have probably taken at least two years.  Mrs. de Braga said the Health Division had been asked what it would have cost for the state to have made up the difference and allowed the data to be entered without a charge and the answer was approximately $100,000 a year.  She said the hope was that eventually there would be no charge to enter data for tracking diseases in the state.  Mrs. de Braga said it cost approximately $39 for each entry, giving no incentive for hospitals to enter information, although the costs were not the only reason for the registry to be behind, but it was part of the cause.  The committee hoped to provide a mechanism where the state picked up the costs and that was what had instigated the creation of A.B. 630. 

 

Mrs. Cegavske asked how much A.B. 630 would cost and Mrs. de Braga answered approximately $100,000 a year.  Mrs. Cegavske asked if that was for one hospital and Mrs. de Braga answered the amount was for all hospitals.  Mrs. Cegavske said the last thing she had read in the newspaper was that DNA research was needed in regard to the Fallon cluster and Mrs. de Braga replied that it had been her committee's recommendation to have the DNA research done because any answers that were found would come from the victims themselves and so there was an urgent need to have it done.  She added there was a bill being drafted that would possibly deal with that issue.  She added that A.B. 630 would only cover reporting to the cancer registry, and hopefully, if hospitals were encouraged to enter the information into the registry in a timely manner, the state would be as close to current with the information as possible.  In other words, the Health Division would be reviewing recent data and if they saw ten cases of some kind of disease located in Gabbs, or somewhere else, this would provide an alert to the division that something needed to be done instantly. 

 

Mrs. Cegavske asked if there had been a cancer cluster, previous to the current cluster in Fallon, in Nevada like Mrs. de Braga was suggesting, and if anything had been set aside in the Health Division's budget for problems such as Fallon was currently facing.  Mrs. de Braga answered in 1969 there had been a problem in Fallon, due to the arsenic issue.  She said the newspapers had a field day at that time, with jokes, cartoons, etc.  In the process of Fallon's investigation of the recent cluster, and acquiring information because the issue had received national attention, people had written from outside of Nevada indicating there might have been another cluster that had occurred in the 1980s and early 1990s.  She said it did not appear to be as big as the current cluster, but the research had not yet been expanded incorporating both periods.  She added, in the 1960s the focus was on the arsenic in the water, and the focus had been on a doctor who had alerted the public to the problem.  The same doctor was currently speaking out on the current cancer cluster. 

 

Alex Haartz, Deputy Administrator, Health Division, Department of Human Resources, said A.B. 630 proposed to make a $100,000 appropriation each fiscal year into the Health Division to offset fees currently charged under Nevada Revised Statutes 457 to hospitals and facilities required to report.  He said there were two levels of fees.  Facilities that the Health Division staff actually went to for the purpose of abstracting the medical records for cancer data were charged a fee of $32, and for facilities where there was a contract with an outside person to do the abstraction, or the facility had its own staff do the abstraction, the fee was $8 to report the information.  His understanding of the bill's amendment was that it would target those facilities that did their own abstraction and provide the State Board of Health with the ability to reduce the fee charged for those facilities where self-abstraction took place and reduce the fee for reporting the required information.  Mr. Haartz explained the fiscal impact within the Health Division's budget account would be approximately $98,800 compared to the Governor's recommended budget, and added the appropriation was not included in the budget. 

 

Ms. Giunchigliani asked what would be the benefit of the state paying the fees for the hospitals who were doing their own abstractions, and if the reporting would be done faster or better with the state paying.  Mr. Haartz reiterated there were two types of abstractions taking place; A.B. 630 would have no impact where the Health Division staff did the abstraction and the fee would remain at $32.  Ms. Giunchigliani asked if the state paid the $32 fee and Mr. Haartz answered in each case the hospital paid the fees, and added there was no General Fund appropriation in the budget account, only federal funding or fee revenues.  He said the federal funding was from a grant from the Centers for Disease Control (CDC) under the cancer registry program.  The concept was if the fee was waived, or reduced, for those facilities that did their own abstraction and paid an $8 fee for reporting the required information, there would be an incentive for the reporting to be done in a more timely manner. 

 

Ms. Giunchigliani asked why the facilities were allowed to do their own abstractions instead of the abstractions being done by the division, and how many hospitals did their own abstractions.  Mr. Haartz said of the 23 hospitals that reported, 13 did their own abstractions.  He said the 13 tended to be the larger hospitals such as Columbia Sunrise and Washoe Medical Center and they paid the $8 fee for each record they submitted.  Ms. Giunchigliani asked if those hospitals received any of the CDC funds, and Mr. Haartz answered no, the CDC money was a grant that the Health Division received primarily to do quality control, data assurance, and other activities that were related to the cancer registry.  He said federal funds could not be used to generate fees, so the division did not use grant-supported staff to go out and generate revenue. 

 

Ms. Giunchigliani summarized that for the other 10 hospitals that did not do their own abstractions, the division's staff would be sent out to do the abstractions and then do a quality control check, and then receive a $32 fee, and for the 13 that did their own abstractions the hospital paid a fee of $8 to the Health Division to do the quality control.  Mr. Haartz said the $8 fee was for the submission of the data, and it was expected that there was some quality control that the hospital did, as they had to meet some reporting standards, however, the division staff had to do some quality control as well and enter the data into the registry.  Ms. Giunchigliani asked why didn't the division just do the quality control instead of worrying if the hospitals were doing their own quality control.

 

Mrs. de Braga said Ms. Giunchigliani raised a good point, and said the goal of bringing the bill forward was to get rid of the fee altogether, so that hospitals would be encouraged to report because there would not be a fee connected with the reporting.  She said she was not sure that the grant money could not be used for the fees, and maybe that was a question that needed an answer. 

 

Ms. Giunchigliani asked if the hospitals were not required to report.  Mr. Haartz said the hospitals were required to report.  Ms. Giunchigliani asked how waiving the fee would encourage them to report.  Mr. Haartz said the concept was that if the fee was reduced, or waived, through the State Board of Health, there would be greater incentive for the facilities to report in a timelier manner.  Ms. Giunchigliani asked why weren't the facilities just told to report within "x" number of days if there was a requirement for reporting, and also asked if there was a penalty for not reporting.  Mr. Haartz responded the facilities were aware of what the requirements for reporting were, and for the most part did report in a timely manner.  Ms. Giunchigliani asked what was considered a timely manner.  Mr. Haartz answered the national standard for reporting was within 12 months of diagnosis.  She asked again, why didn't they just put in an incentive that stated the facilities must report within the 12 months because it was a federal standard and if they did not report they would be fined, and added that she just did not see how the state paying the fee would be an incentive for timelier reporting.  Mr. Haartz said that could be how the State Board of Health could set the program up, stating if the reporting was done in a timely manner, the fee could be waived, but if they did not report in a timely manner, the $8 fee would remain intact.  Ms. Giunchigliani said she would suggest that the state should require a shorter reporting period than 12 months, as it was not a very long window to react for something like what was happening in Fallon.  Mr. Haartz said what sometimes would drive the reporting would be the complexity of a diagnosis and the confirmation process that took place. 

 

Ms. Giunchigliani asked if someone could make the accusation that the state was going to the ten hospitals who were not doing their own abstractions and the state was behind in its own reporting, and asked if there was a penalty for late reporting by the state.  Mr. Haartz said currently there was no penalty.  Ms. Giunchigliani asked if the state completed its reporting within the 12-month period.  Mr. Haartz answered those facilities where a preponderance of cases were located, absolutely, as the state was often in those facilities monthly.  He said for those hospitals in rural areas where there would be one case per year, due to the economics involved, the state often did not go but every other year, because it was not cost-efficient.  Ms. Giunchigliani asked if the department could craft regulations to deal with that issue through the State Board of Health and Mr. Haartz answered yes.   

 

Mrs. Cegavske asked again if the State Department of Health had ever set aside money for problems such as Fallon was currently facing, and if not, was that something that would be planned for the future.  Mr. Haartz answered that a contingency fund had not been built into the Cancer Registry's budget account or in other Health Division accounts, as the type of situation found in Fallon was a rare occurrence.  He said the division had been attempting to address the Fallon issue by working through the Division of Emergency Management to access available federal funds so as to respond to the issue in a timely manner.  Mr. Haartz said the division's first response had been to look at using whatever resources had been available internally before seeking outside funds. 

 

Mrs. Cegavske asked Mr. Haartz if he had been privy to any of the information that might have been collected or kept within the Health Division, in regard to the situation in the 1960s mentioned earlier in testimony by Mrs. de Braga, prior to his knowledge of the cancer cluster currently going on in Fallon.  Randall Todd, M.D., State Epidemiologist, Health Division, Department of Human Resources, said the best answer to Mrs. Cegavske's questions was to be aware that the cancer registry was started in 1979 so the historical data did not go back prior to that date, as far as looking at historical trends for reported cancer cases. 

 

Being no further testimony, Chairman Arberry closed the hearing on A.B. 630.

 

 

Assembly Bill 635:  Creates commission on autism. (BDR 39-225)

 

Johanna Fricke, M.D., Associate Professor of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Nevada School of Medicine, said her roll before the committee was to give an overview of what was being discussed when the term "children of autism" was used, and to introduce ladies in the audience who had worked very hard and to whom she referred to for help for every new family she saw with autism.  She said she had resided in Reno for 22 years, and was currently located in Las Vegas, and in the last month she had 40 referrals for the issue of autism.  She explained that autism came from a Greek word that meant, "into one's self" and had a very broad spectrum from severe to mild and could be accompanied by mental retardation.  She said the hallmarks of autism were listed in a handout that had been distributed (Exhibit D) which was from the Pediatrics Journal, Academy of Pediatrics.  Dr. Fricke said that she taught residents and community physicians to be able to recognize the signs and symptoms of autism early.  She explained there were three components involved with autism, which included social or relational delays, communication delays, and restricted or repetitive patterns of interest.  She said autism was probably a genetic disorder involving multiple genes and some trigger sets off the system, but that was all that was known.  Dr. Fricke said even though the condition was a neurological, biological condition it was not a mental illness as had been previously thought, and the basis of treatment was educational and behavioral.  She said it was a very difficult concept for Medicaid and other funding agencies to grasp, making it very difficult to get the kind of funding needed to help the children.  She said the next few speakers would be discussing how early intervention worked and said she was adding her voice as an associate professor and as the treasurer of the state chapter of the American Academy of Pediatrics. 

 

Jan Crandy, Director, Families for Effective Autism Treatment (FEAT), said she was a volunteer parent and tried to help other parents.  She explained she was an original founder that started FEAT four years earlier and said the organization had done a great deal for Nevada without funding.  Ms. Crandy said the original request had been for $700,000 and a commission to look at Nevada's response to autism.  Referring to her handout, which showed the amendments to A.B. 635 (Exhibit E), Ms. Crandy advised the committee the bill had been trimmed by cutting out the commission, changed the amount requested to $250,000 to set up two state teams, one for the north and one for the south.  Each team would have a program designer/implementer of intervention, a parent mentor/advocate, and one interventionist.  She said it might be possible to split that into two individuals.  Ms. Crandy explained what was being requested was crisis teams that would go out into communities when families had problems, educate the parents, and do some training.  She stated it would be a minimal stepping-stone but it was a start.  The request was for a one-year pilot program where data could be kept to show the actual need in Nevada.  Currently, families had to help each other and experts were being brought in, at a great expense to the families.  She said she was also asking the committee to look at Medicaid coverage and wished it could be mandated to require Medicaid to cover the expense for autism treatment as insurance did not cover it.  She said A.B. 635 would have Medicaid look at the feasibility of adding the CPT codes to cover autism specific treatment.  Ms. Crandy said if Medicaid covered behavior intervention it would solve the problems in the majority of the families affected by autism.  She added she had families currently whose homes were in foreclosure because they were paying for their children's program and they were allotted $6,000 a month through Medicaid that they could not use because it did not cover autism.  Ms. Crandy said that was "crazy" because money was "sitting there" for them that they could not even use.  She said "please" do something to make a difference. 

 

Speaking in favor of A.B. 635, Michele Tombari said she had a son named Alden who was affected by autism.  She explained in 1996 when her son was diagnosed he had no speech or eye contact and was unable to respond to his name.  She searched for treatment options since his doctors could not offer much hope.  The only treatment that had been supported by scientific research was Applied Behavior Analysis (ABA), so she had searched for an ABA provider and found none in Las Vegas.  After a seven-month wait an out-of-state provider came to Las Vegas and did a training workshop for her family and the people she had recruited.  Ms. Tombari said she was happy to be on the right road even though they had to go out of state to find help.  She said it was decided that her family would sacrifice the time necessary to manage a five-person team to work under the ABA provider and implement the day-to-day home program.  The program entailed creating therapy materials, preparing and running weekly staff meetings, analyzing and correlating statistical data to show progress, and writing monthly reports to the out-of-state provider. 

 

Ms. Tombari said her son's story would have a happy ending as in 1996 his IQ of 69-75, which was borderline mentally retarded, gave the doctors little hope that Alden would be able to function successfully in our world.  She explained the ABA program had tapped Alden's underestimated potential and recent testing indicated his IQ was currently 113, which was in the high average range.  She said think about how Alden's possibilities had changed, what could have been a lost opportunity for him to be a productive Nevada citizen but because of the ABA program, he would be fully included in a regular education classroom with children of the same age.  Ms. Tombari added, hopefully in a year or two Alden would need no special services at all, but without the program he would have needed a lifetime of special education services and some form of institutional living.  The ABA program saved him from a nonproductive and isolated life. 

 

Ms. Tombari informed the committee there had been many pit stops along the road to recovery.  She said her husband's medical insurance through Nevada Power Company, a large statewide employer, had refused to cover autism treatment.  Not only did they have to run the day-to-day home program themselves, but they also had to fund it.  She said they had paid a lot of money for what they thought was great medical coverage and yet, somehow, the company was able to exclude treatment for the neurological condition of autism.  She stated they had also found out there were no state programs to help them, and in fact, Medicaid did not even have the CPT codes for ABA treatment.  She advised the committee about half the children treated with appropriate early intervention were recovered enough to attend regular school classes and become productive members of society and most others improved enough to live in the community and not be institutionalized.  Ms. Tombari said many desperate parents were moving their families out of state to receive treatment.  She explained families who stayed in Nevada were struggling to provide the life-altering treatment for their child.  The large commitment of both time and money prevented many Nevada children from getting appropriate treatment.  She asked if the state of Nevada would pass the children along through years of ineffective special education and park them in institutions for the rest of their nonproductive and isolated lives.  Ms. Tombari expounded treatment was still not available throughout Nevada.  Even the United States Surgeon General recommended ABA treatment in his 2000 Report on Mental Health.  She said the City of Las Vegas, the Clark County School District, and the people of Nevada supported A.B. 635 and out of all the bills proposed during the current legislative session, A.B. 635 was ranked 18^th in support shown from voters casting their opinions at the Nevada Legislative Web site. 

 

In conclusion, Ms. Tombari said she wanted all Nevada children with autism to have the same chance to reach their potential that had been provided to her son.  She said the Health and Human Services Committee had agreed there was a legitimate health care need and forwarded A.B. 635 to the Ways and Means Committee.  She explained the bill would be cost-effective for Nevada as existing studies had shown that left untreated a lifetime of autism services for one person could cost over $2 million; a recent study that had been done at the Center of Economics of Mental Health estimated lifetime costs could be as much as $4.35 million.  A recent article in Advocate Magazine entitled "The Cost of Autism, More Than Meets the Eye" stated work currently being done to improve treatment and social services would lead to decreased costs per individual.  For example, if early intervention treatments could be applied to a large number of children there would be a reduction in continuing costs, bearing in mind that most costs were incurred later in life.  Ms. Tombari said the committee had a unique opportunity to help Nevada's children and in the long run save money for the taxpayers.  She said A.B. 635 was a win/win situation, and asked the committee to show Nevadans that their children deserved effective autism treatment by voting for the bill. 

 

Florence LaRoy said she had a soon-to-be 17-year-old son with autism who had not had appropriate services over his lifetime.  She said there was no need to study autism treatment because what could be done was known; it just needed to be done.  Twenty years ago, families of children with autism were looking for appropriate programs for their children, and Ms. LaRoy said she had been searching for ten years to get appropriate intervention services.  She said it was time to stop searching and get the appropriate treatment because early, intensive intervention would achieve the best outcome for young children, but older children, adolescents, and adults would still benefit from the same intensive behavioral intervention.  Using current best practices for autism could make the difference between a productive and independent life and a person being able to work in society versus someone who needed a lifetime of state care and support.  Appropriate behavior intervention could make the difference between a child remaining at home or becoming a ward of the state.  It could make the difference between a family staying together, supporting one another, and one parent being responsible for full-time care of a special individual.  The average person could not imagine the behavior of children with autism and what a family must cope with.  

 

Ms. LaRoy said imagine a day filled with hours of screaming, biting, scratching, hitting, kicking, head pounding, and all out tantrums.  She said then consider trying to go through the day with a six-foot, two-hundred-pound adult doing the same thing, how long could a person cope.  She stated that was the reality for families dealing with autism.  Just providing respite support and counseling without treatment would not provide the long-term change families needed.  Ms. LaRoy agreed that behavior intervention was expensive but not providing it was even costlier.  An intensive care facility for one person could cost between $750,000 to $1 million for ten years, based on the current cost of support within the state.  A group home would cost approximately $100,000 for ten years.  She reminded the committee a person with autism had an average lifespan so that could mean $3.4 million for one individual.  She said compare those amounts with someone who could live and work independently if behavior intervention had started early.  She said there was an ever increasing number of children with autism and she pointed out that would have an impact on the state budget.  In just the past six months the Kids Count Coalition for autism had an increase of 150 individuals and that was a gross underestimate of the real numbers.  She said it was not known how many children had autism. 

 

The Division of Mental Health and Developmental Services had served 115 at one point, and in the past year the Division of Child and Family Services might have had 15 in its early intervention program, and there might be a few within the Special Children's Clinic, but the bottom line was the state did not have good, accurate data.  Part of the responsibility of the proposed intervention team would be to collect information and hopefully, the autism task force would be able to do some public service announcements and get an accurate number of children with autism.  Many children were thought to have the disability of mental retardation, but they really had autism and mental retardation.  Children with autism came under several different categories within the disabilities code for education, so there weren't good numbers and those numbers were needed to really see the true impact on the budget.  Ms. LaRoy asked the committee to join the Nevada Developmental Disabilities Council, the Doug Flutie Jr. Foundation, the mayor of Las Vegas, medical professionals, and service providers to children with autism, and the thousands of families that endorsed A.B. 635. 

 

Mrs. Cegavske welcomed Ms. LaRoy and said she had the pleasure of working with Ms. LaRoy on a special education committee through the school district for several years.  She said it was sad to hear the state had not gotten any further than it had ten years ago when concerns were first starting to be heard.  Mrs. Cegavske asked what was the school district and the City of Las Vegas willing to do to assist the state regarding autism, and had the school district improved what was done through the special education department, because she had concerns about where the school district had not gone, and the things it had not done.  She added that everyone who had spoken during the hearing had made a statement about insurance and it was devastating to hear and know, and asked what the federal government was doing in regard to autism.  Mrs. Cegavske also asked what was expected of the commission that was proposed in A.B. 635. 

 

Ms. Crandy said she had been told to come to the committee with a trimmed bill that reduced the appropriation, so less had been asked for than what was really wanted.  She said the bill could make an impact by allowing for the collection of data because the teams would be crisis teams, working out in the field directly with families putting out fires, but at least it would be a start.  Ms. Crandy said if the committee could mandate a Medicaid revision it would be a huge change for families with autism.  Mrs. Cegavske asked if that was a state or a federal issue, and Ms. Crandy said the state of Nevada would have to cover autism, and that other states already did.  She said the reason the bill asked for two teams was because currently families called her and other parents, and they were "just" a parent organization.  She said there was a single mother in Elko whose 13-year-old child was kicked out of school, and now she had to stay at home with her child and the child was getting only two hours a week of education where teachers came into her home.  She said she was working on getting together a team of therapists who worked for her child to go to Elko to help the Elko family for a weekend.  She said there were not enough experts in Nevada that could go out and help the families in the communities.  She added the school districts were changing, adding a model program, including Washoe County and Clark County.  Ms. Crandy stated in Clark County there were 327 children with autism and of those only 22 were getting their home programs funded, and her family was one of those families, because she had hired a lawyer.  She said kids whose parents did not know to say something did not get the help.  She said Clark County was making a change and had hired, for $300,000 a year, an out-of-state provider who had been brought to the district to set up programs.  She said if that $300,000 had been placed in the state, they could hire people who would be in the state permanently.  She said two people could be hired for one year if the funds requested in A.B. 635 were approved.  

 

Mrs. Cegavske asked why the Clark County School District was paying $300,000 and Ms. Crandy said the school district was paying $300,000 for an out-of-state provider to come in and train them on how to set up model programs.  She said she was glad they were doing that, but the school district could have hired someone in the state and the person would still be employed.  She said if there was funding in Nevada there would be people who had the expertise in the state, and people needed to be recruited to Nevada to stay in Nevada.  She added there had been an "awesome" doctor at the University of Nevada, Reno, and he left the state because he could not get enough funding for his program and was now located in Michigan. 

 

Dr. Fricke said she had worked for the state Health Division in the past and had spoken to people at the Medicaid office after she received a packet from the state of Wisconsin showing how Medicaid in that state paid for Intensive Behavioral Intervention, or Applied Behavioral Analysis, which was the basis of treatment for autism.  She explained she received two phone calls stating that Medicaid currently did not pay for any services.  She said she had wanted to point out that as a developmental pediatrician she often encouraged parents to get Katie Beckett Waivers when their children could not get Social Security Insurance because the family received too much money.  She said the Katie Beckett Waiver gave them a "pot of money" every month, possibly as much as $6,000, but when the funds were limited to occupational therapy and speech therapy the families could not get the behavioral therapy needed even though the money was set aside for that purpose.  Dr. Fricke stated that was incredibly frustrating.  She said she received a phone call the previous day from someone with Medicaid, which she had been unable to return due to her flight to come to Carson City and testify, and would provide the committee with the information received from Medicaid as soon as possible. 

 

Ms. LaRoy explained early intervention for children in school districts was improving, but for the older children it was not.  She said she received at least two calls a week from a new parent to discuss services.  These parents had children who were 15, 16, or 17 years of age, were struggling with problems, and were ready to give up their children because they could not cope any longer.  Ms. LaRoy said that was because the children had not had early intervention.  She said nationally there was a big push because autism was coming to the forefront due to the increased number of children with the problem, and the federal insurance issues were being reviewed, but full funding was not close. 

 

Ellen Koivisto, Assembly District 14, said A.B. 635 had originated during the interim through the Committee on Health Care.  She said the bill that had come out of the committee was not the same bill that was before them, and referred to Exhibit E, which explained the changes to the bill.  She said the program had changed from a commission to statewide autism intervention teams that would fall under the Developmental Disabilities Council.  She explained the funding request in the original bill had been a lot higher.  She said what the bill requested was funding for a one-year demonstration project with two statewide autism intervention teams.  She advised the committee that currently there were 60 children a year born with autism, and those children lived a normal lifespan, so that number was cumulative.  She said every year there were more children and there was a need to deal with them as a state.  She said Nevada did not have a history of putting its resources toward helping those who could not help themselves, so the most vulnerable populations were not getting the help they needed.  She said it was an important thing for the state to look at and if it could be part of the Medicaid program it would be a way to leverage state dollars with federal dollars and do something for a situation that needed to be improved. 

 

Ms. Tiffany said the bill appeared to offer the most cost-effective way to get an intervention team into the field, and asked Mrs. Koivisto if the Interim Committee on Health Care had looked to see if there was grant money available to sustain the program or would it always be General Fund reliant, and why didn't the interim committee put a Medicaid waiver in as a bill.  Mrs. Koivisto answered she was not sure. 

 

Marla McDade Williams, Senior Research Analyst, Research Division, Legislative Counsel Bureau, said the short answer was the division had not been asked to look into the Medicaid aspect of autism treatment.  She explained during the interim there had been a lot of testimony about services that were needed, but not a lot of testimony about how to get there and outside of committee hearings the division had worked on the bill that had come forward. 

 

Mrs. Cegavske said it might be possible to make an amendment to the bill in regard to Medicaid.  She asked why the Health Division had not thought of putting together a task force on autism.  Mrs. Koivisto said, personally, she thought it was a case where the parents had been out there working very hard themselves and a state agency would not say they were going help out unless they were forced to.  Mrs. Cegavske said it was unfortunate that it had not come from the Health Division, and felt there was a consensus in the Ways and Means Committee that an amendment would fit appropriately in regard to Medicaid. 

 

Ms. Giunchigliani said she was a special education teacher and thanked those who were taking care of the children.  She said she taught learning disabled and emotionally disturbed children and said it was a special area to deal with autistic children because of their full lifespan, unlike many other special education children, and respite care alone would be wonderful, just to assist families.  She said the State Department of Education had a special task force and wondered if during the interim a task force could be assembled from that to specifically deal with autism.  Ms. Crandy said the state had several task forces and she sat on all of them and there was a lot of talk and not a lot of action.  She explained the State Board of Education had a task force and a technical assistant document was developed two years ago.  The technical document asked to push for Medicaid, and they were told over and over again that it was "poison" and they would never get that, so they would not do it.  Ms. Crandy said they had not asked for help from Medicaid for the current bill because they were parents and were not educated enough in how bills were developed. 

 

Being no further testimony, the hearing on A.B. 635 was closed.

 

 

Senate Bill 415:  Requires Legislative Auditor to conduct audit of Department of             Transportation and Board of Directors of Department. (BDR S-964)

 

Senator Dina Titus, District 7, said she was present to request a legislative audit of the Department of Transportation (NDOT).  She explained it would not be a full-fledged audit, but one that would focus specifically on the planning and selection of processes of the department's duties.  She stated that the NDOT was an agency with tremendous resources and corresponding power.  She said decisions made by the NDOT greatly affected the economy and quality of life throughout the state, impacting commuters in the south, farm to market access in rural Nevada, and tourism in Carson City.  The agency controlled hundreds of millions of dollars in bonds, federal funds, and Nevada gasoline taxes, among other sources.  She said, however, the agency was largely inaccessible and unaccountable to both the public and the legislature.  The legislature had very little oversight of the agency's decisions, expenditures, and the projects they funded.  Senator Titus added that a better handle was needed on how the department made decisions about which projects to fund, how much to fund, and when to fund them.  Other concerns including asking if the right priorities were set, or were political strings being pulled, was there cronyism or favoritism occurring in the selection of projects.  Senator Titus said the perception was often reality in politics and there was a need to establish some procedures and guidelines to assure the taxpayers that it was not happening.  Senator Titus said the audit would help to do that.  Highways were the arteries and veins of the state carrying the lifeblood of our economy, connecting our communities, and providing citizens with access to work, school, and recreation.  The audit would help the state be sure the decisions made by the NDOT concerning when, where, and how our roads and highways were constructed and maintained were fair, and if they were based on good planning, reliable information, and scientific analysis, not just on politics.  She urged the support of the bill. 

 

Ms. Giunchigliani asked if there would be an objection to amending the bill to include review of minority and female hiring as well.  She said there were federal projects that had certain requirements for employment but she thought there were some non-federal projects that did not currently deal with the issue.  Senator Titus and Senator Mark Amodei, Capital Senatorial District, said they would have no problem amending the bill to include that issue. 

 

Senator Amodei said S.B. 415 was about oversight.  He said the legislature was not famous for oversight due to the fact that the legislature only met every other year, for only 120 days, and everyone had other jobs they pursued over the interim.  He said he would submit to the committee that this was an appropriate area for the legislature to do a bit of oversight.  Senator Amodei said he sat in, before the session started, on the combined budget hearings where all the state agencies came and rolled out their budgets.  He said he had reviewed The Executive Budget that had first been presented and noticed when it came to transportation issues the state budget had a dozen pages which dealt with what was approaching, in FY2003, almost a billion dollars.  He said that was a very large cost center for the state and he felt the legislature owed their constituents a little more oversight than in the past. 

 

Senator Amodei said the first page of the bill, lines five through ten, discussed procedures used to develop selected projects and determined the appropriate funding methods for projects.  He explained the bill was not aimed at a "checkbook" look at what was going on at NDOT, rather a process focus which would enable the legislators to have a good understanding so that when they returned to their districts they would be able to tell their constituents why decisions were being made, what processes were being used, and how that affected them. 

 

Senator Amodei said the legislators had the tax responsibility when it was time to fund highways and projects like that, although the state did get a great deal of funds from the federal government.  He added that the legislators had the responsibility for voting on gas tax increases, DMV fee increases, etc., and with that responsibility came the responsibility to have a better understanding of how the process worked as far as utilization of the funds.  He said it had been a while since a performance audit had been completed on the NDOT and it was time.  He explained the bill was not a forum, or vehicle, to build any legislator's project in their specific district, rather it was to take a look at how the department was making decisions.  He noted it was not a dig at the Executive Branch, or the State Transportation Board, who had the responsibility of making many of the decisions in the context of quarterly meetings.  What is was, was an effort, under the existing checks and balances system, to take a look at one of the major cost centers in the state, and how decisions were made that affected everyone in the state. 

 

Senator Amodei advised the committee there had been opposition to the bill in the Senate, which came from the Department of Transportation, and the testimony had been related to the fact that S.B. 415 asked for $10,000 to conduct the audit.  He said the $10,000 appropriation, in the context of an 800 plus million-dollar budget in FY2003, was something affordable and appropriate to exercise oversight. 

 

Mr. Parks said one of his concerns in reviewing the budget during the current year, especially the Department of Motor Vehicles and Public Safety, was there had been repeated requests to increase the DMV budget beyond the 22 percent cap.  He asked if that issue would be audited as well.  He said he realized the bill was more of a management audit than a numbers audit but the 22 percent cap was a concern for the Ways and Means Committee.  Senator Amodei answered that the bill, as presently constituted, would focus on management and process issues.  He said, however, speaking as a co-sponsor of the bill, to the extent that there were concerns of the committee that represented consensus, there was no pride of authorship in terms of the scope.

 

Gary Crews, Legislative Auditor, Legislative Counsel Bureau, said in response to Mr. Parks' question about the 22 percent cap, and although not included in the original bill, it was something that could be reviewed.  He explained the original bill's purpose was for an audit of the planning function and the utilization of right-of-way properties.  Mr. Crews said the bill had a provision for a $10,000 transfer from the Highway Fund to the Legislative Counsel Bureau to cover the additional out-of-pocket costs, that had not been anticipated in the bureau's original budget, for travel, per diem, some Information Technology costs, etc.  The personnel costs for the audit would be absorbed in the budget as submitted to the legislature, so they were not requesting any additional funds for salaries, or anything of that nature. 

 

Speaking in opposition to S.B. 415, Tom Stephens, Director, Department of Transportation, said the department was opposed to the bill because the cost had not been included in the budget.  He added he had also been concerned about the impression left during testimony on the Senate side that there was something wrong with the way the department handled project priorities and that things were being done secretly, or that budget information was sketchy.  Comments like that appeared in the media after hearings concerning the bill.  He referred the committee to Exhibit F, which was a list of the information that had been submitted during session, in support of the department's budget.  He said the information previously submitted included financial data and a 250-page list of the department's annual work program and projects.  He said there had been a lot of information that had been provided, which did not mean the committee might not want more information or want to look into things further, but he did not want to leave the impression that the NDOT did not do things in a very public forum.  He advised the committee the department was required by law to take their work program to every rural county commission and to both of the Regional Transportation Commissions (RTC) in the state, and that had been done.  The RTC had reviewed the work program and then the entire program had to be approved in a very public format by the State Transportation Board, which consisted of the Governor, Lieutenant Governor, Attorney General, Controller, and three appointed members.  The projects that were done were generally divided into three large groups.

 

• Maintenance projects, which involved a maintenance management system where the highways were evaluated to see which ones needed to be maintained and the appropriate time to maintain them. 

 

• Capacity projects, which were prioritized by local input along with the transportation board's input, and others, and were scheduled.  If a project was scheduled for a certain year, the department made every attempt to complete it that year. 

 

• Special committees that set enhancement priorities. 

 

Mr. Stephens added there were many people who audited the department including internal auditors, the Governor's auditors, the legislature auditors, and there were 13 people from the Federal Highway Administration who oversaw the program located in Carson City.  He said it was a very open process, and the NDOT was the only agency in the state that had been required to meet with all the county commissions every year.  He explained the project selection was not a mystery and was outlined in the information that had previously been submitted to the legislature.  He stated if the legislators just wanted to take a look at the department, they were not afraid of audits, and he did not want to leave the impression the department had anything to hide, and agreed with Senator Titus that highways were the lifeblood of Nevada.  He said he did not agree that the department was largely inaccessible and unaccountable, and respectfully took exception to that implication. 

 

Mr. Stephens said there was another part of the bill that talked about real property, which was an area where improvements had been identified.  He said the department was currently working on a Request for Proposal (RFP) to go out and do its real estate and real property management more like a title company did.  Most of the department's records, deeds, and property were located in file cabinets, similar to the way it had been done 50 years ago, and needed to be automated.  He said if a person went to any title company in the state they could get the deed to their house, but the department did not have its system automated like that.  Mr. Stephens informed the committee automation was being planned for the department, which should improve its responsiveness when someone asked who owned a particular piece of property or if a property had an easement and how the department could get someone to release a piece of property.

 

In regard to hiring practices, Mr. Stephens said the department had a federal program called Disadvantaged Business Enterprise and the department had had quite a bit of correspondence with Ms. Giunchigliani in regard to that subject.  He added, the department was fulfilling the federal requirements on that program, but there was no state hiring program and the federal program did not currently apply to contracts that were not federally funded contracts.  He said there was no mandate in state law to require reporting of contractors the way they did with federal law. 

 

Mr. Stephens concluded saying the department felt it was doing a good job and any audit that was done would validate that the procedures were in accordance with all the laws, in a very open process. 

 

Ms. Giunchigliani said just because the state might be in compliance with the federal government, why hadn't a state plan that looked at hiring more African Americans, Asians, and women, etc. been developed so that the state would be more proactive rather than not doing it just because no one required it.  Mr. Stephens responded that it was a policy issue for the legislature to require departments to be more proactive.  He said if the department started requiring reporting from contractors when there was no mandate for the requirement, the contractors would tell the department "no."  Ms. Giunchigliani said there was a huge market available in skilled and unskilled labor in Nevada that contractors should be made aware of.  Mr. Stephens replied the minority hiring among the unskilled and semi-skilled area was much higher than among the skilled area.  He said he suspected it might be evidence of the low percentage of minorities in some of the skilled trades.  He said they also found that certain minorities had a much higher percentage of hiring, for example, Native American's had a high level of hiring because many of the department's projects were in rural areas where there was a high population of Native Americans.  Mr. Stephens said projects in southern Nevada might have a higher proportion of other minorities because of the work force there.  Most people from Reno did not go to work in Elko and Elko residents did not go to work in Las Vegas, and the minority populations, outside of Native Americans, were relatively low in the rural counties.  He said statistics from the latest census did not indicate there was a problem.  Ms. Giunchigliani said the department might be complying with what the federal government required, but why didn't the state have a plan.  She added she was tired of seeing women just holding flags because they could do a lot more than hold a flag, including drive a rig, be mechanics, etc., and so could African Americans, Asians, and Hispanics, and she felt the state should be more proactive.  Mr. Stephens reiterated that was a policy issue for the legislature to give direction to the departments.  He said there was a need for a mandate so that they could go to their contractors to require them to set up goals, do reporting, etc.  He said at the current time that had not been done, for the state, or any local areas. 

 

Senator Amodei said the only opposition to the bill had been in regard to the appropriation not contained in The Executive Budget.  He stated in FY2002 the total projected revenues were just short of three quarters of a billion dollars, and in FY2003 projected revenues were $861 million.  He said the audit could be done by just asking the Legislative Commission to go ahead and order it, and if the bill was passed the legislature would still be paying the costs for personnel.  He said, as Mr. Crews had indicated, the $10,000 was for incidentals associated with doing the audit and he wanted to leave the committee with the thought that $10,000, out of a multi-hundred million dollar budget, to satisfy the Branch that had the constitutional authority for appropriating funds in the state, would be $10,000 well spent for all involved if the audit came out as he hoped it did, proving everything Mr. Stephens had said. 

 

Being no further testimony the hearing on S.B. 415 was closed.

 

 

BUDGET CLOSINGS

 

 

DEPARTMENT OF EMPLOYMENT, TRAINING AND REHABILITATION

 

Mrs. Chowning read from the Closing Report of May 15, 2001, as follows:

 

THE SUBCOMMITTEE ON GENERAL GOVERNMENT DEVELOPED THE FOLLOWING RECOMMENDATIONS FOR THE BUDGETS OF THE DEPARTMENT OF EMPLOYMENT TRAINING AND REHABILITATION (DETR).

 

DIRECTOR’S OFFICE (BA 3270) AND ADMINISTRATIVE SERVICES (BA 3272)

THE SUBCOMMITTEE RECOMMENDED CLOSING THE DIRECTOR’S OFFICE BUDGET AND THE DEPARTMENT’S ADMINISTRATION ACCOUNT AS RECOMMENDED BY THE GOVERNOR WITH TECHNICAL ADJUSTMENTS.  INCLUDED IN THE RECOMMENDATION WAS THE AUTHORIZATION TO MERGE THE DEPARTMENT’S TWO ADMINISTRATION ACCOUNTS INTO A SINGLE ADMINISTRATIVE BUDGET (BA 3272).  

 

INFORMATION DEVELOPMENT AND PROCESSING (BA 3274)

IN CLOSING THE BUDGET OF THE INFORMATION DEVELOPMENT AND PROCESSING DIVISION, THE SUBCOMMITTEE APPROVED THE RECOMMENDATION TO TRANSFER TO THIS BUDGET ACCOUNT A COMPUTER NETWORK TECHNICIAN POSITION FROM THE DEPARTMENT’S ONE-STOP CENTERS BUDGET WHICH TERMINATES AT THE END OF THIS CURRENT BIENNIUM WHEN FEDERAL FUNDING FOR THE PROJECT IS SCHEDULED TO TERMINATE.  THE POSITION TRANSFERRED TO THIS BUDGET WILL CONTINUE TO PROVIDE ONGOING TECHNICAL COMPUTER ASSISTANCE TO ALL THE ONE-STOP CENTERS.

 

EMPLOYMENT SECURITY DIVISION, ESD (BA 4770)

THE SUBCOMMITTEE CLOSED THE ESD BUDGET ACCOUNT ACCORDING TO THE GOVERNOR’S RECOMMENDATION WITH STAFF TECHNICAL ADJUSTMENTS.  MAJOR ELEMENTS OF THIS BUDGET INCLUDED APPROVAL OF $290,000 IN FUNDING OVER THE BIENNIUM TO FUND THE EXPANSION OF THE DEPARTMENT’S TELEPHONIC CLAIMS CENTER, $30,500 IN EACH YEAR OF THE BIENNIUM TO FUND THE ONGOING MAINTENANCE EFFORT ASSOCIATED WITH THE DEPARTMENT’S NEW CLAIMS ADJUDICATION SYSTEM BEING PROPOSED IN THE ESD SPECIAL FUND ACCOUNT (BA 4771), AND THE CONSOLIDATION OF THE TECHNICAL ASSISTANCE AND MONITORING BUDGET (BA 1007) INTO THIS BUDGET.

 

ESD SPECIAL FUND (BA 4771)

WITH THE DEPARTMENT FACING A $3.3 MILLION REDUCTION IN ANTICIPATED FEDERAL FUNDING THE DEPARTMENT WILL NEED TO FUND MUCH OF ITS FY 2001-03 ESD OPERATING EXPENSES THROUGH USE OF REVENUES IN ITS ESD SPECIAL FUND, BUDGET ACCOUNT 4771.  THE SUBCOMMITTEE VIEWED THE RECOMMENDATION AS A ONE-TIME STOPGAP MEASURE TO HELP THE DEPARTMENT DEAL WITH THE ANTICIPATED REVENUE SHORTFALL.  THE SUBCOMMITTEE THUS APPROVED THE USE OF THESE FUNDS FOR THE FOLLOWING MAJOR ESD EXPENDITURES: $1 MILLION WAS RECOMMENDED TO FUND ESD PROPOSED SALARY INCREASES; $686,000 WAS RECOMMENDED TO DEVELOP AND IMPLEMENT A NEW AUTOMATED ADJUDICATION PROCESS, WHICH IS PART OF A PILOT PROGRAM BEING SPONSORED BY THE FEDERAL SOCIAL SECURITY ADMINISTRATION; $2.1 MILLION WAS RECOMMENDED TO COMPLETE PHASE II OF THE UNEMPLOYMENT INSURANCE TAX SYSTEM; AND $2 MILLION WAS RECOMMENDED TO FUND THE DESIGN AND CONSTRUCTION OF A NEW ADMINISTRATION BUILDING IN LAS VEGAS. 

 

THE SUBCOMMITTEE EXPRESSED CONCERN OVER THE LEVEL OF EXPENDITURES PROPOSED BY THE DEPARTMENT FROM THIS ACCOUNT.  THE SUBCOMMITTEE NOTED THAT THE RESERVE LEVEL, BASED ON THE PROPOSED EXPENDITURES, WILL GO FROM APPROXIMATELY $7.1 MILLION AT THE END OF FY 2001 TO AN ESTIMATED LEVEL OF JUST OVER $2 MILLION BY THE END OF FY 2003.  THE SUBCOMMITTEE RECEIVED ASSURANCE FROM THE DEPARTMENT THAT THE ESTIMATED FY 2003 ENDING RESERVE BALANCE OF $2 MILLION WAS NOT A MAJOR CONCERN AND THAT THE DEPARTMENT FULLY EXPECTS THE FY 2003 ENDING RESERVE BALANCE TO BE HIGHER THAN CURRENTLY PROJECTED.

 

CAREER ENHANCEMENT PROGRAM (BA 4767)

THE CLAIMANT EMPLOYMENT PROGRAM’S BUDGET WAS CLOSED AS RECOMMENDED BY THE GOVERNOR INCLUDING THE RECOMMENDATION TO INCREASE FUNDING IN THIS BUDGET FOR PURCHASE OF TRAINING SERVICES BY $2.1 MILLION FOR THE UPCOMING BIENNIUM.

 

BUREAU OF VOCATIONAL REHABILITATION (BA 3265) AND BUREAU OF SERVICES TO THE BLIND (BA 3254)

THE SUBCOMMITTEE CLOSED THE DEPARTMENT’S TWO REHABILITATION BUDGETS, THE BUREAU OF VOCATIONAL REHABILITATION (3265) AND THE BUREAU OF SERVICES TO THE BLIND (BA 3254) AS RECOMMENDED BY THE GOVERNOR WITH TECHNICAL ADJUSTMENTS.  FUNDING AUTHORITY WAS RECOMMENDED TO ACCOUNT FOR THE DEPARTMENT’S PROJECTED FEDERAL FUNDING INCREASE OF APPROXIMATELY $2.9 MILLION, OR 6.11 PERCENT PER YEAR, OVER THE BIENNIUM.  THE SUBCOMMITTEE ALSO APPROVED THE RECOMMENDATION TO MOVE THE VOCATIONAL ASSESSMENT BUDGET (BA 3264) BACK INTO THE VOCATIONAL REHABILITATION BUDGET ACCOUNT.

 

IN CONSIDERING ADDITIONAL FUNDING AUTHORITY FOR THESE TWO BUDGETS, THE SUBCOMMITTEE EXPRESSED CONCERN OVER THE BUREAU’S INABILITY TO UTILIZE EXISTING LEVELS OF FUNDING AND QUESTIONED WHETHER THE BUREAUS HAD THE ABILITY TO UTILIZE ADDITIONAL FUNDING WHICH WOULD REQUIRE THE STATE TO COMMIT MATCHING GENERAL FUND EQUIVALENT TO 21.7 PERCENT OF THE TOTAL PROGRAM EXPENDITURES, OR APPROXIMATELY $790,000 OVER THE BIENNIUM. THE DEPARTMENT PROVIDED THE SUBCOMMITTEE WITH ASSURANCES THAT THE BUREAU WOULD BE TAKING AGGRESSIVE ACTION TO IMPROVE ITS SERVICE DELIVERY PROCESS AND PROCEDURES TO ASSURE MAXIMUM UTILIZATION OF AVAILABLE FUNDING AND INCREASE SERVICES PROVIDED TO ITS CLIENTS. 

 

THE SUBCOMMITTEE ALSO APPROVED FUNDING FOR A NEW REHABILITATION COORDINATOR POSITION TO ESTABLISH A PILOT PROGRAM WITHIN THE BUREAU OF SERVICES TO THE BLIND AND VISUALLY IMPAIRED THAT WILL PROVIDE EARLY INTERVENTION AND TRAINING SERVICES TO SCHOOL-AGE CHILDREN IN THE CLARK COUNTY SCHOOL DISTRICT.  THIS PROGRAM WILL BE FUNDED SOLELY BY THE DEPARTMENT’S GIFT FUND.

 

THE SUBCOMMITTEE RECOMMENDED APPROVING THE BUDGETS OF THE REHABILITATION DIVISION’S ADMINISTRATION BUDGET (BA 3268), BUREAU OF DISABILITY ADJUDICATION (BA 3269), BLIND BUSINESS ENTERPRISE PROGRAM (BA 3253), AND THE EQUAL RIGHTS COMMISSION (BA 2580) AS RECOMMENDED BY THE GOVERNOR WITH SOME TECHNICAL ADJUSTMENTS. 

 

COMMUNITY-BASED SERVICES (BA 3266) AND

DEVELOPMENTAL DISABILITIES (BA 3154)

 

THE SUBCOMMITTEE APPROVED THE BUDGETS OF THE OFFICE OF COMMUNITY‑BASED SERVICES AND DEVELOPMENTAL DISABILITIES AS RECOMMENDED BY THE GOVERNOR WITH TECHNICAL ADJUSTMENTS.  SIGNIFICANT DEBATE AS TO THE FEDERAL ACCEPTABILITY OF THE GOVERNOR’S RECOMMENDATION TO TRANSFER THESE BUDGETS TO THE DEPARTMENT OF HUMAN RESOURCES CAUSED THE RESPECTIVE DEPARTMENTS TO RECONSIDER THE PROPOSAL.  THE SUBCOMMITTEE ACCEPTED THE DEPARTMENT’S REQUEST TO DEFER THE DECISION TO TRANSFER THE BUDGET AND CLOSE THE BUDGETS WITH THE ASSOCIATED TECHNICAL ADJUSTMENTS TO MAINTAIN THE ACCOUNTS WITHIN THE DEPARTMENT OF EMPLOYMENT, TRAINING, AND REHABILITATION.

 

WELFARE TO WORK (BA 3226)

THE SUBCOMMITTEE APPROVED THE TRANSFER OF THE WELFARE TO WORK BUDGET TO DETR FROM THE DEPARTMENT OF HUMAN RESOURCES AS RECOMMENDED BY THE GOVERNOR WITH TECHNICAL ADJUSTMENTS.  CONGRESS AUTHORIZED STATES TO EXPEND CURRENTLY APPROVED FEDERAL FUNDING BUT DID NOT PROVIDE ADDITIONAL FUNDING FOR THE PROGRAMS BEYOND FY 2003.  UNLESS ADDITIONAL FEDERAL FUNDING IS PROVIDED IN THE COMING BIENNIUM, THIS BUDGET WILL EXPIRE AT THE COMPLETION OF FY 2003.

 

WHILE NO SIGNIFICANT GENERAL FUND SAVINGS WERE IDENTIFIED IN THESE ACCOUNTS, THE SUBCOMMITTEE’S RECOMMENDATIONS PROVIDE ADDITIONAL RESOURCES TO IMPROVE SERVICES FOR THE DEPARTMENT’S CUSTOMERS, INCLUDING FUNDING TO MEET ANTICIPATED CASELOAD INCREASES, A NEW POSITION TO ENHANCE SERVICES FOR BLIND STUDENTS IN CLARK COUNTY, EXPANSION OF THE DEPARTMENT’S TELEPHONIC CLAIM CENTER, AND THE REDEVELOPMENT AND DESIGN OF CURRENT SERVICE DELIVERY PROCESS TO IMPROVE THE LEVEL OF SERVICE PROVIDED TO THE DEPARTMENT OF EMPLOYMENT AND REHABILITATION CLIENTS.

 

I WOULD LIKE TO EXPRESS MY THANKS AND APPRECIATION TO THE MEMBERS OF THE SUBCOMMITTEE ON GENERAL GOVERNMENT FOR THEIR HARD WORK AND ASSISTANCE IN DEVELOPING THESE RECOMMENDATIONS.

 

ASSEMBLYMAN MARVEL MADE A RECOMMENDATION TO ACCEPT THE BUDGET AS RECOMMENDED.

 

ASSEMBLYWOMAN CEGAVSKE SECONDED THE MOTION.

 

THE MOTION CARRIED UNANIMOUSLY.

 

(Assemblyman Goldwater, Chairman Arberry, Assemblyman Hettrick, Assemblywoman Leslie, and Assemblywoman Tiffany were not present for the vote.)

 

BUDGETS CLOSED.

 

********

 

 

PUBLIC EMPLOYEES BENEFITS PROGRAM

 

Mrs. Chowning read from the Closing Report of May 15, 2001, as follows: 

 

THE SUBCOMMITTEE ON GENERAL GOVERNMENT DEVELOPED THE FOLLOWING RECOMMENDATIONS FOR THE PUBLIC EMPLOYEES’ BENEFITS PROGRAM BUDGETS.

 

THE SUBCOMMITTEE RECOMMENDS STATE SUBSIDY AMOUNTS OF $357.50 FOR FY 2002 AND $384.50 FOR FY 2003 FOR ACTIVE STATE EMPLOYEES.  THE PUBLIC EMPLOYEES’ BENEFITS PROGRAM BOARD ADOPTED A RATE STRUCTURE THAT BLENDS RETIREE RATES WITH ACTIVES WHICH SUBSIDIZES RETIREES ABOVE THE LEGISLATIVE SUBSIDY AMOUNT.

 

THE SUBCOMMITTEE RECOMMENDS INFLATIONARY RATES AS RECOMMENDED BY THE SEGAL COMPANY, THE ACTUARY FOR THE PUBLIC EMPLOYEES’ BENEFITS PROGRAM.  AN EIGHT PERCENT INCREASE PER YEAR IS RECOMMENDED FOR EACH FISCAL YEAR IN THE UPCOMING BIENNIUM FOR VISION AND DENTAL COSTS; A 10 PERCENT INCREASE PER YEAR FOR MEDICAL COSTS; AND A 20 PERCENT INCREASE PER YEAR FOR PRESCRIPTION COSTS.  MEDICAL CLAIMS ARE PROJECTED TO REACH $104,819,621 IN FY 2002 AND $117,820,562 IN FY 2003.  THE SUBCOMMITTEE RECOMMENDS AN IBNR RESERVE FOR INCURRED BUT NOT REPORTED CLAIMS AT 16.7 PERCENT OF MEDICAL CLAIMS, AT A MINIMUM, AS RECOMMENDED BY THE SEGAL COMPANY.  THIS IS AN AMOUNT APPROXIMATELY EQUAL TO TWO MONTHS OF MEDICAL CLAIMS.  DUE TO CONCERNS ABOUT THE FINANCIAL STABILITY OF THE PUBLIC EMPLOYEES’ BENEFITS PROGRAM, THE SUBCOMMITTEE RECOMMENDS THAT A LETTER OF INTENT BE ISSUED DIRECTING THE PUBLIC EMPLOYEES’ BENEFITS PROGRAM TO REPORT TO THE INTERIM FINANCE COMMITTEE AT THE FIRST MEETING FOLLOWING THE CLOSE OF FY 2001 AND FY 2002 ON THE FINANCIAL STABILITY OF THIS BUDGET AND, SPECIFICALLY, THE RESERVE LEVEL.

 

THE SUBCOMMITTEE DOES NOT RECOMMEND THE TRANSFER AND CONSOLIDATION OF THE RETIRED EMPLOYEE GROUP INSURANCE BUDGET WITH THE PUBLIC EMPLOYEES’ BENEFITS PROGRAM BUDGET ACCOUNT.  THE SUBCOMMITTEE REASONED THAT WITH ALL THE CHALLENGES FACING THE PUBLIC EMPLOYEES’ BENEFITS PROGRAM, THESE TWO BUDGETS SHOULD REMAIN SEPARATE RATHER THAN COMMINGLING ACTIVE AND RETIREE FUNDS IN ONE BUDGET.

 

Mrs. Chowning said she could not stress enough the hard work that the legislative staff had done in regard to the budget.  She said at some points the entire budget figures were given to Ms. Rohrs at midnight, with the subcommittee having to make decisions at 7:30 a.m. the next morning.  She said the figures changed again and again.  She expounded that to be able to bring the budget closing recommendations before the committee was an "unbelievable conclusion" and staff needed to be thanked immensely. 

 

Mr. Dini said the vision and dental cost had increased, and with the 20 percent increase for subscription drugs, which had already doubled the previous year, it was cheaper to buy generic drugs across the board than to have the insurance companies pay.  He said if the new costs were imposed on people on the plan, the plan was being destroyed.  He asked what kind of testimony had the subcommittee received from the system, were they broke or what was happening.  Ms. Rohrs answered the projections mentioned were the projections of the claims costs, not the charge to participants in the plan.  She expounded that the projections were what was expected for prescription drugs to increase over the next biennium.  Ms. Rohrs said the projections were in line with national trends, and some were saying that the increases would be around 25 percent. 

 

Vice Chairman Giunchigliani asked about previous budget cuts where retirees were hit with an "extra whammy," with the Medicare carve up, and had anything been done about that issue.  Mr. Dini said they were still stuck with $2,000 and there was a need for another Letter of Intent to the board to direct them to eliminate the carve out.   

 

ASSEMBLYMAN DINI MADE A MOTION TO ACCEPT THE BUDGET CLOSINGS AS RECOMMENDED BY THE SUBCOMMITTEE, AND WITH A LETTER OF INTENT.

 

ASSEMBLYMAN PARKS SECONDED THE MOTION.

 

THE MOTION CARRIED UNANIMOUSLY.

 

(Assemblyman de Braga, Assemblywoman Leslie, Assemblyman Hettrick, Chairman Arberry, and Assemblywoman Tiffany were not present for the vote.)

 

Mrs. Chowning asked if the Letter of Intent was in addition to the Letter of Intent already mentioned in the budget closing recommendations, and Vice Chairman Giunchigliani answered yes. 

 

BUDGETS CLOSED.

 

********

 

 

DEPARTMENT OF AGRICULTURE AND DIVISION OF MINERALS

 

 

Mrs. Chowning read from the Closing Report of May 15, 2001, as follows:

 

THE JOINT SUBCOMMITTEE ON GENERAL GOVERNMENT HAS COMPLETED ITS REVIEW OF THE BUDGET ACCOUNTS FOR THE DEPARTMENT OF AGRICULTURE AND THE DIVISION OF MINERALS.  THE CLOSING ACTIONS OF THE SUBCOMMITTEE HAVE RESULTED IN A GENERAL FUND SAVINGS TOTALING $312,843 IN FY 2002 AND $367,496 IN FY 2003 WHEN COMPARED TO THE GOVERNOR’S RECOMMENDED BUDGET.

 

THE EXECUTIVE BUDGET RECOMMENDED THE CONSOLIDATION OF MOST OF THE DEPARTMENT’S NON-GENERAL FUND ACCOUNTS INTO ACCOUNTS THAT RECEIVE GENERAL FUND APPROPRIATIONS.  BASED ON THE LIMITED ADVANTAGES TO COMBINING THE ACCOUNTS, THE SUBCOMMITTEE VOTED TO DENY THE CONSOLIDATION OF MOST OF THE DEPARTMENT’S ACCOUNTS.  THE SUBCOMMITTEE APPROVED THE CONSOLIDATION OF THE HIGH SCHOOL RODEO ASSOCIATION ACCOUNT WITH THE DEPARTMENT’S ADMINISTRATION ACCOUNT AND THE CONSOLIDATION OF THE APIARY INSPECTION ACCOUNT WITH THE PLANT INDUSTRY ACCOUNT.  THE SUBCOMMITTEE ALSO APPROVED THE DEPARTMENT’S REQUEST TO COMBINE THE GARLIC AND ONION RESEARCH AND PROMOTION ACCOUNT WITH THE ALFALFA PROMOTION ACCOUNT.

 

THE SUBCOMMITTEE APPROVED THE IMPLEMENTATION OF THE DEPARTMENT’S COST ALLOCATION PLAN TO FUND THE ADMINISTRATIVE COSTS OF THE DEPARTMENT.  THE PLAN WAS THE RESULT OF A LETTER OF INTENT ISSUED BY THE 1999 LEGISLATURE.  THE IMPLEMENTATION OF THE PLAN RESULTED IN A REDUCTION OF GENERAL FUND SUPPORT FOR THE ADMINISTRATION ACCOUNT TOTALING $256,426 IN FY 2002 AND $241,791 IN FY 2003.

 

IN THE PLANT INDUSTRY ACCOUNT, THE SUBCOMMITTEE APPROVED THE CONTINUATION OF TWO POSITIONS THAT WERE APPROVED BY THE INTERIM FINANCE COMMITTEE DURING FY 2001.  THE POSITIONS WILL CONDUCT INSPECTIONS OF NURSERIES AND LANDSCAPING COMPANIES IN SOUTHERN NEVADA AND ASSIST WITH NEW LICENSING REQUIREMENTS FOR THE PESTICIDE INDUSTRY.  THE SUBCOMMITTEE ALSO VOTED TO ELIMINATE THE RESERVE FOR THE PLANT INDUSTRY ACCOUNT THAT HAD BEEN ESTABLISHED IN THE EXECUTIVE BUDGET.  THE SUBCOMMITTEE BASED ITS DECISION ON THE FACT THAT THE ACCOUNT RECEIVES A GENERAL FUND APPROPRIATION AND THAT ALLOWING A RESERVE IN SUCH AN ACCOUNT WOULD ESTABLISH A PRECEDENT THAT WOULD NEGATIVELY IMPACT THE STATE GENERAL FUND.  THE SUBCOMMITTEE RECOMMENDED A LETTER OF INTENT DIRECTING THE DEPARTMENT TO REQUEST CONTINGENCY FUNDS FROM IFC IF AN UNANTICIPATED NEED ARISES FOR THE PEST CONTROL LICENSING, REGULATION, AND CONTINUING EDUCATION PROGRAM OR THE NURSERY INSPECTION PROGRAM.

 

Mrs. Chowning reminded the committee that those programs had been established in 1999 to address the rats, bees, etc., in southern Nevada.  She said they had come a long way and would continue to inspect the nurseries, etc., hopefully very well.  She then continued her reading her report. 

 

AFTER THE SUBCOMMITTEE CLOSED THE PLANT INDUSTRY ACCOUNT, THE DEPARTMENT REQUESTED AN ADJUSTMENT TO THE BUDGET.  THE DEPARTMENT INDICATED THAT FUNDING TO BE RECEIVED FROM STATE AND LOCAL AGENCIES FOR REIMBURSEMENT OF WEED CONTROL AND WEED SURVEY ACTIVITIES WAS OVERSTATED IN THE EXECUTIVE BUDGET BY $34,411 IN FY 2002 AND $34,491 IN FY 2003.  FISCAL ANALYSIS DIVISION STAFF HAS REVIEWED THE REQUESTS AND IT APPEARS THAT AN ADJUSTMENT TO THE BUDGET ACCOUNT IS WARRANTED.  ALTHOUGH THE GENERAL FUND APPROPRIATION NECESSARY TO SUPPORT THE ACCOUNT WILL BE INCREASED BY THIS ADJUSTMENT, THE OVERALL GENERAL FUND APPROPRIATION FOR THIS ACCOUNT WILL STILL BE REDUCED FROM THE AMOUNT RECOMMENDED BY THE GOVERNOR BASED ON THE SUBCOMMITTEE’S DECISION TO ELIMINATE THE RESERVE.

 

IN THE WEIGHTS AND MEASURES ACCOUNT, THE SUBCOMMITTEE VOTED TO ELIMINATE THE RESERVE FOR THE ACCOUNT THAT HAD BEEN ESTABLISHED IN THE EXECUTIVE BUDGET.  SIMILARLY TO THE PLANT INDUSTRY ACCOUNT, THE SUBCOMMITTEE BASED ITS DECISION ON THE FACT THAT THE ACCOUNT RECEIVES A GENERAL FUND APPROPRIATION AND THAT ALLOWING A RESERVE IN SUCH AN ACCOUNT WOULD ESTABLISH A PRECEDENT THAT WOULD NEGATIVELY IMPACT THE STATE GENERAL FUND.  THE ACTIONS OF THE SUBCOMMITTEE IN THIS ACCOUNT RESULTED IN A GENERAL FUND SAVINGS TOTALING $53,267 IN FY 2002 AND $117,750 IN FY 2003.

 

IN THE LIVESTOCK INSPECTION ACCOUNT, THE SUBCOMMITTEE APPROVED THE GOVERNOR’S RECOMMENDATION FOR A NEW FULL-TIME MICROBIOLOGIST POSITION TO ASSIST WITH THE DEPARTMENT’S FOOD SAFETY AND QUALITY ASSURANCE PROGRAM.  THE POSITION WILL EXPAND THE DEPARTMENT’S EDUCATIONAL PROGRAMS REGARDING FOOD QUALITY AND SAFETY AND ASSIST LIVESTOCK OWNERS IN CERTIFYING THAT THEIR ANIMALS MEET NEW REQUIREMENTS IMPOSED BY LIVESTOCK MARKETERS AS A RESULT OF THE RECENT INCIDENCE OF MAD COW DISEASE.  THE SUBCOMMITTEE ALSO APPROVED THE GOVERNOR’S RECOMMENDATION TO ELIMINATE A MANAGEMENT ASSISTANT POSITION AND TO REPLACE THAT POSITION WITH A NEW FULL-TIME PROGRAM OFFICER POSITION TO COLLECT THE LIVESTOCK HEAD TAX, WHICH IS ONE OF THE REVENUE SOURCES USED TO SUPPORT THE ACCOUNT.  CURRENTLY THE HEAD TAX IS COLLECTED BY THE COUNTY ASSESSORS AND TRANSFERRED TO THE DEPARTMENT. 

 

ALSO IN THE LIVESTOCK INSPECTION ACCOUNT, THE SUBCOMMITTEE APPROVED THE GOVERNOR’S  RECOMMENDATION TO INCREASE A PART-TIME POSITION TO FULL-TIME AND TO TRANSFER THAT POSITION AND THREE OTHER POSITIONS FROM THIS ACCOUNT TO BEGIN A NEW PROGRAM TO PATROL HIGHWAYS THROUGHOUT NEVADA AND TO INSPECT AGRICULTURAL MATERIALS AND LIVESTOCK AT VARIOUS DESIGNATED POINTS.  THE GOAL OF THE PROGRAM IS TO ENSURE THAT AGRICULTURAL PRODUCTS ARE FREE FROM INVASIVE PESTS, NOXIOUS WEEDS, AND DISEASE.  THE POSITIONS ARE CURRENTLY FUNDED ENTIRELY THROUGH FEES IN THE INSPECTION ACCOUNT, BUT THE SUBCOMMITTEE APPROVED THE GOVERNOR’S RECOMMENDATION TO FUND APPROXIMATELY 73 PERCENT OF THE COSTS FOR THE POSITIONS THROUGH A GENERAL FUND APPROPRIATION.  ALTHOUGH THE SUBCOMMITTEE APPROVED THE USE OF THE POSITIONS FOR THE NEW PROGRAM, THE SUBCOMMITTEE DID NOT SUPPORT THE TRANSFER OF THE POSITIONS TO THE DEPARTMENT’S ADMINISTRATION ACCOUNT.  INSTEAD, THE SUBCOMMITTEE VOTED TO TRANSFER THE POSITIONS TO THE PLANT INDUSTRY ACCOUNT.

 

IN THE VETERINARY MEDICAL SERVICES ACCOUNT, THE SUBCOMMITTEE DID NOT APPROVE THE GOVERNOR’S RECOMMENDATION TO FUND A NEW POSITION TO MANAGE A WILD HORSE-GENTLING PROGRAM IN COOPERATION WITH THE NEVADA DEPARTMENT OF PRISONS.  INSTEAD, THE SUBCOMMITTEE RECOMMENDED THE POSITION BE FUNDED IN THE PRISON INDUSTRY PROGRAM AS AN EMPLOYEE OF THE DEPARTMENT OF PRISONS.

 

Mrs. Chowning thanked Mr. Marvel for his assistance with this budget.  Mrs. Chowning said there had been national coverage of the Wild-Horse Gentling Program and the program was serving as a model shown for the Department of Prisons.

 

AS RECOMMENDED IN THE EXECUTIVE BUDGET, APPROXIMATELY 85 PERCENT OF THE COSTS FOR THE POSITION WOULD HAVE BEEN FUNDED THROUGH A GENERAL FUND APPROPRIATION, WHILE THE REMAINING COSTS WOULD HAVE BEEN FUNDED THROUGH THE SALE OF ESTRAY HORSES.  THE HORSE-GENTLING PROGRAM USES PRISON INMATES TO TAME AND CARE FOR ESTRAY HORSES ROUNDED UP FROM THE VIRGINIA RANGE.

 

IN THE PREDATORY ANIMAL AND RODENT CONTROL ACCOUNT, THE SUBCOMMITTEE RECOMMENDED THE ISSUANCE OF A LETTER OF INTENT REGARDING THE COSTS OF A CONTRACT WITH THE FEDERAL GOVERNMENT.  DURING FY2001, A STATE POSITION WAS ELIMINATED BY THE AGENCY AND CONVERTED TO A FEDERAL POSITION BECAUSE THE POSITION REQUIRES BIOLOGICAL KNOWLEDGE AND EXPERIENCE.  THE AGENCY BELIEVED ADVERTISING AND HIRING THE POSITION THROUGH THE FEDERAL PROGRAM WOULD PROVIDE A GREATER FIELD OF APPLICANTS WITH THOSE QUALIFICATIONS.  THE COSTS FOR THE FEDERAL POSITION ARE CURRENTLY FUNDED THROUGH A CONTRACT WITH THE DEPARTMENT.  THE SUBCOMMITTEE VOTED TO ISSUE A LETTER OF INTENT DIRECTING THE DEPARTMENT TO ENSURE THAT THE COSTS FOR THE CONTRACT NEVER EXCEED THE COSTS TO HIRE A STATE POSITION TO PERFORM THE DUTIES CURRENTLY PERFORMED BY THE FEDERAL POSITION.

 

THE SUBCOMMITTEE VOTED TO CLOSE THE FOLLOWING ADDITIONAL ACCOUNTS WITH ONLY MINOR AND TECHNICAL ADJUSTMENTS:

 

GAS POLLUTION TRANSFER ACCOUNT (ba 4537)

aGRICULTURE REGISTRATION AND ENFORCEMENT (ba 4545)

GRADE AND CERTIFICATION OF AGRICULTURAL PRODUCTS (ba4541)

rURAL REHABILITATION TRUST FUND (ba 4553)

NOXIOUS WEED AND INSECT CONTROL (ba 4552) 

 

IN THE DIVISION OF MINERALS ACCOUNT, THE SUBCOMMITTEE APPROVED THE GOVERNOR’S RECOMMENDATION FOR TWO SEASONAL INTERNS AND ASSOCIATED EQUIPMENT AND OPERATING SUPPLIES TO SECURE ABANDONED MINES THROUGHOUT NEVADA.  THE SUBCOMMITTEE ALSO APPROVED FUNDING FOR THE COSTS OF MOVING THE DIVISION’S LAS VEGAS OFFICE FROM THE BRADLEY BUILDING TO NON STATE-OWNED RENTAL SPACE AND FUNDING TO PURCHASE A NEW TRUCK FOR USE IN CLOSING ABANDONED MINE SITES.

 

Mrs. Chowning thanked Rick Combs, Program Analyst, for his hard work with the budget accounts.

 

ASSEMBLYMAN MARVEL MADE A MOTION TO CLOSE THE BUDGET AS RECOMMENDED BY THE SUBCOMMITTEE. 

 

ASSEMBLYWOMAN GIUNCHIGLIANI SECONDED THE MOTION.

 

THE MOTION CARRIED UNANIMOUSLY.

 

(Assemblyman Perkins, Assemblyman Hettrick, and Assemblywoman Leslie were absent for the vote.)

 

BUDGETS CLOSED.

 

********

 

WELFARE DIVISION

 

Ms. Giunchigliani read from the Closing Report of May 15, 2001, as follows:

 

THE JOINT SUBCOMMITTEE REVIEWING THE HUMAN RESOURCES/K-12 BUDGETS HAS COMPLETED ITS REVIEW OF THE WELFARE DIVISION BUDGETS AND HAS CONCURRED IN THE CLOSING ACTIONS RECOMMENDED.  THE FOLLOWING HIGHLIGHTS THE MORE SIGNIFICANT ISSUES AND BUDGET CLOSING ACTIONS THE SUBCOMMITTEE IS RECOMMENDING.

 

WELFARE ADMINISTRATION (101-3228) VOLUME 11 – PAGE 1

 

THE SUBCOMMITTEE RECOMMENDS APPROVING APPROXIMATELY $31.6 MILLION FOR THE 2001-03 BIENNIUM TO FUND NOMADS.  THE FUNDING INCLUDES APPROXIMATELY $12 MILLION EACH FISCAL YEAR TO REIMBURSE THE DEPARTMENT OF INFORMATION TECHNOLOGY (DOIT) FOR COMPUTER FACILITY USAGE AND PROGRAMMING SUPPORT AND $2.7 MILLION EACH FISCAL YEAR FOR CONTRACTOR SUPPORT.  IN ADDITION TO ONGOING SUPPORT FOR OPERATIONS AND MAINTENANCE, THE AMOUNT OF FUNDING RECOMMENDED WILL BE USED TO ADDRESS THREE AREAS TO MODERNIZE THE NOMADS SYSTEM.  FIRST, CRITICAL WORK ITEMS WILL BE ADDRESSED THAT WILL IMPROVE THE PERFORMANCE OF NOMADS.  SECOND, THE APPLICATION DEVELOPMENT ENVIRONMENT FOR NOMADS WILL BE TRANSITIONED TO A PRODUCT THAT IS CURRENT TECHNOLOGY AND VENDOR SUPPORTED.  AND THIRD, THE DIVISION IN CONJUNCTION WITH DOIT AND THE LOCAL DISTRICT ATTORNEY’S OFFICES WILL BEGIN MOVING CERTAIN NOMADS APPLICATIONS OFF THE MAINFRAME TO CLIENT-SERVERS.  OVER TIME, THE MIGRATION WILL REDUCE PROCESSING COSTS AND ALLOW GREATER USER FLEXIBILITY.

 

THE SUBCOMMITTEE RECOMMENDS RE-STARTING THE OASIS PROJECT USING THE TANF HIGH PERFORMANCE BONUS THE DIVISION WILL RECEIVE FOR BEING ONE OF THE TOP TEN PERFORMING STATES FOR MOVING WELFARE CLIENTS TO WORK.  THE $2.2 MILLION PROJECT WILL BEGIN THIS JULY AND DEVELOPMENT WILL TAKE APPROXIMATELY ONE YEAR.  THE OASIS SYSTEM WILL BE ON A SERVER-BASED ENVIRONMENT WITH INTERNET CAPABILITIES.  THE SOFTWARE DEVELOPMENT AND IMPLEMENTATION PHASES WILL BE ACCOMPLISHED USING DOIT STAFF AND MSA SUPPORT UNDER THE PROJECT OVERSIGHT OF THE DIVISION.

 

THE SUBCOMMITTEE RECOMMENDS A TOTAL OF NINE NEW POSITIONS FOR THE IMPLEMENTATION AND CONTINUED OPERATION OF THE ELECTRONIC BENEFIT TRANSFER (EBT) SYSTEM FOR THE FOOD STAMP PROGRAM.  THREE OF THE NEW POSITIONS RECOMMENDED WILL BE RESPONSIBLE FOR PROJECT MANAGEMENT, FINANCIAL ANALYSIS AND ACCOUNTING.  SIX OF THE NEW POSITIONS WILL BE LOCATED IN THE DIVISION’S LARGEST DISTRICT OFFICES AND WILL SERVE AS EBT COORDINATORS IN THE FIELD.  IN ADDITION, THE SUBCOMMITTEE RECOMMENDS APPROXIMATELY $1.5 MILLION OVER THE BIENNIUM FOR THE IMPLEMENTATION AND ON-GOING OPERATIONAL COSTS FOR THE EBT SYSTEM.  FEDERAL MANDATES REQUIRE THAT THE EBT SYSTEM BE FULLY OPERATIONAL NO LATER THAN OCTOBER 2002.  TO HELP OFFSET A PORTION OF THE ADDITIONAL COSTS FOR THE NEW POSITIONS AS WELL AS FOR IMPLEMENTATION, THE SUBCOMMITTEE RECOMMENDS ELIMINATING 11 EXISTING POSITIONS AS WAS PROPOSED BY THE GOVERNOR.

 

WELFARE FIELD SERVICES (101-3233) VOLUME II – PAGE 12

 

THE SUBCOMMITTEE SUPPORTS THE GOVERNOR’S RECOMMENDATION TO ELIMINATE THE CHAP ASSETS TEST AND TO EXPEDITE CASE PROCESSING FOR PREGNANT WOMEN.  THE CHAP ASSETS TEST IS AN EXISTING REQUIREMENT FOR DETERMINING MEDICAID ELIGIBILITY FOR PREGNANT WOMEN AND CHILDREN AND IS CONSIDERED AN ENROLLMENT BARRIER AND POTENTIALLY A REASON FAMILIES FAIL TO COMPLETE THE MEDICAID APPLICATION PROCESS.  ELIMINATING THE CHAP ASSETS TEST CREATES AN OPPORTUNITY FOR THE DIVISION TO EXPEDITE ELIGIBILITY DETERMINATIONS.  THE GOAL IS TO PROCESS APPLICATIONS AND MAKE A MEDICAID ELIGIBILITY DETERMINATION FOR PREGNANT WOMEN WITHIN SEVEN DAYS.  THE SUBCOMMITTEE RECOMMENDS A TOTAL OF 17 NEW ELIGIBILITY WORKER POSITIONS FOR THE ADDITIONAL CASELOAD ANTICIPATED FOR THESE NEW INITIATIVES.  DUE TO THE SIGNIFICANT REVENUE SHORTFALL, THE SUBCOMMITTEE RECOMMENDS THE IMPLEMENTATION OF THE NEW INITIATIVES BE DELAYED UNTIL JULY 2002.  THE DELAY WILL SAVE APPROXIMATELY $1.6 MILLION IN STATE FUNDS OVER THE 2001-03 BIENNIUM IN THE WELFARE FIELD SERVICES AND MEDICAID BUDGETS. 

 

THE SUBCOMMITTEE RECOMMENDS FIVE NEW QUALITY CONTROL POSITIONS TO BE LOCATED AT THE DIVISION’S LARGEST DISTRICT OFFICES.  THE POSITION’S WILL BE RESPONSIBLE FOR ENSURING THROUGH A RETROSPECTIVE QUALITY REVIEW PROCESS THAT DATA INPUT INTO THE NOMADS SYSTEM BY ELIGIBILITY WORKERS IS ACCURATE AND FOR FIELD INITIATIVES DESIGNED TO KEEP CASE PROCESSING ERROR RATES IN CHECK.   

 

 

TANF (101-3230) VOLUME II – PAGE 21

 

THE SUBCOMMITTEE RECOMMENDS AUGMENTING THE TANF BUDGET BY APPROXIMATELY $8 MILLION FOR FY 2002 AND BY $4 MILLION FOR FY 2003.  THE AUGMENTATION WILL ACCOUNT FOR THE TOTAL AMOUNT OF THE ANNUAL TANF BLOCK GRANT AWARD IN ADDITION TO SUPPLEMENTAL TANF FUNDING IN FY 2002 THAT HAS PREVIOUSLY BEEN AWARDED TO NEVADA FOR HAVING BEEN DESIGNATED AS A STATE WITH HIGH POPULATION GROWTH.  IT SHOULD BE NOTED THE SUPPLEMENTAL FUNDING WILL BECOME AVAILABLE IF RE‑AUTHORIZED BY CONGRESS.  A MAJORITY OF THE ADDITIONAL TANF FUNDS WILL BE PLACED IN TANF RAINY DAY RESERVE.  APPROXIMATELY $2.4 MILLION FOR FY 2002 AND $2.6 MILLION FOR FY 2003 WILL BE USED TO COVER THE COSTS OF TANF CASELOADS FOR THE UPCOMING BIENNIUM WHICH ARE PROJECTED TO BE HIGHER THAN THE CASELOADS RECOMMENDED IN THE EXECUTIVE BUDGET. 

 

THE SUBCOMMITTEE RECOMMENDS APPROVING THE GOVERNOR’S PROPOSAL TO INCREASE THE TANF CASH GRANT FROM $348 PER MONTH TO $535 PER MONTH FOR FAMILIES WITH ILL, INCAPACITATED OR DISABLED MEMBERS WHO CANNOT PARTICIPATE IN WORK-RELATED ACTIVITIES.  THE RECOMMENDED INCREASE RECOGNIZES THAT TANF RECIPIENTS WHO ARE DISABLED OR CARE FOR A FAMILY MEMBER WHO IS DISABLED HAVE EXCEPTIONAL EXPENSES.

 

THE SUBCOMMITTEE RECOMMENDS USING AVAILABLE TANF FUNDS TO ESTABLISH THE KINSHIP CARE PROGRAM AS OUTLINED IN ASSEMBLY BILL 15.  THE KINSHIP CARE PROGRAM IS DESIGNED TO PROVIDE A NON-NEEDY RELATIVE CARETAKER WITH ASSISTANCE IN ESTABLISHING GUARDIANSHIP OF A RELATIVE CHILD AND PROVIDES FOR A HIGHER MONTHLY CASH GRANT FOR THE CARE OF THE CHILD WITHOUT HAVING TO GO THROUGH THE LEGAL PROCESS OF OBTAINING THE CHILD.  THE INTENT OF THE KINSHIP CARE PROGRAM IS TO ESTABLISH A PERMANENT PLACEMENT FOR THE CHILD. 

 

THE SUBCOMMITTEE RECOMMENDS APPROVING THREE INITIATIVES RECOMMENDED BY THE GOVERNOR USING TANF FUNDS.  THE INITIATIVES INCLUDE RE-ESTABLISHING THE SELF-SUFFICIENCY PROGRAM IN FY 2003 AT A COST OF APPROXIMATELY $500,000; ESTABLISHING A PROGRAM WHICH PLACES TANF RECIPIENTS IN CLERICAL POSITIONS WITHIN THE DEPARTMENT OF HUMAN RESOURCES AND SUBSIDIZES THEIR EMPLOYMENT AT A COST OF APPROXIMATELY $330,000 FOR EACH FISCAL YEAR; AND ESTABLISHING PROGRAMS DESIGNED TO REDUCE OUT-OF-WEDLOCK BIRTHS AND TO ENCOURAGE THE FORMATION OF TWO-PARENT FAMILIES AT A COST OF $1 MILLION OVER THE UPCOMING BIENNIUM.

 

 

 

 

EMPLOYMENT AND TRAINING (101-3267) VOLUME II – PAGE 38

THE SUBCOMMITTEE RECOMMENDS TRANSFERRING THE NEW EMPLOYEES OF NEVADA (NEON) PROGRAM TO THE TANF BUDGET AS AN ORGANIZATIONAL CHANGE DESIGNED TO ISOLATE ALL CHILD-CARE RELATED EXPENDITURES IN ONE BUDGET ACCOUNT.  THE EMPLOYMENT AND TRAINING BUDGET WILL BE RE-NAMED THE CHILDCARE ASSISTANCE AND DEVELOPMENT BUDGET.  THE SUBCOMMITTEE RECOMMENDS APPROVING APPROXIMATELY $65.4 MILLION IN CHILDCARE FUNDING FOR THE UPCOMING BIENNIUM WHICH INCLUDES APPROXIMATELY $18.7 MILLION IN STATE FUNDS.  THE SIGNIFICANT INCREASE IN CHILD-CARE FUNDING WILL BE USED TO SERVE APPROXIMATELY 13,600 CHILDREN PER MONTH IN FY 2002 AND APPROXIMATELY 14,500 CHILDREN PER MONTH IN FY 2003.  ADDITIONALLY, THE SUBCOMMITTEE RECOMMENDS SEVERAL NEW INITIATIVES DESIGNED TO IMPROVE THE QUALITY OF CHILD-CARE SERVICES.  THE INITIATIVES INCLUDE PROVIDING APPROXIMATELY $2.1 MILLION OVER THE BIENNIUM TO ESTABLISH A TIERED REIMBURSEMENT SYSTEM FOR CHILD-CARE PROVIDERS.  THE TIERED REIMBURSEMENT SYSTEM WILL PROVIDE INCREASED CHILD-CARE SUBSIDY PAYMENTS TO PROVIDERS WHO MEET HIGHER LEVELS OF CARE; WILL PROVIDE FOR FACILITY IMPROVEMENT GRANTS WHICH PROVIDERS CAN ACCESS TO MEET ACCREDITATION STANDARDS; AND WILL PROVIDE INCENTIVE GRANTS FOR PROVIDERS TO HELP OFFSET THE COST OF ACCREDITATION.

 

THE SUBCOMMITTEE VOTED TO CLOSE THE CHILD SUPPORT ENFORCEMENT, THE CHILD SUPPORT FEDERAL REIMBURSEMENT, THE AGED AND BLIND AND THE ENERGY ASSISTANCE BUDGETS WITH MINOR AND TECHNICAL ADJUSTMENTS OR AS RECOMMENDED BY THE GOVERNOR.

 

IN CONCLUSION, THE SUBCOMMITTEE’S RECOMMENDATIONS WILL REDUCE THE GENERAL FUND APPROPRIATION FOR THE WELFARE DIVISION BY ($457,191) FOR FY 2002 AND BY ($428,331) FOR FY 2003, FOR A NET REDUCTION OF ($885,522) OVER THE UPCOMING BIENNIUM.

 

 Mrs. Chowning said during the interim there had been a lot of complaints and concerns from the workers saying their jobs were extremely difficult because of the NOMADS system and their child support payments weren't being mailed in a timely fashion.  She asked if that had gotten better.  Ms. Giunchigliani said yes, things had gotten better but there was the issue of updating the department's technology.  The committee, with the help of Mr. Beers, supported the recommendation to move from the mainframe to the client-based servers, and part of that would assist the local district attorneys in processing in a much more timely manner and more efficiently.  

 

ASSEMBLYWOMAN TIFFANY MADE A MOTION TO ACCEPT THE REPORT AS RECOMMENDED BY THE SUBCOMMITTEE AND CLOSE THE BUDGETS.

 

ASSEMBLYWOMAN CEGAVSKE SECONDED THE MOTION.

 

THE MOTION CARRIED UNANIMOUSLY.

 

(Assemblyman Hettrick and Assemblywoman Leslie were not present for the vote.)

 

BUDGETS CLOSED.

 

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Assembly Bill 235:  Makes supplemental appropriation to Department of             Business and Industry for unanticipated shortfall in money budgeted for             salaries for personnel in Nevada Athletic Commission’s Amateur Boxing             Program. (BDR S-1259)

 

Mr. Stevens said A.B. 235 was a supplemental appropriation that had been recommended in The Executive Budget for $1,583 due to an anticipated shortfall in budgeted salaries.  He said staff recommended the amount be adjusted to $2,815, as there had been a problem with overtime due to fights that had come into the state in the last four or five months and anticipated a shortfall in the operating area. 

 

ASSEMBLYWOMAN CHOWNING MADE A MOTION TO AMEND AND DO PASS.

 

ASSEMBLYMAN MARVEL SECONDED THE MOTION.

 

THE MOTION CARRIED UNANIMOUSLY.

 

(Assemblyman Hettrick and Assemblywoman Leslie were not present for the vote.)

 

********

 

Assembly Bill 313:  Creates conclusive presumption that hepatitis is             occupational disease for certain employees. (BDR 53-843)

 

Mr. Stevens said the fiscal note on A.B. 313 had been substantially reduced due to the amendment that removed the presumptive eligibility provision from the bill. 

 

ASSEMBLYMAN PARKS MADE A MOTION TO AMEND AND DO PASS.

 

Mr. Dini said the amendment also took the volunteers out of the bill.  Mr. Stevens said that was correct.  Ms. Giunchigliani said, in talking with Assemblyman Oceguera, the local governments and Risk Management had said the volunteers would be handled through some of the local government issues. 

 

Mr. Stevens explained the amendments as follows:

• Amend Section 1, page 2, by deleting lines 17 through 19 and inserting: “in this state.”

 

 

• Amend Section 4, page 4, by deleting lines 12 through 18 and inserting: “of his employment if the employee has been continuously employed for 5 years or more as a full-time salaried fireman or emergency medicalattendant in this state before the date of any temporary or permanent disability or death resulting from the hepatitis."

 

• Amend Section 4, page 4, line 26, by deleting “or volunteer."

 

• Amend Section 5, page 5, by deleting lines 14 through 16 and inserting: "attendant in this state; or,"

 

• Amend Section 5, page 5, by deleting lines 18 through 21 and inserting: “a full-time salaried fireman or emergency medical attendant in this state,"

 

• Amend Section 5, page 5, by deleting lines 30 through 33 and inserting:“or emergency medical attendant in this state,”

 

Ms. Giunchigliani asked if on page 4, line 26, it would be better to keep "or volunteer fireman" in that case because that was where the test was taken to create the threshold, giving a baseline, which had been the intent of the bill.  Mr. Dini responded his understanding was another bill would cover that issue.  She said she would second the motion if Mr. Stevens would double check to see if that was the proper place to eliminate "volunteer" because the goal of the bill was to get a threshold baseline and she did not want that part to be lost, and she was not sure if they had to be removed from all the sections or just left in on Section 3, line 26.  Mr. Dini said the problem of leaving it in the bill was there were 2,500 volunteer firemen in the state and the local government would get stuck.  Ms. Giunchigliani said they were not going to leave it in, but just wanted to double check to make sure it was not necessary. 

 

ASSEMBLYWOMAN GIUNCHIGLIANI SECONDED THE MOTION.

 

THE MOTION CARRIED UNANIMOUSLY.

 

(Assemblyman Hettrick and Assemblywoman Leslie were not present for the vote.)

 

********

 

Assembly Bill 448:  Provides for licensing and operation of railroad gaming and             makes appropriation to White Pine County for repair of trains and             renovation of track. (BDR 41-1066).

 

Mr. Stevens said A.B. 448 was the Railroad Gaming bill and would provide a $2 million appropriation for the repair of track and repair of two steam locomotives. 

 

ASSEMBLYWOMAN GIUNCHIGLIANI MADE A MOTION TO AMEND AND DO PASS, REMOVE THE APPROPRIATION, ADD THE WORDS "PURCHASE AND RENOVATION" IN SUBSECTION 3, AND ALLOW THE GAMING ON BOARD TO ENABLE THE GENERATION OF REVENUE TO PAY FOR THE REPAIRS. 

 

Mrs. de Braga said if there was no money approved for the bill, the railroad would like the gaming approved, but the gaming could not happen unless the railroad cars were upgraded, because they could not continue to run the train.  Mrs. de Braga said it was a federal requirement that the engines were fixed.  She said it would not generate any revenue without the repair of the trains. 

 

Chairman Arberry held discussion on A.B. 448.

 

 

Assembly Bill 460:  Revises provisions governing remittance of fees collected by             short-term lessors of passenger cars to department of taxation. (BDR 43-            589)

 

Mr. Stevens said A.B. 460 involved the short-term car lease and having the car rentals pay on a quarterly basis.

 

ASSEMBLYWOMAN GIUNCHIGLIANI MADE A MOTION TO AMEND AND DO PASS, AND TO PHASE OUT THE REBATE TO THE CAR RENTAL AGENCIES BY THE END OF THE BIENNIUM, AND THE FUNDS REVERT TO THE GENERAL FUND.

 

ASSEMBLYWOMAN TIFFANY SECONDED THE MOTION.

 

Mrs. Chowning said that could not be done without a second provision for a different plan for the Nevada-based companies, if not, it was being said to the Nevada-based rental companies that the legislature did not care about them, and they would be impacted differently.  She said it was not as easy as the motion made it sound, and thought the issue should be worked on.  She said by doing away with the rebate, the national companies would shout "hurray, hurray" because they would be making more money and the Nevada-based companies would be unfairly impacted.  She reiterated the nationally-based companies would be "gleefully shouting" but the Nevada-based companies would suffer.  She said the committee needed to come up with a different plan that did not say "We don't care about you, Nevada–based companies."  Ms. Giunchigliani said her motion included a two-year phase-out, which gave plenty of time to figure out a plan, but at the current point the committee had an obligation to move forward.  She added the plan was something that should have been dealt with seven years ago, and the companies had benefited since that time, and it was money that belonged to Nevada taxpayers and should be put in the General Fund.  Mrs. Chowning asked who would come up with the plan, as it didn't make much sense to just say "go away" and added the committee didn't usually do things that way. 

 

Chairman Arberry said there was a motion and a second and asked for a vote. 

 

AFTER A VOICE VOTE, THE MOTION LOST. 

 

Chairman Arberry indicated the bill would be held for future discussion. 

 

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Assembly Bill 605:  Makes various changes relating to state purchasing fund.             (BDR 27-1315)

 

Mr. Stevens said A.B. 605 was a bill from the State Purchasing Division that would allow the division to go forward on contracting with a private entity to do a Web-based system for state agencies to get routine supplies.  State Purchasing would not be involved other than setting the system up and contracting with the private company.  The state agencies would deal directly with the private company.  The proposed funding source was to take a maximum of $150,000 per year out of the State Purchasing Fund and then reduce the Purchasing Fund by whatever the cost was to develop the Web-based system.  Mr. Stevens said the division had indicated they would have to come back to the Interim Finance Company (IFC) once the plan was developed to move the funds into the appropriate expenditure category.  Mr. Stevens advised the committee that it was the recommendation of staff that the division come before the IFC because currently there was no plan other than a shell of an outline of what would be done.  He said the committee might want to send a Letter of Intent informing the division to come before the IFC once the plan had been established. 

 

            ASSEMBLYMAN BEERS MADE A MOTION TO DO PASS.

 

ASSEMBLYWOMAN GIUNCHIGLIANI SECONDED THE MOTION.

 

Ms. Tiffany asked if the system to be used would be the module from the Integrated Financial System.  Mr. Stevens said he did not believe the system would be linked to the IFS, unless possibly for payments, but as he understood it the system would be developed by a private entity.  Ms. Tiffany asked if this was the Nevada Mall project and Mr. Stevens said yes.  Ms. Tiffany said then it was a module out of the IFS. 

 

            THE MOTION CARRIED UNANIMOUSLY.

 

(Assemblyman Hettrick and Assemblywoman Leslie were not present for the vote.)

 

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Assembly Bill 618:  Makes various changes relating to regulation of insurance.             (BDR 57-564)

 

Mr. Stevens said A.B. 618 was a comprehensive bill, which would prevent federal intervention on regulation on the insurance industry.

 

ASSEMBLYMAN DINI MADE A MOTION TO DO PASS.

 

ASSEMBLYWOMAN GIUNCHIGLIANI SECONDED THE MOTION.

 

THE MOTION CARRIED UNANIMOUSLY.

 

(Assemblyman Hettrick and Assemblywoman Leslie were not present for the vote.)

 

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Being no further business, Chairman Arberry adjourned the meeting at 10:57 a.m. 

 

              

RESPECTFULLY SUBMITTED:

 

Kathryn Fosnaugh

Committee Secretary

 

 

APPROVED BY:

 

                       

Assemblyman Morse Arberry Jr., Chairman

 

 

DATE: