MINUTES OF THE
	SENATE COMMITTEE ON HUMAN RESOURCES AND FACILITIES

	Sixty-eighth Session
	June 14, 1995


The Senate Committee on Human Resources and Facilities was 
called to order by Chairman Raymond D. Rawson, at 3:50 p.m., on 
Wednesday, June 14, 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)

STAFF MEMBERS PRESENT:

Kerry Carroll Davis, Senior Research Analyst, Legislative 
Counsel Bureau
Linda Chapman, Committee Secretary

OTHERS PRESENT:

Myla C. Florence, Administrator, Welfare Division, Department of 
Human Resources
Mary Ellen McCarthy, Staff Attorney, Nevada Legal Services
Henry W. Cavallera, Attorney
John Sande, Lobbyist, Nevada Bankers Association
William Prezant, Attorney, Saint Mary's Regional Medical Center
Christopher Thompson, Chief, Health Care Financial Analysis 
Unit, Department of 	Human Resources

Chairman Rawson told the committee all the provisions of Senate 
Bill (S.B.) 461 were amended into Senate Bill 149, therefore 
S.B. 461 is no longer necessary.


SENATE BILL 461:	Creates interagency panel to make 
recommendations concerning placement of 
certain persons with disabilities into 
foster homes or residential facilities.  
(BDR 34-2004)

SENATE BILL 149:	Creates interagency panel to make 
recommendations concerning placement of 
certain persons with disabilities into 
foster homes or residential facilities.  
(BDR 34-1474)

SENATOR WASHINGTON MOVED TO INDEFINITELY POSTPONE 
S.B. 461.

VICE CHAIRMAN LOWDEN SECONDED THE MOTION.

THE MOTION CARRIED.  (SENATORS MATHEWS, COFFIN AND 
AUGUSTINE WERE ABSENT FOR THE VOTE.)

* * * * *

Chairman Rawson opened the hearing on Senate Bill (S.B.) 560.

SENATE BILL 560:	Increases opportunity for recapture of 
public assistance after death of recipient. 
 (BDR 38-846)

Myla Florence, Administrator, Welfare Division, Department of 
Human Resources,  presented the committee with prepared written 
testimony (Exhibit C) relative to S.B. 560 outlining the Welfare 
Division's position on the bill.  She also presented the 
committee with a copy of the proposed amendments to S.B. 560 
(Exhibit D), and summary of S.B. 560 (Exhibit E) which describes 
the reasons for the suggest changes.  She explained the 
amendments are not finalized as yet, but by tomorrow they will 
have all entities "sign off" on them before they present them to 
the committee.

Discussion ensued relative to the bill.  Ms. Florence explained 
in detail many of the provisions of the bill, and how it will 
interface with federal requirements.


Mary Ellen McCarthy, Staff Attorney, Nevada Legal Services, told 
the committee she represents a number of elderly clients 
including patients in nursing homes.  She said Nevada Legal 
Services has been working with the Welfare Division on 
amendments to S.B. 560 and has reached agreement on those 
amendments.  She maintained the right of recovery from the 
estate of the surviving spouse was an issue before the Senate 
Committee on Human Resources and Facilities during the last 
session.  She told the committee she anticipated authority would 
be given in the federal law which was pending at that time, but 
it was not, therefore they are asking for that right to be 
deleted in state law since it is not provided for in federal 
law, and explained the deletion of lines 28 and 29 will 
accomplish that.

Ms. McCarthy also requested that the lien provisions, which are 
optional under federal law, only be applicable to Medicaid 
benefits paid on or after the date of enactment so that those 
who have obtained benefits without a lien law would not be 
retroactively affected.  Ms. McCarthy indicated Ms. Florence is 
in agreement with those amendments.

Chairman Rawson asked Ms. McCarthy if the amendments are 
adequately drafted to allow the committee to take action on the 
bill today.

Ms. McCarthy replied there are a couple of changes in wording 
which are not included in the printed amendments.  She advised, 
in the provision dealing with foreclosure of the lien at page 5, 
section 10, line 23, which states "by federal law," they request 
the addition of: ",UFC section 1396p(b)."  Ms. McCarthy 
explained that is a citation of the specific federal law.

Chairman Rawson asked if the specific tie-in to the federal code 
will present any problems.

Ms. McCarthy replied the alternative would be the inclusion of 
another complete section which mirrors the federal code, and 
they felt it could be adequately addressed by the citation.

Ms. McCarthy testified the other amendment deals with the 
effective date for the lien provisions in section 3 of the bill 
which would only be effective for Medicaid benefits paid on or 
after the date of enactment.


Henry W. Cavallera, Attorney, told the committee prior to 1990 
he served as the directing attorney for the Senior Citizen 
Center in Reno, and worked with the same type of clientele as 
Ms. McCarthy.  He asserted in dealing with Medicaid estate 
recovery, a balance between public and private concerns is 
necessary.  He asserted senior citizens need to feel secure with 
the type of benefits they receive.  He said the proposed 
amendments achieve the balance wherein the state will receive 
the appropriate return on expenditure on behalf of a Medicaid 
beneficiary, and the surviving spouse will maintain the ability 
to live in the community.  He opined the proposed legislation is 
in accord with federal requirements.  

Chairman Rawson asked Mr. Cavallera if the committee should be 
concerned about family members who may not be totally disabled, 
but may have a need for Medicaid.  He further asked if there is 
authority in this bill for the division to do anything other 
than a total recovery.

Mr. Cavallera answered in the affirmative.  He explained, under 
federal law, there are hardship provisions.  He noted the 
agencies which deal with these matters are very helpful in 
accommodating the needs of the community when their situations 
do not "fit the mold" of anticipated outcomes.

Mr. Cavallera suggested an amendment to page 5, line 46 which 
would shift the burden to the public from the county recorder 
when submitting a notice or a copy of an affidavit to the 
Welfare Division relative to a claim to rights under a joint 
tenancy.

Senator Neal asked Mr. Cavallera how this bill would affect 
homesteaded property.

Mr. Cavallera opined the homestead protects claims against the 
equity in a person's home while he is alive, but is accessible 
after death.  He said he does not believe this has anything to 
do with a homestead claim.

Senator Neal asked Mr. Cavallera, "Even if it is held jointly?"

Mr. Cavallera said he does not believe homestead protection 
passes to a surviving joint tenant if the surviving joint tenant 
is a child.

Ms. McCarthy testified a homestead does continue after the death 
of a co-tenant under the homestead statutes, but opined it does 
not impact the estate recovery provisions.  She said she advises 
her clients a homestead does not protect them against Medicaid 
estate recovery, but there may be some timing issues as to when 
it can be enforced. 

Senator Augustine asked Mr. Cavallera if an adult joint tenant 
would be protected to the amount of the homestead, and if 
Medicaid could recover against the balance [of the equity].

Mr. Cavallera reiterated he tells his clients the homestead law 
does not protect them against Medicaid's right to recover.  He 
asserted the intent of Congress in the hardship provision was to 
protect a homestead of modest value.

Mr. Cavallera suggested some other minor amendments which would 
shift the burden of notification to petitioners and away from 
the county clerk or recorder.

Chairman Rawson surmised if the proposed amendments are 
currently amenable to all parties, the committee probably will 
not seek to perfect the bill at this late date in the session 
and risk holding up the bill.

John Sande, Lobbyist, Nevada Bankers Association, addressed 
section 2 of the bill which deals with joint tenancy.  He said 
the Nevada Bankers Association do support it to that extent, and 
have no comment on the remainder since it does not affect them.

Chairman Rawson closed the hearing on S.B. 560.


SENATOR AUGUSTINE MOVED TO AMEND AND DO PASS S.B. 560.

VICE CHAIRMAN LOWDEN SECONDED THE MOTION.

Chairman Rawson appointed Senator Neal as a committee of one to 
review the additional language in the amendment.

THE MOTION CARRIED.  (SENATOR MATHEWS WAS ABSENT FOR 
THE VOTE.)

* * * * *

Chairman Rawson opened the hearing on Assembly Bill (A.B.) 330.


ASSEMBLY BILL 330:	Extends date for prospective expiration of 
provisions that limit increase in charges 
that major hospitals may impose.  (BDR S-
1763)

William A. Prezant, Attorney, Saint Mary's Regional Medical 
Center, presented the committee with a proposed amendment to 
Nevada Revised Statutes 449.243 (Exhibit F).  He explained the 
reason for the amendment is that the voters in 1994 failed to 
pass an exemption for charitable institutions on sales tax.  He 
stated the Department of Taxation has taken the position that 
because hospitals have itemized bills that provide an 
itemization of goods and equipment provided to patients incident 
to service, they are tangible personal property and therefore a 
sales tax should attach to them.  He asserted that has 
significant economic implications to patients and third party 
payers.  He said the irony is that a statute which was designed 
to assist in reducing health care costs triggered an event which 
increases health care costs by imposing a sales tax on those 
goods.  He said they have developed language designed to address 
the issue of whether or not a hospital would be a retailer for 
the purpose of the sales tax.  Mr. Prezant stated the addition 
of subsection 4 addresses that issue specifically.  

Mr. Prezant told the committee he and Christopher Thompson, 
Chief Health Care Financial Analysis Unit, Department of Human 
Resources, changed some of the language in section 2.  He 
commented Mr. Thompson felt patients should retain the right to 
see the itemization of their bill.  Mr. Prezant insisted Saint 
Mary's Regional Medical Center has no objection to Mr. 
Thompson's proposal, and went on to delineate the proposed 
changes in Exhibit F.

Chairman Rawson asked Mr. Prezant if Fred Hillerby is aware of 
the proposed amendments.

Mr. Prezant answered in the affirmative, and added he has also 
discussed the proposed amendments with Mike Pitlock, Director, 
Department of Taxation, who endorses the amendments, and 
supports the inclusion of paragraph 4.

Christopher Thompson, Chief, Health Care Financial Analysis 
Unit, Department of Human Resources, explained the provisions of 
the bill revelant to patient billing statements.  He assured the 
committee any question a patient has about their bill will be 
addressed by the hospital, and an itemized statement will be 
issued on request.


Mr. Prezant emphasized a summary bill is only sent in the 
instance where the patient has no personal liablity to pay the 
bill, otherwise an itemized bill is sent.

SENATOR AUGUSTINE MOVED TO AMEND A.B. 330 ON THE 
FLOOR.

SENATOR WASHINGTON SECONDED THE MOTION.

THE MOTION CARRIED.  (SENATOR NEAL ABSTAINED FROM THE 
VOTE.  SENATORS MATHEWS AND LOWDEN WERE ABSENT FOR THE 
VOTE.)

* * * * *

There being no further business before the committee, Chairman 
Rawson adjourned the meeting at 4:45 p.m.

RESPECTFULLY SUBMITTED:



	
Linda Chapman,
Committee Secretary

APPROVED BY:





Senator Raymond D. Rawson, Chairman


DATE: 						

Senate Committee on Human Resources and Facilities
June 14, 1995
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