MINUTES OF THE meeting
of the
ASSEMBLY Committee on Ways and Means
Seventy-Second Session
May 7, 2003
The Committee on Ways and Meanswas called to order at 11:26 a.m., on Wednesday, May 7, 2003. Chairman Morse Arberry Jr. presided in Room 3137 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:
Mr. Morse Arberry Jr., Chairman
Ms. Chris Giunchigliani, Vice Chairman
Mr. Walter Andonov
Mr. Bob Beers
Mrs. Vonne Chowning
Mrs. Dawn Gibbons
Mr. David Goldwater
Mr. Josh Griffin
Mr. Lynn Hettrick
Ms. Sheila Leslie
Mr. John Marvel
Ms. Kathy McClain
Mr. David Parks
Mr. Richard Perkins
COMMITTEE MEMBERS ABSENT:
None
STAFF MEMBERS PRESENT:
Mark Stevens, Assembly Fiscal Analyst
Lila Clark, Committee Secretary
Carol Thomsen, Committee Secretary
Assembly Bill 430 (1st Reprint): Prohibits Department of Human Resources from taking certain actions to restrict access to certain prescription drugs for mental illness provided pursuant to Medicaid and to antiretroviral prescription drugs provided to certain persons pursuant to Medicaid. (BDR 38-984)
Assemblywoman Sheila Leslie, District No. 27, introduced herself. She said A.B. 430 as amended would require the state to exempt certain mental health drugs on the formulary from pre-authorization and other preferred drug lists in Medicaid and the Mental Health Division. Assemblywoman Leslie said A.B. 430 had been amended to apply only to the atypical, unconventional antipsychotic medications; in other words, the drugs that were used by the most severely mentally ill. Ms. Leslie said the antidepressant medications and the antianxiety medications had been removed from the bill. Those medications were often used by people whose mental illness was less severe.
Assemblywoman Leslie said the reasoning behind the bill was to be certain that there were no unnecessary barriers that would prevent the severely mentally ill from receiving necessary medications. She said the medication was very costly and everyone was very cognizant of that but there had also been dramatic turnarounds from clients who were able to receive the correct medication.
Assemblywoman Leslie said that representatives from the Division of Health Care Financing and Policy, after further review of the bill, were going to present testimony regarding an objection to the bill that had not been raised in the Health and Human Services Committee. Ms. Leslie said the staff from the Division of Health Care Financing and Policy had determined there was a problem with prior authorization.
Mr. Tom Wood, representing Pharmaceutical Research and Manufacturers of America (PhRMA), introduced himself and Mr. Pat Coward. He said they had worked extremely hard with Assemblywoman Leslie, the Division of Mental Health and Developmental Services, and with the Division of Health Care Financing and Policy, in order to satisfy the objections and fiscal concerns that had been raised. Mr. Wood said that PhRMA had concerns that patients should have access to the best medications and should not have to go through policy procedures in order to get the medications. He said that was the consensus that was formed in the Health and Human Services Committee. Mr. Wood said the interested parties had met for a day and a half “hammering out” an agreement. He thought the agreement was going forward until Assemblywoman Leslie told him the day before the meeting that the Division of Health Care Financing and Policy had another objection. Mr. Wood stated that if the Division had an objection it would be a policy objection and probably best handled in the Senate Committee on Human Resources. He said he realized that the Committee on Ways and Means was not a policy committee.
Chairman Arberry interjected that whatever needed to be changed should be changed here. He said the Committee on Ways and Means would not send anything out of committee that needed to be amended. Chairman Arberry told Mr. Wood that whatever needed to be done to the bill should be done in the Committee on Ways and Means.
Mr. Wood said he understood Chairman Arberry.
Ms. Mary E. Wherry, Deputy Administrator, Division of Health Care Financing and Policy, introduced herself. Ms. Wherry said that in the Division’s original testimony she had focused on the fact that the Division wanted clinicians who participated in the Drug Utilization and Review Board (DUR) to be the ones making the decisions about such things as when a prior authorization was or was not required and when step therapy was appropriate. Ms. Wherry said that during the prior testimony she had not focused heavily enough on prior authorization being an issue because the testimony was that she would like to leave that up to the DUR Board.
