MINUTES OF THE
joint subcommittee on human resources/k-12
OF THE
SENATE COMMITTEE ON FINANCE
AND THE
ASSEMBLY COMMITTEE ON WAYS AND MEANS
Seventy-second Session
February 11, 2003
The Joint Subcommittee on Human Resources/K-12was called to order by Chairman Raymond D. Rawson at 8:05 a.m. on Tuesday, February 11, 2003, in Room 3137 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.
COMMITTEE MEMBERS PRESENT:
Senator Raymond D. Rawson, Chairman
Senator William J. Raggio
Senator Bernice Mathews
Senator Barbara Cegavske
ASSEMBLY COMMITTEE MEMBERS PRESENT:
Ms. Sheila Leslie, Chairman
Mrs. Dawn Gibbons
Ms. Christina R. Giunchigliani
Mr. David E. Goldwater
ASSEMBLY COMMITTEE MEMBERS ABSENT:
Mr. Lynn C. Hettrick (Excused)
STAFF MEMBERS PRESENT:
Gary L. Ghiggeri, Senate Fiscal Analyst
Mark W. Stevens, Assembly Fiscal Analyst
Larry L. Peri, Senior Program Analyst
Bob Atkinson, Program Analyst
Julie Brand, Program Analyst
Pamela Carter, Committee Secretary
OTHERS PRESENT:
Michael J. Willden, Director, Department of Human Resources
Michael Torvinen, Chief Financial Officer, Department of Human Resources
Kirk A. Goddard, President, Dimension Express
Jan Gilbert, Lobbyist, Progressive Leadership Alliance of Nevada
Denise Abbey, Special Programs Coordinator, Family Resource Center, Department of Human Resources
Carol Aiello-Sala, Administrator, Aging Services Division, Department of Human Resources
Carla L. Watson, Administrative Services Officer, Aging Services Division, Department of Human Resources
Bruce J. McAnnany, Deputy Administrator, Aging Services Division, Department of Human Resources
Jon L. Sasser, Lobbyist, Washoe County Senior Law Project
Susan Swenson, Public Guardian, Carson City Public Guardian’s Office
Larry Spitler, Nevada Associate Director, American Association of Retired Persons (AARP)
Department of Human Resources - Administration
Michael Willden, Director, Department of Human Resources (DHR), referred to the handout, Director’s Office Budget Presentation (Exhibit C. Original is on file in the Research Library.). The program statistics tab indicates DHR has addressed several questions on program statistics in the revenue maximization contract. Mr. Willden said there are several Senior Rx statistics on page 31, including current status information and analysis and cost projections. He drew attention to statistics and information on the Office of Community Based Services (OCBS) beginning on page 41. He stated the budget proposes to transfer OCBS from the Department of Employment, Training, and Rehabilitation (DETR) to DHR. Mr. Willden indicated data and statistics would be addressed on Family-to-Family Connection, Healthy Nevada Fund grants, also known as the tobacco grants, Community Services Block Grant, Title XX, and the Children’s Trust Fund.
Mr. Willden stated DHR provides general oversight and direction to eight division offices within the department. He said DHR directly manages the Senior Rx program. He stated DHR provides administrative support to the Task Force for the Healthy Nevada Fund, known as the tobacco fund, and to the Blue Cross Blue Shield (BCBS) settlement fund. Mr. Willden noted DHR has 11 budget accounts in the director’s office to be reorganized. He said DHR would like to eliminate five budget accounts dealing with pass-through funds in the grants program and combine them into one new fund called the Grants Management Unit. Mr. Willden stated the budget recommends the transfer of two new accounts from DETR to DHR, Community-Based Services and Developmental Disabilities. He proposed one account be transitioned from community connections to the Health Division as a new administrative compliance office for early intervention services.
Mr. Willden reported DHR is downsizing from 11 accounts to 6 and adding 2 administrative and budget support accounts. He noted six major themes proposed by DHR are consolidating and enhancing fiscal oversight, eliminating Community Connections, consolidating early intervention programs, promoting the Healthy Nevada Fund and Senior Rx programs, reorganizing Community Based Services and Developmental Disabilities, creating a Grants Management Unit budget account, and realigning funding for Family-to-Family Connection and Family Resource Centers.
