MINUTES OF THE SENATE COMMITTEE ON HUMAN RESOURCES AND FACILITIES Sixty-eighth Session April 10, 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, April 10, 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 COMMITTEE MEMBERS ABSENT: Senator Bernice Mathews (Excused) GUEST LEGISLATORS PRESENT: Assemblywoman Genevieve Wines Segerblom STAFF MEMBERS PRESENT: Kerry Carroll Davis, Senior Research Analyst Mary Gavin, Committee Secretary Linda Chapman, Committee Secretary OTHERS PRESENT: Donald S. Kwalick, M.D., M.P.H., State Health Officer, Health Division Donny Loux, Office of Community Based Services, Department of Employment, Training and Rehabilitation Paul Gowins, Coordinator, Americans with Disabilities Act, Office of Community Based Services, Department of Employment, Training and Rehabilitation Chairman Rawson opened the hearing on Assembly Bill (A.B.) 262. ASSEMBLY BILL 262: Provides limitation on rules and regulations governing use of public spas by children. Chairman Rawson explained that A.B. 262 will amend Senate Bill (S.B.) 197 of the Sixty-seventh Session, which did not pass last session, and which provided that children 7 to 12 years of age may use public spas with adult supervision. A.B. 262 changes that to all children under the age of 12 may use public spas with adult supervision. Assemblywoman Genevieve Wines Segerblom testified when A.B. 262 was before the Assembly committee, most members did not know there is a law on the books stating children could not be taken into hot tubs in Nevada. No such law exists in either California or Utah. Mrs. Segerblom advised that in the past, she had been a Red Cross swim instructor and had never found it harmful for children to go into hot tubs, if the time was limited to 10 minutes or less. Mrs. Segerblom stated further she had checked with the health department in Clark County and also the state health department, but found no record of any child drowning in a hot tub or suffering ill effects from a hot tub. On the basis of this information, she finds A.B. 262 very acceptable and most of the members of the assembly committee were in favor of this bill. Mrs. Segerblom testified further that item 2 under section 1 of the bill changed the age from allowing children 7 to 12 years of age to use spas under adult supervision to allowing all children under 12 years of age to use public spas with adult supervision. Senator Coffin said he continues his support of this bill, but feels there are dangers involved that public authorities must acknowledge, and these dangers are not limited to children. Adults, too, are subject to these dangers because of the tremendous suction in the spas caused by the Jacuzzi motors. The senator mentioned that a paraplegic drowned in Las Vegas in a spa because he was unable to release himself from the suction and could not get out. Senator Coffin commented further that A.B. 262 will at least allow the local authorities to draw up regulations. Mrs. Segerblom concurred and mentioned she had confirmed with the state Health Division that for all spas open to the public, it will be mandatory to have signs posted on the premises giving the rules and regulations governing the use of those public spas. Senator Coffin asked if this amended bill requires an adult be present with the youngster. Mrs. Segerblom replied in the affirmative. Chairman Rawson commented because of previous problems with spas, with both adults and children, the suction apparatus has been changed so such an event as mentioned earlier by Senator Coffin could not happen again. Mrs. Segerblom said that is true. The chairman also mentioned health authorities indicate in the past it was children under 3 years of age, because of overheating, that required a temperature regulation. Senator Augustine asked Mrs. Segerblom if she had read S.B. 197 of the Sixty-seventh Session, the bill which was not passed last session, and asked if Mrs. Segerblom had any problem with the senate committee amending A.B. 262 to read like S.B. 197 of the Sixty-seventh Session. Mrs. Segerblom said she feels S.B. 197 of the Sixty-seventh Session is better. Senator Augustine mentioned the original bill, S.B. 197 of the Sixty-seventh Session, allowed for children to be in the spa for 10 minutes out of every 60 minutes; whereas, this bill would allow children under 12 years of age to be in the spas with no time limit, just as long as they are under adult supervision. Mrs. Segerblom said she preferred that it read "any child under 12." Senator Augustine commented that pediatricians are very much opposed because a child that young cannot regulate his or her body temperature. Mrs. Segerblom indicated because young people drown in swimming pools, we do not close the swimming pools. The parents must take responsibility for their children, whatever the age. Senator Augustine pointed out that here we are talking about the heat, the body regulation of temperature in a small child. Donald S. Kwalick, M.D., M.P.H., Health Officer, Health Division, testified his only concerns with A.B. 262 relate to Senator Augustine's statement regarding young children, especially those of diaper age, being in the spa whereby their core temperature might be raised if they remain in the spa for a prolonged period of time. Dr. Kwalick advised as long as the health authority has the responsibility to come up with a sign that cautions users as to what they should or should not be doing in the spa, he does not have any public health issues with the spa bill. Senator Neal asked if the Health Division regulates the temperatures of the spas. Dr. Kwalick replied when Health Division inspectors go out into the rural areas, they check to see if there is indeed a thermometer in the spas and the top temperature does not exceed 104 degrees. Senator Neal asked Dr. Kwalick if the state Health Division does then regulate the temperature; you have a top setting regulation of 104 degrees? Dr. Kwalick replied in the affirmative. Chairman Rawson asked Dr. Kwalick if he supports this amendment in A.B. 262 allowing children under 12 in public spas under adult supervision or, as previously written in S.B. 197 of the Sixty-seventh Session, children from 7 to 12 years being permitted in the spas with adult supervision. Dr. Kwalick said he supports the bill either way, as long as the sign is posted at the spas. The hearing was then closed on A.B. 262 and opened on Senate Concurrent Resolution (S.C.R.) 16. SENATE CONCURRENT RESOLUTION 16: Urges Congress to amend Social Security Act to allow states to pay recipient of Medicaid who has disability directly for certain services provided in home of recipient. Kerry Carroll Davis, Senior Research Analyst, testified from prepared text (Exhibit C) and explained under current regulations and except in rare cases, Medicare requires states to pay providers of services directly, rather than making payments to Medicare recipients. These regulations do not allow the disabled to have control over the hiring, supervision and payment of those providing personal, nonmedical assistance to them. Donny Loux, Chief, Office of Community Based Services, Department of Employment, Training and Rehabilitation, testified in support of S.C.R. 16, saying her office administers legislatively directed personal assistance services (PAS.) Ms. Loux introduced Paul Gowins of the department, a long-time advocate for PAS and a member of the legislative task force on personal assistance. Ms. Loux called the committee's attention to some of the department's concerns set forth in prepared text (Exhibit D) submitted to the committee. She advised the department's main concern is that people with disabilities be given a range of options. There are some people who, because of the severity of their disabilities or other environmental circumstances, are not able to be responsible for many things insofar as their providers are concerned, such as recruiting, checking backgrounds, withholding taxes, paying taxes, arranging for a backup assistant in case of absence or illness of the primary provider, keeping up-to-date with rising costs of state industrial insurance rates and things of that sort, which are being dealt with on a national basis. Ms. Loux went on the say the department will support this exact bill for those who are able to manage their total assistant care, including all of the things previously mentioned. Further, those recipients in this category should be able to hire, fire, supervise and pay their assistants. The department would recommend a middle ground for those people who can manage most of their assistant care, but who would need assistance with the exceptions mentioned of withholding taxes, recruiting, getting background checks and those kinds of things. Ms. Loux further explained there are some people, because of the severity of their disabilities and other factors, who want and need the assistance of an agency for almost all assistant care, while still maintaining the ability to select and supervise their assistants, and the department has recommended changes in federal and state law in regard to that. Ms. Loux said the department has a draft of an American Bar Association study which was conducted for the World Institute on Disability, and the department has been given permission to quote from that study paper and present an overview of the result which will be presented to the committee this week with all of the liability concerns addressed. The federal government now permits what they call a fiscal agent to be provided to do the taxes and so forth. She suggested language be included in this bill which would expand that permission just a little to include the things noted in Exhibit D, page 2, item 2. Ms. Loux continued, referring to page 2, item 3, suggesting that in order to protect agencies from liability, possibly a state acknowledgment in law of that same ability of an agency to act as a fiscal agency and supportive intermediary might be included in such language. Ms. Loux advised it has been suggested by the Bar Association in order to protect the worker because the costs of state industrial insurance do go up so dramatically when paid by an individual, that some sort of pool might be established to subsidize the SIIS requirements for PAS consumers. Ms. Loux then referred to page 3, item 5, suggestions for the federal Medicaid program, and pointed out these would not be things that could be changed by the state Medicaid program but would require change at the federal level. Ms. Loux then directed attention to item 6 on page 3 regarding individualized consumer training; for instance, how to manage services, how to hire and fire and that type of thing. Ms. Loux submitted a publication by the Task Force on Personal Assistance (Exhibit E) entitled A Report to the 68th Session of the Nevada Legislature on the Existing and Proposed Programs in this State for Providing Personal Assistance Services for Persons with Disabilities. In conclusion, Ms. Loux stated the final thing to come out of this study is language suggested by the consumers which would exempt them from the Nurse Practice Act in terms of PAS and services provided by their assistants. That language proposed by consumers was originally opposed by the nursing board. However, it appears a compromise has been reached, and that language will be given to the committee this week. Ms. Loux, speaking for the consumer constituency, expressed her appreciation for this legislation and advised the committee that it means a great deal to the consumers with disabilities. Chairman Rawson asked Ms. Loux if she has submitted the specific language the department would like to have incorporated in the bill. She replied that it is contained in Exhibit D. Senator Lowden asked Ms. Loux if she would clarify some points made in her presentation on workers' compensation because she is working on that in another committee. The senator asked if the consumers presently buy workers' compensation insurance individually. Ms. Loux replied workers' compensation is either paid by an agency which is acting on behalf of the consumer or by the consumers themselves. Generally, the agency will get a better cost. Should the consumer be required to pay for workers' compensation, which they would under this resolution, those costs will go up. Ms. Loux continued by saying one of the things that has been suggested nationally is that right off the top there be a subsidy provided from the various health service programs to assist in paying for workers' compensation so the costs to the consumer will not be so high. Senator Lowden commented that she understood coverage for realtors is $128 a year, which she thought was very reasonable for workers' compensation coverage for an individual. Ms. Loux said she would research the matter and get back to Senator Lowden. However, she stated she believes the premium must be based on the potential risk involved, and this would be considered a high-risk profession with further liability issues and therefore is more costly than other occupational workers' compensation. Senator Lowden said she recognizes that fact and if there is anything the Senate can do this session to make way for the matter of subsidized payments, they would be glad to do that as the commerce and labor committee is right in the middle of workers' compensation matters at this time, so answers would be immediately available. Ms. Loux expressed her thanks on behalf of the consumers with disabilities. Paul Gowins, Coordinator, Americans with Disabilities Act, Office of Community Based Services, State Department of Employment, Training and Rehabilitation, testified in favor of S.C.R. 16, saying it is important for Nevada to have options open to it and this legislation would help develop some of those options. Further, he said, his experience as a disabled consumer and as an independent living counselor in other areas of work he has done in the past, indicates this would be an option that could be utilized and would be very useful for disabled consumers in Nevada. The hearing was then closed on S.C.R. 16. Chairman Rawson advised the committee that a meeting on youth violence was held previously before the committee, and he has made arrangements to go to Las Vegas on Tuesday, May 2, to participate in a community coalition exchange on this subject. He asked the committee if anyone is interested in attending, advising it will be essentially the same presentation that was before the committee on March 6, 1995. It will take place in the morning on May 2 and in the afternoon, there will be some breakout sessions where some recommendations will be presented. If anyone would like to participate, the chairman asked that they let him know and arrangements will be made. The chairman shared with the committee a resolution, Senate Concurrent Resolution (S.C.R.) 5, that was indefinitely postponed and asked the feeling about a reconsideration. This resolution urges the State Department of Education and the State Department of Human Resources to participate fully in the "Kids Count" survey. By way of explanation of the program, the chairman said there is a nationwide publication that talks about the issues facing children, mainly the difficulties children have. All the other states in this nation participate in providing statistics to this organization so this "Kids Count" book can be published. SENATE CONCURRENT RESOLUTION 5: Urges Department of Education and Department of Human Resources to participate fully in "Kids Count" survey. SENATOR NEAL MOVED THAT THE INDEFINITELY POSTPONED DECISION ON S.C.R. 5 BE RESCINDED. SENATOR COFFIN SECONDED THE MOTION. The chairman further explained that "Kids Count" has been under grant from a philanthropic foundation to WE CAN, the local administrator. Senator Lowden voiced her objection to using any funds for a survey that would otherwise go to the State Department of Education. Chairman Rawson said the survey is supported by grant money, and the information gained from the survey is beneficial or supportive of our own programs, so Nevada is seeking this information anyway. The chairman said it is really a matter of sharing information we would normally be gathering, and he did not think the committee needs any legislative authority to share that information; it is merely speaking out in favor of sharing that information. Senator Augustine asked if in essence they are going to use this information anyway, so it doesn't matter whether or not the resolution is passed. The chairman said they have that option to use or not use the information, and this resolution would not force them to do it; it is simply an expression that that type of information can be available to us. They essentially collect this type of information anyway, but it has not been an issue where there has been any resolution. The chairman read from the description of Kids Count: "The overreaching goal of the Kids Count survey and the policies and programs established by individual states in response to the survey is to foster greater statewide and national commitment in improving the outcome for vulnerable children and their families." Senator Coffin said he was absent on the day the committee held this bill, and he asked why it was not passed. The chairman said it was the general opinion that it was not a necessary bill. Senator Washington said his notes on the testimony heard indicated this would promote more social programs. Chairman Rawson said the Annie E. Casey Foundation has been granting the money for Kids Count statistics, and he had a meeting with a representative of that foundation who indicated Nevada is the only state not cooperating in furnishing statistics. Senator Lowden said she was the member who asked that the bill be indefinitely postponed and in her opinion, there was no overwhelming testimony one way or the other. She did not feel the state needed another resolution that did not do anything. Chairman Rawson expressed his opinion that there is no harm in trying to indicate some support for the Kids Count survey with this resolution. Further, he said, there were several bills heard that same day of a rather inane nature, and this one happened to be grouped in with the rest. Senator Lowden said the only persons who testified on this resolution was John Sarb from the Division of Child and Family Services and Mary Peterson from the State Department of Education. Senator Lowden said she is an advocate of WE CAN and is happy to support Chairman Rawson, if he feels strongly on the matter. Chairman Rawson said he would like to see this bill pass. He thinks the publication is valuable and has used it a lot in preparing remarks for various presentations. Senator Neal said when he first came to the senate in 1973, Nevada hardly participated in any type of national organization or summary because the people here thought we had everything, we knew everything, and we found ourselves being left behind in terms of information about what was going on at the national level. Finally, Nevada joined the National Legislative Conference and got involved, and look what has happened to us. Senator Neal said he sees no harm in sharing information, especially since we are the only state not participating in the Kids Count survey, and we have already received information from that survey so we might as well participate and become a part of it. He concluded by saying we might learn something. THE MOTION CARRIED UNANIMOUSLY. * * * * * SENATOR NEAL MOVED TO DO PASS S.C.R. 5 AND PLACE IT ON THE CONSENT CALENDAR. SENATOR LOWDEN SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. * * * * * Senator Augustine asked if the chairman was willing to take an amend and do pass on A.B. 262. The amendment would be the same as the copy she submitted last session; the same as the language in S.B. 197 of the Sixty-seventh Session from last session. SENATOR AUGUSTINE MOVED TO AMEND AND DO PASS A.B. 262. Senator Neal said this motion in a sense would make the bill meaningless because that is already existing law. Senator Augustine said no, this bill died last session. Senator Lowden expressed her opinion that it should be up to the parents to decide on the appropriate age for children to use a public spa, and she is not sure 7 years is that age. THE MOTION TO AMEND AND DO PASS A.B. 262 FAILED FOR LACK OF A SECOND. * * * * * SENATOR NEAL MOVED TO DO PASS A.B. 262. SENATOR COFFIN SECONDED THE MOTION. Senator Augustine said there is no one here today to oppose this bill. Pediatricians are adamantly opposed to this bill as written, and she has submitted information from the American Academy of Pediatrics (Exhibit F) wherein it says a small child in a spa can be deadly because its body temperature cannot regulate to the temperature in a spa, especially in children under 5 years. This is indicated in Exhibit F under the Hyperthermia heading. The academy does not voice any opinion about older children because they can stand up and do things young children cannot do. Senator Augustine said the Health Division cannot be expected to regulate the time a child can stay in the spa. The chairman pointed out that the way the bill is written, without the amendment, would allow them to develop, adopt and enforce those rules and regulations. This bill could be a very time-consuming issue and it doesn't need to be. Senator Augustine said she had discussed the bill with Dr. Kwalick, and it would allow the pool owners to put on any regulation they want. The chairman asked if there is any middle ground; if the makers of the motion would consider ages 5 or 6. Senator Neal asked if we are saying we don't want to deal with the bill as written; that the parents in this particular case could not be good supervisors? Senator Augustine advised a lot of children will be under the direct supervision of parents, but also a lot of children will not be under the supervision of parents. Also, the American Academy of Pediatrics advises pregnant women not to get into hot spas because of the temperature for the unborn infant, and this is covered by the paragraph entitled "Pregnant Women" in Exhibit F. Senator Neal pointed out the child cannot go into the spa without adult supervision, and a parent who frequents these spas would undoubtedly like to care for their children. The State Board of Health is going to be promoting regulations to deal with this situation. Senator Augustine said no, they are not. The State Board of Health does not want to be the police force. Senator Neal said he asked previously if the State Board of Health regulates the water temperature, and was told they do. Yes, Senator Augustine replied, at a temperature of 104 degrees, and for a small child, that is an excessive amount of heat. Senator Neal commented further that a letter could be sent to regulate the time which the child can stay in the spa. Senator Augustine answered that is the problem. If you look at S.B. 262 of the Sixty-seventh Session the way it was originally written, that is exactly what was in there; a child under 7 years of age would not remain in the public spa for longer than 10 minutes of each 60-minute period. The State Board of Health has said they do not want to have to regulate and police the length of time children are in the spas. Senator Rawson noted that Dr. Kwalick indicated earlier he would accept it either way. The chairman called for a vote on the motion. THE MOTION CARRIED. (SENATOR AUGUSTINE VOTED NO. SENATOR WASHINGTON ABSTAINED FROM THE VOTE.) * * * * * Chairman Rawson reopened the hearing on S.C.R 16 and pointed out at this time, Medicaid does not have the option to make these payments directly to consumers with disabilities, and Ms. Loux left proposed amendments (Exhibit D) to rectify this situation. The chairman then asked Senator Coffin if he would be willing to serve as chairman of the subcommittee on this bill and work with staff to implement the amendments. Senator Coffin agreed to do so. There being no further business, the meeting was adjourned at 2:30 p.m. RESPECTFULLY SUBMITTED: Mary Gavin, Committee Secretary APPROVED BY: _____________________________________ Senator Raymond D. Rawson, Chairman DATE: Senate Committee on Human Resources and Facilities April 10, 1995 Page