MINUTES OF THE SENATE COMMITTEE ON HUMAN RESOURCES AND FACILITIES Sixty-eighth Session March 13, 1995 The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 1:30 p.m., on Monday, March 13, 1995, in Room 226 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. COMMITTEE MEMBERS PRESENT: Senator Raymond D. Rawson, Chairman Senator Sue Lowden, Vice Chairman Senator Maurice Washington Senator Kathy M. Augustine Senator Joseph M. Neal, Jr. Senator Bob Coffin Senator Bernice Mathews GUEST LEGISLATORS PRESENT: Senator Ernest E. Adler STAFF MEMBERS PRESENT: Kerry Carroll Davis, Senior Research Analyst Mary Gavin, Committee Secretary Linda Chapman, Committee Secretary OTHERS PRESENT: Frank Ewell, Lyon County Commissioner Chet Hillyard, Lyon County Commissioner Edrie LaVoie, Director of Human Services, Lyon County David Cable, Secretary/Treasurer, Advisory Board, Silver Springs Senior Center Sylvester Kelly, Chairman, Advisory Board, Silver Springs Senior Center Clarence Hubbell, Member, Advisory Board, Silver Springs Senior Center Mary Liveratti, Deputy Administrator, Department of Human Services, Aging Services Division, State of Nevada Bill Langley, Social Services Program Chief, Department of Human Resources, Aging Services Division, State of Nevada Roberta Baker, Concerned Citizen Richard J. Swinney, President, Sierra Transfer Acute Team Bryon Meyer, Chief Executive Officer, Sierra Transfer Acute Team Janine Hansen, State President, Nevada Eagle Forum Jeanne Simons, Concerned Parent Chairman Rawson advised one of the committee members had requested a bill be drafted that essentially would allow Washoe County to be under the state regulation for emergency medical services (EMS). A bill was presented in a previous session addressing this matter, stating that any county with a population of less than 250,000 would be under the state's control. Any county with a population of over 250,000 would have to develop their own regulations. At this point, Washoe County would like to change the population base to 750,000 so they would have the option to go either way. Senator Lowden asked for an explanation of the requested bill draft. Chairman Rawson explained there is a state EMS that develops regulations for ambulances and related services. The County Fire Department EMS has developed its own regulations, which have been stricter than the state's. They want the option to be able to run it that way. Last session, the Clark County Fire Department EMS was allowed to do that, and Washoe County wanted to be with Clark County at the time. Now Washoe County's EMS does not want to remove the state from this process and wants to be able to either draw up their own regulations or go with the state's regulations. * * * * * SENATOR MATHEWS MOVED FOR A COMMITTEE BILL DRAFT. SENATOR LOWDEN SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. * * * * * Chairman Rawson requested the committee's introduction of Bill Draft Request (BDR) 38-636, which was provided by the attorney general's office. BILL DRAFT REQUEST 38-636: Requires reports of missing children be sent to "clearinghouse" for compilation. Chairman Rawson advised this BDR will revise the provisions governing duties of law enforcement agencies receiving reports of missing children. * * * * * SENATOR LOWDEN MOVED TO INTRODUCE BDR 38-636. SENATOR AUGUSTINE SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. * * * * * The hearing on Senate Bill (S.B.) 143 was then opened. SENATE BILL 143: Requires consideration of wishes of elderly persons in provision of services to those persons. Senator Ernest E. Adler introduced himself as state senator from the Capital Senatorial District representing Carson City, Lyon and Storey Counties, stating he wished to introduce a proposed amendment (Exhibit C) to S.B. 143. Senator Adler advised that for years, the Senior Citizens Center in Silver Springs traditionally served a meal in the evening. Last summer, the staff changed service of this meal to lunchtime. That change was ratified by the Lyon County Board of Commissioners. However, because of protests from some of the senior citizens, the Board of County Commissioners did reverse that decision and after 6 or 7 months, the time of service of this meal was changed back to evening. Senator Adler further advised the amendment addresses two points, the first being the age definition of "elderly persons." S.B. 143 indicates that as age 65; whereas, all of the statutes indicate that age to be 60 years of age or older. The senator said this age should be uniform, and the proposed amendment (Exhibit C) would change section 1, line 7, to read "...60 years of age or older." The second point addresses a request from seniors to incorporate into state law a provision that wishes of senior citizens be considered when changes like this are made. The regulations of the Aging Services Division state that the program should consider the wishes of participating individuals whenever feasible. This just expands this provision to a state law. Chairman Rawson commented that a bureaucracy should be less bureaucratic and more sensitive to the people being served. However, he suggested that rather than legislation, a letter of legislative intent would accomplish the same purpose. Senator Adler said the senior citizens really want something they can show to a board or whoever is making decisions in the future that concern them. Senator Augustine said she does think this issue needs to be addressed, but does not think this needs to be put in statute. Senator Augustine asked Senator Adler if he is opposed to the letter of intent. Senator Adler said he would rather have it in the statutes. Senator Augustine asked if it is appropriate to put this in the statutes of the State of Nevada. Senator Adler replied affirmatively, explaining the senior citizens think if it is not in the statutes, it will be ignored. Senator Neal asked if Senator Adler really wants to include private organizations in the statutes. They usually have to be chartered and bylaws must be drawn up. Senator Lowden said she was anxious to hear the views of the senior citizens present at the hearing. She asked also who pays for the evening meal. Senator Adler replied the money comes from a federal grant which is administered through the Aging Services Division. Senator Augustine asked if the location where they have the meals is run by the county and if federal grants pay for the meals. Senator Adler responded in the affirmative. Senator Augustine asked who pays the people who prepare the meals, and Senator Adler replied the county pays them with the grant money. Senator Augustine asked if this would also affect clinics providing senior services. Senator Adler said it would be for services designed solely for senior citizens. Frank Elwell, Lyon County Commissioner, speaking as a private citizen, said he was surprised at Senator Adler's knowledge of the affair in Silver Springs. It is his understanding Senator Adler had not talked with any of the commissioners or the staff. Referring to the amendment (Exhibit C), Mr. Elwell testified from prepared text (Exhibit D), which set forth his views in opposition to the amendment. Chet Hillyard, Lyon County Commissioner, testified in favor of the amendment to S.B. 143. saying Lyon County had built this senior center for the purpose of giving seniors an opportunity to get together, relax and enjoy themselves. He had watched the seniors get together and do volunteer work, raising money for extras around the senior center. They had been getting along very well for 17 years with the evening meal. Edrie LaVoie, Director of Human Services, Lyon County, testified her position is neither for or against the issue in Silver Springs. She just wanted to offer some insight into the ways federal, state and county governments do work together to allow for and consider the wishes of the elderly. Ms. LaVoie continued by saying at the federal level, under the Older Americans Act, there are several statements allowing for input from participants. At the state level, the Community Ombudsman Program offers a way for seniors to voice their concerns and have their complaints addressed. The Office of Elder Rights, through the Aging Services Division, is to advocate and assist seniors 60 years of age and older and to develop effective responses. It also advocates improvements in state and federal laws and regulations. Through Nevada Revised Statutes (NRS) 427, there are provisions for the Nevada Commission on Aging Services that consider the wishes of the senior population. Through the Nevada Aging Services Division, there are program instructions for sponsorship, and Lyon County is a sponsor of the senior program. On the county level, there are procedures set up to handle grievances of seniors whereby seniors can address unfair treatment by the program and its representatives. There are many other programs in place to assist seniors with any problems. There are several ways senior citizens can offer their input into the services they receive. Senator Mathews asked how many seniors are served the evening meal, and how many of these objected to going to noon meals. Ms. LaVoie answered between 60 and 70 are served on a daily basis, and more than half of that number objected to the change. Senator Neal said it seems to him there is something Lyon County did not do insofar as senior wishes are concerned. Obviously, a majority of the senior citizens did not want the mealtime changed. It seems someone who provides the services to seniors is not listening. He asked Ms. LaVoie about the decision Lyon County made that was adverse to senior citizens' wishes. Ms. LaVoie said she went to the county commissioners and asked them to consider this change on a 6-month trial basis. Chairman Rawson said there is obviously a communication problem that needs to be corrected, rather than passing legislation. Senator Washington said it looks like there is an underlying problem which legislation will not correct. He pointed out Human Services of Lyon County is supposed to be providing a service to the seniors, and they should have considered their wishes and worked out the problem at that level, instead of bringing in legislation. Chairman Rawson thanked Ms. LaVoie for her presentation, saying it was obvious she cared very much about senior citizens. David Cable, Secretary-Treasurer, Advisory Board, Silver Springs Senior Center, testified in support of the amendment, saying perhaps if more information had been provided to the seniors explaining why the mealtime was being changed, the idea may have been accepted. Meetings could have been held for question and answer sessions. Senator Washington agreed. He asked if it is necessary for the legislators to pass a bill before such things can happen. Mr. Cable wondered why, when the law says seniors should be consulted on things that concern them, this mealtime change was done against their will. Chairman Rawson said he does not want to have legislation that would impose penalties for not consulting senior citizens about all issues concerning them, but there is no question the senior citizens should be consulted. Senator Adler said there was a misunderstanding and the senior citizens did not call the proper agencies when this mealtime change took place. Calls were made to the Aging Services Division, every U.S. senator in the state, and everyone else who might be of help to them. The senior citizens really did exercise the options available to them, but there was no response to their letters or phone calls. Senator Washington asked what prompted the staff to change back to the evening meal, and Senator Adler responded it was in response to citizen protest. Senator Washington commented that if this amendment had never come before the committee, the mealtime would still have been changed back to evening. Senator Adler agreed, but pointed out it was some 7 months later this happened. He felt that was too long, and the seniors should not have had to go through that sort of a process. Senator Adler indicated all the amendment asks is that seniors' wishes be considered up front. Sylvester Kelley, Chairman, Advisory Board, Silver Springs Senior Center, testified that a year ago October at the advisory board meeting in Silver Springs, Mrs. LaVoie and the site manager came to the senior center and told the board, whether they liked it or not, the traditional evening meal would be served at noon in the future because with the evening meal, senior citizens had to be driven to remote areas after dark. At that time, there was a lot of protest. On July 11th, 1994, the staff commenced serving the meal at noon. This was very inconvenient for the senior citizens because of daytime doctor and dental appointments and the like. Mr. Kelley said at that time, he had a petition signed by 72 of the members of the senior citizen center and personally wrote letters to the Silver Springs state legislator, the U.S. Senators and U.S. Representatives, as well as the Aging Services Division. In all, he sent out about 25 letters with return receipt requested. The only response received was that the county commissioners were the only ones who could help. It was finally the county commissioners who reversed the staff decision, and the meal was once again served in the evening. Senator Neal asked if the evening meal is used as a means of fellowship. Mr. Kelley replied affirmatively and added when the meal was served at noon, only 15 to 25 people came; when the meal was again served in the evening, some 49 to 73 people came for the evening meal. Clarence W. Hubbell, Member, Advisory Board, Silver Springs Senior Center, said the advisory board actually has no say in the running of the center. Some 70 to 80 people, out of a total membership of some 100, objected to changing the meal to noon, but the advisory board was unable to prevail upon the staff to serve the meal in the evening. Mr. Hubbell said the members need to have a say in how their centers are run, and for that reason they contacted Senator Adler. Mary Liveratti, Deputy Administrator, Aging Services Division, testified from prepared text (Exhibit E). Bill Langley, Social Services Program Chief, Aging Services Division, also testified from prepared text (Exhibit F). Senator Neal asked Ms. Liveratti if she had read the declaration of the legislative purpose of the Older Americans Act regarding service to older persons in this state and NRS 427(a), section 10, where it talks about senior citizens and where it lists about 12 things, and specifically it says they should have the freedom, independence and the free exercise of individual initiative in planning and managing their own lives. Senator Neal asked Mrs. Liveratti what that section means to her. Ms. Liveratti said it means the seniors should have a say in how they are going to live their lives; they should have choices they can make for themselves, and they should be able to maintain their independence in as many ways as possible. Senator Neal said it does not appear this was followed in the case of Silver Springs. Ms. Liveratti said the Aging Services Division grants the money to the Lyon County Commissioners, the grantee. Senator Neal asked if the division feels it is its duty and responsibility to point out to its grantees what the law says? Ms. Liveratti said yes, and this responsibility is taken very seriously. Senator Neal asked why, then, when the seniors called you, were you not able to respond? Mr. Langley said the division did respond to letters and phone calls from concerned seniors on this matter, but the division does not like to dictate to the county commissioners what should be done. Senator Neal asked Mr. Langley what he thinks the law means in regard to older Americans. He replied to be in tune to their needs and desires, and to be as responsive as possible. Senator Neal said it looks like there is a problem here. Senator Adler pointed out he did not request this bill draft until he was told by personnel from the Aging Services Division that absolutely nothing could be done; it was in the county commissioners' hands because once they had given the grant, the county commissioners ran the program. The decision to change the mealtime was made by the commissioners, not the Aging Services Division. Had the division advised him if the commissioners did not comply with the law, the division could impose sanctions, he would not have asked for the amendment. Roberta Baker, Concerned Citizen, testified the seniors were told the vote was two to two by the commissioners. Mr. Hillyard has always been a supporter of the center. The chairman came prepared to vote for the change in mealtime, but after listening to the seniors, he voted against the change. The other two commissioners said they were going to vote for the meal change because they had appointed Ms. LaVoie, and they were going to stand behind her decision. Chairman Rawson thanked the participants for their testimony and advised that before the committee makes a decision, they will look at the budgets, the authority structure and all other factors involved. The hearing was then closed on S.B. 143 and opened on Senate Bill (S.B. 251). SENATE BILL 251: Provides for licensure and regulation of ambulances which are used solely to transfer patients between medical facilities. Richard J. Swinney, President, Sierra Transfer Acute Team (STAT), explained STAT is a Nevada company that does interfacility medical transfers. He testified in favor of S.B. 251 from prepared text (Exhibit G). Byron E. Meyer, Chief Executive Officer, Sierra Acute Transfer Team (STAT), testified regarding a letter (Exhibit H) dated December 13, 1993, from Yvonne Silva, Administrator, Department of Human Resources, advising the Board of Health chose not to regulate interfacility transfer units under NRS 450B, Emergency Medical Services. At that time, STAT was operating under a provisional license. Mr. Meyer continued by saying the second letter (Exhibit I) was from Sharon M. Ezell, Chief, Department of Human Resources, indicating under Legislative declaration NRS 450B.015, the department does not have the authority to regulate STAT under NRS 450B, since that section of NRS applies only to emergency medical services and does not apply to services that do only interfacility transfers. Mr. Meyer then testified regarding letters of recommendation for STAT. The first letter is dated March 10, 1995, (Exhibit J), from Joan S. Hall, R.N., Administrator, South Lyon Medical Center. The second is a memorandum (Exhibit K) dated March 9, 1995, from Mark Lanier, Assistant Director of Marketing, Rehabilitation Hospital of Nevada-Reno. Mr. Lanier does the patient transfers in and out of their rehabilitation facility. These facilities have used the STAT services over the last 2 years, and see the necessity for interfacility transfers within the state. Mr. Meyer continued his testimony regarding a fee comparison recapitulation (Exhibit L) which he prepared in September of 1994. This recapitulation shows the comparison of fees charged for interfacility transfers by REMSA, MEDIC AIR and STAT. Mr. Meyer pointed out the main purpose of STAT is to bring down health care costs in transferring patients. Medicare reimbursement for such transfers is 53 percent of the cost, and secondary insurance will pay another 20 percent. Medicare patients make up the bulk of these transfers. Mr. Swinney advised that depending on the type of patient, they can determine which of their three ambulances will be required to insure the comfort and safety of the patient. All STAT ambulances have life support systems. The chairman asked if this is long-term transport or is it between hospitals in a given area. Mr. Swinney replied STAT operates from outside the county in and inside the county out, not intra-county. REMSA operates within the county. The chairman asked for an example. Mr. Swinney said for 2 years STAT has been transferring patients from Carson-Tahoe Hospital in Carson City to the rehabilitation hospital in Reno, to Barton Memorial at Lake Tahoe, to the South Lyon Medical Center and to Lovelock, Elko and Ely. The chairman asked if there is anything that restricts them from doing those transfers. Mr. Swinney replied that right now, STAT is considered just like many other unregulated services in the state; for instance, vans that run for nursing homes and that type of thing where there is absolutely no regulation on them as to what standards they need to meet. STAT falls into that category at the present time. If a company is not licensed or certified, it is viewed as not being legitimate. The chairman asked if this is an economic issue for STAT. Mr. Swinney replied that it is, and hospitals have said they would use the service if STAT is licensed. STAT paramedics and emergency medical technicians are fully trained under NRS 450B, but STAT cannot issue a license or a continuation of a license for paramedics or for Emergency Medical Technicians I or Emergency Technicians II. Senator Neal said he does not understand the purpose of bill. Mr. Swinney advised STAT wants regulation for companies providing transfer services so patient care and safety is guaranteed. The reason STAT was taken out of the emergency bill is it does not do some of the things that are regular ambulance work, such as responding to a wreck on the street. What STAT is seeking is a way to be regulated. Presently, STAT cannot be licensed under NRS 450B, although such licensing was sought before asking for this bill. Senator Neal pointed out the bill defines an ambulance for interfacility transfer as an ambulance or air ambulance used solely to transport persons whose medical condition requires special observation during the transfer from one medical facility to another. It does not say where the medical facility is located. It can be out-of-state, in-state, in-county or in- city. Senator Augustine asked why, if STAT hires certified personnel, were they not seeking to become a full ambulance service? Mr. Swinney replied under NRS 450B, a full ambulance service must be staffed 24 hours a day. This escalates costs. REMSA and MEDIC AIR are 24-hour ambulance services and because of this, their fees are higher. STAT asks for legislation to cover interfacility transfers only. Senator Lowden pointed out with the type of service STAT provides, they are guaranteed payment; whereas, the 24-hour ambulance services have a lot of risk involved and may not get paid. Mr. Meyer said there is no guarantee STAT will get paid, but they do have the opportunity to select which patients they transport by the type of insurance coverage carried. They do transfer all Medicare patients. They do not take Medicaid patients because of Medicaid's reimbursement policy. STAT could not run an ambulance with a crew of two for the dollar amount reimbursed by Medicaid. Senator Washington wondered if STAT were to provide 24-hour service, would their rates be the same as or more than REMSA's. No reply was received. At that time, the hearing was closed on S.B. 251 and opened on Senate Bill (S.B.) 255. SENATE BILL 255: Repeals prospective expiration of authority of school districts to establish rules concerning school-based decision making. Senator Ernest E. Adler testified he had not received any opposition to this bill, and he hopes there is none. Essentially, this bill simply takes away the expiration date on S.B. 255 to enable the Washoe County program of site-based decisions to continue and the Carson City program to be started up. He advised the state teachers' association is not opposed to deleting the limitation period. If the committee does not delete the expiration date, it may possibly sunset the Washoe County program. Janine Hansen, State President, Nevada Eagle Forum, suggested there has not been sufficient time to ascertain if this experimental program of site-based decisions is making a big difference, and there should be the opportunity to observe this. Perhaps it should be looked at in a couple of years to see if there are some significant improvements. If there are improvements, it should be extended; if not, it should be looked at again. Ms. Hansen commented that innovative programs for the school are desirable, but these programs should be assessed to ascertain if they are economically and academically sound, and this is an opportunity to do so. Senator Augustine asked Senator Adler why he wants to take off the June 30, 1997, date at this time. Senator Adler said he agrees with Ms. Hansen's testimony. He advised he has had the opportunity to see how slowly this process is going, and does not feel there will be enough information available by 1997 for a thorough evaluation. Senator Adler pointed out that this is not a funded program, it offers flexibility in the administration of schools, and he questions whether sunsetting flexibility in administration is a good idea. Flexibility should be encouraged. Jeanne Simons, Concerned Parent, commented when this bill was discussed at the last session, it was hoped by getting parents involved in the system, it would bring about all the changes needed for the schools. Ms. Simon supports the bill, as written. She is concerned this might be a priority for the teachers' association and be made part of NRS 288, and she does not support that. The chairman asked if she would explain what she meant by that last statement. Ms. Simon reported she understood it is a goal for the teachers' association to have this as part of contracts and negotiations. As a parent, she is concerned because if it is handled in that manner, the opportunity for parents and community members to be involved is removed. There being no further business, the meeting was adjourned at 4:25 p.m. RESPECTFULLY SUBMITTED, ____________________________________ ____ Mary Gavin, Committee Secretary APPROVED BY: Senator Raymond D. Rawson, Chairman DATE: Senate Committee on Human Resources and Facilities March 13, 1995 Page