Ms. Wherry explained that the most critical point, from her standpoint, was that the Division was very supportive of the Division of Mental Health and Developmental Services (MHDS), who had taken the modified version of the Texas Medication Algorithm Project (TMAP) and created a step therapy program, which used the management by clinicians for medicating recipients with antipsychotic medications. Ms. Wherry said that in order for the Division to be able to support and mimic the program MHDS used it needed to be able to utilize step therapies and prior authorizations. She said the program MHDS used had a specified number of providers in the program whom the Department had more direct authority over and who had policies that were followed as the outpatient/inpatient programs were implemented. Ms. Wherry said that in Medicaid it was any willing provider and the Division wanted continuity of care for recipients who had come out of an MHDS service area into a general public service area. Ms. Wherry said the recipients should stay on the same protocols that they had been using at MHDS and the Division could only achieve that through a step therapy process or a prior authorization process. Ms. Wherry said her concern was that if the Division was not able to control those types of continuity of care issues, and it became a legislated process, that Nevada would end up with a two-tiered system where Medicaid recipients at MHDS would have the TMAP protocols applied to them but the Division would not be able to implement that for Medicaid. She said those very same recipients who might go to another provider would experience a disruption in how their medications might be utilized or prescribed.
Ms. Wherry said that the Division had testified previously and was committed to leaving medication decisions in the hands of clinicians, who had the most skill and expertise to make those types of decisions. Ms. Wherry said the Division would like to be able to use the regulatory process to administer prior authorizations when appropriate. She said the Division had committed to Assemblywoman Leslie and to the recipients that the Division valued the effectiveness of the new drugs that were available and that the Division did not want to disrupt the recipients’ benefits. Ms. Wherry said that was as strong a commitment as she could make and that would be demonstrated over time.
Assemblywoman Leslie asked if Ms. Wherry had asked the Health and Human Services Committee to make the amendment to remove the drug exemptions from the prior authorization lists.
Ms. Wherry responded that the Division had not done a formal amendment to the bill.
Assemblywoman Leslie asked if the problems identified would be issues in A.B. 384 as well. Ms. Wherry said that bill had been amended to restrict prior authorization and would cause the same problem as had been identified in A.B. 430. Assemblywoman Leslie said that bill should probably also have been amended before it was sent to the Senate and Ms. Wherry agreed.
There being no further testimony on A.B. 430, Chairman Arberry closed the hearing and opened the hearing on A.B. 508.
Assembly Bill 508 (1st Reprint): Revises provisions governing academic standards for certain grade levels to include certain cultural studies. (BDR 34-1217)
Ms. Tya Mathis introduced herself and referred the Committee to Exhibit C. Ms. Mathis said A.B. 508 would require school districts to adopt standards for existing social studies requirements that would include instruction regarding cultures and people of various racial and ethnic groups that were represented within the United States. Ms. Mathis said that being exposed to foreign languages and their concurrent cultures would benefit Nevada students throughout their educational careers and into their day-to-day lives. Ms. Mathis said the current emphasis of the legislation was to expand elementary schools’ social studies requirements in order to better prepare our children for the diverse world in which we live.
Ms. Mathis said the bill would establish a program of instruction in the cultures associated with certain foreign languages in elementary schools. She said that as boundaries between countries were being dissolved, the need for foreign language instruction had become a necessary component for linking with the rest of the world and for producing an enlightened citizenry able to function in today’s shrinking world.
Ms. Mathis said the purpose or intent of the bill was to offer elementary school students in Nevada an opportunity to become familiar with other cultures besides their own. She said the lessons learned would help them later on in life when they were exposed to people from many diverse cultures. Through the program, our children would hopefully gain an appreciation for a new language and its culture, or language and culture in general.
Ms. Mathis went on to say that it was easier to learn a foreign language when a person was young and it was imperative that children be educated and prepared for a changing society by teaching them about many different cultures. Those skills would add to their diversity as well as help them in future foreign language cultures that would be mandatory at both the high school and collegiate levels. In addition to the need for communication within a global world, the study of foreign language would be needed to ensure economic competitiveness, to maintain national security, and to teach tolerance and respect for others outside of the United States.
Ms. Mathis said that there were four types of foreign language and culture programs that were currently available in elementary schools throughout the United States. She said there were Foreign Language in the Elementary School (FLES) programs, FLEX programs, Immersion programs, and Two-Way Immersion programs. Ms. Mathis said that currently in Clark County FLES programs were being used and they were the most frequently offered foreign language programs in U.S. elementary schools. She said that if the culture aspect was added it would be added to the FLES programs already in use.
Ms. Mathis said that since the FLES program had already been established in some Nevada schools, she wanted the Committee to be aware of the importance of teaching both the language and the concurrent culture in elementary schools. She said that learning about diverse cultures was important and it should be included in the social studies curriculum and, therefore, Amendment Number 291 to the bill had been made. Ms. Mathis said the Council to Establish Academic Standards for Public Schools was required to adopt standards for existing social studies subjects that included the teaching of cultures of people of various racial and ethnic groups represented in the United States. The racial and ethnic cultures would be taught in grades kindergarten through five. The new social studies standards would apply statewide, beginning with the 2004-2005 school year.
Assemblywoman Giunchigliani complimented Ms. Mathis on her presentation and asked how many schools in Clark County were offering foreign languages.
Ms. Mathis said she did not know the number of schools offering foreign languages but Ms. Wright knew and would answer the question.
Ms. Karyn Wright, Legislative Representative, Clark County School District, said that currently in the Clark County School District every elementary school had access to the Foreign Language in the Elementary School (FLES) program. She said it was a videotaped program that was available to all elementary schools. She said it was a 15-minute program for kindergarten and a 30-minute program for the other elementary grades.
Assemblywoman Giunchigliani asked if the program was an actual instructional “piece” that focused on Spanish, French, Italian, German, or all of them.
Ms. Wright responded that currently the focus was on Spanish. She said it was Spanish instruction along with teaching about the culture.
Assemblywoman Giunchigliani said that the cultural study was needed. She asked if the program was a video. Ms. Wright said it was a videotaped program of an instructor and the purpose of the program was for the teacher to be involved with the students watching and interacting with the teacher on the video. Ms. Wright said the teacher would be learning in conjunction with his or her students.
Assemblywoman Giunchigliani asked if it was part of the bill to incorporate the standards of the cultural issues. Ms. Giunchigliani also asked if cultural studies were not currently included in the curriculum.
Ms. Wright stated that currently in the social studies standards there were standards that addressed multiculturalism. She said the bill would put more emphasis in that area.
Assemblywoman Giunchigliani said that emphasis on multiculturalism was probably necessary but would require more time than was available. She said that a teacher was lucky in the elementary schools if the teacher had 15 minutes per week to do science, let alone social studies or any other topic. Ms. Giunchigliani said that perhaps part of the discussion should be the time to teach the component.
Assemblywoman Chowning said that teaching foreign language used to be her career and she was well acquainted with the subject matter. She agreed that it was much easier to learn a foreign language when a person was younger although she never had that chance. Mrs. Chowning said she had a hard time learning a foreign language since she began learning as a ninth grader but she kept on learning through school and was very comfortable with foreign languages. Mrs. Chowning said that as a teacher she used to consider that an absolute critical, integral part of teaching foreign language was teaching the culture as well. She said she was very supportive but she wondered if 15 minutes was enough time, although anything would be better than nothing to make our world smaller in terms of communication and would benefit all of us. She said the bill had been heard in the Education Committee and since she was a member of the Academic Standards Council, she could say that the cultural emphasis was already a part of the standards in the elementary grades through secondary school. Mrs. Chowning asked what the fiscal note was on the bill and how effective the program would be.
Mr. Jack McLaughlin, Superintendent of Public Instruction, introduced himself. He said that the Department of Education had dropped its fiscal note based on the amended bill. Mr. McLaughlin said that originally there were other issues that would have required opening up the standards but as the bill stood now the program could be incorporated within the current standards.
Ms. Karyn Wright said she wanted to go on record saying that the Clark County School District supported the amended version of the bill.
Assemblywoman Giunchigliani asked for an explanation of what the bill would accomplish.
Ms. Mathis said the bill placed an emphasis on the FLES program. She said that emphasis would be placed on the culture of whatever language was being taught.
Assemblywoman Giunchigliani confirmed that there was no fiscal note from the Department of Education or the Clark County School District.
Ms. Karyn Wright stated that the bill would reinforce the cultural aspect of the language.
Assemblyman Andonov asked if the goal of the program was to teach the language or was the goal exposure to the language and culture.
Ms. Mathis responded that it was not expected that the students would be proficient in any language after three to five years of exposure to the program but she believed the exposure in elementary school would help the student to learn the language faster in high school or college.
Assemblyman Andonov said that the program would also help to get the students excited about learning a foreign language.
Mr. David Schumann, representing the Independent American Party and himself, introduced himself. He said he was in favor of foreign language training. Mr. Schumann said he had studied three years of Latin, beginning in seventh grade, two years of Spanish, beginning in tenth grade, a year of Italian, beginning as a freshman in college, and he flunked out of German, beginning as a sophomore in college. Mr. Schumann reiterated that he was in favor of teaching foreign languages but he believed the bill was a “feel good” measure. He said he thought that 15 minutes of a language might not even make students acquainted with the language. Mr. Schumann said the Latin class he took lasted 45 minutes a day, 5 days a week, and was a great course because it had facilitated his learning of English in the higher grades. Mr. Schumann said that Latin was at the base of the English language and he favored teaching foreign languages although he did not favor the bill.
Mr. Schumann said we had a major problem in education and he had just happened to compile documentation for the Committee on Taxation about a statement he had made in that committee that Mr. Goldwater took exception to. He said he would be documenting that for him but in compiling a stack of evidence he said he discovered that the United States Department of Education had printed the Pursuing Excellence Study, which was an examination of the most recent Third International Math and Science research. Mr. Schumann stated that the performance of twelfth grade students in the United States on physics and advanced mathematics was the lowest of the 16 countries that administered the assessments in all 5 content areas of physics and in all 3 content areas of advanced mathematics. Mr. Schumann stated that American students were no better in English because schools did not teach English or United States history well. He went on to say that Americans should study the basics, English, math, history, and science. Mr. Schumann said he advocated that all students should start taking a foreign language in the seventh grade but he doubted that grades one through six were a reasonable place to study a foreign language. Mr. Schumann said if the program was enacted he hoped it would be started at grade seven and more than 15 minutes allowed for it. Mr. Schumann said that when a student studied any language that student would also study the culture. He said that when he took Spanish the teacher also provided elements of culture although he could not say the same for Latin since it was a dead language. Mr. Schumann said that when he took Italian in college he also studied the culture such as the foods. Mr. Schumann stated that although he favored teaching foreign languages in school, he thought the bill was a waste of elementary school children’s time.
Chairman Arberry asked Mr. Schumann if he attended a public or private school for grades kindergarten through twelfth grade.
Mr. Schumann responded that he had attended the Episcopal Academy, which was a private school. He said that his friends in public schools studied languages beginning in junior high school.
There being no further testimony, Chairman Arberry closed the hearing on A.B. 508 and opened the hearing on A.B. 513.
Assembly Bill 513 (1st Reprint): Revises provisions governing provision of safe and respectful learning environment in public schools. (BDR 34-443)
Assemblyman David Parks, District No. 41, introduced himself. He said he had adopted the bill although he had not initially introduced the bill. Mr. Parks said A.B. 513 was a natural progression and carry forward of A.B. 459, which had been passed in the 71st Legislature. Mr. Parks said the bill was scheduled in the Committee on Ways and Means because a fiscal note had been placed on the bill. He said there had been discussion regarding the bill and a letter received from Dr. Keith Rheault, Deputy Superintendent, Department of Education, withdrawing the fiscal note.
Assemblyman Parks said the intent of Section 2 of the bill was that the Department of Education would develop a program and when the Department developed its fiscal note it included the cost of not only developing the program but also presenting it to the 17 school districts. Mr. Parks said that the fiscal note had been withdrawn by the Department of Education.
Mr. Jack McLaughlin, Superintendent of Public Instruction, Department of Education, introduced himself. He pointed out that the Department had withdrawn the fiscal note on the bill in a May 6, 2003, letter, Exhibit D. Mr. McLaughlin said the Department would work with the national Equity Access Centers (EAC) and the Office of Civil Rights in developing a model policy, and would work through the state and the various organizations and associations listed in the bill to develop a model policy and a workbook that would be disseminated at no cost to the state. Because of that, the Department had withdrawn its fiscal note.
Assemblyman Parks said that he had been given a copy of an amendment that would be proposed as Floor Amendment 510. He said the amendment would change Section 2 to delete the direction of the Department and replace it with the Board of Trustees of each school district. Mr. Parks said he was fearful that the bill would leave the Assembly Committee on Ways and Means and end up having to be returned to the Committee on Ways and Means if the Floor amendment was approved because it would then create a mandate on the part of the individual school districts to develop such a program.
Chairman Arberry asked who had proposed the amendment.
Assemblyman Parks said the amendment had been proposed by Assemblyman Hardy. Mr. Parks said he had discussed the amendment with Assemblyman Hardy and Mr. Parks was hopeful that Mr. Hardy would amend Amendment 510. Mr. Parks said there were other items in the amendment that were non-fiscal that Mr. Parks thought would be good for discussion purposes. Mr. Parks said that he felt they would be able to develop a viable piece of legislation.
There being no further testimony, Chairman Arberry closed the hearing on A.B. 513 and opened the hearing on A.B. 534.
Assembly Bill 534: Makes various changes concerning State Public Works Board. (BDR 28-556)
Mr. Daniel K. O’Brien, P.E., Manager, State Public Works Board, introduced himself and referred the Committee to Exhibit E. Mr. O’Brien said he was there to request the Committee’s support of A.B. 534. The bill referred to changes that were being requested by the State Public Works Board relating to Nevada Revised Statutes (NRS) 341. That chapter determined the roles, responsibilities, and authorities of the State Public Works Board. Mr. O’Brien said there were seven areas that were addressed in the bill.
Mr. O’Brien said the first area addressed the role of the State Public Works Board as the “building official” over buildings that were located on state property. The second area was the authority to enforce building code provisions as they related to the issuance of stop-work orders and the issuance of possible citations for violation. The third area addressed the area of change order limits on small projects. The fourth area related to interest on agency funds that were provided to the Public Works Board for agency projects. The fifth area related to the order in which funds would be expended. The sixth area related to savings to the state resulting from separate contracts, and the seventh area related to clarifying the policy of the state as it related to buildings on state property.
Mr. O’Brien stated that the first area dealt with the role of the State Public Works Board as the building official. Sections 2 and 3, page 1, line 3, and Section 6, page 3, line 39, related to that issue. Mr. O’Brien said he was proposing that the changes to the law would clarify that the building official on buildings placed on state property would be with the State Public Works Board. Mr. O’Brien said that NRS 341.153, subsection 2, stated the state’s policy and from that the State Public Works Board got its building official role. Mr. O’Brien said he felt the changes would clarify the state’s position.
Chairman Arberry said that on page 5, item 3, he would like (a) to become (b) and (b) to become (a). Mr. O’Brien said he had no problem with that change. He said it referred to when there were multiple funding sources on a project and how the money would be spent. Mr. O’Brien said that through the Capital Improvement Fund discussions it had always been stated that the funds from the agency would be the funds that were first spent, prior to the spending of state funds.
Chairman Arberry stated that the Committee wanted the federal dollars to be expended first. Mr. O’Brien confirmed that Chairman Arberry wanted federal funds to be expended first, followed by reallocated funds.
Chairman Arberry confirmed that (b) would become (a), (c) would become (b), and (a) would become (c).
Mr. O’Brien said there had always been questions regarding which fund should be expended first and the agencies argued that general obligation funds should be spent first before the agency’s money was spent. Mr. O’Brien said that would be clarified in the bill.
Assemblywoman Giunchigliani asked if there was anything in A.B. 534 that would negatively impact Speaker Perkins’ bill that had prioritized the design/build portion.
Mr. O’Brien responded that there was no conflict whatsoever between the two bills.
Ms. Giunchigliani reminded Mr. O’Brien that he was on the record and Mr. O’Brien said he believed that under the current law the State Public Works Board had the authority to do construction management and did not require legislation to do so.
Mr. O’Brien said he would like to discuss the interest on funds that came from agencies. He said that, for instance, the University System might provide $25 million. Mr. O’Brien said that the past Capital Improvement Project (CIP) bills and probably the future CIP bills would require that those funds be provided to the state prior to the state going out to bid. Mr. O’Brien said the agencies were concerned that if they provided the funds early in the project that the interest on the funds did not come to them. Mr. O’Brien said that on $25 million matching funds the interest would add up to a great deal of money. He said the bill would allow the treasurer to allow that interest money to go back into that account and be part of the funds. Those funds would help fund any additional work that might be wanted. Mr. O’Brien said the funds would go toward the project, not to the General Fund. Mr. O’Brien said he had found that when the State Public Works Board was doing project management for agencies they were very reluctant to turn the money over up-front to the Public Works Board because they did not get the benefit from it. Mr. O’Brien said the Public Works Board had gone through elaborate processes to place the funds into special accounts to ensure the money was available before the Board signed a contract. Mr. O’Brien said he believed he had to be certain the money was available before a contract was signed or he thought he would be in violation of state law. Mr. O’Brien said the bill would assist the State Public Works Board to get the money into its account so it had good control over the funds without having to go through ”special hoops” to do it.
Mr. O’Brien said the bill would also assist the State Public Works Board with the ability to issue stop-work orders and issue notices of violations. Mr. O’Brien said there should be “teeth” in the enforcement of the codes. He said that currently the only way they could stop a contractor from doing work was to either withhold money from him or issue a Notice of Noncompliance, which was a breach of contract. Mr. O’Brien said the State Public Works Board did not have time to go to court to stop a violation or a possible life safety issue. Mr. O’Brien said the bill would put “teeth” into the State Public Works Board’s actions as the building official.
Assemblyman Hettrick asked why the bill was in the Committee on Ways and Means and Mr. O’Brien responded that he was unsure why the bill was in the Committee on Ways and Means.
Assemblywoman Giunchigliani said that there were four other bills that dealt with the State Public Works Board and the Committee wanted to determine how they interfaced or whether each bill could stand alone.
There being no further testimony, Chairman Arberry closed the hearing on A.B. 534 and opened the hearing on S.B. 198.
Senate Bill 198: Clarifies provision governing advances to budget accounts supported by administrative assessments. (BDR 31-604)
Mr. Stevens said he would explain S.B. 198. He said that Section 1 of the bill indicated that for an agency that was funded with administrative assessments, NRS 176.059 provided that not more than one-twelfth of the total money received in the previous fiscal year could be advanced to that agency if there was a shortfall in administrative assessments.
Mr. Stevens said that in the current interim period that particular section had been interpreted to be one-twelfth multiple times. When the bill was originally passed it was staff’s understanding that it would be limited to one-twelfth of the annual allocation. Mr. Stevens said that would not be two-, three-, or four- twelfths. Mr. Stevens said that more than one-twelfth had been advanced in the current interim period to at least one agency. Mr. Stevens said that staff had brought that to the attention of Chairman Arberry and Chairman Raggio. He said that Senator Raggio asked that the bill be introduced to make it very clear that the maximum limitation would be one-twelfth of the allocation to an agency in a fiscal year.
Assemblyman Beers asked if a hypothetical agency that was not appreciated by those it assessed and had collection problems would stop operating under S.B. 198 if it had a serious cash flow crunch.
Mr. Stevens responded that it would depend upon the agency and what actions would have to take place to balance the budget. Mr. Stevens asked the Committee to review page 2, lines 6 and 7, to ascertain that if the agency did not have the money to pay the advance back, the shortfall would be contingently appropriated. Mr. Stevens said that the fiscal staff’s concern was that if it was not a loan but instead a contingent appropriation, there would be appropriations made without the Legislative Branch being involved. Mr. Stevens said that would usually be a non-General Fund account and was a policy issue that the Committee should decide. Mr. Stevens said the Executive Branch had not interpreted it in the same manner that the fiscal staff thought it was intended when it was originally passed. He said the issue was now before the Committee and the Committee could choose to do with it as it wished.
There being no further testimony, Chairman Arberry closed the hearing on S.B. 198 and adjourned the meeting.
RESPECTFULLY SUBMITTED:
Lila Clark
Committee Secretary
APPROVED BY:
Assemblyman Morse Arberry Jr., Chairman
DATE: