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
April 28, 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 8:12 a.m. on Monday, April 28, 2003, in Room 3137 of the Legislative Building, Carson City, Nevada. The meeting was videoconferenced to the Grant Sawyer State Office Building, Room 4406, 555 East Washington Avenue, 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
Bob Atkinson, Program Analyst
Judy Coolbaugh, Committee Secretary
OTHERS PRESENT:
Carlos Brandenburg, Ph.D., Administrator, Division of Mental Health and Developmental Services, Department of Human Resources
Dave Luke, Ph.D., Associate Administrator for Developmental Services, Division of Mental Health and Developmental Services, Department of Human Resources
Jessi Evans, Interagency Coordinating Subcommittee, Board Member, Las Vegas
Yvonne Sylva, M.P.A., Administrator, Health Division, Department of Human Resources
Michael J. Willden, Director, Department of Human Resources
Philip Weyrick, Administrative Services Officer, Health Division, Department of Human Resources
Michael J. Chapman, Program Analyst, Fiscal Analysis Division, Legislative Counsel Bureau:
Before we go through the overview of the Division of Mental Health and Developmental Services (MHDS), I would like to direct your attention to Budget Closing List #4, page 4. (Exhibit C. Original is on file in the Research Library.).
HR, MHDS Administration – Budget Page MHDS-1 (Volume 2) Budget Account 101-3168
Mr. Chapman:
The first item is the Governor’s recommendation for a new management analyst IV position to oversee the Health Insurance Portability and Accountability Act (HIPAA) of 1996 for the entire division. The Executive Budget recommends $51,142 from the General Fund in fiscal year (FY) 2003‑2004 and $61,904 in FY 2004-2005 for the position and associated staffing costs in support of the program. During the February 17, 2003, budget hearing the administrator testified the division needed to have its own HIPAA officer to adequately ensure compliance with the HIPAA because the agency has 2 inpatient hospitals, emergency services units, outpatient services, a forensic facility, and 19 clinics to oversee and support the facilities within the agency. Staff does recommend an adjustment to remove dues and registration of $500 per year in the out-of-state category, since the amount is duplicated in the training category. Adjustments are also recommended for the prices of computer hardware and software as provided by the purchasing division.
The other item of note in this budget account is the elimination of the psychiatric resident program with the University of Nevada, Reno (UNR). The resident program was utilized by the Northern Nevada Adult Mental Health Services (NNAMHS) to provide psychiatric interns from the UNR Medical School in support of services provided at the medication clinic, inpatient facility, and psychiatric emergency services. The agency’s request indicates that elimination of the interns will increase the length of time required for clients to obtain these services. Eliminating the program reduces the General Fund appropriations by the amount of $143,969 in each year of the biennium.
Under other closing items in this budget account, I refer you to item 1, page 5. The Governor recommends transferring a 0.75 full time employee (FTE) licensed psychologist position to the Lakes Crossing Center (LCC). The position will be increased to a full-time position in the LCC budget account, (B/A) 101‑3645. The position will continue to provide evaluation and treatment services to clients subject to the review of the Department of Corrections’ (DOC) sex offender panel. During the budget hearing, the administrator testified the number of cases and associated preparation time has increased because the DOC has requested a single evaluator be assigned to all sex offender panels. In‑state travel is necessary due to the various locations in the State where the panel meets. Technical adjustments are recommended for revised computer and software pricing as provided by the purchasing division. The Governor recommends General Fund appropriations in the amount of $14,026 in FY 2003-2004 and $6443 in FY 2004-2005.
Under item 4, page 5, the budget office submitted amendment 6 reducing the partnership approach to health (PATH) grant by $1000 in each year of the biennium for proper alignment with the amount of the award and associated program costs. Staff concurs with this amendment.
Senator Rawson:
During our first budget hearing on this agency we had discussions about replacing or canceling the psychiatric resident program. Are there any further comments on the elimination of the psychiatric resident program at UNR?
Assemblywoman Leslie:
I recall the discussions. For the amount of money it costs to fund the program, the State receives back far more in services to the community. I recommend reinstatement of the program.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3168 AS RECOMMENDED BY THE GOVERNOR AND WITH REINSTATEMENT OF THE PSYCHIATRIC RESIDENT PROGRAM WITH UNR AND WITH THE AUTHORITY FOR STAFF TO MAKE TECHNICAL ADJUSTMENTS AS NEEDED.
ASSEMBLYWOMAN GIUNCHIGLIANI SECONDED THE MOTION.
Assemblyman Hettrick:
I have a technical question on page 4 under the totals shown as General Fund impact made by the closing changes. In FY 2004, the line item changes to expenditures show a reduction of $1306 and the grand total General Fund impact is a reduction of $171. In FY 2005, the line item changes to expenditures show a reduction of $802 and the grand total General Fund impact is a $280 increase. Could I have clarification on the discrepancy in the figures?
Mr. Chapman:
In the revenue portion, General Funds are added to realign the PATH grant, which increases the General Fund appropriation, but decreases the PATH grant award to its program cost level. The line item changes to revenues line shows all revenue adjustments. The last line is showing only the amounts that impact the General Fund.
THE MOTION CARRIED UNANIMOUSLY.
*****
Assemblywoman Giunchigliani:
Is the subcommittee keeping track of the total number of HIPAA positions being authorized?
Senator Rawson:
Yes, we are watching the HIPAA positions closely.
Mr. Chapman:
Before we move to the next budget, I refer the subcommittee to the overview of mental health services issues on page 1. The division of MHDS is responsible for the development, administration, coordination and evaluation of State treatment and training programs for the mentally ill and for mentally retarded citizens. The division consists of the administration division and the following programs and facilities: NNAMHS, Southern Nevada Adult Mental Health Services (SNAMHS), LCC, Rural Clinics (RC), Desert Regional Center (DRC), Sierra Regional Center (SRC), Rural Regional Center (RRC), and the Family Preservation Program (FPP).
The Governor recommends a total 2003-2005 biennium budget for the division of MHDS of $371.6 million, a 33.8 percent increase over the 2001‑2003 biennium legislatively approved total of $277.8 million. General Fund appropriations recommended in the 2003-2005 biennium total $247.3 million, an increase of $63.6 million, or 34.6 percent, over the 2001‑2003 biennium legislatively approved appropriations of $183.8 million.
This common issue-closing document addresses the service provider rate increases that affect all the budgets in both mental health services and developmental services. Other common issues, that affect only the mental health budgets, are medication cost inflation increases and pharmacist salary reclassifications.
The recommended rate increases for service providers are covered under item 1, page 1. The service provider rate increase is included in the NNAMHS, SNAMHS, RC, DRC, SRC, and RRC budgets. The Governor recommends an increase of 7 percent in FY 2003-2004, effective January 1, 2004, and an additional increase of 8 percent in FY 2004-2005 to supported living arrangement (SLA) and community training center (CTC) service providers. Recommended funding totals $1.7 million, $1.1 million in General Fund appropriations, in FY 2003-2004 and $8.7 million, $5.4 million in General Fund appropriations, in FY 2004-2005. The amounts recommended to fund the rate increases for each agency are displayed in the chart at the bottom of page 1.
This recommendation was developed by the passage of Assembly Bill (A.B.) 513 of the 71st Session, which directed the Department of Human Resources (DHR) to develop a strategic plan related to service provider rates. A letter of intent was also included with A.B. 513 of the 71st Session directing the DHR to apply the findings of the rate increase studies to the construction of the division’s budget request for the FY 2003-2005 biennium. During a review of the documentation supporting the rate increases, it was determined that $337,948, of which $280,009 is from the General Fund, can be reduced from the 2003-2005 biennium budget.
If the subcommittee chooses to consider another rate, each 1 percent increase in the amount of rate increase impacts the General Fund by approximately $302,000 in FY 2003-2004 and approximately $343,000 in FY 2004-2005, based upon the revised calculations provided in the budget amendments.
Under item 2, page 2, the inflationary increases in medication costs affect the NNAMHS, LCC, SNAMHS, and RC budgets. The Governor’s recommended budget provides for significant increases in medication costs, from $11 million in FY 2001‑2002 to $17 million in FY 2003-2004 and to $20.9 million in FY 2004-2005. Actual and recommended medication costs are displayed by agency in the table at the bottom of page 2. The subcommittee should note the amounts do not include medication costs reimbursed by the Division of Child and Family Services. The increases noted are a combination of adjustments reflecting inflation, caseload growth, and utilization of new generation medications. The mental health budget accounts reflect compounded inflation increases based upon data provided by the Center for Medicare and Medicaid Services. During a review of documentation supporting medication inflation increases, a Budget Division amendment was submitted that results in a combined General Fund savings of $480,496 in FY 2003-2004 and $523,508 in FY 2004-2005.
Staff notes it is in the process of evaluating new information recently identified that may provide an opportunity for additional savings to the General Fund. However, staff did not have ample time to adequately analyze the information prior to this closing hearing. If there should be additional reduction adjustments to the inflation component of the module units, staff would like to return to the subcommittee with the new figures. Currently, staff does not recommend any other changes to this item in order to close the budget.
Under item 3, page 3, the pharmacist salary reclassifications that affect the SNAMHS and NNAMHS budgets are reviewed. The recommendation affects 6 FTE pharmacists at the SNAMHS and 5.01 FTE pharmacists at the NNAMHS. The Governor recommends the pharmacist class series be moved from the regular classified pay schedule to the classified medical pay schedule. A recent Department of Personnel study suggests the State pharmacists’ salaries are substantially less than those paid in the private sector, which has resulted in a high turnover rate. Staff also notes a technical adjustment to align the salary step for the current pharmacist III position in the SNAMHS budget. The adjustment reduces the General Fund need by a total of $51,346 in the 2003‑2005 biennium.
It may be preferable and more expeditious to take action on the items staff has just covered because they affect a number of budget accounts.
Assemblywoman Leslie:
I would like to see us hold faith with A.B. 513 of the 71st Session and approve the rate increases. These agencies have been underfunded for years, and if we do not approve the rate increases we are going to lose even more of our service provider networks.
Senator Rawson:
I will accept a motion.
ASSEMBLYWOMAN LESLIE MOVED TO APPROVE THE SERVICE PROVIDER RATE INCREASES OUTLINED IN THE BUDGET CLOSING DOCUMENT, THE MEDICATION COSTS INCREASE WITH STAFF TO REVIEW FOR GENERAL FUND SAVINGS, AND THE PHARMACIST SALARY RECLASSIFICATIONS.
SENATOR RAGGIO SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Northern NV Adult Mental Health – Budget Page MHDS-7 (Volume 2) Budget Account 101-3162
Mr. Chapman:
The NNAMHS provides psychiatric and psychological services to the seriously and chronically mentally ill population in northern Nevada, including inpatient hospital, service coordination, and residential support services. The inpatient hospital is staffed for 40 beds and a 10-bed psychiatric observation unit (POU).
There are three closing items staff would like to call to the subcommittee’s attention. Under item 1, page 8, the Governor recommends additional funding of $4 million, $3.7 million in General Fund appropriation, in the 2003‑2005 biennium for projected caseload growth in the medication clinic, community residential support services, and outpatient counseling. The division utilizes a linear regression model in determining caseload growth through its caseload evaluation organization (CLEO). The Executive Budget recommends a total of 8.77 FTE positions for all three services. A total of 7.02 FTE positions are needed in the medication clinic to serve an additional 637 clients in FY 2003-2004 and 130 clients in FY 2004-2005. The division indicates the large caseload growth in the first year of the biennium is the result of not budgeting for medication caseload increases in the 2001-2003 biennium. The CLEO analysis indicates outpatient counseling caseload increases of 128 clients in the 2001‑2003 biennium, with an additional 27 clients in FY 2003-2004, for a total of 155 clients. A total of 465 clients are projected to be receiving outpatient services by the end of the 2003-2005 biennium. The table at the bottom of page 8 summarizes recommended funding and positions for the caseload decision units.
Under item 2, page 9, the Governor recommends funding to continue the mental health court, implemented by Washoe County in January 2001, as an alternative to sentencing severe mentally ill individuals to jail by ordering them to undertake a program of outpatient treatment. Recommended funding totals $292,205 in FY 2003-2004, including $272,711 in General Fund appropriations; and $385,760 in FY 2004-2005, including $355,628 in General Fund appropriations to contract with Project Restart, which provides service coordination for program clients. Staff would note that A.B. 29, currently in the Assembly Committee on Ways and Means, would provide for an additional court assessment to pay for specialty court programs including the mental health court program.
ASSEMBLY BILL 29: Provides for additional administrative assessment to be collected in certain cases involving misdemeanors to pay for certain programs established by district courts. (BDR 14-130)
The agency’s request indicates the Project Restart contract funding supports service coordination in tiers of 15 clients each up to a total of 45 clients. The subcommittee should note the amount for the Project Restart service coordination contract is overstated by $18,968 per year. The budget office submitted Amendment No. 32 reducing the General Fund by the same amount in each year to align the cost with the terms of the contract. The division indicates approximately 67 percent of the individuals assigned to the mental health court will require SLAs, and funding is included to support up to 30 community residential support services.
In response to questions posed by the subcommittee at the February 17, 2003, budget hearing, the division provided three performance indicators for consideration. The first performance indicator is to record the percent of time clients were in inpatient care before and after assignment to the mental health court. The second indicator is to record the percent of time clients were incarcerated before and after assignment to the mental health court. The third indicator is to record the percent of no-shows recorded for the medication clinic for Project Restart clients as compared to the overall no-show rate for the NNAMHS medication clinic.
If the subcommittee wishes to approve the Governor’s recommendation to fund the mental health court, staff suggests the inclusion of a letter of intent directing the division to incorporate the performance indicators for the mental health court into the Executive Budget in future biennia.
Under item 3, page 9, the Governor recommends total funding reductions in the 2003-2005 biennium of $446,490, including $218,475 in General Fund appropriations. The items eliminated to generate the budget reductions are as follows: elimination of a psychiatric caseworker position in outpatient services, elimination of client bus passes, reduction in training for mental health technicians, elimination of the NNAMHS campus security contract, and elimination of the 8-bed residential treatment program. However, the Governor recommends reallocating a portion of the budget reduction savings to support 15 additional residential support placements including 2 intensive supportive living arrangements (ISLA), 5 regular plus supportive living arrangements (PSLA), and 2 SLAs.
Under item 3, page 10, subcommittee discussion at the previous hearing focused on the duplication of computer equipment between the various MHDS division’s accounts and the computer equipment provided for in the Advanced Institutional Management Software (AIMS) to the Avatar system conversion project, which is in the information technology projects account, B/A 101-1325 found in Volume 1. The agency indicates the Creative Socio-Medics (CSM) Corporation acquired the assets of AIMS in May 2001. The MHDS division contracted with CSM in May 2002 to conduct a system design study and gap analysis to upgrade the AIMS system with the Avatar system. A final draft of the gap analysis recommendations identified the implementation strategy necessary to complete the transition to the Avatar system. Staff has determined there is no duplication of funding for the NNAMHS account. The only technical adjustment staff would note is to align the property and contents insurance costs with the amounts provided by the risk management division. There is a corresponding adjustment for the same amount in the SNAMHS budget.
Assemblywoman Leslie:
I want to disclose for the record that I work in the mental health court system, but I will be voting on this budget account since the funds go directly to NNAMHS.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3168 AS RECOMMENDED BY THE GOVERNOR WITH A LETTER OF INTENT TO THE MENTAL HEALTH COURT TO INCLUDE PERFORMANCE INDICATORS AND WITH THE AUTHORITY OF STAFF TO MAKE TECHNICAL ADJUSTMENTS.
SENATOR RAGGIO SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Facility for the Mental Offender – Budget Page MHDS-18 (Volume 2)
Budget Account 101-3645
Mr. Chapman:
The Lakes Crossing Center is located in Washoe County and is Nevada’s only program for mentally disordered offenders.
Under item 1, page 11, this account receives the 0.75 FTE licensed psychologist position transferred from the division of MHDS administration, B/A 101-3168, with a decision unit to increase the position to full time. The agency is requesting a 0.25 FTE psychologist position, which along with the transfer of a 0.75 FTE psychologist will create a full-time position. Additional General Fund appropriations of $22,031 in FY 2003‑2004 and $21,972 in FY 2004-2005 are required to fund the position.
Under item 2, page 12, the Governor recommends funding reductions totaling $764,745 in the 2003-2005 biennium, $409,684 in General Fund appropriations, to eliminate five positions that provided mental health services to the Clark County Detention Center and the Las Vegas city jails.
In item 2, page 12, under other closing items, the Governor recommends $28,000 per year to enter into a contract with the UNR Medical School to provide for a psychiatric resident program.
In item 5, page 12, under other closing items, the Governor recommends a General Fund appropriation of $5,020 in FY 2004-2005 to purchase a variety of body protection equipment for staff safety when client disturbances occur at the facility. Staff recommends moving the funding to FY 2003-2004 because of the staff safety issue.
Under other items at the bottom of page 12, the Governor recommends increases in the costs of fringe benefits. However, since some of the funding for this budget account comes from Washoe County and the rural counties, staff would like the opportunity to explore the issue with the agency to determine whether county reimbursements could be increased for a net result of reductions in General Fund appropriations. Staff would bring those recommendations back to this subcommittee for consideration.
Assemblywoman Leslie:
I want to disclose for the record that I am the Washoe County staff person who handles the contract with the LCC. I am not representing Washoe County in this matter.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3645 AS RECOMMENDED BY THE GOVERNOR AND WITH APPROVAL TO MOVE THE SAFETY EQUIPMENT APPROPRIATION TO FY 2003-2004 AND WITH THE AUTHORITY FOR STAFF TO MAKE TECHNICAL ADJUSTMENTS AS NEEDED.
ASSEMBLYWOMAN GIUNCHIGLIANI SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Southern Nevada Adult Mental Health Services – Budget Page MHDS-34
(Volume 2) Budget Account 101-3161
Mr. Chapman:
The 71st Session approved funding to staff a total of 88 inpatient beds at the facilities. The funding provided 78 acute inpatient beds and a 10-bed POU. In May 2002, in response to the increasing demand for emergency services, the SNAMHS increased the POU to 20 beds and reduced the acute inpatient beds to 68. The SNAMHS realigned its staff to support this reorganization.
Under item 1, page 14, the Governor recommends additional funding to reinstate the staffing for the acute inpatient facility to restore its capacity to 77 acute inpatient beds. The one bed reduction is attributable to a change in the building utilization. The Governor recommends increasing the staffing for the POU from 10 to 26 beds. The total funding is $3.3 million over the biennium, including $3.2 million in General Fund appropriations. A total of 36.7 FTE staff positions will be added to support the POU bed increase. The recommended staffing for the increase in POU beds is based upon the previously approved staffing level for the original 10 beds.
Under item 2, page 14, the Governor recommends expanding the program for assertive community treatment (PACT). The current program has reached its capacity of 72 clients. The expansion of the program would provide funding for an additional 72 clients and adds 7.53 FTE staff positions. This is the same staffing level that supports the current PACT.
Under item 3, page 15, the Governor recommends establishing a new mobile crisis unit which would employ 5.6 FTE positions to provide crisis intervention services to mental health clients on site in Clark County hospital emergency rooms 24 hours a day, 7 days a week. The program would require funding of $613,447 over the 2003-2005 biennium, $561,085 in General Fund appropriations. The division provided a staffing analysis indicating there would be at least one clinical social worker assigned to each 8-hour shift, with the supervising clinician also available to provide direct care. The 0.6 FTE position is intended to cover one 8-hour shift each week, and provide coverage for sick and annual leave for the full-time positions. This is a new program, and the subcommittee may want to include a letter of intent directing the division to develop performance indicators for the program and to provide semi-annual status reports to the Interim Finance Committee (IFC) to monitor the program’s progress.
Senator Raggio:
Since acute inpatient beds and POU beds are being increased for the PACT, why is this mobile crisis unit necessary at this point in time? What is the cost for this new program?
Mr. Chapman:
The cost of the program would be $613,44 in the 2003-2005 biennium, $561,085 in General Fund appropriations.
Senator Rawson:
The biggest concern here that is the emergency rooms in the Las Vegas hospitals have a disproportionately large number of days that are under “divert.” Mr. Brandenburg, would you clarify the divert problem?
Carlos Brandenburg, Ph.D., Administrator, Division of Mental Health and Developmental Services, Department of Human Resources:
Even though the number of POU beds is being increased in the SNAMHS, there are currently approximately 68 individuals on a daily basis waiting in the emergency rooms of the Las Vegas hospitals for up to 72 plus hours for treatment. The whole intent of the mobile crisis unit is to divert and triage out of the emergency rooms. There are 11 emergency rooms in the Las Vegas area that are funneling all clients who are dangerous to themselves and others to the SNAMHS. The mobile crisis unit, through triage, would move the individuals into other less restrictive services within the system.
Senator Raggio:
What program is utilized in northern Nevada for diversion?
Dr. Brandenburg:
Northern Nevada does not have the tremendous problem of referrals that southern Nevada is experiencing.
Senator Raggio:
How will this program divert those particular patients from the 11 southern Nevada emergency rooms?
Dr. Brandenburg:
Most of the emergency rooms do not have any form of mental health services. Many times, the emergency room physicians make the referrals to the SNAMHS. Having a mental health person actually on the emergency room staff will make possible an immediate evaluation to determine whether the patient needs to be in the POU or treated through an outpatient appointment. The mobile crisis unit will diffuse the large numbers of referrals being directed to the SNAMHS.
Senator Rawson:
I would like to comment for the record that since the 71st Session, southern Nevada has had ambulance response time in the Las Vegas area increased from 12 minutes to 28 minutes. The ambulances are backed up at the emergency rooms, unable to get patients into the emergency rooms because no space is available. The University Medical Center was in a divert mode for 285 days last year. It is a serious problem. I have asked the agency to develop more extensive divert programs, but the current budget constraints limit further expansion.
Assemblywoman Giunchigliani:
I want to reemphasize the seriousness of the problems being experienced by the emergency rooms and ambulance services operating in southern Nevada. A program is needed to provide triage for mentally unstable individuals, and to relieve the pressures on the staff and facilities at medical centers in southern Nevada.
Senator Rawson:
The Dini-Townsend Hospital and the successful PACT in Washoe County actually prevented a similar crisis from developing in northern Nevada.
Mr. Chapman:
Under item 4, page 15, the Governor recommends additional funding of $6.4 million, including $5.4 million in General Fund appropriations, for projected caseload growth in the medication clinics, residential support services, psychiatric ambulatory services, and service coordination to serve residential support services caseload increases. Staff reviewed the linear regression model used for determining the caseload growth using its CLEO for the development of recommended positions. The Executive Budget recommends a total of 22.1 FTE positions. The table on pages 15 and 16 summarizes the recommended funding and staffing support for caseload increases. Staff recommends nominal technical adjustments in module M-205 to properly align General Fund appropriations, Medicaid Title XIX, and client charge revenues supporting the decision units.
Under other closing items on page 16, item 1 is the recommendation in the Executive Budget to eliminate the 10-bed Bruce Adams Residential Treatment (BART) program. Information submitted by the division at the time the BART program was discontinued indicated only six beds were occupied. This recommendation provides for the placement of the individuals from the BART program into SLAs and adds an additional 10 SLAs. Funding reductions will total $501,441, with $162,154 in General Fund appropriations, in the 2003‑2005 biennium. Overtime costs will be reduced by a total of $116,025 in the 2003-2005 biennium.
Under items 2 and 3, page 16, staff has made technical adjustments to reflect revised computer and printer pricing costs provided by the purchasing division. Staff also recommends a technical adjustment to align the property and contents insurance cost with the amounts provided by the risk management division. As mentioned in the mental health-closing overview document, staff recommends a technical adjustment to align the proper salary step for the pharmacist III position with the salary step for the position in the base budget.
Assemblywoman Leslie:
I want to commend the Governor and Dr. Brandenburg for this budget. It is an excellent response to southern Nevada’s mental health needs. Although the funding total is $28.5 million, I do not view the funding as an enhancement but rather a bare minimum response to the tremendous needs in southern Nevada.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3161 AS RECOMMENDED BY THE GOVERNOR, AND TO INCLUDE A LETTER OF INTENT DIRECTING SNAMHS TO DEVELOP THE PERFORMANCE INDICATORS FOR THE MOBILE CRISIS UNIT, AND WITH THE AUTHORITY FOR STAFF TO MAKE TECHNICAL ADJUSTMENTS OUTLINED IN THE CLOSING DOCUMENT.
ASSEMBLYWOMAN GIUNCHIGLIANI SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Mental Health Information System – Budget Page MHDS-78 (Volume 2)
Budget Account 101-3164
Information Technology Projects – Budget Page ADMIN-14 (Volume 1)
Budget Account 101-1325
Mr. Chapman:
The Governor recommends replacement of the current AIMS client billing software package and customer information system with a new product identified as the Avatar system. Overtime costs are included in this budget to support the agency during the conversion process. The recommended overtime costs are $10,154 in FY 2003-2004 and $7690 in FY 2004-2005. The actual capital costs, identified in the chart on page 18, are included in the Department of Administration Information Technology Projects budget (B/A 101-1325). Due to the acquisition and subsequent discontinuance of the AIMS software license by CSM, it appears the division has little choice but to make the transition from the AIMS environment to the Avatar environment. If the subcommittee approves the overtime and capital costs, staff recommends a letter of intent directing the division to provide quarterly reports, including project cost information, to the IFC during the 2003-2005 biennium. The only other closing item in this account is technical adjustments to reflect new software pricing figures provided by the purchasing division.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3164 AS RECOMMENDED BY THE GOVERNOR, AND TO INCLUDE A LETTER OF INTENT DIRECTING THE DIVISION TO PROVIDE QUARTERLY REPORTS, INCLUDING PROJECT COST INFORMATION, TO THE IFC.
SENATOR MATHEWS SECONDED THE MOTION.
Senator Raggio:
What is the advantage of having the Avatar system?
Senator Rawson:
The CSM Corporation no longer provides service for the AIMS system.
Dr. Brandenburg:
The Avatar system allows the division to have a software package that will track billing, accounts receivable, accounts payable, and medication costs. If the agency does not have the new system, the work will have to be done manually or another new software package will have to be considered.
THE MOTION CARRIED UNANIMOUSLY.
*****
Mr. Chapman:
The next group of budgets for your consideration is the developmental services agencies. As staff did for the mental health agencies, an overview of all the agency budgets with common issues are covered in the closing document on page 19. The developmental services agencies of the MHDS provide service coordination, family support and respite, community residential services, and jobs and day training to individuals with developmental disabilities and related conditions through the DRC, SRC, and RRC.
The Executive Budget for developmental services, including the FPP, recommends total funding of $169.6 million in the 2003-2005 biennium, an increase of $45.4 million, or a 36.6 percent increase over the 2001‑2003 biennium budget. The General Fund appropriations are recommended to increase by $23.9 million in the 2003-2005 biennium.
The first common issue is the rate increase for service providers and the subcommittee has already taken action on it.
Under item 2, page 19, the Governor recommends additional funding of $12.8 million, with $7.5 million in General Fund appropriations, for the 2003‑2005 biennium for caseload growth in service coordination, family supports, residential supports, and community jobs and day training programs. An additional $6.2 million, including$3.6 million in General Fund appropriations, is recommended to meet waiting list demands for the same services. The table at the bottom on page 19 displays the recommended increases in clients for both caseload increases and waiting lists, and corresponding increases in positions, using the agency’s CLEO model for evaluating projections. The Governor recommends 32.54 FTE positions be added to support the caseload increases. Attachment 1, page 23, is a schedule identifying the projected waiting lists for services provided by the division in response to a subcommittee question during the March 13, 2003, budget hearing. Attachment 1 indicates the agency intends to reduce the residential supports waiting list to within 90 days by the end of the 2003-2005 biennium.
Staff asked the division to update its caseload projections. The only agency with significant caseload changes was the DRC, which shows a decrease of 152 clients in the upcoming biennium. Based on the updated caseload projection, the division identified a combined overall funding reduction of $2.9 million, including$1.7 in General Fund reductions, over the 2003‑2005 biennium. The decrease in projected caseload growth would reduce the number of recommended additional positions by 6 FTE. The agency indicated it would like to utilize a portion of the funding reduction to address funding shortages for clients transitioning from intermediate care facilities for mental retardation (ICF/MR) to community residential placements.
Under item 3, page 20, the Governor recommends continuation of bed reductions that were implemented in the current biennium. The 71st Session approved a 6-bed reduction at the DRC and a 12-bed reduction at the SRC. An additional 12 ICF/MR beds at the SRC and the DRC, and 20 community replacements at the DRC are recommended for elimination. As a result of the bed closures, 16.49 FTE positions at the DRC and 14.28 FTE positions at the SRC are eliminated. The Governor recommends reinstating the 20 community placements eliminated in FY 2003, and placing the 24 clients displaced from the IFC/MR beds into community placements. The net reduction in funding would result in a $1.67 million, with $683,027 in General Fund savings, in the 2003‑2005 biennium. The actual costs for SRC and RRC clients moved from an ICF/MR beds to community residential placements are higher than the amounts recommended in the Governor’s budget creating a funding shortfall. The agency has requested utilization of a portion of the projected savings from revised caseload projections to fund the shortfall. If the subcommittee approves the request the overall net reduction in funding would be $1.38 million, including $521,371 in General Fund savings, in the 2003‑2005 biennium.
The budget office submitted an amendment recommending an additional 10-bed reduction at the DRC and one FTE position, see page 21, placing those individuals in community residential placements. It is projected that shifting the clients to community residential placements will require an additional $10,219 each year of General Fund appropriations in future biennia. This is a result of a shift of the ICF/MR service costs being 90 percent Medicaid reimbursable to an 80 percent Medicaid reimbursable cost for community residential placements.
The division indicated to staff that future overtime costs for the DRC should equate to those of the SRC on a per-bed basis in future biennia due to the staffing realignment. The projected annualized overtime costs of $187,592 would equate to $3,126 per bed.
Dr. Brandenburg:
This budget amendment was necessitated by an oversight on the part of the agency in evaluating the overtime costs.
Senator Rawson:
Would the agency’s normal procedure be to staff those beds or cut them back?
Dr. Brandenburg:
Since 1991, the agency has been staffing the beds using the overtime hours. In terms of normally staffing those beds, the agency needs to continue with its bed reduction, moving clients into a less restrictive environment in compliance with the Olmstead Decision.
Mr. Chapman:
Under item 4, page 21, the Governor recommends total funding of $1.8 million using $1 million in General Fund appropriations, in the 2003-2005 biennium to return 14 individuals residing in out-of-state institutions back to Nevada. Ten of the clients would return to the DRC service coordination program. Two each of the remaining four clients would return to the SRC and the RRC. The subcommittee should note the division’s analysis of compared costs, as shown on the table on page 22, which indicates the annualized cost of community residential supports is comparable to the annualized out-of-state inpatient care costs currently provided to the 14 individuals. However, the addition of job and day training costs, if the 14 individuals are returned to Nevada, would generate an additional annualized need of approximately $252,000, including $116,550 in General Fund appropriations, per year.
Senator Raggio:
Do the clients in out-of-state placements require special handling and higher levels of support? Is the State able to move all the clients back, and does the State have the capability to properly care for these individuals?
Dave Luke, Ph.D., Associate Administrator for Developmental Services, Division of Mental Health and Developmental Services, Department of Human Resources:
Currently the State has 22 out-of-state placements, but the 14 individuals identified were the ones the agency felt it could properly serve. With the rate increase for service providers, the agency believes it can develop the infrastructure in Nevada to serve these clients.
Senator Raggio:
Is the agency certain it can provide the required treatment and necessary placement?
Mr. Luke:
Yes, it is certain.
Assemblywoman Leslie:
Is the agency comfortable with the reduction in caseload projections at the DRC? Why does the DRC require additional residential placements costs when they are not indicated at the SRC or the RRC?
Dr. Brandenburg:
The agency does not have a particularly high comfort level with the caseload reduction projections at the DRC. I do not have a suitable explanation for what variables created the decreased caseload at the DRC. The DRC is assigned the bulk of the new cases coming in. If this reduction in caseload at the DRC is a ”blip” and the caseload increases, the agency’s ability to reduce the waiting list will be negatively impacted. If the subcommittee gives the agency authority to request additional funding from the IFC, reduction in the waiting list can be assured.
Assemblywoman Leslie:
If we permitted an additional funding request to go to the IFC, every agency would be asking for the same consideration.
Dr. Brandenburg:
I understand that.
Assemblywoman Leslie:
Why are the residential placement costs higher at the DRC?
Mr. Luke:
The SNAMHS projected its costs correctly by using three placement categories:
ISLA, PSLA, and SLA, but the SRC and the RRC only projected placements at the ISLA level. The SRC and RRC costs were incorrectly presented, which was an oversight on the part of the agency. The costs are the same.
Senator Rawson:
I will accept a motion.
ASSEMBLYWOMAN LESLIE MOVED TO APPROVE THE REVISED CASELOAD PROJECTIONS AND APPROVE THE INCREASE IN THE COMMUNITY RESIDENTIAL PLACEMENTS AND APPROVE REVISING OVERTIME COSTS WITH AUTHORITY FOR STAFF TO ADJUST ASSOCIATED STAFFING COSTS AND APPROVE THE RETURN TO NEVADA OF THE OUT-OF-STATE CLIENTS.
ASSEMBLYWOMAN GIUNCHIGLIANI SECONDED THE MOTION.
Senator Mathews:
The overtime seems to be the most costly way to fund the program. Is there a reason the agency did not request additional positions?
Dr. Brandenburg:
It was just an oversight on the part of the agency. Even if the agency had included the request in the Executive Budget, the choice would still be to reduce the number of beds instead of requesting additional positions.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Sierra Regional Center – Budget Page MHDS-51 (Volume 2) Budget Account 101-3280
Mr. Chapman:
The major common issues for the regional centers have been covered.
Under item 1, page 25, the budget office submitted amendment 18 to reduce funding for service provider rate increases by $5,250, using $2,969 in General Funds, in FY 2003-2004, and $22,500, with $12,415 in General Funds, in FY 2004‑2005 based upon revised calculations.
Staff recommends technical adjustments in revised computer pricing figures provided by the purchasing division.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3280 AS RECOMMENDED BY THE GOVERNOR WITH AUTHORITY FOR STAFF TO MAKE TECHNICAL ADJUSTMENTS.
ASSEMBLYWOMAN GIUNCHIGLIANI SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Desert Regional Center – Budget Page MHDS-59 (Volume 2) Budget Account 101-3279
Mr. Chapman:
Under item 1, page 27, the Executive Budget recommends the elimination of a 0.51 FTE position, which is no longer required at the DRC due to the 12 ICF/MR bed reductions.
Under technical adjustments on page 27, staff recommends the elimination of one-time computer and software costs totaling $13,721 in each year of the biennium, and reductions of $2223 in FY 2003-2004 and $1285 in FY 2004‑2005 for revised computer pricing figures provided by the purchasing division.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3279 AS RECOMMENDED BY THE GOVERNOR WITH AUTHORITY FOR STAFF TO MAKE TECHNICAL ADJUSTMENTS.
ASSEMBLYMAN GOLDWATER SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Family Preservation Program – Budget Page MHDS-67 (Volume 2) Budget Account 101-3166
Mr. Chapman:
The FPP is a statewide program that provides monthly cash assistance to low‑income families who provide care in their homes for relatives with profound or severe mental retardation of children under 6 years of age who have developmental delays.
The 71st Session approved funding for 166 families at $310 per month in the 2001-2003 biennium. The actual number of families receiving payments increased to 234 in FY 2001-2002, decreasing the average payment to $219 per month. The Executive Budget recommends increasing payments back to $310 per month for 234 families, which requires an additional General Fund appropriation of $254,827 per year.
The Governor also recommends expanding the program for an additional 34 families in FY 2003-2004 for a General Fund appropriation of $74,098, and for an additional 56 families in FY 2004-2005 for a General Fund appropriation of $233,775. Overall the total General Fund increase in appropriations would be $1.1 million in FY 2004-2005.
Senator Rawson:
I will accept a motion to close this budget.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3166 AS RECOMMENDED BY THE GOVERNOR.
ASSEMBLYWOMAN GIBBONS SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Rural Regional Center – Budget Page MHDS-70 (Volume 2)
Budget Account 101-3167
Mr. Chapman:
Under item 1, page 31, the Governor recommends funding of $63,396, using $32,414 in General Fund appropriations, in FY 2003-2004 and $25,995, using $12,886 in General Fund appropriations, in FY 2004-2005 to relocate the Carson City office to a new location on Goni Road. When the budget was presented in January 2003 the new location had not been identified. The agency has developed a draft rental agreement that provides for first year lease costs of $1.15 per square foot and second year costs of $1.1845 per square foot. The amounts recommended in the Governor’s budget for a new office were based upon estimates of $1.25 per square foot each year. Staff requests authority to make technical adjustments for non-state owned building rental costs should this budget be closed with the caseload increases already approved in previous actions of the subcommittee.
Senator Rawson:
Is there a potential for some savings in rent cost since the square footage rental rate came in lower than the estimated amount?
Mr. Chapman:
It may generate some savings.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3167 AS RECOMMENDED BY THE GOVERNOR AND WITH AUTHORITY FOR STAFF TO MAKE TECHNICAL ADJUSTMENTS.
ASSEMBLYMAN GOLDWATER SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Consumer Health Protection – Budget Page HEALTH-18 (Volume 2) Budget Account 101-3194
Bob Atkinson, Program Analyst, Fiscal Analysis Division, Legislative Counsel Bureau:
The consumer health protection program is responsible for inspection and enforcement of regulations pertaining to public water systems, food establishments, hotels, motels, institutions, schools, correctional facilities, and recreational vehicle parks throughout the State.
Under other closing items, page 33, the Executive Budget recommends additional license and plan review fee increases of approximately $200,000 each year to support current staffing levels in this account. If the State Board of Health does not approve the fees, 2.20 FTE positions will have to be eliminated.
Under technical adjustments item 1, page 33, the bureau chief was reclassified to a lower classification at the November 21, 2002, meeting of the IFC. The salary realignment resulted in a General Fund savings of $13,190 in each year of the upcoming biennium.
Under item 2, page 33, the revenue provided by the public water system supervision agreement with the federal government has been adjusted to the most recent award notification, resulting in a General Fund savings of $8000 in each year of the 2003-2005 biennium.
Under item 3, page 33, the FY 2003-2004 budget has been adjusted to include the new federal water protection coordination grant approved at the February 18, 2003, meeting of the IFC. The grant is not expected to continue beyond FY 2003-2004. Staff recommends this budget account be closed as adjusted.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3194 AS RECOMMENDED BY THE GOVERNOR WITH THE TECHNICAL ADJUSTMENTS OUTLINED BY STAFF.
SENATOR MATHEWS SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Health Facilities Hospital Licensing – Budget Page HEALTH-34 (Volume 2) Budget Account 101-3216
Mr. Atkinson:
The health facilities program has the responsibility to inspect, monitor, and evaluate the care and treatment services received by individuals residing in medical and group-care facilities.
Under item 1, page 35, the Governor recommends the elimination of 13 vacant positions in this account and indicates this reduction in staffing levels is necessary to remain within anticipated revenue levels. The recommendation includes a further reduction of 4 FTE positions that have been vacant for more than a year. The agency has assured the subcommittee that the statutorily-required activities will continue to be performed with this reduced amount of personnel through increased efficiency and targeting the required work.
Under item 2, page 35, the Governor recommends the transfer of the environmental health laboratory program, including two positions from this account to the Environmental Protection Water Quality Planning budget account 101-3193.
Under other technical adjustments on page 35, a number of revisions were made at the request of the agency including adjustment of the clinical laboratory improvement grant and the Medicare certification grant to reflect the most recent grant award notification. The expenditures under the contract with the State Board of Nursing were reduced to the recently negotiated amount, and expenditures for medical laboratory inspections were separated into a unique category to assist the division in tracking these expenditures.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3216 AS RECOMMENDED BY STAFF.
ASSEMBLYMAN HETTRICK SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Community Health Services – Budget Page HEALTH-40 (Volume 2) Budget Account 101-3224
Mr. Atkinson:
During the earlier budget hearing, the subcommittee received a request from the Health Division to merge the Family Planning Project budget account, 101-3219, into this account. The agency indicated the consolidation would remedy a federal audit finding regarding the allocation of time and expenses between the two accounts, and would result in increased efficiency of the program. Staff concurs with the recommended consolidation of these two accounts. The budget office in amendment 114 indicated it was in support of the merger.
Under item 2, page 37, the family planning budget account included federal revenues and fee revenues and carried a reserve and balance forward each year. Since the account, as combined, will be supported by a combination of General Fund and other revenue sources, a reserve appears unnecessary. Staff recommends the reserve be reduced to $150,000 at the end of the FY 2003-2004 and to $100,000 at the end of FY 2004-2005, resulting in a General Fund savings in the amount of $61,113 for FY 2003-2004 and $90,475 for FY 2004-2005. Staff suggests the subcommittee consider a letter of intent advising the agency that the reserve is to assist with cash flow in the account.
If the division wants to use the funds for any other purpose, it would have to make a request to the IFC. If it is determined during the course of the upcoming biennium a reserve is not necessary for the management of cash flow, the biennial budget request for the 2005‑2007 biennium should eliminate the reserve in this account.
Under item 1, page 38, the Governor recommends fee increases of approximately $80,000 in each year of the biennium to support the increased cost of program operation. A large portion of this increase is requested for contract services to provide coverage in the health clinics when permanent staff is not available.
Under item 2, page 38, budget amendment 114 included the request to move two federally funded grants, the sexual assault program and the rape prevention program, to the Maternal Child Health Services budget account 101-3222.
Under other technical adjustments, page 38, the base budget was adjusted to include an increase in a position from half-time to full-time to support the immunization grant, which has been adjusted accordingly.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3224 WITH THE CONSOLIDATION OF BUDGET ACCOUNT 101‑3219 AS REQUESTED BY THE HEALTH DIVISION AND WITH A REDUCTION OF THE RESERVE AND A LETTER OF INTENT TO THE HEALTH DIVISION REGARDING UTILIZATION OF RESERVE FUNDS AND WITH AUTHORITY FOR STAFF TO MAKE TECHNICAL ADJUSTMENTS.
ASSEMBLYWOMAN GIUNCHIGLIANI SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Family Planning Project – Budget Page HEALTH-50 (Volume 2) Budget Account 101-3219
Mr. Atkinson:
Prior to transferring this budget account to B/A 101-3224, a couple of technical adjustments are necessary.
Under item 1, page 40, the revenue from the federal family planning grant has been increased to the amount of the most recent grant award, and medical services charges have been increased to the amount received in FY 2001-2002.
Under item 2, page 40, the price for four replacement computers each year has been adjusted to the most recent pricing figures available from the purchasing division.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3219 AS RECOMMENDED BY STAFF.
SENATOR MATHEWS SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Immunization Program – Budget Page HEALTH-59 (Volume 2) Budget Account 101-3213
Mr. Atkinson:
For the information of the subcommittee, this account includes only the funding for vaccines that are purchased with State funding. The vaccines provided with federal funds are provided through a voucher system. The Executive Budget does not contemplate the introduction of any new vaccines. Funding for the program is provided by a combination of a federal direct assistance grant, State appropriations, and transfers from Nevada Check Up program, Title XX, and Title XXI funds.
The increase in General Fund support is based on a higher demand for immunizations based on population projections and current vaccine prices. When the budget was constructed, the agency neglected to consider the amount of federal Title XXI funds received in support of the State‑purchased vaccines. The budget has been adjusted to correct this error, which results in a General Fund savings in the amount of $425,513 in each year of the 2003‑2005 biennium. The subcommittee may wish to recommend the standard letter of intent when closing this account. The letter would specify that if the Health Division (HD) decides to add new vaccines, then IFC approval would be required prior to implementing any modifications in the existing vaccine regimen.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3213 AS RECOMMENDED BY STAFF AND WITH A LETTER OF INTENT TO THE HEALTH DIVISION STATING NEW VACCINES CANNOT BE IMPLEMENTED WITHOUT PRIOR APPROVAL OF THE IFC.
ASSEMBLYWOMAN GIBBONS SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Special Children’s Clinic – Budget Page HEALTH-70 (Volume 2) Budget Account 101-3208
Mr. Atkinson:
Under item 1, page 44, the Governor recommends several decision units, all of which are funded with 100 percent General Fund support in the amount of $1.9 million in FY 2003-2004 and $2.2 million in FY 2004-2005. The funds are to be used to address the problem of waiting lists for initial appointments and for treatment services. The agency has indicated services are provided without regard to a family’s ability to pay. When private insurance companies, Medicaid, and the Nevada Check Up program can be billed, they are. The agency notes the parents must be informed that the State’s right to access the family’s private insurance may be denied by the family. Even with all these considerations, it is reasonable to assume these other revenue sources should be available to offset some of the costs for the additional caseload growth recommended in this budget account. The agency furnished estimates of medical services charges that could possibly be obtained through serving the additional children on these waiting lists. The estimates furnished by the HD result in medical services charges in an amount slightly greater than 10 percent of the requested General Fund support for each decision unit.
Staff recommends replacing a portion of the General Fund support of caseload growth with medical services charges, which would result in a General Fund savings of $140,290 in FY 2003-2004 and $172,864 in FY 2004-2005. By replacing a portion of General Fund support for the reduction of treatment waiting lists with medical services charges, a General Fund savings of $51,786 in FY 2003-2004 and $52,466 in FY 2004-2005 could be realized. To reduce the waiting lists for initial appointments, medical services charges billed in the amount of $7,726 in FY 2003-2004 and $7,828 in FY 2004-2005 would result in those amounts being saved in General Fund appropriations. The division proposed reducing the treatment waiting lists by one-half statewide, which would still leave the Las Vegas area with a longer waiting list than northern Nevada. Staff suggests the subcommittee may wish to inquire whether the agency would be willing to try to equalize the waiting time statewide.
Under item 2, page 45, the Governor recommends a number of early intervention services for children currently in the Division of Child and Family Services (DCFS) budget account be merged with the HD’s, Special Children’s Clinic (SCC) budget account. The first step program (FSP), the home activities program for parents and youth (HAPPY), and the infant enhancement program (IEP) are recommended for transfer from the DCFS. The FSP provides early intervention services for children, from birth to age three, with developmental delays for those who are likely to need lifelong support. This program operates in southern Nevada in Clark, Nye, Lincoln, and Esmeralda Counties. The FSP transfer would include the 25.56 FTE positions that support the program, along with additional funding to support caseload growth and to reduce waiting lists.
The HAPPY program is a home-based program for children, from birth to age three, with developmental delays. The program provides services in the rural areas of northern Nevada to assist with the young child’s development. The SCC currently provides similar services to families in Reno and Carson City. The HAPPY program transfer will include 11.13 FTE positions that support the program.
The IEP provides development assessment and consultation for very low birth weight babies in the neonatal intensive care units in hospitals in Reno. In addition, the program provides training in the area of low birth weight babies for hospital staff in Reno and Las Vegas. The transfer of the IEP will include 2.51 FTE positions that support the program.
Staff recommends closing the account with the consolidation of programs if the transfer is approved when the DCFS budgets are closed. The only other technical adjustment in this account is in the maternal child health block grant where the revenues have been increased to the level provided by the most recent grant award. This adjustment results in a reduction in General Fund support in the amount of $56,225 for FY 2003-2004 and $57,010 for FY 2004-2005.
Senator Rawson:
We have some comments from Las Vegas.
Jessi Evans, Interagency Coordinating Subcommittee, Board Member, Las Vegas:
The specific concern of the Interagency Coordinating Subcommittee (ICS) is the consolidation of the FSP, HAPPY, and IEP from the DCFS to the HD’s SCC budget. The two expectations of this proposed merger are to save money and improve the quality of services for Nevada’s children with disabilities. As you can see from the HD’s budget proposal, the merger would cost over $840,000 initially and continue to cost money for 4 to 5 years in the future. As for improvement of services, the statistics on Nevada’s early intervention programs speak for themselves. The FSP and the HAPPY program do a far better job than the SCC does in achieving positive outcomes for Nevada’s children with disabilities. By law, children should not wait more than 45 days from referral to a program to receive services. SCCs waiting lists have increased from 152.8 days in FY 2001 to 217.4 days in FY 2003. The FSP waiting list has decreased from 70.8 to 67.6 days and the HAPPY program waiting list has gone from 69 to 56.4 days during the same period.
Families have been told over and over this would be a “seamless” merger based on “best practice.” At the last ICS meeting, Alex Haartz finally admitted there is no “plan” for building a new early intervention program and there is no staff training going on. After the ICS meeting, less than 3 months before this merger was to take place, the HD finally agreed to meet with families and staff from the FSP and the SCC program. The SCC has not changed its service delivery model to come into compliance in over 20 years and again stated that it will not give up the medical delivery model.
I recall Mike Willden stated the federal funding is only $3 million and maybe it should be sent back so compliance would cease to be a headache. Alex Haartz stated that he is not a fan of natural environments, another requirement in the federal law.
If the subcommittee votes to approve this budget transfer, we hope it would be with the stipulation that if the programs were not in compliance with the federal law within 2 years, there would be some sort of accountability. I have submitted a complete copy of my testimony (Exhibit D). A copy of a petition signed by Nevada taxpayers objecting to the proposed merger has also been submitted (Exhibit E. Original is on file in the Research Library.).
Yvonne Sylva, M.P.A., Administrator, Health Division, Department of Human Resources:
Ms. Evans provided some compelling information and, from our perspective, it is compelling information for change. The State believes it needs to take the best out of all program applications in the State and consolidate them. It will then be possible to deliver services in a more comprehensive and appropriate manner. SCCs serve 85 percent of the total early intervention population in the State.
It is erroneous to say the SCCs have not been in compliance or changed the delivery of services model in 20 years. Over the years, the agency has continually juggled with the diagnostic model versus the intervention model of service. The agency does provide intervention services in the natural environment, for the most part, through the SCCs. Providing the necessary services in the natural environment setting is a federal requirement, but it is extremely costly. Some families still choose to use a clinic-based model. It is not the HD’s intent, nor is it the DHR’s intent, to provide all services from a clinic. It is the agency’s intent to ensure that services will continue as is on July 1, 2003, and some efficiency changes will be instituted.
The agency’s goal is to eliminate the waiting lists by the end of the upcoming biennium, and it will be reviewing the plan to put efficiencies in place in the SCCs. The issue has been available funding, not willingness to change. The population has been growing so fast, the agency has been unable to keep up. There are some distinct differences in how to best serve the different client populations. For example through a memorandum of understanding with the HD, the FSP in Las Vegas serves those children who have disabilities that are unlikely to get better over time. For these children the diagnostic portion of treatment is not as extensive as the services required by children with different types of disabilities. For these children, the diagnostic part of their program is extensive and includes physical therapy, occupational therapy, psychological testing, and pediatrician evaluations. The agency hopes to create a seamless system so the goal of no waiting lists is attained.
Michael J. Willden, Director, Department of Human Resources:
There are a couple of issues the agency would like to address, in particular the quotes that were attributed to me from the family meetings. The agency has had a series of meetings with families on reorganization and funding issues. The quote attributed to me about the “$3 million in federal funds” was not accurate. The comment was “there are some people in Nevada who believe that taking federal dollars and all the strings attached to those dollars is not always the wisest step to take.” The State can build its own system. Three million dollars is available in federal funding for early intervention services, but there is also another $13 million coming from the General Fund. The federal law and its funding are not the only driving forces for early intervention services. The driving force is the belief that all the children with disabilities need to have the services they require. The DHR intends to fully comply with the federal law. The agency has paid some penalties and fines in the past for not being in compliance with all the federal regulations. The agency’s goal is to get the resources that are needed to the children who require the services, including the children on the waiting lists.
Assemblywoman Giunchigliani:
The waiting list for services is a key issue. The proposed budget does not get the State to the 45-day waiting time goal to be in compliance. Is there a dollar amount available that would actually show us how much funding it would take to reduce the waiting list in these programs to the required 45 days? Is $8 million over the biennium the correct amount?
Ms. Sylva:
In the estimates given to staff, half of the funding for the decision units can be covered through the economies and changes in the way the agency does business. Change is what the whole issue is about, and change is frightening for everyone. The agency plans on doing everything possible to meet the 45‑day waiting list goal.
Assemblywoman Giunchigliani:
I realize that is the agency’s commitment and that we are dealing with an emotional issue. I suggest we have some type of reserve so in the second year of the biennium, if the 45-day goal does not seem to be possible, some additional funds can be allocated to achieve the required reduction. We do need to change the way we are doing business because we are not serving the families and children we need to. I want some assurances that part of what we are doing is taking the necessary steps not to increase the waiting lists, but to reduce them.
Senator Rawson:
We anticipate the potential for increases in services by the integration, coordination, and consolidation of agencies. We have had this continuous debate about the medical model versus the social model for delivery of services. Some children need one and some, need the other. It is a combination of both. There has been some criticism, but the subcommittee has great confidence in the HD and the DHR’s ability to resolve the issues and provide the services needed. I request the agencies be very sensitive to the concerns of the parents, because the parents will come back to us if we do not resolve the issues satisfactorily. I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3208 AS RECOMMENDED BY THE GOVERNOR AND WITH THE INCLUSION OF THE OFFSETS SUGGESTED BY STAFF AND APPROVAL OF THE CONSOLIDATION OF SERVICES AND WITH AUTHORITY FOR STAFF TO MAKE TECHNICAL ADJUSTMENTS AND WITH THE REQUEST FOR QUARTERLY REPORTS OF PROGRESS IN REDUCING THE WAITING LISTS.
ASSEMBLYWOMAN GIUNCHIGLIANI SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR, Emergency Medical Services – Budget Page HEALTH-82 (Volume 2) Budget Account 101-3235
Mr. Atkinson:
There are no major issues in the closing of this budget account. Staff recommends a few technical adjustments including the elimination of an incorrect charge against the emergency medical services grants category, which has been moved to the proper operating category. Budget Amendment No. 31 from the budget office removes the software assurance costs. This adjustment reduces the General Fund support in this account by $1910 in each year of the 2003-2005 biennium. In addition, the account has been adjusted to increase the software license maintenance fees to $10,000 in FY 2003‑2004 and $20,000 in FY 2004-2005 in accordance with the testimony of the HD at the February 13, 2003, hearing. This adjustment requires the addition of miscellaneous revenue, which the HD indicated it would locate.
Senator Rawson:
I would like the assurance that the funding for the software license maintenance fees is available.
Ms. Sylva:
The agency believes the funds will be available.
Senator Rawson:
I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3235 AS RECOMMENDED BY STAFF AND WITH AUTHORITY FOR STAFF TO MAKE TECHNICAL ADJUSTMENTS AS NOTED.
ASSEMBLYMAN HETTRICK SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
HR Health Alcohol & Drug Rehabilitation – Budget Page HEALTH-86 (Volume 2) Budget Account 101-3170
Mr. Atkinson:
In the previous hearing, there were a number of discussions about the adolescent treatment programs in this account that have been funded through MAXIMUS. At that time, the HD indicated it anticipates an increase in the substance abuse, prevention, and treatment (SAPT) block grant of approximately $1 million in each year of the 2003-2005 biennium. The agency further indicated that the adolescent treatment programs would be a priority for any increase in the amount of funding received. Staff suggests a letter of intent be issued to the HD prioritizing the first $500,000 increase in SAPT grants funds to be directed to adolescent treatment programs. The subcommittee may recall discussions regarding the maintenance of effort (MOE) required by the SAPT block grant and how the MOE might be affected by the MAXIMUS funding in this account. Currently, the HD has made application to the federal government to not include the MAXIMUS funding for either the current year or last year in the MOE. If the waiver is granted, the current funding levels, without the MAXIMUS funding, will be sufficient to meet the MOE. If that waiver is not granted, additional funding of approximately $500,000, either from MAXIMUS or from the General Fund, would be required to meet the MOE requirements during each year of the 2003-2005 biennium and into the future. Staff recommends that MAXIMUS funding not be added to the account for the FY 2003‑2005 biennium. If the waiver is not granted, the agency could approach the IFC to add MAXIMUS funding, if available, or an allocation from the Contingency Fund of approximately $500,000 in each of the next 2 years.
Senator Rawson:
I do not believe we should put the MAXIMUS funding in this account at this time. I will accept a motion to close this budget account.
ASSEMBLYWOMAN LESLIE MOVED TO CLOSE BUDGET ACCOUNT 101‑3170 AS RECOMMENDED BY STAFF WITHOUT THE MAXIMUS FUNDING AND WITH THE LETTER OF INTENT PRIORITIZING $500,000 OF ANY INCREASE IN THE SAPT BLOCK GRANT TO BE DIRECTED TO THE ADOLESCENT TREATMENT PROGRAM.
SENATOR MATHEWS SECONDED THE MOTION.
Senator Raggio:
Why is a waiver necessary?
Philip Weyrick, Administrative Services Officer, Health Division, Department of Human Resources:
The waiver is required because the MOE calculations require the agency to include all funds that come from State sources. Since the MAXIMUS funds appear to be State funds, it would have to be included in the calculation for the MOE.
Senator Rawson:
If the MAXIMUS funds were added in, then the MOE would be set $500,000 higher.
Senator Raggio:
What consideration, if any, has been given to the methadone treatment program, particularly for former inmates? I know the DOC has some interest in it.
Ms. Sylva:
The agency would be happy to provide you with information about the methadone treatment program funding as it relates to the DOC.
Senator Raggio:
I would like that information. It appears to be cost-effective although there is some controversy about the program.
THE MOTION CARRIED UNANIMOUSLY.
*****
Senator Raggio:
What is the status of the supplemental appropriation in the amount of $38,915 to meet the MOE requirements for FY 2002-2003 for the SAPT block grant? I thought the funding was required immediately.
Ms. Sylva:
The Assembly Committee on Ways and Means will hear it on Wednesday.
Assemblywoman Giunchigliani:
Has any action been taken on trying to pull together all the various rehabilitation funds and programs so the State can begin to better utilize the funds available? The State needs to know what programs are working and which ones are not so funds can be realigned to support the best programs. Do you have any comments or ideas how the subcommittee can help the agency proceed with an evaluation?
Ms. Sylva:
Are you suggesting that the HD would be the lead agency in the analysis and evaluation?
Assemblywoman Giunchigliani:
I am not sure who is the lead agency, which is why I am asking. We have talked to the K12 education agencies and have made a strong recommendation for them to begin an analysis and evaluation in the educational arena. There may be a way to maximize the use of funds. We have requested the Department of Education to identify three to five key programs that are really working in the State, so funds can be directed to them. If you have a better idea of which agency in the health arena would be most suited to do its part in the evaluation, we would like to know.
Assemblywoman Leslie:
Is it possible the evaluation and analysis for the prevention programs could utilize funding from the State incentive grant (SIG)?
Ms. Sylva:
The prevention component could fit under the SIG grant, but the treatment portion would have to be handled differently. The agency needs to look at what potential resources are available. The HD is the State’s alcohol authority. The agency will have to look at the scheduled workload for this upcoming biennium. An interim study committee may be the best approach. The HD has an advisory committee with an interest in this area, but it does not have the capability of putting together an interim study committee.
Senator Rawson:
The one problem with an interim study committee is that the requests the committee would make of the HD will require the same resources. What would be entailed in assigning a person to evaluate and analyze all the programs in the State? There are a lot of funds going into alcohol and drug rehabilitation programs. It may be enough funding; it may not. Certainly the funds are spread around in various programs. The subcommittee needs to have a better overall view.
Assemblywoman Giunchigliani:
Going through the SIG grant to get the resources for the study of the prevention part of the report would be a start. Perhaps, the HD could respond to this subcommittee on how to develop resources to complete the treatment part.
HR Health Alert Network – Budget Page HEALTH-97 (Volume 2) Budget Account 101-3218
Mr. Atkinson:
The health alert network (HAN) is a nationwide, integrated information and communications system serving as a platform for national disease surveillance, epidemiological investigation, professional training, electronic laboratory reporting, and rapid communication. When fully developed, the HAN will link local health departments to other local agencies within the State with critical roles for bioterrorism preparedness and response. The HAN will also connect the state health departments with federal agencies, including the Centers for Disease Control (CDC), responsible for responding to bioterrorism events.
This budget account includes the public health preparedness grant funded by the federal Health Resources and Services Administration and the response for bioterrorism (RFB) grant federally funded by the CDC. The RFB grant is intended to develop comprehensive bioterrorism recognition and response plans supported by computer hardware and software purchases necessary to maintain a statewide communications network. Large federally funded and authorized network purchases are necessary to support the communications network. There are no major closing issues and staff recommends closing the account as recommended by the Governor.
Senator Rawson:
I will accept a motion to close this budget account.
SENATOR RAGGIO MOVED TO CLOSE BUDGET ACCOUNT 101-3218 AS RECOMMENDED BY THE GOVERNOR.
ASSEMBLYMAN HETTRICK SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
Senator Rawson:
The meeting is adjourned at 10:14 a.m.
RESPECTFULLY SUBMITTED:
Judy Coolbaugh,
Committee Secretary
APPROVED BY:
Senator Raymond D. Rawson, Chairman
DATE:
Assemblywoman Sheila Leslie, Chairman
DATE: