MINUTES OF THE meeting
of the
ASSEMBLY Committee on Health and Human Services
Seventy-Second Session
May 19, 2003
The Committee on Health and Human Serviceswas called to order at 2:51 p.m., on Monday, May 19, 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.
Note: These minutes are compiled in the modified verbatim style. Bracketed material indicates language used to clarify and further describe testimony. Actions of the Committee are presented in the traditional legislative style.
COMMITTEE MEMBERS PRESENT:
Mrs. Ellen Koivisto, Chairwoman
Ms. Kathy McClain, Vice Chairwoman
Mrs. Sharron Angle
Mr. Joe Hardy
Mr. William Horne
Mr. Garn Mabey
Ms. Peggy Pierce
Ms. Valerie Weber
Mr. Wendell P. Williams
COMMITTEE MEMBERS ABSENT:
Ms. Sheila Leslie (excused)
GUEST LEGISLATORS PRESENT:
None
STAFF MEMBERS PRESENT:
Marla McDade Williams, Committee Policy Analyst
Terry Horgan, Committee Secretary
OTHERS PRESENT:
Robert Desruisseaux, representing the Northern Nevada Center for Independent Living; Member, Task Force on Disability
Mary Liveratti, Deputy Director, Department of Human Resources
Susan Rhodes, Social Work Supervisor, Clark County Department of Social Service; Chair, Senior Services Task Force
Connie McMullen, Publisher, Senior Spectrum newspapers
Robin Keith, President, Nevada Rural Hospital Partners; Chair, Nevada Rural Health Care Task Force
Chairwoman Koivisto:
I’m going to call the Health and Human Services Committee to order. [Roll taken.] Please mark the others present when they arrive. Ms. Leslie is excused.
We are going to hear S.C.R. 36 today, which came about as a result of S.B. 513 of the 71st Legislative Session.
Senate Concurrent Resolution 36: Expresses support of Nevada Legislature for four long-term strategic plans developed by Department of Human Resources concerning health care needs of residents of Nevada. (BDR R-742)
Robert Desruisseaux, representing the Northern Nevada Center for Independent Living; Member, Task Force on Disability:
[Introduced himself.] I’m here today to strongly urge your support of S.C.R. 36. In the process of developing a strategic plan for people with disabilities we included individuals across Nevada, people with disabilities, their families, and their caregivers. We also included service providers and advocates in the disability field.
The development of this was a compilation of hundreds of those individuals across Nevada coming together to develop this strategic plan. There’s a 10‑year strategic plan that addresses independent living as well as economic self-sufficiency issues in the disability field.
For the sake of time, I will ask if there are any supporters in the audience. [Two individuals stood up.] Once again, I would like to urge your support of S.C.R. 36.
Mary Liveratti, Deputy Director, Department of Human Resources:
[Introduced herself.] S.C.R. 36 supports the work of four task forces authorized by A.B. 513 of the 71st Legislative Session. The Governor appointed these four task forces to develop strategic plans to address the needs of seniors, the needs of people with disabilities, rural health, and rates for providers of health care services.
We would like to recognize the four chairpersons of the task forces: Sue Rhodes, Chair of the Senior Services Task Force; Dr. Brian Lahren, Chair of the Task Force on Disability; Robin Keith, Nevada Rural Health Care Task Force Chair; and Ed Guthrie, Provider Rates Task Force Chair.
The four strategic plans represent the work of over 200 members of the Task Forces and their subcommittees. In addition, over 2,000 seniors, people with disabilities, their families, health care providers, and advocates participated in the yearlong process through public hearings, focus groups, and surveys. Mike Willden, Director of the Department of Human Resources, has called these plans the “people’s plans” because of the participation of so many Nevadans in the planning process.
Each plan gives us a blueprint for services for the next ten years. These plans, however, are just the first step. Governor Guinn has indicated that he does not want these plans to be put on a shelf and ignored. The plans must continue to be evaluated, updated, and revised as necessary. We’re pleased to report to you that a number of the objectives listed in the plans have moved forward for the next biennium. For example, The Executive Budget includes funding to address waiting lists for community-based services for seniors, for people with disabilities, and for mental health services. In addition, the Department is collaborating with both public and private organizations to develop a “no-wrong-door/single point of entry” system to help families in accessing services. Legislation based on recommendations in the strategic plans has also been introduced. For example, S.B. 164 will establish the Office of Disability Services within the Department of Human Resources.
The four strategic plans offer us a vision for the future but we must now put those plans into action. We’d like to thank you for your support.
Susan Rhodes, Social Work Supervisor, Clark County Department of Social Service; Chair, Senior Services Task Force:
[Introduced herself.] It has been my privilege to serve as the Chair of the Senior Services Task Force and as such, and on behalf of the entire Task Force to now sit before you and ask for your support in favor of S.C.R. 36.
[Ms. Rhodes continued] The Senior Services Task Force was comprised of 14 members representative of agencies both public and private, profit and nonprofit, northern [Nevada] and southern [Nevada]. Senior advocates as well as senior consumers themselves were also represented. The goal of the Task Force was to provide a long-term strategic plan addressing health care needs and concerns of Nevada’s growing senior population. While such a project may seem daunting on the surface, it was tackled with a great deal of enthusiasm and vitality since all of us involved in this project realized that an opportunity such as this does not come about very often.
The strategic plan itself begins with a vision that states that:
All seniors in Nevada are knowledgeable, secure, respected, and able to make choices towards health, hope, and happiness. They have maximum independence, direct their own care, and are fully engaged in the occupation of life. A balanced care system is equally available, too, and of equal quality for all seniors. It has an adequate supply of the right resources with all types of services readily available.
Six overarching strategies run through the entire plan. The first relates to ongoing informational campaigns to educate and empower individuals and caregivers. The next follows continuing efforts to develop private-sector initiatives in housing, transportation services, and long-term care insurance. Third is the expansion and retention of a qualified long-term care workforce. Fourth is the development of a single-point-of-entry system. Fifth is that timely data collection and analysis will allow for improved tracking of our overall success. Finally, and perhaps most significantly, is the shift from institutional-based to home- and community-based care for our seniors.
The Senior Services Task Force had the input of over 2,000 Nevadans in the creation of the strategic plan through focus groups, questionnaires, the Internet, and response cards. The strategic plan presented by the Task Force is representative of that input and reflective of that desired most by Nevada’s seniors and their families. It is also reflective of the potential cost savings to Nevada as well as increases in the quality of life for our state’s seniors.
A deeper purpose of the plan is to foster a more integrated approach to improving seniors’ health and well-being. Various aspects of this approach include improved care coordination and case management among service providers, a focus on health care management rather than chronic disease management, and finding creative solutions for filling areas of greatly reported need such as dental services and transportation. Seniors want to remain in their own chosen environments and be informed and involved.
[Ms. Rhodes continued] The Las Vegas Sun in an editorial on October 29, 2002, said, “The long-term care study has merit and the Task Force’s plan for in home care should be pursued by the Governor and the Legislature.” As the Task Force says in the strategic plan, Nevada does have a compelling opportunity for action and this is the time to take it. Thank you for the opportunity to appear before you this afternoon.
Connie McMullen, Publisher, Senior Spectrum newspapers:
[Introduced herself.] I sat on the strategic plan for seniors representing the City of Reno. I come before you to strongly urge you to adopt the recommendations proposed in the plan, “Act Now, Pay Later: 10 Year Targets to Preserve the Health and Independence of Nevada Seniors.”
Act Now or Pay Later essentially advocates shifting the way the state funds senior services to allow more people to live independently in their own home and to avoid premature institutionalization. The plan recommends achieving this goal largely with the funding of home- and community-based services, ultimately filling gaps in a multitude of senior needs. Act Now or Pay Later offers two scenarios: continue the present system with the full understanding the current system is not efficiently meeting the state’s needs, or develop a system desired by the seniors and their families that actually shifts services from skilled nursing homes to homes and the community.
The plan urges lawmakers to rethink how care and services should be provided in the state, already ranked among the lowest in the country. In 1999, Nevada ranked 50th among states in per capita spending for all community-based care, including home health services, personal care, and home- and community-based service waivers. A shift in how the state delivers services for long-term care is clearly an intelligent approach and a long overdue change in public policy. A concept that has been projected would save the state over $73 million in fiscal year 2009-2011 if implemented beginning in fiscal year 2003-2005, keeping nearly 3,000 elders out of skilled nursing homes and limiting the drains on the state budget.
I strongly urge the state to take charge of this provision and adopt it as a practical approach to the future health care policy of the state.
Robin Keith, President, Nevada Rural Hospital Partners; Chair, Nevada Rural Health Care Task Force:
[Introduced herself.] It was my honor to serve as chairman of the Governor’s Task Force for the development of a strategic plan for rural health care.
We set about developing a rural strategic plan by setting up a process that enabled us to gather input from communities and stakeholders all over Nevada. I’m pleased to say that we feel we obtained a great deal of public input into the plan and in that way think we were very true to Mr. Willden’s comment about this being the people’s plan.
In essence, the underlying theme of the rural plan is maintenance of access to services for the residents who live out in the 91,000 square miles that comprise rural Nevada.
The Task Force worked with the international consulting firm of LECG to develop the plan. It includes goals, objectives, and action steps in three layers. The most specific layer is a series of recommendations that deal with needs at the county levels.
Next, there is a whole series of goals, objectives, and action steps that relate to rural health care needs at the state level, and finally, the plan includes what I consider to be a very important policy statement that establishes a supportive context for the discussion of rural health care policy solutions.
We view the plan as a beginning, not an end. Two key recommendations in the plan were that the Governor establish an ongoing task force for the implementation of the plan so that it does not turn out to be yet another document that gets put on a shelf somewhere. Second, in our effort to make decisions about needs and resource allocation we found that we had a dearth of good data. We strongly recommend that a data repository related to rural health care be established. We felt that could happen in the existing Office of Rural Health that is part of the University of Nevada School of Medicine. It would not be the intent to redevelop all of existing data but rather to gather the great deal of information that’s already available and [develop] a coherent, understandable set of documentation.
Nevada Rural Hospital Partners is very supportive of S.C.R. 36 and we hope you will be, too.
Chairwoman Koivisto:
For the Committee, AARP (American Association of Retired Persons) sponsored panel discussions on the public television stations in Nevada. Many of the people in this room participated in those discussions as well as Senators Rawson, Titus, and Amodei. From the Assembly Mr. Beers, Ms. McClain, and I [participated] as well as Ms. Rhodes, Ms. Keith, Mike Willden, and a number of other folks. I have tapes [of the discussions], so let me know when you want to see them and I’ll have them in my office.
Assemblywoman McClain:
I accidentally participated in [some of the discussions]. I was in the audience as the Clark County Senior Advocate and it was a good exercise. I have a question for Sue [Rhodes] and Mary [Liveratti]. Since I am really familiar with this plan, the things to be implemented over the next biennium, are they in place? Did we miss something or are we on track?
Susan Rhodes:
I’m not sure what you mean by “are they in place.” We have a plan in place. We have an implementation schedule and we have an implementation plan. With the Legislative session going on right now everything is being held in abeyance. Once the Legislative session is closed, it’s our intention to move into what we call the implementation phase.
In the plan itself there is a call for a subcommittee under the Commission on Aging to be put into place that will consist of certain members from the original [Senior Services] Task Force as well as some new people to be brought in to move toward implementation. We call for a phase-in of various aspects and portions of the plan over the next eight years, at which point in time we’ll do a regrouping and a re-analysis. The interesting thing about a strategic plan is that it’s a very dynamic, living document. It’s meant to be tweaked and manipulated and maneuvered all the way along the process. It’s not static; it’s a living being. We will be moving toward that implementation phase and we will be moving toward putting plans in place.
Assemblywoman McClain:
I just wanted to make sure that if there was something Department of Human Resources needed in the way of funds, that they were made available to you.
Mary Liveratti:
There are a number of items in that first two years, that first biennium, that are being addressed through the Legislative process and through The Executive Budget process. Each plan has an executive summary. The senior plan has each target and what [should take place in] each two-year period for the next ten years. There are quite a few things being addressed through the legislative process, actually, such as Senior Rx expansion. Some of this also is baseline information. As Ms. Keith mentioned earlier, we did have a very difficult time occasionally knowing where we stood because the data has either not been comparable or it is not there. Part of it has been getting that baseline data so that we can be sure that, at the end of ten years’ time, we actually can see what progress we’ve made or not made, as the case may be.
[Ms. Liveratti, continued] I would like to say that each plan is going to have a committee that will look at the plans on an ongoing basis to make sure there’s accountability for the plan, what strategies were put in place and what progress is being made or isn’t being made. They will also be looking at revisions that need to be made over each session. I believe the Governor plans to do that by Executive Order, but each of the four groups will have an ongoing group to monitor and make sure we have accountability for the plan.
Assemblywoman McClain:
You said that the senior plan is going to be under the Commission on Aging?
Mary Liveratti:
Yes, that is what the Task Force proposed. Rather than trying to set up a new committee, it would be stand-alone. It would just be a subcommittee of the Commission on Aging.
Chairwoman Koivisto:
For the Committee’s information, each of these four groups came out with a report to go with the tapes and these folks worked very hard. What they did was something that should have probably been done 50 years ago. It’s done now and the plans are in place and I think it behooves us to watch and make sure that those plans are [completed].
Questions or comments from the Committee? [There were none.]
ASSEMBLYMAN HARDY MOVED TO ADOPT S.C.R. 36.
ASSEMBLYWOMAN McCLAIN SECONDED THE MOTION.
THE MOTION CARRIED. (Assemblywoman Leslie was absent for the vote.)
Chairwoman Koivisto:
Thank you, ladies and gentlemen. This is our last and final meeting. There being nothing further to come before the Committee, we are adjourned [at 3:12 p.m.].
RESPECTFULLY SUBMITTED:
Terry Horgan
Committee Secretary
APPROVED BY:
Assemblywoman Ellen Koivisto, Chairwoman
DATE: