MINUTES OF THE meeting
of the
ASSEMBLY Committee on Health and Human Services
Seventy-Second Session
February 12, 2003
The Committee on Health and Human Serviceswas called to order at 1:37 p.m., on Wednesday, February 12, 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:
Mrs. Dawn Gibbons, Assembly District No. 25
STAFF MEMBERS PRESENT:
Marla McDade Williams, Committee Policy Analyst
Terry Horgan, Committee Secretary
OTHERS PRESENT:
Frankie Sue Del Papa, Organ Donor Task Force
Cassandra Smith, Regional Supervisor, Sierra Eye and Tissue Donor Services
Larry Matheis, Executive Director, Nevada Medical Association
Dan Musgrove, Clark County
Charles Duarte, Administrator of the Nevada Division of Health Care Financing and Policy
Mary Liveratti, Deputy Director, Nevada Department of Human Resources
Jane Smedes, Management Analyst, Nevada Department of Human Resources
Mike Willden, Acting Director, Nevada Department of Human Resources
Chairwoman Koivisto turned the gavel over to Vice Chairwoman McClain so Mrs. Koivisto could be present at the witness table to introduce her bill, A.B. 51.
Assembly Bill 51: Revises provisions regarding anatomical gifts. (BDR 40-121)
Assemblywoman Ellen Koivisto, District No. 14, introduced Assemblywoman Dawn Gibbons and former Attorney General Frankie Sue Del Papa, both of whom appeared at the witness table with her. Mrs. Koivisto testified A.B. 51 would give “teeth” to an organ donor’s wishes to donate their organs. Mrs. Koivisto explained that even though individuals had signed organ donor cards, sometimes their survivors would refuse to honor those wishes.
Assemblywoman Dawn Gibbons, District No. 25, added her support to the bill.
Frankie Sue Del Papa, co-chair of the Organ Donor Task Force for the state of Nevada, spoke in favor of A.B. 51. Ms. Del Papa wanted the record to be very clear about Nevada’s strong public policy in favor of honoring organ donors’ wishes. Ms. Del Papa recounted a phone call she had received from the mother of a victim of drunk driving whose wishes were not respected even though he had a donor card.
Assemblyman Horne inquired whether A.B. 51 would undermine competency issues as related to an individual’s competency to make such a gift.
Ms. Del Papa, saying the Legislative Counsel Bureau (LCB) had researched the issue, acknowledged that ethical questions did arise and agreed the issue was very sensitive and needed to be determined based on individual circumstances. She repeated that A.B. 51 would merely put “teeth” into the current law, which gave each individual the right to expect their wishes would be carried out. Ms. Del Papa noted that the Nevada Center for Health Ethics and Policy tried to educate the public, as well as doctors, hospitals, and other health care providers and emergency responders about the matter. Ms. Del Papa emphasized that what really was needed was enhanced education and continuation of current efforts to encourage donors to talk with their families so their families understood very clearly what their wishes were. Ms. Del Papa added she did not think anything else could be done and noted there would always be circumstances one could not predict. She reiterated that public education was the answer.
Assemblywoman Leslie requested further information about the example of an organ donor’s wishes not being fulfilled that Ms. Del Papa had referred to earlier.
Ms. Del Papa replied that the body was left at an accident scene because it had been a felony DUI situation. She added that additional educational outreach to the law enforcement community and coroners was needed.
Assemblywoman Leslie, commenting that the body had probably been left because of an investigation, queried whether A.B. 51 would change that particular situation.
Ms. Del Papa acknowledged passage of A.B. 51 would not change that particular situation, but explained that she had used the example to illustrate a painful and difficult situation that had arisen when a donor’s wishes had not been fulfilled.
Assemblywoman Leslie wondered how often a donor’s wishes were not respected and asked whether “family members most often got in the way.”
Ms. Del Papa replied it could be that family members wanted to “hold on,” which was why organ donors were encouraged to have conversations with their families.
Cassandra Smith, Regional Supervisor, Sierra Eye and Tissue Donor Services, testified that when a person died, the next of kin were approached for consent. She added if the next of kin were not comfortable with the donation, under current law, their wishes were being respected “because they have to live with it the rest of their lives and we don’t want any negative publicity.”
Assemblywoman Leslie inquired why donor cards were necessary if next of kin were consulted rather than the wishes of the person who had the donor card.
Ms. Smith explained that the process had been revised since passage of “new laws,” and added that with the formation of the Task Force on Organ and Tissue Donation, families were being approached differently. Instead of asking for consent, families were being told consent for organ donation had been obtained, based on either a driver’s license or a completed “living bank” form. Family was still consulted because, Ms. Smith noted, there were a number of misconceptions about organ donation and also so medical personnel could answer any questions family members might have. Ms. Smith emphasized she had never been turned down by a family.
Assemblywoman Leslie asked whether her organ donor card “was any good” and whether passage of A.B. 51 would “make it good.”
Ms. Del Papa responded she thought the law was very clear, but noted that there were unique and very specific circumstances in each individual case. She indicated passage of A.B. 51 would enhance existing law and would help to fulfill a donor’s wishes.
Vice Chairwoman McClain, agreeing with Ms. Del Papa, said the previous language was rather vague. Now, she continued, the law would specify that the concurrence or consent of another person was not required.
Assemblywoman Weber, citing the time-sensitive nature of organ donations, inquired whether there had ever been an instance where a family had put a restraining order on harvesting organs so as to search for a revocation document.
Ms. Del Papa testified that she was not aware of any cases with that specific circumstance, nor was anyone else in the room.
Vice Chairwoman McClain asked whether “first responders” were trained to look for a driver’s license immediately upon being called to the scene.
Ms. Del Papa replied that a lot depended upon what was occurring at the scene; however, she pointed out that a wallet holding identification would probably be one of the first things emergency personnel would look for.
Assemblyman Hardy indicated steps taken by emergency personnel would first involve ascertaining whether the victim was alive, searching for medical information such as allergies, and ways of notifying family or next of kin. Mr. Hardy added that he had never heard of any insensitivity toward the family of an organ donor by any organ donation people. He stressed notification of family in emergency situations was critical.
After rereading A.B. 51, Assemblywoman Leslie claimed the existing language appeared quite clear that organ donations could not be revoked other than by the donors themselves. However, she added, the new language contained in A.B. 51 read that one “may not require consent” of next of kin. Ms. Leslie then inquired whether there was any penalty if people refused to allow organ donation for religious or other reasons at a Nevada hospital.
Assemblywoman Gibbons replied, “The penalty is, we lose someone else’s life.”
Assemblywoman Leslie concluded, “So it’s unenforceable.”
Mrs. Gibbons responded, “Yes.”
Ms. Leslie asked whether there was any resistance to passage of A.B. 51.
Mrs. Gibbons, stating much hard work had gone into crafting the language in A.B. 51, asserted the language could not be made much clearer.
Ms. Leslie opined that someone might sue, although “the person whose wishes were not followed would be dead.”
Assemblyman Hardy indicated that relatives of victims were generally in no position to make decisions, as they were usually in a state of shock. Mr. Hardy added passage of A.B. 51 would allow relatives to know what the victim’s wishes were.
Vice Chairwoman McClain asked whether anyone in the audience wanted to comment on A.B. 51.
Larry Matheis, Executive Director, Nevada State Medical Association, testified that the way the law had been written, it combined both the direction to the physician and the health facility to abide by a properly executed organ donation directive and the statement that the directive could not be revoked by a family member. Mr. Matheis indicated there had been several instances where either the physician or the hospital had hesitated about executing the deceased’s wishes because there were complicating factors, such as the threat of liability. Mr. Matheis explained Section 11 of A.B. 51 made it very clear that the family could not override a properly executed organ donation document. Referring to Section 12 of A.B. 51, Mr. Matheis explained if the deceased had not revoked the directive, the facility and the physician were bound to recognize “the autonomy” of that decision and respect it.
Mr. Matheis added that all Nevadans who were organ donors or the recipients of donated organs owed a great deal to Assemblywoman Dawn Gibbons and Frankie Sue Del Papa, who had kept the task force together.
Dan Musgrove, representing Clark County and the Clark County Coroner’s Office, expressed support for A.B. 51. However, Mr. Musgrove wanted the legislative record made clear that Section 12 of A.B. 51 would not pre-empt NRS 451.585 that related to the duties of the coroner. Mr. Musgrove added he would not want the investigatory procedures that the coroner must follow to be pre-empted.
Noting that in Clark County there was good interaction between the health care professionals and the coroner’s office, Mr. Musgrove maintained there might need to be some clarification that Section 12 would not pre-empt the state laws governing autopsies. He noted it was important that the legislative intent was clarified and that there was no potential conflict between the Uniform Anatomical Gift Act and the investigation of death by the coroner’s office. Mr. Musgrove reiterated his support for A.B. 51, as long as there was no conflict.
Vice Chairwoman McClain inquired whether Mr. Musgrove’s concerns were allayed.
Mr. Musgrove indicated that he would like to get a legal opinion because A.B. 51 did not reference NRS 451.585 and he thought the language would be clearer if it did.
Vice Chairwoman McClain replied that A.B. 51 referenced NRS 451.500 to NRS 451.590.
Mr. Musgrove responded that he was talking about NRS 451.585 that related to autopsies.
Vice Chairwoman McClain stated she did not think there was a problem, but it could be checked out.
Mr. Musgrove reaffirmed his position that passage of A.B. 51 not interfere with autopsies or a coroner’s duties and he wanted the legislative intent to be clear.
Vice Chairwoman McClain asked staff to investigate Mr. Musgrove’s concerns.
Referring to drafting the language in A.B. 51, Assemblywoman Gibbons explained that the task force had worked with the Washoe County Coroner, who had approved the language.
Vice Chairwoman McClain added that A.B. 51 simply referred to requiring consent, noting it had nothing to do with a coroner’s duties. Ms. McClain closed the hearing on A.B. 51 and returned the gavel to Chairwoman Koivisto.
Chairwoman Koivisto introduced Mr. Duarte, who would make a presentation concerning Nevada Medicaid.
Charles Duarte, Administrator, Division of Health Care Financing and Policy, provided a document to Committee members (Exhibit C) that contained an overview of the budgets of the Nevada Medicaid and Nevada Check Up programs. Mr. Duarte explained that the Division’s job was to purchase and ensure provision of quality health care services for Medicaid in the most efficient manner possible. The Division was also responsible for promoting access to health care at an affordable cost to the taxpayers of Nevada, he added.
Mr. Duarte directed Committee members’ attention to a spreadsheet on page 1 of his presentation and mentioned the Division’s budget request for fiscal years 2004 and 2005 was $2.17 billion.
Mr. Duarte indicated there had been administrative changes to the Division, some of which were organizational and had resulted in the Division being able to purchase services more effectively for recipients, particularly in the area of home and community-based services. Mr. Duarte also noted implementation of a Medicaid management information system (MMIS). Mr. Duarte indicated the first phase of the MMIS implementation, a pharmacy point-of-sale system, had gone very well. Nevada had been the last state in the nation to implement an electronic billing system for pharmacy services, he added, but the first state in the nation to implement the new Health Insurance Portability and Accountability Act (HIPAA) compliant formats for pharmacy claims.
Mr. Duarte said that during the last legislative session, the Division had requested the elimination of the Childrens Health Assurance Program (CHAP) assets test. Explaining that CHAP was a program for low-income pregnant women and low-income children, Mr. Duarte added that even though elimination of the assets test had been approved last session, it had not been implemented due to budget constraints, so it had appeared again in his budget request. One program that had been implemented, he continued, was the Breast and Cervical Prevention and Treatment Program.
Mr. Duarte added that a number of rate increases for in-patient hospital and nursing facilities and for obstetrical care had been funded during the last legislative session and those had been implemented. Further rate increases had been deferred, he mentioned, due to the state’s fragile economic condition.
Mr. Duarte noted that caseloads were higher than projected in Nevada Medicaid and Nevada Check Up programs, especially since September 11, 2001, and indicated a need for an additional $14 million supplemental appropriation in the Medicaid program and a $1.7 million supplemental appropriation in the Nevada Check Up program. All reserve funds in the intergovernmental transfer account had been exhausted, Mr. Duarte continued.
Mr. Duarte enumerated budget reduction and cost containment initiatives in the Division’s program that included HMO payments, some pharmacy reimbursements, and control of high-cost pharmaceuticals.
Mr. Duarte indicated his belief that his budget represented a balanced mix of budget decision units to address a number of federal and state mandates in the program, as well as to improve services and better manage the cost of health care.
Assemblywoman McClain asked whether the Nevada Check Up enrollment had been increased because of new outreach efforts or advertising.
Mr. Duarte replied that the caseload growth was a result of projections from the prior fiscal year. He added there were no new initiatives, but that the State Division of Health Care Financing and Policy had received an $800,000 grant that was being used to acquire federal matching funds to assist local coalitions to reach children who would be eligible for Medicaid and Nevada Check Up.
Assemblywoman McClain inquired what the projected number of qualifying children would be.
Mr. Duarte answered that the latest projection he had seen, published by the Great Basin Primary Care Association, reported that there were approximately 38,000 children living under 200 percent of the federal poverty limit.
Assemblywoman McClain queried whether Mr. Duarte planned to insure almost all 38,000 children in the next biennium.
Explaining that those children were currently uninsured, Mr. Duarte responded that the caseload growth projection would not capture all of the children.
Assemblyman Hardy asked whether the 38,000 uninsured children were new to the state, newly born, or without insurance because of the economy.
Noting that the study had just been released, Mr. Duarte replied he had not seen a trend analysis. He added that establishing residency was a requirement in the Division’s programs, however, and he mentioned that the children in those families had to be uninsured for at least six months before they qualified for coverage.
Assemblyman Hardy commented that the people who had conducted the survey would know where the children were coming from.
Mr. Duarte explained that a field survey had been done but added that he did not know what the sample size had been. He also indicated he did not know whether any specific question on the survey had asked where the children had come from.
Speaking about budget reductions and cost containment issues, Mr. Duarte mentioned the Medicaid pharmacy program had limitations on maximum doses for certain pain medications, such as oxycontin, a narcotic.
Assemblyman Mabey explained that oxycontin was a very effective narcotic for pain relief, particularly post-operatively; however, he added, the drug had been abused by some patients. He noted the drug could be crushed or otherwise altered to make it work faster. That was when the drug became a problem, he added.
Chairwoman Koivisto said it sounded like Medicaid patients suffered more pain.
Mr. Duarte replied that he was not certain. He repeated that the Division had instituted dose limitations to control any potential for abuse of the drug. He also indicated institution of a number of prior-authorization policies for “proton pump inhibiters,” which were gastric-acid-reducing medications and quite expensive. Mr. Duarte wanted the less expensive, generic versions of the drugs to be tried first.
Chairwoman Koivisto commented that the drug Prilosec was now available in a generic form.
Mr. Duarte added that the practice of drug pre-authorization had also been instituted for non-steroidal anti-inflammatory drugs, and he also indicated the Division proposed implementing a Medicaid preferred drug list.
Referring to other driving forces in the Division’s budget, Mr. Duarte mentioned HIPAA, was the reason for the rapid implementation of their MMIS. In addition, implementation of MMIS, Mr. Duarte continued, would accelerate provider payments.
Assemblywoman Angle asked about implementation of the MMIS system.
Mr. Duarte responded that the project time line was on track. He explained the Division had an independent quality assurance and verification contractor overseeing the progress of the project. The first phase, he added, had been implemented on time.
Noting that Nevada was the last state to implement a Medicaid information system, Assemblywoman Angle inquired whether Mr. Duarte anticipated any problems with implementation of the system.
Mr. Duarte replied that there would be challenges along the way, the biggest challenge being his overworked staff because implementation was occurring concurrently with the legislative session.
Assemblywoman Angle opined implementation of the MMIS would make Medicaid payments arrive more quickly.
Mr. Duarte agreed.
Referring to changes in graduate medical education payments, Assemblyman Mabey inquired if the Division paid the School of Medicine or any hospitals for resident training.
Mr. Duarte replied that the Medicaid program provided for a supplemental payment to teaching hospitals to help offset some of the costs associated with graduate medical education. Hospitals that had attending physician coverage programs, teaching physician coverage programs, and resident positions often were not as productive, so some teaching facilities needed assistance in order to continue those teaching programs. Mr. Duarte noted the payments were made directly to the teaching hospitals.
Assemblyman Mabey commented that the teaching facilities would bill Medicare for the procedures, too.
Mr. Duarte agreed and added that the payment was a supplement.
Assemblywoman Weber, noting some providers claimed to be waiting 200 days to be paid, inquired what the average turnaround time might be. She also inquired whether payments and/or filings were processed electronically.
Mr. Duarte, explaining the current system had been overwhelmed by caseload growth, said it was his understanding the average payment time was around 33 days. He added that in the fee-for-service Medicaid program, providers had 180 days to submit their bills. He agreed payment would be expedited under the new system.
Chairwoman Koivisto mentioned there was a bill draft request awaiting Committee introduction.
ASSEMBLYMAN WENDELL WILLIAMS MOVED FOR COMMITTEE INTRODUCTION OF BDR 51-539.
ASSEMBLYWOMAN SHEILA LESLIE SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
Chairwoman Koivisto requested that Committee Policy Analyst Marla McDade Williams explain one of the bill draft requests to Committee members.
Ms. McDade Williams said a bill was being requested to appropriate $300,000 to the Nevada Commission for National and Community Service, which coordinated volunteer services. She explained a one-time appropriation had been made the preceding session, but had not been placed in any budget for the current session.
ASSEMBLYMAN WENDELL WILLIAMS MOVED TO REQUEST A BILL DRAFT.
ASSEMBLYWOMAN KATHY McCLAIN SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY.
Chairwoman Koivisto explained that the next request for a bill draft would provide insurance coverage for patient costs during clinical trials.
ASSEMBLYMAN WENDELL WILLIAMS MOVED TO REQUEST A BILL DRAFT.
ASSEMBLYWOMAN VALERIE WEBER SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY.
Mary Liveratti, Deputy Director, Department of Human Resources, introduced Jane Smedes, Management Analyst, Department of Human Resources, who presented an overview of the senior citizens prescription program (Exhibit D). Ms. Smedes directed Committee members’ attention to a Senior Rx program application (Exhibit E), which enumerated the qualifications for the program and included a postage-paid application form. She noted the application forms had been widely disseminated throughout the state and were also available by calling the Department of Human Resources at their toll free number or via their Web site.
Ms. Smedes explained the application provided the Department with the information it needed to determine eligibility. In addition, it provided the insurance company, PRAM Insurance Services, with the information it needed to provide prescription coverage. PRAM provided insurance identification cards, information on accessing the insurance, and an insurance policy.
Once the insured senior citizen received an insurance card, Ms. Smedes continued, it could be used at most pharmacies in Nevada. Senior citizens were required to pay a co-payment based on the type of drug; i.e., generic or preferred brand. Ms. Smedes noted co-payments were $10 for a generic or $25 for a preferred brand.
Ms. Smedes indicated that once a senior citizen had been accepted into the plan, they remained in it unless their circumstances changed and they were no longer eligible. Ms. Smedes reported that a letter was sent once a year to every senior on the program asking them to verify that they were still eligible.
In discussing program performance, Ms. Smedes directed Committee members’ attention to the overview which documented utilization during 2002, noting the program was funded for 7,500 seniors, and that the average number of prescriptions filled each month per plan member was three. Ms. Smedes also pointed out the “per member/per month” (PMPM) rate was the amount the insurer paid in prescription costs divided by the number of eligible members.
Assemblywoman McClain inquired if the PMPM was the amount of money the insurance company paid for each member.
Ms. Smedes said it was and reiterated that the PMPM was calculated by taking the total amount of prescription costs, less what the senior citizen paid, divided by the number of members.
Assemblywoman McClain then asked how much the state of Nevada paid the insurance company per member.
Ms. Smedes replied the insurance company was paid a total of $85 per person.
Mike Willden, Director, Department of Human Resources, requested Committee members turn to page 9 of the handout, which gave a brief history of the Senior Rx program. Mr. Willden noted the program currently had a $2 million credit balance with the insurer and that the premium had been negotiated down to $65 per person. The PMPM contract, he explained, would be renegotiated again this year, and with a mature insurance product of two years, he hoped to drive the cost down again.
Chairwoman Koivisto, for clarification, inquired whether the state had suspended payments to the insurer until the credit was used up.
Mr. Willden said she was absolutely correct.
Assemblywoman McClain asked how much money would be saved if the state of Nevada ran its own program.
Mr. Willden responded that the state would save nothing on the PMPM. He noted the state would be exempt from the 3.5 percent premium tax, but he did not know what the state’s administrative costs might be. Mr. Willden explained re-insurance costs might be quite expensive because there was a huge concern that, as the population grew, sicker people would use the program. Two additional concerns he mentioned were increased utilization as people became more familiar with the program and increased costs for medicines. Mr. Willden noted the dilemma involved having an insured product with the state not at risk, which was the current situation, versus how much risk the state wanted to assume.
Assemblywoman McClain added that part of the balancing act was how much could be provided to the citizens at a reasonable cost by utilizing multi-state consortia to buy the drugs, and Medicaid waivers to leverage the money, rather than always utilizing insurance-based products.
Assemblywoman Leslie asked whether the state could purchase the re-insurance if it ran the prescription program.
Mr. Willden said it could.
Assemblywoman Leslie reiterated that the state would not have to pay the insurance premium tax. She then inquired whether Mr. Willden knew what amount of rebate the prescription management company received directly from the pharmacy company.
Mr. Willden stated he did not have that information but was attempting to get it. He added that he felt Senior Rx was a good product and added that he was trying to get the least expensive product for Nevada’s senior citizens. He also stated it was important the Committee recognize that only one insurance company had bid for the contract or had tried to work with the state to provide the existing program.
Chairwoman Koivisto suggested the Committee consider how many more people the program could cover if the state were not paying out extra money to a third party.
Assemblyman Mabey said he had inquired about the Senior Rx program last summer and that he had understood it was full. Based on what he had heard, he asked whether 3,000 more people could join.
Mr. Willden said the program was “maxed out” with 7,500 enrolled. He noted language in the law stated the state had to be able to fund the program with the dollars that were available.
Assemblyman Mabey inquired whether people in the program could be rotated in and out.
Ms. Smedes replied that the program was not set up that way and that once someone was eligible, even if they were not using the program, they could not be removed from it. She noted that people were not required to use the benefit and some even signed up for it with future usage in mind.
Assemblywoman Weber asked what verification process was in place to guard against fraud.
Ms. Smedes answered that the applications were run through their system and matched with the Medicaid system and with senior citizen property tax, so information such as age, residency, and income was verified. Incomes of the group of people who did not match were audited by their staff auditor, Ms. Smedes added. She also emphasized that they had never found anyone who had fraudulently applied for the program.
Assemblywoman McClain inquired whether Nevada was the only state utilizing insurance-based assistance for seniors.
Mr. Willden replied that there were various versions being used among the states, but that Nevada was the only one with a fully insured model.
Assemblywoman McClain agreed that Nevada was a leader in utilizing that product. She requested Mr. Willden investigate some Medicaid waivers, especially the “pharma-plus” program and possibly some others. Ms. McClain said she would like to be able to use state dollars to leverage federal dollars so either the Senior Rx program could be expanded or another, possibly different program, could be instituted.
Mr. Willden said he had additional information he could provide on the five states that had the Pharmacy Plus waivers.
Assemblywoman McClain asked Mr. Willden if he would “lay out what it would mean to the budget and the citizens of the state and how we would pursue it.” She added that he could provide the information at a later date.
Ms. Smedes continued her explanation of the handout by pointing out utilization versus beneficiaries in the Senior Rx program and noted that a lot of people did not use the program, or at least the same people were not using it each month. Ms. Smedes indicated the average person on the program was a 74-year-old female. She also pointed out that seniors were also using more generic drugs as opposed to brand name drugs.
Assemblywoman McClain observed that the reason senior citizens preferred generic drugs over brand-name ones was the difference in the co-pay amount.
Ms. Smedes added that there were many more drugs available now in generic versions.
In discussing prescription cost sharing, Ms. Smedes noted senior citizens were paying a good portion of the cost of the drugs. For instance, she continued, in the month of December, the average cost of a prescription was $42, of which $18 was paid by the senior and almost $24 paid by the plan.
Ms. Smedes pointed out another page of the Senior Rx handout that listed numbers of senior citizens on a waiting list to join the program. As of December 31, she noted, there were 1,328 seniors on the list, which was prioritized by income so that people with the lowest incomes were at the top of the list.
Mentioning Governor Guinn’s plan to increase program funding by $5 million, Ms. Smedes stated the number of enrollees would increase to 10,500 in 2004 and then to a maximum of just over 12,000 in 2005. Ms. Smedes also indicated a bill draft request would soon be introduced that would add a consumer price index inflater to the maximum annual income of seniors, just as the senior property tax currently had. She also said the Department would like to increase the maximum income level for couples to $28,660.
Assemblywoman Leslie inquired about the co-pay amounts for prescription drugs.
Ms. Smedes reiterated that the generic co-pay was $10; the brand name drug was $25.
Assemblywoman Leslie, noting different charts had been provided to her during the Ways and Means Committee hearing on this budget, asked for verification that lower income people would be included first.
Ms. Smedes agreed that they would be included first.
Assemblywoman Leslie mentioned that 53 percent of the current caseload was in the lower income category of $12,700 or less.
Ms. Smedes again agreed.
Assemblywoman Leslie queried whether adding the $5 million would still enable inclusion of everyone at the lower income levels. To clarify, Ms. Leslie asked whether, even with an expansion, the state would end up with the same kind of problem we currently had where people stay on the waiting list a long time.
Ms. Smedes replied that adding the $5 million should accommodate everyone on the waiting list.
Assemblywoman Leslie inquired if there were other seniors at that income level not being served.
Ms. Smedes explained that they had some estimates and directed Committee members’ attention to the “service plan” on page 8 of her handout. She explained that the Department anticipated that in fiscal year 2004 enrollment would be increased per month because 1300 senior citizens would be added from the waiting list, 25 couples would be added, if the maximum income for couples were increased, and 115 new enrollees would be added. Those numbers, Ms Smedes continued, were the Department’s estimate of people who might want the program over and above the waiting list.
Chairwoman Koivisto indicated she had another BDR for Committee introduction; BDR 38-692, she added, was from the Legislative Committee on Children, Youth, and Families.
ASSEMBLYMAN WENDELL WILLIAMS MOVED FOR COMMITTEE INTRODUCTION OF BDR 38-692.
ASSEMBLYWOMAN SHEILA LESLIE SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY.
Chairwoman Koivisto explained she had a request for a bill draft that would create a new program called “Senior Choice” for all seniors earning less than 300 percent of the federal poverty level and who would be eligible either for Senior Rx or Senior Select, which would be a discount program.
ASSEMBLYMAN WENDELL WILLIAMS MOVED TO REQUEST A BILL DRAFT.
ASSEMBLYWOMAN SHEILA LESLIE SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY.
Assemblywoman Weber asked if eligibility requirements had been revised since the Senior Rx program had been put into place. She said she was trying to understand the relationship between members in the system and utilizers of the system. It appeared that not all members of the Senior Rx program were taking advantage of it and she wanted to know whether, even if seniors did not use the program, they were still on it “forever.”
Ms. Smedes testified that members could not be removed from the program if they did not use it.
Assemblywoman Weber, stating there might be people on the waiting list with real need, yet could not be admitted to it, were there people who signed up in anticipation of using the program, who were not yet using it?
Ms. Smedes said she did not know exactly why people were not using the program; however, she indicated many seniors had signed up with the program thinking they might need it in the future. She added that some people might not be aware of how to use the program, so they were doing some education on how to access the benefit.
Assemblyman Horne said he was under the impression that he could use the plan for a couple of months and then might not need it again for several more months and that that was where the usage numbers came from. He said it was not as though completely healthy members were on it and just not using it. He asked whether he was correct.
Mr. Willden agreed with Assemblyman Horne. He clarified that the number of “eligibles” were card-carrying plan members who were entitled to go to a pharmacy if they needed one or more prescriptions. The “utilizers” were the count for the month of the number of eligible seniors who got at least one prescription.
Assemblyman Hardy added he could understand seniors being on the program because they wanted to be able to have prescriptions if they needed them. He explained the elderly did not care for themselves, especially if they could not afford what was prescribed for them. In that case, they hesitated to go to a doctor when they could be treated easily instead of waiting until they are extremely sick. If they could get early care, they could be kept out of the hospital.
Assemblywoman McClain asked whether the extra infusion of money to get the enrollment up to 15,000 total would cover enough people. She asked if Mr. Willden knew how many people would actually qualify.
Mr. Willden replied that he did not have a “hard” number. He commented the Senior Citizen’s Property Tax Rebate Program had a similar income guideline and that there were over 13,000 seniors enrolled in that program, which the Division of Aging Services was planning to “grow” to 15,000 in the next two years.
Assemblywoman McClain asserted that in Clark County alone, there were 220,000 people 65 years and older. Explaining that 150 percent of the federal poverty level was the guideline, she hypothesized that if 11 percent of that population was at or below the 150 percent level, there would be approximately 24,000 to 25,000 people. If one subtracted the people eligible for Medicaid, she continued, that would probably leave 20,000 seniors who would qualify for Senior Rx in Clark County alone.
Mr. Willden noted that the Great Basin Primary Care Association had conducted an annual study about Nevada’s uninsured population and had just released the current study, but he could not remember the current statistics.
Chairwoman Koivisto, noting there were no more questions or comments from Committee members or the public, adjourned the meeting at 3:40 p.m.
RESPECTFULLY SUBMITTED:
Terry Horgan
Committee Secretary
APPROVED BY:
Assemblywoman Ellen Koivisto, Chairwoman
DATE: