MINUTES OF THE MEETING OF THE JOINT SUBCOMMITTEE ON HUMAN RESOURCES/K-12 ASSEMBLY COMMITTEE ON WAYS AND MEANS AND SENATE COMMITTEE ON FINANCE Sixty-eighth Session April 18, 1995 The meeting of the Joint Subcommittee on Human Resources/K-12 of the Committee on Ways and Means and the Senate Committee on Finance was called to order at 7:43 a.m., on Tuesday, April 18, 1995, Chairman Lynn Hettrick presiding in Room 352 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. ASSEMBLY SUBCOMMITTEE MEMBERS PRESENT: Mr. Lynn Hettrick, Chairman Mr. Dennis L. Allard Mrs. Vonne Chowning Mr. Joseph E. Dini, Jr. Ms. Sandra Tiffany Mrs. Jan Evans SENATE SUBCOMMITTEE MEMBERS PRESENT: Senator William J. Raggio Senator Bob Coffin Senator Dean A. Rhoads ASSEMBLY SUBCOMMITTEE MEMBERS ABSENT: None SENATE SUBCOMMITTEE MEMBERS ABSENT: Senator Raymond D. Rawson, Chairman STAFF MEMBERS PRESENT: Mr. Mark Stevens, Fiscal Analyst Mr. Dan Miles, Fiscal Analyst Mr. Steve Abba, Program Analyst AGING SERVICES - PAGE 1259 Mr. Steve Abba, Program Analyst, said the Executive Budget recommends four new positions: three Community Ombudsmen and one Information Services Specialist. The three Community Ombudsmen positions will enhance the program which targets home-bound and at-risk seniors who live in the community and adult group care facilities. The Division currently has one Ombudsman position in Las Vegas. The additional positions will be in Las Vegas, Reno and one position in Elko in the second year of the biennium. The Information Services Specialist will be located in the Las Vegas office. Mr. Abba explained another important item in this budget is continued state General Fund support to offset shortfalls in Federal Nutrition and Social Services funding that will no longer be available due to distribution formula requirements to local rural senior citizen centers. The total state recommendation is $551,451 in each year of the biennium. Mr. Abba explained recommended closing adjustments. The base budget contains $16,626 of unused Title III administrative funds which are available to offset general operational costs. These funds could be used to offset General Fund. Delaying by three months hiring the three Ombudsmen would result in General Fund savings of $21,826 and $10,787 in the first year and second year of the biennium. The Division has requested funding for two trips to Elko to organize the Community Ombudsman Program during the first year of the biennium. The Elko position would be hired in the second year of the biennium. The Division was provided a significant increase in in-state travel over the biennium; it was felt the travel to Elko could be accommodated by the overall increase in travel funding. Mr. Abba indicated the Division and the Taxicab Authority supported the transfer of the Seniorride Program from the Taxicab Authority to the Division of Aging Services. It was felt that Aging Services' daily interaction with seniors would enable better administration of the Seniorride Program. The transfer includes two positions currently performing the duties associated with the Seniorride Program be transferred to the Division of Aging Services. Senator Raggio inquired whether the transfer opened the possibility of obligating General Fund money for the Seniorride Program in the future and requested explanation of the reason for the requested program transfer. Suzanne Ernst, Administrator of the Division of Aging Services, explained the Taxicab Authority is an investigative authority and the program would be more successfully managed by the Division for Aging Services. She noted there is no intention to ever request state General Fund. Senator Coffin confirmed that the Taxicab Authority is in favor of the transfer. Ms. Ernst indicated the Division has worked with the Taxicab Authority, reviewed the Taxicab Authority's records of the program and plans to hold public hearings regarding the proposed transfer. Senator Coffin inquired if company owners are supportive. Ms. Ernst responded affirmatively. Mr. Abba said concern had been expressed regarding non funding of the Local Project Share Program. In the past, the program was funded with $50,000 from the petroleum overcharge rebate account; those funds have been disseminated by the Division of Aging Services to various rural and local programs for senior transportation programs, to purchase vehicles and as match for federal Department of Transportation funds. If the committee wishes to continue to fund the match requirement, the $16,626 of Title III Administrative funds could be used; for FY 96 approximately $7,300 in unspent petroleum rebate funds could be used. SENATOR RAGGIO MOVED TO CLOSE THE AGING SERVICES BUDGET AS RECOMMENDED BY STAFF AND TO FUND THE LOCAL PROJECT SHARE PROGRAM USING TITLE III ADMINISTRATIVE FUNDS AND UNSPENT PETROLEUM REBATE FUNDS. ASSEMBLYWOMAN EVANS SECONDED THE MOTION. Mr. Dini asked if there was a means to fund the program at its historical level of $50,000. Mr. Abba said funding at that level would require addition of General Fund. ASSEMBLYMAN DINI MOVED TO AMEND THE MOTION TO FUND THE PROJECT SHARE PROGRAM AT THE LEVEL OF $50,000 IN EACH YEAR OF THE BIENNIUM. ASSEMBLYWOMAN CHOWNING SECONDED THE AMENDMENT. Mr. Abba clarified approximately $7,000-$8,000 of additional General Fund would be required in the first year and $24,000 of additional General Fund in the second year of the biennium to maintain the program at the $50,000 level. Chairman Hettrick called for a vote on the amendment. THE AMENDMENT CARRIED. ASSEMBLYMEN TIFFANY AND ALLARD VOTED NO. Chairman Hettrick called for a vote on the motion to approve the budget. THE MOTION CARRIED UNANIMOUSLY. BUDGET CLOSED. **************** SENIOR SERVICES PROGRAM - PAGE 1267 Mr. Abba said the Senior Services Program budget includes a significant increase in the purchase of services for the CHIP (Community Home-Based Initiatives Program) program. This program provides assistance so that elderly people can remain in their homes rather than being moved to skilled nursing facilities. The additional funds will increase the purchase of services and allow for the caseload to increase to nearly 9,400 cases in FY 97. Additional staff requested to handle the additional caseload includes two social workers, one clerical support position and one accounting technician position. Closing adjustments provide for a net reduction in the purchase of services costs. Purchase of service costs are funded based on the number of per unit hours of services provided to clients (mostly attendant care and homemaker services), caseload and CPI rate increases. CPI increases were adjusted to correspond to Medicaid CPI increases. The Medicaid budget funds the purchase of services costs in this program so the reduction will not impact General Fund in this budget but will in the Medicaid budget; the impact will be approximately one-half of the $134,282 and $231,744 reductions recommended in each year of the biennium. Senator Raggio expressed concern that the caseload not be impacted and requested assurance the committee's action would not impact the anticipated caseload. Ms. Ernst agreed the caseload would not be affected. Mr. Abba said during the Aging Services Division's budget hearing, testimony was received requesting consideration to increase state funded Caregiver Training. It is feasible to increase Caregiver Training with some of the savings that will be accrued to the Medicaid budget. Caregiver Training at this time is primarily provided to urban areas; rural areas are neglected because of the low level of funding. If funding is increased, it would target the rural areas. Mrs. Evans expressed concern that funding for Caregiver Training is still less than half of what was budgeted eight years ago and requested the committee consider some type of incremental increase over the $20,000 recommended in the Executive Budget. Mrs. Evans requested clarification of services currently provided while noting an increase of $10,000 would be of great benefit to the program. Ms. Ernst explained the current funding of $20,000 provides service to Clark County and a portion of Washoe County. Additional funds of $10,000 per year would provide an additional 665 Caregiver kits to be used statewide. She stressed the additional $10,000 would provide service not only for rural areas but wherever need arose. Ms. Tiffany requested clarification. Ms. Ernst explained additional funding would be used in increments: an additional $10,000 would target rural caregiver training; another additional $10,000 would provide an additional 665 caregiver kits. Caregiver kits are provided to individuals who cannot or will not leave the individual they care for to attend a training class. Senator Raggio inquired what service was provided in Washoe County. Ms. Ernst said a limited amount of training is provided through a grant program called Lend A Hand. Ms. Tiffany asked how many individuals would like to receive training. Ms. Ernst estimated of the 189,000 individuals over 55 years of age in Clark County, approximately 20 percent are being cared for at home and that estimate is probably low. Ms. Tiffany asked if additional staff was required. Ms. Ernst responded negatively because the program does not provide direct service but rather provides grant funding to organizations skilled at providing appropriate training. Ms. Tiffany asked what types of organizations receive grants. Ms. Ernst said an organization in Clark County called the Aging Services Directors Organization received a small grant to determine what should be included in a Caregiver kit. Lend A Hand teaches older caregivers how to care for individuals without harming themselves. Ms. Tiffany asked how individuals learn of services available. Ms. Ernst said many individuals call the Division and are referred to other appropriate agencies; the Division also advertises its services. Ms. Tiffany asked how much funding is used for administrative and advertising costs. Ms. Ernst responded Aging Services keeps none of the funding. Mr. Dini asked what would be required to fully fund Washoe County and Carson City. Ms. Ernst said an additional $5,000 would be sufficient. ASSEMBLYMAN DINI MOVED TO CLOSE THE BUDGET AS RECOMMENDED BY STAFF WITH AN ADDITIONAL ALLOCATION OF $50,000 OVER THE BIENNIUM. SENATOR COFFIN SECONDED THE MOTION. THE MOTION CARRIED. SENATOR RAGGIO AND ASSEMBLYWOMAN TIFFANY VOTED NO. BUDGET CLOSED. **************** SENATOR RAGGIO MOVED THAT IN THE EVENT ADDITIONAL FUNDING OF $50,000 FOR CAREGIVER TRAINING OVER THE BIENNIUM IS APPROVED, A LETTER OF INTENT BE SENT SPECIFYING THE ADDITIONAL FUNDING BE USED IN THE MANNER INDICATED BY THE DIRECTOR: $10,000 FOR CAREGIVER KITS, $5,000 TO AUGMENT THE WASHOE COUNTY PROGRAM AND $10,000 FOR THE RURAL AREAS. ASSEMBLYMAN DINI SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY . ****************** STATE HEALTH OFFICER - PAGE 1093 Mr. Abba explained two additional positions are recommended in decision units M200 and M201, a Personnel Technician and an Account Technician. Both positions are recommended because of caseload growth and increased levels of staffing in the Division. Mr. Abba said closing recommendations include a reduction in General Fund appropriation in the base budget based upon a re-projection of available indirect cost recovery. An augmentation for Information Services in decision unit E912 is to correct an error in the Executive Budget. Decision unit E912 recommends the Information Systems Specialist position be transferred to the Department of Information Services (DIS); as budgeted, the recommendation incorrectly reduced the Division's funding authority and does not allow for a mechanism to pay DIS for any services rendered. ASSEMBLYWOMAN EVANS MOVED TO CLOSE THE STATE HEALTH OFFICER BUDGET AS RECOMMENDED BY STAFF. ASSEMBLYMAN DINI SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. BUDGET CLOSED. **************** VITAL STATISTICS - PAGE 1099 Mr. Abba explained decision unit M200 provides $15,000 in FY 96 to expand the fire proof vault used to house all permanent records, $20,000 in FY 96 for special shelving to store permanent records, and $4,693 in each year of the biennium for additional building space absorbed from the Radiological Health Program. An accounting clerk position is recommended to handle additional work load associated with the collection of vital records fees. The Federal Health Statistics grant is recommended to be augmented based on the FY 95 grant award level. An increase is anticipated in the amount of reimbursement the program will receive from the Social Security Administration. A reduction in the EDP Systems/ Programming charge reflects projected savings of $750 per month for implementing a PC-based birth certificate indexing system. The reductions have been agreed to by the Division. ASSEMBLYWOMAN EVANS MOVED TO CLOSE THE VITAL STATISTICS BUDGET AS RECOMMENDED BY STAFF. ASSEMBLYMAN DINI SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. BUDGET CLOSED. ***************** CANCER CONTROL REGISTRY - PAGE 1103 Mr. Abba explained adjustments to this budget include the addition of a new federal grant from the National Program of Cancer Registries which was approved by the Interim Finance committee in November 1994. The grant includes funding for several new positions and associated operating costs. The Cancer Registry had included funding to pay state owned building rent; however, the grant will provide funding for building rent and the General Fund appropriation is reduced accordingly. ASSEMBLYMAN DINI MOVED TO CLOSE THE CANCER CONTROL REGISTRY BUDGET AS RECOMMENDED BY STAFF. ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. BUDGET CLOSED. ************** HEALTH FACILITIES - PAGE 1107 Mr. Abba said this budget is supported entirely by federal Title XVIII and Title XIX funds and fees. Under the M200 decision unit, 11 new positions are recommended for FY 96. Eight of the positions are Health Facility Surveyors; three are clerical support. The recommendation also provides funding for the Health Facilities Office in Las Vegas to move from the Belrose complex into a non-state facility and also to move a component of people in the Carson City office to a Reno location to allow better access to health facilities in the Reno area. The adjustments recommended reflect reductions in operating, travel and training costs which were overstated for the recommended new positions. Mr. Abba added there will be an increase in licenses and fees charged to regulated facilities to pay for the additional staff and operational costs. Mr. Dini asked whether any of the new position could be delayed until October 1, 1995, to realize some savings. Mr. Abba said salary costs for the new positions have been built into the budget with an October 1 start date. Ms. Tiffany asked when licenses and fees were last increased. Yvonne Sylva, Administrator of the State Health Division, said fees were last increased in 1993. Mrs. Chowning asked why it was necessary to raise fees again. Ms. Sylva responded the fees that were raised in 1993 were not reflective of the number of staff necessary to meet the intent of NRS or NAC. The current fees are reflective of what is required for the bureau to meet NRS intent, including the addition of staff and the amount of time they spend in facilities. The fees were developed based upon actual time studies. Senator Raggio asked how much additional money will be raised by the fee increases. Ron Lange, Division of Health, said total revenue generated from medical facilities will be $551,000 in FY 96 and $592,750 in FY 97. Licensure will generate revenues of $188,000 in FY 96 and FY 97. Mrs. Evans asked whether options other than increasing fees or appropriating General Fund in order to meet the statutory survey requirements were available. Ms. Sylva indicated the only other option would be to revise the statutes. If additional staff cannot be hired, the Division will not be able to meet the statutory requirements and would be in violation of NRS. Ms. Tiffany requested explanation of the interpretation of what was required in the statutes. Ms. Sylva explained there are twenty sets of regulations mandated in the statutes; there are currently seven sets of regulations that have never been developed. Nine sets of regulations were developed prior to 1990. Only four out of twenty regulations are current. The Division received 674 complaints last year and NRS mandates each complaint must be investigated. Investigating a complaint can take up to 20 hours. Currently, facilities are not charged for investigations but that has been added into the fee schedule and will be charged if a complaint is substantiated. Ms. Sylva indicated the Division's interpretation of the statutes is not obsessive. Ms. Tiffany suggested hiring a consulting firm or privatization firm to review the regulations rather than hiring staff to perform this function. Mr. Lange explained the focus is to have individuals who can ensure quality care is provided to patients in nursing homes. Even if regulations are revised, a certain number of individuals still must go to health facilities to ensure patients are receiving appropriate care. Ms. Tiffany observed there are already individuals, such as physicians, who can monitor nursing homes. Mr. Allard asked how many surveyors are currently on staff. Ms. Sylva said there are currently 17 surveyors. Mr. Allard confirmed eight additional surveyors are requested and asked whether the surveyors are reflected in performance indicators. He noted the increase in staff is nearly 50 percent but the performance indicators do not reflect a workload increase of that magnitude. Ms. Sylva said the workload has increased at least 50 percent but that could not be demonstrated without the staffing levels necessary to complete the work. Sharon Ezell, Chief of the Bureau of Licensure and Certification, said the performance indicators had been revised. Mr. Allard confirmed the additional staff would perform the inspections and asked why the number of inspections is projected to increase from 661 to 1,078. Ms. Ezell said the number of required inspections were not able to be done over the past few years because of insufficient staff; with the addition of eight surveyors, it should be possible to inspect all the facilities. The surveyors also perform duties relative to quality assurance reviews and investigating complaints. Senator Coffin observed health care is the most heavily regulated industry in the state and noted he had received no complaints of over regulation from those in charge of health care facilities. The performance indicators reflect a 50 percent increase in the number of facilities expected to be licensed but do not reflect the number of beds in each facility. He observed legislation created the regulations the Division is required to enforce and the Division should be funded at a level to allow those regulations to be enforced. Ms. Sylva said the Division does have the support of industry and has received industry assistance in developing policy. Chairman Hettrick called for a motion. ASSEMBLYMAN DINI MOVED TO CLOSE THE HEALTH FACILITIES BUDGET AS RECOMMENDED BY STAFF. SENATOR RHOADS SECONDED THE MOTION. THE MOTION CARRIED. ASSEMBLYMEN ALLARD AND TIFFANY VOTED NO. BUDGET CLOSED. **************** MATERNAL CHILD HEALTH SERVICES - PAGE 1113 Mr. Abba said decision unit E176 includes the Governor's proposal for a new initiative to implement a statewide Perinatal Substance Abuse program. The Health Division is the designated lead state agency and will be provided two positions to coordinate the various state agencies involved in serving pregnant addicted women and drug or alcohol affected women. Mr. Abba said closing actions relate to changing the CPI rate increase recommended in the medical category to the rates recommended for Medicaid. The Maternal Child Health program puts medical providers at the Medicaid rate. Closing actions also include delaying the hiring of the two new staff positions by three months. Mrs. Evans requested explanation of the deletion of a genetics screening grant and asked whether any decline in services would result. Ms. Sylva explained the Genetics Grant from the California Public Health Foundation allows the Division to provide certain support services not available within the state and to conduct annual meetings for families. Those funds are still available but are being accessed directly through the California Public Health Foundation rather than coming into the state budget. Ms. Tiffany questioned the addition of two staff positions. Ms. Sylva said a Management Analyst and a Management Assistant will work with a subcommittee of the Maternal and Child Health Advisory Board to coordinate information and resources relative to perinatal drug abuse in the state. The program will identify problem areas and then target programs at those problems to prevent children from having to be in special children's clinics or neonatal intensive care units. Ms. Tiffany observed there seemed to be no well-defined plan of what the program will do. ASSEMBLYWOMAN EVANS MOVED TO CLOSE THE MATERNAL CHILD HEALTH SERVICES BUDGET AS RECOMMENDED BY STAFF. ASSEMBLYMAN DINI SECONDED THE MOTION. THE MOTION CARRIED. ASSEMBLYMEN TIFFANY AND ALLARD VOTED NO. BUDGET CLOSED. **************** SPECIAL CHILDREN'S CLINICS - PAGE 1121 Mr. Abba said introduction of the Medicaid managed care program on January 1, 1996 will impact Special Children's Clinics' ability to be reimbursed for revenues historically received for services provided. Medicaid eligible AFDC, CHAP or Child Welfare children will no longer be required to use the Special Children's Clinic for treatment services. Currently treatment services are reimbursed by Medicaid. The Clinic has recently received approval to charge Medicaid for rehabilitative services, a revenue stream that is not reflected in the Executive Budget. The impact is difficult to estimate because whether or not the clinics will be able to contract with the HMO providers of Medicaid managed care is not known. Based on a number of assumptions, the Division anticipates a net increase in reimbursement in FY 96; for the first six months of FY 96 rehabilitative services revenue will continue. A loss of revenue is projected for the last six months of FY 96. Once Medicaid managed care is instituted in FY 97, there is the potential of a $42,000 loss in revenue. The one and a half new positions recommended by the Governor to perform delinquent insurance billings and collections might mitigate some of the potential loss in revenue. Decision unit M200 requests an additional 1,476 square feet of building space to be used for waiting room, conference room and modification of the clerical support area in the Las Vegas Clinic. Decision unit M201 recommends five new positions: a half time physician, an accounting clerk and a management assistant for the Las Vegas clinic; a speech pathologist, public service intern and a half-time accounting clerk for the Reno Clinic. The positions will alleviate some of the existing waiting list for diagnostics and treatment but the Division anticipates the waiting list will continue to grow for the 1995-97 biennium; however, this might be mitigated by the impact of Medicaid managed care. The Special Childrens' Clinic has historically received a federal supplement of approximately $143,000 to offset costs for contract physical therapy and occupational therapy. These funds have been phased out at the federal level and the Executive Budget recommends the substitution of General Fund so the Division can continue to provide contract occupational and physical therapy support. Decision unit E710 provides for a replacement telephone system in Reno. Decision unit E850 provides additional rent cost for the Las Vegas clinic for the second year of the biennium because the existing lease will end in FY 97. Ms. Tiffany questioned whether the impact of Medicaid managed care has been fully accounted for in this budget. Mr. Abba said the Special Children's Clinic's diagnostic services will be exempt. Ms. Tiffany observed this budget might be dramatically impacted by Medicaid managed care and questioned whether staff should be added when in a year or two the Division might be downsized. Ms. Sylva commented the recommended staff relates primarily to the diagnostic portion of services with the exception of the Speech Pathologist who provides treatment in the rural areas. Rural areas are exempt from the managed care portion of the RFP. Ms. Sylva agreed there is the potential for major impact in this budget relative to the treatment portion of services but not to the exempt diagnostic portion of service. Mr. Abba said if the budget is closed as recommended by the Governor, a $6,000 reduction could be made to reflect the impact of additional square footage the Las Vegas Clinic would acquire. The building owner has agreed to modify that building at his own expense. ASSEMBLYWOMAN EVANS MOVED TO REDUCE DECISION UNIT E850 BY $6,000 IN FISCAL YEAR 1995-96 AND TO CLOSE THE REMAINDER OF THE SPECIAL CHILDREN'S CLINIC BUDGET AS RECOMMENDED BY THE GOVERNOR. ASSEMBLYMAN DINI SECONDED THE MOTION. THE MOTION WAS CARRIED UNANIMOUSLY (ASSEMBLYWOMAN CHOWNING WAS NOT PRESENT AT THE TIME OF THE VOTE.) BUDGET CLOSED. **************** COMMUNITY HEALTH SERVICES - PAGE 1127 Mr. Abba explained a clerical support position is recommended for the Carson City office; inflationary adjustments are made for medical supplies and vaccines; and, adjustments have been made for projected caseload increases due to population growth. Closing actions reflect adjustments to correct errors in the areas of in- state travel and to take advantage of MCH block grant carry forward funds to be used in lieu of General Fund. SENATOR RAGGIO MOVED TO CLOSE THE COMMUNITY HEALTH SERVICES BUDGET IN ACCORDANCE WITH STAFF RECOMMENDATIONS. ASSEMBLYWOMAN EVANS SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. (ASSEMBLYMEN DINI AND CHOWNING AND SENATOR RHOADS WERE NOT PRESENT AT THE TIME OF THE VOTE.) BUDGET CLOSED. *************** LABORATORY AND RESEARCH - PAGE 1133 Mr. Abba pointed out a number of technical adjustments that relate to policy issues the committee might wish to discuss. A correction is recommended in decision unit M201 to properly account for laboratory supplies and utility costs in separate expenditure categories. A one-shot appropriation has been recommended which provides for new and replacement equipment and outfitting the expanded facility. Discussion has related to whether the laboratory should continue to provide water testing services and whether fees charged to users are comparable to private sector laboratories. The Division has indicated that chemistry VOC testing, DNA probe testing and milk/dairy product testing fees could be raised and would generate approximately $115,000 per year; the Division has requested these fee increases not be effective until January 1, 1996 to allow the appropriate regulations to be adopted and users to be notified. One-half of the $115,000 would be realized in FY 96; the full amount in FY 97. Mr. Abba observed the Division had expressed concern about the ability to pay back money borrowed early in FY 95 because fee revenues have not met projected levels. Senate Bill 212 would provide equipment for enhanced services; the Division was asked to determine whether fees could be charged for those enhanced services and has indicated fees could generate $20,000-$30,000 per year; however, there is concern that obtaining appropriate equipment and training staff to use it will take a considerable period of time; also, EPA certification is required so fees will not be realized for enhanced services until the second year of the biennium. Mr. Abba indicated three new staff positions are recommended in the budget, one chemist, one laboratory assistant and one clerical support position. The chemist and laboratory assistant positions are directly linked to the proposed expansion of the laboratory's environmental water chemistry testing capability. The Division has indicated service cannot be enhanced unless these positions are approved. The clerical position will provide support to the laboratory director and administrative services section supervisors. Decision unit E201 provides for additional utility costs associated with the laboratory expansion and for additional laboratory supplies. Decision unit E425 provides for a General Fund appropriation for both fiscal years to compensate for federal STD grant funds and Safe Drinking Water grant funds that will no longer be available. The funds had been used to offset costs for public health testing where no fees were received. Decision unit E710 provides for continuation of an appropriation to purchase replacement equipment not specifically budgeted. Decision unit E730 provides for a $25,000 contingency fund for emergency maintenance or repairs necessary for the current or expanded facility. The facility is not supported by the Buildings and Grounds Division and must provide for maintenance costs from the Division budget. The Division has indicated that fund could be reduced by $15,000 per year based on a re-analysis of potential need. Senator Raggio indicated the Senate Finance Committee is still reviewing the operation of the laboratory in light of the concern over competition with the private sector. Mr. Hettrick wondered whether the budget should be closed with the E200 decision unit contingent upon the passage of S.B. 212. Mr. Dini expressed concern that the Division could make the revenues projected in the budget if fees are increased. Mr. Lange indicated he shared Mr. Dini's concerns and noted if fees do not materialize, workload and staffing levels will need to be addressed. Ms. Tiffany asked what portion of the one-shot appropriation relates to water chemistry equipment. Mr. Lange responded approximately $900,000 is for water chemistry equipment. Ms. Tiffany noted perhaps decision unit E200 should be excluded from budget closing pending outcome of the Senate Finance Committee's review of laboratory operations. ASSEMBLYMAN DINI MOVED TO CLOSE THE LABORATORY AND RESEARCH BUDGET AS RECOMMENDED BY STAFF, REDUCING DECISION UNIT E730 BY $15,000 IN EACH YEAR OF THE BIENNIUM, AND NOTING THAT DECISION UNIT E200 COULD BE REOPENED. ASSEMBLYWOMAN EVANS SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY . BUDGET CLOSED. **************** SEXUALLY TRANSMITTED DISEASE CONTROL - PAGE 1139 Mr. Abba said the addition of $726,567 in federal HIV Prevention Grant funds is a supplemental award for FY 96. The adjustment provides authority for the Division to accept those additional grant funds. Senator Raggio asked whether the grant funds would be used for four new positions. Mr. Abba responded HIV grant funds previously awarded provided the four new positions which were approved by the Interim Finance Committee in May and September of 1994. The additional award will be subgranted to local health districts; the Health Division has indicated there may be a need to come to the Interim Finance Committee to consider the possibility of adding a position relative to the new award. Senator Raggio asked what portion of the new money will go to local agencies. Mr. Lange responded except for approximately $70,000, the entire amount is being provided to local agencies. The $70,000 is held in abeyance pending negotiation with the Center for Disease Control to use that money for administrative support. Senator Raggio inquired if this will be a one-time grant. Mr. Lange said it appears HIV prevention funding will continue to rise. Senator Raggio cautioned about building in positions based on federal grant money. ASSEMBLYWOMAN EVANS MOVED TO CLOSE THE SEXUALLY TRANSMITTED DISEASE CONTROL BUDGET AS RECOMMENDED BY STAFF. ASSEMBLYMAN DINI SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. BUDGET CLOSED. *************** FAMILY PLANNING PROJECT - PAGE 1143 Mr. Abba indicated there were no adjustments to the Family Planning Project budget. ASSEMBLYWOMAN CHOWNING MOVED THE FAMILY PLANNING PROJECT BE CLOSED AS RECOMMENDED BY THE GOVERNOR. ASSEMBLYMAN DINI SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. BUDGET CLOSED. ************** COMMUNICABLE DISEASE CONTROL - PAGE 1147 Mr. Abba noted the Interim Finance Committee in FY 94 and FY 95 approved two separate contingency fund allocations of $319,000 in FY 94 and $330,000 in FY 95 to continue the Division's TB suppression program. The recommended budget continues the level of appropriation for TB suppression and provides for CPI increases of 10.3 percent in FY 96 and 5.6 percent in FY 97. Recommended enhancements to the program include $22,500 in FY 96 and $26,250 in FY 97 for additional residential care services. Decision unit M201 provides $51,500 in FY 96 and $70,700 in FY 97 for the purchase of second line drugs for TB patients who have developed resistance to the typical TB drugs. The closing action adjustment is a $1,500 reduction in General Fund for out-of-state travel. Senator Raggio inquired whether new measurement indicators were provided for the Communicable Disease Control budget. Mr. Lange indicated new measurement indicators had been provided. ASSEMBLYMAN DINI MOVED TO CLOSE THE COMMUNICABLE DISEASE CONTROL BUDGET AS RECOMMENDED BY STAFF. SENATOR RHOADS SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. (ASSEMBLYMAN HETTRICK WAS NOT PRESENT AT THE TIME OF THE VOTE.) BUDGET CLOSED. ************** WIC FOOD SUPPLEMENT - PAGE 1151 Mr. Abba said funding in this budget depends upon events at the federal level. If realized, the funding would allow for WIC services to be provided to an enhanced caseload of approximately 29,000 recipients monthly in FY 95 to 32,000 recipients monthly in FY 96 and 34,000 recipients monthly in FY 97. The technical adjustments recommended correct errors in the Executive Budget. The M200 decision unit included inflation costs for new staff and operating activities which were not typically budgeted for. A microcomputer specialist is recommended to be transferred to the Department of Information Services; the revenue source for that salary was deleted and must be added back. ASSEMBLYWOMAN CHOWNING MOVED TO CLOSE THE WIC FOOD SUPPLEMENT BUDGET AS RECOMMENDED BY STAFF. ASSEMBLYMAN DINI SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. BUDGET CLOSED. ****************** HEALTH AID TO COUNTIES - PAGE 1157 Mr. Abba said the recommended closing action is to maintain the same level of funds that are transferred to the Washoe and Clark County Health Districts but to use Department of Motor Vehicles Pollution Control Funds and increase them proportionately as General Fund revenue has been increased. ASSEMBLYMAN DINI MOVED TO CLOSE THE HEALTH AID TO COUNTIES BUDGET AS RECOMMENDED BY STAFF. SENATOR RAGGIO SECONDED THE MOTION. THE MOTION CARRIED. (ASSEMBLYMAN ALLARD WAS NOT PRESENT AT THE TIME OF THE VOTE.) *************** IMMUNIZATION PROGRAM - PAGE 1159 Mr. Abba commented the Executive Budget recommended vaccine inflation levels of 10.3 percent and 5.6 percent for the upcoming biennium. Based on a review of historical inflation trends, vaccines have not increased in cost at those levels; however, no adjustments are indicated because protocol changes recommended by the Academy of Pediatrics have resulted in more costly vaccines being used. There is also concern that efforts at the federal level to make the program an entitlement program will not occur and there are potential decreases in federal direct assistance. Medicaid funding for the purchase of vaccines is also questionable. Staff recommends the inflation rates used to build the immunization budget be maintained at the level recommended. There is a closing adjustment to correct an error in the application of those inflation rates. Staff also suggests a letter of intent be transmitted to the Division to discuss with the Interim Finance Committee any actions regarding immunization program enhancements. Senator Coffin inquired if the newly approved chicken pox vaccine would reduce the amount of funding available for other vaccines. Mr. Abba said there were many approval procedures at the national level before the drug would become part of a recommended protocol. Ms. Sylva explained the American Academy of Pediatrics has recommended the chicken pox vaccine be a part of the vaccine package; however, there are still several levels of approval to be obtained. The Advisory Committee for Immunization Practices still has not made a ruling. Because the Vaccine for Children Program is an entitlement program, it will require congressional action to fund implementation of a chicken pox vaccine so funding will be available to states. SENATOR RAGGIO MOVED TO CLOSE THE IMMUNIZATION PROGRAM BUDGET AS RECOMMENDED BY STAFF WITH THE INCLUSION OF A LETTER OF INTENT. SENATOR COFFIN SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. (ASSEMBLYMAN ALLARD WAS NOT PRESENT AT THE TIME OF THE VOTE.) BUDGET CLOSED. *************** EMERGENCY MEDICAL SERVICES - PAGE 1163 Mr. Abba said the recommended adjustment is to reduce the amount of appropriation included in the budget for a computer installation. SENATOR COFFIN MOVED TO CLOSE THE EMERGENCY MEDICAL SERVICES BUDGET AS RECOMMENDED BY STAFF. ASSEMBLYWOMAN EVANS SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. (ASSEMBLYMAN ALLARD WAS NOT PRESENT AT THE TIME OF THE VOTE.) BUDGET CLOSED. **************** CONSUMER PROTECTION - PAGE 1167 Mr. Abba said three new positions are requested for the Safe Drinking Water Program. Closing adjustments are based on a re-analysis of the amount of plan review fees the program could recoup for the upcoming biennium which reflects a reduction in General Fund appropriation. Senator Raggio confirmed decision unit E426 was deleted because Department of Energy funds will not be available. SENATOR RAGGIO MOVED TO CLOSE THE CONSUMER PROTECTION BUDGET AS RECOMMENDED BY STAFF. ASSEMBLYMAN DINI SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. (ASSEMBLYMAN ALLARD WAS NOT PRESENT AT THE TIME OF THE VOTE.) BUDGET CLOSED. *************** RADIOLOGICAL HEALTH - PAGE 1173 Mr. Abba said the budget included stand-by pay in the base budget which was moved to a decision unit but the General Fund appropriation was not deleted; the recommended adjustments remove $12,000 in each year of the biennium from the base budget. As a result of the vault modification for Vital Statistics, the Radiological Health program must move to another location and funding is provided for that move into more expensive non state-owned building space. Adjustments for additional revenues are made from the Radioactive Material Disposal Trust Fund. ASSEMBLYWOMAN TIFFANY MOVED TO CLOSE THE RADIOLOGICAL HEALTH BUDGET AS RECOMMENDED BY STAFF. SENATOR RHOADS SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. (ASSEMBLYMAN ALLARD WAS NOT PRESENT AT THE TIME OF THE VOTE.) BUDGET CLOSED. ****************** RADIOACTIVE MATERIAL DISPOSAL TRUST FUND - PAGE 1179 SENATOR RAGGIO MOVED TO CLOSE THE RADIOACTIVE MATERIAL DISPOSAL TRUST FUND BUDGET AS RECOMMENDED BY STAFF. SENATOR COFFIN SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. BUDGET CLOSED. ****************** With no further business to come before the subcommittee, the meeting was adjourned at 9:57 a.m. RESPECTFULLY SUBMITTED: Deborah Salaber, Committee Secretary Joint Subcommittee on Human Resources/K-12 Assembly Committee on Ways and Means and Senate Committee on Finance April 18, 1995 Page