MINUTES OF THE
SENATE Committee on Human Resources and Facilities
Seventy-First Session
March 19, 2001
The Senate Committee on Human Resources and Facilitieswas called to order by Chairman Raymond D. Rawson, at 3:00 p.m., on Monday, March 19, 2001, in Room 2135 of the Legislative Building, Carson City, Nevada. The meeting was videoconferenced to the Grant Sawyer Office Building, Room 4412, Las Vegas, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.
COMMITTEE MEMBERS PRESENT:
Senator 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
GUEST LEGISLATORS PRESENT:
Senator Terry John Care, Clark County Senatorial District No. 7
STAFF MEMBERS PRESENT:
Marsheilah D. Lyons, Committee Policy Analyst
Cynthia Cook, Committee Secretary
OTHERS PRESENT:
Doreen Saly, Concerned Citizen
Harvey Whittemore, Lobbyist, Nevada Resort Association
Jeanette Hills, Deputy Administrator, Program and Field Operations, Welfare Division, Department of Human Resources
Janelle Mulvenon, Program Administrator, Community Connections, Department of Human Resources
Carlos Brandenberg, Ph.D., Administrator, Division of Mental Health and Developmental Services, Department of Human Resources
Robert S. Bennett, Lobbyist, Mental Health Association of Nevada
James Vilt, Attorney, Nevada Disability Advocacy and Law Center Incorporated
Charlotte Crawford, Director, Department of Human Resources
Cynthia Pyzel, Senior Deputy Attorney General, Division of Mental Health and Developmental Services, Department of Human Resources, Office of the Attorney General
Richard L. Siegel, Lobbyist, American Civil Liberties Union of Nevada
Chairman Rawson:
We will open this meeting as a subcommittee, and listen to testimony on Senate Bill (S.B.) 236.
SENATE BILL 236: Requires certain entities that employ children in entertainment industry to pay for tutoring. (BDR 34-1035)
Senator Terry John Care, Clark County Senatorial District No.7:
There is no fiscal note attached to this bill. Because of the hours of some children employed in the entertainment business, the children are often home schooled. A child who is employed in the entertainment business would be entitled to tutoring to be paid for by the employer under S.B. 236.
Doreen Saly, Concerned Citizen:
My son Kristofor is employed in the entertainment business. After 5 months of employment he was requested to stay late to complete the finale in the show. The schools we were zoned for were unable to accommodate his schedule. We decided to go with home schooling, which is costly. The employer was not willing to help very much with the payments, and as a result his schooling is coming out of his paycheck. As a parent I believe he needs protection.
Chairman Rawson:
Will Kristofor’s career be in jeopardy by pushing this?
Ms. Saly:
I know his employer is aware of what I am trying to do, and at this point I have received no comment one way or another.
Harvey Whittemore, Lobbyist, Nevada Resort Association:
The association does not object to S.B. 236. With Senator Care, we have drafted an amendment we would like added to the bill. The amendment would require the employer to pay the costs of at least 3 hours of tutoring per day for at least 5 days per week, pursuant to a written contract for a period in excess of 120 days.
Chairman Rawson:
The time period of 120 days is considerably more than one-half of a school year, which is 180 days. Is a typical contract 90 days?
Mr. Whittemore:
What we tried to do, because this was for calendar days, we thought it more appropriate. If you want to say 90 school days or 120 calendar days, make it clear what we are talking about is 4 months. Once you exceed that period I believe the obligation to provide tutoring would in fact take place.
Chairman Rawson:
If you are setting that for 4 months, why do we not talk in terms of one-half of a school year, or 91 school days?
Mr. Whittemore:
We would have no objections to that.
Chairman Rawson:
We will close the hearing on S.B. 236, and we will hear a motion.
SENATOR WIENER MOVED TO AMEND AND DO PASS S.B. 236.
SENATOR AMODEI SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS TOWNSEND AND MATHEWS WERE ABSENT FOR THE VOTE.)
*****
Chairman Rawson:
We will open the hearing on Senate Bill 110.
SENATE BILL 110: Repeals certain provisions relating to assistance to homeless persons. (BDR 38-623)
Jeanette Hills, Deputy Administrator, Program and Field Operations, Welfare Division, Department of Human Resources:
The homeless board was established as a result of legislation in 1987, and became effective on July 1, 1987. There has been no additional funding beyond 1989, and the board has not functioned since that time. Although homelessness has not gone away since the creation of the board, the method by which money is received and distributed in Nevada has.
Nevada has received federal funds for the homeless from three grants: the Emergency Shelter Grants (ESG), the Emergency Housing Program (EHP), and Supplemental Assistance for Facilities to Assist the Homeless (SAFAH). The SAFAH grant applied to Clark County. The Welfare Division acted as the “pass-through” agency for these funds.
The Welfare Division now receives only the allocation for the Emergency Shelter Grant for northern Nevada. The Housing Division receives Home Investment Partnership Program funds and the Commission on Economic Development receives Community Development Block Grant funds. These agencies participate in the development of a comprehensive document identifying affordable and supportive housing needs, community development, and a strategy to address those needs.
Clark and Washoe Counties have created local homeless advisory boards, staying within U.S. Department of Housing and Urban Development (HUD) regulations.
Through the Governor’s Fundamental Review process, a recommendation has been made to transfer the ESG program from the Welfare Division to the Housing Division. The Housing Division has accepted the transfer and plans to incorporate the ESG program into their existing programs.
The changing in funding streams, methods of distributing funds, and creation of local homeless advisory boards have rendered the homeless board obsolete.
Are those funds actually allocated through the community block grant money, or does the housing authority handle that job now?
Ms. Hills:
The funds that are still sent through the Welfare Division are federal funds and not a part of the community block grants.
Chairman Rawson:
We will close the hearing on S.B. 110, and open the hearing on S.B. 112.
SENATE BILL 112: Revises certain provisions concerning amelioration of causes of poverty to conform to changes in federal law. (BDR 38-535)
Janelle Mulvenon, Program Administrator, Community Connections, Department of Human Resources:
Community Connections is an organizational structure within the Department of Human Resources. One of our primary responsibilities is to pass through funds to community entities, and one of those grants is the Community Services Block Grant. This grant provides funds to community-action agencies to address poverty issues. Senate Bill 112 will bring us into compliance with the Federal Community Services Block Grant Act. Changes in dates conform to timelines required by the act, from a fixed date of June 1 to the timeline requirements as specified by the act. The change will still ensure there will be a public hearing prior to developing a plan for the statewide use and distribution of the money provided through the federal Community Services Block Grant Act. The second change allows the director of the Department of Human Resources to enact discretion to limit the amount of grant funds that a grantee can carry over from one year to the next, at a maximum level of 20 percent as established in the federal act. These are the two revisions in S.B. 112.
Senator Washington:
I received an e-mail message from Mr. Cloyd Phillips of Washoe County Community Services Agency, and he was concerned about the bill.
Ms. Mulvenon:
We have had a meeting with Mr. Phillips to address his concerns. We indicated to him that they would be addressed in the state plan. The issues we discussed will all be covered in the federal requirements that we must comply with.
Chairman Rawson:
We will close the hearing S.B. 112 and open the hearing on S.B. 116.
SENATE BILL 116: Clarifies and revises certain provisions governing use of restraints and interventions by facilities for mental health. (BDR 39-346)
Carlos Brandenberg, Ph.D, Administrator, Division of Mental Health and Developmental Services, Department of Human Resources:
During the 1999 Legislative Session, Assemblywoman Barbara E. Buckley, Clark County Assembly District No. 8, introduced Assembly Bill (A.B.) 280.
ASSEMBLY BILL 280 OF THE SEVENTIETH SESSION: Prohibits use of aversive intervention on persons with disabilities under certain circumstances. (BDR 34-286)
The provisions of A.B. 280 of the Seventieth Session do not apply to correctional or juvenile detention facilities. Lake’s Crossing Center for the Mentally Disordered Offender is Nevada’s secure forensic facility for the treatment of the mentally disordered offender and houses a population with a high risk for aggressive behavior. Lake’s Crossing Center inadvertently falls within the definition of a facility. Assemblywoman Buckley has confirmed it was not the intent of A.B. 280 of the Seventieth Session to include Lake’s Crossing Center in its restrictions. I have consulted with Assemblywoman Buckley and she supports S.B. 116.
Chairman Rawson:
I do not think any of us considered it would affect you through Lake’s Crossing Center for the Mentally Disordered Offender, and I do not know how you can operate under the restrictions that were put in.
Robert S. Bennett, Lobbyist, Mental Health Association of Nevada:
Currently chemical, physical, and mechanical restraints are allowed under certain conditions. While it may seem unreasonable of me to argue against reasonable restraints, as S.B. 116 would allow, it is only because I have been so adversely affected by so-called reasonable restraints.
Reasonable restraints have included my right arm being twisted behind my head for 6 days. Reasonable restraints have also had me strapped to a bed for 8 days. Being forced to lie in your own urine and feces is no fun, nor is it reasonable. Neither is having a tray placed on your chest, and then having to feed yourself, while both your arms and your legs are strapped down. These are the results of reasonable restraints. By the way, this last happened as the result of a warrant issued in the wrong name. Included in my handout (Exhibit C) is how Nashville, Tennessee, and the State of Pennsylvania have been able to almost totally do away with restraints in their forensic units. Ninety-six percent fewer hours of restraints in Pennsylvania within 2 years, and injuries decreased by 67 percent.
You say this was 10 years ago that you went through this process.
Mr. Bennett:
Yes, in Los Angeles.
Chairman Rawson:
There are restrictions written into Nevada law. It is important to note this is for the forensic facility, and accreditation standards must be met. Each client must be checked every 15 minutes. There are not any of us who feel your treatment was appropriate. We have a history in Nevada that is different than California. We think we are more enlightened. As the chairman, and I think every member of this committee, feel very strongly, and we appreciate your fears.
James Vilt, Attorney, Nevada Disability Advocacy and Law Center Incorporated:
As an initial matter, and we may be totally off on this, but our reading of the statute seems to indicate that Lake’s Crossing Center would be exempt from accreditation guidelines. It would be subject only to a standard of reasonableness. If I am wrong on that, I really do not have any more to say.
Chairman Rawson:
Let us look at S.B. 116. There is certain language that is struck but language remaining states a facility accredited by a nationally recognized accreditation association or certified for participation in the Medicaid or Medicare program may use restraint only to the extent the accreditation of certification would allow. It seems to me that language would remain. I am subject to correction on that.
Mr. Vilt:
The way I see it is the accredited agencies are subject to the accreditation standards. The Lake’s Crossing Center facility is subject only to reasonableness standards, and that is where our concern is.
Charlotte Crawford, Director, Department of Human Resources:
As a forensic facility, Lake’s Crossing Center is the one facility within the Department of Human Resources that does not carry an accreditation. I believe there is not a national accrediting body for it to be accredited under, nor is it eligible to be certified under Medicaid or Medicare programs. Dr. Brandenberg has worked with Assemblywoman Buckley, and she has indicated it was never her intent to include Lake’s Crossing Center just as she did not include juvenile or adult correctional facilities, jails, or detention centers. The facility falls more under the definition of a correctional facility than a forensic facility.
Chairman Rawson:
It does fall to a reasonable standard then.
Ms. Crawford:
Under the way the statute is now structured, those standards within the bill would apply to Lake’s Crossing Center, because it does not otherwise have an accreditation or certification standard to be substituted. This is not what Assemblywoman Buckley indicated she had envisioned, and that is why she was very willing to have Lake’s Crossing Center excluded from the statute. It only falls in because of a reference to the Division of Mental Health and Developmental Services.
Chairman Rawson:
I understand. We are caught now with it in statute, and we do have people who are concerned about taking it out. We have to address their concerns as well as Assemblywoman Buckley’s.
Mr. Vilt:
Essentially, that is where our concern lies; the Lake’s Crossing Center facility will not be subject to any written standard. They will be subjected to a reasonable standard, but who is going to be the final arbiter of reasonableness?
Chairman Rawson:
There is a different situation in that facility. Statistics indicate it is the most dangerous, based on the high frequency of time missed from work because of staff injuries. Essentially, it looks to me like you are asking for the ability to restrain people in order to control the situation and protect staff. It is not a maximum-security facility, and it is not set up like that. There is more freedom. We might ask if it is not possible to produce a written policy that we can evaluate to ensure there are adequate safeguards.
Cynthia Pyzel, Senior Deputy Attorney General, Division of Mental Health and Developmental Services, Department of Human Resources, Office of the Attorney General:
The facility currently has policies and procedures in place that are modeled closely on those developed by the Department of Prisons, which does have some accreditation standards. We have it with us today. It suits the needs for the facility very well. This is not an unregulated area; it is an area of client’s rights that folks in the facility are very aware of. The committee needs to be aware there is currently litigation pending in federal court brought by the group Mr. Vilt represents. In the injunction phase, the judge found no reasonable likelihood of their succeeding in terms of attacking the policies and procedures that we were using, largely because of the deference the courts give for reasonable application of rules within a facility to govern that facility.
Dr. Brandenberg:
We will be happy to provide, for committee review, the “Lake’s Crossing Center Guidelines for Seclusion and Restraints” (Exhibit D).
Chairman Rawson:
We can have an abusive situation, no matter what the law. I think the concern is that although these people are charged with a crime, it has not been adjudicated. They are there for an evaluation to see if they are fit to stand trial. So, I read into that there needs to be not a prison standard related to them, but a grievance standard.
Dr Brandenberg:
We are in complete and total support of that. For your information, we recently terminated an employee accused of mistreating a client. Any staff member that might come close to abusing or neglecting a client is investigated and reviewed. We will not tolerate such conduct.
Mr. Vilt:
I would respond, I have not looked at the policy, and we might not have any specific problems with the policy. But, if you are going to have a law speaking to the subject, I think you should have the whole law. I think formality is necessary to prevent dilution of the rules and possible modification.
Richard L. Siegel, Lobbyist, American Civil Liberties Union of Nevada:
I think we understand S.B. 116 fairly well now, and the remaining issue is whether the policy that has been developed by the division should be referenced some way in statute. I think this would provide an opportunity that the division should welcome, to reference their obligation to provide a policy that would protect the people in Lake’s Crossing Center and guarantee their rights in all respects. The kinds of policies we are referring to should be required by statute somewhere.
Chairman Rawson:
We will close the hearing on S.B. 116, and entertain a motion on S.B. 110 and S.B. 112.
Senator Washington:
I would like to call Mr. Cloyd Phillips, Washoe County Community Services Agency, again, on S.B. 112, to make sure his concerns have been taken care of.
SENATOR WIENER MOVED TO DO PASS AND PLACE S.B. 110 ON THE CONSENT CALENDAR.
SENATOR MATHEWS SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR TOWNSEND WAS ABSENT FOR THE VOTE.)
*****
Chairman Rawson:
We now have a presentation by the Department of Human Resources.
Ms. Crawford:
I would like to review some of the substantial health care policies in the Governor’s budget. I have distributed a report titled, “Budget Highlights 02-03.” (Exhibit .). On page 1, the Governor has eliminated the assets test for the Medicaid Child Health Assurance Program (CHAP) and expedited eligibility for pregnant women. The expedited eligibility is an attempt to get early treatment for pregnant women. This change will shift some children who are covered under CHAP into Medicaid, and with that shift will allow coverage of their entire family under Medicaid. There is also substantial expansion of Nevada Check Up (Childrens Health Insurance Program) proposed, to allow us to cover up to slightly fewer than 25,000 children in the coming biennium. The budget also provides one-shot funding of $5 million to assist families without health care insurance to access health care services.
Chairman Rawson
We expected leeway last biennium, realizing that we might have more sign up than budgeted for. We thought that could be taken in by the savings in the first part of the biennium. While 15,000 is not a big leap for the first year, 25,000 is a very respectable leap for the second year. If we overshoot the 15,000 in the first year do you feel you have a target that you have to stay at that figure?
Ms Crawford:
I think the Governor has made a commitment that every eligible child will be covered. Page 2 (Exhibit E) speaks to Medicaid Home and Community-Based Services Waivers. The Governor’s budget has basically doubled the number of individuals that can be covered under the waiver. His intent was to fund Medicaid Home and Community-Based Services Waivers at a level to provide coverage to any individual who qualifies. Page 3 (Exhibit E) addresses the breast and cervical cancer coverage program, and the senior pharmacy program. The program adds $1 million to the subsidy available for senior’s pharmacy-insurance premiums.
On page 7 of the report (Exhibit E), the Governor has also proposed an additional $2 million in funds to assist in the establishment for treatment clinics for individuals with HIV/AIDS in Reno and Las Vegas. Page 8 details the funds to support our projected Medicaid caseload, and a Medicaid provider rate increase to assure we incorporate rate increases on a systematic basis. Also proposed is a one-shot appropriation of $1 million to establish a revolving fund to assist certain rural health programs, and promote the availability of essential health care services in rural Nevada.
There has been much discussion about the subject on page 9, the Long-Range Strategic Health Care Plan. I have provided you with a summary of the “Comprehensive Health Care Strategic Plan” (Exhibit F). It offers more detailed information concerning the plan. The identified areas we are talking about are: individuals with disabilities, seniors, rural health care services, health and human services payment rates, and domestic violence. We need to establish what the revenue basis will be for these areas. This is what the Governor means by a blueprint to guide the development of public and private resources necessary to meet the financial commitment required to support such resources.
Page 9, of Exhibit E, includes the long-overdue family foster care rate increase, and subsidized adoption expansion to encourage the adoption of special needs children in Nevada. The next page continues the level of support for caretakers other than parents, such as grandparents, and provides for a substantial decrease in the ratio of cases per worker. Pages 11 and 12 describe additional funding in the area of child-care assistance. The Governor has also included an increase in payments to families who are temporarily incapacitated. The reconfiguration of the Family to Family program is outlined on page 13.
The Governor has also proposed $5 million to expand energy assistance to low-income households. We are proposing to expand the existing program by this $5 million. Currently we are augmenting the energy bills for those who are at or below 150 percent of the federal poverty level. This money will allow help with increased utility costs.
Senator Washington:
The threshold is 150 percent of the federal poverty level, and it is administered through the Welfare Division. Is there a bill proposed by Assemblyman David E. Goldwater, Clark County Assembly District No. 10, which is similar to this proposal?
Ms. Crawford:
I believe he has done so, and I believe it has some slight changes. It proposes a transfer to the attorney general’s office for the administration of the program, and also includes a levy on the counties in order to fund it.
Senator Washington:
Why would he want to shift it to the attorney general’s office?
Ms. Crawford:
I do not know.
On page 14 of Exhibit E, the Governor has proposed $500,000 in direct grants to individuals for lifts, ramps, and other adaptations to enable disabled citizens to maintain an independent living environment. Page 17 allots $5000 for the Nevada Silver Haired Legislative Forum to help keep them operational. Page 17 also includes $500,000 to help develop an electronic Medicaid, Nevada Check Up, and Temporary Assistance to Needy Families (TANF) application process. Also included is funding for the Electronic Benefit Transfer (EBT) to replace the current paper coupon Food Stamp Program system. Included in the report are both a one-time General Fund appropriation and an ongoing appropriation for a Medicaid Management Information System. Nevada is the only state without a management information system. The Governor has funded it, and we really hope our report next biennium will tell you about this new system.
Page 18 includes a business process reengineering system for mental health and developmental services. This will also encompass a system that could integrate the Division of Child and Family Services. Page 19 contains a grants management unit, to develop a structured system for awarding, managing, evaluating and tracking funds to non-state entities.
Senator Amodei:
Is this to create a central office for all family-related grants?
Ms. Crawford:
The Governor has proposed within his office a family coordination office for grants and assistance, and to be able to direct families to the best resources. It is not the same as this item, which will track all grants that flow through the Department of Human Resources.
Senator Amodei:
Would the unit you have described on page 19 go out to more aggressively pursue health grants, or would that be the job under the Governor’s auspices?
Ms. Crawford:
The Governor is deeply frustrated that we do not pursue grant opportunities. And he is accurate; we do not have the resources. That would be under his office, and we would manage existing grants.
Page 20 of Exhibit E adds seven staff positions to support the growth in foster care placements and allow the licensure of all relative care now federally required to ensure the safety and well being of children.
Chairman Rawson:
Committee, this just touches some of what we are going into in depth in the finance committee and ways and means committee. If you have any questions or concerns, let us know, and we will have staff look into them
Senator Washington:
I was wondering about the Medicaid reimbursement for group care and nursing homes.
Ms. Crawford:
The senior group-care waiver and the senior Community Home-Based Initiatives Program (CHIP) have both been expanded. Under group care we are accepting an increase in the income level to 300 percent of Supplemental Security Income benefit, therefore expanding the waiver, and under CHIP the capacity of the program is increased by 34 percent. Rate increases for long-term care facilities have been built into the budget. It is also one of the major areas of the “Comprehensive Health Care Strategic Plan” (Exhibit F).
Senator Washington:
The nursing facilities have indicated Medicaid reimbursement is not paid in a timely manner, and the rates are too low to cover costs.
Ms. Crawford:
We currently have hospital rates and long-term care rates out for a contracted study to assure our rates are fair. On page 8 of Exhibit E, there is also slightly under $80 million built into the Medicaid budget to give rate increases throughout the biennium.
Senator Washington:
Another concern was within the procedures and policies set up by Health Care Financing Administration (HCFA), there are no hidden procedures, policies, and guidelines, within the inspections that the facilities were not aware of.
Ms. Crawford:
We have been meeting frequently with long-term care providers on a variety of issues including the timeliness of the payments, processing time, and the duplication of regulations and inspections. We have made changes in a variety of those areas. The medical review team process has been eliminated. The Medicaid Management Information System will also help expedite all systems. A group met with the Governor a couple of weeks ago, and we are pleased that a lot of problems have been resolved.
Senator Washington:
Would it be possible to obtain some of the recommendations and policies in writing for my review?
Ms. Crawford:
We will be glad to provide you with that information.
Chairman Rawson:
I think we will have additional questions that will come up for the Department of Human Resources.
For the record, the guidelines for Lake’s Crossing Center specify restraint and seclusion are never used to punish or discipline a client or for the convenience of staff. Clients in seclusion and/or restraints will be under constant observation. An order cannot be written for more than 4 hours, and the clients are under constant observation for that period. Restraints or seclusions can only be ordered by a physician, and supervised by a nurse.
This meeting stands adjourned at 4:22 p.m.
RESPECTFULLY SUBMITTED:
Cynthia Cook,
Committee Secretary
APPROVED BY:
Senator Raymond D. Rawson, Chairman
DATE: