MINUTES OF THE
JOINT SUBCOMMITTEE ON HUMAN RESOURCES / K-12
OF THE
SENATE committee on Finance
AND THE ASSEMBLY COMMITTEE ON WAYS AND MEANS
Seventy-First Session
May 10, 2001
The Joint Subcommittee on Human Resources/K-12 of the Senate Committee on Finance and the Assembly Committee on Ways and Meanswas called to order by Chairman William J. Raggio at 3:01 p.m., on Thursday, May 10, 2001, in Room 3137 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.
SENATE COMMITTEE MEMBERS PRESENT:
Senator Raymond D. Rawson, Chairman
Senator William J. Raggio
Senator Bob Coffin
Senator Bernice Mathews
ASSEMBLY COMMITTEE MEMBERS PRESENT:
Ms. Christina R. Giunchigliani, Chairman
Mrs. Barbara K. Cegavske
Mr. Joseph E. Dini Jr.
Ms. Sheila Leslie
Ms. Sandra J. Tiffany
ASSEMBLY COMMITTEE MEMBERS ABSENT:
Mr. David E. Goldwater (Excused)
STAFF MEMBERS PRESENT:
Bob Guernsey, Principal Deputy Fiscal Analyst
Mark W. Stevens, Assembly Fiscal Analyst
Steven J. Abba, Principal Deputy Fiscal Analyst
Larry L. Peri, Senior Program Analyst
Jennifer Ruedy, Committee Secretary
OTHERS PRESENT:
Charles Duarte, Medicaid Administrator, Division of Health Care Financing and Policy, Department of Human Resources
Stephen A. Shaw, Administrator, Division of Child and Family Services, Department of Human Resources
Jim Baumann, Administrative Services Officer III, Division of Child and Family Services, Department of Human Resources
Assemblywoman Christina R. Giunchigliani directed attention to Joint Subcommittee on K-12/Human Resources Closing List Number 9 (Exhibit C).
HR, Health Care Financing & Policy – Budget Page HCF&P-1 (Volume 2)
Budget Account 101-3158
Steven J. Abba, Principal Deputy Fiscal Analyst, stated the committee previously discussed the value-purchasing model the division is implementing, but he would address the specific closing issues.
Mr. Abba said the 9 positions that have been recommended in decision units E‑275 and E-278 are recommended in lieu of 13 positions that have been eliminated in the Medicaid budget. He noted some of the 9 requested positions are intended to replace some of the 13 positions eliminated.
E-275 Working Environment & Wage – Page HCF&P-4
Mr. Abba stated this decision unit includes 3 new Administrative Service Officer (ASO) positions as follows: ASO II, accounting manager/unit chief; ASO III, rate development/unit chief; and ASO I, facility services, budget and planning, contract management and property control. He pointed out an organizational chart illustrating where the new positions would be located included in Exhibit C. He said 7 of the 9 new positions are included in the organizational chart, but the 2 clerical positions are not included. He commented staff recommends approval for the 3 new ASO positions.
E-278 Working Environment & Wage – Page HCF&P-4
Mr. Abba indicated this decision unit provides for 6 new positions as follows: 3 Management Analyst positions for the rate development unit, 1 Management Analyst for the budget/planning section, 1 Personnel Technician, and 1 Accounting Specialist. He commented further detail of the responsibilities of each of the new positions is provided in Exhibit C. He explained the Fiscal Analysis Division requested a prioritized list of the proposed positions, but in lieu of a list, the agency provided information on what would happen if the positions were not approved.
Mr. Abba stated information regarding the rate development unit that was provided by the agency is included in Exhibit C. He said he believes the additional positions are well justified by the agency with the exception of the Management Analyst III position for the Budget/Planning unit. He noted the responsibilities of that position are in the area of maintaining program performance indicators, designing data collection tools, and monitoring state and federal legislation with potential fiscal impact on the state’s Medicaid program. He added that is the only position staff does not recommend for approval because it is not sufficiently justified.
E-900 Transfer from B/A 1010 – Page HCF&P-5
Mr. Abba said this decision unit recommends merging the Health Resources Cost Review budget account into the division’s administrative budget. He indicated staff agrees with this change. All the costs related to this program will be separately maintained, he added.
SENATOR RAWSON MOVED TO CLOSE BUDGET ACCOUNT 101-3158 AS RECOMMENDED BY STAFF.
MRS. CEGAVSKE SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR RAGGIO, MS. TIFFANY, AND MR. GOLDWATER WERE ABSENT FOR THE VOTE.)
*****
HR, HCF&P, Nevada Medicaid, Title XIX – Budget Page HCF&P-8 (Volume 2)
Budget Account 101-3243
Mr. Abba stated he had discussed the technical adjustments with the agency and they are in concurrence. He addressed the technical adjustments as listed on pages 9 and 10 of Exhibit C.
Mr. Abba pointed out the subcommittee on general government would be meeting on Friday, May 11, 2001, to address the Veterans’ Home budget as outlined on page 11 in the section for “Other Issues.”
Mr. Abba addressed the first closing issue as found on page 11 of Exhibit C, which increases the federal financial participation rate for last three quarters of Fiscal Year (FY) 2003. He stated the Medicaid budget is capped, but the General Appropriations Act includes language that allows the division to approach Interim Finance Committee (IFC) under certain conditions. He explained those conditions have been unfunded federal mandates or a reduction in the federal match participation (FMAP) rate. He said the language might need to be modified because the Legislature is considering the approval of a higher FMAP rate.
E-278 Working Environment & Wage – Page HCF&P-16
Mr. Abba stated this decision unit provides for the elimination of 8 existing positions to help offset the costs for 9 new positions previously recommended in the division’s administrative budget. He provided information directly from pages12 and 13 of Exhibit C, including clarifying the division had implemented or was proposing to implement several changes that would significantly modify a number of work processes currently performed in the Medicaid program. The first change, he stated, was implemented in the current fiscal year by contracting for personal care scheduling (PCA) services, which had reduced the division’s administrative responsibilities for hiring and scheduling PCA services. Additionally, he noted, by increasing PCA rates and increasing the availability of these services the division had been able to eliminate the payment of more expensive services provided by certified nursing aids. Mr. Abba indicated these changes produced a projected saving of $1,448,194 each fiscal year, which had been included as a reduction to medical payment expenditures in The Executive Budget.
Mr. Abba added that for that upcoming biennium, the division is proposing to contract out the prior authorization request (PAR) process for pharmacy, outpatient services, durable medical equipment, and home health agency services. He explained that PARs are required when a provider wants confirmation that Medicaid has numerous policies by provider type that place limitations on services unless prior approval is received. Additionally, he indicated the activities in the areas of Pre-Admission Screening and Annual Resident Review (PASARR), PCA functional assessments and level of care determinations that were performed by the Health Division or could be contract out for better management of utilization. Mr. Abba stated the division proposes to discontinue performing duplicative services and to contract out the PASARR, PCA function assessments and level of care determination to an outside agency. Moreover, he added, The Executive Budget recommended approximately $1.6 million in FY 2002 and $1.5 million in FY 2003 to contract for these services. By contracting out these services, he mentioned, the division feels confident the 13 positions identified in decision units E-278 and E‑279 can be eliminated.
E-279 Working Environment & Wage – Page HCF&P-16
Mr. Abba referred to the closing packet for additional information regarding the 5 existing nurse positions that would be eliminated in exchange for 5 new positions. He clarified those positions include 1 Management Analyst II position; 1 Medicaid Services Specialist position, 1 Social Welfare Program Specialist position, 1 Program Assistant and 1 Management Assistant. He said this recommendation appears reasonable
E-300 Maximize Internet & Technology – Page HCF&P-16
Mr. Abba noted this decision unit provides for 4 new technology positions to support the implementation and operation of the Medicaid management information system (MMIS) and point of sale (POS) system. He commented the positions are described on page 12 of the closing document (Exhibit C). He noted 3 of the 4 positions appear reasonable, but the Management Analyst position should be delayed at least until the beginning of FY 2003 or possibly even eliminated.
E-350 Service at Level Closest to People – Page HCF&P-17
Mr. Abba discussed the request to provide discretionary rate increases for Medicaid providers. He addressed this matter on pages 12 through 14 in the closing document (Exhibit C). He noted there are 3 different scenarios to implement the rate increase. He said the first scenario would implement the increase effective on July 1, 2001, and July 1, 2002. The second scenario would have effective dates of October 1, 2001, and October 1, 2002, he added. The third scenario would have the rate increase effective on January 1, 2002, and January 1, 2003
E-351 Service at Level Closest to People – Page HCF&P-17
Mr. Abba said the POS system has been delayed until May 2002, and it is the first phase of an integrated MMIS system. He added the delay would result in additional costs of approximately $2.7 million, which the division indicates they can handle with the authority to move funds from one fiscal year to another. He pointed out the division presently has that authority under the General Appropriations Act. He indicated staff concurs with the division’s analysis and would not recommend any additional funding or modifications to this decision unit.
E-429 Nevadans with Health Insurance – Page HCF&P-18
Mr. Abba articulated this decision unit provides for an additional 160 new slots for the Community Home-Based Initiatives Program (CHIP) over the biennium. He presented five scenarios of phase-in dates for the slots and the corresponding savings to the state located on page 15 of Exhibit C. He stated that the subcommittee requested information on the potential savings that would be realized if the new slots recommended were reduced in number or if the phase-in dates were delayed. Mr. Abba pointed to the table on page 15 (Exhibit C), which displays the savings in state funds over the 2001-2003 biennium ranging from $434,545 to $824,299 depending on the number of slots and the phase-in dates.
E-430 Nevadans with Health Insurance – Page HCF&P-18
Mr. Abba stated this decision unit provides an additional 100 Adult Group Care Waiver slots over the biennium. He presented three scenarios of phase-in dates for the slots and the corresponding savings to the state on page 15 (Exhibit C). He stated that, in addition to the new slots recommended, The Executive Budget proposed the eligibility criteria for the Adult Group Care waiver be increased to 300 percent of the SSI income level to establish consistency between all Medicaid waivers. The recommendation, he stated, should enable more individuals the opportunity to choose a less restrictive living environment compared to nursing home care.
E-434 Nevadans with Health Insurance – Page HCF&P-20
Mr. Abba said this decision unit provides an additional 180 new slots, 90 slots each fiscal year, for the Physically Disabled Waiver program. He presented five scenarios involving the reduction of the proposed slot number and different phase-in dates with the corresponding savings to the state illustrated in a table on page 16 (Exhibit C).
E-435 Nevadans with Health Insurance – Page HCF&P-20
Mr. Abba said this decision unit includes requested funding to provide treatment services authorized by the Breast and Cervical Cancer Prevention and Treatment Act of 2000 for eligible women. He provided further detail on page 15 of Exhibit C. He commented that if this recommendation is approved, staff requests permission to apply the higher FMAP rate that was approved for the Check-Up program to this budget account in the second year of the biennium.
M-200 Demographics/Caseload Changes – Page HCF&P-11
M-535 Qualified Medicare Beneficiary – Page HCF&P-14
Ms. Giunchigliani stated both of these decision units appeared satisfactory.
If the federal match rate is increased, Ms. Giunchigliani stated, the Letter of Intent requested of the money committees by the director of the Department of Human Resources appeared reasonable. She acknowledged the Letter of Intent should include the dollar amount of the adjustments and demonstrate the intent to fully fund the Medicaid and Check-Up programs. She agreed to the director’s request to include direction for remedying any shortfall that may occur in the Medicaid and Check-Up budgets if the federal match rate does not materialize.
Mr. Abba indicated the Department of Human Resources could provide a supplemental request or approach IFC. Ms. Giunchigliani agreed.
Ms. Giunchigliani reiterated decision units E-278 and E-279 were reasonable.
Mr. Abba commented he had received information from the division earlier in the day that could reduce some software costs included in the E-300 decision unit from approximately $160,000 each fiscal year to $17,000 each fiscal year. Therefore, he recommended committee staff make that adjustment to the budget.
Ms. Giunchigliani directed attention to decision unit E-350.
E-350 Service at Level Closest to People – Page HCF&P-17
Senator Rawson inquired whether the Governor made any recommendations regarding this issue.
Mr. Abba said the Governor recommends the rate increase become effective July 1, 2001 and July 1, 2002. He pointed out the version the Governor recommends is the division preference under the first scenario on page 14 of the closing report (Exhibit C). He said that version provides for a total cost of $90,437,714, which would represent an increase of approximately $13.6 million.
Senator Rawson inquired whether staff had any recommendations regarding this matter.
Mr. Abba responded he “might” recommend the division preference version under the second scenario, which has effective dates of October 1, 2001, and October 1, 2002. He pointed out the total cost of this scenario is $76,912,706, which is very close to the cost included in The Executive Budget.
Ms. Giunchigliani commented she did not want to delay the effective date beyond October as it is in the third scenario, but the division preference version under the second scenario appeared reasonable.
Senator Coffin requested further clarification of versions under the second scenario.
Mr. Abba explained the Governor’s recommended budget includes rate increases for all providers in both fiscal years of the biennium. He said those increases range from 3.5 percent to 10.4 percent in FY 2002. He commented that the contractor has determined there are certain providers that should receive higher rate increases for equitable purposes. As an example, he cited, the long-term care industry, which reflects a 21.65 percent rate increase. He said under the division preference, the only provider group that would not receive a rate increase in the first year of the biennium would be those in the “all others” category. However, he articulated in the second year of the biennium, under the division preference scenario, “all others” would be receiving a 5.39 percent increase compared to the 3.5 percent increase the Governor had recommended. He noted that all other providers would be receiving rate increases in both fiscal years of the biennium.
Senator Coffin stated there is an $8 million difference between the Governor recommended version under the first scenario and the division preference version under the second scenario. Mr. Abba said that is true.
Senator Coffin questioned which provider would be hurt the worst by the different proposals. Mr. Abba clarified all providers will receive a rate increase over the biennium, but the “all others” category would only receive a rate increase in the second year of the biennium.
Senator Coffin questioned whether long-term care would be “the biggest loser in the $8 million difference.”
Mr. Abba responded long-term care would receive a significantly higher rate increase under the division preference version in the second scenario despite that version costing $8 million less. He said he is not certain of the specific figures for each category. He said historically rate increases for Medicaid providers are given in October.
Senator Coffin asked, “That is the most striking difference of all categories. Why is it that the division saw that difference?”
Ms. Giunchigliani responded the contractor discovered the discrepancy during the equalizing process. She asked Charles Duarte, Medicaid Administrator, Division of Health Care Financing and Policy, Department of Human Resources, whether her explanation was correct.
Mr. Duarte responded that her explanation was correct. He stated the significant difference between the original proposal and The Executive Budget of $76 million and the $90.4 million, which is subsequently recommended in the Governor’s revised recommended budget, is caused by two factors. He said the first factor is the division miscalculated the impact of certain percentage increases on the original submission to The Executive Budget. The correct figure for the original submission should have been $104 million, he added. He said the contractor performing the rate analysis for the division indicated $90 million would be necessary to give all the providers rate increases effective July 1 of each fiscal year and to meet the needs of the industry, specifically long-term care, hospitals, ambulatory surgical centers, and durable medical equipment. He said the majority of that will be applied to long-term care, which is necessary because of significant increases in their costs and a long-standing rate freeze. He added, “The rates that we were provided by the contractor are the most conservative estimates that we could get of the methodologies provided.”
Senator Coffin questioned whether any beds would be lost in this process.
Mr. Duarte suggested it would be more appropriate for the industry to respond to that question. He said he would prefer a July effective date, if not in both years, possibly in the second year, which would create yet another version. He noted this version would utilize $52,599,342 from the Governor’s recommended version under the first scenario, and $26,019,918 from the division’s preference version under the second scenario.
Mr. Duarte commented staff provided him with the cost of implementing the rate increases on October 1, 2001, and July 1, 2002, as he suggested earlier. He said the total cost would be $88.8 million.
Ms. Giunchigliani indicated the committee would prefer to implement the rate increase effective October 1, 2001, and October 1, 2002, unless additional funding is discovered.
E-429 Nevadans with Health Insurance – Page HCF&P-18
Ms. Giunchigliani requested further discussion of the different scenarios under consideration for this decision unit.
Ms. Leslie stated she would like to approve the most slots that the division is capable of handling, and she questioned how many slots the division could handle.
Mr. Abba explained Medicaid has entered a department agreement for Division of Aging Services to handle the case-management activities of CHIP. He said additional staff has been approved in the Division of Aging Services budget for the 160 requested slots. He said if a reduced number of slots were approved, a corresponding reduction in approved staff for the Division of Aging Services would be necessary. He commented the division has indicated they are capable of handling all 160 slots. He added the Division of Aging Services also handles the Adult Group Care Waiver slots, and they have requested appropriate staff to handle all of the requested slots.
Ms. Giunchigliani explained Ms. Leslie is concerned because in the past, slots that were approved were not utilized. Ms. Leslie stated she is content with Mr. Abba’s response.
E-434 Nevadans with Health Insurance – Page HCF&P-20
Mr. Duarte stated all of the Physically Disabled Waiver slots have been filled for the calendar year 2001. He added approximately 140 people are eligible for slots, but are currently waiting. He said he believes another 40 people will come forward to justify the requested 180 slots.
Ms. Giunchigliani stated the 180 slots appear justified, but questioned whether a delay in implementation would be possible.
Mr. Duarte replied people are currently waiting for services and the slots could be filled as they become available.
Mr. Abba explained The Executive Budget provides for the addition of 30 slots on October 1, 2001, and an additional 30 slots would be added every quarter thereafter. He said any quarter delay would result in losing 30 slots. He noted the division appears ready to begin filling those slots, so the current scenario appears appropriate.
Ms. Giunchigliani agreed the current scenario appears reasonable, especially if the division intends to fully utilize the slots.
E-435 Nevadans with Health Insurance – Page HCF&P-20
Ms. Giunchigliani noted this is a new optional program approved by Congress regarding the Breast and Cervical Cancer Prevention and Treatment Act.
Mr. Duarte commented the implementation of this program would require a state plan amendment, which he stated is not a lengthy process.
Ms. Giunchigliani questioned why some amendments are more difficult than others. Mr. Duarte stated, depending on the issue, the process can take anywhere from 3 to 6 months, but he said he believes this type of state plan amendment would not be very difficult.
Ms. Giunchigliani suggested a delayed start date might enable better estimates of the funds available and allow for the completion of the amendment.
Ms. Giunchigliani requested a motion to close the budget with staff recommendations including approval of: the financial participation rate for the federal dollars, the PCA services, the exchange of 5 positions in E-279, 3 of the 4 positions requested in E-300 with the exclusion of the position for the POS system, the division preference version under scenario number 2 with October start dates for the rate increase to Medicaid providers, E-429, E-430, and E-434 as proposed, and E-435 as proposed with a July 2001 start date.
Mr. Abba stated the committee is considering increasing the FMAP rate for Medicaid to 51.54 percent from 50 percent effective October 1, 2002. He commented staff would request the subcommittee allow staff to review the Medicaid funds that have been included in the Mental Health Governmental Services budget to apply the same FMAP rate, which should generate further state savings.
Mark W. Stevens, Assembly Fiscal Analyst, pointed out the rate-change delay would also affect the Division of Mental Health and Developmental Services budgets as well, so staff would request authority to make the necessary adjustments to those accounts.
Ms. Giunchigliani responded that as long as the committee knows, the necessary changes can be reviewed when the budget is closed in full committee. She pointed out this is similar to what the committee will have to do for the Veterans’ Home, depending on how the committee closes that budget, to determine the impact on the Medicaid budget. She asked Senator Rawson whether that was an acceptable motion for him to make.
SENATOR RAWSON MOVED TO CLOSE BUDGET ACCOUNT 101-3243 WITH THE TECHNICAL ADJUSTMENTS AS RECOMMENDED BY STAFF SUBJECT TO REVIEW BY STAFF OF MEDICAID FUNDS INCLUDED IN THE MENTAL HEALTH GOVERNMENTAL SERVICES BUDGET ACCOUNT AND THE DIVISION OF MENTAL HEALTH AND DEVELOPMENTAL SERVICES BUDGET ACCOUNT.
MRS. CEGAVSKE SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR RAGGIO AND MR. GOLDWATER WERE ABSENT FOR THE VOTE.)
*****
Ms. Tiffany questioned whether there are any other barriers for Medicaid-eligible individuals, such as a state requirement, to qualify for targeted case management. She asked whether targeted case management would handle it if she can get her “homeless bill” passed and subsequently individuals are located who might become eligible for Medicaid.
Mr. Duarte responded:
If an individual is determined to be Medicaid eligible, and is subsequently determined to be seriously mentally ill, mentally retarded, seriously emotionally disturbed, or a member of several other possible high-risk groups (juvenile services, CPS [Child Protective Services], etc.), we do have a requirement that they be under targeted case management. If the individual is not Medicaid eligible, then Medicaid services do not apply, and even if they are pending Medicaid eligibility, then there is no requirement that Medicaid pay for any services. They have to be Medicaid eligible.
Ms. Tiffany asked, “Then that goes back to the question that if they are Medicaid eligible, and if they qualify for targeted case management, is the targeted case management still an exclusive for the state agency and for Mojave?”
Mr. Duarte responded part of the division’s organizational change plan is to apply some management time and resources toward evaluation of targeted case management. He said he is uncertain to what degree targeted case management is being overseen, and there have been significant increases in costs. He commented the division needs to understand better what is currently going on before evaluating other models of care and financing that might offer better control of the process. He noted the division could then develop a specific contract that would allow other providers, beside existing regional mental health centers and Mojave Mental Health, to provide targeted case management services. He said he believes the division needs some time to evaluate this matter.
Mr. Duarte thanked the committee for their recommendations on some of the division’s staffing, which will assist the division in the oversight of these services. He commented that he believes over a period of a year, the division could engage in the discussion with this committee, the division’s sister agencies, and the provider community as to how to best deliver services, including case management services, to the populations he mentioned.
Ms. Tiffany asked:
Do we need to close in any way asking that you start this review, because right now with having just the state agency being able to provide it and the exclusive to Mojave, there isn’t that pre‑authorization utilization review? There’s not the oversight that there needs to be, but you could start looking at that so you could come back to us with the numbers that you feel you need to decide if we can go out to another provider. Do we need to have a Letter of Intent from this committee to ask you to do that, and to give you a timeframe in which to do that?
Mr. Duarte responded he did not believe a Letter of Intent was necessary because it is the division’s intent to do that anyway. He said he believes these services are being overseen to some extent, but he is not certain of the extent. He commented the division intends to apply management and staff resources to address the matter.
Ms. Tiffany indicated she would like to include a Letter of Intent to Medicaid to request evaluation of opening up the state plan for targeted case management and Medicaid. She added those should be completed within a specific time frame, preferably within 90 days.
Ms. Leslie stated she would like to make sure targeted case management and the direct services that the state is paying for would be specifically designated in the Letter of Intent. She added she supports Ms. Tiffany’s suggestion to include a 90‑day timeframe, at least for a preliminary report. She said she believes it is time to break up the monopoly Mojave Mental Health Services has.
Ms. Giunchigliani indicated she would accept a motion to include the Letter of Intent in closing the budget.
SENATOR RAWSON MOVED TO INCLUDE A LETTER OF INTENT TO REQUEST EVALUATION OF OPENING UP THE STATE PLAN FOR TARGETED CASE MANAGEMENT AND MEDICAID WITHIN THE STATE PLAN, WHICH SHOULD BE COMPLETED WITHIN 90 DAYS.
MRS. CEGAVSKE SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR RAGGIO AND MR. GOLDWATER WERE ABSENT FOR THE VOTE.)
*****
HR, Child and Family Administration – Budget Page DCFS-1 (Volume 2)
Budget Account 101-3145
Ms. Giunchigliani directed attention to pages 17 and 18 of the closing document (Exhibit C).
E-275 Working Environment & Wage – Page DCFS-9
Larry L. Peri, Senior Program Analyst, stated this decision unit recommends $187,012 in FY 2002 and $195,576 in FY 2003 for increased costs for the lease of non-state owned office space in Las Vegas. He explained the division’s administrator indicated at the initial budget hearing on January 31, 2001 this decision unit might need to be modified because of the proposals by the interim subcommittee on the Study of the Integration of State and Local Child Welfare Systems. He commented the subcommittee is considering tentative approval of that integration, and recent discussions with the division’s representatives indicate funding of this decision unit may not be prudent primarily because Clark County, who the division will partner with in the integration, has no desire to occupy the building. He noted the subcommittee might want to eliminate the decision unit and cease to put any further resources into the building if it will not be used by both entities.
Ms. Giunchigliani requested a motion to close the budget as staff recommended and with the elimination of decision unit E-275.
MR. DINI MOVED TO CLOSE BUDGET ACCOUNT 101-3145 AS RECOMMENDED BY STAFF AND WITH THE ELIMINATION OF DECISION UNIT E-275.
MS. TIFFANY SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR RAGGIO AND MR. GOLDWATER WERE ABSENT FOR THE VOTE.)
*****
HR, UNITY/SACWIS – Budget Page DCFS-13 (Volume 2)
Budget Account 101-3143
Mr. Peri noted the Statewide Adoptions and Child Welfare System (SACWIS) is now being referred to as Unified Nevada Information Technology for Youth (UNITY). He said 12 full-time Information Systems Specialist positions would be transferred into this budget from the Department of Information Technology (DoIT) to support the UNITY system. He noted the transfer is part of the pilot decentralization of DoIT programmers. He stated computer prices were adjusted to reflect revised computer hardware prices.
SENATOR RAWSON MOVED TO CLOSE BUDGET ACCOUNT 101-3143 AS STAFF RECOMMENDED.
MR. DINI SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR RAGGIO AND MR. GOLDWATER WERE ABSENT FOR THE VOTE.)
*****
HR, Youth Community Services – Budget Page DCFS-24 (Volume 2)
Budget Account 101-3229
Mr. Peri addressed the technical adjustments, subcommittee issues, and budget recommendations on page 23 and 24 of Exhibit C.
Ms. Giunchigliani advised a motion to close this budget might include a reduction in the Foster Care Payment expenditure category.
E-225 Reward More Efficient Operation – Page DCFS-28
Ms. Giunchigliani commented the subcommittee has asked the division repeatedly whether the division could use increased Temporary Assistance for Needy Families (TANF) funding. She suggested the subcommittee might provide $250,000 of TANF revenue in each fiscal year. She continued, “Maybe, in order to track that . . . we could give them a Management Systems Analyst.”
Mr. Peri said an additional position might help the division address disaggregate reporting requirements. He suggested the relative caregiver area might be a potential area to use TANF funds.
Stephen A. Shaw, Administrator, Division of Child and Family Services, Department of Human Resources, stated, “I didn’t want the first $250,000 because I cannot spend it. I think I have $3 million in there right now I can’t spend. You can put $1 million in there and I can’t spend it.”
Ms. Giunchigliani said she believes there are areas in which TANF funds could be used.
Ms. Leslie commented she understands Mr. Shaw’s concerns. She said Mr. Peri appeared to indicate the Kinship Care Program might qualify for the use of TANF funds.
Mr. Peri suggested the area of relative placements has not been considered before.
Mr. Shaw said, “I can be quiet and do what you say, or I can tell you what I think. I’m willing to do either.”
Ms. Leslie asked Mr. Shaw whether he could spend the additional $250,000 of TANF funds in the relative foster care placement program.
Mr. Shaw responded that he already has $250,000 of TANF funds that he is attempting to spend on relative foster care, so he does not believe he can spend an additional $250,000. He said this budget historically gets in trouble because “every piece of junk that’s on the floor gets put in this budget,” and he inevitably must return to IFC for a “supplemental.”
Ms. Leslie asked whether a new Management Systems Analyst would help the division spend the money.
Senator Mathews suggested, “We could lower the age from 62.”
Ms. Giunchigliani explained the age could not be lowered to help the relatives providing foster care to qualify.
Jim Baumann, Administrative Services Officer III, Division of Child and Family Services, Department of Human Resources, said he does not believe an additional Management Analyst would benefit the division. He commented a computer tracking system would be more beneficial.
Mr. Shaw pointed out there are 118 data elements that the division is not capable of tracking. He said the action the subcommittee is considering is “a mistake.”
Mr. Peri said the disaggregate data reporting requirements are very complicated. He commented the 12 programmers that will transfer back from DoIT to UNITY would be a substantial resource.
Senator Rawson asked whether authorizing the division to approach IFC would mitigate the problem to any degree.
Mr. Shaw responded affirmatively. He added TANF funds were inappropriately added to numerous budgets last session including the Nevada Youth Training Center budget. As a result, he said, he had to appeal to IFC for supplemental funding for nearly all of those budgets.
Ms. Giunchigliani said, “Steve, you still get that other $250,000 that you get to find a way to use.”
Senator Rawson added the division would have the authority to approach IFC regarding the original $250,000.
Ms. Giunchigliani urged Mr. Shaw to find a way to spend the original $250,000 before next session.
SENATOR RAWSON MOVED TO CLOSE BUDGET ACCOUNT 101-3229 AS STAFF RECOMMENDED.
MS. LESLIE SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR RAGGIO AND MR. GOLDWATER WERE ABSENT FOR THE VOTE.)
*****
Mr. Stevens pointed out in the last budget the child welfare integration funds were placed in a separate budget account, and the analysts are still working on recommendations regarding that account.
Ms. Giunchigliani stated her attendance was needed at another meeting, so she handed the gavel to Senator Rawson.
HR, Southern Nevada Child & Adolescent Services – Budget Page DCFS-83 (Volume 2)
Budget Account 101-3646
Mr. Peri addressed technical adjustments, subcommittee issues, and budget recommendations as detailed on pages 26 through 28 of Exhibit C.
Senator Rawson questioned whether the On Campus Family Learning Homes (Oasis program) could access state contingency emergency funds in the event the mold found in five of the homes is a larger problem than currently anticipated.
Mr. Peri responded affirmatively. The Governor recently approved the use of Emergency Assistance Account of the Disaster Relief Fund (emergency management funds) to proceed with the remediation process on mold in other buildings found in the past, he added.
Senator Rawson commented, upon visiting the homes, he observed they were unclean and humid. He said it was unclear whether the humidity was due to a lack of proper circulation or fluids remaining in the homes. He commented that staff recommends a Letter of Intent in the budget closing that would request the division report to the IFC quarterly on the status of the program, mold remediation, and any changes in the staffing and treatment model. He noted a request for an evaluation of their cleaning procedures and possible ways to avoid similar problems in the future should be included in the Letter of Intent. He said the source of the problem needs to be identified and addressed.
Senator Rawson asked whether the subcommittee had any further concerns with the technical adjustments to budget account 101-3646.
Ms. Leslie commented Mojave Mental Health Services would be included in the budget to enable better tracking. She questioned whether targeted case management and direct services would accompany Mojave Mental Health Services’ inclusion into The Executive Budget.
Senator Rawson said he believes the subcommittee has clearly expressed its desire for those items to be included.
Mrs. Cegavske questioned why Southern Nevada Child and Adolescent Services could not use two-way radios in lieu of the cellular phones to save money. Senator Rawson commented the purchase of two-way radios is very expensive, but he is not sure of the reasons for the cellular phone requests.
Senator Mathews stated the range of the two different options is different also. Mr. Peri stated the cellular phones are recommended to keep in the vans in case of emergencies. Senators Mathews and Rawson both stated the cellular phones were appropriate for that use.
Ms. Leslie pointed out that only four homes are open out of eight Oasis Homes, so the division needs to act quickly to ensure children continue to receive necessary services. Senator Rawson commented Ms. Leslie’s concerns should be alleviated by the quarterly report requested in the Letter of Intent.
Mr. Peri asked whether the subcommittee wished to approve the budget on the Oasis Homes in its current form including a Letter of Intent that the agency should communicate quarterly to the IFC. He said this approach would allow the administrator the flexibility to act in whatever way is necessary once the problems are defined better.
Senator Rawson stated the subcommittee would also like a report on the housekeeping procedures in the Oasis Homes to be included in the Letter of Intent.
MR. DINI MOVED TO CLOSE BUDGET ACCOUNT 101-3646 AS STAFF RECOMMENDED WITH THE INCLUSION OF A LETTER OF INTENT THE AGENCY REPORT TO THE INTERIM FINANCE COMMITTEE QUARTERLY ON THE STATUS OF THE OASIS HOMES.
MS. LESLIE SECONDED THE MOTION.
THE MOTION CARRIED. (MS. GIUNCHIGLIANI AND MR. GOLDWATER WERE ABSENT FOR THE VOTE.)
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Senator Coffin suggested there could be numerous reasons for the mold in the buildings. Mr. Dini agreed.
Senator Rawson thanked all of the staff for their efforts.
The meeting was adjourned at 4:24 p.m.
RESPECTFULLY SUBMITTED:
Jennifer Ruedy
Committee Secretary
APPROVED BY:
Senator Raymond D. Rawson, Chairman
DATE:
APPROVED BY:
Assemblywoman Christina R. Giunchigliani
Chairman
DATE: