minutes of the MEETING 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

March 20, 2001

 

 

The Joint Subcommittee on Human Resources/K-12 of the Senate Committee on Financeand the Assembly Committee on Ways and Means was called to order by Chairman Raymond D. Rawson at 8:09 a.m., on Tuesday, March 20, 2001, in Room 3137 of the Legislative Building, Carson City, Nevada.  The meeting was videoconferenced to the Grant Sawyer State 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. 

 

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.

Mr. David E. Goldwater

Ms. Sheila Leslie

Ms. Sandra J. Tiffany

 

GUEST LEGISLATORS PRESENT:

 

Ms. Genie Ohrenschall, Clark County Assembly District 12

 

STAFF MEMBERS PRESENT:

 

Mark W. Stevens, Assembly Fiscal Analyst

Bob Guernsey, Senate Principal Deputy Fiscal Analyst

Mindy Braun, Education Program Analyst

Lu Chen, Education Research Statistician

Judy Jacobs, Committee Secretary

 

OTHERS PRESENT:

 

Mark V. Hilario, Group Home Operator, President, Adult Care Association of Nevada

Marieta Narciso, Group Home Operator, President, Adult Care Association of Nevada

Carlos Brandenburg, Ph.D., Administrator, Division of Mental Health and Developmental Services, Department of Human Resources

Michael Torvinen, Administrative Services Officer IV, Division of Mental Health and Developmental Services, Department of Human Resources

Ed Guthrie, Opportunity Village, Las Vegas

Linda Carson, Mother of a Severely and Profoundly Mentally, Physically, and Medically Challenged Adult Child

Keith Beard, Employee, Opportunity Village

Carolyn Lehner, Client, Opportunity Village

Linda Smith, Parent

Jean Recomanta, Contract Care Provider

Andreo Bote, Contract Care Provider

Dave Luke, Ph.D., Associate Administrator for Developmental Services, Division of Mental Health and Developmental Services, Department of Human Resources

Brian L. Lahren, Ph.D., Lobbyist, Washoe Association for Retarded Citizens

Nancy Neill, Parent of Special Needs Son

Art Woolston, Owner, Danville Services Corporation

Steven G. McGuire, State Public Defender, Office of the State Public Defender, Department of Human Resources

Debbra J. King, Administrative Services Officer IV, Department of Human Resources

Richard Harjo, Chairman, Nevada Indian Commission

Sherrada L. James, Executive Director, Nevada Indian Commission

 

 

Senator Rawson noted that people in Clark County were participating in the hearing through a simultaneous videoconference from Room 4412 of the Grant Sawyer State Office Building in Las Vegas.

 

DEPARTMENT OF HUMAN RESOURCES

 

Division of Mental Health and Developmental Services

 

Senator Rawson invited Ms. Ohrenschall to speak first so that she could return to her Assembly committee hearing.  He welcomed her guests.

 

Genie Ohrenschall, Clark County Assembly District No. 12, said several members of the Adult Care Association of Nevada (ACAN) wished to testify.  She explained ACAN members operate group homes that cater to the developmentally disabled, including persons with both mental and physical disabilities.  She stated that, although the cost of living has risen and allotments from Social Security have gone up, there has been no increase in the rate group home operators have been allowed to charge to maintain a client.  She reported group home operators are allowed to charge less than $800 per month, which includes food, shelter, utilities, and transport vehicles used to take clients to doctors or on recreational outings. 

 

Senator Rawson pointed out the budget is constrained because of a shortfall in revenue.  He noted the committee will not be able to take any early action while awaiting figures from the Economic Forum.  He warned it may even be necessary to cut budgets.  Ms. Ohrenschall rejoined that the impact on the General Fund should be minimal because most payments to group homes are the responsibility of the counties. 

 

Mark V. Hilario, Group Home Operator, President, Adult Care Association of Nevada, said seven members of ACAN from Las Vegas had come to Carson City for the hearing.  He asserted it requires special techniques to maintain a quality of life for clients of the mental health programs.  At the present time, he said, the contract with the Division of Mental Health and Developmental Services increases by approximately 4 percent each year for the Cost of Living Adjustment (COLA), and it now provides $796 per client. 

 

Mr. Hilario noted the price of everything has been going up, but there have been insufficient increases provided to group homes.  He complained group homes can just barely exist.  He said he has been operating a home since 1990, and most of the group homes in Las Vegas are licensed by Filipino residents.  He said two assemblywomen, Ms. Ohrenschall and Ms. Giunchigliani, were responsible for encouraging his group to attend the hearing. 

 

Mr. Hilario requested an increase in rates to guarantee clients will continue to receive good care in group homes.  He pointed out that the regulations set by the Bureau of Licensure and Certification (BLC) are very difficult to abide by, and there are special rules that must be followed for the mental health agency.  He said although the regulations are good for the clients, the home operators need financial help.  He stated that once financing is increased, the homes will be able to hire efficient caregivers, but right now the homes cannot afford to do so. 

 

Ms. Giunchigliani commented that Mr. Hilario runs a “wonderful home, and the clients have always been very well taken care of.”  She apologized for not bringing in a letter Mr. Hilario had written to her at the beginning of the session and asked him to explain the sources of funding.  Mr. Hilario responded that different clients collect varying amounts of Social Security.  He said if one earns $600, the mental health agency often contributes to bring the total up to $796, financed by the state. He added the client is also allotted a stipend of $84 per month for personal needs. 

 

Marieta Narciso, Group Home Operator, Adult Care Association of Nevada, reported she has lived in Las Vegas for 16 years, contracting with the mental health division to run a group home care facility.  She agreed help is desperately needed.  She stated the business is very hard because most of the clients are mentally ill people.  She explained she and her family employ 45 people, including her four brothers and their wives, in twelve houses, and they have been under contract since 1986. 

 

Ms. Narciso explained the mental health division only subsidizes clients who receive insufficient funds from the Social Security Administration.  She asserted the Division of Mental Health and Developmental Services needs a big increase in its budget.  She noted the administrator is unable to accomplish much, and declared it is the duty of the Legislature to help.

 

Senator Rawson asked whether the stipend given to the client is in addition to the $796 fee.  Ms. Narciso answered that the stipend is additional, making a total of $880 paid to the client.  She explained the group home operator receives the stipend and then doles it out to the client as requested.  She reiterated the operator receives $796 for every client. 

 

Senator Rawson asked how much the operators hope to receive.  Mr. Hilario responded:

 

Our target is maybe just half of the nursing home recipient.  The nursing home pays $3,000 or more.  If we can assume one-half of that, we will be happy to.  I wrote so many letters to some of our ladies here, the assemblywomen.  That letter, last year, we only had $1,300 asking.

 

Senator Rawson asked whether the operators were aware of how much an increase would be to raise distribution from $800 to $1,300.  He called it a “huge increase.”  Mr. Hilario responded that is why the group came to Carson City, because “we know we cannot make it at $800 now.” 

 

Mr. Hilario noted all the insurance has gone up, and the BLC has increased fees.  He added that fees for business and state licenses have been increasing.  He said that union members receive pay increases in increments of $100 and suggested the Legislature provide similar raises for clients.  He suggested the appropriation be raised to provide $1,000 per month as is paid by Clark County, and that next year it go to $1,100.  He explained his present contract with Clark County is $1,000 per client, and all of his clients are under 65 years of age, but when they reach 65 the payment will be made by the Social Security Administration and will drop to $796.  Ms. Narciso interjected that is for the same, ambulatory, mental health service.  

 

Senator Rawson responded the committee now understands the picture, so it would not be necessary to hear additional testimony.  Saying its members provide vitally needed services, Ms. Ohrenschall presented a petition outlining the requests of ACAN (Exhibit C).  She declared that without the operators running the group homes, there would be nowhere for their clients to go.

 

Senator Rawson commented there will be a movement of mental health clients from institutional placement to the community.  He noted there is a rate increase coming for institutions, but not for group homes, and he asked whether the community beds fulfill the needs of the clients. 

 

Carlos Brandenburg, Ph.D., Administrator, Division of Mental Health and Developmental Services, Department of Human Resources, noted that when the division removed eight beds from Southern Nevada Adult Mental Health Services (SNAMHS), the division included twelve special needs group-home beds in the budget.  He said those beds were funded at $1,200 each per month, comparable to what Clark County was paying.  He said that is one small way to address the issue, although he admitted there is a disparity between the rates the county pays and the rates the state pays.

 

Senator Rawson asked how many beds are available in group homes.  Michael Torvinen, Administrative Services Officer IV, Division of Mental Health and Developmental Services, Department of Human Resources, responded he would inform the committee as soon as he returned to his office to collect the information.

 

Senator Rawson suggested Dr. Brandenburg and Mr. Torvinen get together with the Legislative Counsel Bureau (LCB) staff to put together an outline of the number of beds, the number being converted, and the probable impact.  Senator Rawson noted the agency is in the process of adjusting the fees upward, and some beds are being allocated at $1,200 per month.  He acknowledged that will not take care of all the beds, but as the process continues, he promised, there will be an attempt to deal with the concerns expressed. 

 

Senator Rawson asked whether there would be a problem using up the space in the institutions as people are moved out of them.  He asked whether there is still a waiting list and a backlog.  Dr. Brandenburg replied the space in the institutions will be reduced in southern Nevada by eight beds, and the division is in the process of submitting a proposal to the Governor to reduce beds by ten at the northern institute.  Dr. Brandenburg stated the new hospital is designed to fit the configurations of the number of clients proposed in the budget, so the northern area should see no changes. 

 

Upon questioning by Senator Rawson, Dr. Brandenburg reported Building 8 at the Nevada Mental Health Institute in Reno is being rented to a private provider, which will bring in some revenue.  At southern Nevada, he said, the eight-bed reduction is insignificant, but the division hopes to use the space for staff.  He noted that when the building was originally designed, no office space was included for psychiatrists or psychologists, so the space will be used for them.  He said the result actually is something of an internal reorganization for staff.

 

Senator Rawson cautioned the committee to put the increase into perspective.  He calculated the increase would amount to approximately $500,000 in state dollars for every 1 percent increase in payments.  He said a 5 percent increase would amount to only about $40 per person, making the rate $836.  To reach $1,000, he said, the increase would be in the range of 25 to 50 percent, and a 50 percent increase would amount to $20 million.

 

Dr. Brandenburg said the director of the Department of Human Resources, Charlotte Crawford, has been planning to develop a methodology regarding rates, including a study of how much is paid by each of the various entities.  Senator Rawson agreed the issue is critical for the future, and the rate structure should not fluctuate because services are lost.  For example, he said, there is overbuilding when rates are high, and the market needs to be stabilized.  Dr. Brandenburg agreed and added the division needs to know just what the providers’ costs are to determine what should be paid. 

 

Senator Rawson asked whether there was anyone in Las Vegas who wished to testify. 

 

Speaking from Las Vegas, Ed Guthrie, Opportunity Village, Las Vegas, reported several people were present in the Grant Sawyer State Office Building who would like to comment.  He noted that over the weekend an article appeared in the Las Vegas Review Journal featuring participants in the Project Pride program.  He said the mother of Chris Carson, who appeared in the article, was present at the Las Vegas hearing.  He added a client from a work center was present, and one staff member was present. 

 

Linda Carson, who identified herself as the mother of a severely and profoundly mentally, physically, and medically challenged adult child, thanked Opportunity Village for creating Project Pride.  She explained Opportunity Village is a service program that serves the most vulnerable people in the community.  She declared they need a rate increase to pay their staff a living wage.  She stated the pay increase is needed to hire experienced and trained staff members to enable them to continue to provide a quality service.

 

Ms. Carson said if the service were not available to her as the single mother of a severely handicapped son, her son would have to be placed in a nursing home, and that would cost the state a great deal more than his daily services cost now. 

 

Keith Beard, Employee, Opportunity Village, voiced his appreciation for the opportunity to speak.  He requested assistance in getting a rate increase, so that he and others can continue to work in the field of group care.  He explained the care field is full of people with compassion who attempt to “uplift other people’s lives.” 

 

Mr. Beard stated it is “an awesome responsibility” working with people with disabilities, and it takes a great deal of time, especially quality time, to ensure their welfare and their benefits.  He said he and the others working in the field must survive in a world of increasing prices, and it is easy to walk away from a worthy cause to go find a job that will pay well, but that does not have the same rewards.

 

Mr. Beard said, “My heart is full, and it is willing to render all the help that is needed in this field.  I want to be a part of this great work, but my heart, full as it may be, still has to put things in order.”  He said service providers like those at Opportunity Village are never sure how long they may be able to work, and it is a shame that some must leave because of the money issue.  He stated that is one of many reasons why there are so few laboring in the field.

 

Mr. Beard said he was not intending to point a finger, but rather he was asking for assistance to help in the cause of obtaining a rate increase.  He noted another problem faced by the clients is how they act when staff leaves.  He said he brought a client from Opportunity Village to state her side of the issue. 

 

Carolyn Lehner, Client, Opportunity Village, testified she has a good memory for ages, years, dates, time, leap years, and other things.  She cited the age of many of her friends and caregivers.  She stated she loves working at Opportunity Village, and if she could not go there every day she did not know where she could work and she would not be able to make any money.  She said she loves her friends there, too, and the people who teach her and help her with her job. 

 

Ms. Lehner said it bothers her when someone who teaches her has to leave.  She stated that has happened more than once, and even when they tell her and the others in the work center that they love them, they say they must go to a job where they can make more money.  She reported those leaving usually say they must leave to do a job they will not like as well, but Opportunity Village does not pay them enough to stay.  She said she wished the people who take care of her and others at Opportunity Village would be paid more because it makes everyone sad when people leave.

 

Mr. Guthrie acknowledged the state must find $500,000 in state funds for every 1 percent increase in fees.  He noted the state once had the wherewithal to find that type of funding for nursing homes and other long-term care providers.  He stated long-term care providers of community services are the only care providers who have been left out.  He called that a “dangerous precedent for the state” to have.

 

Linda Smith, Parent, asserted there is a crisis.  She said she represents her son, Christopher, who is 29 years old, and who has Down’s syndrome.  She said Christopher has a caregiver who is paid $800 a month, which equals $1.04 per hour for round the clock care.  She declared something must be done now, because there are not enough caregivers.  She stated people do not want the jobs because, as at Opportunity Village, people only make $8 per hour, and there is an incredible turn-around.  She pointed out people can get jobs at MacDonald’s or as a porter in a hotel and make more money. 

 

Ms. Smith declared, “We have to do something now.  In the year 2002 over 50 percent of all Americans are going to be over age 50 for the first time in American history.”  She noted people now live until age 85, and it is not only the disabled population that needs care.  She reiterated, “There is a caregiver crisis.”  She said she was scared because it does not appear anyone is taking the career field of caregiving seriously.  Voicing her fear that people will not work for such a low wage, she asked, “Who is going to take care of my son?”

 

Senator Rawson inquired whether there were any people from the Filipino community in Las Vegas who cared to testify.

 

Jean Recomanta, Contract Care Provider, declared it is necessary to have an increase for care providers under contract to the mental health division to enable them to give better quality rehabilitation programs to patients.  She stated more staff is needed to give the patients a closer relationship, including one-on-one, with their case managers.  Referring to providers, she said, “I feel we are the underdogs of the field, because it is not very cost-efficient to us providers.”  

 

Ms. Recomanta said providers only receive a few hundred dollars for round-the-clock supervision and room and board for each resident.  She noted reimbursements do not even cover all the requirements of the Bureau of Licensure and Certification every year, and every year, she asserted, it is becoming tougher to comply with the requirements.  She stated caregivers cannot provide activities for clients on such a limited budget, which she indicated she would like to do at least once a week.  Ms. Recomanta reiterated her request for higher payment rates in order to provide better quality care for residents.

 

Andreo Bote, Contract Care Provider, related he has been providing quality care since 1994.  He expressed concern and requested support in regard to the petition to raise the rate of pay to providers.  He stated a raise would enable him and others to continue to provide valuable services to the mentally challenged population. 

 

Senator Rawson declared he would have to move on to the budgets listed on the agenda.  He said if time remained after discussion of the budgets he would hear additional public testimony on this issue. 

 

Senator Rawson pointed out the budget provides $19.55 an hour for the community training center (CTC) rate, which includes an administrative allowance of 20 percent.  However, he said, even when the administrative allowance is removed, it is $15.64 an hour. Considering that, he said, he could not understand the $8 an hour wage. 

 

Carlos Brandenburg, Ph.D., Administrator, Division of Mental Health and Developmental Services, Department of Human Resources, recited highlights of some of what the division has been able to accomplish with the assistance of funding from the Legislature.  He drew attention to the first page of a 10-page handout (Exhibit D) distributed by the division, which outlines some of the accomplishments in recent years. 

 

Dr. Brandenburg noted that services have increased by nearly 90 percent since 1996 as reported on page 2 of the handout.  He reported the division has gone from serving 1,705 in 1996 to a recommendation for 3,242 from the Governor for 2003.  He referred to page 3 and said community placements have increased by 154 percent, from 503 individuals to 1,277. 

 

Turning to the chart on page 4, Dr. Brandenburg noted there has been an increase of 150 percent in funding.  He said the budget went from $25 million in 1996 to over $65 million by the end of 2003.  Also, he said, there has been a tremendous increase in community services funding, nearly 302 percent, going from a budget of $10 million to a budget of over $43 million. 

 

Dr. Brandenburg traced the waiting list figures on page 5 from 1996 through January 2001.  He noted there are 127 clients on the present waiting list, which equates to 4.56 percent of those served, an actual decrease.  He opined the most significant statistic shows that the average length of time from when a person submits an application until the person is served has decreased by 2.5 months. 

 

Dr. Brandenburg drew attention to the rates paid to developmental service providers depicted on page 6.  He attributed the rate increases for most of the jobs to funding provided by the 1999 Legislature, which allowed the division to pay the providers higher rates as the staffs’ qualifications rose.  As an example, he said, a case manager with a bachelor of arts degree who has a Quality Mental Retardation Professional (QMRP) certificate is paid up to $20.69.  He said:

 

Mr. Chairman, the issue you raised was the CTC hourly rate.  We actually pay the CTCs $19.55 an hour for services that they provide, per day.

 

Dave Luke, Ph.D., Associate Administrator for Developmental Services, Division of Mental Health and Developmental Services, Department of Human Resources, interjected:

 

For your information, we have an hourly rate of $19.55 that we pay.  There is also a daily rate of $19.55, which I think is being referred to. However, that would be multiplied times 8 times since that one staff would be asked to serve 8 individuals, so then the provider would receive whatever 8 times the $19.55 is for that.

 

Senator Rawson asked, “So it is equivalent to an hour?”  Dr. Luke responded, “It is equivalent to at least $19.55 an hour, yes.”

 

HR, Sierra Regional Center – Budget Page MHDS-37 (Volume II)

Budget Account 101-3280

 

Dr. Brandenburg said there is an adjustment in the base because clients that were of phased in.  He explained the developmental service agencies have been phasing in clients on a monthly basis, requiring an adjustment to the base in The Executive Budget for those to continue to be phased in between now and June 30 and then annualized. 

 

Referring to Budget Page MHDS-39, Dr. Brandenburg said the state demographer calculated population growth at 1.9 percent for 2001, 2.9 percent for 2002, and 2.0 for 2003, which he said will amount to 33 individuals over the biennium at Sierra Regional Center.  He said a half-time position is recommended in decision unit M-202. 

 

Dr. Brandenburg reported 12 immediate care facility (ICF) beds will be closed and those resources will be transferred to the community, with hope that 12 intensive supportive living arrangement (SLA) beds can be funded.  He stated the budget includes a reduction of 15.5 positions, a net savings over the biennium of approximately $152,000, and a continued savings of $278,000 per year.  He explained the reduction of 15.5 institutional positions would allow the resources to be moved to community placements.  He stated those would be funded at the intensive SLA rate plus approximately $4,200 per month because the clients need supervision 24 hours a day, 7 days a week.

 

Senator Raggio asked what kind of positions the 15.5 to be deleted are. 

 

Dr. Brandenburg responded that there are two Mental Retardation (MR) Technicians IV, ten MR Technicians III, one Developmental Specialist, one half-time Dietician, one Licensed Practical Nurse (LPN), and one custodian. 

 

Senator Raggio recalled earlier testimony related to the facility that the deletion of the positions would seriously impact the care of those remaining in the Sierra Regional Center.  He expressed concern and asked what assurances could be given to those who have family members there.  He asked whether the problem is an issue of finding qualified caregivers to work with the patients in the institution.

 

Dr. Luke responded the earlier testimony was in regard to services received from a provider for an individual that had formerly lived in a state-operated facility.  He said the concern involved the qualifications and turnover of staff.  He stated the positions to be eliminated in the budget are those that currently serve beds that will be vacant once the patients move out.  He explained that when individuals move out, and they are not satisfied with the level of care, they are given an option to return to the facility.  He noted there is a build-up of infrastructure required by private providers to develop a stable provision of service and a stable workforce.  He suggested that was the problem in the particular case to which Senator Raggio referred, and there may have been disability concerns other than developmental disabilities.

 

Dr. Brandenburg commented $4,200 was built into the budget to address concerns such as that voiced by Senator Raggio.  He explained it is funded at a higher, intensive SLA rate because the needs of those clients will be greater, and it should help providers to recruit and retain the staff they need to provide round-the-clock services.  As part of the continuity of care, he said, the program includes intensive SLAs, regular SLAs, and a variety of other residential placements within the community.  He said the higher rate should pay providers for those clients who really need intensive care. 

 

Dr. Brandenburg opined there are sufficient resources built into the budget to provide sufficient funding to hire qualified staff.  Senator Raggio acknowledged that was his concern, and the deletion of staff raised that concern.  He said he was worried whether there was a problem regarding the qualifications of staff, and whether there were sufficient numbers of staff.

 

Dr. Brandenburg reported cottage 8C, one of the vacant buildings at the Sierra Regional Center, will be closed, and the institute is looking for a tenant for the building, such as a care provider.

 

Dr. Brandenburg noted decision unit M-300 applies to fringe benefit changes, and M-303 is the one-grade increase for MR Technicians that was approved as the result of an occupational study.

 

Dr. Brandenburg said enhancement unit E-125 recommends the use of federal Temporary Assistance for Needy Families (TANF) funding.  He explained the director of the Department of Human Resources has enabled the various divisions to coordinate and help each other.  He said for the first time the division is using TANF funding in division budgets totaling about $1.8 million, which will result in a General Fund savings of approximately $1 million.  He said there will be a biannual savings of $156,000 in unit E-125 in budget account 101-3280 in General Funds because of the ability to use TANF funds.  He explained the purpose of TANF is to keep families intact, to preserve the unity of the family. 

 

Continuing, Dr. Brandenburg stated the Governor’s intent to reduce the waiting list is reflected in decision unit E-431.  He said that should provide for approximately 61 additional clients for the Sierra Regional Center. 

 

Senator Rawson asked for comment on how construction of the budget meets the mandates of the Olmstead Decision, and whether it will help with the Olmstead Decision provisions.  Dr. Brandenburg replied, “Absolutely, sir.”  He opined the Legislature and the Governor should be commended for placing such great emphasis on community placements.  He said, “It is taking folks from the most restrictive setting, and placing them in the least restrictive setting.”  He explained that under the Olmstead Decision the waiting lists are not illegal, but the state must show it is making reasonable progress.

 

Dr. Brandenburg declared Nevada has gone beyond showing reasonable progress toward the waiting list.  He said the division is attempting to totally eliminate the waiting list, but one variable the division had been unable to calculate in the past was the issue of persons who meet the criteria of related conditions.  He explained that last session the related conditions factor was included in the budget, and the division could only estimate how many people that would involve.  He said a budget was developed based upon a projection of 8 percent growth for related conditions, and it appears to actually be growing at 10 percent.  The new budget, he said, is based on 10 percent, and he expressed hope the 10 percent is valid.  He said the division is trying to develop a baseline for it.  He asserted the division is in good stead regarding the Olmstead Decision. 

 

Referring to the 302 percent increase in community funding, Ms. Leslie asked whether sufficient funds are being passed along as individuals are being shifted from institutions into the community.  She voiced concern whether those individuals will be properly cared for in the community.  She asked,  “Are you confident that we will have providers who are willing to take the clients when you shut down this cottage at Sierra?  Are there going to be providers who will be able to take these clients, and are we paying them enough money?”  She surmised the community would say no, and she characterized that as the core issue. 

 

Dr. Brandenburg responded that he has no doubt that providers for intensive SLAs will be available.  He explained the division built in rates that should be sufficient for them to provide those services.  He agreed with Ms. Leslie that the methodology as to whether the division is paying providers enough for them to give adequate services is of concern, especially when so much emphasis is being put onto the community-based services.

 

Dr. Brandenburg acknowledged he should determine exactly what the providers’ needs are, what costs they have, and then build a solid methodology so they will be reimbursed for the services they provide.  He agreed it makes little sense to move clients from institutions back into the community when the providers cannot be paid enough.  He explained that is why the budget includes higher rates for intensive SLAs and why the mental health budgets include an additional $1,200 for special needs beds.  He said the aim is to provide a continuity of care, and to ensure the services are properly reimbursed. 

 

Ms. Leslie agreed and said she is concerned that the clients will get lost during the shift.  She opined many of the complaints may be due to the inability to set rates, and she said she is worried the cottage will be shut down and the clients that are shifted into the community might not receive appropriate services.

 

Dr. Brandenburg said it could be the methodology.  However, he stated, when the budget was being prepared the division attempted to ascertain what costs providers actually incur, but the division received inadequate information from providers to make that determination.

 

HR/Desert Regional Center – Budget Page MHDS-43 (Volume II)

Budget Account 101-3279

 

Dr. Brandenburg called attention to Budget Page MHDS-44 for the Las Vegas program.  He noted decision unit M-200 provides for adding 218 individuals to the caseload.  He explained the budget is funded at the “high level” of demographic growth projections at 6.31 percent in 2001, 5.81 in 2002, and 5.48 in 2003.

 

Dr. Brandenburg said another nine positions will be added over the biennium under decision unit M-200 because of the demographic growth, primarily developmental specialists, accounting specialists, and a computer technician.  In decision unit M-202, he said, six beds will be closed at Desert Regional Center (DRC) and seven positions will be eliminated.  He added that from those savings, six intensive community-based SLAs will be funded.  He noted that will result in a biennial savings of $83,000 and an ongoing savings of $73,000 each year.  He said the plan for the vacated space at Desert Regional Center is to utilize it for single bedrooms.  He explained many clients are calmer and display less aggressive behavior when they do not have to share bedrooms. 

 

Dr. Brandenburg mentioned the fringe benefit changes in decision unit M-300, the 9 percent and 4 percent cost of living adjustments (COLA) in M-301, and the Occupational Studies in M-303.  He noted decision unit E-125 would include revenue from TANF, with a corresponding biennial savings of $700,000 in the General Fund.  He said decision unit E-431 reflects the Governor’s intent to reduce the waiting list for DRC by adding funding for another 54 clients.

 

Ms. Giunchigliani asked what restrictions there are on using TANF funds in place of General Fund, and whether there is some way to further capitalize on that ability.  She asked whether the TANF funds could be used to offset funding for some of the group homes or respite care.  Dr. Luke replied the TANF program is designed to keep families together, in the TANF program Goal One.  He said the funds are being used to replace state expenditures to support case management for families, respite services, and in-home training services.  He said the savings realized from the TANF funds were redeployed to other services, and he admitted he was unsure whether TANF funds could be allocated to adult group homes. 

 

Dr. Brandenburg responded the division has worked hard to find all possible ways to use TANF funding.  He said the possibility of using TANF funding for group homes was explored, but it was determined it would stretch the funding regulations too far. 

 

HR, Family Preservation Program – Budget Page MHDS-49 (Volume II)

Budget Account 101-3166

 

Dr. Brandenburg explained this budget provides financial assistance to families providing home care for family members with mental retardation, thus avoiding the necessity for out-of-home or out-of-state placement.  He indicated 112 individuals were transferred from the Family Preservation Program to TANF and this budget will only serve individuals who do not qualify for TANF support.  He explained 112 of 175 division clients are being transferred to the Welfare Division for a total of 287 clients for whom support is being provided.  He noted the Legislature has approved a maximum payment of $332.93 per month, and the division hopes to accomplish that with the transfer of 112 to the Welfare Division. 

 

Senator Rawson asked what part the Division of Mental Health and Developmental Services (MHDS) will play regarding those people once they are transferred.  Dr. Brandenburg responded the division will continue to maintain the case, including service coordination and clinical oversight.  He said the division must meet federal mandates of collecting over 150 data elements in order for those patients to be in the program.  He said it requires a lot of coordination between his staff and  Welfare Division staff.  He noted the responsibility for clinical oversight remains within the Division of MHDS. 

 

Senator Rawson asked whether the Welfare Division is able to add a new aid code, and whether it will have a major impact on the Welfare Division’s computer records.  Dr. Brandenburg replied that it was his understanding it would be a fairly simple change. 

 

Dr. Brandenburg stated the program has tremendous cost avoidance.  He explained if the 287 individuals needed institutional beds, it would cost the state more than $22 million.  He said providing families with the support to enable them to keep their loved ones home while maintaining them in the system will result in a tremendous savings to the state.  More importantly, he declared, is the support for the families. 

 

HR,Rural Regional Center – Budget Page MHDS-51

Budget Account 101-3167

 

Dr. Brandenburg said decision unit M-200 provides for an additional 23 clients in the Rural Regional Center, and adds 1.5 Developmental Specialist IIIs and 1 half-time Computer Network Specialist.  He said TANF funding is included in unit E-125 in this budget.  He indicated all the developmental service budgets have the same categories and decision units, and he noted there will be a $76,000 General Fund savings in unit E-125 in this budget.  He said decision unit E-431 reflects the Governor’s intent to reduce the waiting list, with the addition of 49 cases.

 

HR, Mental Health Information System – Budget Page MHDS-56 (Volume II)

Budget Account 101-3164

 

Mr. Torvinen explained this is the budget account to track costs of the mental health information system.   He said there are four staff members, two in southern Nevada and two in northern Nevada, who manage the 400 computers using the Advanced Information Management System (AIMS) software.  He reminded the committee there are challenges associated with AIMS. 

 

Mr. Torvinen said the budget primarily includes the base and some replacement computer equipment for billing and data systems.

 

Senator Rawson asked whether the agency has researched other systems, whether any have been found that would be satisfactory, and what the cost would be.  Mr. Torvinen responded the Governor made a $300,000 one-shot proposal to fund a business process reengineering (BPR) study.  He said it should include a review of the division’s basic needs.  He reported vendors of systems in other states have approached the agency, and an invitation has been received to attend a user’s group in San Antonio.  He said there have also been offers from software vendors to conduct a needs assessment, but those will be biased towards their product.  Mr. Torvinen stated the costs of such a needs assessment will probably be less than $100,000.  He stated there is an issue as to whether an Internet application service provider should be used.  He explained that if software services are provided over the Internet there will be issues of confidentiality, but he said they are operating in other states.  He acknowledged the agency has not taken a specific look at any of those yet, but that will be done before a request is made to fund a replacement system. 

 

Mr. Torvinen opined AIMS could be put to better use, and he added that the agency is entering into a contract for the accounts receivable module. 

 

Senator Rawson asked whether AIMS provides full communication between both ends of the state, or whether it is regional.  Dr. Brandenburg replied it provides full communication for the state for mental health, but each region utilizes AIMS differently.  He said the division has tried to maintain central office oversight, but there are variations that cause concern.  He explained AIMS was designed as an inpatient billing system, and it has metamorphosed for the outpatient side.  He said sometimes it is not compatible or user-friendly for outpatient billing. 

 

Dr. Brandenburg said vendors have displayed systems at national conferences he has attended.  He reported the vendor to six sister states has contacted the division to offer the same services that are already on-line, that are user-friendly, and that can be easily transferable not only to mental health programs, but also for a developmental services site to tie the entire division together.  He stated initially he had trepidation about looking at another system after seeing what has occurred in other areas.  He said the tremendous amount of data needed requires a great deal of management oversight, and a new, efficient program should enable the division to “do our work smarter.” 

 

Senator Rawson commented that sometimes Nevada seems to isolate itself from the systems and it is dependent upon the vendors.  Noting that the Legislature has often been obliged to restrict travel, he opined it is a good thing that Dr. Brandenburg has attended conferences at which he could see what is out there.  Senator Rawson said he works with a “Reforming States” group, which has funding available to put together conferences dealing with the need for health data, and he suggested it might be appropriate to have one of the conferences in Nevada.  He said the conference would bring in experts from around the country who can provide state-of-the-art information on a broad scope. 

 

Ms. Tiffany asked whether it is normal for recommendations from a BPR study to take into consideration not only the agency’s practices, but also what is happening in other states.  Dr. Brandenburg replied that is what happened.  Ms. Tiffany surmised the $300,000 should provide an update on current technology, what has been implemented lately, or what expansion should take place.  She asked whether anyone has outlined the scope of the BPR.  Mr. Torvinen responded a decision unit package has been prepared that describes how the $300,000 would be used.  He agreed to provide a copy of it for Ms. Tiffany. 

 

Senator Rawson pointed out the Legislature is preparing for final closings on budgets so it would be best to get the information in right away.  Mr. Torvinen responded the information is ready except for one or two questions from the department level, and the information should be ready later in the day.

 

Senator Rawson invited other people wishing to testify to come forward. 

 

Brian L. Lahren, Ph.D., Lobbyist, Washoe Association of Retarded Citizens (WARC), indicated he was also speaking on behalf of the Nevada Association of Community Training Centers, Nevada Association of Service Providers, and the Community Unity Coalition.  He stated that even with the growth enrollment mentioned by Dr. Brandenburg, Nevada would still be serving one-seventh of the number of clients shown in incidence figures for developmental disabilities published by the Centers for Disease Control (CDC).  He stated that is the lowest rate of program enrollment in the nation, which he called a serious problem.  He said the growth in funding referred to by Dr. Brandenburg has improved the life of state employees, but there has been minimal additional funding for service providers since 1996. 

 

Dr. Lahren explained the funding growth for state employees was designed to help avoid a lawsuit on a child issue emanating from a Florida district court.  He stated that would have caused huge litigation regarding people being on waiting lists for longer than allowed by federal law. 

 

Dr. Lahren asserted the waiting list that was discussed does not reflect reality, which he surmised must be true if only one-seventh of the incidence figures are being served.  He said even if Nevada does not have the same incidence rates as the rest of the nation, the rate is not likely to be too far off, because the incidence figures are based on statistical models, and Nevada has a population base of 2 million. 

 

Dr. Lahren said the $19.55 per day paid to providers for approximately 98 percent of the population is basically a 1955 rate, rather than the $19.55 per hour rate for 2001.  He said if $19.55 per hour were an adequate rate, there would not be 30 people housed in institutions out of state who are probably drawing down $5,000 per month.  He declared there is no standardized assessment, and no standardized allocation of funds by clients, with the intensive SLA programs.  He asserted the system should be changed, as proposed, to have a rate commission and a standardized approach to determining individual needs.

 

Dr. Lahren recalled that Dr. Luke had said unsatisfied consumers could return to the institution.  Dr. Lahren indicated that would be unacceptable.  He said, “It flies in the face of Olmstead; it flies in the face of Medicaid law that requires services in the least restrictive setting.”  He added it is out of touch with reality.  He said the emphasis is on community-based services, but the community-based service system is collapsing.  He said he met with Dr. Brandenburg a number of times over the last 2 years to talk about the need for rate increases, but those did not make it into the budget for a variety of reasons. 

 

Dr. Lahren pointed out it is not because the rates are adequate.  As an example, he said, since 1980, when adjusted for inflation, there has been a 14 percent increase in rates for providers.  He declared in 1980 the division was providing “a baby-sitting service” to adults.  He reported he had helped transform the system into one based on every person in the system being given the opportunity to work, earn wages and become as self-supporting as possible.  Since 1980, he said, there has been a huge increase in responsibilities.  He pointed to all the requirements of the state to provide individualized services in an individualized way and to provide active treatment.  He said those requirements are monitored every year or so by the Health Care Financing Administration.  He acknowledged the records are not good, and the state loses money because of that.

 

Dr. Lahren said the program at WARC costs $1.2 million per year to provide direct client service programs and he indicated WARC is audited by Grant-Thornton.  He said WARC receives $503,000 from all state and federal sources for support, and WARC raises the additional $700,000 itself.  He said the CTC program was started in 1969 as a joint venture between the state and the community.  He said that over the years the state has not kept pace with the cost of services, and the providers have had to shoulder a greater burden.  He said, “We are here to let you know that we are in crisis.”

 

Dr. Lahren pointed out that simple childcare, for children with no problems, runs between $400 and $500 per month, a rate calculated at around $20 per day.  He said that is for “cute little kids, not adults with moderate to severe mental retardation, who have great programming needs, some of whom have to have their diapers changed just like children do, but it is not the kind of thing that people want to do very often.”  He noted untrained childcare providers are being paid the same as trained people that have many more requirements. 

 

Dr. Lahren stated not only are there problems with the amount of money, but also there are problems with the way the money is administered.  He said not only is there a lack of standardization, but also the simple process of enrolling people and getting them into services does not work well within the state system.  He said Sierra Regional Center overspent its residential services budget by $423,000 in the first 2 months of this year.  As a result, he said, the center has had to shut down placements except for emergency situations, they have had to close homes, and people have returned to the institution. 

 

Dr. Lahren asserted the truth is that the residential providers are in crisis and there are not enough funds to pay staff to provide any continuity of care.  He cited cases in which the options for family members have been the lesser of problematic situations, such as returning them to institutions.  He declared that is not “a humane and rational approach to solving the problem.”  He said: 

 

We need to address the need for rate increases for providers, and then we need to build the system within state government that is structurally intact enough that it can make rational assessments prior to budget hearings that is not dependent on whether Carlos [Brandenburg] has the opportunity through the Department of Human Resources to ask for what it is that we need, but where there is a rational, independent assessment of what the rate needs are for providers in the community, because the state has taken the tack of asking its community to provide services through private, non-profit, and for-profit entities in a contract bid situation where they are not contracting with enough money to provide an adequate service.

 

Dr. Lahren asserted Nevada has put forth the lowest rate of fiscal effort on behalf of people with developmental disabilities of any state in the nation for the last 23 years.  He reiterated there is a problem.  He said, “If you step back from specific points, it is all there for you to see.”

 

Senator Rawson noted the CTCs developed as private, non-profit entities to handle the burden for the state.  He recalled at the time it was recognized that, through their good will, the providers would find resources to deal with things that the state did not.  He opined that was good on a small scale, but it has grown to a $40 million budget, and it is now a big problem.  He said it is difficult to transfer from the idea that community members will come forward in good grace to try to handle the problems being neglected.  He declared he wants to see significant progress, and he agreed Nevada is far behind the country.  However, he stated, there have been huge increases in the efforts by the state to meet needs, although there is still a long way to go.

 

Senator Rawson stated the difficult part of dealing with the problem now is that a crisis has arisen in mental health programs, but the state is also in a budget crisis.  He said there are many projects in need of support that may have to be cut by 5 or 10 percent.  He noted sales taxes, gaming taxes, and property taxes are down.  He stated more revenue is needed in Nevada, although not everyone has come to the same conclusion.  He said each system is facing the same problem.

 

Senator Rawson pointed out it does not help to be presented with confusing information that does not give legislators a fair comparison and tends to mislead.  He cited the discussion regarding payment of $19.55 per day as an example of misleading information, since each service provider was paid $19.55 for each client, and since there were often 8 clients per worker, the actual pay turned out to be approximately $19.55 per hour. 

 

Dr. Lahren acknowledged awareness of the limitations in revenue right now.  He said one of the problems has been that the budget process does not allow his groups to come forward in ways that would make it appear that the problem is anything other than a crisis that suddenly arose.  He reminded the committee that the problem has been discussed for several sessions, and with all the increases that have been distributed to the division, they have not been allocated to the direct service providers.  He noted the division draws in $85 per hour for case management through Medicaid, but only passes along $15 to the few providers who receive case management compensation.  He said the balance of people in the community do not receive that compensation, yet regional centers pass their responsibilities onto the providers.  He stated, “Those kinds of things are unfair.” 

 

Dr. Lahren stated the issue regarding the $19.55 per hour versus $19.55 per day is that the hourly rate is an intensive rate paid to approximately 2 or 3 percent of the total population.  He said the other 98 percent are under the $19.55 per day figure, about the same as a childcare reimbursement rate.  He said audited financial statements show what it costs to run the program and show that the state compensation only pays for a fraction of costs.  He indicated when originally constructed, the CTC program was a partnership, weighted on the side of the state because it was the state’s responsibilities that the Community Training Centers were assuming.  Over the years, he said, the state involvement has been less and less, and now it is a minority partner in the cost of providing direct care for the people who are its primary responsibility. 

 

Dr. Lahren said the organizations have provided services because they care, with many of the organizations under the management of parents.  He cited WARC as an example of a parent organization.  He said the organizations will continue to try to find ways to provide services, even when the state has not been a good contributing partner.  He said, “We just happen to be the people who, after the hospital associations and after everybody else in the long-term care industry, with permanent lobbyists, gets their rate increases, we are the last one at the table, and we are always told that there is nothing left for us.”

 

Senator Rawson interjected that even after an ideal world is reached, it may be that there will still be a community responsibility to seek donations, hold fund-raisers, and participate in United Way.  Dr. Lahren responded that the organizations want to participate, and if WARC were able to participate by 50 percent it would be happier than it is now. 

 

Senator Rawson asked how much is anticipated by the providers that the state will put into the budget.  Dr. Lahren said it would probably be around $40 million.  Dr. Luke noted that the table in the division handout (Exhibit D) shows $40 million targeted toward community services, most of which goes to vendors. 

 

Senator Rawson pointed out that if so, and the state is only providing one-seventh of what it should, it would mean a budget of $280 million.  He noted the state would not be able to make much progress toward that goal during the coming fiscal year.  However, he said, the state probably should begin to set 5- or 10-year goals to provide a measurement of progress. 

 

Senator Rawson asked whether it would confuse the Olmstead Decision process to include the matter in discussions to be held later during the summer.  Dr. Luke responded that should be an important part of the discussion.  Senator Rawson suggested all the issues should be thoroughly brought out during the Olmstead Decision study, and not only should the state establish what should be accomplished by the end of the study, but also what should be accomplished over the next 10 years to reach the right goal.  He suggested there will be no other way to change unless there is a written plan showing incremental changes to be made each year.

 

Senator Rawson stated, “I will pledge myself to really go into that effort, to make a difference over the next 10 years.” 

 

Ms. Leslie reported she has received complaints from people in the community that the budget has been overspent, with the result that community provider homes have been closed, and clients have had to move back into the centers.  She asked for comment.

 

Dr. Luke responded no additional funds are being requested in category 11.  He said funds would not be overspent at Sierra Regional Center.  In response to Dr. Lahren’s concerns, Dr. Luke explained the budgets are built to phase in services, so not all new services will be in place at the beginning of the year.  He said a number of services were started, and then there was a period in which consolidation was needed.  He said a number of people needed roommates.

 

Dr. Luke stated there is problem in attempting to address a large growth in need in which people have to be moved on an individualized basis and then be provided an opportunity for choice in finding a place to live.  He said people are not necessarily returned to the institution.  He explained that if people are uncomfortable, the offer to return to the institution is made available, but very few select that option. 

 

Ms. Leslie asked whether homes have had to close because the state ran out of money.  Dr. Luke answered that the state has not closed any homes.  He pointed out the state does not operate any homes.  He said there have been cases in which persons have been given some responsibility over management of their own Supplemental Security Income (SSI), who could rent their own accommodations, but who need roommates to help with the rent.  He said the agency needs to work with those people to help them find roommates, and to coordinate care plans for them to provide the opportunity for them to stay in homes.

 

Ms. Leslie said if there were no roommates available the people should not have been moved there in the first place.  Dr. Luke responded the agency attempts to coordinate with individuals, but it also tries to allow freedom for the people so they will not have to become tied to a group.

 

Ms. Leslie suggested that might be an area in which the state could provide more efficient management to help the provider avoid that kind of chaos.  She opined the system could work a little better.  She clarified that Dr. Lahren had never mentioned the problem to her, but other people in the community had complained that moving around has caused many problems. 

 

Senator Rawson pointed out administrative costs would cause an additional expense with increasing caseloads.  He noted the entire Division of Mental Health and Developmental Services would cost from $102 million to $140 million by the end of the biennium, a $40 million increase.  He said it is a step in the right direction, but he recognized that more needs to be done.  He said the only way to deal with it adequately would be to chart it out and grapple with the steps over a period of time.  He noted the same is needed for education, higher education, human services, and other areas, which will cost the state a lot more.  He stated, “I am sick and tired of being last in the country in everything that is important to us.”  He indicated many other people agree with him.

 

Ms. Giunchigliani pointed out it is a matter of “pay now or pay later.”  She said part of what the Legislature does is defer matters.  She agreed with Senator Rawson that the entire matter needs review.  She agreed that the community will always have to be involved, entailing community fund-raising efforts.  She surmised most cuts will probably come from the human services budgets.  She suggested the focus group and the community should be looking for another revenue stream. 

 

Nancy Neill, who identified herself as the parent of a son with special needs, spoke from written testimony (Exhibit E).   She said when her son, Andy, was 4½ years old he had to be placed in a home for special needs children.  She reported she and her husband were devastated to learn Nevada had no place for him, and they found a place in Orem, Utah, 300 miles from their home in Elko.  She stated her goal is to prevent any other parent from having to go through the same experience in which the child had to be left with perfect strangers. 

 

Mrs. Neill said she worried for 3½ years about the kind of care her son, Andy, received, and whether he missed his family.  When her son was able to return to Elko the family was elated, she said, and he now thrives in a home nearby.  She questioned how Nevada could justify spending millions to send people out of state.  She calculated Nevada is spending over $3 million each year to place people out of state.  She suggested spending that sum here would create jobs, diversification, and revenue.  She presented a letter written by another family in Elko (Exhibit F).

 

Senator Rawson noted that has been the highest priority for relatives. 

 

Senator Coffin asked whether Andy was improving because he was getting relief through medication.  Mrs. Neill responded he is improving because he receives better care in Nevada, he lives in a smaller home, and he is near his parents.  She said she can visit at any time. 

 

Senator Coffin asked for specifics regarding Andy’s affliction.  Mrs. Neill replied he was born with a disability in which part of his brain never developed, so his physical and mental abilities are very slow in developing.  She noted that with constant therapy, and with Rural Regional Center and Medicaid help, he is progressing.

 

Art Woolston, Owner, Danville Services Corporation, testified via videoconferencing from Las Vegas.  He said his company supplies approximately $20 million in services in Utah, Oregon, and Nevada, of which approximately $4 million is attributable to Nevada.  He said there has been no increase in the supported living arrangement (SLA) rate since 1996, even thought costs have gone up.  He stated he is committed to the business, but unless it is run like a business with sufficient funding to hire good people, it will fail.

 

Mr. Woolston said there have been many meetings in which the matter has been discussed, and it makes no sense for all the funds to go into new services when existing services are underfunded, making it impossible to hire people.  He suggested the problem is not that new providers are needed, but rather that existing providers need sufficient remuneration to hire people who can be trained and who will stay.  

 

Dr. Luke said the CDC indicates about 1 percent of the population has this type of disability, but neither he nor CDC feel all those individuals need service at any given time.  He said the approach to addressing needs and growth has been to focus on the waiting list because those are actual individuals.  He asserted the state has set a positive trend to achieve the level of service needed.  He stated only time will tell what the need will be, and he declared no other state serves that level.

 

Senator Rawson stated there are problems with simply responding to the waiting list.  He noted people coming from other states are often discouraged by the length of the waiting list.  He said the same problem is happening with education in the state, with the lowest percentage of children going on to college, which he attributed to classes being full when students try to register.  He pointed out students will only put up with waiting for a couple of times, and then they give up.  He suggested there is a more appropriate way to handle the problem than only through shortening time for waiting lists.  He opined more needs to be done.

 

Dr. Luke voiced agreement.  He disputed the allegation that there are 30 individuals with mental retardation placed out of state.  He said many were brought back to Nevada, and none are being placed out of state now, with very positive results.  He also said it is incorrect that the state collects $85 in case management and fails to pass it along to vendors, because the state does not collect those funds. 

 

Dr. Luke stated the agency met with providers earlier to discuss concerns about rates.  He noted that some of the higher rates approved during the last legislative session have not been fully implemented yet, and more are scheduled to come on line.  As an example, he said the Legislature approved a higher administrative rate of $335 for intensive placements as referred to by Mr. Woolston.  Dr. Luke said there may be 20 or 30 intensive placements in place now, but they are done by using a standardized instrument to determine which individuals have the greatest need and qualify for that intensive level of care.  He said there will be 90 situations being paid that higher rate soon, so there will be some relief. 

 

Senator Rawson opined Nevada is growing up as a state, from less than 1 million residents to over 2 million, and many systems have not kept up with growth.  He acknowledged public hearings are needed, and a higher level of sophistication is needed in the development of budgets.  He voiced appreciation for the input. 

 

Committee members were provided with a publication entitled Developmental Services Program Evaluation: Personal Outcomes & Satisfaction by the Division of Mental Health and Developmental Services (Exhibit G.).

 

HR, Public Defender – Budget Page PUB DEF-1 (Volume II)

Budget Account 101-1499

 

Senator Rawson noted that the budget for post-conviction relief has been increased to an amount higher than the agency request or the historical high.  He indicated what was recommended appears to be exceptionally high and asked why.

 

Steven G. McGuire, State Public Defender, Office of the State Public Defender, Department of Human Resources, responded there has been tremendous growth in the post-conviction area, and it is very difficult to project what will be experienced in the future.  He said the chief appellate deputy developed the theory that there is an interaction of two factors.  Those factors are the new fast-track appeal process implemented several years ago by the state Supreme Court and the truth-in-sentencing laws, which are beginning to have an impact on mandatory minimum sentences.

 

Mr. McGuire said that under the old system most defendants who had been convicted and imprisoned, who considered appealing, often found that their sentences had expired, or they were on parole, or were within a few months of the parole date.  At that point they lost interest in pursuing other relief.  Under the new fast-track system, he said, the majority of criminal appeals are disposed of in the fast-track manner.  He noted that within less than a year people have the results of their appeals and, typically, they are denied.  He explained with the new minimum mandatory sentences, the first parole hearing is often years away.  Thus, he said, there is a surge of people filing for post-conviction relief, which may account for the systemic change in the way cases are handled, and those generate large increases. 

 

Mr. McGuire opined a new equilibrium is about to be reached.

 

Senator Coffin asked whether death penalty statistics have changed.  Mr. McGuire responded they have not been separated out in the statistics, but in the past 2½ to 3 years there has been a surge in death penalty cases.  He said six have been filed in the past 3 years.  He expressed pride that all except one have been resolved with non-death penalty results.  He noted that is an abnormal number of capital cases.  He said in the past only one capital case arose every other year, so two each year for 3 years was remarkable.  Several are still pending, he said, but the state has withdrawn efforts to seek the death penalty.  He called the results excellent.  He pointed out that nearly all defendants in death penalty cases claim they had ineffective assistance from counsel, a normal part of the job, but so far none have resulted in a finding of ineffectiveness. 

 

Senator Coffin asked whether the defenders are trained sufficiently on death penalty cases.  Mr. McGuire answered that is built into the training, and for the last several years the National Judicial College has given free death penalty seminars.  He said the public defender’s office has taken advantage of that opportunity because there has been a lot of litigation in the field, and because it provides an opportunity for free training and saving in the training budget.  He remarked that, if anything, the people in the office are overtrained in death penalty litigation, perhaps at the expense of training for driving under the influence (DUI), or domestic battery training. 

 

Senator Rawson recalled that the 1999 Legislature approved a Deputy Public Defender position for the Carson City office to enable a 20 to 30 percent increase in that office and 50 percent in Storey County.  He said prior to that time the statistics showed a decrease in caseload.  He asked whether Mr. McGuire could provide caseload statistics.

 

Mr. McGuire answered that the caseload statistics were not available since the year 2000 ended, and those came in below projections.  However, he said, the fact that the caseload was projected higher was offset by the fact that there have been such a high number of capital cases, and non-capital murder cases.  He reported the attorney who came on board at that time has spent a substantial amount of time in Ely on a prison death-penalty case that was just resolved within the last month as a noncapital plea of guilty.  He pointed out that is the equivalent of several cases.

 

Senator Rawson remarked that the assumptions may have been in error during the last session when the position was funded, and it should now be put on a better basis.  He suggested if the workload is high, there should be a way to measure it and deal with it on that basis.  He acknowledged that once a position is provided it normally will not be taken away.  However, he said, the assumptions were wrong, with the wrong thing being measured.  He said he wanted to refine the process.

 

Ms. Tiffany commented decision units E-710 and E-720 seemed confusing regarding the addition of equipment, and the software applications being used.  She asked whether there are 19 personal computers in use, 6 printers, and a file server, or whether the office plans to buy those.  Mr. McGuire replied the office plans to buy those.  He said at the present time everyone has a computer, but there is no interconnectivity.  He said in the last biennium each of the three offices got onto the Internet and hooked up to on-line legal research services.  However, he said, that did not deal with a long-standing problem pointed out by the legislative Audit Division.

 

Mr. McGuire explained the office has an antiquated management information system.  He said the new equipment should provide the interconnectivity to allow administrative material on-line, with all three secretaries able to input data. 

 

Senator Rawson suggested legislative staff should work with the defender’s office.  He said the office received $11,000 in April for new computers, and now there is a request for $31,000 to buy computers for everyone there.  He said this recommendation requires explanations.  Mr. McGuire responded that last time only the secretarial computers were upgraded, and this request is to upgrade attorney computers. 

 

Ms. Tiffany asked what the overall plan is regarding the information management system.  She noted it appears there are many needs.  Mr. McGuire responded the information management system will be used to track clients for case management, conflicts, tracking hours, and the like.  He said the office wants to track how well the clients are being represented, such as the length of time from receipt of the case to the first visit with the client, and what kind of results are being reached in various categories of cases. 

 

Ms. Tiffany acknowledged a lot of data reporting is done by hand.  Mr. McGuire responded all of it is done by hand. 

 

Senator Rawson asked what out-of-state travel needs will be and noted travel should be tracked. 

 

Debbra J. King, Administrative Services Officer IV, Department of Human Resources, commented that $3,000 for investigative travel was included on the recommendation of the Legislative Counsel Bureau Audit Division.  She explained that previously the public defender investigators would go to a local judge and get permission to travel out of state to make investigations, and with approval the investigator would submit his travel claims to the local jurisdiction.  She said the budget places the $3,000 reimbursement from the counties into the budget, and the $3,000 in investigative travel is put into a separate category in order to track it and document the activities of the agency.

 

Senator Rawson agreed there should be tracking.  He admitted he was unsure just how much the travel allocations should be.  Mr. McGuire noted the figure will fluctuate dramatically.  He said out-of-state travel occurs typically in major cases, nearly exclusively in capital cases, in which out-of-state witnesses are needed.  Senator Rawson interjected that is understood, and it would be best to establish a track record.

 

Mr. Dini asked whether figures are available on the cost per person for Carson City or Storey County.  He said the public defender system in Lyon County costs $255,000 for three public defenders.  Mr. McGuire said the figures have not been tracked, but offered to do so.  Senator Rawson agreed that would be helpful to smaller counties to decide whether to employ their own public defenders.

 

HR, Indian Affairs Commission – Budget Page INDIAN-1 (Volume II)

Budget Account 101-2600

 

Ms. King testified that the Governor assigned the Nevada Indian Commission to the director’s office of the Department of Human Resources for administrative purposes.  She said the administrative oversight will include items such as the budget.  She stated she had been notified there are some inconsistencies between performance indicators and the expanded program narrative in the budget, which she anticipates can be resolved with input from the legislative fiscal staff.  She said both numbers came from the Executive Director of the Nevada Indian Commission.  She noted the budget is basically flat, and is sufficient to meet the current statutory requirements, but not sufficient to meet the expanded statutory requirements requested by the Nevada Indian Commission.  She noted a bill is pending to address the additional duties.

 

Ms. King stated the Governor has agreed to work with the Nevada Indian Commission over the next biennium to review both current statutory authority, and the proposal.  She said, other than decision unit M-300 for cost-of-living issues, the only other item included in the budget out of the ordinary is decision unit M-100.  That relates to information services to add support from the Department of Information Technology (DoIT). 

 

Ms. Giunchigliani asked how much was over-expended.  Ms. King responded:

 

The Executive Director of the Indian Commission submitted a letter to the Legislature indicating that they would need a supplemental appropriation for FY [fiscal year] 2001.  Based upon further review of their statutory responsibilities and of their existing budget, what was included by this Legislature for their budget, it has been determined that they can live within their existing budget for the rest of this fiscal year and a supplemental will not be necessary.

 

Ms. Giunchigliani asked how much they had requested.  Ms. King replied they had requested over $5,900.   Ms. Giunchigliani asked whether the Executive Director position was vacant for 10 months.  Ms. King responded that during FY 2000 the position of Executive Director was vacant from July 1999 until April 2000.  Also, she said, from February 2000 until approximately August 2000 the secretary position was vacant. 

 

Ms. Giunchigliani asked what caused the vacancy.  Richard Harjo, Chairman, Nevada Indian Commission, responded that the vacancy was due to the fact the Executive Director retired, and it took 10 months to complete a nation-wide search for the position.  He said the commission submitted three names to the Governor, and Ms. James was selected from the list.

 

Ms. Giunchigliani inquired where Ms. James came from.  Sherrada L. James, Executive Director, Nevada Indian Commission, replied she was raised in Carson City, Pyramid Lake, and the Washoe Reservation. 

 

Ms. Giunchigliani asked whether the title should be changed to “Native American.”  She explained someone had contacted her regarding another commission for which the title has not been updated.  Senator Rawson asked whether that would be preferred.  Mr. Harjo suggested it would be best to poll the tribes.  He noted Native American is a “geopolitical nomenclature.”  He stated he is personally comfortable with the word “Indian.” 

 

Ms. Giunchigliani stated she would not want to make a change unless the Nevada Indian Commission requested it.  Senator Rawson said during session is the time to make such a change, and if there are concerns the commission should inform the Legislature. 

 

Ms. Leslie reminded Ms. King that she had asked about a bill draft to abolish the Indian Commission, but at the time Ms. King indicated there was no such bill draft.  Ms. Leslie said when she checked she found a bill draft on the fundamental review report that had the name of the Department of Human Resources associated with it.  She noted the bill draft said that the Nevada Indian Commission was requested to be abolished. 

 

Ms. King responded she had no idea about the bill draft request.  She said, “There were three alternatives provided to the Governor’s office in development of the agency request budget.”  Ms. Leslie pointed out she just wanted to let Ms. King know it does exist.  She asked whether the department has taken a position on Senate Bill 365 or whether the department has reviewed the fiscal note.

 

SENATE BILL365:  Makes various changes relating to Indian affairs. (BDR 18-719)

 

Ms. King replied the only thing the department noticed in the bill was that the enhancements have only been funded for the Executive Director for 1 of the 2 years of the biennium.  She suggested both years should be funded if the Legislature decides to approve the enhancements.  Senator Rawson said it could be that the first year is for the search and the second year is to hire the person.

 

Ms. King said the commission would still need the additional operating funds for the first year search.  She noted a lot was spent on advertising in FY 2000 for newspaper ads in the national search. 

 

Ms. Leslie asked whether the Nevada Indian Commission was involved in the preparation of the budget.  Ms. King replied,  “The Indian Commission followed the exact same process as every other state agency followed.  She was provided with copies of the budget instructions.  She was provided with opportunities. . .”

 

Ms. Leslie interjected that she was referring to the commission, not the Executive Director.  Ms. King replied, “Perhaps you should ask the Executive Director whether or not it involved them.”

 

Ms. Leslie asked Mr. Harjo whether the commission had been involved.  Mr. Harjo responded, “No, they were not.”  Ms. James added, “The budget that was prepared and submitted was submitted by the department prior to my hiring, so it was already done.”  Ms. King interjected, “Excuse me.  The Executive Budget is . . . agency requested, submitted in August.”

 

Ms. Giunchigliani asked what S.B. 365 will do.  Mr. Harjo responded it will make the commission autonomous. He explained it is an act creating a Department of Indian Affairs and providing for its duties.  He said it will revise the membership of the Nevada Indian Commission by adding one more position, and the membership will be composed of all Indians representing each of the nations in the state, plus two urban Indians from the northern and southern ends of the state.  He said it also authorizes assessment of certain fees. 

 

Mr. Harjo explained, “We have been too diligent in our duties in that we have made so many contacts with all the state agencies and departments that we are being inundated with requests to network them with the tribes.”  He handed out copies of a paper (Exhibit H) indicating the number of reports issued, projects and requests for assistance, the number of inquiries and assistance, number of telephone calls, and other information.  He also distributed copies of the Tribal Fire Protection Services Report (Exhibit I) and the Report on Tribal Housing Authorities (Exhibit J.).  Ms. Giunchigliani stated that will help the legislators understand the activities of the commission better and what the needs would be.

 

Ms. Giunchigliani asked whether it would be possible to support the commission by fees from the tribes if it is determined it is needed and the bill moves.

 

Mr. Harjo distributed copies of the biennial report, Informational Packet on the Nevada Indian Commission’s Budget Subcommittee (Exhibit K.  Original is on file in the Research Library) produced by the commission.  He drew attention to a chart on page 6 to show how the process works with Indian communities.

 

Senator Rawson noted the organization chart depicts issue areas of concern.  He asked whether there will be a different person managing each issue, or whether several of them can be lumped together.  Mr. Harjo replied that each one could be separate, but, realistically, the tribes know they cannot ask for that.  He proposed making a cursory investigation of what is happening in each area, and reporting back later. 

 

Senator Rawson noted the accounts have a certain flow of human services covering all sorts of issues.  He suggested nothing would be accomplished if the items are only proposed on paper.  Mr. Harjo responded the document came about as the result of the activities. 

 

Ms. Giunchigliani asked for confirmation that there are 19 tribes in the state.  Mr. Harjo replied there are 19 federally-recognized tribes in the state, and a total of 27 if all the bands and colonies are counted. 

 

Ms. James noted the commission prepared a strategic plan to adjust to each category to give an idea of what the commission would like to implement.  She said the biennial report was requested last session, and it is very comprehensive.  She said there has been an increase in the Native American population.  Since the census came out, she pointed out, it is evident that enrolled members increased.  She also said the population increased from a combination of mixed race including Native Americans and others, which has doubled across the country.  She pointed out that, although the statutes have not changed, the tribes have progressed since 1965.

 

Senator Rawson asked how many live in the state.  Ms. James said the commission attempts to track tribal members, but the total population needs to be reviewed.  She said the census of reservation populations was undercounted, and the only figures to be compared with Bureau of Indian Affairs (BIA) figures show about 20,000 Native Americans in 1990 in Nevada.  She said the state demographer estimated in 2001 there would be over 28,000.

 

Senator Rawson adjourned the meeting at 10:40 a.m.

 

 

RESPECTFULLY SUBMITTED:

 

 

Judy Jacobs,

Committee Secretary

 

APPROVED BY:

 

 

                       

Senator Raymond D. Rawson, Chairman

 

 

DATE:           

 

 

                       

Assemblywoman Christina R. Giunchigliani, Chairman

 

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