MINUTES OF THE

JOINT Subcommittee on

Human Resources/K12

of the

Senate Committee on Finance

AND THE

Assembly Committee on Ways and Means

 

Seventy-second Session

March 13, 2003

 

 

The Joint Subcommittee on Human Resources/K12 of the Senate Committee on Finance and the Assembly Committee on Ways and Means was called to order by Chairman Raymond D. Rawson at 8:03 a.m. on Thursday, March 13, 2003, in Room 3137 of the Legislative Building, Carson City, Nevada. The meeting was videoconferenced to the Grant Sawyer State Office Building, Room 4401, Las Vegas, 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.

 

Senate COMMITTEE MEMBERS PRESENT:

 

Senator Raymond D. Rawson, Chairman

Senator William J. Raggio

Senator Barbara K. Cegavske

Senator Bernice Mathews

 

Assembly COMMITTEE MEMBERS PRESENT:

 

Ms. Sheila Leslie, Chairman

Mrs. Dawn Gibbons

Ms. Christina R. Giunchigliani

Mr. David E. Goldwater

Mr. Lynn C. Hettrick

 

STAFF MEMBERS PRESENT:

 

Gary L. Ghiggeri, Senate Fiscal Analyst

Steven J. Abba, Principal Deputy Fiscal Analyst

Michael J. Chapman, Program Analyst

Denise Davis, Committee Secretary

 

OTHERS PRESENT:

 

Dave Luke, Associate Administrator for Developmental Services, Division of Mental Health and Developmental Services, Department of Human Resources

Stan Dodd, Clinic Director, Desert Regional Center, Division of Mental Health and Developmental Services, Department of Human Resources

Michael J. Willden, Director, Department of Human Resources

Marcia Bennett, Director, Rural Regional Center, Division of Mental Health and Developmental Services, Department of Human Resources

Brian L. Lahren, Lobbyist, Washoe Association for Retarded Citizens

Dr. Rena M. Nora, Commission on Mental Health and Developmental Services; Chairman, Psychiatry Advisory Committee to the Director of Human Resources

LaVonne Brooks, CEO and Executive Director, High Sierra Industries

Vic Davis, President, Nevada National Alliance for the Mentally Ill

Kristina Wahlmeier

Toni Richard

Esperanza Gudino

Michelle Hogue

 

 

HUMAN RESOURCES, MENTAL HEALTH AND DEVELOPMENTAL SERVICES

 

Dave Luke, Associate Administrator for Developmental Services, Division of Mental Health and Developmental Services, Department of Human Resources, began his presentation by describing some of the types of mentally disabled people served by the division’s programs. A 10-year old boy who suffered serious brain injury during birth is helped in his home by the Rural Regional Center with financial assistance and family relief, and the family preservation program has helped his family stay intact. A 36-year old man, diagnosed with moderate mental retardation and seizures after birth, moved from an institution to a home shared with friends through an intensive supported living arrangement funded through Desert Regional Center. He works in a small supervised work group; he learned his job skills at a community training center funded by the regional center. An 18-year old woman experienced head trauma during an accident. After 30 years of group homes, the mildly retarded 54‑year old lives in her own apartment through the Sierra Regional Center’s supported living arrangement. She has gone from 20 hours a week of private provider assistance to 4 hours a week. Job coaches from the regional center helped her find jobs, and she volunteers with the community cleanup organization.

 

Dr. Luke reported 3200 Nevadans receive services from the Division of Mental Health and Developmental Services. He explained the proposed budget will serve 800 additional people over the next biennium. Senator Rawson asked what percentage of Nevadans are diagnosed with mental retardation or developmental disabilities. Dr. Luke estimated approximately one-tenth of 1 percent of the population needs assistance to function. He pointed out the intake system in Nevada allows people to qualify quickly for assistance, which aids diagnosis, so reported numbers accurately reflect the need for assistance. Projections based on the State’s experience indicate 4088 individuals will be receiving services by the end of the next biennium.

 

Senator Rawson inquired whether advocates are promoting the idea of separating mental retardation from mental health. Dr. Luke responded the main issue of people with disabilities is the desire to be seen as individuals and not as their disability. Senator Rawson asked whether the organizational structure fit the needs of the State. Dr. Luke explained there are three regional centers serving the major areas of Nevada; they are the entry points for people seeking help.

 

Assemblywoman Leslie asked if the mentally retarded people receiving assistance in Nevada, which is estimated to be one-tenth of 1 percent of the population, is a low percentage compared to other states. Dr. Luke responded it is not unusual compared to other states, and a certain number of people who qualify for help do not seek it. Assemblywoman Leslie asked how many people have both mental illness and mental retardation and whether they are the most difficult clients to serve. Dr. Luke replied it is a very challenging group to serve. He indicated the group is probably overrepresented because these people have been identified as needing assistance. Assemblywoman Leslie noted many also have addiction problems and inquired whether specific programs exist for them in the State. Dr. Luke responded addictions are experienced by a minority of people being helped, and added the regional centers have dual diagnosis programs for individuals diagnosed with both mental retardation and mental health disorders. He pointed out many of these people are able to live in the community, but require additional support.

 

Senator Rawson noted families are placed under severe stress trying to cope with disability situations. He asked if Nevada has a higher number of single parents raising disabled children. Dr. Luke said he did not have statistics for Nevada, but replied national surveys indicate there is a higher incidence of breakup and divorce in families facing disabilities. Senator Rawson asked if families have access to other public funding, such as Medicaid and Temporary Assistance to Needy Families (TANF). Dr. Luke explained the family preservation program gives approximately $300 a month in cash assistance, based on need. He said the division also tries to help individuals with all assistance available to them, such as Medicaid and in-home supports, including respite and habilitation.   

 

Senator Rawson asked whether there has been controversy regarding rate increases, and whether the increases will be adequate for the biennium. Dr. Luke replied the increases, which are proposed at 7 percent the first year and an additional 8 percent the second year, will help strengthen the provider network, which the community-based care model depends on. Dr. Luke said he participated in the study group for A.B. No. 513 of the 71st Session, which recommended higher increases than providers requested. He explained the rate increases will aid in decreasing turnover of direct-care staff, which is a major concern.

 

Senator Rawson asked if adjustments for caseload increases are included and how the waiting list will be affected. Dr. Luke answered budgets for all regional centers include caseload increases. Maintenance unit 200 (M‑200) projects caseloads will increase by 296, based on State population increases and regression analysis. Enhancement unit 431 (E-431) will provide services to 258 people on the waiting list. He said services will be phased in, so waiting lists will continue. Dr. Luke added the number of people waiting for services has grown in the past year due to the State’s fiscal situation; as an example, the number of individuals waiting for residential support has increased from 160 a year ago to 235 now. Senator Rawson asked how long people are waiting to receive services. Dr. Luke answered the statewide average is 8 months. He said performance indicators have a goal of 90 days, but half of the people on the list have been waiting longer than 90 days.

 

Assemblywoman Giunchigliani asked whether the rate increases are for community training centers and supportive living arrangement programs. Dr. Luke replied they are. Assemblywoman Giunchigliani confirmed the 1.7 percent increases scheduled for the second year of the current biennium were never implemented due to budget cuts. She asked if the proposed rate increases of 7 percent and 8 percent incorporate the previously approved 1.7 percent increase. Dr. Luke answered they do not; the 1.7 percent increase is lost. Assemblywoman Giunchigliani asked how 800 additional people will be served if M-200 and E‑431 only total 554. Dr. Luke explained M‑200 projections of 296 are for the first year of the biennium; growth for the second year is estimated to be 594 people. Assemblywoman Giunchigliani asked what amount would be required to eliminate all waiting lists for the different programs offered. Dr. Luke replied the proposed budget should eliminate all waiting lists. He explained waiting lists will always exist because of initial processing time, moving from one living arrangement to another, and waiting for apartment vacancies. He repeated the goal is to take less than 90 days to provide services, which is also the federal recommendation.

 

Assemblywoman Giunchigliani asked how many people will not be served under the proposed budget. Senator Rawson asked where Nevada ranks in comparison to other states. Dr. Luke answered Nevada is last among states in terms of fiscal effort. He added the State will remain in last place with the proposed budget because the utilization rate is low. He reported Nevada ranks in the top half for the number of people in community settings. Assemblywoman Giunchigliani stated she would like to fund all human services adequately and improve Nevada’s low rankings. Senator Rawson asked which programs should be increased to improve the State’s rankings. Dr. Luke replied some programs and services require startup time; taking all things into consideration, the State is doing a good job of meeting needs. Senator Rawson asked how much, in dollar terms, the lost 1.7 percent increase represented. Dr. Luke said he did not have that figure in his information.

 

Assemblywoman Leslie reviewed the rate study, which notes Nevada is paying 35 percent less than it should be paying. She stated her belief that budget limitations have hampered the State’s ability to reach the people needing help. She agreed timelines prevent implementation of all the programs that could be done, but she wants to see Nevada’s rankings improve. She asked, if Nevada was ranked 45 instead of 50, what would be different in terms of people served and programs offered. Senator Rawson said rankings of other states in the western region are also useful, in addition to national rankings. Assemblyman Hettrick asked what the expenditure per enrollee is for each program, and how it compares to regional expenditures. He pointed out Nevada will rank low in studies using per capita statistics because the State’s population is low.

 

Senator Rawson inquired how intermediate care facility beds are being used since people are being moved into the community. Dr. Luke reported the number of institutional beds is being reduced by 24. The Sierra Regional Center reconfigured its space to create individual bedrooms. Senator Rawson asked if staffing levels are adequate for the new arrangement. Dr. Luke answered there are fewer behavioral problems because there is less crowding; the quality of life and the quality of services has improved. Stan Dodd, Clinic Director, Desert Regional Center, Division of Mental Health and Developmental Services, Department of Human Resources, reported similar decreases in behavioral problems at the Desert Regional Center since reconfiguration. He told the committee 18 beds and 1 building have been closed at the facility, and the building is being used as office space for maintenance staff, and for storage of records and residents’ belongings. Senator Rawson said the building will be discussed in more detail during the capital improvement presentation.

 

Senator Rawson asked whether bringing patients back to Nevada from other states will result in General Fund savings. Dr. Luke explained the current plan is to bring 14 patients back to Nevada, and the cost of their in-state community services is included in the budget. Savings will show up in the Medicaid budget. Senator Rawson said staff had been unable to find the savings calculations.

 

HR, Sierra Regional Center - Budget Page MHDS-51 (Volume 2)

Budget Account 101-3280

 

Dr. Luke briefly reviewed items listed on page 2 of Budget Overview, Developmental Services Agencies, FY2004-05 (Exhibit C. Original is on file in the Research Library.).

 

HR, Desert Regional Center - Budget Page MHDS-59 (Volume 2)

Budget Account 101-3279

 

Senator Rawson asked why an unfilled computer position is being retained in the budget while a half-time speech therapy position, which is filled, is being eliminated. Mr. Dodd replied there is currently no support staff for over 100 computer users at the center, and the position is in the process of being filled. He explained the center has two full-time speech therapists. Since the number of residents is decreasing and the center has been asked to eliminate one position, the decision was made to eliminate the speech position. Assemblywoman Leslie asked whether the speech therapist will be employed in another position. Not at the center, Mr. Dodd answered, but possibly at the school district.

 

Senator Rawson asked about the likelihood of capital improvement items being cut from the budget. Dr. Luke replied most projects are scheduled maintenance items and depend on money from the State Public Works Board. Senator Rawson said he has concerns about paying for maintenance projects for 30 years. He asked whether all the projects are necessary, considering parts of the facility are being closed.

 

HR, Family Preservation Program - Budget Page MHDS-67 (Volume 2)

Budget Account 101-3166

 

Dr. Luke explained the family preservation program consists of cash assistance to families of people with severe mental retardation living in the home. He stated it is one of the most cost-effective things the State does. The program is capped, so as the number of participants increases, the amounts awarded decreases. At the current budget funding level, payments will be $178 a month. Using estimates of participants, the proposed budget will raise the payment to $310. Senator Rawson asked why the payment level on page 18 is indicated as $310.05. Dr. Luke said $310.05 is the average payment; payments depend on family income.

 

Senator Rawson asked whether more of the participants could qualify for TANF money. Dr. Luke answered TANF pays for 112 people. More could qualify, he said, but he understood there is no more TANF money. Senator Rawson asked whether there is a maximum amount of TANF funds available from the federal government. Michael J. Willden, Director, Department of Human Resources, replied the maximum is approximately $47 million a year in the TANF block grant, which is capped. The State maintenance of effort level is about $27 million, and in the next biennium, an additional $56 million is needed. Senator Rawson asked whether the State’s federal delegation is involved in getting more federal aid for the State. Mr. Willden explained letters are sent and representatives from the department meet with the federal legislators before TANF is reauthorized to explain a different formula is needed for states with high population growth. Senator Rawson proposed the committee write a letter or vote on a resolution to ask the federal delegates to address the issue. Assemblywoman Leslie agreed with the proposal, and mentioned the governor of Florida is discussing the same issue.

 

Assemblywoman Leslie asked whether families participating in the program typically receive other services. Dr. Luke replied 100 percent of families receive other services.

 

HR, Rural Regional Center - Budget Page MHDS-70 (Volume 2)

Budget Account 101-3167

 

Senator Rawson noted the request for a new phone system. Marcia Bennett, Director, Rural Regional Center, Division of Mental Health and Developmental Services, Department of Human Resources, explained the office is moving and expanding, so a new phone system is necessary. Senator Rawson asked about the accreditation review timeline. Dr. Bennett responded the survey is expected no later than October, then the Council on Quality and Leadership will take another 6 to 7 months. Assemblywoman Leslie asked whether the other two centers are accredited. Dr. Luke confirmed the other centers are accredited by the council, which is known for its high standards.

 

HR, Mental Health Information System - Budget Page MHDS-78 (Volume 2)

Budget Account 101-3164

 

Senator Rawson commented the committee has already heard about most of the items in the budget.

 

Brian L. Lahren, Lobbyist, Washoe Association for Retarded Citizens (WARC), reiterated 1 percent of Nevada’s population has developmental difficulties, and one-tenth of those people receive services. He explained waiting lists are not reliable indicators of need because people drop out of the process while waiting for services. He pointed out waiting lists still exist, despite full funding for the past two biennia. Dr. Lahren stated no one knows what Nevada’s actual background rate of severe disabilities is, but it should be close to 1 percent. Reading from his written statement (Exhibit D), he gave a brief history of the previous 22 years. He stated it has taken a decade to return to the level of service achieved in 1992, approximately 27,000 people. He stressed consistent effort over time is required to reach individuals needing help. Dr. Lahren pointed out the largest transfer of wealth took place during the 1990s, and the tax base needs to be reexamined. He said the United States is one of the only industrial societies that does not take care of its frail elderly, the medically indigent, and people with disabilities. He stated Nevada takes care of only a small number of its disabled; more and better services are needed.

 

Dr. Lahren explained the community training center system in Reno used to contribute $700,000 a year, which it earned through its Pier 1 store, coffee shop, and 4 thrift stores, to support services because funding was not provided at promised levels. Now the system is on the verge of collapse. As an example, Dr. Lahren reported that even though WARC earned $4.5 million last year, it recorded a loss of $90,000 for the year. He told the committee it will cost the State $12.45 an hour to provide direct care services to people if WARC goes broke. He stated the turnover rate at WARC is over 100 percent per year; workers are responsible for helping individuals with personal hygiene, feeding, and transportation, but their starting pay is just under $8 an hour. He said money is needed for training programs.

 

Dr. Lahren reminded the committee Nevada is the lowest fiscal effort state and the lowest state drawing Medicaid. This means there is no money for services. Nevada receives 54 cents from the federal government for every dollar spent on services. More matching money is required to improve services. Senator Rawson said the taxation committee needs to understand the State’s obligation to the disabled so more money is raised to support programs, and urged Dr. Lahren to speak before them also. Assemblywoman Leslie asked how the State’s poverty ranking relates to the number of people not served by programs. Dr. Lahren said he is not sure there is a connection. He told the story of a working single parent who eventually had to stop working and go on welfare because services could not be provided to the family in a timely fashion because of the budget crisis. He pointed out welfare is more expensive than providing services, and no one benefits. Assemblywoman Leslie stated middle- and upper-income families also need services, and explained how the State’s programs are helping a member of her extended family. She thanked Dr. Lahren for his work and excellent programs.

 

Dr. Rena M. Nora, Commission on Mental Health and Developmental Services; chairman, Psychiatry Advisory Committee to the Director of Human Resources, said the budget is beyond a “bare bones” level; it is at a “marrow” level. She explained increases in the budget will have to be used to catch up with items that have already been deferred; new services will have to wait. She read her prepared statement (Exhibit E). Dr. Nora expressed appreciation for the commitment to a new psychiatric acute bed wing, but she stressed a short-term solution is needed until it is operational. Senator Rawson replied a task force of the subcommittee is working on a solution.

 

LaVonne Brooks, CEO and Executive Director, High Sierra Industries (HSI), said 116 people are participating in employment training. She reported HSI has a new contract with the Fallon Naval Air Station for grounds maintenance and a small supported living program. Ms. Brooks mentioned her involvement as vice chairman of the rate study task force for A.B. No. 513 of the 71st Session, and thanked the committee for its work on the issue. She emphasized the programs of HSI, WARC, and Opportunity Village contribute about $2 million a year to the State; they are not just cost-saving measures. At HSI, the cost to serve an individual is approximately $15,000 a year; reimbursement is about $8500. Ms. Brooks reported her program is capped at 40 people and maximum enrollment was reached 6 months ago. It cannot be increased due to staff turnover. She said if funding is increased, HSI would do more employment support. She stressed technology training must be increased, because many of the jobs being performed today will soon be exported to other countries. She introduced Chantale Perry, a participant in the supported living program and worker in the production facility. Ms. Brooks shared Ms. Perry’s monthly budget: $304 in revenues to pay for groceries, leisure recreation, personal hygiene, and housekeeping. Ms. Brooks pointed out an 8 percent increase will only increase Ms. Perry’s revenues to about $324 a month.

 

Ms. Brooks explained the goal of assisted living programs opposes the needs of the agency. As people become more independent and require fewer services, the organization receives less money. For example, HSI has 40 contracts for the supported living program and returned almost $6500 last year. She stated almost two more contracts could have been served, but from the organization’s viewpoint, it loses money by helping people become independent. 

 

Vic Davis, President, Nevada National Alliance for the Mentally Ill, discussed the proposed mental health information system. He reported the State has already supplied a database system, which includes billing and patient tracking modules. He said the patient tracking will allow the crisis center, hospital, medical clinic, service coordinators, psychotherapists, and social rehabilitation to access patient records and coordinate services. He explained the system is scheduled to be installed in the Reno area first; the Las Vegas system is planned for 2005. Mr. Davis said transferring paper records has been relatively easy in Reno, but Las Vegas has problems because more facilities are involved. Patients often begin treatment without their records available. Mr. Davis urged the committee to reconsider the current plan, and install the system in Las Vegas first.

 

Kristina Wahlmeier read her testimony (Exhibit F) concerning the services she receives from the Sierra Regional Center. Toni Richard stated her belief that the statistics reported are low compared to actual need, and families are leaving the State in frustration. She said her 2-year old autistic son has been on waiting lists for 8 months; it is important that he receive services now because he is at an optimum age in the learning process. She emphasized if he does not receive services soon, he might lose the opportunity to be helped and could ultimately be institutionalized, which will cost the State more. Assemblywoman Leslie asked which waiting lists he is on. Ms. Richard replied he is on the list at special children’s, Sierra Regional Center, respite care, and speech at the University of Nevada, Reno. Assemblywoman Leslie asked if any service dates have been given. Ms. Richard responded service at the university is a possibility in the summer or fall, which will be over a year since application.

 

Esperanza Gudino explained the skills she has learned from her foster parents over the past 3 years, such as cooking, riding public transportation, and decision-making. Michelle Hogue, Ms. Gudino’s foster mother, told the committee she has been participating in Sierra Regional Center’s supported living program for about 6 years. She explained she often assists participants who have children with learning disabilities. Ms. Hogue encouraged the committee to provide funding for programs that will help families keep their children at home and not in institutions. Ms. Gudino introduced her daughter Ashiah. Written testimony by Joe Tyler (Exhibit G), Elaine Evans (Exhibit H), Marie Hoagland (Exhibit I), and Elizabeth Millett (Exhibit J) was submitted to the committee. Senator Rawson adjourned the meeting at 9:31 a.m.

 

 

RESPECTFULLY SUBMITTED:

 

 

                                                           

Denise Davis,

Committee Secretary

 

 

APPROVED BY:

 

 

                                                                                         

Senator Raymond D. Rawson, Chairman

 

 

DATE:                                                                             

 

 

                                                                                         

Assemblywoman Sheila Leslie, Chairman

 

 

DATE: