MINUTES OF THE SENATE COMMITTEE ON COMMERCE AND LABOR Sixty-eighth Session February 3, 1995 The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 8:05 a.m., on Friday, February 3, 1995, in Room 227 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. COMMITTEE MEMBERS PRESENT: Senator Randolph J. Townsend, Chairman Senator Ann O'Connell, Vice Chairman Senator Sue Lowden Senator Kathy M. Augustine Senator Raymond C. Shaffer Senator Jack Regan Senator Joseph M. Neal, Jr. STAFF MEMBERS PRESENT: Scott Young, Senior Research Analyst Molly Dondero, Committee Secretary OTHERS PRESENT: Cookie Bible, Nurse Practitioner, Planned Parenthood Patricia A. Peer, R.N., Health Professionals Advisory Board (HPAC), March of Dimes Tamara Lieberman, Executive Director, March of Dimes Keith J. Tierney, Vice President, Planned Parenthood of Southern Nevada Donna Legg, Assistant Division Director, Community and Clinical Health, Washoe County District Health Department Dr. Jean Lyon, Nevada Nurses Association Dr. Eric Albers, Associate Professor, University of Nevada-Reno School of Social Work Stephanie Tyler, Lobbyist, Nevada State Chiropractic Association Dr. Gary Whitehead, D.C., President, Nevada State Chiropractic Association, Cooperative Association of Chiropractic Physicians May Shelton, Director, Washoe County Social Services Alicia Smalley, National Association of Social Workers John Hyde, President, Nevada Pharmacists Association Dr. Jerry Nims, Nevada State Psychological Association Barbara Cox, Registered Dietitian, Nevada Dietetic Association Paula Berkley, Lobbyist, Board of Psychological Examiners, Board of Chiropractors Betsy Gornet, Chief Executive Officer, Nathan Adelson Hospice Jan Austin, President, Home Care Association of Nevada John D. Busse, Executive Director, Home Health Care Association of Nevada Joni Moss, Administrator, Vital Care and Home Health Care Association of Nevada Larry Hardy, Nevada Association of Life and Health Underwriters Senator Townsend presented two bill draft requests (BDRs) to the committee for vote. BILL DRAFT REQUEST 46-411: Establish state energy office. SENATOR REGAN MOVED TO DO PASS BDR 46-411. SENATOR O'CONNELL SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. ***** BILL DRAFT REQUEST 28-422: Revises duties of public works board relating To conservation of energy. SENATOR O'CONNELL MOVED TO DO PASS BDR 28-422. SENATOR SHAFFER SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. ***** Cookie Bible, Nurse Practitioner, Planned Parenthood presented Exhibit C ( a letter from Planned Parenthood of Northern Nevada). Patricia A. Peer, R.N. Health Professionals Advisory Board (HPAC), March of Dimes, presented Exhibit D (A collection of information on Insurance Coverage for Well Baby Care and Preventive Pediatric Care). She stressed health care should be increased in the areas listed in Exhibit D rather than decreased. She stated protecting the health care of pregnant women and infants is a responsibility of society. She stressed the importance of prevention in Nevada since Nevada has one of the highest teenage pregnancy rates in the country. She emphasized the need for newborn well-baby care and for the development of rating approaches which do not discriminate against women of reproductive age. She commented any major changes in the health care financing system will have an impact on the health of the 4 million babies born nationally. She asked for their protection by practicing preventive care. Senator Regan asked if the Governor's program on prenatal care has been effective. Ms. Peer stated it had shown a significant impact. Senator Regan asked how the Legislature could legislate prenatal care since prenatal care is a choice many woman do not make due to lack of understanding of their need. This lack of understanding encompasses all socioeconomic groups. It is difficult to legislate understanding. Ms. Peer stated there is an increase in understanding with the programs developed and many women take advantage of the programs to learn more about prenatal care. Tamara Lieberman, Executive Director, March of Dimes, stated there is minimal coverage in the insurance mandates. To remove those mandates would remove coverage for the women who do understand the need for prenatal care and would increase the problems of the children. Senator Augustine asked if a cap of 0-5 years was placed on well baby care, would the insurance companies be more inclined to offer it. Ms. Peer stated this is an approach used in many communities. She stated 0-6 years would take the child into school. Senator Townsend stated the purpose of the hearing was to analyze the proposal by the Nevada State Medical Society with regard to mandated benefits. The proposal would have the insurance commissioner chair a committee in the interim to analyze the soundness of each benefit. He stressed the importance of sharing comments with the medical society. Keith J. Tierney, Vice President, Planned Parenthood of Southern Nevada, read Exhibit E ( a letter). Senator Townsend stressed the need for the committee to have information about any statistics or interviews regarding the reasons people do not seek health care early. He wished to know if the reasons were due to cost or other reasons. Donna Legg, Assistant Division Director, Community and Clinical Health, Washoe County District Health Department, stated her concern that any benefits would be removed. She highlighted her concerns for the "Healthy Families Nevada" program which is an intensive home visitation program for parents who are at risk for abusing and neglecting their children. She stated over 50 percent of the families at risk are alcohol and drug abusers. She emphasized the need for care of pregnant women and handicapped individuals. To treat them early helps them throughout the rest of their lives. To not treat them will eventually cost the state more over the years. She stated the health department is committed to reach the "Year 2000 Goals and Objectives" for health throughout the nation. To remove the preventive care services would be detrimental to reaching those goals. Dr. Eric Albers, Associate Professor, University of Nevada-Reno School of Social Work, read Exhibit F. Dr. Jean Lyon, Nevada Nurses Association, read Exhibit G. Dr. Gary Whitehead, D.C., President, Nevada State Chiropractic Association, presented Exhibit H (articles on back pain). He stated chiropractic care reduces the need for other types of care. He stated chiropractic care was 43 percent more efficient cost-wise than traditional medical treatment for low back related problems. Stephanie Tyler, Lobbyist, Nevada State Chiropractic Association, discussed Exhibit H, the section listing mandates. She commented that a bare bones insurance plan does not offer all that is needed by an employer for his employees. She stated that though cost is a factor in terms of insurance, employers and employees look at the entire package of benefits. She cautioned against doing away with the mandates. May Shelton, Director, Washoe County Social Services, commented on the Health Access Nevada proposals. She presented Exhibit I. She questioned financing of insurance and portability of insurance. She asked if the coverage would cover part-time employees and seasonal employees. Senator Townsend asked if Ms. Shelton had statistics about coverage for those employees. She stated all three hospitals in Washoe County were working on collecting data of people they serve who are employed but uninsured, and unemployed and in between jobs, but it is a slow process. Senator O'Connell asked for Ms. Shelton's definition of portability. Ms. Shelton continued with her comments against eliminating preventative care. She stated if elimination of hospice and home health care became a reality, it is likely a person entering a nursing home would be the responsibility of the county for long term care. Matching federal money of $2.5 million is used for care. She stated over 55 percent of the child abuse cases in the state are combined with alcohol and drug abuse in the family. She stressed the need to continue counseling and preventative care. Alicia Smalley, National Association of Social Workers (NASW), read Exhibit J. John Hyde, President, Nevada Pharmacists Association, stated he has used the services of the various agencies represented in this hearing. He illustrated how a person may not be able to administer their own medications, and without such services as home health care, the patient would have to go to a nursing home. Home care is much less expensive than hospital care. Senator Neal asked how many independent pharmacists there were in the state. Mr. Hyde answered between 30 percent and 50 percent was the national average, and Nevada is within that percentage. Senator Neal asked if there was a contract between the pharmacy and the drug manufacturer to sell a certain drug. Mr. Hyde stated there was not. He said the independents in the state have a representative who helps negotiate different insurance contracts and rebates for generic drugs. He stated there are no incentives from the major manufacturers. Dr. Jerry Nims, Nevada State Psychological Association, read from Exhibit K. He stressed the need for psychologists, social workers, and marriage and family therapists. A great many of the people seen by these professions are women and children. It is necessary for these victims to have women to whom they can relate. More than half of the counselors in these fields are women. It would create a hardship on these victims if the psychologists, social workers, and family therapists were not included in health care. He discussed the proposal by the Nevada Medical Association. He stated he is, generally, in support of the proposal. He supports the concept that professionals, rather than clerical, or administrative personnel make treatment decisions. An insurance company has a conflict of interest. Every dollar in services denied is a dollar of profit for the company earned. He stated: The newest source of liability for the health care provider is if I make a recommendation for treatment, the insurance company denies it, if I do not do battle with the insurance company, I am professionally negligent. I can not just recommend it, I have to go in and fight, and fight, and fight and appeal that insurance company. Otherwise a whole new source of professional liability occurs in negligence in failure to assert the need for treatment on behalf of the patient. That is how big this thing has become...we want to have a variation on the Nevada State Medical Association proposal. That would be that written into Nevada law whenever an insurer, or health care organization, denies authorization of a recommended treatment that there be an automatic and an immediate review by an independent panel of professionals. This should not be left to a battle between a claims clerk and a physician, or a psychologist, or treating professional...lives are lost while we fiddle around arguing about these things. He stated the Nevada State Medical Association made some recommendations which should be expanded. He commented consumers talk about freedom of choice in health care, but do not mean freedom as to which claims clerk or which bureaucracy to deal with. They want the freedom to see the providers of their choice. If they change employers, the consumer does not want to wade through a list of providers to see if their doctor is on the list. The legislation should make it clear that insurance companies must cover services performed by any willing provider. Any qualified professional who is willing to provide services under the terms offered by the insurer would be covered. Barbara Cox, Registered Dietitian, Nevada Dietetic Association, spoke of her job as a dietitian. She gives home visits for infants with failure to thrive, home-bound patients on tube feeding, and for children with feeding disorders. Nutrition services which prevent malnutrition can avert chronic illnesses and the need for expensive hospital care. She stated patients are often malnourished when they are discharged from the hospital. Home health care dietitians help the patient regain lost weight and to regain an appetite. Pressure sores may be alleviated and prevented with proper nutrition. The alternative therapy is much more expensive. She illustrated three cases of infants diagnosed with failure to thrive. Traditional therapy requires the physician to admit the child to the hospital. Home dietitians may evaluate the child better in the home because the child's environment, eating habits, and family situation may be better diagnosed. After four home visits all three infants gained weight after the nutrition changes were made. There was a cost savings of $3000 to each case. Expanded coverage of nutrition therapy would provide more savings to the state. Paula Berkley, Lobbyist, Board of Psychological Examiners, Board of Chiropractors, read Exhibit L ( letter, Nevada State Board of Psychological Examiners) and Exhibit M (letter, Nevada State Board of Chiropractic Examiners). Betsy Gornet, Chief Executive Officer, Nathan Adelson Hospice, presented Exhibit N (packet presenting mandated benefits information). Ms. Gornet stressed the necessity of hospice care. Hospice care gives support to the dying patient and support for the family. A hospice is a cost-effective alternative for the dying patient. Without the hospice, a patient has no choice but to submit to the hospital environment with its added expense and loneliness. To die at home offers no support for the family or the patient. Without mandated benefits for hospice care, these patients are left without choice. Jan Austin, President, Home Care Association of Nevada, read Exhibit O. Ms. Austin presented Exhibit P Mandated Health Insurance Benefits, Legislative Counsel Bureau, Bulletin No. 93- 7 (reference to library). Joni Moss, Administrator, Vital Care and Home Health Association of Nevada , read Exhibit Q (packet of costs). John Busse, Executive Director, Home Health Care Association of Nevada, submitted Exhibit R ( a letter from Rick Bennett) and Exhibit S ( a letter from Roberta Skelton). Larry Hardy, Nevada Association of Life and Health Underwriters, was asked by Senator O'Connell if he could compile information on the total uninsured population, along with their ranking on health care costs for the following states: New York, Texas, Virginia, Pennsylvania, North Dakota, North Carolina, Wyoming, Vermont, South Carolina, and New Hampshire. Senator Townsend closed the hearing at 10:00 a.m. RESPECTFULLY SUBMITTED: Molly Dondero, Committee Secretary APPROVED BY: Senator Randolph J. Townsend, Chairman DATE: Senate Committee on Commerce and Labor February 3, 1995 Page