Mr. Willden stated DHR proposes to transfer two fiscal positions from Community Connections to the director’s office, one administrative services officer (ASO) position from Family-to-Family Connection to the director’s office, and one auditor position, funded by the tobacco account, to the director’s office. He said DHR is requesting an additional supervisory position for the director’s office. Mr. Willden explained transferring positions would consolidate fiscal functions, allow for proper cost allocation, and improve the department’s ability to manage contracts, budgets, accounting, and auditing of all sub‑grantees. He stated elimination of Community Connections and transferring five budget accounts to a single budget account would consolidate early intervention programs within the Health Division. Mr. Willden said tobacco receipts need to be located in the tobacco fund, and transfers should be made to fiscal and administrative funds. He noted the Healthy Nevada Fund would become the operating account for Senior Rx. He stated Senior Rx would expand from 7500 to 12,000 seniors if the Governor’s recommended $5 million in General Fund monies are approved.
Mr. Willden said DHR is requesting one additional clerical position for expansion of Senior Rx. He pointed out DHR has been working on a strategic plan for people with disabilities. He indicated DHR proposes to create the Office of Disability Services, transfer two budget accounts to the director’s office, and allow disability services to work with the Division for Aging Services (DAS), Medicaid, and Mental Health and Developmental Services (MHDS) to consolidate disability services.
Mr. Willden stated two important DHR programs are Family-to-Family Connection and the Family Resource Centers. He said the programs are neighborhood programs for families who do not want to utilize welfare or Medicaid programs. He said DHR recommends combined funding for the programs with 91 percent of General Fund monies being allocated to direct service organizations. He stated current funding resources and allocations are shown on page 10 of the handout. Mr. Willden explained one goal DHR hopes to achieve is nearly $2.7 million, or 90.5 percent of the total budget, to support Family Resource and Infant Support Centers.
Michael Torvinen, Chief Financial Officer, Department of Human Resources, explained the Health Insurance Portability and Accountability Act (HIPAA) Overview (Exhibit D. Original is on file in the Research Library.). Mr. Torvinen stated a covered entity, as defined by the Office of Civil Rights (OCR), must designate a privacy officer to ensure protection of personal patient information. He said OCR defines covered entities as health plans, health care clearinghouses, and health care providers. He added DHR has identified five covered entities within the department.
Senator Rawson stated he does not see a need for eight privacy officer positions as shown on page 16 of the handout. Senator Rawson noted DHR’s revised request for five privacy officer positions.
Assemblywoman Leslie questioned how DHR would pay for five privacy officer positions. She asked whether General Fund monies would cover the positions.
Mr. Torvinen replied General Fund monies and Title XIX and XXI would cover the positions. Assemblywoman Leslie asked whether DHR had thought of using MAXIMUS money to fund the positions. Mr. Torvinen replied DHR has MAXIMUS money designated for other priorities. Assemblywoman Leslie questioned the $500,000 set-aside for HIPAA compliance and asked how much has been spent. Mr. Torvinen replied the $500,000 is in budget account 3150 as a carry forward item. Assemblywoman Leslie asked whether DHR is planning to use the funds for privacy officer positions. Mr. Torvinen replied DHR could use those funds for the privacy officer positions.
Assemblywoman Giunchigliani asked whether existing staff could assume HIPAA privacy officer responsibilities. Mr. Torvinen replied yes, because OCR states a covered entity must designate someone as a privacy officer. Assemblywoman Giunchigliani noted if everything is in place by the April 14, 2003, deadline, then privacy officer responsibilities assumed by existing staff might monitor HIPAA compliance regulations. Mr. Torvinen replied monitoring the regulations is a remote possibility because there is staff training, records auditing, and forms completion to be accomplished.
Senator Rawson stressed the need for a budget summarization. He asked how many new positions were being requested and what the total General Fund increase would be. Mr. Torvinen replied the request includes five new privacy officer positions for HIPAA compliance, one supervisor in the Grants Management Unit, one auditor, and one clerical position for Senior Rx.
Senator Rawson asked whether DHR had a sense of bottom-line dollars for services. Mr. Torvinen replied bottom-line dollars for services would increase, but administrative dollars would comprise less than 4 percent of the budget. Senator Rawson stated DHR should look at priorities if a 5 percent budget cut is mandated.
Assemblywoman Leslie asked whether a privacy officer position would be transferred to DHR, and if it would be the sixth privacy officer position in DHR. Mr. Torvinen replied budget account 3150 contains an administrative services officer to be transferred from Community Connections. Assemblywoman Leslie stated the responsibilities description for this position in the budget narrative relates to HIPAA compliance. Mr. Torvinen responded the responsibilities describe types of programs to be managed in the director’s office. Assemblywoman Leslie asked who would oversee the privacy officers. Mr. Torvinen replied each division administrator would oversee a privacy officer. Assemblywoman Leslie asked whether any attempt is being made by DHR to coordinate their HIPAA compliance efforts. Mr. Torvinen replied no coordination effort is underway at this time.
Mr. Willden stated two HIPAA oversight programs are in place, one in the Governor’s office, chaired by Mr. Torvinen, to provide direction to State agencies on HIPAA compliance, and the second program to oversee HIPAA compliance within DHR.
Senator Rawson asked whether the Welfare Division is exempt from HIPAA compliance. Mr. Willden stated the Welfare Division is exempt and will not have to comply.
Senator Rawson stated one major concern the committee has for budget account 3150 is the nearly $2.9 million expenditure of MAXIMUS revenue. Mr. Willden referred to the Revenue Maximization Contract on page 26 in the budget presentation handout (Exhibit C). He replied there would be a point of diminishing return on MAXIMUS. He said the MAXIMUS project started several years ago, and in fiscal year (FY) 2002 DHR collected $2.9 million in MAXIMUS revenue. He stated after fees were paid to MAXIMUS, net cash totaled over $2.5 million. He explained DHR provided funding in response to a Letter of Intent requested by the Legislature, giving $500,000 each year in the current biennium to the Bureau of Alcohol and Drug Abuse (BADA) for adolescent treatment programs. Mr. Willden added DHR supported a work program to solve director office shortfalls, funded a mental health project, Health Opportunities for People Everywhere (HOPE), and fully funded the HIPAA contract. He said DHR had $885,000 at the end of FY 2002 that reverted to the General Fund. He said in FY 2003 DHR supported a work program for $4.7 million based on the MAXIMUS estimate of collectable revenues from current projects. Mr. Willden noted to date $455,000 has been collected because projected revenue was overstated. He explained MAXIMUS would not be a continuous source of funding within DHR. He stated DHR currently has $380,000 in available MAXIMUS cash.
Mr. Willden indicated in FY 2004 and FY 2005 DHR has projected gross revenue at $2.9 million, based on FY 2002 total actual revenue. He stated a realistic total revenue projection is between $500,000 and $600,000, based on daily estimates discussed with MAXIMUS.
Senator Rawson asked whether a projected decrease in total revenue is the reason DHR is not recommending funding to BADA. Mr. Willden replied DHR will address four major shortfalls, shown on page 30, to be funded through the rainy day fund or MAXIMUS monies. He stated DHR has identified a number of areas to fund in FY 2004 and FY 2005.
Senator Rawson stated if DHR is building budgets on MAXIMUS, then revenues should be directed to the General Fund. He stressed DHR budgets should not depend on MAXIMUS revenue because MAXIMUS eventually decreases. He added MAXIMUS should not be used as a slush fund because MAXIMUS revenue should replenish the General Fund.
Assemblywoman Leslie asked why DHR asking for $2.9 million in budget authority if $500,000 in revenue is expected. Mr. Willden replied $2.9 million is a carryover collected in FY 2002. Assemblywoman Leslie asked whether a large portion of MAXIMUS is collected at fiscal year end. Mr. Willden replied yes, it is. Assemblywoman Leslie asked whether a portion of MAXIMUS money has been used in some of the budgets presented today. Mr. Willden replied yes, the Title XX shortfall in FY 2004 is projected at $195,488 and $210,780 in FY 2005. Assemblywoman Leslie asked whether MAXIMUS revenue can be used for anything, or whether its use is restricted. Mr. Willden replied yes, it can be used to replenish the General Fund or for anything.
Assemblywoman Leslie asked why substance abuse treatment program funding was not included in the budget. Mr. Willden replied all DHR programs are good programs and budget priorities were considered. Assemblywoman Leslie said MAXIMUS money should be used to fill the gap on programs not included in the budget.
Senator Rawson pointed out the Grants Management Unit contains $340,000 in MAXIMUS revenue not reflected as an expenditure from the director’s office.
Mr. Torvinen responded that transferring fiscal positions to the director’s office creates 3.5 fiscal positions to manage 7 budgets totaling approximately $54 million. He stated there would be 39 budgeted positions for revenue collection, payments to grantees, travel, payroll, and other budget-related responsibilities. Mr. Torvinen explained the audit position will be an audit supervisor in the director’s office to oversee between 130 and 150 grants.
Senator Rawson asked whether the Grants Management Unit would fund the auditor III position. Mr. Torvinen replied yes, Grants Management would fund the auditor III position and some of the fiscal positions.
Mr. Willden referred to the organizational chart on page 9 of Exhibit C. He stated positions in grants management are listed with each primary area of interest.
Mr. Torvinen referred to the developmental disabilities budget account BA 3154 on page 16. He said this budget is being transferred from DETR, and funding would be continued for three full-time equivalencies (FTE). He stated DHR requests additional general funds and budget authority to adjust the budget to expected levels of federal funding and State match.
Mr. Torvinen referred to the HR, Children’s Trust Fund account BA 3201 on page 17. He stated DHR plans to spend down the accumulated reserve over a 3-year period to approximately $250,000.
Senator Rawson asked how many dollars comprise an appropriate reserve, whether anything would be gained by delaying the spending of $300,000 over 3 years, and whether DHR needs any reserve in this account. Mr. Torvinen replied $250,000 represents a 3-month cash flow and it might be too much for a reserve.
Senator Rawson asked whether child immunizations are funded by this budget.
Assemblywoman Leslie replied this account funds child abuse prevention. Assemblywoman Leslie stated she sponsored a bill draft request allowing the Children’s Trust Fund to award grants for up to 3 years so agencies do not have to request funding every year.
Assemblywoman Leslie asked whether there would be a problem transferring positions to the Grants Management Unit and jeopardizing the 5 percent administrative cap. Mr. Torvinen replied DHR does not believe there will be a problem because less than 4 percent is identified for administration.
Mr. Torvinen stated OCBS is the second budget account being transferred from DETR. He said this budget continues funding for seven existing positions and adjusts appropriate expenditure categories due to an expected decrease in federal funding. He added the Governor recommends replacing the funding with General Fund appropriations. Mr. Torvinen explained this budget contains funding for construction of an accessible housing and supportive services complex in Clark County for people with disabilities. He indicated DHR is requesting that funding be available in FY 2004.
Senator Rawson said he has seen some of the construction in Las Vegas and OCBS is going ahead. Mr. Torvinen referred to the Healthy Nevada Fund BA 3261 on page 18. He stated this budget contains funding from the tobacco settlement for administering programs in tobacco use cessation, improving the health of children and disabled persons, and providing a prescription drug program for low-income seniors. He explained General Fund monies would support expansion of Senior Rx to over 12,000 enrollees by the end of the biennium. He stated Senior Rx would require an additional administrative assistant position. He added all tobacco funds would flow through this budget account.
Assemblywoman Giunchigliani inquired how many seniors are being served in Senior Rx. Mr. Torvinen replied approximately 7500 are being served. Assemblywoman Giunchigliani asked whether a new contract is required for projected expansion to 12,000 seniors and a budget increase to $5 million. Mr. Torvinen responded there is a new contract and DHR will be paying actual paid claims amounts every month with a lower premium retention added on. Assemblywoman Giunchigliani asked what was paid in the past. Mr. Torvinen replied $85 per member per month (PMPM) including retention and paid claims amounts. He stated approximately $1.9 million additional funds were realized in calendar year 2002 due to an underwriting gain.
Mr. Willden referred the committee to the underwriting gain calculation on page 33 of the handout. Assemblywoman Giunchigliani asked how the $1.9 million would be spent. Mr. Torvinen explained the $1.9 million credit would provide a 2-month advance to Pharmaceutical Care Network (PCN) to cover Senior Rx prescriptions. He stated no payments have been made on the contract this calendar year. Assemblywoman Giunchigliani asked the name of the pharmacy benefit management company. Mr. Torvinen replied Pharmaceutical Care Network administers the pharmacy program, PRAM Insurance Services is the third-party payor, and Fidelity Security Life Insurance insures the risk. Assemblywoman Giunchigliani asked whether any other pharmacy benefit management company bid on this contract. Mr. Torvinen replied no other company bid on the pharmaceutical contract. Assemblywoman Giunchigliani stressed DHR should review the Senior Rx program and contracts. She asked whether the State Board of Pharmacy reviewed the contract. Mr. Willden replied yes, it reviewed the contract. He explained when the contract went out to bid, letters of interest were received, but Fidelity Security Life (FSL) was the only company to bid. He stated FSL is insuring against the State’s risk in Senior Rx if all 7500 enrollees take full advantage of the pharmaceutical benefit.
Assemblywoman Giunchigliani quoted from an audit report by Milliman and Robertson actuaries stating, “State administered drug programs should estimate administered costs at 8 percent of total cost, 5 percent to contract for a pharmacy benefit manager, and 3 percent to administration for costs allocated to state agencies.” She noted DHR far exceeds those amounts and the Senior Rx contract needs to be reviewed.
Assemblywoman Giunchigliani asked whether PCN’s contract is in place until 2007. Mr. Willden replied yes, but in July 2003 the contract can be renegotiated. He said FSL is the only company talking with DHR. He explained the $1.9 million credit would be recovered by March 2003 because it is offset each month by charges from the pharmacy benefit manager.
Assemblyman Goldwater asked whether the State wants to purchase insurance and shift the risk to an insurance company, or wants to assume the risk. He stated DHR is not doing enough due-diligence to determine whether the risk is worth taking.
Assemblywoman Leslie asked why $25,000 each year in this biennium is being spent on printing and designing a new Senior Rx application when Senior Rx already has an application. Mr. Torvenin replied $50,000 is replacing money donated in the previous biennium from a small grant provided to Senior Rx used for printing existing applications. Assemblywoman Leslie asked why DHR is planning to mail out 70,000 applications per year. Mr. Torvenin replied applications are not only mailed, they are distributed to various senior centers throughout the State. Assemblywoman Leslie asked whether insurance companies have to be licensed in Nevada. Mr. Willden replied yes, insurance companies operating in Nevada have to be licensed in Nevada. Assemblywoman Leslie pointed out this could be one reason there is no competition for the insurance contract. Mr. Willden replied yes, and another reason is risk.
Mr. Torvinen referred to the Blue Cross Blue Shield (BCBS) settlement budget account on page 19, stating the net balance would total approximately $450,000 at the end of the biennium. He stated this amount could fund suicide prevention, Nevada Check Up, or Medicaid programs. He said this type of spending would be consistent with the original purpose of the charitable trust.
Mr. Torvinen explained adjustments to the Title XX social services block grant funding will increase revenues to expected levels. He stated there would be elimination of an administrative cost-allocation, and reallocation of funding for both positions transferring to the Grants Management Unit.
Mr. Torvinen addressed the HR, Community Services Block Grant budget account BA 4864 on page 20 of the handout. He stated 90 percent of the money in this budget account is distributed to three counties, 5 percent is used for administration, and 5 percent is used for technical assistance and other projects.
Assemblywoman Leslie said she would like confirmation on service dollars going directly to grantees. Mr. Willden referred to charts on pages 10 and 11 in the handout and said DHR plans to give $2.7 million to grantees. Assemblywoman Leslie questioned whether every Family Resource Center offers Family-to-Family Connection services. She also asked what role the Block Grant Commission would play. Mr. Willden replied State staff will directly manage contracts with Family Resource Centers and infant support districts. He explained local governing boards would receive a $5000 combined total because State staff will directly manage the contracts.
Senator Rawson invited other testimony on the Family-to-Family Connection Program.
Kirk A. Goddard, President, Dimension Express, stated he had recently attended a “daddy boot camp.” He expressed delight in learning more about being a good father to his 10-day old daughter, Chloe. He stressed the importance of families providing a loving, secure environment for children. He said there are approximately 50 different classes offered through Family-to-Family Connection.
Mr. Torvinen stated the HR, Family Resource Centers budget account, BA 3294 on page 22, is being transferred to the Grants Management Unit. He said there would be elimination of an administrative cost-allocation, continuation of funding for two FTEs, an adjustment to align funding sources for a program manager position, and transfer of all remaining positions to the Grants Management Unit. Mr. Torvinen referred to HR, Grants Management Unit budget account 3195 on pages 22 and 23. He said six different budget accounts would be transferred to this budget, including funding for a social welfare program chief II position to manage the Grants Management Unit.
Senator Rawson stated the transfers will be costly. He said the committee is concerned about a decrease in grant funding to recipients. Mr. Torvinen replied DHR could address the committee’s concerns.
Mr. Torvinen referred to the State and Community Collaborations budget account 3276 on pages 23 and 24. He said this budget account contains federal Individuals with Disabilities Education Act (IDEA) part C funds for early intervention services and a federal Head Start grant. He stated DHR has transferred Head Start to the Welfare Division. Mr. Willden emphasized DHR is trying to put all early intervention programs under one administration with federal and state funding.
Jan Gilbert, Lobbyist, Progressive Leadership Alliance of Nevada (PLAN), Block Grant Commission member, stated the block grant commission supports DHR’s reorganization. She said the reorganization would help with evaluation and coordination of grants. She expressed her support of performance statistics because the programs have performed well. She urged the committee to study the performance statistics presented in the handout.
Denise Abbey, Special Programs Coordinator, Social Worker, Family Resource Centers, spoke in favor of resource centers. She stated the north valley area resource center provides services and programs to families and children in north Reno. She said the north valley area is a low socio-economic area with many people in need.
Department of Human Resources – Division for Aging Services
Carol Sala, Administrator, Department of Human Resources, Division for Aging Services, referred to the Division for Aging Services, Services for Nevada’s Elders handout (Exhibit E. Original is on file in the Research Library.).
She said independent living grants enhance independence for older Nevadans through services enabling them to remain at home. She illustrated her point by referring to an 89-year old woman who lived in a mobile home with broken steps and railings. The client could not safely go in and out of her home. An independent living grant was arranged to repair the steps, improving both her safety and the quality of her life. Ms. Salas went on to explain that the funding is provided through tobacco settlement money. She stressed there are no State General Fund appropriations in this budget account.
Carla Watson, Administrative Services Officer, Department of Human Resources, Aging Services Division drew attention to performance indicators on page 3 of the handout. She stated two of the performance indicators concerned program and fiscal monitoring, which are generally conducted on‑site. Program monitoring ensures that the sub-recipients are accomplishing their budget agreements for service. Fiscal monitoring determines whether the sub-recipients are in compliance with the division’s grant agreement and program instructions. She said two new performance indicators were added which require preliminary reviews of new and high-risk programs within 6 months of the beginning of the grant period. Ms. Watson explained these indicators represent a proactive position to ensure that problems are identified and resolved in an expedient manner. She also explained there is no projected growth beyond FY 2003 because the division is expecting a decline in allocations over the biennium. As such, they have asked sub-recipients to seek alternative funding.
Ms. Watson referred to the listing on page 4 of all independent living grant awards for FY 2002, including $238,407 used to match $715,220 in federal grant funds for the National Family Caregiver Support program. She stated the DAS statewide single point of entry telephone system 211 is in phase one of a multi-phase program. This phase involves input and feedback from senior network, information referral, and assistance sectors. She indicated the system is consistent with division funding and program requirements.
Ms. Watson said the estimated allocation for aging services is approximately $6.9 million in FY 2004 and $6 million in FY 2005. She explained there will be a reduction in the Community Home-Based Initiatives Program (CHIP) to $670,632 in FY 2004 and $672,345 in FY 2005.
Senator Rawson asked what the CHIP allocation would be in FY 2003. Ms. Watson replied she did not know the exact number, but the number is close to $670,000.
Senator Rawson noted one concern of the committee is a decrease in funding available for independent living grants because funds are being shifted to other programs. He indicated CHIP is receiving a larger percentage of the tobacco allocation, increasing by approximately 5 percent, while other accounts are decreasing. Ms. Watson responded DAS is using tobacco settlement funds to match Title XIX federal funds in FY 2004 and FY 2005.
Assemblywoman Leslie expressed her concern about shifting funds from independent living grants to the tobacco settlement account to support State programs because it is contrary to the Legislative Letter of Intent sent last session. Ms. Sala said that DAS has looked at using alternative funds to match. She explained that tobacco settlement funds were the only funds available to use for the Title XIX match.
Senator Rawson reiterated expressed the committee’s concern on the issue.
Ms. Watson referred to page 26 of the handout, pointing out total available funds for independent living grants in FY 2004 increased to $764,632. She stated total available funds for independent living grants in FY 2005 decreased to $258,724 because increased funds are being transferred to CHIP. She said the adjusted base plus $764,632 calculates to approximately $5.1 million available for independent living grants in FY 2004, and the adjusted base plus $258,724 calculates to approximately $4.1 million available in FY 2005 for independent living grants.
Ms. Sala stated federal funds are received from the U.S. Department of Human Resources Administration on Aging under Title III of the Older Americans Act, the Department of Labor under Title V, and the Community Services Block Grant Act. Ms. Sala said DAS receives partial funding from the Taxicab Authority to operate the Senior Ride program in Clark County. She indicated grants and resource development funds provide for these programs. Ms. Sala described the Elder Rights unit in Nevada and how it was a comprehensive program designed not only to prevent elder abuse, but also to provide legal services, and advocate and ombudsmen services.
Senator Rawson asked whether a privacy officer has been included in the budget. Ms. Watson replied yes, one information privacy officer is requested because DAS performs health-care-provider functions, and electronically transmits health information when Medicaid is billed. She stated this position would also support Senior Rx to ensure compliance with HIPAA privacy standards.
Assemblywoman Leslie asked why there is no increased projection in the number of clients to be served if more federal funding is anticipated.
Bruce J. McAnnany, Deputy Administrator, Department of Human Resources, Aging Services Division, replied DAS expects a decrease in federal funding by 1.8 percent in FY 2004 because Congress is debating a continuing resolution on aging services. He confirmed DAS budgets were written anticipating a 3‑percent increase. He said Congress should resolve this issue by the end of March 2003. Assemblywoman Leslie stated performance indicators do not give committee members enough tools to judge effectiveness of DAS programs. Ms. Watson replied that decision units will be evaluated after the decision from Congress.
Senator Rawson asked whether there would be a $1 million reduction in the estimated tobacco settlement. Ms. Watson replied the division anticipates a reduction of approximately $900,000 in estimated tobacco settlement funds from FY 2004 to FY 2005. Senator Rawson asked whether DAS is looking at another source of funding to replace the nearly $1 million reduction in the tobacco settlement fund. Mr. McAnnany replied yes, DAS is looking at alternative sources of funding.
Assemblywoman Giunchigliani asked whether there is an anticipated increase in long-term care units. Mr. McAnnany replied yes, there is an increase projected in FY 2004 and FY 2005. He said DAS would be performing more timely investigations of complaints. Assemblywoman Giunchigliani asked whether DAS has jurisdiction over assisted living facilities. Mr. McAnnany replied yes, the Bureau of Licensure and Certification licenses assisted living facilities, and DAS investigates complaints from those facilities.
Assemblywoman Giunchigliani asked whether a courtesy visit is a drop-in visit and separate from the investigation of a complaint. Mr. McAnnany replied a courtesy visit is performed to check on the well being of a resident. He explained courtesy visits could generate complaints to be investigated. Assemblywoman Giunchigliani asked whether there is a training program for managers of assisted living facilities. Mr. McAnnany replied DAS trains over 400 managers per year.
Ms. Watson stated DAS currently funds ombudsman positions through General Fund appropriations. She explained ombudsmen serve Medicaid clients. Assemblywoman Giunchigliani asked how many ombudsman positions there are. Mr. McAnnany replied there are currently seven ombudsman positions for long-term care. Assemblywoman Giunchigliani asked how five additional positions would be funded. Ms. Watson replied grant awards would partially fund the positions, and if a 5-percent increase in funding were realized, grant awards would fully fund the positions.
Ms. Watson explained there are no appropriations from the General Fund in the Senior Ride program. She stated the Taxicab Authority funds this program and DAS administers it. She said $278,218 in funding is received each year in the current biennium from the Taxicab Authority for Senior Ride. She added funding provides for the sale of 20,000 coupon books to support two positions and program operating costs. Ms. Watson pointed out the Senior Ride program was eliminated in the Governor’s budget and module E-500 would re-establish the program. She added the Taxicab Authority stated funding for the program is dependent on passage of Bill Draft Request (BDR) 58-538.
BILL DRAFT REQUEST (BDR) 58-538: Makes various changes concerning taxicabs. (Later introduced as Senate Bill 476.)
Ms. Watson explained BDR 58-538 proposes to increase the surcharge paid to the Taxicab Authority by 5 cents. Ms. Watson indicated if BDR 58-538 is successful, the Taxicab Authority will transfer an additional $100,000, increasing DAS funds to $378,218 for the sale of an additional 10,000 coupon books, for a total of 30,000 books.
Senator Rawson asked whether the Alzheimer’s demonstration grant money ends this biennium. Mr. McAnnany replied yes, it was a 3-year demonstration grant and it is currently before Congress to be renewed.
Ms. Sala stated funding for the community-based care unit, providing services to seniors most at risk of being placed in a nursing facility, is funded through Medicaid and the State General Fund. She said Medicaid funding represents approximately 60 percent of budget account 3146. She added State appropriations support CHIP and caregiver training.
Ms. Sala said DAS is requesting funding for in-home services and three new direct service positions and supporting costs from Medicaid and the tobacco settlement fund. She said this request would provide services for an additional 108 clients over the biennium. She stated tobacco settlement funds and independent living grants would be utilized to match federal Medicaid Title XX funds. She said the three positions requested are one administrative assistant and two social workers to support the unit.
Senator Rawson pointed out the three new positions handle growth and do not address the waiting list. He asked how long a client is on the waiting list.
Ms Sala replied 6 months for both northern and southern Nevada. She stated a total of 591 clients are currently on the Medicaid waiting list. Senator Rawson asked how many positions would be needed to cut the waiting time by 50 percent. Ms. Sala replied a total of 80 additional slots would cut waiting time by 50 percent. Senator Rawson asked what is the cost on 80 additional slots. Ms. Watson replied the cost will be $49,364 in FY 2004 and $380,935 in FY 2005. She explained a staggered rate is used to add positions at the end of FY 2004.
Ms. Sala explained DAS is requesting one new nurse case manager providing services to northern Nevada for medically fragile clients. She said this position provides technical nursing support and education for community-based care and elder rights. Ms. Sala stated three new positions, an administrative assistant and two social workers, are being requested for the group care program. She explained group care offers individuals an alternative to nursing home placement and provides supplemental services in a group care setting. She indicated client increases in the group care program correlates to initiatives developed by the Affordable Assisted Living Advisory Committee and the Strategic Plan for Seniors.
Ms. Sala explained Senate Bill (S.B.) 174 of the Seventy-first Session requests personal assistance service providers to address needs of severely disabled persons.
SENATE BILL (S.B.) 174 of the Seventy-first Session: Requires cooperative efforts to make available through existing state programs community-based services to provide minimum essential personal assistance to certain persons with disabilities. (BDR 38‑190)
Ms. Sala said DAS is requesting funding for one new social worker position to manage cases and serve persons on the waiting list for CHIP. She stated there are 33 persons meeting S.B. 174 eligibility requirements currently on the CHIP waiting list.
Ms. Sala explained Medicaid determined the personal care services under CHIP were a duplication of services and in violation of Medicaid regulations. She said the personal care component of CHIP is being transferred to the Medicaid division, bringing DAS into compliance with federal Medicaid regulations.
Mr. McAnnany said the Title XX Homemaker program and Elder Protected Services (EPS) program transferred to DAS July 1, 1999, and is a part of the community-based care unit. He stated EPS investigations are expected to grow by 8 percent in FY 2004 and 7 percent in FY 2005.
Senator Rawson asked how DAS is administering the Homemaker and EPS programs. Mr. McAnnany replied each caseworker opens 15 cases per month and carries a 20 to 40 case backlog.
Assemblywoman Giunchigliani asked for clarification of the term “investigation.” Mr. McAnnany replied a case is a combination of several investigations. Assemblywoman Giunchigliani asked under what circumstances would a case result in a direct face-to-face meeting. Mr. McAnnany replied if a complaint does not involve abuse, neglect, exploitation, or isolation, it is considered a consultation and not a case. He added if there is criminal intent, the case is referred to law enforcement.
Mr. McAnnany said DAS is requesting General Fund financing for 3.5 social workers and 2 intake workers for the Homemaker and EPS programs.
Ms. Watson explained the Department of Taxation transferred the Senior Citizens Property Tax program to DAS on October 1, 2001. She stated the program provides relief to eligible senior citizens carrying an excessive residential tax burden relative to their income. She said the program is fully funded by General Fund appropriations. She pointed out DAS is concentrating on outreach programs utilizing the assistance of social workers. She indicated social workers explain the program to seniors and assist seniors in filling out applications. She proposed an additional 0.5 administrative assistant III position.
Senator Rawson asked DAS to look at inconsistent growth rates and General Fund savings. Ms. Watson replied she would review the numbers.
BILL DRAFT REQUEST (BDR) 38-499: Makes various changes to provisions concerning property taxes and the schedule of distribution. (Later introduced as Assembly Bill 515.)
Assemblyman Goldwater asked about the effect BDR 38‑499 will have on DAS budgets. Assemblyman Goldwater explained BDR 38-499 makes various changes to provisions concerning property taxes and their schedule of distribution. Ms. Watson replied DAS has not looked at the effect BDR 38-499 might have on their budgets.
Jon L. Sasser, Lobbyist, Washoe County Senior Law Project, declared he is the statewide advocacy coordinator for the project. He expressed his support for the budgets presented by DAS. He noted the importance of interaction between the Senate Committee on Finance, the Assembly Committee on Ways and Means, and the Department of Taxation.
Susan Swenson, Public Guardian, Carson City Public Guardian’s Office, pointed out the importance of elder protective services to the safety of seniors. She stated Nevada is the fastest growing state in the nation with a senior growth rate at more than 70 percent between 1990 and 2000.
Senator Rawson stated he has a bill draft request for a senior count book with statistics on seniors much like the children’s count book.
Larry Spitler, Nevada Associate Director, AARP Nevada, voiced his support for the Governor’s recommendation on expansion of Senior Rx. He said it is imperative DAS develop more programs to support independent living for seniors. He expressed his support for the budgets presented by DAS.
Senator Rawson adjourned the meeting at 10:53 a.m.
RESPECTFULLY SUBMITTED:
Pamela Carter,
Committee Secretary
APPROVED BY:
Senator Raymond D. Rawson, Chairman
DATE:
Assemblywoman Sheila Leslie, Chairman
DATE: