MINUTES OF THE ASSEMBLY COMMITTEE ON WAYS AND MEANS Sixty-eighth Session April 28, 1995 The Committee on Ways and Means was called to order at 1:35 p.m., on Friday, April 28, 1995, Chairman John Marvel presiding in Room 352 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. COMMITTEE MEMBERS PRESENT: Mr. Morse Arberry, Jr., Chairman Mr. John W. Marvel, Chairman Mrs. Jan Evans, Vice Chairman Ms. Sandra Tiffany, Vice Chairman Mr. Dennis L. Allard Mrs. Maureen E. Brower Mrs. Vonne Chowning Mr. Jack D. Close Mr. Joseph E. Dini, Jr. Mr. Thomas A. Fettic Ms. Chris Giunchigliani Mr. Lynn Hettrick Mr. Bob Price Mr. Larry L. Spitler STAFF MEMBERS PRESENT: Mr. Mark Stevens, Fiscal Analyst Mr. Gary L. Ghiggeri, Principal Deputy Fiscal Analyst Mr. Steve J. Abba, Program Analyst ASSEMBLY BILL 253 Makes appropriation to welfare division of department of human resources for safety and security equipment, computer equipment and vehicles. Myla Florence, Administrator, Welfare Division, Department of Human Resources, introduced Mike Willden, Deputy Administrator for Administrative Services. She provided a handout regarding A.B. 253 (Exhibit C) and explained the bill provided a one-time appropriation of $278,254 to the Welfare Division's administration budget to purchase equipment. The funds were linked to three modules within the welfare administration budget, module E-425 in the amount of $72,725, module E-710 in the amount of $83,094, and module E-720 in the amount of $122,435, and would provide for equipment as recommended by a security consultant. Module E-425 provided for the purchase of lobby equipment, room dividers, and alarm systems. Module E-710 related to 6 replacement vehicles for vehicles which had in excess of 90,000 to 120,000 miles and were 6 to 13 years old. Some staff had indicated their unwillingness to drive the vehicles when traveling long distances. Module E-720 related to the purchase of computer equipment and workstations. Chairman Marvel inquired if these items had been discussed during subcommittee hearings. Ms. Florence replied yes, and indicated the general fund share would be considered as a one-time appropriation, which was not included in the budget, but the federal share was displayed in the budget. Mr. Arberry inquired where security equipment as reflected in Exhibit C would be located. Ms. Florence replied the security equipment would be located in all of the Welfare Division urban offices in Las Vegas and Reno as displayed in module E-425. Mr. Arberry asked if a discount had been provided on the eight cellular telephones. Ms. Florence stated staff would be looking for the best price through state purchasing. She assumed the price included the battery packs and other items associated with cellular telephones. The price quotes had been received in June or July 1994 and probably would have decreased in the meantime. Mr. Hettrick inquired if some of the figures reflected in E-425 were also included in 95-S9 of the CIP. Ms. Florence stated she was not familiar with the CIP figures. Gary L. Ghiggeri, Principal Deputy Fiscal Analyst, explained the Governor's budget recommended approximately $200,000 for security upgrades in a number of state buildings, including the Belrose, Charleston and Owens offices. Michael J. Willden, Deputy Administrator, Administrative Services, Welfare Division, remarked the reference may have been directed to the Belrose office which had three offices, one for the Welfare Division, one state office, and one for the Division of Child and Family Services. Mr. Hettrick asked if the Welfare Division had offices on Charleston and Owens Streets, and Mr. Willden replied no. Chairman Marvel requested a clarification be provided to the committee. When Mr. Spitler inquired if the matching funds were 50% federal and 50% state, Ms. Florence replied yes. Chairman Marvel closed the hearing on A.B. 253 and opened the hearing on S.B. 213. SENATE BILL 213 Makes appropriation to welfare division of department of human resources for replacement of room dividers and office equipment. Ms. Florence explained S.B. 213 was for a one-time appropriation of $7,852 to the Welfare Division's Medicaid budget for the purchase of equipment. The appropriation was linked to two modules. Module E-425 provided for the purchase of 90 room dividers for a total cost $13,500, of which 50% of the total cost would be borne by federal participation. The request came about as a result of the review of the Belrose office by a security consultant, who indicated there was easy and unchallenged access from lobbies to areas of administration and operation, and recommended the installation of room dividers. Module E-710 provided for the purchase of 3 replacement desks and 6 replacement chairs totaling $2,205, of which 50% would be provided by federal funds. The desks and chairs were replacements for old and worn equipment which were of concern regarding workers' safety. When Chairman Marvel inquired if $7,852 was included in the budget, Ms. Florence responded yes. Mr. Arberry asked if consideration had been given to putting room dividers in the Owens office. Ms. Florence stated room dividers were included in A.B. 253 in module E-425. Mr. Arberry inquired who was paying for the remodel of the Belrose building. Ms. Florence explained the state did not own the Belrose building but had renegotiated the lease to include the remodel. Mr. Arberry asked what the possibility would be to relocate some of the staff from the Belrose building to an office on Shadow Lane. Ms. Florence indicated the division did co- location where possible. It was her understanding there was no available space at Shadow Lane. Mr. Arberry had hoped consideration would be given to looking for office space at the five-story building near Shadow Lane so people would not be traveling such long distances between different agencies. Ms. Florence explained the people at the Owens office should be served at the Owens Clark County Social Services since they were both in the same complex. There was a problem with people being served out of the Belrose office having to get back and forth between Belrose and Shadow Lane. Mrs. Evans inquired which agencies were being addressed by S.B. 213. Ms. Florence explained S.B. 213 was in Medicaid and A.B. 253 was in welfare administration. Mr. Spitler noted the one-shot appropriations were being requested in the current biennium, yet the budget from which the federal funding will come would be the July 1, 1995, budget. He inquired how the vehicles would be acquired since the agency had only half the money to pay for them. He also asked whether the budget reflected only 50% of the actual expense in each category. Mr. Willden noted the Executive Budget reflected only the 50% federal share for equipment. A note in the narrative indicates the state share was provided through a one-shot appropriation. If the appropriations are approved, the state share will be added into the Executive Budget, resulting in all the money being made available to purchase the vehicles. Mr. Spitler inquired if the funding was done in this manner because the federal fiscal year was different from the state's fiscal year. Mr. Willden stated he thought it was done as a means of pulling out the big equipment purchases so they could be addressed as separate decision items. Don W. Hataway, Chief Assistant Budget Administrator, Budget Division, explained one-shot appropriations were work programmed into FY 1995, automatically balanced forward to FY 1996 and matched with federal funds. Whatever is not spent by the end of FY 1997 reverts to the general fund. AGING SERVICES DIVISION SUBCOMMITTEE CLOSING REPORT Mrs. Evans reported the joint subcommittee reviewing the Human Resources/K-12 budgets has reviewed and developed closing recommendations for the Division of Aging Services. In the Aging Services' budget, the Executive Budget proposed three new positions to expand the Community Ombudsman program in Las Vegas and to introduce the program to the Reno and Elko areas. The Community Ombudsman program was originally approved by the 1991 Legislature and focuses on the educational and advocacy needs of seniors residing in the community and in adult group settings. The program is currently staffed with one position in Las Vegas. The subcommittee supports the Executive Budget's proposal which will enable the Aging Services Division to target homebound and at-risk seniors in areas of the state currently not served or under-served. The subcommittee supports the transfer of the Senior Ride Program from the Taxicab Authority to the Aging Services Division jointly agreed to by both agencies. The subcommittee received testimony that the Aging Service Division is much better suited to administer the Senior Ride Program since the Division works closely with seniors on a daily basis and is in a better position to identify transportation needs and monitor the program's success. The Aging Services Division will most likely modify the program's eligibility criteria and initiate a reasonable means test and establish a new registration process due to concerns on how the Senior Ride Program is currently used and who can qualify. Since the transfer includes existing staff and resources used to administer the program, there should be minimal program interruptions. As many of you will recall, the State Transportation Program has for years distributed $50,000 annually primarily to rural senior centers to be used as match to access federal transportation funds to purchase vehicles, to supplement rural transportation grants, to supplement rural transportation operating budgets and for emergency repairs. The rural senior centers generally have very tight budgets and the match funding provided has been extremely beneficial to maintain the viability of rural senior transportation programs. The Executive Budget does not recommend funding the State Transportation Program for the 1995- 97 biennium. The subcommittee is recommending to continue the program at its historical funding level. Federal changes to the Older American Act's methodology for distributing Title III Nutrition and Social Service grants to local entities and the 1990 census data have caused a significant shift in available funding from rural to urban counties. In response to this change, the 1993 Legislature appropriated approximately $411,000 for each fiscal year of the 1993-95 biennium in state funds to replace the federal funds shifted to urban counties to stabilize senior service funding levels in the rural counties. The Subcommittee concurs with the Executive Budget's recommendation to continue the state's support to stabilize rural senior service funding for the 1995- 97 biennium with an appropriation of approximately $550,000 for each fiscal year. SENIOR SERVICES PROGRAM The Community Home Based Initiatives Program (CHIP) initiated at the Legislature's direction in 1987 is designed to provide home and community based services for frail and elderly individuals who are at risk of institutionalization. The CHIP program helps promote the independence of frail elders in the least restrictive environment possible and provides a less expensive alternative to nursing home care. The subcommittee concurs with the Executive Budget's recommendation to expand the CHIP program's current caseload of 7,500 cases to 8,790 cases for FY 1996 and 9,340 cases for FY 1997. The subcommittee also recommends approval of the additional case managers and program support staff for the expanded caseload. As the Committee will recall, concern was expressed during the Aging Services budget hearing on the methodology used in the Executive Budget to fund Purchase of Service costs, the major expenditure in the CHIP program. Approximately 98 percent of the costs for purchased services in the CHIP program are for attendant care and homemaking services. The subcommittee is recommending an alternative approach to budget Purchase of Service costs. The alternative approach recommended takes into consideration the per unit hourly cost for providing purchased services, the average number of service hours purchased per client on a monthly basis, the recommended CHIP caseload and CPI increases consistent with those recommended in the Medicaid budget. The alternative approach recommended allows for technical adjustments which reduces Purchase of Service costs, however, will not result in a reduction in caseload to be served or in the amount of services provided per client. The reduction recommended will provide for a general fund savings in the Medicaid budget of approximately $175,000 over the 1995-97 biennium. The subcommittee recommends approval of the Executive Budget's proposal to increase state-funded CHIP caseload from an average of 10 clients per month to approximately 50 clients per month. The state-funded CHIP caseload was significantly reduced as a budget reduction measure during the 1991-93 biennium. During the Aging Services budget hearing, testimony was received requesting consideration to increase state-funded Caregiver Training. Caregiver Training is provided to family and professional caregivers of elderly persons. Generally, funds are subcontracted to non-profit organizations to provide workshops on issues of concern to caregivers such as the mechanics of physical care, dealing with difficult patients and how to cope with the demands for care giving. Prior to the budget reductions instituted during the 1991-93 biennium, Caregiver Training was funded at $50,000 per fiscal year. Caregiver Training was reduced to $10,000 per fiscal year after the budget reductions and increased to $20,000 per fiscal year by the 1993 Legislature, the level currently recommended in the Executive Budget for the 1995-97 biennium. According to the Aging Services Division, $20,000 will only provide Caregiver Training for the urban counties. The Subcommittee is recommending an additional $25,000 per fiscal year be approved to allow for a more concerted effort to provide Caregiver Training on a statewide basis. Mrs. Evans noted during testimony it was pointed out there was limited training in Washoe County and almost nonexistent in the rest of the state. The Subcommittee also recommends a letter of intent be transmitted to the Aging Services Division specifying the additional Caregiver Training funds be used to purchase $10,000 in caregiver training kits to be used statewide, $10,000 for Caregiver Training in the rural areas and $5,000 for Caregiver Training in the Washoe County area. Overall, the subcommittee's recommendations will increase general fund appropriations for the Division of Aging Services by $29,216 in FY 1995-96 and $47,587 in FY 1996-97. However, Title XIX funds are recommended to be reduced in the CHIP program, resulting in a reduction of general fund match in the Medicaid budget. Overall, the subcommittee's recommendations reduce general fund by $37,925 in FY 1995-96 and $68,285 in FY 1996-97 compared to levels recommended by the Governor. Ms. Giunchigliani inquired how much money went into the urban areas as a result of the federal grants shifting the dollars into the urban areas. Mrs. Evans stated the federal requirement was based on population. Ms. Giunchigliani requested more detail on the recommended alternative funding of the per-unit hourly cost for purchased services. Steve Abba, Program Analyst, explained the Governor's recommended budget used medical Consumer Price Index (CPI) rates of 10.3% and 5.6%. The Medicaid budget CPI rate increases were far lower and were applied to the recommended case load and number of hours per service per person which resulted in a new formula that tended to reduce the cost with no consequence to service levels. * * * * * MRS. CHOWNING MOVED TO ACCEPT THE SUBCOMMITTEE'S RECOMMENDATIONS. MR. ALLARD SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY BY VOICE VOTE. * * * * * Mrs. Evans wished to acknowledge the hard work and good effort of Mr. Abba. Chairman Arberry stated the chair and the committee acknowledged and appreciated the efforts of Mr. Abba for his work on the subcommittee. SENATE BILL 205 Makes appropriation to University and Community College System of Nevada for scholarships for students. Richard S. Jarvis, Ph.D., Chancellor, University and Community College System of Nevada, introduced Dr. Tom Anderes, Vice Chancellor for Finance and Administration, and he requested the committee's support for the bill to fast track student financial aid moneys proposed in the Executive Budget in the amount of $7 million. The bill was significant in that it would raise state support for financial aid from its long traditional bottom ranking in the country to a very healthy 40 to 41 percentile. The bill would enable students to plan their lives for four semesters. A high proportion of students work, which means they must find alternative sources of funding to get through the academic year. The University of Nevada, Reno, had one of the highest proportions of part-time students, working students, and one of the most rapidly lengthening times to degree in the country. Tom Anderes, Ph.D., Vice Chancellor, Finance and Administration, University and Community College System of Nevada, provided a chart to the committee members (Exhibit D) which reflected the planned annual and biennial allocation of the one-shot scholarship funding, as determined by the presidents of each institution. The allocations were based on cost to the student, need and enrollments. Specific guidelines were applied to the allocation of the funding for each student relative to federal need methodology. Mr. Price inquired if the Clark County community college had more full-time employees than the other campuses. Dr. Anderes stated they had more full-time employees than the University of Nevada, Reno (UNR). One of the reasons for a higher allocation to the universities was because it cost twice as much to attend. The allocation was based on employees and the need. Mr. Spitler asked if 100% of the allocation went to students as opposed to a portion going to administrative costs. Dr. Anderes replied there were no administrative costs. Mrs. Brower questioned what the appropriation had been in the past and if only in-state students received scholarships. Dr. Anderes explained student access dollars within the operating base amounted to $1.7 million, which would not increase into the next year. The intent was to make sure the resident student was the first in line in terms of student financial aid. Mrs. Brower inquired if allocations for student scholarships in the past had been $1.7 million. Dr. Anderes responded for student access dollars, yes. Ms. Giunchigliani requested a definition of student access dollars. Dr. Anderes explained the dollars could be broken down into student access dollars and grant-in-aid dollars. The grant-in-aid dollars were either statutory or policy based by the board relative to particular groups of students. Three percent of the students that are nonresidents are eligible for grant-in-aid dollars, which relate to tuition waiver, and there is a 3% allocation for resident students which relates to registration fees. Student access dollars were specifically set aside from the increases in registration fees on a need basis. Grant-in-aid dollars were designated in terms of purpose, while the student access dollars were based on need for any student. Ms. Giunchigliani requested a copy of the allocation guidelines. She inquired how many students were on the campus of UNR. Melissa Chorosy, Assistant Vice President, Enrollment Services, University of Nevada, Reno, replied approximately 13,000 students. Ms. Giunchigliani inquired how many students were on the campus of UNLV. Dr. Anderes responded approximately 18,000 students. Ms. Giunchigliani requested the enrollment figures for all the institutions be provided to the committee. Ms. Chorosy remarked in 1994 5,418 UNR students applied for financial aid, of which 2,450 were allocated financial aid and 2,960 needy students were denied financial aid. Mr. Spitler inquired if any out-of-state students received any grant money from general fund allocations to the university system and, if so, how many. Mr. Anderes responded yes and explained, as established by statute, the limitation was no more than 3% of the nonresident enrollment. The $7 million appropriation was not related to grants-in-aid nor support to the nonresident grant-in-aid area. Mr. Spitler asked if any portion of the $7 million from S.B. 205 would go to out-of-state students. Dr. Anderes stated the primary intent was to fulfill the needs of the state residents first. One of the problems experienced by the university system was comparing a northern Nevada community college to UNLV. The conditions and demands of each institution were different. A small amount of room should be left to provide a small amount of money in each institution, but the primary purpose was to support the resident student. Mr. Spitler stated he could not support the bill unless he knew specifically that general fund dollars were being directed only to resident students of the state of Nevada. Mr. Close expressed his support of the concept presented by Mr. Spitler and suggested an amendment be included in the bill that money be provided only to resident students. Mr. Price inquired which board made the allocation decision Dr. Anderes was referring to. Dr. Anderes explained the allocation process was agreed to by the Council of Presidents. Mr. Price stated he had a procedural question regarding why the decision in reference to the allocation was not brought before the policy-making board elected to make decisions. Dr. Jarvis pointed out the board in 1993 approved a distribution model for the region access funds which were created out of the prior registration fee increase. The region access funds were not the same type of funds as those referenced in S.B. 205, but the same methodology was used in distributing funds among the campuses. Mr. Price requested a copy of the minutes of the board meeting showing approval of the distribution model referenced by Dr. Jarvis. Ms. Chorosy underscored the timely need for consideration of the bill and pointed out the federal financial aid deadline for priority funding was April 15, 1995, and awards for students for 1996 were being packaged. The ability to provide students with a complete package will help families and students plan for their financial needs. It will also make the difference between many students coming to the state universities and not going to school at all. Chairman Marvel remarked the bill was a one-shot appropriation which was not to be built into the base budget for the next biennium. With the concurrence of Co-Chairman Arberry and the committee, a letter will be sent underscoring the committee's intent. Mrs. Chowning expressed support for funding scholarships. She requested a breakdown of the number of students applying for need from the various institutions so as to provide assurance the numbers were proportional. Ms. Chorosy stated the numbers could be provided for the students who had applied to date; however, applications for financial need would continue until the following spring. The number of applications for financial aid and scholarships to the present date would represent approximately 60% of those who would be applying for the 1995-96 year. Mrs. Chowning requested information from past allocations be provided to the committee. Dr. Anderes stated if there was concern funding would be provided to a nonresident to the point it would jeopardize the allocation, then the university would not follow through with that type of decision. He stated there was little doubt in his mind that people would support the idea that the allocation would be spent only for residents. Mr. Price inquired if the appropriation would involve the good neighbor exchange agreement where students from California would get a break on tuition in Nevada. Mr. Anderes did not believe so. Mr. Price asked if the legislative body directed that all of the appropriation be spent on Nevada students, the university system would follow that directive. Mr. Anderes responded yes. Mr. Price questioned whether an effort would be made to draw money from some other location to try to help out-of-state students. Mr. Anderes replied no and stated there were different sets of resources but this would be the primary resource to provide student financial aid for those purposes. Chairman Marvel called for further testimony regarding S.B. 205. There being none, Chairman Marvel closed the hearing on S.B. 205. HEALTH DIVISION SUBCOMMITTEE CLOSING REPORT Mr. Hettrick expressed his appreciation for the excellent job done by Mr. Abba and Co-Chairman Evans. He reported the joint subcommittee reviewing the Human Resources/K-12 budgets has completed its review of the Health Division's 18 budgets and have concurred in the closing actions recommended. The following highlight the more significant budget closing actions recommended by the joint subcommittee. OFFICE OF THE STATE HEALTH OFFICER The subcommittee concurs with the Executive Budget's recommendation to provide two new positions for the Division's personnel and accounting functions based on growth in the Division's programs and the corresponding increase in workload. The Executive Budget also recommends the transfer of the Division's Information Specialist position to the Department of Information Services (DIS) as part of the proposal to consolidate certain information service functions. To correct an error in the Executive Budget which deleted the position, the subcommittee is recommending revenue authority be provided to restore the position's salary and operational costs. A majority of the position's restoration costs will be made up through a general fund appropriation with the balance financed through the Division's cost allocation plan. VITAL STATISTICS The subcommittee recommends approval of the one-time costs included in the Executive Budget for modifying and expanding the fireproof vault used to store all permanent vital records. The additional vault space will satisfy projected growth needs for the next 12 years. The subcommittee supports the Executive Budget's recommendation for a new Account Clerk position. The number of monetary transactions the Vital Statistics program processes has grown from 6,000-7,000 record requests yearly to a projected 25,000 record requests for FY 1996. The subcommittee, in conjunction with the Health Division, was able to identify additional non-state revenues and savings with the implementation of a pc-based birth certificate indexing system which will allow for an approximate $55,900 reduction in state general funds in the Vital Statistics budget over the 1995-97 biennium. HEALTH FACILITIES The subcommittee supports the Executive Budget's proposal to provide eight new Health Facility Surveyors and three additional clerical support staff for the 1995-97 biennium. The subcommittee received testimony and documented justification which supports the additional staff recommended based on workload associated with the growth in the number of medical and dependent care facilities surveyed and licensed statewide over the past several years which is anticipated to continue, a significant increase in the number of complaints which are actively investigated and the Bureau's inability to comply with statutory requirements for licensing medical and related facilities on an annual basis. At the urging of the subcommittee, the Health Division will initiate a thorough review of medical and dependent care facility inspection and licensing regulations and statutory requirements. As part of the review, the Health Division will determine if current regulations (which in some cases have not been revised since 1976) are still appropriate for today's health care practices and whether they may be too onerous when compared to other state and federal standards. The subcommittee supports the proposal to establish a Reno office which will improve the Bureau's response time and allow for an increase in the number of hours for on-site inspection time. The subcommittee recommends several technical corrections to the Health Facilities' budget which will more appropriately reflect the outfitting and start-up costs for the recommended new staff. The additional staff recommended will be funded by a combination of federal Medicare and Medicaid funds and an increase in the level of fees assessed the various medical and dependent care facilities regulated. MATERNAL CHILD HEALTH SERVICES (MCH) The subcommittee recommends the approval of the Governor's new initiative to implement a statewide peri-natal substance abuse program. The recommendation provides for the creation of a two- position umbrella unit within the MCH program to coordinate and act as a clearinghouse for the various state agencies involved in serving pregnant addicted women or drug and/or alcohol- affected women. The Executive Budget includes medical CPI increases for the MCH budget which are not consistent with CPI increases proposed for the Medicaid budget. The MCH program pays Medicaid rates for all medical services provided. By making the appropriate adjustments, the subcommittee was able to identify approximately $314,000 in general fund savings for the 1995-97 biennium. I wish to assure the committee service levels are not being reduced. This recommendation simply corrects an error in budgeting methodology. SPECIAL CHILDREN'S CLINIC During the review of the Special Children's Clinic budget, the subcommittee was apprised the introduction of Medicaid managed care may impact the amount of reimbursement revenues the Clinics currently receive for treatment services provided Medicaid eligible AFDC, CHAP and Child Welfare recipients. The Clinic's diagnostic services are exempt from Medicaid managed care and fee for service reimbursement levels are not anticipated to change. However, treatment services are not exempt and unless the Clinic successfully subcontracts with managed care providers, Medicaid reimbursement will be reduced. The net effect of Medicaid managed care on the Clinic's revenues at this time is speculative. The subcommittee realizes revenue shortfalls may occur in the Clinic's budget especially in FY 97 once managed care is fully implemented. However, due to the uncertainties on what the impact may be on revenues or treatment services, the subcommittee does not recommend modifications to the Executive Budget funding proposals at this time. Mr. Hettrick remarked it would be a shot in the dark to guess what is going to happen. He felt if there was some kind of change, it could be addressed as it came. The subcommittee supports the Executive Budget's staffing recommendation for the upcoming biennium which provides for additional accounting support for both Clinics to assist in collecting delinquent insurance billings. Currently, there is approximately $275,000 in outstanding private insurance billings over 90 days old. Additionally, the subcommittee recommends the approval of a half-time Physician position for the Las Vegas Clinic which will help reduce the lag time for client evaluations and will expedite triage, case conferences and multi-disciplinary team meetings. The subcommittee supports the recommended Speech Pathologist and Public Service Intern positions for the Reno Clinic which will help reduce the treatment waiting list for speech therapy services in the Carson Valley area and provide for a greater opportunity to promote group versus individual treatment sessions. The additional staff recommended will provide for needed administrative support and will mitigate the more critical diagnostic and treatment service needs. However, waiting lists will continue to exist for both the Las Vegas and Reno Clinics. The subcommittee recommends $143,325 in state general funds be approved for each fiscal year to replace the loss of federal Chapter I funds, which historically has been budgeted to offset costs for children with special needs. The appropriation will maintain at existing levels contract physical and occupational therapy services for both clinics. The subcommittee's budget recommendations will allow the Las Vegas Clinic to acquire 1,746 square feet of additional building space and to enter negotiations for a long-term lease arrangement to retain the Clinic at its current site. A long-term lease arrangement will ensure the best available price for the Clinic's space needs. STATE HEALTH LABORATORY The State Health Laboratory's 8,500 square feet expanded facility approved by the 1993 Legislature is anticipated to be completed in August, 1995. The expanded facility was approved because the Laboratory's workload exceeded the Laboratory's physical plant capacity and safety conditions were at risk of being compromised. Additionally, the expanded facility would allow the Laboratory to enhance water chemistry testing capabilities for Safe Drinking parameters currently not tested. The funds to outfit the expanded facility as well as to replace antiquated equipment, to provide for a laboratory management information system and for new equipment to enhance water chemistry and dairy product testing are recommended in Senate Bill 212, the Health Division's one-time appropriation. S.B. 212 is currently under review by the Senate Finance Committee. If the Laboratory's portion of S.B. 212's appropriation is modified, changes in the Laboratory's recommended budget will be necessary. The subcommittee recommends pending final decisions on S.B. 212, that the State Health Laboratory's budget, be approved as proposed in the Executive Budget with minor modifications. The subcommittee's recommendation reserves the option to re-open the Laboratory's budget to determine whether or not the additional staff recommended for enhanced environmental water chemistry testing is necessary. The additional staff will only be needed if the appropriation for new equipment to enhance environmental chemistry water testing capabilities is approved. The subcommittee supports the Executive Budget's proposal to provide additional utility costs and laboratory supplies for the expanded facility, to replace the loss of federal funds with state general funds which will allow the Laboratory to continue providing public health testing services when fees are not appropriate or collected on a partial basis, to provide the Laboratory replacement equipment funding and to provide for emergency maintenance and repair costs anticipated with the expanded facility. SEXUALLY-TRANSMITTED DISEASE (STD) The subcommittee recommends technical adjustments to the STD budget which will allow the Health Division to accept approximately $726,500 in supplemental HIV Prevention Grant funds for FY 1996. A majority of the additional federal funds will be used for HIV risk reduction and educational programs administered by community-based organizations and the Clark and Washoe County health districts. Federal HIV Prevention Grant monies available to Nevada are projected to increase by approximately $2 million for the 1995-97 biennium compared to the 1993-95 biennium and will be used to promote diverse outreach programs and for HIV prevention activities such as counseling and testing, referral and partner notification, public information and health educational risk reduction; and, minority outreach. COMMUNICABLE DISEASE CONTROL (TB) As the Committee will recall, the Interim Finance Committee approved two contingency fund allocations in the amounts of $319,000 for FY 94 and $330,000 for FY 95 to supplement the Communicable Disease program's TB Suppression activities. The subcommittee recommends the Communicable Disease Control budget be approved as proposed by the Executive Budget with minor technical adjustments. The recommended budget will provide sufficient funding to maintain a viable TB drug suppression program for the 1995-97 biennium. The recommended budget will also allow for an additional 57 patient months in residential care for FY 1996 and 62 patient months for FY 1997. TB patients were denied residential care in FY 1994 due to lack of funding. The recommended budget will also provide approximately $122,000 for the 1995-97 biennium to purchase second line drugs for TB patients who have developed a TB drug resistance. WIC FOOD SUPPLEMENT The subcommittee recommends the WIC budget be approved as proposed by the Governor with technical adjustments to correct inflation factors used which were not consistent with the Executive Budget's overall inflation policy. Depending on budget actions pending in Congress, the amount of USDA grant funding and infant rebate formula funding recommended in the Executive Budget will increase WIC participation to 32,000 participants monthly for FY 1996 and 34,000 participants monthly for FY 1997. WIC services were provided to approximately 25,000 participants monthly for FY 1994. The subcommittee recommends revenue authority be restored to correct an error in the Executive Budget which eliminated WIC program's Micro-computer Specialist position salary and operational costs. This position is recommended to be transferred to DIS as part of the consolidation proposal. Further adjustments may be necessary since it appears the subcommittee reviewing the DIS budgets has approved payment to DIS for overhead charges not reflected in the Health Division's closings. IMMUNIZATION The subcommittee recommends approval of the Immunization budget as proposed by the Executive Budget with technical adjustments to correct how medical CPI rate increases for vaccines were applied. The subcommittee is recommending the transmittal of a letter of intent which requires the Health Division notify and receive Interim Finance Committee approval prior to expanding or enhancing the childhood series of vaccines beyond current levels. The subcommittee received testimony a vaccine for chicken pox will most likely be added to the recommended childhood vaccine series sometime next year. The subcommittee was concerned if the Immunization Program is expanded with the introduction of a new but not mandated vaccine, additional state resources will be required. The subcommittee feels that prior to committing limited vaccine resources to a new or augmented Immunization Program, the Health Division provide the Interim Finance Committee documentation justifying the purpose and need for the recommended vaccine and long-term fiscal considerations. CONSUMER PROTECTION The subcommittee recommends the Executive Budget's proposal to provide three new positions to maintain state primacy for the federal Safe Drinking Water program be approved. The additional staff recommended will be used to implement the Safe Drinking Water program's federal lead and copper rule statewide and pending regulations for arsenic, radon, sulfates and groundwater disinfection. The subcommittee was concerned if Nevada loses primacy, the U.S. Environmental Protection Agency would administer the Safe Drinking Water program as an enforcement oriented, non-assistance program which would result in additional costs to Nevada's water suppliers. The subcommittee is recommending an increase in the amount of plan review fees collected by the Consumer Protection program based on a re- projection of FY 1995 collections. The adjustments will provide for a general fund savings of approximately $43,000 over the biennium. Overall, the subcommittee's recommendations will decrease the general fund appropriation for the Health Division budgets by $280,625 in FY 1995-96 and $305,703 in FY 1996-97. Mrs. Chowning remarked Mr. Spitler's sign language bill was heard in the Committee on Education, and one of the parents who testified in favor of the bill stated his daughter became deaf as a result of chickenpox. * * * * * MR. ARBERRY MOVED TO ACCEPT THE SUBCOMMITTEE REPORT AND TO HOLD THE BUDGET ON MATERNAL CHILD HEALTH SERVICES. MRS. EVANS SECONDED THE MOTION. * * * * * Ms. Giunchigliani inquired if there was a recommendation to bring all water issues under one budget. Mr. Hettrick asked if the question was in reference to laboratory services. Mr. Dini remarked that safe drinking water was under the health division because of its relation to health, whereas other water issues related to water rights and adjudication. Chairman Marvel called for a vote on the motion. * * * * * THE MOTION CARRIED UNANIMOUSLY BY VOICE VOTE. * * * * * SENATE BILL 148 Makes supplemental appropriation to state board of parole commissioners for retroactive retirement contributions. * * * * * MR. DINI MOVED DO PASS S.B. 148. MR. HETTRICK SECONDED THE MOTION. * * * * * Mr. Stevens explained S.B. 148 was a supplemental appropriation which was included in the budget for payment of retroactive retirement contributions for one of the parole board commissioners who had since retired. Chairman Marvel called for a vote on the motion. * * * * * THE MOTION CARRIED UNANIMOUSLY BY VOICE VOTE. * * * * * SENATE BILL 149 Makes supplemental appropriation to department of education for expenses related to residential and educational needs of children with disabilities. Mr. Stevens explained S.B. 149 was a supplemental appropriation for what was commonly referred to as the 395 program for out-of- state placements within the Department of Education. The program was jointly administered by the Division of Child and Family Services and the Department of Education. The bill addressed the shortfall amount to allow for the payment of obligations through June 30, 1995. The Senate Committee on Finance lowered the appropriation by approximately $260,000. Fiscal staff reviewed the amount and concurred it should be sufficient to cover the obligations through the end of the fiscal period. Mrs. Evans noted during the budget closing the Division of Child and Family Service was removed from the pairing with the Department of Education. She inquired if a statutory change was required as a result of that action. Mr. Stevens confirmed a statutory change would be required, which had been requested from the bill drafters. Mrs. Evans commented perhaps the statutory change could be included in the bill. Chairman Marvel noted the chair would be amenable to amend and do pass S.B. 149. * * * * * MRS. EVANS MOVED TO AMEND AND DO PASS S.B. 149. MS. GIUNCHIGLIANI SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY BY VOICE VOTE WITH MRS. CHOWNING ABSENT AT THE TIME OF THE VOTE. * * * * * There being no further business, Chairman Marvel adjourned the hearing at 3:05 p.m. RESPECTFULLY SUBMITTED: Jonnie Sue Hansen, Committee Secretary Assembly Committee on Ways and Means April 28, 1995 Page