MINUTES OF THE
SENATE Committee on Finance
Seventy-First Session
February 26, 2001
The Senate Committee on Financewas called to order by Chairman William J. Raggio at 8:05 a.m., on Monday, February 26, 2001, in Room 2134 of the Legislative Building, Carson City, Nevada. The meeting was videoconferenced to the Grant Sawyer Office Building, Room 4401, Las Vegas, 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.
COMMITTEE MEMBERS PRESENT:
Senator William J. Raggio, Chairman
Senator Raymond D. Rawson, Vice Chairman
Senator Lawrence E. Jacobsen
Senator William R. O’Donnell
Senator Joseph M. Neal Jr.
Senator Bob Coffin
Senator Bernice Mathews
GUEST LEGISLATORS PRESENT:
Senator Mike McGinness
Senator Maurice E. Washington
Assemblywoman Barbara K. Cegavske
Senator Raymond C. Shaffer
STAFF MEMBERS PRESENT:
Gary L. Ghiggeri, Senate Fiscal Analyst
Bob Guernsey, Principal Deputy Fiscal Analyst
Steven J. Abba, Principal Deputy Fiscal Analyst
Brian L. Davie, Legislative Services Officer, Administration Division, Las Vegas
Marla McDade Williams, Senior Research Analyst
Jennifer Ruedy, Committee Secretary
OTHERS PRESENT:
Rita Huneycutt, Ph.D., Interim President, Truckee Meadows Community College, Reno, University and Community College System of Nevada
Robert S. Hadfield, Lobbyist, Executive Director, Nevada Association of Counties
Dr. William Hausman, State Volunteer Coordinator, Health Advocacy Services, American Association of Retired Persons
C. E. Edwin Fend, Lobbyist, American Association of Retired Persons
Martin Bibb, Lobbyist, Retired Employees of Nevada
Robert H. Miller, M.D., M.B.A., Dean, School of Medicine, University of Nevada, Reno, University and Community College System of Nevada
Renny Ashleman, Lobbyist, Clark County
Greg W. Ferraro, Lobbyist, Chairman, NPALS
Richann Johnson, ALS Association of Nevada
Joyce A. Newman, Lobbyist, NPALS, and Board member, ALS Association of Nevada
Anne Loring, Lobbyist, Washoe County School District
Dotty L. Merrill, Ph.D., Lobbyist, Washoe County School District
Christine Forsch, R.D.H., Legislative Chair, Nevada Dental Hygienists’ Association
Al Bellister, Lobbyist, Nevada State Education Association (NSEA)
Elizabeth Gant-Davis, Program Director, Dairy Council of Utah/Nevada, Reno
Pat Marble, Assistant Director, Nutrition Services Office, Washoe County School District
Keith Rheault, Deputy Superintendent for Instructional, Research, and Evaluative Services, Department of Education
Sherrie Coy, Member, State Welfare Board, Welfare Division, 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
May S. Shelton, Lobbyist, Washoe County
Martha B. Gould, Board Member, Nevada Diabetes Association for Children and Adults
Martha Rugg, Volunteer, Nevada Diabetes Association for Children and Adults
Annie Munn, Volunteer, Nevada Diabetes Association for Children and Adults
Mike Hayes, a private citizen
Rosalie Clark Montoya, Diabetes Support Coordinator, Pediatric Diabetes and Endocrine Program, School of Medicine, University of Nevada, Reno, University and Community College System of Nevada
Sherri Coffman, Facilitator, Diabetic Children and Families Support Group
K. Neena Laxalt, Lobbyist, Nevada Podiatric Medical Association
Denell A. Hahn, Lobbyist, Sunrise Hospital & Medical Center
Maureen Brower, a private citizen
Charles Duarte, Medicaid Administrator, Division of Health Care Financing and Policy, Department of Human Resources
Dr. Henry Artman, Pediatric Endocrinologist
Jacqueline Taylor, Chief Administrative Officer, University Medical Center of Southern Nevada
Liza Conroy, a private citizen
Senator Raggio requested motions to introduce six bill draft requests (BDRs). He noted Exhibit C provides detailed information on the supplemental appropriations included in the six BDRs.
BILL DRAFT REQUEST S-1252: Makes supplemental appropriation to Office of Attorney General for unanticipated shortfall caused by overestimation of revenues in budget. (Later introduced as Senate Bill 246.)
SENATOR O’DONNELL MOVED TO INTRODUCE BDR S-1252
SENATOR JACOBSEN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS RAWSON AND NEAL WERE ABSENT FOR THE VOTE.)
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BILL DRAFT REQUEST S-1257: Makes supplemental appropriation to Department of Human Resources for unanticipated shortfalls and expenses at Nevada Mental Health Institute and in Division of Child and Family Services. (Later introduced as Senate Bill 247.)
SENATOR O’DONNELL MOVED TO INTRODUCE BDR S-1257
SENATOR MATHEWS SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS RAWSON AND NEAL WERE ABSENT FOR THE VOTE.)
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BILL DRAFT REQUEST S-1255: Makes supplemental appropriation to Department of Museums, Library and Arts for unanticipated additional utility expenses. (Later introduced as Senate Bill 248.)
SENATOR JACOBSEN MOVED TO INTRODUCE BDR S-1255
SENATOR O’DONNELL SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS RAWSON AND NEAL WERE ABSENT FOR THE VOTE.)
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BILL DRAFT REQUEST S-1253: Makes supplemental appropriation to Secretary of State for unanticipated shortfall in money budgeted for salaries. (Later introduced as Senate Bill 249.)
SENATOR O’DONNELL MOVED TO INTRODUCE BDR S-1253
SENATOR COFFIN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS RAWSON AND NEAL WERE ABSENT FOR THE VOTE.)
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BILL DRAFT REQUEST S-1260: Makes supplemental appropriation to Department of Conservation and Natural Resources for certain shortfalls in budget. (Later introduced as Senate Bill 250.)
SENATOR MATHEWS MOVED TO INTRODUCE BDR S-1260
SENATOR JACOBSEN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS RAWSON AND NEAL WERE ABSENT FOR THE VOTE.)
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BILL DRAFT REQUEST S-1262: Makes supplemental appropriation to Department of Education for shortfall in money budgeted for contractual obligations for Terra Nova Tests. (Later introduced as Senate Bill 251.)
SENATOR O’DONNELL MOVED TO INTRODUCE BDR S-1262
SENATOR JACOBSEN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS RAWSON AND NEAL WERE ABSENT FOR THE VOTE.)
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Senator Raggio stated there has been confusion regarding the Fund to Stabilize Operation of State Government (“Rainy Day Fund”) as established by Nevada Revised Statutes (NRS) 353.288. He said The Executive Budget presented to the committee includes a transfer of $7.4 million to the “Rainy Day Fund.” This transfer amount, he pointed out, is based on the unappropriated General Fund balance at the conclusion of fiscal year (FY) 2000. The State Controller’s annual report includes an $18.2 million transfer to the “Rainy Day Fund.” The Attorney General’s staff analyzed the approximately $10.8 million difference in proposed transfers, he noted. The opinion of the Attorney General’s office, provided at the request of the Budget Division, indicates historical methodology is appropriate but identifies concern regarding the methodology of the Controller’s office. Senator Raggio said he believes it is necessary to clarify the terminology used in the process of calculating the transfer amount to the “Rainy Day Fund.” He said that, in light of the state’s current struggle to fund The Executive Budget, it is important to address this issue before an additional $10.8 million is transferred.
Senator Raggio asked Gary L. Ghiggeri, Senate Fiscal Analyst, Legislative Counsel Bureau, to meet with representatives of the State Controller’s office, the Attorney General’s office, and the Legal Division of the Legislative Counsel Bureau to develop appropriate language concerning calculation of the transfer amount to the “Rainy Day Fund.” Senator Raggio urged the committee to request a bill draft to clarify the language of NRS 353.288. He further suggested the new language should allow the Controller, regardless of different opinions, to make the transfer for the fiscal year ending June 30, 2000 pursuant to the amended provisions of the act.
SENATOR COFFIN MOVED TO REQUEST THE BDR.
SENATOR JACOBSEN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR NEAL WAS ABSENT FOR THE VOTE.)
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Mr. Ghiggeri discussed the sales and gross gaming tax collections for the month of December 2000 (Exhibit D). The December 1, 2000, projections by the Economic Forum estimated gaming percentage fee collections would grow by 5.9 percent in fiscal year 2001, but year-to-date collections are down 1 percent. Year-to-date sales tax collections are up 5 percent, but the Economic Forum estimated growth of 5.9 percent. This translates into a combined shortfall of $25 million to $30 million unless revenue collections improve, he added. Mr. Ghiggeri explained that December 2000 was the third consecutive month in which gaming had a negative collection. He noted that the sales tax collection had improved slightly with the Christmas sales activity.
Senator Coffin questioned whether Legislative Counsel Bureau (LCB) staff could provide relevant comparisons with national sales figures for the same period. He further inquired whether Internet and catalog sales figures could be compared to determine how Nevada compares to other states.
Mr. Ghiggeri said a national sales figure comparison could be provided shortly, but the Internet and catalog sales comparison would necessitate further research.
Senator Coffin pointed out that, according to the handout, “Eating and Drinking Places” experienced an increase of 10 percent (10.6 percent) and “Automotive Dealers & Service Stations” also increased (Exhibit D). He said he would appreciate additional comparisons provided by the LCB staff.
Mr. Ghiggeri addressed the progress of the Senate Committee on Finance as of February 26, 2001. He stated this committee, in conjunction with joint subcommittees, has reviewed 42.6 percent of the budgets or 178 of 418 total budgets, and 75 budgets will not be reviewed by the committee. LCB staff, he noted, will review the 75 budgets not reviewed by the committee and provide recommendations to the committee. There are currently 56 bills in committee, he added.
SENATE BILL 80: Requires division of child and family services of department of human resources to establish program for compensation of providers of foster care for damage to their property caused by foster children in their care. (BDR 38-930)
Senator Raggio stated that Senator Neal had requested, as the sponsor of Senate Bill (S.B.) 80, to have the bill withdrawn. Senator Neal indicated to Senator Raggio that the bill is not necessary.
SENATOR O’DONNELL MOVED TO INDEFINITELY POSTPONE S.B. 80.
SENATOR MATHEWS SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR NEAL WAS ABSENT FOR THE VOTE.)
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Rita Huneycutt, Ph.D., Interim President, Truckee Meadows Community College (TMCC), Reno, University and Community College System of Nevada, presented a proposal (Exhibit E) for TMCC to purchase a large portion of the Reno Town Mall through a 15-year master lease with an option to purchase. She explained that TMCC began leasing approximately 12,000 square feet in 1989, and they currently lease 60,938 square feet. Included in the lease would be 157,340 total square feet. The purchase price would be $51 per square foot versus a construction price of $150 per square foot; this would result in cost savings of $15.6 million, she added. She requested a bill draft to use their appropriated lease money for this 15‑year master lease.
Senator Raggio said the committee would honor her request for a bill draft. He cautioned that complications would arise if the total cost of the 15-year lease were chargeable against the state debt.
Senator Coffin questioned the physical condition of the building and the burden of potential future improvements.
Dr. Huneycutt explained this purchase has been analyzed for the past 2 to 3 years by TMCC. Numerous appraisals have been conducted during that time, she added, and the current owner assures TMCC all areas “not up to code” will be rectified prior to the date of purchase.
Senator Coffin asked whether that agreement includes removal of mold and asbestos. Dr. Huneycutt replied that is included in the agreement.
Senator Mathews stated her support of this proposal.
Dr. Huneycutt indicated she believes TMCC would pay the Treasurer the first two years before it is included in the debt obligation.
Senator Raggio reiterated that the potential complications from charging against the state debt would have to be addressed. He recommended the formal request of the BDR. (Later introduced as Senate Bill 497.)
SENATOR MATHEWS MOVED TO REQUEST THE BDR.
SENATOR JACOBSEN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR NEAL WAS ABSENT FOR THE VOTE.)
*****
Senator Raggio opened the hearing on S.B. 8, S.B. 12, S.B. 40, S.B. 107, S.B. 120, and S.B. 166. He indicated these bills are not included in The Executive Budget, and final action will be deferred until receipt of the final report of the Economic Forum.
SENATE BILL 8: Directs Legislative Commission to appoint subcommittee to continue study of long-term care in this state. (BDR S-300)
Senator Mike McGinness chaired the Legislative Subcommittee to Study Long-Term Care in Nevada during the past interim. He reported that during the five meetings held by the interim study committee, a multitude of issues related to long-term care in Nevada were reviewed. He said this study resulted in seven recommendations, including three BDRs, in addition to S.B. 8. The $26,900 General Fund Appropriation requested in this bill is to retain the services of a consultant, he added.
Senator Raggio asked whether the interim study committee had utilized a consultant. Senator McGinness responded that Mr. Robert Mollica, Deputy Director, National Academy for State Health Policy, Portland, Maine, assisted the committee in exchange for reimbursement of his airfare. He expressed that Mr. Mollica’s assistance was extremely beneficial in the complex technical areas.
Senator McGinness explained that any consultant retained would be an “independent, subject-matter expert, knowledgeable on the national trends and issues that would be considered.” Travel expenses and 250 hours of consulting costs are included in the appropriation, he explained.
Senator Raggio asked whether the study would continue with the present legislators participating. Senator McGinness replied that continuity of membership would be ideal, but it has not been addressed presently. Senator McGinness further added that many organizations offered advisory assistance during the interim study without compensation because of the deemed importance of this issue. He said he anticipates continued support from many of these organizations, such as Nevada Association of Counties, League of Cities, American Association of Retired Persons (AARP), Alzheimer’s Association, Nevada Health Care Association, and Retired Public Employees of Nevada (RPEN).
Senator McGinness introduced Steven J. Abba, Principal Deputy Fiscal Analyst, Legislative Counsel Bureau and indicated Mr. Abba provided valuable support to the interim study committee.
Robert S. Hadfield, Lobbyist, Executive Director, Nevada Association of Counties (NACO), testified in support of S.B. 8 and the provision for appointment of an advisory committee. He said the Nevada Association of Counties advised the interim study committee, and they wish to continue their advisory involvement despite the lack of compensation.
Dr. William Hausman, State Volunteer Coordinator, Health Advocacy Services, AARP, provided written remarks in support of S.B. 8 (Exhibit F). He stated one reason to continue this study is the high cost of nursing home care; he believes home care and other facilities provide cheaper alternatives, which have not been fully realized. The single most important issue for the development of an effective long-term care program is probably “single point of entry,” he opined. He said he hopes the interim study and proposed consultant would endeavor to integrate efforts with the “Department of Human Service’s Comprehensive Plan” in the area care for handicapped persons.
Senator Raggio asked for clarification of “single point of entry.” Dr. Hausman said people who seek assistance in the area of long-term care should have a single place where their needs can be evaluated and where they can be advised on care and facilities available to them and the corresponding payment and insurance options. He stated this must be an interagency effort to unite and simplify these functions.
Senator Raggio inquired whether a single point of entry had been addressed during the interim study. Dr. Hausman responded affirmatively.
C. E. Edwin Fend, Lobbyist, American Association of Retired Persons, reiterated the importance of a “single point of entry.” He said many key issues were addressed at the March 9, 2000, meeting of the Legislative Subcommittee to Study Long‑Term Care in Nevada.
Martin Bibb, Lobbyist, Retired Employees of Nevada, stated his support of S.B. 8.
In an effort to accommodate Senator Maurice E. Washington, Senator Raggio addressed S.B. 40.
SENATE BILL 40: Makes appropriations to Department of Administration for allocation to Board of Regents to provide scholarships for certain students enrolled in medical and dental schools. (BDR S-646)
Senator Washington testified in support of S.B. 40. He explained the appropriations are for two $200,000 appropriations from the State General Fund to the Board of Regents for scholarships for medical and dental school students. He said $50,000 would be allocated for each school for four fiscal years beginning 2001 and ending 2005. The Board of Regents would establish eligibility criteria for the scholarships to identify disadvantaged and underrepresented students. The Interim Finance Committee would have ultimate approval of the eligibility criteria, he added. The bill outlines the prescribed use of scholarship funds.
Senator Raggio asked for clarification of “disadvantaged and underrepresented students.” Senator Washington explained that low-income, ethnicity, academic performance, and a desire to attend dental or medical school would be included in the criteria.
Senator Raggio said it would be very unusual for the committee to approve an appropriation that extends beyond the current biennium into the year 2005.
Robert H. Miller, M.D., M.B.A., Dean, University of Nevada School of Medicine, said Senator Mathews is just one of several people to express concern over the lack of diversity in the student population at the University of Nevada School of Medicine. He said many universities currently offer full scholarships to medical students. Therefore, full scholarships would enhance Nevada’s ability to recruit on a competitive basis. The School of Medicine is currently unable to offer a scholarship for a period longer than two years, and that is not sufficient for this course of study, he added. He estimated the annual cost of attending medical school at $25,000. Dr. Miller said that this bill would enable the School of Medicine to offer full four-year scholarships to at least one class.
Senator O’Donnell disclosed that his son has been accepted to the University of Nevada School of Medicine.
Senator Rawson said he believes these scholarships would improve the lack of diversity that has been a long-standing concern to Senator Neal and many other people in Nevada. The lack of diversity extends beyond the student population to the faculty, he added. Senator Rawson commented that, of approximately 900 dentists in Nevada, the Hispanic, African American and female populations each constitutes approximately 1 percent of the total dentist population.
Senator Raggio inquired what scholarships are currently available.
Dr. Miller said the scholarships currently offered are limited to two years. The number of minority students applying to medical school has declined in recent years, so schools have become increasingly aggressive to recruit the smaller pool of minority students, he explained. Harvard, Tulane, and UCLA are some of the schools that offer full four-year scholarships to actively recruit minority students.
Senator Rawson said the distribution of appropriations in the bill is “an attempt to try not to make so much funding available in this session.”
Senator Raggio returned attention to S.B. 8.
Renny Ashleman, Lobbyist, Clark County and the Nevada Health Care Association said long-term care is a multi-million dollar issue, and this study could result in significant cost savings in the future. He said he supports S.B. 8 as written.
Senator Raggio closed the hearing on S.B. 8.
SENATE BILL 12: Makes appropriation to ALS Association Nevada Chapter. (BDR S-289)
Greg W. Ferraro, Lobbyist and Chairman, NPALS (Nevadans for the Prevention of Amyotrophic Lateral Sclerosis), said there are over 200 cases of Amyotrophic Lateral Sclerosis (ALS) in Nevada. His interest in ALS stems from the recent diagnosis of two friends: Jeanne Botts and Steven. W. Rigazio. ALS is commonly known as Lou Gehrig’s Disease, he noted. Mr. Ferraro stated that Nevada has a higher incidence of ALS than the national average because of an aging population and the climate of southern Nevada.
Mr. Ferraro read a letter (Exhibit G) from Mr. Rigazio, the President of Nevada Power, in support of S.B. 12. The letter explains the inception and purpose of NPALS, which is to raise private donations to increase awareness and to fund research for a cure to this fatal disease. Mr. Ferraro said NPALS donates 20 percent of all money received to the local ALS Chapter specifically for patient care. He said Mr. Rigazio acknowledges he is a rare case to be able to afford the necessary care, but ALS is financially devastating to most sufferers. NPALS has donated $80,000 this year to the local ALS Chapter, and Mr. Rigazio suggested S.B. 12 would “provide the perfect private/public partnership, which benefits the State of Nevada.”
Senator Raggio disclosed he is a member and director of NPALS. Jeanne Botts was an appreciated member of the fiscal analysis staff at the Legislative Counsel Bureau for many years, he added. He stated that Wayne Hurt, the former Chief of Police for the Legislative Counsel Bureau was also diagnosed with ALS last year.
Richann Johnson, ALS Association of Nevada, discussed her organization, which has been in operation for a mere 30 months. She said the organization has evolved slowly because of a lack of funding; they rely heavily on volunteers. Current programs for ALS patients and their families include the Alternative Augmentative Communication Devices Program for patients have lost the ability to speak and Aids for Daily Living to enable independent living as long as possible. She explained that patients eventually become immobile and dependent on a ventilator. Most families are financially devastated, as insurance typically covers about 20 percent of incurred expenses and generally does not cover rehabilitative services. She estimated the annual cost of care for one ALS patient is $200,000.
Senator Raggio asked where any ALS research is taking place. Ms. Johnson replied that there are national research programs that have made advances in slowing the process and maintaining the patient at a better quality of life. Senator Raggio asked about research performed at Baylor University.
Mr. Ferraro said Dr. Stanley H. Appel of the Baylor College of Medicine in Houston, Texas, is a leader in ALS research. Dr. Appel has recently established experimental stem cell research to promote a new immune system through transfusion, he added. He said Baylor is one of many research programs nationwide that is aggressively seeking a cure to ALS.
Joyce A. Newman, Lobbyist, NPALS and Board member, ALS Association of Nevada, cited the medical school at Harvard University as another prominent research center for ALS research. NPALS supports ALS research at Harvard University among other research programs, she added. She explained that the cause and cure remain elusive, but she suspects genetic research will be vital to a future cure. In Nevada, she said, the average time period to elapse from diagnosis to death is only 18 months.
Senator Raggio requested specific information regarding how the proposed funding would be used.
Ms. Johnson responded this appropriation would provide 50 percent of the funding for a full-time patient service coordinator to implement programs throughout Nevada. It would also be used to start a respite care program to provide relief for caregivers of the ALS patients. Many ALS families have requested this type of assistance, she added. The Alternative Augmentative Communication Devices Program and Aids for Daily Living Program would also benefit from the additional funding, she said.
Mr. Ferraro said although NPALS has been in existence only one year, it is ranked eighth nationwide in raising funds for ALS. They host two annual fundraisers with one each in northern and southern Nevada, he added.
Senator Coffin questioned Ms. Johnson’s comments regarding insurance coverage. He said he understood equipment is provided at the end stage of life, and acknowledged there are differences in plans regulated by the state versus by the Department of Labor.
Ms. Newman said she will provide further information on insurance coverage to Senator Coffin because she is unable to respond at this time.
Anne Loring, a private citizen, spoke in support of S.B. 12 out of concern for her friend, Jeanne Botts.
Dotty L. Merrill, Ph.D., a private citizen spoke in support of S.B. 12 out of concern for her friend, Jeanne Botts. She said the disease is cruel in that the mind remains bright and capable despite rapid physical deterioration.
Senator Raggio closed the hearing on S.B. 12 and S.B. 40.
Senator Neal explained that he requested S.B. 80 be indefinitely postponed because it had proven to be unnecessary.
SENATE BILL 107: Requires establishment of standards and programs pertaining to promotion of health, wellness, physical fitness and good nutrition at public schools. (BDR 34-835)
Senator Rawson informed the committee that he and other legislators, LCB staff, and State Board of Education members, attended a conference on risk factors in school-aged children in New Mexico during the interim. The conference was managed by the Centers for Disease Control and Prevention (CDC), and they provided state specific information, he added. Senator Rawson said that conference information indicated that driving, substance abuse, and diet are the top three risk factors. He indicated approximately one-third of all hospitalizations in Nevada are associated with excessive weight and sedentary lifestyle. He explained this is just one of several bills resulting from attendance at this conference.
Continuing, Senator Rawson said the bill requires the State Board of Education to prescribe standards for the independent vending contractors. He indicated some schools receive nearly $50,000 annually from these contracts, and vending machines often cover the entire length of a wall in the cafeteria. He suggested easy access to vending machines might inhibit children from selecting healthier alternatives for dining.
Christine Forsch, R.D.H., Legislative Chair, Nevada Dental Hygienists’ Association, provided written copy (Exhibit H) of her testimony in support of S.B. 107. She said the Surgeon General’s Report on Oral Health indicates the nation is in the midst of an epidemic of oral disease; she cited various first-hand experiences attesting to widespread dental decay in Nevada’s schools. She explained that tooth decay occurs when three things are present: teeth, Streptococcus mutans, and fermentable carbohydrates (sugar). She stated that Streptococcus mutans requires a steady supply of sugar to produce the acid that decays the tooth. Approximately half of Nevada’s population now benefits from fluoridated water as a result of legislation passed during the 1999 session, and she said fluoride makes teeth more resistant to the acid. She suggested tooth decay would abate in the absence of sugar.
Ms. Forsch advocated restricting foods and beverages laden with sugar in the schools and teaching children the importance of good nutrition. In addition to dental decay, she cited concern over obesity, diabetes and heart disease in school-aged children.
Senator Coffin inquired why legislation is necessary to require the State Board of Education to address this issue, which is clearly within their realm of responsibility. Ms. Forsch said other states have successfully reduced school-aged children’s exposure to sugar through similar legislation.
Senator Coffin indicated the fiscal note of $1.7 million might impede approval of this bill. He suggested, in lieu of funding this bill, an alternative approach would be to pursue this issue with the superintendents of schools and the State Board of Education. Ms. Forsch agreed that a policy statement without the funding would still assist in working toward their goals.
Senator Coffin suggested children probably consume a significant amount of sugar outside of school, so this legislation may not be the most appropriate solution.
Senator Raggio stated the fiscal note provides $850,000 each year over the next biennium, which is to be distributed to the professional development centers within the school districts of Clark County, Douglas County, Elko and Washoe. There is an additional cost of $34,534 within the current budget associated with this issue, he added.
Assemblywoman Barbara K. Cegavske presented testimony, at the request of Assemblyman Wendell P. Williams, in support of S.B. 107. She said she attended the conference on risk factors in school-aged children held in New Mexico during the interim that Senator Rawson discussed earlier. The conference addressed many issues relevant to teenagers, such as unintentional injuries, drugs, alcohol, HIV, sexual behavior, and health, she explained. Nevada leads the nation in teenage pregnancies, suicide, and youth at risk for HIV/AIDS, drug use, and tobacco use, she added. Mrs. Cegavske said that the CDC states that the incidence rates among American children of obesity-related diseases such as heart disease and diabetes, are increasing. She cited a growing threat of osteoporosis for young women who are replacing milk with beverages that contain no calcium.
Mrs. Cegavske cautioned that increased health care and insurance costs would coincide with the maturing of a generation of unhealthy Nevadans. She said she believes good health habits are essential to curbing many of the obesity-related diseases, and research indicates children learn better in a classroom setting. The 1995 Legislature passed a resolution to encourage school districts to teach health, but the resolution was passed without specific guidelines to assist the school districts, she added.
Mrs. Cegavske addressed Senator Coffin’s previous question regarding the necessity of legislation. She explained that the school administrators are reluctant to remove vending machines unless the school board replaces the forfeited income, which is significant. She estimated electricity costs $270 annually for each soda vending machine, and there are over 2,000 soda vending machines in Clark County School District alone. She estimated the annual electricity costs to operate those machines is approximately $540,000, which will become an issue if electricity rates continue to increase.
Senator Raggio pointed out that the bill addresses the contents of the vending machines, not the removal of them. Mrs. Cegavske said that is true. She said federal legislation requires schools to turn off vending machines during lunchtime, but many ignore the requirement because they prefer the vending machine revenue to the associated federal funds. Physical education standards need to be addressed, in addition to nutrition, she added.
Senator Coffin asked whether fluoridation provided by legislation from the 1999 legislative session has been successful thus far. Mrs. Cegavske said she believes there are no studies on the effects of the mandated fluoridation yet.
In an effort to accommodate Senator Raymond C. Shaffer, Senator Raggio directed attention to S.B. 120.
SENATE BILL 120: Makes appropriation to provide medical assistance to adopted children with special needs under certain circumstances. (BDR S-174)
At the request of Senator Shaffer, Brian L. Davie, Legislative Services Officer, Legislative Counsel Bureau, Administration Division, Las Vegas, provided background information on S.B. 120. Mr. Davie explained that Senator Shaffer introduced the bill at the request of Sherrie Coy, a private citizen. Section 32 of S.B. 497 of the 1997 legislative session appropriated funds to financially assist adoptive parents who discover after the adoption, that the adopted child has special needs. He explained that the financial assistance was provided to adoptive parents who were ineligible for the federal Title IV-E adoption program. He noted the appropriation from 1997 has been continued in budget account 101-3229. This provides Medicaid assistance for those special needs children under this limited category, he added.
SENATE BILL 497 OF THE SIXTY-NINTH SESSION: Makes various changes concerning governmental entities. (BDR S-1871)
Mr. Davie said that the Department of Human Resources has indicated the total appropriation for this bill should be nearly $2 million for the biennium because of the possibility of large numbers of unanticipated applicants. He said he disagrees with their excessive appropriation estimate, as the number of potentially eligible applicants is limited to those currently receiving the subsidy provided by S.B. 497 of the 1997 legislative session. Mr. Davie said he calculated the appropriation amount based on the exclusivity of the applicants to arrive at the present requested amounts.
HR, Youth Community Services – Budget Page DCFS-24 (Volume 2)
Budget Account 101-3229
E-475 Effectiveness of Family Service, BA 3229 – Page DCFS-30
Senator Raggio, in response to Mr. Davie’s reference to budget account 101‑3229, Youth Community Services, discussed a proposed enhancement to that budget. He said the enhancement increases subsidized adoption payments to adoptive parents of special needs children by 42 percent from an average of $345 per month to an average of $490 per month. He pointed out that the Governor further recommends $1.8 million the first year and $2.4 million the second year of the biennium for subsidized adoption expenditures. Senator Raggio asked whether those funds would address the needs presented by Mr. Davie.
Mr. Davie responded they were associated. He agreed to provide detailed information to the committee.
Senator Raggio re-addressed S.B. 107.
Al Bellister, Lobbyist, Nevada State Education Association (NSEA) testified that he opposes S.B. 107, in particular sections 3 and 4 of the bill. He cited line 18 of section 3, which states school employees “will serve as role models to pupils in the promotion of health and wellness.” He said he is concerned this language could result in unfavorable employment decisions based on an employee’s decision to drink a “Dr. Pepper.” In reference to section 4, he indicated he would prefer to see the potential appropriation directed toward training and technology.
Elizabeth Gant-Davis, Program Director, Dairy Council of Utah/Nevada, Reno, testified in opposition to S.B. 107. She said she believes the bill is well intentioned, but it is not the solution to improving the nutritional intake of schoolchildren. She referenced Section 2 subsection 4(d)(1) which states “water, coffee, tea or milk, if such beverages are unsweetened” are excluded from this bill. Flavored milks and milkshakes would be eliminated from school lunch programs by this bill, she explained. Milk, regardless of sweetening, provides essential nutrients to a child’s diet, she stated. Peak bone mass is achieved during the ages of 6 through 17 as shown in her handout (Exhibit I). She cited the following statistics: 62 percent of boys and 70 percent of girls ages 6 to 11 are deficient in their calcium intake, while 68 percent of boys and 88 percent of girls ages 11 to 17 are deficient in their calcium intake. She said adequate nutrition and calcium intake are the best prevention for osteoporosis
According to Ms. Gant-Davis, despite the sweetening, flavored milks and milkshakes are a healthier “fun” alternative to many other beverages such as soft drinks, sports drinks, and juices, which are readily available from vending machines. She pointed out that flavored milks and milkshakes are loaded with calcium, protein, Vitamin D, Phosphorous, Magnesium and Vitamin A. She referred to her handout (Exhibit I) that illustrates the merits of milk and flavored milk in comparison to other beverage alternatives. She suggested further review of wording within the bill to avoid eliminating healthy alternatives along with the “junk food.”
Dotty L. Merrill, Ph.D., Lobbyist, Washoe County School District, introduced her colleague Pat Marble, Assistant Director, Nutrition Services Office, Washoe County School District. She agreed with the intent to encourage improved nutrition for children, but said she was concerned with Section 2 of the bill. Education and good role models, both at home and at school, are essential to establishing good dietary habits, Ms. Marble said. She indicated she does not believe limiting children’s choices will ensure they make better choices. In fact, she said, she believes more students in the high schools will leave campus to purchase fast food resulting in increased car traffic and student tardiness. The school breakfast and lunch program meets United States Department of Agriculture (USDA) nutrition guidelines, and students will undoubtedly choose high-fat fast foods off-campus, she stated.
Ms. Marble stated she believes this bill will move the problem off campus rather than solve it. She said she believes that desserts balance the nutrients and fats level of the school lunch program’s menus. She said milk consumption dramatically increased with the introduction of flavored milks into the school lunch program. At the request of Health Access Washoe County Community Health Center (HAWC), Ms. Marble said she and her staff conducted a pilot breakfast program in November 2000. For the pilot breakfast, she said, they provided cereals low in sugar and entrees high in protein to assess participation. Overall participation decreased by 25 percent, she noted. Lower participation will result in lower revenues and potential discontinuation of school lunch programs, she said.
Ms. Marble indicated she believes it would be better to educate students to develop healthy eating and exercise habits. She further cited concern that this bill will remove the power of the school districts to make decisions locally.
Senator Raggio asked why the federal requirement limiting vending machine use during lunchtime is not observed by all schools in Washoe County. Ms. Marble explained that most principals do enforce this requirement, but she does not believe all principals are in compliance.
Anne Loring, Lobbyist, Washoe County School District, stated she was unaware some schools are not in compliance, and said she would address this immediately. She noted she recognized the importance of complying with the federal requirement.
Senator Raggio suggested complete compliance would alleviate the need for this legislation.
Ms. Loring said, in reference to Section 4 of S.B. 107, new health and physical education standards were implemented last year. Nutrition is included in health education at the elementary and secondary level, she added. She said current implementation of the core academic standards would limit their ability to comply with Section 4 of this bill.
Keith Rheault, Deputy Superintendent for Instructional, Research, and Evaluative Services, Department of Education, testified he supports the intent of the bill, but recommends further consideration on several areas of the bill. He questioned what foods and activities are included in Section 2 subsection 1 of the bill, which states the state board of education “prescribe standards for the sale of candy.” He said he wonders whether bake sales, vending machines, and candy sales at after school sporting events are all included in the reference to candy, or will further definition be at the discretion of the State Board of Education. He cited concern over milk also.
Senator Raggio asked Dr. Rheault to assist the LCB staff by providing appropriate amendments addressing his concerns. At this point, he closed the hearing on S.B. 107 and re-opened the hearing on S.B. 120.
Sherrie Coy, Member, State Welfare Board, Welfare Division, Department of Human Resources, testified from Las Vegas in support of S.B. 120. She described various special needs of her adopted son, which were not diagnosed until after the adoption. She said she benefits from the “post-legal adoption subsidy program,” in which a total of 14 families are currently participating. She requested additional assistance for payment of medical bills. She said insurance often does not cover the necessary treatments and procedures for the special needs children. Her son is 16 years old, she added.
Ms. Coy explained that a disclosure law took effect in 1985 that requires adoptive parents be informed of medical conditions. She said only the few people who adopted children prior to 1985 or with diagnoses after formal adoption would be eligible for the assistance provided by S.B. 120.
Mr. Davies reiterated his offer to assist in making the appropriation amenable to the committee.
Stephen A. Shaw, Administrator, Division of Child and Family Services (DCFS), Department of Human Resources, pointed out that his division believes their fiscal note is accurate. Their fiscal note for the biennium is $688,308 for the first year and $1,317,288 for the second year.
Senator Raggio asked him to explain computation of their fiscal note. Mr. Shaw deferred the explanation to his colleague, Mr. Baumann.
Jim Baumann, Administrative Services Officer III, Division of Child and Family Services, Department of Human Resources, indicated he received the initial request for a fiscal note from Steven J. Coburn, Senior Deputy Legislative Counsel, Legislative Counsel Bureau. Mr. Baumann said he met with his staff and Wanda Scott, who works for the division in Las Vegas. He said they made several assumptions. The first was that the participation will increase beyond the category 22 adoption subsidy enrollment, once this bill is passed and eligible families become aware of medical coverage. The second assumption was that medical costs would be 100 percent state-funded since any who are Medicaid eligible, under one of the current eligibility criteria, would already be enrolled in the Medicaid program. He pointed out the appropriation does not change eligibility criteria. The third assumption was enrollees would likely be high users of medical services, because the special needs designation would be for medical reasons, rather than ethnicity or sibling groups allowed under the Title IV-E special needs categories.
Mr. Baumann explained DCFS assumed an average of 33 recipients in FY 2002 and an average of 57 recipients in FY 2003. Senator Raggio asked how they arrived at those numbers. Mr. Baumann responded that in FY 2000 there were 22 subsidy payments under the current program, which equals $36,403. This was divided by the average number of recipients, 9, to arrive at an average annual payment of $4,045, he explained. The $4,045 average annual payment was applied to the estimated number of recipients in FY 2002, 33, and FY 2003, 57. He said the medical costs were taken from category 18, which is the non-Title XIX medical category paid from budget 101-3229 when an individual is not eligible for Medicaid. He noted this is a 100 percent state-funded program. This average medical cost was again applied to the estimated number of recipients, 33 and 57, he explained. Mr. Baumann stated that their fiscal note included $97,000 the first year and $194,000 the second, and medical, which was $591,000 the first year and $1,123,000 the second year.”
Senator Raggio asked whether Mr. Baumann had ever resolved the difference in estimated recipients with Mr. Davies. Mr. Baumann said he had never discussed the issue with Mr. Davies, only with Mr. Coburn. Mr. Baumann said, currently, there are only 14 subsidy recipients because some eligible people were financially able to forego the $300-$400 subsidy. He said he believes the medical benefit would be much more substantial, and consequently, more eligible recipients would feel compelled to apply for it. Furthermore, he said, he understands there is an annual review process for the subsidies, in which many people may potentially become aware of the additional medical subsidy.
Senator Raggio asked Mr. Baumann to provide the LCB staff a compilation of the fiscal note calculations that he presented today. He agreed to do so.
Senator Raggio inquired where Ms. Coy might be able to receive assistance. Mr. Shaw stated that Ms. Coy’s situation is fairly unique because she did not adopt through the division and her son’s special needs were not identified prior to adoption.
Senator Raggio asked Mr. Shaw to explain why Ms. Coy is ineligible for Medicaid. Mr. Shaw said he believes it is because she has existing insurance. He stated that income and assets are also factors in determining Medicaid eligibility.
Senator O’Donnell stated that children whose special needs are diagnosed prior to adoption often become wards of the state, and their care is subsequently provided by the state. He said when the special needs are not diagnosed prior to adoption, the state avoids the financial responsibility of their care. “We treat lemon cars better than we treat these people who adopt kids like this, and I think it’s a tragedy that we don’t step up to the plate,” Senator O’Donnell said. He urged the committee to provide assistance to these parents.
Senator Raggio asked, if the bill is approved with the current appropriations, whether Nevada would be compelled to provide additional funding. He questioned whether the Olmstead Decision would affect this bill. Mr. Shaw said he did not think so. Senator Raggio requested the legal division to verify that.
Mr. Shaw explained the process should this proposed appropriation be approved for recipients who are ineligible for Medicaid. He said eligible recipients would receive a DCFS medical card, which is processed by Anthem Blue Cross/Blue Shield and functions similarly to a Medicaid card. The division would receive a bill 30 to 90 days after services have been rendered. He said he is concerned this program could result in cost overages. He explained that category 18 medical payments are the most volatile part of their budget with monthly bills ranging from $30,000-$400,000. He cited as an example a liver transplant that cost approximately $800,000.
May S. Shelton, Lobbyist, Washoe County, testified she is concerned how the provisions of this bill, coupled with those resulting from the A.C.R. 53 interim study, would financially affect Washoe County.
ASSEMBLY CONCURRENT RESOLUTION 53 OF THE SEVENTIETH SESSION: Directs Legislative Commission to conduct interim study of integration of state and local child welfare systems in this state. (BDR R-1712)
Senator Raggio closed the hearing on S.B. 120.
SENATE BILL 166: Requires department of human resources to include continuous subcutaneous insulin infusion pumps and podiatric services in state plan for Medicaid and makes appropriation for Pediatric Diabetes and Endocrinology Center. (BDR 38-222)
This bill was introduced on behalf of the Legislative Committee on Health Care, an interim study chaired by Assemblywoman Ellen Marie Koivisto, Senator Rawson explained. As a member and Vice Chairman of the interim committee, Senator Rawson explained the committee was privy to numerous discussions on the subcutaneous insulin infusion pumps and podiatric services. He said the discussions indicated that the pump enables people with diabetes to manage the disease more effectively and reduce future side effects of the disease. He said he understands that podiatric services are now included in Medicaid coverage, but the committee is interested in ensuring that podiatric services would continue to be included. He pointed out there is direct evidence that indicates cost savings from both the pump and preventive podiatric care.
Senator Raggio welcomed testimony on the bill. He pointed out that Section 5 of S.B. 560 from the 1999 Legislative Session appropriated $379,500 per year for the items included in Section 5 of S.B. 166.
SENATE BILL 560 OF THE SEVENTIETH SESSION: Makes various changes relating to governmental administration. (BDR S-1788)
Senator Rawson disclosed his son is a podiatrist, and he is a dentist. He said he does not feel that any of the legislation discussed would affect him or his son.
Martha B. Gould, Board Member, Nevada Diabetes Association for Children and Adults, testified in support of S.B. 166. She presented written testimony prepared by Claude K. Lardinois, M.D., Board Certified Adult Endocrinologist (Exhibit J). She said Dr. Lardinois believes that preventative podiatric care for diabetics is cost effective and critical to decrease the amputation rate, she said. She cited a monofilament test, which costs approximately 10 cents that could be administered to diabetic patients to assess sensation in the feet. Insensate patients should receive prompt podiatric care to avoid future amputation, she added.
Senator Raggio summarized that diabetics are at a greater risk for amputation and preventive foot care would alleviate the risk. Ms. Gould added that many diabetics are unable to afford preventive foot care.
Martha Rugg, Volunteer, Nevada Diabetes Association for Children and Adults, presented written testimony from Mylan Hawkins, Executive Director, Nevada Diabetes Association for Children and Adults (Exhibit K). Ms. Rugg said health care cost savings and improved quality of life for pediatric children will result from this legislative measure. She urged the committee to pass S.B. 166.
Annie Munn, Volunteer, Nevada Diabetes Association for Children and Adults, testified in support of this bill. She cited experience with diabetics through her volunteer efforts and professional work at Abbott Diagnostics. As a volunteer at Camp Buck (a summer camp for diabetic children organized by the Nevada Diabetes Association for Children and Adults) she said she has witnessed improved control and self-esteem for the children with the pumps. It is particularly difficult for children to manage diabetes; many struggle with proper nutrition and insulin shots, she added. Furthermore, she noted, they are constantly at risk for ketoacidosis, a potentially life-threatening emergency medical condition. Lack of podiatric care is the most prevalent reason diabetics become disabled, she said. She believes that amputation of toes and limbs may be avoided through early podiatric care.
Ms. Gould presented written testimony (Exhibit L) prepared by Kathryn Eckert, M.D., Board Certified Pediatric Endocrinologist, University of Nevada School of Medicine, in support of S.B. 166.
Ms. Munn commented on the increased use of insulin pumps by children at Camp Buck. Use of the pump improves the children’s attitudes and their control of the disease, she indicated. She said she believes this improved control will result in fewer hospitalizations and sick days for diabetic children.
Mike Hayes testified as a private citizen from Las Vegas in support of the bill. He said he is a member of the Diabetic Children and Families Support Group Legislative Committee. He provided a written statement (Exhibit M). He informed the committee his son was diagnosed with Type I Juvenile Diabetes at the age of 10. Diabetes requires an extremely regimented lifestyle, especially eating, and specialized care including podiatrists, he explained. He stated, “The pump brings freedom from rigidity, restores a sense of normalcy and provides dignity.” He explained the significance of this sense of normalcy, particularly for children who constantly struggle to assimilate with their peers.
Mr. Hayes suggested three amendments to the current bill. First, restore funding to at least the level received over the past two years, $379,500. Second, amend Section 5(3)(b) to include only medical equipment. Third, amend Section 5(3)(c) to include the following words after salaries “. . . or contract with pediatric endocrinologist and other medical professionals” (Exhibit M). He stressed the importance of pediatric endocrinologists in effective medical care for diabetics.
Rosalie Clark Montoya, Diabetes Support Coordinator, Pediatric Diabetes and Endocrine Program, School of Medicine, University of Nevada, Reno, University and Community College System of Nevada, testified from Las Vegas in support of the bill. She provided a written copy of her testimony (Exhibit N). She stated that the stress of living with diabetes causes many young patients to become “acutely suicidal or can lead to recurrent ketoacidosis.” Immediate assessment followed by medical and mental health treatment could alleviate the stress, she added.
Sherri Coffman, Facilitator, Diabetic Children and Families Support Group, suggested two amendments to the current bill. First, she recommended increasing the annual funding for diabetes and endocrine care to at least the level received over the past two years, $379,500. Second, she said she would amend Section 5(3)(c) to mandate that the University of Nevada School of Medicine “contract out for the services of a pediatric endocrinologist, if there is no local pediatric endocrinologist on staff.” Ms. Coffman provided a written statement (Exhibit O). She attested to the importance of local access to pediatric endocrinologist services from her experience as a nurse case manager assisting families of children with diabetes and endocrine disorders. Diabetic care is too complicated to be treated from a distance by out-of-state pediatric endocrinologists, she added. She urged passage of this bill with these two considerations.
K. Neena Laxalt, Lobbyist, Nevada Podiatric Medical Association, testified in support of S.B. 166.
Denell A. Hahn, Lobbyist, Sunrise Hospital & Medical Center, testified in support of S.B. 166. She said she believes the Pediatric Diabetes and Endocrinology Center at the University of Nevada School of Medicine has had a positive effect on diabetes care in Nevada, and she supports continued funding of their services.
Maureen Brower, speaking as a private citizen, said she has had diabetes for 44 years, and she has had a pump for the past six years. She attested to the merits of the pump for maintaining a good quality of life.
Senator Rawson and Senator Raggio discussed the importance of the University of Nevada School of Medicine being able to contract private services when deemed necessary. Senator Raggio concluded an amendment to the bill would not be necessary, as it currently allows them to contract private services.
Charles Duarte, Medicaid Administrator, Division of Health Care Financing and Policy, Department of Human Resources, said he believes that the cost of the insulin pump services, alone, would absorb the entire appropriation within the first year, as the funding would be insufficient. He stated that it is difficult to assess total costs of proposed podiatric services, because there are no outlined limitations to those services.
Senator Raggio asked Mr. Duarte to provide LCB staff any estimates of cost increases and associated information, which may help determine the fiscal impact of this bill. Mr. Duarte agreed to comply and provided a written statement (Exhibit P).
Senator Coffin asked Mr. Duarte whether he participated in the budget process, and whether he perceived a decrease in funding. Mr. Duarte responded that he participated in the development of the Medicaid budget.
Senator Raggio clarified for Senator Coffin that Mr. Duarte is referring to a “one-shot” appropriation from the 1999 Legislature, rather than the budget. Senator Raggio acknowledged that the previous appropriation was larger than the current appropriation under consideration.
Dr. Henry Artman, Pediatric Endocrinologist, provided written copy (Exhibit Q) of his testimony from Las Vegas. He stated that childhood diabetes is the most underserved chronic disease in Las Vegas. The American Diabetes Association endorses a team approach to educate and treat diabetic children and their families, he added. He said he believes this team approach is the only effective treatment approach, but it is very costly because a pediatric endocrinologist, diabetes nurse educator, dietician, and social worker see the patient. There is a national shortage of pediatric endocrinologists, and Las Vegas currently has only one, Dr. Artman, he stated.
Dr. Artman said he withholds support of this bill for reasons detailed in his written statement (Exhibit Q). First, he stated the funding is insufficient, as it is nearly $100,000 less then the appropriation from S.B. 560 of the Seventieth Session. Population and corresponding caseload, especially incidences of type 2 diabetes in children, have increased dramatically in Nevada, he added. Second, he explained “all of the money is allocated to the medical school, which currently does not have a diabetes program in southern Nevada.” Dr. Artman said the following:
In a precedent-setting gesture, the school has announced it will share the unspent money from S.B. 560 with the UMC clinic and my clinic. This surplus is due to the closure of the medical school’s diabetes clinic in Las Vegas. I feel the proposed bill should continue to support those organizations who provide diabetes care to the community. The funding should be allocated accordingly to support this continued care.
He summarized that Nevada’s diabetic children are severely underserved.
Jacqueline Taylor, Chief Administrative Officer, University Medical Center of Southern Nevada, stated the following:
The only clinic presently in town (Las Vegas) is at the Lied’s Ambulatory Care Center, which is treating at least 160 type 1 diabetic children. We employ the staff that is presently there under the direction of Dr. Henry Artman, and I appreciated, Dr. Rawson, that you did clarify stating that the monies allocated to the grant can be allocated to those providers that are presently providing the services.
Liza Conroy, testifying as a private citizen, submitted a letter (Exhibit R) from Susan Gary in support of S.B. 166. Both Ms. Conroy and Ms. Gary are parents of diabetic children, she said. Ms. Conroy explained that Ms. Gary’s eight-year-old daughter has celiac disease, intolerance to gluten, in addition to diabetes. She explained that celiac disease is more prevalent in type 1 diabetics than the general population, and it further complicates the medical care her daughter requires. She believes that the comprehensive team approach to treating diabetes is essential because of the complexity of the disease, and pediatric endocrinologists are vital to the process.
Marla McDade Williams, Senior Research Analyst, Legislative Counsel Bureau, explained she was a staff participant for the Legislative Committee on Health Care during this past interim. She clarified in her handout (Exhibit S) that the “1997 Nevada Legislature” reference found on both pages one and three should have been written as “1999 Nevada Legislature.” She clarified that the Pediatric Diabetes and Endocrinology Center funding is intended for the University of Nevada School of Medicine, and the podiatry care funding is intended for the Medicaid program.
Senator Raggio requested that written statements provided during the committee meeting be included, for the record, regardless whether the testimony was heard. To this end, a statement prepared by Jo Ann Vice, President, Nevada’s Child Nutrition Programs, in opposition of S.B. 107 is included as Exhibit T. In addition, “Pediatric Diabetes and Endocrine Center: Progress Report to Senate Finance Committee February 26, 2001,” prepared by Bernard H. Feldman, M.D., Professor and Chairman, Department of Pediatrics, University of Nevada School of Medicine is included (Exhibit U).
The meeting was adjourned at 10:54 a.m.
RESPECTFULLY SUBMITTED:
Jennifer Ruedy
Committee Secretary
APPROVED BY:
Senator William J. Raggio, Chairman
DATE: