MINUTES OF THE
SENATE Committee on Human Resources and Facilities
Seventy-second Session
March 26, 2003
The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 1:50 p.m., on Wednesday, March 26, 2003, in Room 2135 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.
COMMITTEE MEMBERS PRESENT:
Senator Raymond D. Rawson, Chairman
Senator Barbara K. Cegavske, Vice Chairman
Senator Maurice E. Washington
Senator Dennis Nolan
Senator Joseph Neal
Senator Bernice Mathews
Senator Valerie Wiener
GUEST LEGISLATORS PRESENT:
Senator Alice Costandina (Dina) Titus, Clark County Senatorial District No. 7
STAFF MEMBERS PRESENT:
H. Pepper Sturm, Committee Policy Analyst
Patricia Vardakis, Committee Secretary
OTHERS PRESENT:
Benjamin H. Venger, M.D., Western Regional Center for Brain and Spine Surgery
Jerry Lewis
A. Somer Hollingsworth, President/CEO, Nevada Development Authority
Brad Hancock, Executive Vice President, Medtronic Sofamor Danek
Mike Griffin, Western Regional Director, Medtronic Neurological
Thomas F. Williams, Executive Director, University of Nevada Las Vegas Research Foundation
James L. Wadhams, Lobbyist, Nevada Hospital Association
Marie H. Soldo, Lobbyist, Sierra Health Services, Incorporated
Jack Kim, Lobbyist, Sierra Health Services, Incorporated
James J. Jackson, Lobbyist, Association of Health Insurers of America
P. Forrest Thorne, Executive Officer, Board of the Public Employees’ Benefits Program
Kami Dempsey, Lobbyist, City of Las Vegas
Robert A. Ostrovsky, Lobbyist, Nevadans for Affordable Health Care
Janice C. Pine, Lobbyist, Saint Mary’s Health Network
Richard Daly, Lobbyist, Labors International Union of North America Local 169
Jeanette K. Belz, Lobbyist, Universal Health Services
Kathryn Silver, Assistant Administrator, University Medical Center
Lynn Fulstone, Lobbyist, Mountainview Hospital, Sunrise Children’s Hospital, and Sunrise Hospital and Medical Center
Bill Welch, Lobbyist, Nevada Hospital Association
Lawrence M. Preston, President, Professional Medical Consultants, Incorporated
Michael R. Alastuey, Lobbyist, University Medical Center
Debbie J. Smith, Lobbyist, Service Employees International Union, Local 1107
Chairman Rawson:
We will open the hearing on Senate Bill (S.B.) 156.
SENATE BILL 156: Provides additional exception to prohibition against practitioner referring patients to certain facilities in which practitioner has financial interest. (BDR 40-710)
Senator Alice Costandina (Dina) Titus, Clark County Senatorial District No. 7:
Eleven years ago, I introduced a bill designed to prohibit doctors from owning shares in hospitals. A number of states and the federal government also took similar action. The various statutes were aimed to address excessive self-referral to their own facility for testing and treatments. It was driving up the already high cost of health care.
Over the past decade, the statute has been amended slightly to allow doctors to own clinics in small communities. This was an incentive to have medical professionals and facilities in rural Nevada. Senate Bill 156 presents a unique opportunity, which would require an exemption to existing self-referral prohibition. There are amendments to S.B. 156 (Exhibit C). The opportunity would be the creation of a small, highly specialized research hospital and facility, which would be limited to spine and pain treatments. It would attract patients from around the country and world. This facility would collaborate with the biology department of University of Nevada Las Vegas (UNLV) for research purposes. It would attract high-tech medical industries to our State.
Benjamin H. Venger, M.D., Western Regional Center for Brain and Spine Surgery:
I am reading from prepared testimony (Exhibit D). I am the managing partner of the Western Regional Center for Brain and Spine Surgery. I wish to announce the establishment of the Jerry Lewis Spine and Pain Center in Las Vegas. I have a particular interest and expertise in neurosurgical pain management. Mr. Lewis is one of many who have benefited from our services.
We asked each of the acute general hospitals in southern Nevada if they were interested in building a 15-bed, focused-specialty facility. Their answer was no. This project will create jobs and diversification of our economy.
Jerry Lewis:
I have had 38 years of pain from taking falls and doing stunts in motion pictures. I have tried everything such as shots, steroids, and injections in the spine, and nothing helped until I heard about Medtronic. The Medtronic Corporation makes a stimulator. I have a battery buried under my skin, in my arm. I can raise the stimulation level with a remote, which stops the pain from going to my brain. Since I have had the implant, I have been pain free for the past 11 months.
There are people in Las Vegas who go out of the State for pain management. There are 75 million people in this country suffering with chronic pain. Chronic pain makes people reclusive and shy, with feelings of being demeaned. People do not know there are other options. I am an advocate of the pain and spine clinic because it has saved my life. Pain is instantaneous and is dangerous to the individual who is suffering. Senate Bill 156 could be helping so many people. This bill should be passed quickly. The Legislature has the power to save the lives of those who are not empowered.
Senator Neal:
On page 1 (Exhibit D), you mentioned there are only two facilities, one in Memphis and the other St. Louis.
Dr. Venger:
We are interested in a multifaceted facility. This will not be just a small hospital to take care of patients. In the United States, the education of physicians is paramount. When a person is in medical school, everything is in one place, but once doctors and surgeons disperse around the country, they would need to go to a center to receive this type of training. Two centers have anatomy labs, courses, and teach on this level; one is in St. Louis and the other is in Memphis. There are none on the West Coast. We can build the same type of facility here. This would enhance the ability to train people and make everyone aware of the help available.
Senator Neal:
Is the intent to have this associated with a medical school or facility?
Dr. Venger:
The advantage of our educational programs being connected with a medical school is we will bring in the most talented and renowned physicians in the world. By coming to Las Vegas, the medical students, interns, residents, and faculty will have the opportunity to go into the anatomy lab, teaching facility, and operating room, and be involved.
Senator Neal:
Senator Titus indicated this is eroding a policy of not allowing doctors to own shares in hospitals to which they refer patients. I am looking for a good reason to overcome the purpose of the original bill. I want to make sure the reasons for the change are the right ones.
Senator Titus:
I had the same concern. When I was approached with this proposal, I told them I wanted this hospital defined as narrowly as possible. Therefore, the floodgates will not be opened. The definition “as amended” makes the bill very narrow. It is a research facility and associated with a hospital. Nevada’s statute is more stringent than other self-referral statutes in existence. The policy will still be intact.
Dr. Venger:
We are the only State where this is not permitted. I have asked each of the hospital corporations with which I am affiliated to do this, but their answer was no.
Senator Neal:
What would be the start-up time for such an undertaking?
Dr. Venger:
It would take up to 2 years. We would need to choose a site. We are considering a site downtown or at University of Nevada, Las Vegas.
Senator Neal:
Would the site be the one in consideration for Sierra Pacific?
Dr. Venger:
If it is being considered as a medical center then we, as Nevadans, should be the first to be considered.
Senator Neal:
Are you saying the mayor of Las Vegas is not committed to doing this project?
Dr. Venger:
We have discussed this with the mayor. He is interested in the project.
Mr. Lewis:
Our government is spending $100 billion a year because of chronic pain. We are losing 500 million workdays because of chronic pain. This measure needs to be passed quickly to help those people who are in pain. There are more suicides from chronic pain than any other reason.
Senator Titus:
There is a letter of support from the mayor of the City of Las Vegas (Exhibit E), which has been submitted to the committee.
Senator Wiener:
Dr. Venger, are you looking to do a preventative component to help people develop lifestyles and avoid these types of chronic conditions?
Dr. Venger:
The hospital we are planning is not a general acute-care hospital. It is a specialty hospital. The key components are education, preventative medicine, as well as limiting health care costs. When you have a focus or place where people can turn, not just the Internet, the possibilities are infinite.
Senator Nolan:
Do you have an estimate of an annual patient volume?
Dr. Venger:
It is difficult to estimate. The number of 15 beds resulted from discussions with general acute-care hospitals. Most centers have started with such a number. Many of the individuals of the Nevada Hospital Association said 15 beds were appropriate. Given the scope of our treatment and becoming more efficient in the future, we believe the turnover will justify the existence of the hospital. We feel a 15-bed hospital can be successful. It can promote research, needed education, and the anatomy lab can benefit countries all over the world.
Senator Nolan:
Will you have the ability to handle life-threatening crises?
Dr. Venger:
Yes. The patients selected for the facility would not be inter-cranial or open‑heart surgeries. Every member of our medical staff must maintain hospital privileges at one or more of the other acute-care facilities. There are two reasons for this; it establishes a relationship with the facility, and our medical staff is responsible for emergency treatment, triage, and assuming care at the acute facility.
Senator Cegavske:
In the amendments you have provided (Exhibit C), there is a reference to “Section III,” however, there is no such section.
Senator Titus:
The new definition of the hospital would replace the existing language on page 4 starting with line 11.
Senator Cegavske:
Where would the other amendment be placed?
Senator Titus:
We replaced 50 beds with 15 beds on page 3, line 29. This was added to be sure the new facility accepts its obligation to take care of the indigent and pay its share.
Senator Mathews:
I suggest the amendment state “not more than 50 beds.” When you are referring to a patient stay of 2 or 3 days in the facility, 50 beds is not a large number.
Senator Titus:
We did debate the number.
A. Somer Hollingsworth, President/CEO, Nevada Development Authority:
The mission of the Nevada Development Authority (NDA) is to diversify the economy in southern Nevada. The NDA has realized in order to create quality, high-paying jobs for our community, we must recruit companies using or developing innovative technology. Dr. Venger’s group does research and development. His international reputation gives instant credibility to our community and the future of medicine in southern Nevada.
Dr. Venger’s group will attract medical, pharmaceutical, and technology industry to southern Nevada. We believe the spin-off of companies, medical research and development, medical practice, pharmaceutical, and manufacturing research and development will be tremendous. The Nevada Development Authority supports S.B. 156.
Brad Hancock, Executive Vice President, Medtronic Sofamor Danek:
I am reading from prepared testimony (Exhibit F). Medtronic Sofamor Danek specializes in offering products to neurosurgeons and orthopedic surgeons for the treatment of spine disease. Our company supplies products to over 3500 medical institutions and over 3000 physicians.
We believe the development of a laboratory training facility in Las Vegas would provide the opportunity to expand our physician training and education initiative for the West Coast.
Senator Neal:
Do you purport to market this product along with the training at the Las Vegas location?
Mr. Hancock:
At this facility, the products the physicians would train with would be marketed.
Senator Neal:
Here in Nevada?
Mr. Hancock:
In Nevada and across the country.
Chairman Rawson:
The normal effective date would be October 1. While we are considering amendments, should the effective date be upon passage and approval?
Dr. Venger:
I will devote my full efforts to getting the project off the ground, under construction, and completed.
Mike Griffin, Western Regional Director, Medtronic Neurological:
Our company is the global leader in the research and development of advanced treatment of patients with chronic, intractable pain. Medtronic Neurological has pioneered the development of spinal-column stimulation and intrathecal drug administration, both of which are routinely applied to patients throughout the world.
Continuous improvement in technology and clinical success depends upon close working relationships with clinical research and training facilities. A special facility such as Dr. Venger’s can represent an excellent venue in which to conduct ongoing education for physicians wishing to expand and update their clinical skills. We seek to collaborate with such centers in order to pursue our research objectives, and to support further education of physicians interested in pain medicine. During the past 12 months, we facilitated 14 training courses, which were attended by 515 physicians and other health care professionals.
The association with the UNLV and the University of Nevada School of Medicine also represents an entity that could provide the infrastructure and resources to conduct clinical research and clinical trials of new products and therapies. The combination of a leading medical research institution and experienced clinicians with large patient volumes is often an excellent setting for us to study, validate products, and therapeutic improvements.
There are few such venues in the Western United States offering such a strong combination of a specialty hospital and medical school. We have a strong interest in exploring new venues for education, training, and research such as the proposed facility in Las Vegas.
Las Vegas has a large, diverse, growing patient population, and a strong medical community. It is considered a favorable and attractive destination for attendees for training and educational functions.
Senator Nolan:
Do you have a site in mind? Does the facility need to be in proximity to other hospitals?
Dr. Venger:
We have been in discussions with the mayor of Las Vegas about the downtown medical site. If there is to be a new medical endeavor in Las Vegas, we should be in the forefront. We have spoken to the university, and the dean of the medical school. There are a number of options. Our major consideration will be to position our facility centrally and in relation to our academic partners.
Senator Neal:
Within your company there are eight businesses. Would you explain them to the committee?
Dr. Venger:
There are divisions in cardiac rhythm management, vascular, cardiac surgery, neurological, movement disorder, and spinal instrumentation.
Senator Neal:
What is the name of the instrument Mr. Lewis uses?
Mr. Lewis:
It is called the Pain Pacemaker. The company is responsible for the original heart pacemaker, and for 5 million to 6 million individuals alive today.
Senator Neal:
Would the eight divisions in your company be associated with the proposed Las Vegas facility?
Dr. Venger:
Because of the narrow scope of the proposed facility, we are focusing on benign, nonthreatening, and non-acute diseases. Our emphasis is on pain and spine rehabilitation. I am involved in some of the other divisions.
Thomas F. Williams, Executive Director, University of Nevada Las Vegas Research Foundation:
I have submitted my written testimony for the record (Exhibit G). In conclusion, the proposal to develop a spine and pain specialty hospital in southern Nevada and the attendant research prospects that will become available to the UNLV researchers and students could present a significant amount of support to the university’s mission and to the economic diversification of our region. The State of Nevada recently ranked in a Milken Institute Research Report in the bottom tier of the 50 states in health care and related research economic impact; we believe that activities advancing and increasing scientific research and technology could prove to be of great benefit.
Mr. Lewis:
Is there a way this could be examined before October?
Chairman Rawson:
I suggested to put language in the bill, “upon passage and approval.” If the Governor signs the bill 2 weeks from now, it would be effective immediately.
SENATOR NEAL MOVED TO AMEND AND DO PASS S.B. 156 WITH SENATOR TITUS’ AMENDMENTS.
James L. Wadhams, Lobbyist, Nevada Hospital Association:
The policy aspect of this bill is not a matter of competition. The parceling out of hospitals will lead to a situation where the primary source of activity is not just indigent care. We realize the value of the amendment proposed, the 0.6 of 1 percent and comments made by its proponents. Specialty hospitals under this amendment can be developed in which their emergency access can be eliminated. It is less an issue of indigent care than it is the emergency room. It is through the emergency room that a vast majority of people enter into a health care facility. We would suggest being careful and not start a trend of subdividing hospitals into their specialty components, and minimize or eliminate what is the current requirement under the federal and State law for emergency services under the Emergency Medical Transportation and Assistance Act (EMTALA) as well as our State laws.
We are concerned about encouraging the subdivision of hospitals and thereby eliminating the primary access point to a hospital through the emergency room system. Desert Springs Hospital is having a severe problem maintaining staffing. If they cannot maintain staffing of nurses and physicians, they will be forced to close. The closing of any facility in Nevada would jeopardize the health of the community. Consider carefully creating an opportunity or incentive for facilities to begin subdividing into their specialty components. If this would become our State’s policy, there might be unintended consequences under which our citizens will suffer.
Senator Mathews:
Do you see this falling under the same category as rehabilitation services?
Mr. Wadhams:
I do, but this is a surgical hospital. Under chapter 449 of Nevada Revised Statutes (NRS) there is a specialty subdivision for surgical hospitals. My concern is this variation. Acute-care hospitals would have the incentive to subdivide rather than try to maintain staffing for specialties. It is not incumbent upon rehabilitation hospitals to have the emergency access as it is upon acute-care hospitals.
Chairman Rawson:
I would not want to send the message that the State is going to open this up for all specialty concerns. We want to move slowly and carefully on this issue. We will close the hearing on S.B. 156 and open the hearing on S.B. 95.
SENATE BILL 95: Requires certain hospitals to accept certain payments for providing inpatient services to insureds admitted upon diversion from another hospital. (BDR 40-679)
Marie H. Soldo, Lobbyist, Sierra Health Services, Incorporated:
Senate Bill 95 is necessary because of the continuing problems caused by divert status that result in unpredictable hospital costs for employers, unions, and all other payors of health insurance. Payors of health insurance plans are responsible for providing the members with access to appropriate, quality care at reasonable cost. They do this by engaging in contractual partnerships with hospitals, physicians, and other providers. This is critical to keep insurance premiums and rates affordable for employer-sponsored plans and individual policyholders. The provisions of these contracts provide for agreed-upon rates that are substantially discounted. As the marketplace dictates, sometimes payors are fortunate to contract for discounted rates with all hospitals in a community. Sometimes business negotiations fail and prevent payors from contracting with all hospitals.
The standard practice in the majority of benefit plans is to require the members to obtain nonemergency inpatient care at contracted or preferred hospitals. The payments for inpatient stays are at the agreed upon contract rates. In situations of critical emergencies, the member is to be taken to the nearest hospital.
The rapid growth in Las Vegas has changed the supply and demand of hospital beds. We no longer have an excess supply of hospital beds; we also have a severe shortage of nurses, and uncontrolled use of emergency rooms. When hospitals experience peaks in demand for emergency services, the response is to divert critically ill patients. In these emergencies, some patients are diverted to noncontracted hospitals. I have provided a chart (Exhibit H) showing the total hours of hospital closure of all facilities from January 2001 through January 2003.
There are times when contracted and preferred hospitals are on divert status and emergency inpatient admissions are diverted to noncontracted hospitals. In these instances, the noncontracted hospital bills the payor-billed charges. These charges are the upper limit rates and are substantially higher than contracted rates. This results in unpredictable costs to all payors.
There is one exception, Medicare is the largest payor. Congress solved the problem by passing the Balanced Budget Act of 1997, and required noncontracted providers or nonparticipating hospitals and physicians to accept established rates for emergency room services and emergency hospital admissions.
Senate Bill 95 is not placing blame on any one particular group. It is not about health plans not wanting to pay for covered benefits as will be suggested by opponents. It is about a systemic problem that does not have any near-term solution. It is a public policy remedy to be used under limited circumstances. It is a safety net for employers, unions, and all payors of health insurance to eliminate unpredictable hospital costs resulting from patients who are diverted to noncontracted hospitals. It is a way to fairly reimburse hospitals well above their contracted rates, but below their billed charges.
Chairman Rawson:
There has been an abundance of communications on this issue. Someone voiced concern they did not want to pay a higher rate than normal on a divert situation. You are attempting to be fair. Some people do not agree.
Ms. Soldo:
Do they want to pay less?
Chairman Rawson:
They want to pay the contracted rate.
Senator Wiener:
Where does the patient, not admitted, and waiting in the emergency room or ambulance come into this?
Ms. Soldo:
This bill is very narrow. It only concerns patients who are admitted to the hospital who have been brought there by ambulances. It is not intended to deal with the emergency room admissions by someone who gets there by other means. Senate Bill 95 is deliberately intended to be narrow. It is deliberately intended to address the inpatient hospital costs, which are the highest costs. It would not address the situation you have described.
Senator Wiener:
For the record: “Do the costs that lead up to the admission, until that admission occurs, what happens to the costs and the reimbursements? This would be for all the costs up to the time of admission. How would they be handled?”
Ms. Soldo:
They are covered costs. The issue for us is paying bill charges in a hospital for which we have no contract. We are trying to get the cost reduced for an emergency admission.
Senator Wiener:
I am hearing the trigger word admission. When is it considered an admission? Can there be costs incurred before admission while still within the emergency setting?
Ms. Soldo:
Are you referring to the costs leading up to a patient being put into a bed?
Senator Wiener:
What does admitted mean?
Ms. Soldo:
Being admitted means a patient being put into a bed and spending overnight in the hospital. We are not talking about patients who are taken to an emergency room and then sent home in 8 hours.
Senator Wiener:
I am talking about a patient that may be transported to an emergency room, cared for by the hospital staff and then admitted. What happens to the costs of medical care incurred from the time they entered the hospital for those 8 hours? A person who had emergency room care and then was admitted. What happens to those costs while they were in the hospital before they get a bed?
Chairman Rawson:
Senator Wiener is asking, what happens to the emergency room costs before they are admitted?
Senator Wiener:
Are they part of the 150 percent?
Chairman Rawson:
The issue arose during the 71st Legislative Session because southern Nevada hospitals were on divert status an average of 285 days. Patients were directed to a hospital under contract, but because the hospital was on divert status, they were sent to another facility. Instead of $2000, the bill charges were $7000. It is an attempt to stabilize those costs.
Senator Nolan:
While people are being transported, the designation of the hospital is given in route. The person may want to go to a hospital their insurance will cover, but medical control may say the hospital is on divert status then the decision needs to be made to go to an available hospital. When a patient is taken to an emergency room where there are a number of other patients waiting, the paramedics will attend the patient in the hallway. There is a two-process admission. There is an emergency room admission where the patient may then be admitted into the hospital or discharged. The emergency room admission occurs after the patient has been triaged, a bed is available in the hospital, and an admission document is created. People are transported to an emergency room, wait to receive a bed, discover the waiting time is too long or a bed in the specialty care unit is not available. Then the patient is transported to another emergency room. There are laws specifying a person is to be treated and stabilized before they are transported.
Chairman Rawson:
When you have a contract, does the contract cover emergency room services?
Ms. Soldo:
In general, a contract covers emergency room services. I am not certain every contract is identical.
Senator Nolan:
Senate Bill 95 proposes a method to contain costs; your contracted rate versus what the hospital would normally bill. Am I correct?
Ms. Soldo:
The intent is not to pay our contracted rate. The language is drafted to cover all payors because there is no relief when a person is diverted. Not every everyone contracts with every hospital. There are times when everyone does. It is mute. It is not a usable provision. Our intent is to pay above the contracted rate. To use the methodology used by Medicare, below bill charges but above the contracted rate. There is an acknowledgement when there is no contract with the hospital but the patient is getting there through no fault of their own or the hospital’s.
Chairman Rawson:
If divert status was not an issue, this situation would not exist.
Ms. Soldo:
Correct.
Jack Kim, Lobbyist, Sierra Health Services, Incorporated:
We have provided the committee with amendments and an explanation of those amendments (Exhibit I). On page 1, section 5: Payors, this should apply not only to health insurers governed by Title 57 but should apply to self-insured companies or self-insured payors. It is also limited to major hospitals in the State with 200 or more beds. The definition of a major hospital excludes county-owned hospitals. The scope of this bill is: when an individual has been diverted from a contracted hospital to a noncontracted hospital and is admitted, then this bill could apply. It would require the patient’s payors have a contract with some hospitals. If you have a payor with any of the hospitals in the area, it would apply to them. If a payor does not have a contract with any hospital, it will not change what they are going to pay.
The payment methodology, a percentage above Medicare, would be the easiest for everyone to calculate. Our proposal was 150 percent above Medicare as a one-payment option. The number can be debated. In a situation where people are diverted through no fault of their own, the hospital can collect whatever co‑payments a noncontracted hospital would collect. Those are the major changes in Senate Bill 95.
Senator Nolan:
Give us an example of an insured arriving at a noncontracted hospital. What would the percentage difference between what would be billed at a customary rate and the proposed 150 percent above Medicare?
Ms. Soldo:
I cannot tell you what the percentage difference would be between our contracted rates and the proposed 150 percent of Medicare. Looking at State numbers and the operating revenue that is reported by the hospitals, if the average operating revenue for the year 2002 is $1700 and there are $6600 in bill charges, we were looking for something in the middle. I believe the number is too low and should be higher. The 150 percent of Medicare rate is around the operating revenues.
Senator Nolan:
Would the person normally be billed 200 percent?
Chairman Rawson:
You could figure the average bed-day bill charge is $6000 to $7000. What is the average cost? You will see more than 200 percent.
Ms. Soldo:
When we did not have a contract with every hospital, we had 340 admissions and they utilized 960 days, our average daily charge was $5000 a day for the diverted population. A few years ago, we compared the average daily charge of $5000 to an average operating revenue of $1600 a day.
Chairman Rawson:
What would be 200 percent of $1600?
Mr. Kim:
We will get the numbers to you.
Senator Neal:
Are you supporting this measure?
Mr. Kim:
Yes.
Senator Neal:
What is in the current statute prohibiting this action? What problems are you trying to cure with this bill? Are you talking about diverting patients from a private to a public hospital?
Mr. Kim:
I am referring to when a patient is diverted from a contracted hospital to a noncontracted hospital.
Senator Neal:
The definition of a major hospital includes a major hospital that is operated by a State or local governmental agency. The University Medical Center (UMC) in Clark County would fit that definition.
Mr. Kim:
The definition of a major hospital includes any hospital with 200 beds or more.
Senator Neal:
Is the definition of a major hospital being changed by this proposal?
Mr. Kim:
It would take the current definition of a major hospital, which is 200 or more beds and include hospitals owned by the county or State.
Senator Neal:
The action word for this bill seems to be “admitted.” It seems to be based upon a person being admitted. You seem to have a different definition than a person being treated and not admitted. If a person is treated and not admitted, your insurance does not pay anything, am I correct?
Ms. Soldo:
No. If a person is treated at the hospital, there is no contract and the person is not admitted, the hospital will give us bill charges and the company will pay them. It does not affect anything unless you are an inpatient.
Senator Neal:
Why is the word admitted being used?
Ms. Soldo:
We are trying to make the bill as narrow as possible. Medicare has a broader protection. If we mirrored Medicare, we would be doing what you are describing.
Senator Neal:
Are we talking about Medicare patients?
Ms. Soldo:
No. Medicare patients are already protected. We are trying to provide the same protection as Medicare for our non-Medicare patients.
Senator Neal:
Why?
Ms. Soldo:
Our job is to find ways to keep our premiums down and to predict our costs as accurately as possible. We are faced with rising health care costs.
Senator Neal:
Are you associated with the hospital?
Ms. Soldo:
We have no ownership in any hospital.
Senator Neal:
What is your relationship with the hospitals?
Ms. Soldo:
Our relationship is contractual. We are business partners. We contract with hospitals and they become our preferred hospitals. Our patients are admitted to the hospitals and we pay the contracted rate. It is a business relationship.
Senator Neal:
Would the rate be any different if a patient is diverted?
Ms. Soldo:
If a patient who needs to be admitted to a hospital is diverted for inpatient care to a noncontracted hospital, the rate would be substantially different.
Senator Neal:
Are you trying to prevent that from happening?
Ms. Soldo:
We are trying to get a rate in the middle between a very high rate and the contracted rates.
Senator Neal:
Could you give me an example?
Ms. Soldo:
If the bill charge for a hospital for which we have no contract is $6000 a day and the contracted rate is $2000, we would like to pay a rate in the middle for a hospital with which we have no business relationship.
Senator Neal:
Are you asking to get paid more than the contracted rate when the hospitals you have a contract with go on diversion status and send patients to other hospitals?
Ms. Soldo:
This affects all payors.
Senator Neal:
Why are they affected?
Ms. Soldo:
There are shortages of nurses and emergency rooms.
Chairman Rawson:
On average, there are 50 mental health people, chronic inebriates, shortages in nursing staff, and other reasons for hospitals not able to take patients.
Senator Wiener:
Why did you delete subsection (d) of section 1, on page 2, (Exhibit I) of your amendment?
Mr. Kim:
We tried to make the language as simple as possible. Hospitals are on divert status even if they have sufficient resources.
Senator Neal:
Is there a definition of admission within the present statute?
Mr. Kim:
I will get the answer for you.
Chairman Rawson:
For the record, there is a letter from Lesley Pittman, Station Casinos Incorporated (Exhibit J) concerning their rising costs of health care for their 17,000 employees. They are in favor of S.B. 95.
James J. Jackson, Lobbyist, Association of Health Insurers of America:
The association supports the concept of S.B. 95. The growing problem of diversion is driving up the cost of health care. This bill will make health care costs more stable. It will benefit insurance companies, the insured, self-insured companies, and groups such as the Public Employees’ Benefits Program.
P. Forrest Thorne, Executive Officer, Board of the Public Employees’ Benefits Program:
I speak in support of S.B. 95. The divert issue is a huge problem in Las Vegas. There is a shortage of beds and nurses. The difference in the cost of contracted and noncontracted hospitals is four times greater. Many times there are retrospect negotiations after the claim is incurred. If a patient can be diverted to a facility where you have a contract, it is better for the patient and the facility. We pay the benefits for them as if they were in a network hospital.
On the admission issue, when a person goes through an emergency admission and is transported, whether the person is there a few hours or 48 hours, if you are admitted to the hospital, all the charges are part of the admission. You would be looking at an inpatient hospital bill with all the charges. Many times under contract with the hospital, it is on a per diem basis. Even though there are emergency room charges included in the bill, the admission is on a flat rate per day.
Senator Mathews:
I want to clarify Mr. Thorne’s testimony. If a person spends 8 hours in the emergency room and is admitted into the hospital, do the emergency room charges become part of the bill?
Chairman Rawson:
Not if you are under contract to the hospital.
Mr. Thorne:
In either situation, it is part of the inpatient hospital bill. The emergency room charges would be a line item charge on a bill charges basis, or part of the per diem if it were under a contract basis.
Senator Mathews:
Could you bill them out on the emergency room costs?
Mr. Thorne:
It is still considered part of the charges for the admission.
Senator Mathews:
You would still have to pay for the emergency room charges.
Mr. Thorne:
Yes.
Kami Dempsey, Lobbyist, City of Las Vegas:
We support S.B. 95. The City of Las Vegas contracts with all the hospitals, but we recognized if that were not the case S.B. 95 would be a cost savings. As an employer of over 3000 employees we always look at the benefits we provide our employees; therefore, whatever we can do to save taxpayer dollars is in our best interest.
Robert A. Ostrovsky, Lobbyist, Nevadans for Affordable Health Care:
We are a business employer coalition dealing with health care costs. We have 300 members and represent over 110,000 employees. We will provide for the record the businesses we represent (Exhibit K). We have not taken a position on S.B. 95. I am here to comment on the divert issue. This issue adds to the increased costs and is very confusing. Until a person is placed in the ambulance and is underway, the hospital’s destination is not known. I encourage the committee to look at the divert issue and S.B. 95 as one solution. If you reduce the payment to a hospital for a particular admission, the hospital makes up the cost elsewhere. Hospitals have an enormous number of patients who do not pay anything, are on Medicaid, and others who are billed. Through the mix, the hospital must be profitable. There is a balance when you ask hospitals to accept less in a divert situation. The divert situation impacts the cost of health care which is rising at rates which are unacceptable. In the year 2001 it was 13.5 percent, over 13 percent in 2002, and the anticipated rate is 15 percent in 2003. The result is more employees do not have insurance because employers do not provide it because of cost, or employees do not provide it for their dependents. This causes them to go to a hospital and become a Medicaid patient or nonpaying charity patient, which results in employers who do buy insurance paying the costs. It is either the employer through the employer‑funded plans or the government through Medicare and Medicaid who must balance the budget.
Chairman Rawson:
The divert issue could be helped by removing the inebriates and putting extra resources into mental health, leaving space in the emergency rooms. Business pays a bigger tax through their health care premium than with any proposals that would take care of these problems.
Janice C. Pine, Lobbyist, Saint Mary’s Health Network:
I speak on behalf of the health plans in our network. We support S.B. 95 and would propose an amendment to address the 150 percent of Medicare. We would suggest the number be between 200 and 250 percent of Medicare.
Richard Daly, Lobbyist, Labors International Union of North America Local 169:
I support the concept in the bill which addresses when a patient is taken, through no fault of their own, to another facility and a higher liability is incurred. Some remedy is warranted.
Mr. Wadhams:
Senate Bill 95 is not a divert bill. Southern Nevada today is far beyond the divert issue. Relatively few hospitals are on divert status for more than a short period because the emergency medical services have reworked how southern Nevada operates. Most hospitals are not on divert status at any time, so the ambulance companies are taking persons to the nearest hospital. The financial problem is far beyond the inability of an insurance company or other payor to price their product for the marketplace in southern Nevada where access to care has become a crisis. Hospitals and ambulance companies are sustaining losses. The Clark County Health Department has set a 60-minute rule, which means the ambulance does not come in and drop off the patient and drive away to pick up another patient; they must wait at least 60 minutes. They are tying up a resource because of a capacity problem in the hospitals.
A suggestion to reduce the economic reimbursement of a hospital in the face of a capacity problem seems to be focusing on the wrong part and is exacerbating the problem. If all the hospital rooms that are projected come on-line in the next 2 to 3 years, we will barely be at a recommended capacity level. When we talk about saving money for certain payors who have the opportunity to price their product appropriately and negotiate in an open marketplace, it seems counter‑productive to address the larger problem of expanding to capacity and affording our citizens access to the care needed, particularly in emergency situations.
Eight hundred licensed health insurance companies reimburse for health care services, but very few have contracts with all the facilities. Most have contracts with none. Another component of hospital reimbursement comes from the liability insurance companies, most commonly the automobile insurers who would not have contracts with hospitals. I believe S.B. 95 is being introduced at a time when the need is in nursing, retaining physicians, rate rollbacks, cost controls, and where costs are rising may be an easy but wrong solution. We encourage you not to process S.B. 95.
Chairman Rawson:
Do automobile insurers pay the full charges?
Mr. Wadhams:
Yes, they do.
Jeanette K. Belz, Lobbyist, Universal Health Services:
Our challenge in the emergency rooms is mental health patients. We have system-wide issues, which need to be addressed in addition to the nursing shortage. Diversion is a complicated issue. One of the requirements of diversion is a hospital cannot be on divert status for more than 1 hour at a time. Hospitals are constantly going on and off divert status.
Kathryn Silver, Assistant Administrator, University Medical Center:
We would submit and put on the record there is a fiscal impact, for UMC, which could be as high as $5 million. Senator Neal has pointed out UMC has been specifically and actively included in this bill. Previously we were excluded for the definition of a major hospital. During the interim meetings, everyone agreed, including the representatives of the Sierra Health Services, Inc. trauma and burn units would be excluded. There has been no mention of such exclusions. There was also an agreement among the group this benefit would not be offered to payors who are not domiciled or who actively do business in this State. It should not be expanded to include residents who do not live in this State. There is no reason to expand such a benefit to those who do not pay taxes in this State. The bill refers to diversion, not divert status. Diversion represents something entirely different. Diversion may be for a different level of care. Some of the hospitals have unique services: pediatric, intensive care units, and level three nurseries. Patients are constantly being transferred to our facilities. This bill could be misinterpreted to include those patients. Then we are taking it to one more layer of patient and rate settings.
With a cap on the financial exposure, the payor has no incentive to move a patient to a more appropriate level of care. Specifically, if a patient could go to home health, a skilled nursing facility, or long-term, acute-care facility and the cost of the care is caped, there is no incentive to move the patient. The patient could linger in an already tight bed market needlessly. The mechanics for auditing this bill are horrendous. The hospitals can only be on divert status for an hour at a time in each quadrant and it is very complicated. This type of suggestion only creates needless and additional costs on both sides of the equation because someone needs to monitor this process. Patients generally go to the closest emergency room. It has no bearing on whether the contracted hospital is on divert status.
University Medical Center is struggling with the ability to care for the uninsured and pay for the uncompensated care. What has been done to this point has offset some of the cost because there are paying patients. This is another way to reduce our ability to have some margin on these patients by rate setting. From a policy position, this is a dangerous precedent. Again, the taxpayer will be asked to shoulder the burden to the benefit of private insurers.
Lynn Fulstone, Lobbyist, Mountainview Hospital, Sunrise Children’s Hospital, and Sunrise Hospital and Medical Center:
This bill does not solve the divert problem. It is a complicated problem with many causes and attempted solutions currently in progress. Senate Bill 95 shifts the costs from hospitals already shouldering a large share of the health care costs in this State. The solution to noncontracted hospitals is not having legislation creating contracts for private parties, but allowing insurance companies and the hospitals to contract for appropriate rates for both parties. Ms. Soldo claimed this bill was narrowly drawn. It is not. Senator Neal and Senator Wiener questioned the definition of an admission. Where does an inpatient admission differ from an emergency room admission? It appears S.B. 95 is broad in scope and could cover a situation where a patient might be in the emergency room for a short time but admitted to a hospital for 30, 60 or 90 days and the facility would be responsible for paying whatever the legislation enacted rather than something agreed upon.
Bill Welch, Lobbyist, Nevada Hospital Association:
I acknowledge the testimony of the proponents of this bill. I am sympathetic to the issue they raise. Every component of the health care delivery system is under stress because of the situation in which we find ourselves. There have been many hearings and discussions concerning S.B. 95.
This is not a divert bill, it is a contracting bill. They are asking the Legislature to set contracting terms. The bill does nothing to solve the divert problem. Everyone who spoke in favor of S.B. 95 acknowledged having a contract with all of the providers. They agree this is a burden on all, but have said the problem has not been addressed. During the 71st Legislative Session we were asked to evaluate the solution to the divert problem and contracting issues. The hospital community and others have made good-faith efforts to accomplish this task. There has been a major revision in the divert policy of Clark County. After the 71st Legislative Session, the divert situation was running from 40 percent, as much as 50 percent on some occasions to the new policy affecting the divert situation. It is less than 15 percent on average. Since 2001 there has been a substantial reduction in the divert problem. It has not resolved the real problems. We have alleviated some of the hardships and burdens for the ambulances, and the health plans, but we have not dealt with the access issues.
We are seeing, on an average, 51 psychiatric patients in our hospitals on a daily basis, which represents over 30 percent of our emergency room capacity in Clark County. This should be the focus. We have witnessed the growth of 490,000 to 520,000 emergency room admissions a year in Clark County. The hospitals are writing off their costs, not charges. There are over $19 million a year of uncollected costs for the emergency rooms because of the patient mix. Over 60 to 70 percent of the visits are not emergent.
Within the next 12 to 18 months the hospitals that are extending facilities will have a 25 percent greater capacity. The hospital industry is doing everything within its power to help resolve the nursing shortage. The hospital industry contributes over $24 million annually to deal with the nursing shortage. If S.B. 95 is to be a divert bill, it should be rewritten to address the issues causing diversion. Diversion only applies to patients who are presented by ambulances, which is a small percentage of total patients presented to the hospitals’ emergency rooms.
Senator Wiener:
What will the triage policy for inebriants and the mentally challenged have on overcrowding issues in the emergency room?
Mr. Welch:
It would reduce the overcrowding by about 10 percent. The efforts are more focused on the inebriated versus the psychiatric population. The mental health patients require a medical evaluation. Currently, they are being brought to the hospital emergency room, they are triaged, ultimately they will need an acute‑care evaluation and a legal 2000R will be performed. Those processes are holding the patient up due to lack of resources to accomplish those tasks and the availability of beds to transfer patients. If the patient is being held in the emergency room, it is because they need inpatient care. This will not significantly reduce the psychiatric patients. It will have a larger impact helping to relieve the problem with the publicly inebriated brought to the hospital.
Senator Nolan:
Is it always presumed a person arriving by ambulance to a hospital needs emergency care, or does the insurer have a right to deny to pay for such service?
Ms. Silver:
There is a prudent layperson standard that applies in many cases to the emergency room; however, the insurer has the opportunity to retrospectively deny the care if it is determined it was not an emergency. The exposure being addressed in the bill has to do with the inpatient side. Stabilizing and transferring a patient back into plan from the emergency room, the option always exists for that patient to be transferred out of the noncontracted facility once the patient is stabilized, so they can be put back into plan. An insurer will pay for the care, but it will be at the noncontracted or no-par rate. This will leave a large balance.
Chairman Rawson:
I will close the hearing on S.B. 95 and open the hearing on S.B. 284.
SENATE BILL 284: Makes various changes concerning public hospitals. (BDR 40-245)
Lawrence M. Preston, President, Professional Medical Consultants, Inc.:
Public money should not be used for inappropriate services. Senate Bill 284 is looking at contracting for services at less than cost as an appropriate use of public money. Section 1 of S.B. 284 addresses this issue. Section 3 of S.B. 284 provides the definitions needed for clarification on direct and indirect cost as well as using generally accepted accounting principles for accountability.
I support S.B. 284. There is a need to have a competitive environment in health care and the need to be financially healthy, both in the private and public sector. Senate Bill 284 is a step in that direction and I urge the support of the committee.
During the last session, S.B. No. 355 of the 71st session was introduced and referred to the Senate Committee on Government Affairs. This committee requested more structure, information, and work sessions. These sessions, “Competition between Local Governments and Private Enterprise” were chaired by Senator Michael A. Schneider, Clark County Senatorial District No. II, and reached many segments of our State’s economy. The working points from these sessions regarding health care resulted in the introduction of S.B. 284.
Greg Griffin, Chief Executive Director, Fremont Medical Centers:
We are in support of S.B. 284. This legislation will require the public hospital to adopt appropriate reimbursement structures and/or expense reduction plans similar to those faced daily by the private sector. Public hospitals will no longer be allowed to use taxpayer’s money to execute managed care contracts with for-profit insurance groups, which reimburse below their actual operating costs.
We offer an amendment to a S.B. 284. Add to section 1, any patients covered by federal and/or State programs also be added as an exempted group in this bill. If a public hospital develops facilities to directly compete with the private sector, then it is only fair that they adopt this basic tenet of business and not use taxpayer’s money to subsidize their deficiencies.
Chairman Rawson:
What is the affect of excluding Medicare and Medicaid patients?
Mr. Griffin:
There are no negotiations involved. University Medical Center will get the rate defined by federal or the State.
Senator Nolan:
How do you establish an objective fee for service?
Chairman Rawson:
You look at the overall expenses and come up with a cost, and it cannot be less.
Mr. Preston:
If an average outpatient visit to a facility would be $80 and you contract at $50, you know you are giving that contract entity $30 of your potential profit. You are actually spending money to make less.
Chairman Rawson:
Even though it may cost you less?
Mr. Preston:
It has to be looked at in a global way. We looked at ways to give input. We considered whether every cost would be included, we took the building depreciation, because there are accepted accounting standards that can be used. We presented testimony that it was cheaper for the hospital to give a patient $10 and let them go to a private facility than to lose $20 and have the patient go through the system. The purpose of S.B. 284 was to make it easier for the contracting staff and administration of a facility to say we cannot contract below our costs. We either have to improve our costs or get reimbursements giving us back our costs.
Senator Nolan:
Is there anything in the bill that would determine the methodology?
Mr. Preston:
Page 2, lines 1 and 2, state, “provision of the service consistent with generally accepted accounting principles.” It lists some costs without limitation.
Chairman Rawson:
Is the Fremont Medical Centers concerned this will drive up medical costs?
Mr. Griffin:
This bill is addressing outpatient facilities, not inpatient. Our concern is quick‑care facilities are signing contracts below their operating costs. If their operating costs are $100 per visit and they sign a contract for $70 a visit they are below their operating costs.
Ms. Silver:
Most businesses should price their reimbursement above their cost. The problem with S.B. 284 is its implications. We prospectively determine a rate, whether it is a flat rate or a rate tied to some other methodology. We do not know what the exact cost of rendering the care is going to be. While it may be the intent, the bill does not say it is meant to look at global averages. It implies it is the entire hospital, any part of the hospital, which would mean we could not contract with anyone. We have units that do not cover their costs. If we look at the total cost of quick care and the fully-allocated costs of the hospital, it is entirely different. No other clinics have to adhere to EMTALA laws. There are no other facilities allocating costs from a full-service tertiary hospital. The bill, in its current form, is problematic. Unless the Legislature is willing to mandate that all insurers will contract with us at our costs or above, UMC is being put at a disadvantage. There are times when a business decision must be made not to cover costs all the time, particularly in health care.
Michael R. Alastuey, Lobbyist, University Medical Center:
I have had many discussions with the proponents of S.B. 284. The discussion included treatment of business decisions UMC makes and the business decisions private providers make in terms of outpatient clinics. Any business endeavor is a mix of transactions. In your best business judgment, you hope you have designed more to win than to lose. If every activity, product, or service has to itself render a profit, you will not be able to develop business or attract foot traffic. The bill would preclude normal business practices for UMC. When contracts are negotiated with providers, they are negotiated on a bundle basis, not just on a service-by-service basis. The provider of health care has to evaluate the number of patients that the insurer, hospital maintenance organization, union trust, or employer will bring, exactly what the mix of patients will be; their demographics, the conditions they present, and the facility’s goods and services of what you have to offer. You have to determine what your even point will be under certain assumptions. University Medical Center could never compete or provide a competitive product in the health care marketplace. Any public facility must become an engineered indigent provider and no more. If a public provider must overcharge at or above market for every service, you are pricing the public provider out of the market. This will make the public provider an indigent care only facility while providing all the paying patients to other providers, and providing a tax subsidy indirectly to those private providers of care.
The genesis is an economic model and a public provider will never have a paying patient. There may be paying patients who are unwise, foolish, or charitable enough to pay too much for the service at a public facility when they could go to a private facility.
During our meetings, I asked the providers if the goal is to have a level playing field, could this model be passed into law and be applicable to all providers? The answer was complete silence, which I took as a “no” answer. If we do look for the level playing field, break-even point in public facilities, S.B. 284 would not tilt the playing field to the taxpayer’s advantage.
Chairman Rawson:
The issue has been raised because there are private sector providers who feel a significant disadvantage, because of the tax subsidy. It is not an issue we should dismiss, but needs further discussion.
Mr. Alastuey:
I agree.
Senator Nolan:
There may be specialty clinics offering free analysis or other forms of enticements to have people utilize the facility. It is my understanding UMC’s burn-care unit is not a profitable part of the hospital’s service. It is somewhat subsidized by other revenues. Would this bill have any impact on such a unit?
Ms. Silver:
The way S.B. 284 is written, it would include the burn-care unit and any other unit. University Medical Center is the only provider of some of the specialty units. We take all patients and there are high costs involved. The bill should include all facilities at the public hospital.
Debbie J. Smith, Lobbyist, Service Employees International Union, Local 1107:
Service Employees International Union opposes S.B. 284. This bill is directed towards public institutions that provide an important service to our community. It is meant to tie the hands of the hospital. University Medical Center must be able to compete for paying patients in order to ensure revenues to meet the county hospital’s obligation to care for the uninsured. If the ability of the public hospital is to compete for paying patients, then taxpayers will be left to subsidize the cost of running the public hospital.
The bill is attempting to impose higher costs upon our health care system at a time when health care costs are skyrocketing and working people are losing their access to health care. Last year, the union health care insurance funds were facing increases in hospital charges in excess of 20 percent. At the time, some legislators were proposing profit caps to reduce costs of health care. The working people of southern Nevada need relief from the high cost of health care, so we are requesting you not take action on S.B. 284, which would inflate the cost of health care.
Chairman Rawson:
I will close the hearing on S.B. 284. Does the committee have any comments on S.B. 95, or S.B. 156?
Senator Neal:
I made a motion to amend, with Senator Titus’s amendment, add the effective date upon passage and approval, and do pass S.B. 156.
SENATOR NEAL MOVED TO AMEND AND DO PASS S.B. 156.
SENATOR MATHEWS SECONDED THE MOTION.
Senator Wiener:
I am not ready to vote. I need more information.
Senator Nolan:
I feel the same as same as Senator Wiener.
Senator Washington:
I wish to echo the sentiments of Senator Wiener and Senator Nolan. I would like to process more information on the bill before voting.
Senator Neal:
I will withdraw the motion. I brought the company up on my laptop. They are a worldwide organization, credible, and their intentions would not damage, but enhance, the health care picture in southern Nevada.
Chairman Rawson:
I am not willing to open a floodgate for specialty services.
Senator Nolan:
I agree with Senator Neal. By bringing this specialty facility into southern Nevada, it will offer many opportunities and possibilities. Hopefully we could guarantee this would not open the floodgates but provide an excellent facility at a time when it is sorely needed in Nevada. I am concerned we do not create a statutory loophole that would allow all these specialty hospitals to develop as profit centers and draw from our hospitals.
Chairman Rawson:
Senate Bill 156 is tightly drafted and will not create a loophole. The Legislature could consider looking into this project. There would be no further approvals until reports and an evaluation of the effects of the proposal were received.
Senator Washington:
Was the number of beds in the bill reduced?
Chairman Rawson:
Yes, it was reduced to 15 beds.
Senator Cegavske:
Senator Mathew’s suggestion was to reword the language.
Senator Mathews:
They have made a commitment to other hospitals to have 15 beds.
Senator Washington:
If only there were a way to insure this bill would not lead the way for others. There is a cardiac group considering a similar project.
Chairman Rawson:
Each of the major hospitals has cardiology as part of their facility. This group did approach each hospital, but none were interested. I understand we cannot bind the future Legislature, but do you see a way to express it without it becoming a general opening?
Senator Neal:
I thought the bill was narrowly drawn. We can talk to legal counsel to see if there is anything else to be done. We can hold it over and have legal counsel look at it.
Chairman Rawson:
Would you take on that responsibility?
Senator Neal:
Yes.
Chairman Rawson:
Mr. Sturm, would you go over S.B. 118.
SENATE BILL 118: Revises provisions governing ability of State Fire Marshal to regulate construction, maintenance and safety of buildings and structures in certain counties. (BDR 42-850)
H. Pepper Sturm, Committee Policy Analyst:
I have provided the committee witha “Work Session Document”(Exhibit L. Original is on file in the Research Library.). Senate Bill 118 would allow the two larger counties to set the standards for construction and maintenance safety. One of the proposed amendments was from Ron Lynn to change the wording on page 4, line 1, from “chief of the fire department in the jurisdiction” to “chief executive officer.” The Legal Division suggested using “governing body of that jurisdiction.” The school districts expressed concern this bill might be removing their ability to contract with the State fire marshal for their needs. They asked there be an exemption to continue their relationship with the State fire marshal for their purposes.
Chairman Rawson:
Senate Bill 118 is about the regulation but it incorporates inspections. Senator Neal had a concern about this bill. Is there a way to relieve all the inspections as long as the standard is as strict as the State standard? It would allow the counties to do all the inspections but allow them to set tougher standards than the State.
Senator Neal:
My concern was the retrofit program. The standards governing that particular program would be similar throughout the State. We would not allow the 17 different counties to deal piecemeal with those issues. It has been successful so far. Years ago we took the State fire marshal out of Clark County, and 7 years later the MGM Hotel/Casino and Hilton Hotel fires occurred. In 1981, the State fire marshal was returned to oversee the retrofit program to make sure those standards were the same throughout the State. Any assurance of the standards being uniform in terms of protecting lives has my approval. If there is a lessening of the standards, then there will be a problem. If the language would state the standards should be as strict as those being imposed on the State level, as the State fire marshal would recommend, I would not be opposed to that concept.
Chairman Rawson:
This would illuminate some duplication of services in the State.
Senator Neal:
My suggestion would be whatever standards are developed by local government would be no less stringent than what the State would require.
Chairman Rawson:
Would this totally inactivate the bill?
Senator Wiener:
I was going to suggest the language, at least equal to or greater than the State.
Chairman Rawson:
We will have the committee staff prepare an amendment to see if it is possible to process the bill. We will bring back S.B. 118.
Senator Mathews:
Based on my notes, the State fire marshal stated there was a need for an impact study before any action was taken.
Chairman Rawson:
The State fire marshal has a budget that must be met; therefore, he is concerned about any action that would illuminate positions. There is no need for duplication of services. We will look at the language and bring it back to the committee.
Mr. Sturm:
Senate Bill 179 was brought forward by the Division of Mental Health and Developmental Services.
SENATE BILL 179: Makes various changes related to mental health. (BDR 39‑480)
I will read from the “Work Session Document” (Exhibit L). On page 7 there are amendments proposed by Mr. Irvin, James Vilt, and Lynne Bigley.
Chairman Rawson:
My reaction to number 4, on page 7 is; why are people sitting for long periods in the emergency room? If they are being evaluated, then they should be admitted to the hospital.
Mr. Sturm:
The complete proposed amendments can be found on pages 8 through 16 (Exhibit L).
Chairman Rawson:
It appears amendments 1, 2, and 3 are not controversial. Amendments 4 and 5 may be divisive. What is the committee’s consensus?
Senator Nolan:
Amendments 1, 2, and 3 help the situation whereas amendments 4 and 5 convolute the issue.
SENATOR NOLAN MOVED TO AMEND WITH AMENDMENTS 1, 2, AND 3, S.B. 179.
SENATOR WASHINGTON SECONDED THE MOTION.
Senator Mathews:
I am not comfortable with amendments 1, 2, and 3.
Senator Neal:
I will not support the motion without amendments 4 and 5.
THE MOTION CARRIED. (SENATORS MATHEWS AND NEAL VOTED NO.)
*****
Mr. Sturm:
There were no proposed amendments to S. B. 254 on page 17 (Exhibit L).
SENATE BILL 254: Authorizes parents of certain pupils to choose which public school pupils will attend. (BDR 34-891)
SENATOR WASHINGTON MOVED TO DO PASS S.B. 254.
SENATOR CEGAVSKE SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS NEAL, MATHEWS, AND WIENER VOTED NO.)
*****
Chairman Rawson:
There being no further business for this meeting, I adjourn this meeting at 4:53 p.m.
RESPECTFULLY SUBMITTED:
Patricia Vardakis,
Committee Secretary
APPROVED BY:
Senator Raymond D. Rawson, Chairman
DATE: