MINUTES OF THE meeting
of the
ASSEMBLY Committee on Health and Human Services
Seventy-Second Session
February 5, 2003
The Committee on Health and Human Serviceswas called to order at 1:37 p.m., on Wednesday, February 5, 2003. Chairwoman Ellen Koivisto presided in Room 3138 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.
COMMITTEE MEMBERS PRESENT:
Mrs. Ellen Koivisto, Chairwoman
Ms. Kathy McClain, Vice Chairwoman
Mrs. Sharron Angle
Mr. Joe Hardy
Mr. William Horne
Ms. Sheila Leslie
Mr. Garn Mabey
Ms. Peggy Pierce
Ms. Valerie Weber
Mr. Wendell P. Williams
COMMITTEE MEMBERS ABSENT:
None
GUEST LEGISLATORS PRESENT:
None
STAFF MEMBERS PRESENT:
Marla McDade Williams, Committee Policy Analyst
Jasmine Shackley, Committee Manager
Cindy Clampitt, Committee Secretary
Terry Horgan, Committee Secretary
OTHERS PRESENT:
None
Chairwoman Ellen Koivisto, stating this was the Committee’s first meeting, requested that Committee members introduce themselves because Assemblymen Hardy, Mabey, and Horne, and Assemblywomen Weber and Pierce were new members on the Committee. She added that returning members were Assemblyman Williams, Assemblywomen Leslie and Angle, Vice Chairwoman McClain, and herself.
Chairwoman Koivisto noted there were copies of the Committee Standing Rules (Exhibit C) included in members’ folders at their places on the dais. She inquired whether Committee members felt they needed to discuss the rules, since most committees had generally similar ones.
Assemblyman William Horne agreed there was no need to discuss the rules.
ASSEMBLYMAN WENDELL WILLIAMS MOVED TO ADOPT THE COMMITTEE STANDING RULES.
ASSEMBLYWOMAN SHEILA LESLIE SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
Chairwoman Koivisto then introduced staff members, who included Committee Policy Analyst Marla McDade Williams, Committee Manager Jasmine Shackley, and Committee Secretary Terry Horgan. Roll was called; all Committee members were present.
Chairwoman Koivisto asked Marla McDade Williams to explain the Committee Policy Brief (Exhibit D) she had prepared.
Ms. McDade Williams, Committee Policy Analyst, reminded the new Committee members that most of the brief had already been provided to them in their pre-session orientation packets. She proceeded to briefly mention some of the issues contained within the brief.
Jurisdiction of the Committee, Ms. McDade Williams explained, included selected chapters in the Nevada Revised Statutes (NRS) that related to public welfare, mental health and mental retardation, public health and safety, and food and other commodities.
Ms. McDade Williams indicated to Committee members that some other health-related issues, such as regulation and licensing of health care providers and health insurance, would not come to the Committee because those issues were generally dealt with in the Commerce and Labor Committee.
Ms. McDade Williams discussed issues taken up by the Committee during the Seventy-first Legislative Session and adopted by members of the Legislature. She mentioned that A.B. 15 had concerned kinship care and required establishment of a program of supportive assistance to certain persons who obtained legal guardianship of certain children. Another bill had been S.B. 539, which provided prescription drug assistance for senior citizens. Ms. McDade Williams mentioned there were no specific bill draft requests to amend the current prescription drug assistance program as yet.
Ms. McDade Williams explained that the Committee dealt with the Nevada Silver Haired Legislative Forum, which had created its own report for the legislators. The Committee also addressed long-term care by expanding the authority of the Legislative Committee on Health Care to include the identification and evaluation, with the assistance of an advisory group, of alternatives to institutionalization for providing long-term care.
With regard to issues affecting children, Ms. McDade Williams indicated that during the Seventy-first Legislative Session, the Committee had dealt with issues involving infants and newborns through A.B. 250, which provided for hearing screening on newborns, and A.B. 191, which addressed infant abandonment by allowing people to take newborn children to certain emergency care providers. If parents believed they could not care for their child, they could leave the child with an emergency care provider and not face any sanctions.
Ms. McDade Williams also touched on other previous measures, including teen pregnancy prevention, patient transportation, public dental health, referral of patients to certain medical facilities, pharmacies and pharmacists, and halfway houses. With regard to assisted living, there had been legislation to clarify the provisions regarding regulation of residential facilities for groups. She also said there had been two bills concerning hospital boards and their memberships. Legislation involving mobile medical facilities, Ms. McDade Williams stated, would be coming back to the Legislature for consideration.
Ms. McDade Williams noted that the issue of medical errors had been considered during a number of previous legislative sessions. The interim Legislative Committee on Health Care had studied the issue but had not made any recommendations.
Ms. McDade Williams continued her briefing by mentioning various miscellaneous health issues the Committee had dealt with last session, including “Do Not Resuscitate” legislation, organ donation and transplantation, and establishment of a prostate cancer task force.
S.B. 207 of the Seventy-first Legislative Session, Ms. McDade Williams explained, had dealt with persons who had disabilities and the Department of Human Resources (DHR). Based on the passage of S.B. 207, the DHR now had in its budget implementation of a program to assist people with disabilities that would allow them to be on Medicaid and still work.
S.B. 377, also from the Seventy-first Session, dealt with the disproportionate share issue. Ms. McDade Williams suggested that subject might be revisited this session.
Ms. McDade Williams stated the Department of Human Resources had been directed to compile four strategic long-term care plans. Findings, recommendations, goals, and objectives of the plans, she pointed out, were available on the Department’s Web site. The plans related to rural health, provider reimbursement rates, persons with disabilities, and seniors.
Mentioning the Nevada Medicaid program, Ms. McDade Williams indicated the Committee might deal with policy issues, but noted that most Medicaid issues concerned appropriations and changes in eligibility that had financial cost and therefore went through the money committees. In addition, the last session had funded the elimination of the assets test for children and pregnant women, implementation of the Breast and Cervical Cancer Prevention and Treatment program, and expansion of several existing home- and community-based waivers. Ms. McDade Williams noted that elimination of the assets test for children and pregnant women in the Medicaid program had not been implemented because of the budget situation in Nevada.
Ms. McDade Williams mentioned the final bulletin of the Legislative Committee on Health Care, which she stated Committee members should have already received. The bulletin included the medical errors discussion as well as other issues the Committee had dealt with, including over-crowded hospital emergency rooms, licensure of mobile medical facilities, access to health and human services providers, indigent care costs, DSH (Disproportionate Share) payments, antibiotic resistance awareness, detection and control of certain diseases, and long-term strategic health plans.
Discussing possible issues to come before the Committee this session, Ms. McDade Williams provided a brief discussion about the senior prescription drug program and some of its legislative history, which began in 1999. She indicated there were approximately 7,400 people enrolled although it had been funded for 7,500 people. New applicants might be placed on a waiting list.
Ms. McDade Williams, again referring to the nursing shortage, said A.B. 378 of the Seventy-first Legislative Session had required the University and Community College System of Nevada (UCCSN) to create a proposal to double the nursing programs within the state. She indicated that over two biennia, the cost to double the programs would be approximately $27 million. She said the Chancellor of the UCCSN had broken the expense down to approximately $11 million for this biennium. Ms. McDade Williams did not think money for expansion of the nursing programs was in the UCCSN’s budget.
Referring again to medical errors, Ms. McDade Williams stated that Sections 18 through approximately 49 of A.B. 1 from the Eighteenth Special Session that began on July 29, 2002, and adjourned on August 1, 2002, had addressed medical errors and called them “sentinel events.” “Sentinel events” were defined as unexpected occurrences involving death or serious physical or psychological injury or the risk thereof, including any process variation for which a recurrence could carry a significant chance of a serious adverse outcome. The bill required an employee of a medical facility to report sentinel events to the facility’s patient safety officer within 24 hours. Within 13 days, the patient safety officer must have reported the date, time, and description of a sentinel event to the Health Division. For purposes of the legislation, “medical facility” included hospitals, obstetrics clinics, ambulatory surgery centers, and independent centers for emergency medical care.
Ms. McDade Williams explained that A.B. 1 of the Eighteenth Special Session also required, to the extent of legislative appropriation and authorization, the Health Division to safely and confidentially maintain reports of sentinel events. The Division must contract with a quality improvement organization to analyze and report trends regarding those events. If the Health Division received notice from a medical facility that it had taken corrective action to remedy the causes or contributing factors of an event, the Division must make a record of the information and ensure that it was aggregated and did not reveal the identity of the person or facility.
A.B. 1, Ms. McDade Williams observed, had required patient safety plans and committees. It had also included “whistle-blower” protections for employees of medical facilities who reported a sentinel event to the Health Division or who reported grounds for initiating discipline or information that raised questions regarding a physician’s competence to a physician licensing board.
Ms. McDade Williams’ policy brief also included a definition of “public health” and her assertion that one of this session’s key issues would relate to the Health Aid to Counties Fund. She explained the state had provided some funding to Washoe and Clark Counties, which had their own public health departments, that assisted them in their public health functions. The aid was at 80 cents per capita; there was a proposal to increase the aid to $1.10 per capita. However, Ms. McDade Williams mentioned that, due to budget constraints, the aid might be eliminated altogether. She explained the transfer occurred through the Health Division, “which did the budget for it and then simply transferred the funding to the counties.”
In discussing public health preparedness, Ms. McDade Williams said the Legislative Committee on Health Care would be forwarding a measure to address bio-terrorism and other issues related to biological events.
With regard to tobacco issues, Ms. McDade Williams reminded Committee members that Nevada had been awarded funding through the Master Settlement Agreement with the tobacco companies that it used to fund the senior prescription drug program and the Millennium Scholarships. Ms. McDade Williams also believed the public health community would be bringing forward a bill concerning tobacco issues. In addition, she stated the Legislative Committee on Health Care had adopted some recommendations to increase the tax on tobacco and also to allow local governments to regulate tobacco and smoking in local jurisdictions. Under current law, she said, the state retained primacy on that issue.
Ms. McDade Williams indicated the policy brief also contained a short section about issues in other states obtained from the National Conference of State Legislatures (NCSL) and a short section about some key federal issues relating to Head Start, the Health Insurance Portability and Accountability Act, Medicaid funding, Medicaid reform, Medicare prescription drugs, the state children’s health insurance program, and welfare reform authorization programs.
Ms. McDade Williams informed Committee members that a number of other reports relating to health care issues were available through the Legislative Counsel Bureau and were listed in her brief. The final three pages of her brief listed key contact people Committee members might want to use as resources in the future, as well as key divisions within the Department of Human Resources.
In summary, Ms. McDade Williams described the previous Friday’s pre-session orientation trip for new legislators to Churchill Community Hospital, where six health care professionals had made a presentation. The people involved in the presentation included Alex Haartz, with the State Health Division; Robin Keith, Nevada Rural Hospital Partners; Bill Welch, Nevada Hospital Association; Barbara Hunt, Washoe County District Health Department; Carolyn Ford, Nevada Office of Rural Health; and Charles Duarte, Division of Health Care Financing and Policy.
Chairwoman Koivisto indicated no one had questions for Ms. McDade Williams and thanked her for her explanation.
Chairwoman Koivisto noted that two physicians, Assemblymen Hardy and Mabey, were serving on the Health and Human Services Committee this current session, as was Assemblywoman Weber, who also worked in the health care field. She believed those new Committee members would be good resources.
Chairwoman Koivisto referred to a pamphlet entitled “Public Health, A Legislator’s Guide” (Exhibit E) she had ordered for committee members from the NCSL. She hoped the book might be of interest.
With no further business to come before the committee, the Chairwoman adjourned the meeting at 2:00 pm.
RESPECTFULLY SUBMITTED:
Terry Horgan
Committee Secretary
APPROVED BY:
Assemblywoman Ellen Koivisto, Chairman
DATE: