MINUTES OF THE ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES Sixty-eighth Session June 19, 1995 The Committee on Health and Human Services was called to order at 2:00 p.m., on Monday, June 19, 1995, Chairman Jan Monaghan presiding in Room 330 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. COMMITTEE MEMBERS PRESENT: Mrs. Vivian L. Freeman, Chairman Mrs. Jan Monaghan, Chairman Mrs. Jan Evans, Vice Chairman Dr. William Z. (Bill) Harrington, Vice Chairman Mrs. Deanna Braunlin Ms. Barbara E. Buckley Mr. David Goldwater Ms. Saundra (Sandi) Krenzer Mr. Dennis Nolan Ms. Dianne Steel Ms. Patricia A. Tripple Mr. Wendell P. Williams STAFF MEMBERS PRESENT: H. Pepper Sturm, Chief Principal Research Analyst OTHERS PRESENT: Donny Loux, Community Based Services Paul Gowins, Nevada Independent Living Council Marsha Berkbigler, Nevada State Medical Association Jeff Whitehead, Nevada State Medical Association John Sarb, Chief, Division of Child and Family Services SENATE BILL 35 - Revises requirements concerning signing of certificates of immunization required of children attending schools and child care facilities. Chairman Monaghan reminded committee members S.B. 35 had been heard on June 12, 1995. She stated there was no opposition. ASSEMBLYMAN WILLIAM HARRINGTON MOVED DO PASS ON S.B. 35. ASSEMBLYMAN WENDELL WILLIAMS SECONDED THE MOTION. THE MOTION CARRIED. ********* ASSEMBLY BILL 634 - Revises provisions governing procedure for involuntary court-ordered admission of persons into mental health facilities. Mrs. Monaghan explained the committee had voted to amend and do pass A.B. 634, however after speaking with the mental health people, it was discovered there was a very large fiscal note attached to the amended bill. Mrs. Monaghan spoke with the bill's sponsor, Assemblywoman Chris Giunchigliani, who agreed to remove every change except the five day hearing schedule, not including weekends. Mrs. Monaghan stated the items removed included the three day hearing schedule which was to begin on January 1, 1997, the reporting and the sunset provision. She also indicated a letter of intent was to be sent which would have the mental health institutions "look into it and see what the problem is and where it is at." ASSEMBLYWOMAN BARBARA BUCKLEY VOTED TO RESCIND HER MOTION TO AMEND AND DO PASS A.B. 634. ASSEMBLYWOMAN DEANNA BRAUNLIN SECONDED THE MOTION. THE MOTION CARRIED. Assemblywoman Jan Evans inquired more specifically about the letter of intent. Mrs. Monaghan replied Ms. Giunchigliani still believed mental health facilities had the ability to report on how many cases they had, how many days each case took to process and whether the number of days before a hearing could be shortened further. ASSEMBLYWOMAN BARBARA BUCKLEY VOTED TO AMEND AND DO PASS A.B. 634. ASSEMBLYMAN WILLIAM HARRINGTON SECONDED THE MOTION. THE MOTION CARRIED. ********* ASSEMBLY BILL 605 - Provides that certain persons arrested must be tested for sexually transmitted disease. Ms. Buckley reminded committee members a motion to amend and do pass A.B. 605 had failed at the last work session. She stated she was still opposed to the bill until questions raised by the HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) Coalition in Las Vegas had been answered to her satisfaction. Mrs. Freeman noted Dr. Harrington requested the bill be brought back to the committee again for discussion. Ms. Buckley indicated the concerns raised by the coalition might never be satisfied, however she wanted to know if the proponents of A.B. 605 had attempted to discuss and work out the differences with the coalition. Mrs. Evans emphasized a need for the legislation and asked if Carlos Concha from Parole and Probation was working on the committee's concerns or making any effort to contact the coalition. She requested Pepper Sturm call Mr. Concha and explain the concerns still pending about A.B. 605. Mrs. Freeman requested Mr. Concha be asked to attend Wednesday's committee meeting to make a short presentation addressing the aforementioned problems. ********* SENATE BILL 362 - Expands circumstances under which practitioner may refer patient to health care facility in which he has financial interest. Assemblywoman Braunlin disclosed she had received an opinion from the Legislative Counsel Bureau on S.B. 362 and as it would not affect her husband any more than any other physician, she would be participating in discussions and voting on the bill. Marsha Berkbigler, representing the Nevada State Medical Association (NSMA), mentioned the concern that had been raised by committee members over lines 21 through 25 on page 1 of the bill. She stated it was the opinion of NSMA and its legal counsel that the language does two things. It allows for a sole practitioner to have a piece of x-ray equipment, a sonogram or any similar equipment in his office. She noted this is already allowed under federal law. Additionally, because S.B. 362 allows for an exception to the self-referral ban for things like lithotripsy and renal dialysis, it probably would be interpreted that any other high tech piece of medical equipment being developed would be banned from being purchased by the physicians who were using it unless it also was written into the law. Mrs. Monaghan inquired whether the NSMA would be offering any amendments. Ms. Berkbigler proposed deleting the words "to a health facility owned by the practitioner" on line 21, page 1. Mrs. Freeman requested a clarification of "why you have to have this in state law." Ms. Berkbigler explained the law currently relates only to group practices. The way S.B. 362 is structured, the only opportunity a provider would have to purchase a piece of equipment for his own patients' use would be if he was making the purchase as a group practice. She noted there is a specific exemption in federal law allowing a sole practitioner to purchase a piece of equipment, but not in S.B. 362. In addition, Ms. Berkbigler mentioned their second concern was that S.B. 362 could be interpreted by the courts to say that sole practitioners cannot purchase high tech equipment. Mrs. Freeman asked how Ms. Berkbigler felt about deleting lines 1 and 2 on page 2 of the bill. Ms. Berkbigler stressed they had not planned that deletion. She interpreted those lines to mean utilization of new high tech equipment was only for those providers who had it within their scope of practice and were trained to use it. Mrs. Freeman queried the physical therapists' concerns. Ms. Berkbigler replied federal law clearly states that no physician can own a physical therapy service outside his own practice. The practitioner can employ a physical therapist in his office for the convenience and use of his patients, but cannot own a facility. Dr. Harrington disclosed he is a physician and even though S.B. 362 would not affect him any differently than any other physician, had decided not to vote on it. Assemblyman Goldwater disclosed he works for a group of physicians and because S.B. 362 revises the definition of group practice and specifically applies to the situation he is involved in, decided he would not be voting on S.B. 362. Ms. Krenzer mentioned she works for Sierra Health Services, however S.B. 362 will not affect her company any more than any other, therefore she will be voting on the bill. Mrs. Freeman mentioned after S.B. 153 was voted down on the Assembly floor, Bill Welch of the Rural Hospital Project requested the whole bill be attached to S.B. 362. She requested committee members consider Mr. Welch's proposal when amending S.B. 362. Ms. Buckley questioned what provisions of S.B. 153 were to be attached to S.B. 362. Mrs. Freeman responded the entire bill was to be attached. Ms. Krenzer indicated her belief there had been a misunderstanding when S.B. 153 was killed. She stated it was a good idea to amend it into S.B. 362 and that she supported the concept. Ms. Buckley asked whether Senator Titus had agreed to the amendment and was informed the senator concurred. Mr. Goldwater mentioned S.B. 153 had been explained to him and because it was needed by the rural counties, had no objection to it riding on S.B. 362. Ms. Buckley requested clarification of exactly what provisions of S.B. 153 were being folded into S.B. 362. Mrs. Monaghan replied it would be the second reprint of S.B. 153. ASSEMBLYWOMAN BUCKLEY MOVED TO AMEND AND DO PASS S.B. 362. THE AMENDMENTS TO S.B. 362 WOULD BE TO DELETE LINES 21 THROUGH 25 ON PAGE ONE AND LINES 1 AND 2 ON PAGE TWO AND ADD S.B. 153, SECOND REPRINT, TO S.B. 362. ASSEMBLYMAN WENDELL WILLIAMS SECONDED THE MOTION. Ms. Krenzer requested the author of the amendments allow the committee to vote on them separately. She stated she was in support of one amendment but not the other. Mrs. Monaghan requested the amendments be separated, at least for discussion purposes. Ms. Buckley agreed. Mrs. Monaghan explained the first part of the amendments included deletion of some language in S.B. 362. Ms. Buckley stated "exemption (e)(3) is so big I think you could drive a truck through it and I think it guts the original intent of the bill which, as I understand it, is to insure that when physicians refer patients to satellite services or other organizations in which they have a financial interest, the self-referral would basically be prohibited." She explained (e)(3) allows a practitioner to refer patients to a health care facility owned by a practitioner if he has some supervisory responsibility, which she believed could be as little as showing up at the business once a year. In addition, the referral must be related to the practitioner's area of competence and recognized scope of practice. Ms. Buckley stated physicians' scope of practice included x-ray and lab services and eliminating referrals to those facilities had been the goal of S.B. 362. Ms. Buckley, responding to the need to exempt specialized services as the bill already does with lithotripsy and renal dialysis, pointed out the Legislature convenes every two years and exemptions for those services could be added at that time. Ms. Steel commented her understanding of S.B. 362 was if a physician owned more than one facility, his patients, for convenience, could go to the closest one. She wondered if a letter of intent would help clarify the point. Mrs. Monaghan explained the bill from last session made it illegal for a physician with a main office and a satellite office to have patients come to the main office once they had been seen in the satellite facility. Senator Titus had indicated that was not the original intent of last session's legislation and S.B. 362 was attempting to remedy the problem by cleaning up the language. Ms. Steel inquired what the difference between the part being deleted and lines 14 and 15 was. Ms. Berkbigler explained lines 14 and 15 only relate to group practices and therefore a sole practitioner would be excluded under Nevada's law. For instance, a sole practitioner would no longer have the ability, under this law, to own his own x-ray machine in his own office for the convenience of his patients. Jeff Whitehead, the Nevada State Medical Association's legal counsel, stated "supervision" mentioned on line 24, page 1 and "area of competence" mentioned on line 1, page 2, was what narrowed and tailored S.B. 362 and would prohibit abuse while allowing cost effective medicine in the state. Ms. Buckley emphasized S.B. 362 only dealt with referrals and did not prohibit a sole practitioner from buying equipment. She reiterated "all the last section does is open up a loophole gutting the original intent of the legislation." Mrs. Braunlin, referring to concern regarding a solo practitioner, questioned whether lines 14 and 15 could be amended to include that. Ms. Berkbigler reiterated the language proposed in S.B. 362 was specifically tailored to stop abuse. Ms. Buckley stated she wished to amend her original motion to take into account Mrs. Braunlin's suggestion that on lines 14 and 15 the words "or solo" be added after the word "group" to take into account the solo practitioner. Mrs. Monaghan inquired whether the individual who seconded the original motion concurred. Mr. Williams, who seconded the original motion, agreed. Mrs. Evans requested clarification of the motion. Mrs. Monaghan explained on line 15, page one the words "or solo" would be added. Lines 21 through 25 on page one and lines 1 and 2 on page 2 would be deleted. THE MOTION CARRIED. A S S E M B L Y M E N K R E N Z E R , E V A N S A N D S T E E L V O T E D N O . A S S E M B L Y M E N H A R R I N G T O N A N D G O L D W A T E R A B S T A I N E D . Stating the original motion, which contained this amendment, had already been moved and seconded, Mrs. Monaghan requested a vote on the second part of the amendment, which would add S.B. 153 to S.B. 362. THE MOTION CARRIED. Mrs. Freeman asked whether a letter of intent would be going with S.B. 362. Mrs. Monaghan responded one was not. Ms. Steel, mentioning she had voted for the bill as a whole, requested her right as a committee member to work out an amendment if possible. ********* SENATE BILL 558 - Requires certification of mental health-mental retardation technicians employed by division of child and family services. John Sarb, Chief of the Division of Child and Family Services, explained S.B. 558 was a bill designed to clear up an omission from the last session which provided for the certification of mental health technicians employed by the state and also provided for the certification of same by the Division of Mental Health and Mental Retardation. He stated omitted from inclusion among those to be certified were approximately 35 mental health technicians in the employ of the Division of Child and Family Services. He testified the bill's provisions had the approval of Dr. Brandenburg, Acting Administrator of the Division of Mental Health and Mental Retardation. ASSEMBLYWOMAN BARBARA BUCKLEY MOVED DO PASS ON S.B. 558. ASSEMBLYWOMAN SAUNDRA KRENZER SECONDED THE MOTION. THE MOTION CARRIED. ********* SENATE BILL 477 - Exempts convention halls from requirement of providing sufficient number of water closets and urinals to comply with Uniform Plumbing Code. Mrs. Monaghan reminded committee members Shelley Berkley from the Sands Hotel Casino had requested an amendment that defined a convention center as "a facility that combines an exhibition space with a substantial number of smaller meeting places, the purpose of these buildings is to host trade shows, public shows, conventions, large food functions and other functions related to the convention industry." Mrs. Monaghan commented the purpose of the amendment was to exempt convention halls but not exempt sports or music theaters or cultural centers and the like. ASSEMBLYWOMAN SAUNDRA KRENZER MOVED AMEND AND DO PASS S.B. 477. ASSEMBLYMAN DENNIS NOLAN SECONDED THE MOTION. THE MOTION CARRIED. ********* SENATE CONCURRENT RESOLUTION 16 - Urges Congress to amend Social Security Act and Internal Revenue Code to aid recipients of Medicaid who have disabilities in obtaining personal assistance services in their homes. Donny Loux, Chief of Community Based Services, presented her testimony in support of S.C.R. 16, (Exhibit C). Mrs. Evans asked if Medicaid is the employer of a care giver. Ms. Loux replied a care giver is either employed by Nevada Medicaid, the Division of Aging or her office. Mrs. Evans inquired what impact adoption of S.C.R. 16 would have on benefits paid to care givers. Ms. Loux responded benefits provided depended upon the program. Paul Gowins, a user of personal care services, stated the importance of adopting resolutions such as S.C.R. 16. Assemblywoman Tripple applauded the intent of S.C.R. 16 and then inquired if one could hire a family member, such as a wife, as a care giver. Ms. Loux stated it would depend upon the agency regulating the specific program and that it was solely an agency decision. Ms. Tripple questioned if there was a common rate of pay for care givers. Ms. Loux stated in Europe there was a common rate established by the funding agency and she expects that will happen here as well. ASSEMBLYWOMAN JAN EVANS MOVED TO ADOPT S.C.R. 16. ASSEMBLYWOMAN VIVIAN FREEMAN SECONDED THE MOTION. THE MOTION CARRIED. There being no further business, the meeting was adjourned at 3:15 p.m. RESPECTFULLY SUBMITTED: Terry Horgan, Committee Secretary APPROVED BY: Assemblywoman Vivian L. Freeman, Chairman Assemblywoman Jan Monaghan, Chairman Assembly Committee on Health and Human Services June 19, 1995 Page