MINUTES OF THE

SENATE Committee on Human Resources and Facilities

 

Seventy-First Session

March 12, 2001

 

 

The Senate Committee on Human Resources and Facilitieswas called to order by Chairman Raymond D. Rawson, at 2:00 p.m., on Monday, March 12, 2001, in Room 2135 of the Legislative Building, Carson City, Nevada.  Exhibit A is the Agenda.  Exhibit B is the Attendance Roster.  All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

 

COMMITTEE MEMBERS PRESENT:

 

Senator Raymond D. Rawson, Chairman

Senator Maurice Washington, Vice Chairman

Senator Randolph J. Townsend

Senator Mark Amodei

Senator Bernice Mathews

Senator Michael Schneider

Senator Valerie Wiener

 

STAFF MEMBERS PRESENT:

 

Marsheilah D. Lyons, Committee Policy Analyst

Patricia Di Domenico, Committee Secretary

 

OTHERS PRESENT:

 

Marybel Batjer, Chief of Staff, Office of the Governor

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

Glenn B. Sheard, Concerned Citizen

C. E. Edwin Fend, Lobbyist, American Association of Retired Persons

Tom Wood, Lobbyist, Wyeth-Ayerst Laboratories, Division of American Home             Products

Janice R. Ayres, Executive Director, Nevada Rural Counties, Retired Senior             Volunteer Program

Caryn Solie, Concerned Citizen

Maury Astley, Lobbyist, Nevada Dental Association

Linda L. Sheldon, Lobbyist, Great Basin Primary Care Association

Michael Johnson, Manager, Outreach Programs, Saint Mary’s Regional Medical             Center

Jon L. Sasser, Lobbyist, Washoe Legal Services Incorporated

Ron W. Sparks II, Director, Western Interstate Commission for Higher             Education

Alexander Haartz, Deputy Administrator, Health Division, Department of Human             Resources

 

Chairman Rawson opened the hearing and invited testimony on Senate Bill (S.B.) 239.

 

SENATE BILL 239:  Makes various changes concerning provision of prescription drugs and pharmaceutical services for senior citizens.  (BDR 40-1318)

 

Marybel Batjer, Chief of Staff, Office of the Governor, stated S.B. 239 has been requested because the Governor is concerned the Senior Rx Program (prescription drug program to aid senior citizens) cannot reach all the population.  She explained S.B. 239 would remove the subsidy cap of $40 a month or $480 a year that has been established.  Seniors at the low end of the economic scale can apply for the program, have a full subsidy paid by the State, and only pay the co-payment for prescriptions, and the $100 deductible. 

 

Debbra J. King, Administrative Services Officer IV, Department of Human Resources, testified 1653 Nevada residents have applied for the Senior Rx Program, 194 are participating, 43 people are in pending status, and 8 others have applied but cannot make the monthly premium.

 

Chairman Rawson asked for a breakdown of the applicants.

 

Ms. King responded 58 percent of the applications listed annual incomes of $12,700 or less.

 

Chairman Rawson questioned Ms. King as to the applicants’ locations.

 

Ms. King replied, 33 percent of the applicants are from rural Nevada, 43 percent are from Clark County, and the remainder is from the Washoe County area.  She explained seniors in Washoe and Clark Counties could participate in health maintenance organizations (HMO), which provide some benefits.  In the rural areas there are no HMOs, therefore, low-income rural seniors have no alternative for medications.

 

Glenn B. Sheard, testified to being a volunteer at the Department of Human Resources who speaks to seniors about the Senior Rx program.  He told the committee that for the last 30 days he has fielded phone calls from senior citizens who want information about the Rx program.  Mr. Sheard voiced his alarm at the number of senior citizens who subsist on less than $1000 a month.  He commented on a senior whose prescriptions cost about $500 and only receives $762 from Social Security.  He noted most seniors could not afford $34.76 for a monthly premium.  Mr. Sheard stated seniors either obtain samples from their physicians or go without their prescriptions.  He said 70 percent could not reach the income level of $12,700.  Mr. Sheard emphasized most seniors are desperate for help.

 

Ms. Batjer relayed the Governor’s concern about the increasing costs of energy and how seniors will have another economic consideration, in addition to their prescriptions.  She reiterated the Governor’s intent in removing the premium cap.

 

Chairman Rawson asked what the co-payment was for someone who has a monthly expense of $500 in prescriptions.

 

Ms. King explained the co-payments are based on the prescription.  She said under the basic program, the co-payment is $10 per month for a generic prescription, and for a preferred brand it is  $35 or 50 percent of the cost of that drug, whichever is greater, and non-preferred brands are not covered.  Under the enhanced program, the co-payment for a generic is $10; the preferred brand is $25; and non-preferred brand would be 40 percent of the cost of the drug or $40 whichever is higher. 

 

Senator Wiener commented some seniors might still have difficulty paying for the deductible or co-payments.

 

Ms. King pointed out there were many community partners who provide assistance to the senior population for their deductibles and co-payments.  She claimed there are many “alternate” ways of designing a senior drug assistance program.

 

Senator Mathews asked for examples of alternative programs.

 

Ms. King replied many alternatives were reviewed when bids were received in preparation for the existing program.

 

Ms. Batjer stated S.B. 239 is the first step in making the program affordable for seniors.

 

C. E. Edwin Fend, Lobbyist, American Association of Retired Persons (AARP) testified in favor of S.B. 239.  He suggested that speaking to the physicians about prescribing generic over brand-name drugs for seniors would be a big help.  Mr. Fend insisted the senior population must be fully informed about the options available to them.  He said it is most important to advertise the program to senior citizens and then evaluate the program’s progress. 

 

Mr. Fend noted that starting April 1, 2000, all retired military personnel and their spouses have had free access to medications.  He stressed this could reduce the number of seniors in the program.  Mr. Fend emphasized another way seniors can benefit is ordering prescriptions with a 90-day supply and saving on the co-payment. 

 

Tom Wood, Lobbyist, Wyeth-Ayerst Laboratories, Division of American Home Products, testified in favor of S.B. 239.  He told the committee, due to the efforts of the Legislature and the Governor, the program is funded by a tobacco settlement of $4.9 million.  He claimed the Senior Rx program must continue to be advertised.  Presently, brochures are distributed in doctors’ offices, and pharmacies, and the Nevada Nurses’ Association is helping to inform seniors of the program.  Mr. Wood said S.B. 239 would simplify the program and make it available to more senior citizens. 

 

Senator Wiener asked for a clarification of the figures of eligible seniors.

 

Ms. King explained there are 122,000 senior citizens covered by an insurance product.  Of the 1653 applicants, 58 percent have incomes of $12,700 or less.  She said the anticipation was to serve 10,000 to 12,000 seniors.

 

Senator Wiener questioned the time period for coverage.

 

Ms. King responded the coverage is for 1 year.

Senator Wiener asked how it related to the $4.9 million obtained from the tobacco industry.

 

Responding, Ms. King said the $4.9 million is what is available for the subsidy and the entire program is funded through the tobacco settlement for the full year. 

 

Chairman Rawson questioned the rejection rate of the 1653 applicants.

 

Ms. King answered, 93 percent of the seniors applying are found to be ineligible.  She listed the various reasons for an application to be denied: their income is too high; they are under the age of 62 years; they are not a Nevada resident; or they currently receive Medicaid benefits.  Ms. King defined the processing time for application as a 60-day period.

 

Chairman Rawson asked the determining factors in the processing time.

 

Ms. King responded, stating each month is an application period, applications are reviewed for eligibility and amount of subsidy. and, by the fifteenth of the following month, a letter would be sent to all applicants.  After the department reviews all the information, makes its decision, and responds, the seniors are issued a card.

 

Janice R. Ayres, Executive Director, Nevada Rural Counties, Retired Senior Volunteer Program (RSVP), voiced endorsement of S.B. 239 on behalf of RSVP, Foster Grandparents, and the Senior Companion Program.  She stated there are 2600 volunteers in the rural areas and many are schooled to help seniors with the program.  Ms. Ayres stressed it is imperative that S.B. 239 be passed for the senior citizens who have to choose between eating and taking medications.  She urged the committee to pass S.B. 239 for seniors to have a better quality of life.

 

Senator Townsend queried the necessity for lines 6 through 11 of S.B. 239. 

 

Ms. King explained the original language said, “the Department of Human Resources shall get an insurance product for senior citizens,” but, the proposed language on page 2, line 19 of S.B. 239 is: “. . . the basic policy of health insurance. . .”  She expounded on the language on lines 6 through 11 as allowing a basic policy of health insurance and an enhanced or alternative product.

 

SENATOR TOWNSEND MOVED TO DO PASS S.B. 239.

 

SENATOR MATHEWS SECONDED THE MOTION.

 

THE MOTION CARRIED.  (SENATOR WASHINGTON AND AMODEI WERE ABSENT FOR THE VOTE.)

 

*****

 

Chairman Rawson closed the hearing on S.B. 239 and opened the hearing inviting testimony on Senate Bill (S.B.) 208.

 

SENATE BILL 208:  Makes various changes to provisions concerning public dental health.  (BDR 40-738)

 

Chairman Rawson told the committee:

 

Timothy M. Westmoreland, the outgoing director of the Center for Medicaid and State Operations within Health Care Financing Administration, [United States Department of Health and Human Services], recently sent a letter that put the states on notice that the Health Care Financing Administration (HCFA) will, for the first time, monitor their compliance in achieving children’s access to dental services under Medicaid.  States providing dental care for less than 50 percent of Medicaid-enrolled children will be subject to review by HCFA, and within 120 days of the issuance of the letter [which was dated January 18, 2000,] and 2 weeks before we finish session, states must submit a plan of action for improving children’s access to dental services.  The plan should undertake to ensure adequate dental access within 3 years and HCFA will take additional steps with regard to states with access rates of less than 30 percent. 

 

Chairman Rawson stated Nevada has an access rate of 15 percent to 20 percent for Medicaid-enrolled children, which puts the state in the bottom tier and on notice if we do not take measures to correct this situation.  He said the

HCFA addresses a number of areas that states need to be involved in, and makes it clear there will not be new regulations or standards, but reiteration of  the existing law.  Senate Bill 208 will repair the budget cuts that happened in 1981, he said, pointing out that since 1981 a serious access problem to dental services has developed in Nevada. 

 

Chairman Rawson noted 16 percent of 600,000 children in the state are fully-insured and only a small percent are insured through public programs.  He referred to the “Miles for Smiles“ program in Las Vegas and a similar program at Saint Mary’s Regional Medical Center as providing services.  Chairman Rawson remarked that at the C. P. Squires Elementary School, the “Miles for Smiles” bus personnel expected to be at the school for a week or 2, but discovered out of 1100 students, 800 had serious dental problems.  He said a survey of 24 other schools in the Clark County area  identified thousands of children as having serious dental needs but no other access to dentistry.  Chairman Rawson claimed S.B. 208 was drafted to provide a “public health dentist and public health dental hygienist” to help identify the dental needs of  and develop dental health programs for children that do not have access to dental services.  He also pointed out senior citizens are another group who are in need of dental service. 

 

Senator Mathews questioned whether the bill would need to go to the Senate Committee on Finance.

 

Chairman Rawson answered in the affirmative. 

 

Caryn Solie, Concerned Citizen, and Dental Hygienist, spoke on behalf of the Nevada Dental Hygienists’ Association and gave support to S.B. 208.  She stated S.B. 208 would give the necessary care and services to the uninsured population of Nevada.  Ms. Solie requested permission to submit a proposed amendment to S.B. 208  (Exhibit C).  She noted on (Exhibit C) two typographical errors: the first is NRS 61.230 should be NRS 631.230; and in section 2 at the bottom of page 1, the language should say                             “. . . dental hygiene . . .” not “. . . dentistry in another state has been suspended. . . “

 

Ms. Solie explained the first portion of the amendment requires a dental hygienist be licensed and have graduated from an accredited school, have successfully performed for our state board of examiners (Board of Dental Examiners of Nevada), and hold a current license in the state of Nevada.  She called attention to the second portion of the proposed amendment, which would guarantee that the people who would look at licensure in Nevada also meet this criterion of educational standards, and be of moral character. 

 

Maury Astley, Lobbyist, Nevada Dental Association, voiced support for Senate Bill 208.  He said there was concern about the part of the state dental officer and hygienist duties regarding teaching at the dental school, which would take time away from their main function, which is to evaluate the services needed for the state.  Mr. Astley stated he took issue with the fact that if this were a teaching position with a limited license, and asked, how would the person be able to supervise in remote rural areas?  He suggested language be added to cover the situation.

 

Linda L. Sheldon, Lobbyist, Great Basin Primary Care Association, voiced support of S.B. 208.  She said the association supports the position being within the dental school.  Ms. Sheldon also stated agreement with Mr. Astley’s position for an amendment.  She expounded on the need for a single contact in the dental program and, especially, dental public health. 

 

Chairman Rawson asked to be informed about the status of the Carlin Clinic.

 

Ms. Sheldon responded the Carlin Clinic does not receive federal, state or local money; it is funded by the Nevada Health Centers.

 

Chairman Rawson queried the reason the Carlin Clinic does not receive federal money.

 

Ms. Shelton replied the Carlin Clinic was opened when there was not an opportunity to apply for an expansion; therefore, they cannot include it in their federal grant.  Approximately $130,000 is needed to keep the facility open, she said.

 

Chairman Rawson pondered the question of federal funding should the clinic close and reopen.

 

Ms. Shelton responded she did not know the answer.

 

Michael Johnson, Manager, Outreach Programs, Saint Mary’s Regional Medical Center, said the hospital supports S.B. 208.  He presented the committee with a proposed amendment to S.B. 208 (Exhibit D) to include the language “not for profit.”

 

Chairman Rawson concurred.

 

Jon L. Sasser, Lobbyist, Washoe Legal Services Incorporated, voiced support of S.B. 208. 

 

Ron W. Sparks III, Executive Director, Western Interstate Commission for Higher Education (WICHE) stated support for S.B. 208. 

 

Alexander Haartz, Deputy Administrator, Health Division, Department of Human Resources, said there needed to be a clarification of the language in S.B. 208 as it relates to the administrative authority of State Board of Health, because the board does not have administrative authority, therefore, it should be directed to the state Health Division.

 

Chairman Rawson asked for a written amendment.

 

Mr. Haartz said he would provide the committee with that information.

 

Chairman Rawson suggested that Mr. Haartz work with the staff analyst in preparation for a work session and refine the fiscal note for the bill, adding, “then we will put it in as an appropriation, rather than leaving it as a fiscal note.”

 

Mr. Haartz answered in the affirmative. 

 

Chairman Rawson asked for a motion to introduce Bill Draft Request (BDR) 40-408.

 

BILL DRAFT REQUEST 40-408:  Revises provisions regarding requirement to         obtain prior approval of certain expenditures for new construction by or    on behalf of health facilities in certain counties.  (Later introduced as             Senate Bill 328.)

 

SENATOR TOWNSEND MOVED TO INTRODUCE BDR 40-408.

 

SENATOR WIENER SECONDED THE MOTION.

THE MOTION CARRIED. (SENATOR AMODEI WAS ABSENT FOR THE VOTE.)

 

*****

 

Chairman Rawson adjourned the meeting at 3:04 p.m.

 

 

RESPECTFULLY SUBMITTED:

 

 

 

Patricia Di Domenico,

Committee Secretary

 

 

APPROVED BY:

 

 

 

                       

Senator Raymond D. Rawson, Chairman

 

 

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