MINUTES OF THE meeting
of the
Assembly Committee on Ways and Means
AND THE
Senate Committee on Finance
JOINT Subcommittee on K-12/Human Resources
Seventy-Second Session
February 13, 2003
The Assembly Committee on Ways and Means and the Senate Committee on Finance, Joint Subcommittee on K-12/Human Resources was called to order at 8:00 a.m., on Thursday, February 13, 2003. Chairwoman Shelia Leslie 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.
Assembly COMMITTEE MEMBERS PRESENT:
Ms. Shelia Leslie, Chairwoman
Ms. Chris Giunchigliani
Mrs. Dawn Gibbons
Mr. David Goldwater
Mr. Lynn Hettrick
Senate COMMITTEE MEMBERS PRESENT:
Senator Barbara Cegavske
Senator William J. Raggio
SENATE COMMITTEE MEMBERS ABSENT:
Senator Bernice Mathews (excused)
Senator Raymond D. Rawson (excused)
STAFF MEMBERS PRESENT:
Steve Abba, Principal Deputy Fiscal Analyst
Bob Atkinson, Program Analyst
Gary Ghiggeri, Fiscal Analyst
Linda Smith, Committee Secretary
Lila Clark, Committee Secretary
Chairwoman Leslie stated that Senator Mathews and Senator Rawson were excused from the meeting, and asked the secretary to mark other members present upon arrival. Chairwoman Leslie then asked Yvonne Sylva, M.P.A., Administrator, Health Division, Department of Human Resources, to begin the overview of the Health Division budgets.
Ms. Sylva introduced Alexander Haartz, M.P.H., Deputy Administrator, and Philip F. Weyrick, Administrative Services Officer III. Ms. Sylva then referred to the handouts distributed to the subcommittee members:
Ms. Sylva said the Health Division had responsibility for six bureaus:
· The Bureau of Alcohol and Drug Abuse provided services to individuals with drug or substance abuse problems.
· The Bureau of Health Protection Services, often referred to as the environmental arm of the Health Division, included areas of health and sanitation, such as restaurant inspections and management of the state drinking water program.
· The Bureau of Community Health addressed chronic and communicable diseases, family planning, and provided community health nurses.
· The Bureau of Family Health Services housed the maternal and child health services.
· The Bureau of Health Planning and Statistics was the primary repository for statistical information.
· The Bureau of Licensure and Certification was a regulatory bureau that had responsibility for licensing and/or certifying facilities for the dependent as outlined in Nevada Revised Statutes (NRS)449.
Ms. Sylva said The Executive Budget included a recommendation for the creation of the Bureau of Early Intervention Services. The Bureau would provide services for children from birth to two years, who currently received services from many agencies within the Department of Human Resources (DHR).
Ms. Sylva explained that the Health Division was authorized under NRS 439and had responsibility for more than 50 programs funded by more than 100 sources. The Division had provided the Subcommittee with a list of all the grants within the Division, which had been requested by Senator Cegavske. Ms. Sylva stated 17 of the 22 Health Division budgets would be covered in the presentation.
Ms. Sylva said the Health Division had 441 FTE positions, and the budget request included 465 FTE positions—the increase resulted primarily from transferring positions in from other agencies within the DHR. Ms. Sylva stated that 59 percent of staff was located in Carson City, 23 percent in Clark County, and 11 percent in rural Nevada. The percentages were low in Clark and Washoe Counties because much of the funding was contracted from the Health Division to the Clark County Health District and the Washoe County Health District to provide public health services in those areas. A review of FY2003 contractual obligations, or Inter-local Agreements, showed commitments in the amount of $6 million to the Clark County Health District and approximately $4 million to the Washoe County Health District for public health services.
Ms. Sylva said The Executive Budget included reductions in three of the Division’s budgets. She said during the 3 percent reductions requested by the Governor, Budget Account (BA) 3209, Health Aid to Counties was eliminated except for the first quarter payment, which had already been made. Subsequently, funding for BA 3209 was placed in a category for special consideration, but was not recommended for funding for the 2003‑2005 biennium.
Ms. Sylva said she wanted to make certain the Subcommittee understood that the funding included in BA 3209 was not the only money that the Health Division distributed to the counties. The Division had commitments to the counties for public health services in the amount of $4 million and $6 million.
Ms. Sylva said the second reduction was in BA 3170, Alcohol and Drug Abuse. The MAXIMUS money was not included as part of the base budget, therefore it was not included for FY2004 or FY2005. The funding that had been received from MAXIMUS was used to serve 600 adolescents over the current biennium and resulted in four new programs and five expansions of existing programs. Ms. Sylva said the Bureau of Alcohol and Drug Abuse continued to operate under a continuing resolution for the federal Substance Abuse and Prevention Treatment grant (SAPT). If the grant was approved and funds appropriated, the Bureau anticipated receiving a large increase in funds that could potentially be used for adolescent services; the Bureau’s main priority.
Chairwoman Leslie asked how much of an increase was anticipated. Ms. Sylva replied that the increase could be as much as $1.9 million per year if the appropriation was authorized. However, Ms. Sylva did not know when, or if, the funds would become available.
Ms. Sylva said the third reduction eliminated 17 positions from the Bureau of Licensure and Certification based upon a fundamental review that had streamlined the Bureau’s operations and reverted to the basic requirements outlined in NRS 449. Decision unit E-900 requested the transfer out of 2 positions to the Division of Environmental Protection, which had responsibility for the Environmental Health Laboratory Certification program.
Ms. Sylva noted that several increases were included in The Executive Budget:
Ms. Sylva advised the Subcommittee that there were seven new grants that would need to be added to existing budget accounts to establish authority for the 2003-2005 biennium, and a new budget account needed to be set up for FY2004 and FY2005 for the Environmental Health Tracking Grant. Ms. Sylva thought these changes would be provided to the Legislative Counsel Bureau staff by the end of February 2003.
Ms. Sylva said the Health Division did have an audit exception that the Division believed could be resolved by combining BA 3224 and BA 3219. Federal law, under the Office of Management and Budget, Circular A87, required that employees be paid from the grant for which they were working. The community health nurses and the family planning nurses were located in the same offices throughout rural Nevada and often one position performed a community health nurse function while the other position performed a family planning function. The federal audit had indicated the Division needed to multi‑fund the nurses in both of those activities based on job responsibilities.
Senator Cegavske asked Ms. Sylva if Committee staff had received a copy of the federal audit that was referenced. Ms. Sylva said the Division would make the audit available to staff.
Ms. Sylva referred to “medical errors” and said A.B. 1, passed by the 18th Special Legislative Session, included the creation of a sentinel events registry within the Health Division. The bill required the Division, subject to legislative appropriation or authorization, to collect and compile data on specific sentinel events from hospitals, obstetric centers, and ambulatory surgery centers. Ms. Sylva noted that A.B. 1 did not include an appropriation. A.B. 1 also required that the Health Division enter into a contractual agreement with a quality improvement organization as defined in 42 CFR Section 400.200. In Nevada, this contractor would be Health Insight. Ms. Sylva said Health Insight would receive data from the Division and then issue quarterly reports and trend analyses of what was occurring within the medical facilities. The legislation also required the Health Division to adopt regulations to implement A.B. 1.
Ms. Sylva said the Division had not received a formal request to submit a fiscal note for A.B. 1 and indicated information presented to the Subcommittee would be informal. She said there were several ways to look at the law to determine whether the bill would be implemented as “a Yugo version versus a Buick or a Cadillac.”
Ms. Sylva pointed out that none of the three scenarios included any remedies on the part of the Health Division, only the generation of a report and a review of trending data.
In accordance with a request by Chairwoman Leslie, Ms. Sylva agreed to provide Committee staff with a schematic detailing how the amounts for the three scenarios were determined. The Chairman thanked Ms. Sylva for presenting an outline of A.B. 1.
Ms. Sylva continued her presentation and said the Subcommittee and the Health Division had always been concerned with performance measures. The Division reviewed the measures each biennium and added or subtracted measures as needed. Ms. Sylva said over the next biennium there would be some reconstructing of the measures included in BA 3224, Community Health Nursing. Ms. Sylva referred to BA 3170, the Bureau of Alcohol and Drug Abuse, and said the Health Division had added what she believed to be excellent performance measures. Ms. Sylva said the Division would be amiable to adding any performance measures that the legislators would like.
Chairwoman Leslie asked Ms. Sylva to begin the presentation with BA 3215, Sexually Transmitted Disease Control.
HR, SEXUALLY TRANSMITTED DISEASE CONTROL (101-3215)
BUDGET PAGE HEALTH-54
Ms. Sylva said BA 3215 included 18 FTE positions, and decision unit E-605 recommended elimination of 1 FTE position. The primary function of the Sexually Transmitted Disease Control program was to reduce and control the incidence and prevalence of sexually transmitted diseases in Nevada. The program included HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome) prevention, a surveillance system for tracking the HIV infection within the state, and a drug treatment program. Ms. Sylva thought the Subcommittee was particularly interested in the AIDS Drug Assistance program, often referred to as the “Jan Evans Program,” because the late Assemblywoman Jan Evans had been instrumental in obtaining $1.3 million for the program for FY1998 and FY1999. The funding was intended specifically for individuals who tested HIV/AIDS positive. Ms. Evans had been concerned that the Health Division did not have available funding to pay for the then new Protease Inhibitors. Ms. Sylva said she and Dr. Trudy Larson had spent many hours determining how many individuals could be served with the $1.3 million. At that point in time the estimate was 350 individuals per year. The agency currently served 606 individuals through the program. The funding included the state General Fund appropriation of approximately $1.35 million and approximately $3 million from the federal grant. Currently there were no waiting lists. Ms. Sylva noted that the actual AIDS diagnosis rate was down in the state, and the rate of HIV infection had increased by approximately 5 percent.
Assemblyman David Goldwater, Assembly District No. 10, thanked the 1997 Legislature for providing the first non-Medicaid state dollars for HIV/AIDS. Incredible strides had been made in the AIDS retrovirus and other viruses since the AIDS epidemic began 22 years ago. Mr. Goldwater said scientific studies related to AIDS might lead to medical breakthroughs for curing cancer, autoimmune diseases, and even the common cold. A cure had not been found for AIDS, but the health profession had discovered how to keep the AIDS virus in check.
Mr. Goldwater said keeping the AIDS virus at bay required a cocktail of antiretroviral therapy, which included as many as seven drugs. He recognized that many Nevadans had little or no health insurance and could not afford the needed medications.
Mr. Goldwater referred to the obvious humanitarian concerns and why the state needed to pay for HIV medications. First, providing HIV-infected individuals with ARV (anti-retroviral) treatment, or HAART (Highly Active Anti-Retroviral Therapy), helped keep the AIDS virus in check. An increasing body of data suggested that the lower the level of the AIDS virus in the blood stream, the less likely a person would be to transmit the virus. In the early 80s, it was presumed that the risk of HIV transmission from a pregnant woman to her child was 70 percent. However, with good prenatal care and HIV treatment, pediatric HIV infection was becoming a thing of the past. In Clark County, no cases of HIV infection occurred in infants whose mothers had received good prenatal care, including HAART, which suppressed the AIDS virus in the bloodstream and protected the baby from contracting the virus. Mr. Goldwater said an emerging body of data indicated suppressing the AIDS virus in the bloodstream decreased the probability of HIV transmission between individuals.
Mr. Goldwater recognized that the AIDS Drug Assistance Program (ADAP) was an excellent program and said many states matched federal assistance for the ADAP with state dollars. Mr. Goldwater promised to bring back to the Subcommittee the amount needed to fully fund the ADAP and hoped the members would consider the request. He stressed the importance of having sufficient funding to provide adequate drug treatment for all individuals in the state needing treatment. Mr. Goldwater pointed out that the state prison system had the ADAP formulary fully funded and thought the same services should be provided to the underinsured within the state.
Chairwoman Leslie thought the Subcommittee would like to review any specific data that Mr. Goldwater could provide related to the ADAP.
HR, OFFICE OF HEALTH ADMINISTRATION (101-3223)
BUDGET PAGE HEALTH-1
Ms. Sylva said the Office of Health Administration included overall administrative functions, including personnel, fiscal management, grants management, a public information office, the State Board of Health activities, as well as the Centers for Disease Control and Prevention Tobacco Control programs. BA 3223 was funded by the General Fund and agency indirect charges. Staff included 4 FTE positions that were recommended for transfer in decision units E-900 and E-907. A .51 FTE position, which had been vacant for over a year, was recommended for elimination under decision unit E-605.
Ms. Sylva said at the Interim Finance Committee (IFC) meeting, scheduled for February 18, 2003, the Division would be requesting approval for four new full‑time positions to support the infrastructure of the Health Division. An Administrative Officer II position would provide Mr. Weyrick with the fiscal support needed. Ms. Sylva emphasized the difficulty the Division had experienced increasing from an agency of $56 million to an agency of $145 million without having sufficient top-level management. Ms. Sylva stated, for the public record, that Mr. Weyrick had worked more than 750 hours of overtime. Ms. Sylva said because of vacancies, Alex Haartz had been performing his duties in addition to those of the Chief in another bureau, and the Management Analyst III position was functioning as an ASO for another vacancy in the Bureau of Licensure and Certification.
Chairwoman Leslie questioned why the four new positions were not included in The Executive Budget for regular review. Ms. Sylva said the positions were to be funded with the agency’s indirect costs, and when the budget was submitted, the indirect cost rate was not known. The Division had received a letter within the past two weeks from the U.S. Department of Health and Human Services (HHS), which indicated the indirect cost rate would be 14.5 percent, which would provide the necessary revenue to fund the new positions. Ms. Sylva said the positions included: 1) Administrative Officer II; 2) Administrative Assistant II to support the Information Technology staff; 3) Management Analyst II position to help manage more than 500 contracts; and 4) Accounting Technician I to address the numerous accounting transactions.
Chairwoman Leslie voiced concern that the IFC members would ask if the Subcommittee had reviewed the Division’s request for the new positions and she emphasized that the Subcommittee members were not in the position to make any recommendations. Chairwoman Leslie asked if the request for the positions could be postponed for consideration during the regular legislative process. Ms. Sylva agreed to review the Chairwoman’s recommendation.
Assemblywoman Giunchigliani asked about the starting date of the new positions. Ms. Sylva said, “ASAP would be my immediate response. We are dying on the vine in terms of upper-level management and overall activities within the Health Division.” Ms. Sylva noted the time frame for filling positions normally required three to six months after receiving approval.
In response to a question posed by Ms. Giunchigliani on the HIPAA position, Ms. Sylva said the position requested for the HIPAA had been included in the budget.
Chairwoman Leslie said it appeared the Computer Network Technician I position proposed earlier by the Division would be more cost-effective located in the Health Division’s budget account rather than utilizing DoIT staff.
Philip F. Weyrick, Administrative Officer III, said, due to growing technology demands, the initial work program that was to be presented at the IFC meeting on February 18, 2003, included a fifth position, a Computer Network Technician I. When the work program was being processed, the Department of Information Technology (DoIT) recommended that the DoIT provide the services, rather than establishing the position within the Health Division. Mr. Weyrick stated that the final work program did not include the Computer Network Technician I.
Chairwoman Leslie asked if the Division would provide a breakdown of how much time the HIPAA position would be spending on federally required tasks that might be more appropriately paid by federal funds rather than the state General Fund. Ms. Sylva said the Division would be happy to provide the Subcommittee with the requested breakdown.
Ms. Sylva referred to the Subcommittee’s recommendation to withdraw the request for four new positions from the IFC meeting scheduled for February 18, 2002, and explained there were activities and functions included in the work program that the Division clearly needed to submit to the IFC at that time, such as basic operating costs and other changes within the Division. Ms. Sylva respectfully requested that those other activities be considered for submission to the IFC. Chairwoman Leslie agreed with the request.
Chairwoman Leslie referred to the State Health Officer position and asked if a bill draft request (BDR) had been submitted to reflect the recommended changes. Ms. Sylva replied that there was a BDR containing the changes, which included:
· Changing the current State Health Officer position from classified to unclassified, to be appointed by the Director of the Department of Human Resources (DHR). The change would provide more flexibility for the appointment of an individual and might accelerate the recruitment process.
· Additional educational requirements for the State Health Officer. Ms. Sylva said in order to meet the current requirements for the State Health Officer an individual had to be board certified, or eligible for certification in preventive medicine; that requirement was no longer state of the art. Ms. Sylva explained that the wording would be expanded to include “or five years of experience at the state, local, or federal level in a responsible position, along with a master’s degree in public health.” The change was consistent with the qualifications of most other states for a state health officer.
Ms. Giunchigliani referred to decision unit E-605 and said the Administrative Assistant II (AA II) position had been vacant for more than a year, yet another AA II position was being requested. Mr. Weyrick said because of funding uncertainty, the half-time AA II position was intentionally left vacant. Ms. Giunchigliani asked how many vacant positions there were within the Division. Ms. Sylva said there were approximately 85 vacant positions in the Health Division, and the only new positions were the 4 positions requested in BA 3223, the HIPAA position, and the arthritis position recently approved by the IFC. The HIPAA position was the only one funded by the state General Fund.
HR, VITAL STATISTICS (101-3190)
BUDGET PAGE HEALTH-7
Ms. Sylva said BA 3190 was a revenue-generating budget and included 14 FTE positions located in Carson City. Most of the funding was generated through fees. The fee amounts for birth certificates and death certificates were included in NRS and had not been updated since 1997. Ms. Sylva explained that the Division had conducted a study of 13 states, and the average cost for a birth certificate exceeded $12 and the average cost of a death certificate exceeded $10. The rates included in NRS were $11 for a birth certificate and $8 for a death certificate. Increasing the fee amounts would require a change in statutes.
Chairwoman Leslie referred to the Trauma Registry and said the budget recommended an increase of $15,368 for FY2004 and approximately $14,000 in FY2005. She noted the activity level in the Trauma Registry was lower than anticipated during the 2001-2003 biennium, and asked for an explanation on the request for increased funding.
Mr. Weyrick said the recommended funding increase in the Trauma Registry was predominately to fund a temporary employee to collect medical information and enter the data into the registry. Some funding was also included for travel and minor operating expenses.
Chairwoman Leslie asked what would be added with the additional person. Ms. Sylva said during the 1999-2001 biennium, the Trauma Registry was part of the Bureau of Licensure and Certification and did not have adequate funding. The registry was transferred to BA 3190 without sufficient money to “make the program whole.” Ms. Sylva said the Bureau had worked with the University Medical Center (UMC) and a variety of facilities within the state to develop a good Trauma Registry, but had not been successful. Ms. Sylva explained that the additional funding was needed to enable the Bureau to meet the intent of the law and produce reports in a timely fashion. Chairwoman Leslie understood the requested position would improve the quality of the work.
HR, HEALTH AID TO COUNTIES (101-3209)
BUDGET PAGE HEALTH-16
Barbara L. Hunt, R.N., M.P.A, District Health Officer, Washoe County District Health Department, referred to a copy of her testimony (Exhibit F and indicated her presentation would be brief. Ms. Hunt said restoration of funds for the Health Aid to Counties’ budget could provide support to programs recommended for significant budget reductions, particularly those programs unable to continue providing services to clients that other community providers might not be able to serve, including:
· The Family Planning Clinic expected to reduce services by 1,000 clients. It was expected that the community would pick up perhaps 500, leaving 500 without services.
· Public Health Nurse Home Visiting, which focused on child abuse prevention, neglect, and abuse prevention.
· Routine tuberculosis testing and medical management of latent tuberculosis.
· Immunizations.
· The WIC program (Women, Infants & Children USDA Special Supplemental Food Program)—possible transfer to another community agency. There were a number of appropriate providers within the community who had indicated extreme interest in the WIC program. The District Board of Health would not make a final decision on the budget until March of 2003, and that would be the proposed budget that would go before the County Commission.
Chairwoman Leslie asked if all five of the programs would be eliminated if the funding for Health Aid to Counties was eliminated. Ms. Hunt said that was the recommendation. Ms. Hunt agreed with Chairwoman Leslie’s observation that the budget situation in Washoe County was a large part of the Health District’s funding problem.
Helen Foley, representing the Clark County Health District, echoed the concerns of the Washoe County Health District. Ms. Foley recapped the presentation made to the Legislative Commission’s Budget Subcommittee during the latter part of January 2003 and said lack of funding would result in a reduction in nursing and environmental health services, elimination of addiction treatment and home health programs, and other programs. Ms. Foley said the Health District was extremely concerned that two communicable disease investigators, who performed TB therapy and tracked contacts with persons with active TB, would have to be cut from the program, as well as two epidemiologists who investigated and contained outbreaks of foodborne illnesses in the restaurant industry, which could directly affect the tourism-based economy. Ms. Foley stated that local health departments in counties with jurisdictions of 100,000 or more received an average of 23 percent of revenue from the state. Without Health Aid to Counties’ support, the state’s contribution to the Clark County Health District’s budget was less than 1 percent, down from 6 percent. Ms. Foley emphasized that the Health District would do the best it could to maintain all the programs. Mr. Foley said the District would like to have “placeholder status” so there would be recognition of the important state contribution the District had made to public health in the counties. Ms. Foley said in August of 2001, Senator Raggio and Assemblyman Arberry forwarded a letter to the state Budget Director that indicated the Legislature hoped to, at a minimum, fund the Health Aid to Counties budget at the 1991 level for the 2003‑2005 biennium.
HR, CONSUMER HEALTH PROTECTION (101-3194)
BUDGET PAGE HEALTH‑18
Ms. Sylva referred to BA 3194, and said the budget included 41.02 FTE positions. The Executive Budget recommended elimination of 2.20 FTE positions. The Bureau of Consumer Health Protection Services was the environmental health arm of public health and primarily performed regulatory services related to public water systems, individual sewage disposal systems, and environmental health activities, including regulating food establishments, cosmetic manufacturers, and shellfish wholesalers. The Bureau also reviewed engineering plans related to water, septic tanks, pools, and bottled water. Bureau staff was located throughout the state. Ms. Sylva noted that one grant needed to be added to the Bureau’s budget—the Water Vulnerability Grant in the amount of $198,700. Ms. Sylva said the E‑275 decision unit used projected fee increases to restore the 2.20 FTE positions eliminated in the adjusted base. Ms. Sylva noted that fees had not been increased since the mid‑1990s and she felt the increase was appropriate. Fee increases to fund the positions and make BA 3194 whole would be presented to the Board of Health in the spring of 2003.
Chairwoman Leslie wondered if the suggested fee increases would be better received than when last requested. Ms. Sylva said the Bureau had been working with all of its health partners, and she thought the fee increases would be accepted. Ms. Sylva stated that the Bureau had completed a time and effort study to determine fee amounts. Ms. Sylva offered to keep the members posted on the status of the recommended fees.
Chairwoman Leslie asked if the Bureau had a long-term plan for the positions in this account that were involved with safe drinking water and requested an explanation of any recommended transfer of those positions. Ms. Sylva said The Executive Budget recommended transferring the safe drinking water program to the Division of Environmental Protection (NDEP), however, no positions in this account were recommended for transfer. During the next biennium, the Health Division would be reviewing the state drinking water program, as well as other environmental health programs, to determine what could be transferred to the NDEP. Chairwoman Leslie noted some of the employees in BA 3194 had safe drinking water responsibilities.
HR, HEALTH FACILITIES HOSPITAL LICENSING (101-3216)
BUDGET PAGE HEALTH-34
Ms. Sylva said at the end of the 2001 Legislative Session the Division was uncertain how BA 3216 would be funded. There were far too many positions and not enough revenue to fund the positions. This biennium The Executive Budget recommended eliminating 17 positions and decision unit E-900 transferred 2 positions to the NDEP to manage the environmental laboratory certification program. Ms. Sylva said the reduction of the 17 positions was directly related to “reinventing ourselves” and performing only those services required by statutes. Ms. Sylva noted BA 3216 traditionally received an $800,000 loan each year of the biennium that was paid back each January 1. Ms. Sylva thought the account would become self-sustaining by FY2006. A bill draft request would be submitted that would allow the Board of Health to vary the time allowed for submission of licensing fees.
Chairwoman Leslie understood that 17 positions were recommended for elimination from the account and the reason the work could be completed with fewer positions would be due to increased efficiency and targeting the required work. Ms. Sylva agreed with the Chair’s assessment.
Chairwoman Leslie acknowledged the Division had addressed liability insurance for skilled nursing facilities and groups homes in an earlier hearing and complimented the agency on their response.
Senator Cegavske asked for a brief explanation of the impact liability insurance had on the Division. Ms. Sylva said the primary impact of the increase in costs of liability insurance in the state rested on the residential facilities for groups. The majority of the 351 facilities had 10 or fewer beds. Many of the facilities cared for the mentally ill. In addition, many of the facilities that had liability insurance in the past were receiving cancellation notices from the carriers. Ms. Sylva said the cancellations were mainly due to the high-risk populations served, specifically the mentally ill. Insurance that had been $5,000 was increased to $45,000. Facilities having fewer than 10 beds could not afford the burden of the significant increases in liability insurance. Ms. Sylva noted that at the last meeting of the Board of Health there were 16 requests for variances to the liability insurance requirement outlined in the Nevada Administrative Code (NAC). The Board of Health granted the requestors 60 days to return to the Board with specific evidence that liability insurance had been requested and to provide letters from the insurance companies stating why the requests were denied. Ms. Sylva said some insurance companies had testified that insurance was no longer available for the clients that had previously been insured by the companies. Ms. Sylva said many other states did not require residential facilities for groups to have liability insurance. The Board would have to make the determination whether to grant waivers. Ms. Sylva noted that the operators of the facilities would have to determine whether it would be feasible to operate without liability insurance.
HR, COMMUNITY HEALTH SERVICES (101-3224)
BUDGET PAGE HEALTH‑40, and
HR, FAMILY PLANNING PROJECT (101-3219)
BUDGET PAGE HEALTH-50
Chairwoman Leslie referred to BA 3224 and BA 3219. Ms. Sylva said, due to the increased costs of personnel benefits as well as cost allocations such as the Attorney General’s allocation, additional revenue was required. Decision unit E‑275 would restore, through fee increases, those areas that had to be removed from the budget. The DHR was recommending that the Community Health Services budget and BA 3219 be combined to allow the Division to serve rural Nevada with the family planning nurses as well as community health nurses. Chairwoman Leslie did not think the Subcommittee had any problems with combining the two budget accounts, but she wanted to make certain no services would be lost. Ms. Sylva emphasized that no services would be lost and said combining the two budget accounts addressed an exception included in a federal audit.
Chairwoman Leslie asked for an explanation of the $347,000 in Temporary Assistance to Needy Families (TANF) funds included in BA 3224. Ms. Sylva said the TANF funds included in the budget primarily funded the salaries of the community health nurses, many of whom were providing services to clients that might be enrolled in TANF as well as working toward the reduction of out‑of‑wedlock births.
Chairwoman Leslie asked the Division to explain the decline in the collection of medical service charges. Ms. Sylva said the Division had experienced difficulty in filling numerous vacant positions—revenue could not be generated without staff. Ms. Sylva thought the projections included in The Executive Budget for collection of medical service charges were close and noted fees would also be increased.
In response to a question asked by Senator Cegavske on the federal audit, Mr. Weyrick said the audit, which was conducted during the summer of 2002, was unexpected.
HR, HEALTH COMMUNICABLE DISEASE CONTROL (101-3220)
BUDGET PAGE HEALTH-45
Ms. Sylva continued the presentation and said BA 3220 included a variety of chronic and communicable disease programs. The budget addressed breast and cervical cancer, the diabetes program, and the tuberculosis program. The epidemiology section of the Health Division was also included in BA 3220. Ms. Sylva commented that the $100,000 arthritis grant had been received recently and was budgeted into FY2004 and FY2005. Decision unit E-900 recommended transferring the federal Tobacco Prevention and Control grant into BA 3220.
Assemblyman Hettrick referred to Ms. Sylva’s earlier comments related to the problems experienced by group homes in obtaining liability insurance. Mr. Hettrick suggested that perhaps the state could extend political subdivision protection to the group homes for liability coverage. Mr. Hettrick recognized if all the group homes closed because of not being able to obtain liability insurance, the people being served would still have to be served and would end up in another state facility, or the state would have to pay an independent facility. The state would not incur any costs by extending political subdivision coverage. The home operators could purchase a policy and would still be liable for negligence, but the base operational costs would be significantly reduced.
Ms. Sylva thanked Mr. Hettrick for the suggestion and said the Division had an advisory committee that was addressing a variety of issues related to the Bureau of Licensure and Certification. Ms. Sylva said she would relay Mr. Hettrick’s suggestion to the committee. Chairwoman Leslie also thanked Mr. Hettrick and thought the idea was worthy of consideration.
H R, IMMUNIZATION PROGRAM (101-3213)
BUDGET PAGE HEALTH-59
Ms. Sylva said BA 3213 included 10 FTE positions, all located in Carson City. The program mission was to avoid the occurrence of vaccine-preventable diseases within the state. Historically, the budget had problems “making ends meet” in terms of having sufficient funds to purchase vaccines. The Division believed the budget, as presented with decision unit M-200, should provide sufficient funding for the 2003-2005 biennium, barring any unforeseen large increase in charges from the vaccine providers or an influx of children into the state. However, the Division would like the opportunity to go before the Interim Finance Committee if additional funding were required. Ms. Sylva said there was a new five-in-one vaccine called Pediatrics. The cost for providing five separate injections was $30; the new Pediatrics vaccine was $35, an increase of $5. However, the Pediatrics vaccine “certainly means less pain and a lot less costs in terms of storing five vaccines.” Ms. Sylva pointed out there were fewer doses administered than had been projected in FY2003 because of the vaccine shortages experienced in a few areas.
Chairwoman Leslie asked why the federal government dosage projections were much higher than the Division’s projections. Mr. Weyrick explained that several different models were used for projections. The model developed by the federal government was based upon federal population estimates. The model used by the Division was similar to the federal model, but was tempered with the actuality of what had occurred the past few years. Mr. Weyrick indicated the Division was comfortable with the agency projections.
Chairwoman Leslie asked if the Division planned any outreach campaign to promote immunizations. Ms. Sylva said the immunization program had an ongoing campaign promoting appropriate immunizations, but no additional campaign was planned for the 2003-2005 biennium.
Assemblywoman Gibbons asked if the Division had requested information from the federal government on the smallpox vaccination. Ms. Sylva said she would briefly address smallpox plans under the public health preparedness activities, but noted the staff of the immunization program were actually working with the public health community, in addition to the public health preparedness staff, to carry out a smallpox plan.
HR, MATERNAL CHILD HEALTH SERVICES (101-3222)
BUDGET PAGE HEALTH 64
Ms. Sylva said decision unit E-605 recommended elimination of 1 FTE position, which had been vacant for an extended period. The Maternal and Child Care program included:
· Newborn screening
· Newborn hearing screening
· Children with special health care needs
· Maternal and child health prenatal services
· Teen pregnancy prevention services
· Oral health
· The Primary Care Health Development Center
· The Governor’s Youth Advisory Council
Ms. Sylva said since the implementation of the newborn hearing bill passed by the 2001 Legislative Session, which Chairwoman Leslie had been instrumental in establishing, 94 percent of all infants born in Nevada were receiving hearing screening. The national rate of referral from screening newborns was about 3 percent, the percentage in Nevada was slightly lower. Ms. Sylva said when screening was first initiated in Nevada the referral rate was much higher, but hospitals had taken the initiative to attempt to weed out unnecessary referrals; a great example of how the public and private sectors working together could make a difference. Chairwoman Leslie was pleased the Newborn Hearing Screening Program had been so successful and recognized that Mrs. Gibbons had also worked on the legislation.
Chairwoman Leslie asked for additional information on the Registry of Birth Defects and asked if the Division had looked at other funding sources. She also requested information on the newborn screening fees. Ms. Sylva said an increase in the newborn screening fees might provide a potential source of funds; the fees had not been increased since 1997. Ms. Sylva noted that the Division was actively searching for any new grant funds that might become available. Ms. Sylva said the Registry of Birth Defects had been approved but funding had not been provided. If funds became available, the registry would be at the top of the list. Chairwoman Leslie said she was not clear how much money would be needed to restore the registry. Based upon the groundwork that had been completed, Ms. Sylva said the registry could be implemented for approximately $100,000 per year. She explained that with the 31,000 births within the state each year, this would equate to an approximate $3 increase in the newborn screening fees.
HR, SPECIAL CHILDREN’S CLINIC (101-3208)
BUDGET PAGE HEALTH-70
Ms. Sylva said BA 3208 had traditionally been called the Special Children’s Clinic (SCC) budget and the Division was proposing the name be changed to the Early Intervention Services budget to more closely align with actual services. Ms. Sylva referred to the waiting lists for services provided through BA 3208. Children needing services often had to wait as long as 6 months for appointments, too long for an infant needing services. An infant receiving services during the first 30 days of life and receiving continual services might develop much faster than one having to wait 6 months to access any services. Ms. Sylva said the Division was pleased that the Governor and Mr. Willden recommended that Early Intervention Services be combined with the SCC. Ms. Sylva said the decision units included in the budget included a General Fund increase of $4.8 million and an additional $250,000 in federal dollars for each year of the biennium.
Alexander Haartz, M.P.H., Deputy Administrator, Health Division, said the Department of Human Resources had asked him to serve as the lead for the various programs that would be consolidated into the new Bureau of Early Intervention Services within the Health Division. Mr. Haartz said BA 3208 contained several decision units, the first was M-200, demographics caseload change, which reflected the projected costs for providing services for the 2003‑2005 biennium for all children served at the SCCs located in Las Vegas and Reno. Mr. Haartz noted that the clinics had a broader overall mission than the information contained in Exhibit E. Mr. Haartz said there were two E-500 decision units related to the SCCs that provided additional funding to reduce the projected waiting lists for diagnostic services and treatment. The Division believed the funding would reduce the waiting lists by half. Mr. Haartz said decision unit E‑605 recommended elimination of 2.51 FTE positions that had been vacant for an extended period of time.
Mr. Haartz continued and said decision unit E‑900, included on page 74 of The Executive Budget, recommended transferring the First Step Program, one of the three programs within the Division of Child and Family Services (DCFS) that would form the nexus of the new Bureau. The First Step Program would provide early intervention services and mental health services for children. The transfer was a straight transfer in from the existing budget. Mr. Haartz noted that E-902 transferred the Home Activities Program for Parents and Youth (HAPPY) from DCFS to BA 3208. The HAPPY program provided early intervention services for children in the rural areas of the state, primarily in the northern and central part of Nevada. The First Step Program provided early intervention services to children and families living in rural southern Nevada, primarily Tonopah, Mesquite, and Caliente. Decision unit E-904 transferred the base funding for the Infant Enhancement program from DCFS to BA 3208. Mr. Haartz said the program, based primarily in northern Nevada, was associated with the birthing hospitals located in Washoe County and provided ongoing staff training. Decision unit E-906 transferred funding for caseload growth for the First Step Program from DCFS and E‑907 transferred funding to reduce the waiting lists for children served through the program.
Mr. Haartz continued and said during the 2003-2005 biennium, both the DHR and the Health Division hoped to eliminate all waiting lists for services to all children, with special emphasis on the federal requirement that each child receive sufficient diagnostic services to allow for generation of an Individual Family Service Plan that detailed treatment services needed during the time the DHR had responsibility. The two goals for the recommended Bureau of Early Intervention Services were the elimination of the waiting lists and making certain the children were ready to learn prior to beginning public school at age 3, thus alleviating the need for the districts to “play catch up.” Specific goals that the Division had identified with regard to the transfer included:
· The creation of a seamless statewide delivery system, which would be easily identified by families and providers.
· Consolidating staff from the four programs who would work in unison without competition.
· Increasing the number of children served through better organization and utilization of existing resources.
· Reviewing position classifications through the fundamental review process, which the Division had been working on for the past seven months. Mr. Haartz said the individuals employed in the various accounts had similar classifications, but the duties were different. There needed to be a similarity between job classification and function. Mr. Haartz said there would also be a study on the best use of staff.
· Improving data collection and analysis. Mr. Haartz said a centralized definition and a tracking system existed, but it was hard to compare the data from various programs due to inconsistency in counting.
· Achieving overall compliance with the mandates of federal Part C, specifically the 45-day maximum for waiting lists. Mr. Haartz said the Health Division, the Division of Child and Family Services, the Department of Human Resources, and the Governor recognized there was a federal mandate to meet the 45-day waiting list requirement, but also recognized eliminating the waiting lists was the “right thing to do.”
Mr. Haartz concluded the budget overview and said he would be happy to respond to any questions.
Senator Cegavske asked if the Division could share with the Subcommittee the number of children referred for initial assessment who might not require treatment. Mr. Haartz said approximately one‑third of all children who received diagnostic services through the SCCs were actually identified with a delay, or required some form of intervention services. Mr. Haartz offered to send additional data to the Subcommittee.
In response to a question posed by Senator Cegavske related to medical schools, Mr. Haartz confirmed the Division had partnerships with the medical schools. Senator Cegavske commented that in the past there had been doctors who had provided pro bono work, and with the current liability problems that work would probably be limited. Senator Cegavske reflected that perhaps there would be a possibility to form those partnerships again under the guidelines presented earlier by Mr. Hettrick. Senator Cegavske recognized there were many doctors within the state that would like to help the children.
Chairwoman Leslie said all the M-200, E-500, and E-501 units were funded entirely by General Fund support and wondered if there was any chance of using other funding sources. Mr. Haartz explained that the General Fund was the stable source of funding. Families had the option to pay for services or not, and had the option to use their private insurance. The Division encouraged families to pay for services. Mr. Haartz said the majority of funds contained in the base budget for medical service charges were actual Medicaid reimbursement. There was some limited private insurance. Mr. Haartz said the Medicaid reimbursement was included under the Medical Services Charge in the budget. Within Budget Account 3208, the Medicaid reimbursement flowed back in and was used to provide services to Medicaid-eligible children.
Ms. Giunchigliani noted children were served regardless of ability to pay and asked what the payment rate was for private insurance. Mr. Haartz replied that payments to the state from private insurance providers were low because the majority of providers had a policy to not reimburse governments for services. Mr. Haartz indicated he would forward information on the payment rate to the Subcommittee. Ms. Giunchigliani suggested that the Division continue to provide services to the children, but have the parents file the claims, rather than the state. Mr. Haartz said another issue faced by the Division related to the federal Part C funds, which allowed families flexibility to use or not use private insurance—the DHR had to honor the provisions of Part C.
Chairwoman Leslie said the workload indicators did not match the budget request. For example, in FY2002, 1,609 new children were evaluated and 2,092 cases were closed. The projected number of new children being served was 1,550 for each year of the 2003-2005 biennium. Ms. Sylva said the Division would provide the Subcommittee with an explanation of the workload indicators. Chairwoman Leslie asked the Division to work with the Legislative Counsel Bureau staff to resolve the workload indicator issues.
Chairwoman Leslie asked for an explanation of what the Division considered a reasonable waiting time for the initial appointment. Mr. Haartz noted that historically the policy of the Health Division had been that no family should wait more than two weeks for either an initial diagnostic visit or for treatment services. Realistically it was easier to reduce the amount of time families waited on the diagnostic side. In December of 2002 the waiting time for all programs was 138 days. The average for FY2002 was approximately 130 days to receive an Individualized Family Service Plan that met the federal requirements. Ms. Sylva anticipated that changing BA 3208 to Early Intervention Services would require new indicators. The goal of the Division was to provide a set of indicators that would go across early intervention programs so that at the next legislative session there would be one set of indicators with consistent numbers. Chairwoman Leslie asked about the consolidation plan discussed earlier and wanted to make certain the Division would be looking at any cost savings and efficiencies. Mr. Haartz said the plan would be completed prior to July 1, 2003.
Ms. Giunchigliani asked what benefits Mr. Haartz anticipated by consolidating early intervention services. Mr. Haartz thought the reorganization would make more dollars available for direct services on the diagnostic side and the treatment side. The direct outcome would be that more services would be provided in a more timely and comprehensive manner. Children leaving early intervention services would be ready to transition to the public school system at age 3. Ms. Giunchigliani recognized there had been competition between the Clark County School District’s early intervention program and the Division’s program. Ms. Giunchigliani asked how the transition to the school system would be different. Mr. Haartz said transition meetings were already occurring. He had recently attended a meeting with staff from the Clark County School District, as well as the First Step Program and the Special Children’s Clinic of Las Vegas. Individual cases were being reviewed to make certain the district was aware of the types of services the children who would be entering the school system had been receiving and what services would be needed. Mr. Haartz said he was not as aware that there was competition between the district and the early intervention services provided by the DHR as much as the competition within the DHR agencies as to who should be providing services. Ms. Giunchigliani asked if there was space at the SCCs to house the new staff. Mr. Haartz answered affirmatively. The Division planned to maintain the community care centers, which provided a good location for the coordination of services. Ms. Giunchigliani asked if the interns were still included in the budget, and Mr. Haartz replied that the interns were included in the First Step budget.
Chairwoman Leslie asked for an explanation of decision unit E-605, which recommended elimination of 1.5 public service interns. Ms. Sylva said the intern positions had been held vacant because of the difficulty in filling positions, the need to meet vacancy savings, as well as the hiring freeze. The Division had elected not to fill the positions because of the possibility of budget cuts. Ms. Sylva acknowledged that the interns in the SCCs were not being used correctly. The Division needed to look at the roles and functions of all positions and decide which positions would be maintained and which positions needed to be eliminated. Ms. Sylva said the elimination of 1.5 positions and the transferring in of 6 positions were not related, but was merely an artifact of combining two budgets. Chairwoman Leslie asked the Division to look at the need for the 6 intern positions and report back to the Subcommittee. The members needed assurance that the new unit would be able to use the positions effectively. Ms. Sylva assured the Subcommittee that the Division would be looking at every position.
HR, WIC FOOD SUPPLEMENT (101-3214)
BUDGET PAGE HEALTH-78
Ms. Sylva said Budget Account 3214 was a nutrition education program and supplemental food program designed to improve the health status of Nevada’s women, infants, and children (WIC). The WIC program often served as “the carrot” that brought pregnant women and children into other kinds of services generally offered by public health agencies or primary care agencies. Ms. Sylva said she had spoken to Michael Rodolico, Executive Director, Health Access Washoe County (HAWC), who said the center was extremely interested and would be submitting a Letter of Intent to potentially be a WIC provider in Washoe County. The WIC program would provide an opportunity for families to receive immunizations on-site as well as other primary care services. Currently 41,000 women, infants, and children were being served on a monthly basis through the WIC program. President Bush’s budget, if passed, included additional money for WIC that would equate to an increase of approximately $2 million in the state for WIC services, which would in essence mean providing the ability to serve up to 44,000 clients.
Ms. Sylva understood the Subcommittee had a concern with BA 3214 related to “rolling out” the Health Passport Project in Washoe County and statewide. The Division had been directed to complete a cost benefit analysis in partnership with the Department of Information Technology (DoIT). When the deliverable was not met by December 15, 2002, the Division became concerned. Ms. Sylva said the Division had just completed a final review of a new Request For Analysis that DoIT was proposing to send out. Ms. Sylva said she did not anticipate receiving any cost benefit information until June 2003. Ms. Sylva explained federal funding was available to develop a Health Passport Project, however, there were no funds available to maintain the project. If the cost savings would be sufficient to maintain the project and actually have benefits ensured, it would be beneficial to use the federal funds. Ms. Sylva indicated a representative from DoIT was in attendance if the members had questions.
Del Byasee, Information Systems Manager II, DoIT, said he was substituting for Angela Grato, Software Systems Executive, DoIT. Mr. Byasee said the Health Passport Project was a strategy-type project and for that reason the management of the DoIT wanted the Subcommittee members to understand the Department had recommended a full‑time project manager. The Interim Finance Committee had suggested that the Department use a contractor for the project. The assignment was short-term and the deliverable was not completed. Throughout the course of the project, the contractor had assured the Department through documentation that the project would be completed. However, the contractor had performed poorly and had hired a subcontractor who did not meet the contract requirements. Mr. Byasee said the Department was negotiating with the contractor and expected a credit for part of the invoice. Mr. Byasee read from a letter received by the DoIT from the contractor:
The materials you forwarded to our office made clear the goals and objectives outlined for this project were not fully satisfied and that your first experience with us was not at all what any of us would like it to be. Having said that, please let me know what you and your department feel would be a satisfactory resolution to this matter. We sincerely look forward to resolving the issue and continuing to provide project assistance to the state.
Due to negotiations, Mr. Byasee did not name the contractor.
Chairwoman Leslie noted that the Community Service Agency, the Food Bank, and the HAWC Center were potential contractors in Washoe County for the WIC program. She then asked if the anticipated additional federal funds for the WIC program would result in serving more people. Ms. Sylva reiterated that the Department was serving approximately 41,000 persons per month. If the additional federal funds became available, the Department anticipated up to 44,000 persons per month would be served. Ms. Sylva acknowledged that the Department did not have a waiting list for services, per se, and noted sometimes it would take more time for an appointment at one clinic than at another. Chairwoman Leslie said the Expanded Program Narrative indicated that one provider underwent a reorganization resulting in a significant drop in clients for a period of six months. She asked if that occurrence could have been avoided. Ms. Sylva asked for permission to forward the requested information to the Subcommittee.
HR, EMERGENCY MEDICAL SERVICES (101-3235)
BUDGET PAGE HEALTH-82
Ms. Sylva said BA 3235 had been a fluctuating budget. Changes had been made in decision unit E-710 as late as the previous evening. She said the account was the Emergency Medical Services (EMS) account and served as the regulatory arm for ambulance services, emergency medical technicians (EMT), pre-hospital providers, and firefighting agencies pursuant to NRS 450B, and also provided for an EMS advisory committee that was established during the 1999 Legislative Session. Ms. Sylva emphasized that the committee had been extremely valuable to the DHR by providing a formal partnership of individuals working together toward a common goal. If it had not been for the membership of the committee, the EMS regulations would not have been revised in a timely manner. The members served an invaluable role in creating and updating training courses and recommendations to the state for new training. Most of the rural EMS volunteers received training grants from the Health Division in order to keep services at an appropriate level. The grants were generated from a $10 fee on the EMT certification.
Mr. Weyrick said decision unit E-710 related to the new EMS pre-hospital data collection system. Mr. Weyrick noted that the Division had a partnership with the University of Nevada School of Medicine and the Nevada Office of Rural Health. Mr. Weyrick said Health Preparedness funds had been used to buy hand-held Palm Pilots for the EMS technicians to log in information at accident sites; the data was compiled through the new data collection system. Mr. Weyrick said the software was Med-Media EMStat. There was an annual cost of $1,000 for housing the data at the Med-Media site located in Pennsylvania. An additional cost included the annual maintenance and licensing agreements. To this point, Med-Media had allowed the partnership to use the software free of charge, however, as of January 1, 2004, the Division would be required to pay the licensing and maintenance agreement on the software at an annual cost of $20,000. During FY2004 the cost would only be $10,000, and the cost for each succeeding fiscal year would be $20,000.
Chairwoman Leslie asked if the $6,597 included in the budget for FY2004 for license maintenance software was necessary. Mr. Weyrick said the funding was necessary and explained that the Division had balanced the budget within the assigned cap detailed in the budget instructions. Although the annual cost was $10,000 for FY2004 and $20,000 in FY2005, the $6,597 was the amount of funding available in the assigned cap. The Division anticipated receiving additional funding through the partnership with the University School of Medicine or through Health Preparedness funds. Mr. Weyrick indicated the Division would find the funding to support the EMS data collection system.
HR, HEALTH ALCOHOL & DRUG REHABILITATION (101-3170)
BUDGET PAGE HEALTH-86
Ms. Sylva said the Bureau of Alcohol and Drug Abuse was selected in December of 2002 as the Health Division’s “bureau of the year.” The selection had been based on the hard work of staff and the community partnerships. Ms. Sylva recognized the representatives of the partnerships present in the meeting.
Ms. Sylva said BA 3170 included 25 FTE positions and was the only budget in the Division that had not experienced staff movement. The Bureau received federal monies of approximately $11.2 million through the Substance Abuse Prevention and Treatment block grant. If Congress passed the new appropriation request, the grant amount could increase up to $13.2 million, which would afford additional funding to maintain the 600 children receiving services through the MAXIMUS money. The primary functions of the Bureau included identification of drug and alcohol abuse needs of Nevadans and support of a continuum of services, including prevention, early intervention, and treatment. The account included 44 sub-grants that provided funding for prevention; approximately 29 of the grants were in the treatment arena. Ms. Sylva said there were two grants that would need to be added to BA 3170; the State Incentive Grant in the amount of $3 million and the State Data Infrastructure Grant in the amount of $100,000. Ms. Sylva was proud of the bureau and said the late Assemblywoman Jan Evans had indicated there was no reason not to capture additional funding for the budget. Ms. Sylva said the Community Youth Mental Health grant, which would end August 31, 2003, was a partnership between the prevention treatment coalitions located in Carson City, Clark County, and Washoe County that addressed mental health, substance abuse, and violence. Ms. Sylva noted the one decision unit included in the budget provided funding for Novell licensing and equipment.
Chairwoman Leslie disclosed that she was a volunteer member of the Board of Directors of Join Together Northern Nevada, which received some of the prevention pass-through grants.
Chairwoman Leslie stated that she was not ready to give up on obtaining additional information on MAXIMUS and was sorry Mr. Willden had left the meeting. Chairwoman Leslie requested a copy of the MAXIMUS plan to determine where funding was being sought for current needs, where funding would be found for the next biennium, time lines for receiving funding, an estimate of the funding amounts, the amount that would be reverted at the end of FY2003 and the next biennium. Chairwoman Leslie then requested a simple, accurate statement that indicated where the MAXIMUS money was included in The Executive Budget. Chairwoman Leslie wanted a specific listing of where the MAXIMUS funds would be spent during the next year and did not merely want a statement such as “We are going to dump it in Medicaid.” Chairwoman Leslie said, “I want a specific amount, and I know it exists, and I really want to see it.”
Chairwoman Leslie asked if $42,000 was still being spent for substance abuse prevention, and Ms. Sylva confirmed the amount was correct.
Chairwoman Leslie thanked Ms. Sylva for the excellent report on adolescents provided earlier by the Health Division. The report verified that the funding in BA 3170 was being spent effectively.
Chairwoman Leslie asked if the Division knew when, or if, Congress would provide additional funding for the Substance Abuse Prevention and Treatment (SAPT) block grant. Ms. Sylva replied that the Division did not have a time line.
Senator Cegavske disclosed that she was an employee of WestCare Nevada.
Senator Cegavske wanted the Subcommittee to know she had attended a “Stand Tall Don’t Fall” vigil in Gardnerville the previous evening that was attended by students and parents. Senator Cegavske was extremely proud of the students who had made a statement that a large number of young people did not drink alcohol and were proud of the fact. Senator Cegavske acknowledged that there were many successful prevention programs sponsored by the Bureau.
Ms. Giunchigliani recognized the Bureau received funds for various programs and then disseminated the funds to the numerous entities. She asked if the Bureau received any funding from the Nevada Department of Education (NDE) for prevention programs. Ms. Sylva replied that the Bureau received 20 percent of the federal Safe and Drug Free Schools money from the NDE. Ms. Giunchigliani had attempted for the past ten years to obtain information on all of the drug prevention grant funds received by the state. Ms. Giunchigliani thought all of the drug prevention funds should be combined into one nexus. She felt the dollars should be allocated to the five or ten programs that worked, rather than funding numerous small programs. Ms. Giunchigliani thought there should be tools to evaluate the existing programs. She acknowledged that the DARE program was popular, but said the program was not well implemented and did not work. Ms. Giunchigliani suggested, if the Chair agreed, that there be a coordination of efforts to collect information on all the drug prevention programs. Chairwoman Leslie thought the suggestion was excellent. Ms. Sylva said the suggestion made by Ms. Giunchigliani was certainly appropriate, and the Division was working toward combining prevention programs by looking at the best practices. The Bureau’s Request for Application (RFA) was formal, extremely complicated, and thorough. Ms. Sylva noted that many agencies were applying for the drug grant funds, but more were combining efforts, merging programs, and providing services from one agency rather than three or four.
HR, PUBLIC HEALTH TOBACCO FUND (263-3212)
BUDGET PAGE 93
Ms. Sylva explained that 10 percent of the proceeds of the tobacco settlement received by the state were placed into the Trust Fund for Public Health. The interest earned on the Trust Fund was allocated to public health programs. Ms. Sylva explained that the late Assemblywoman Jan Evans had been instrumental in passing legislation during the 1999 Legislative Session that ensured 10 percent of the tobacco settlement funds would be placed into a fund where interest would be earned. The State Health Division and the eleven‑member board created by the legislation had responsibility to allocate only the interest in the form of grants to public health programs within the state. The interest earned had been approximately $300,000 annually, but Ms. Sylva felt in the future the amount would increase significantly.
HR, HEALTH ALERT NETWORK (101-3218)
BUDGET PAGE 97
Ms. Sylva said BA 3218 included the Public Health Preparedness and Response to Bioterrorism grant. The grant represented the total public health preparedness program within the Health Division. The program was intended to strengthen the capacity of public health through early detection and assessing and responding quickly to control any potential public health consequences of acts of bioterrorism. Funds provided assistance to state and local health departments to develop systems for rapid detection of unusual outbreaks of illnesses and expand epidemiology capacity to investigate and mitigate such outbreaks. The program included upgrading the public health laboratory to provide for more sophisticated tests related to anthrax.
Ms. Sylva said $3 million had been allocated to Clark County to renovate space to create a public health laboratory. The laboratory would be located on the Clark County Health District campus. Chairwoman Leslie asked the Division to provide a brief summary that detailed the use of the $3 million. Ms. Sylva said she would be happy to provide the summary and said 47 percent of the $10.4 million received in bioterrorism funds was allocated to southern Nevada and 14 percent to northern Nevada. The upgrade of the northern Nevada laboratory to a level C had been a priority.
Ms. Sylva said the agency had not received funding to address smallpox. However, under the directions of the new federal Homeland Security Department and Tommy Thompson, Secretary of Health and Human Services, the Division had been required to submit response plans for smallpox late in December 2002. Ms. Sylva said there were major issues related to liability and workmen’s compensation. Division staff had met with the CEOs of hospitals in southern Nevada and would be meeting with hospital CEOs in northern Nevada. The Division continued to work with the Nevada Hospital Association that had received $1 million of grant funds to ensure that the hospitals in the state were as ready as the rest of the public health community to deal with any sort of bioterrorism event. The budget was 100 percent federally funded and the Division was anticipating the funds would be available at the same level for 2004.
Chairwoman Leslie complimented Ms. Sylva on the outstanding presentation of the Health Division’s budgets and for providing requested information in a timely manner. The Chairwoman then asked if there was any public comment.
Tom Murtha, CEO, Bristlecone Family Resources, introduced Tom Bolan, CEO, Step 2/Lighthouse of the Sierra, and Dorothy North, CEO, Vitality Center, and said all were representing the Nevada Alliance for Addictive Disorders, Advocacy, Prevention, and Treatment Services (AADAPTS).
Mr. Bolan explained that the Nevada AADAPTS was a statewide organization representing over 25 community-based substance abuse treatment and prevention providers and served more than 11,000 individuals and families each year with funding from the SAPT block grant. Mr. Bolan said Nevada AADAPTS was grateful to Director Yvonne Sylva and Maria Canfield, Chief, Bureau of Alcohol and Drug Abuse, for providing excellent leadership. Mr. Bolan said Nevada AADAPTS believed the $500,000 in MAXIMUS funding provided a stable base for adolescent services and asked the Subcommittee to provide stability to the funding base, regardless of the fluctuations in federal funds.
Mr. Bolan noted the waiting list for treatment services had increased more than 43 percent; the number of days individuals waited for services had increased from 27 days to 44 days.
Chairwoman Leslie asked why the waiting lists had increased so dramatically. Mr. Bolan said the waiting list issue was a capacity issue that was driven by funding, and the programs would be able to expand if additional funding was provided.
Mr. Murtha referred to the $1.9 million increase in the SAPT block grant that might be received from the federal government and pointed out the funds would not be a windfall that would “make all of our programs flush.” Mr. Murtha explained that all of the treatment and prevention providers struggled to meet expenses and were in need of expanding capacities or providing innovative services. The Nevada AADAPTS did not have a great deal of power, however, the organization had a large effect on society.
Chairwoman Leslie said she had received waiting list information dated January 2003 and would share the document with the Subcommittee members.
Mr. Murtha said the document contained informal data and Nevada AADAPTS was still working on the numbers. Chairwoman Leslie asked Mr. Murtha to provide the final document when it became available.
Ms. North said having a waiting list for alcohol and drug abuse services in the state of Nevada was similar to a waiting list in an emergency room. Those needing services were in terrible straits and many were lost before receiving any level of care. Ms. North recognized there was a budget shortfall, but knowing that the priority was adolescent treatment and at the same time looking at having the MAXIMUS money moved from BA 3170 to help balance the state’s budget did not make any sense.
Chairwoman Leslie said she recognized the importance of treating drug abuse problems in adolescents prior to reaching adulthood when the cost to the state would be more.
Chairwoman Leslie adjourned the meeting at 10:28 a.m.
RESPECTFULLY SUBMITTED:
Linda J. Smith
Committee Secretary
APPROVED BY:
Assemblywoman Shelia Leslie, Chairwoman
DATE:
Senator Raymond D. Rawson, Chairman
DATE: