MINUTES OF THE
SENATE Committee on Human Resources and Facilities
Seventy-second Session
April 7, 2003
The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 1:43 p.m., on Monday, April 7, 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
STAFF MEMBERS PRESENT:
H. Pepper Sturm, Committee Policy Analyst
Cynthia Cook, Committee Secretary
OTHERS PRESENT:
Yvonne Sylva, M.P.A., Administrator, Health Division, Department of Human Resources
Jane Smedes, Management Analyst, Department of Human Resources
Mary Liveratti, Deputy Director, Department of Human Resources
Benjamin H. Venger, M.D., Western Regional Center for Brain and Spine Surgery
Jeff Simmons
Bill Welch, Lobbyist, Nevada Hospital Association
Robert A. Ostrovsky, Lobbyist, Lake Mead Hospital (Tenet Health Care)
Lynn Fulstone, Lobbyist, Sunrise Hospital and Medical Center
Denell Hahn, Lobbyist, Sunrise Hospital and Medical Center
Michael R. Alastuey, Lobbyist, University Medical Center
Charles Duarte, Administrator, Division of Health Care Financing and Policy, Department of Human Resources
Chairman Rawson:
We will call the meeting to order. It is my intention to withdraw Senate Bill (S.B.) 455. There has been significant opposition, and no support for the bill.
SENATE BILL 455: Requiring licensure of emergency medical technicians by Committee on Emergency Medical Services. (BDR 40-105)
SENATOR CEGAVSKE MOVED TO INDEFINITELY POSTPONE S.B. 455.
SENATOR WIENER SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS WASHINGTON AND NOLAN WERE ABSENT FOR THE VOTE.)
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Chairman Rawson:
We will open the hearing on S.B. 411.
SENATE BILL 411: Revises certain provisions relating to qualifications and appointment of State Health Officer. (BDR 40-1243)
Yvonne Sylva, M.P.A., Administrator, Health Division, Department of Human Resources:
The State health officer position is a classified position. A position of this rank should be unclassified to provide the director of the Department of Human Resources appropriate flexibility to appoint and remove from service. This change, and the addition of educational and work experience requirements, will make Nevada consistent with other states. The State Health Division has had a difficult time recruiting the State health officer. The division would like to recommend the following changes: the number of years’ experience from 5 to 2, and the deletion of section 1, subsection 3.
Senator Mathews:
Would these changes have resulted in the hiring of the person who had been offered the job?
Ms. Sylva:
It would not have had any affect. He was unable to meet the requirements of the Board of Medical Examiners. We have made an offer to a candidate for health officer who has a masters degree in public health. He is also eligible for board certification in preventative medicine, and is licensed to practice in Nevada.
Chairman Rawson:
We will close the hearing on S.B. 411 and open the hearing on S.B. 412.
SENATE BILL 412: Authorizes State Board of Health to allow or require payment of fees for licensing medical and other related facilities in installments. (BDR 40-1244)
Ms. Sylva:
This bill was requested by the Health Division on behalf of facilities that are licensed by the Bureau of Licensure and Certification. Passage of the bill will allow the State Board of Health to establish a fee payment schedule to reduce the burden to facilities paying annual licensure fees in a lump-sum payment prior to December 31 of each year. This will allow facilities to better manage their cash flow.
Senator Wiener:
Has the current method of paying fees been a burden to the facilities?
Ms. Sylva:
We have not experienced any closings, but it is a burden for the small residential facilities to come up with a lump sum.
Chairman Rawson:
We will close the hearing on S.B. 412, and open the hearing on S.B. 458 and S.B. 118.
SENATE BILL 458: Makes various changes to provisions governing State Fire Marshal and fire prevention. (BDR 42-515)
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:
The proposed amendments for these bills are located in the work session document (Exhibit C).
Chairman Rawson:
Are we going to consolidate these bills?
Senator Nolan:
These bills have many of the same proponents. The fire departments I spoke to would like the option to provide services within those counties having a population of 100,000 or more. We could amend the bills into each other, and any counties exempted in the bill shall adopt and enforce regulations that require a standard of safety that meets or exceeds the regulations of the State Fire Marshal. Any county or jurisdiction exempt from the fire marshal’s authority shall be charged a fee in the same amount as is charged in nonexempt jurisdictions, since the larger counties have the ability to use the training facilities of the fire marshal.
Chairman Rawson:
Since S.B. 118 has a fiscal note, and S.B. 458 does not, I suggest we combine them within S.B. 458.
Mr. Sturm:
I will review the recommended amendments in Exhibit C.
Senator Neal:
Who will determine if the counties exempted under the bill adopt and enforce regulations that require a standard of safety that meets or exceeds the regulations of the fire marshal?
Chairman Rawson:
The office of the attorney general would ultimately have to make a determination if there were any questions. We would request all the documents developed at the local level be filed with the State fire marshal.
Senator Washington:
Senate Bill 118, suggested amendment number 2, states school districts would continue to be authorized to contract with the fire marshal for inspections. There was testimony concerning the multiple layers of government they have to go through.
Chairman Rawson:
The school districts requested the ability to have the fire marshal do their plan checks and the county building boards indicated they would like the fire marshal to do so. This allows it to be done, and I do not believe it creates two levels. Mr. Sturm informs me this bill does have a fiscal note also, so it will have to go to the Senate Committee on Finance.
Senator Cegavske:
If we merge the bills, will the primary bill be S.B. 458?
Chairman Rawson:
It could be either one.
Mr. Sturm:
I will review the amendments proposed for S.B. 458 (Exhibit C).
Senator Nolan:
Part of the complaint was multiple checks were required to be drafted to various agencies for the fees charged by the fire marshal. We could alleviate that if one check were processed to the local agency and they then determined a method to forward the money to the fire marshal’s office.
Chairman Rawson:
We can insert “local jurisdictions may consolidate payments.” We will bring the amendments before the committee for review prior to the bill going to the floor.
SENATOR NOLAN MOVED TO AMEND AND DO PASS AS AMENDED S.B. 458.
SENATOR NEAL SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
Chairman Rawson:
We will open the hearing on S.B. 459.
SENATE BILL 459: Revises amount of limit on income of senior citizens to qualify for subsidy for prescription drugs or pharmaceutical services from money in Fund for a Healthy Nevada. (BDR 40-1247)
Jane Smedes, Management Analyst, Department of Human Resources;
Senate Bill 459 was requested by the Department of Human Resources. There is a technical change to the language from “purchase” to “is eligible for” a policy of health insurance. This change is necessary because we no longer require seniors to purchase insurance. Revisions to the regulations were made in 2002 to correspond with changes made to the Senior Rx Program in the 2001 Legislative Session. The department proposes to increase the maximum income for married couples from $21,500 to $28,600. The increased income allowable for married couples will provide a fair distribution. The one-third increase is a common method used in other programs to determine a level for couples. The department estimates 5,000 households of persons over age 62 would meet the increased income maximum.
Since the program began, 190 couples who applied to Senior Rx were denied for not meeting the income requirement. We propose to adjust the maximum income levels for all participants in accordance with the consumer price index. Doing so will allow current participants to remain enrolled if their income increases slightly. There are approximately 75 seniors in the program who could become ineligible with a 2 percent increase in their annual income.
The department proposes revisions to the income eligibility waiver section. There are no provisions to waive income requirements for seniors enrolled in the program who experience a temporary income increase or hardship. For example, a one-time payment to a senior for an insurance distribution, and the funds are used to pay medical bills. Some seniors may sell their homes or cash life savings to pay medical bills or day-to-day living expenses. The department believes there should be a method for these seniors to request a waiver of the income requirement.
Chairman Rawson:
In some of the Senate Committee on Finance subcommittee meetings, there have been discussions about the possibility of a purchase program to allow all seniors to enroll. Is the language in this bill broad enough to allow this?
Mary Liveratti, Deputy Director, Department of Human Resources:
The first section currently states “shall” is being changed to “may.” I believe this allows for more options.
Senator Cegavske:
If the combined income of both seniors totals $28,660, and both of the seniors would be covered, how many more seniors would qualify? Also, from where does the money come?
Ms. Smedes:
We have estimated there are 5000 households in the State who may qualify. Whether they would apply for the program we do not know. We did accommodate for 300 couples within the budget for the next biennium.
Ms. Liveratti:
In our executive budget proposal, we have estimated the number of seniors on the program. We currently have 7500 seniors enrolled and we are proposing to go to 12000 seniors by the end of the biennium. That estimate accommodates the increase in married couples.
Chairman Rawson:
This bill would not have any authority without budget authority. The final budget would ultimately determine what happens.
Senator Cegavske
How do you find the seniors for the program?
Ms. Smedes:
We have approximately 1300 seniors on a waiting list. If we were to add more, we would do additional outreach such as going to senior centers and health fairs.
Senator Wiener:
Are any of the people who would qualify under this bill in the program now?
Ms. Smedes:
They would not be eligible now if they applied.
Chairman Rawson:
You control your budget by the use of a waiting list. You work with the money you have available.
Senator Wiener:
Of the seniors on the waiting list, how many would qualify in the couple category?
Ms. Smedes:
I do not have the exact number. Historically, about 90 percent of those who apply are individuals.
SENATOR WIENER MOVED TO DO PASS S.B. 459.
SENATOR MATHEWS SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
Senator Cegavske:
I would like to make it clear I could change my mind on the Senate floor.
Chairman Rawson:
We will close the hearing on S.B. 459 and open the hearing on 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)
Mr. Sturm:
The proposed amendments for S.B. 156 are included in the work session document (Exhibit D).
Senator Neal:
What does the language on page 6, which states “does not include an intensive care unit” mean?
Chairman Rawson:
It would not be a full hospital in the sense it would have an intensive care unit. It would not duplicate University Medical Center or Sunrise Hospital.
Senator Nolan:
I might expand on the question. Is there a definition in statute of the definition of an intensive care unit? Many recovery units are meant to be a temporary place to stabilize a person. An intensive care unit can handle a patient for several months. Under this bill, how long can a patient, who may have complications, remain in the recovery unit?
Chairman Rawson:
I do not know how to answer that question. A recovery unit can give very intensive care, but is not long term. I think we heard testimony they would transport to an intensive care unit if a patient needed that care. We will ask the maker of the amendment to address it. Dr. Venger, would you come forward and address the intensive care issue.
Dr. Benjamin H. Venger, M.D., Western Regional Center for Brain and Spine Surgery:
We have decided since we are not dealing with life-threatening illness, in order to narrow the scope of our hospital and to narrow the services, per the request of the committee there be no intensive care unit. An intensive care unit implies we would care for critically ill patients. We do not want to compete with the acute care hospitals. The amendments meet our needs.
Chairman Rawson:
I believe the committee would be concerned about whether this opens the possibility of other specialty hospitals. Is this sufficiently restricted to deal with just your situation?
Dr. Venger:
The language within the amendment focuses on a narrow, specific, and limited number of diseases we will treat. As a neurosurgeon I could not practice only at this hospital. I would have to be at all hospitals and abide by their bylaws. So I feel this functions to further define what we want to do. It clearly identifies what we are and what we are not, and gives us focus for what we must provide in the future.
Chairman Rawson:
Would you require the doctors on staff have privileges at other hospitals?
Dr. Venger:
As I previously testified, it is our intent to complement the hospitals, not compete with them. I could not practice my specialty, nor would I imply that anybody on staff would relieve themselves of those responsibilities. As a part of the bylaws, they would be required to have membership on a hospital medical staff which would include emergency.
Senator Wiener:
The preamble talks about assuring the laws of the State facilitate the location of this type of hospital in Nevada, and, at the same time, balance the needs of the residents of the State for quality health care at all levels. The intensive care issue raised a concern. If you are taking patients at a surgical level, what kind of influence would this have on existing hospital facilities. How will that balance be affected by taking part of what they do in your facility?
Chairman Rawson:
I believe you are asking if a patient is critical following an operation, will the facility be able to give the intensive care service necessary to protect the patient.
Dr. Venger:
Aside from the surgical operation, the most critical part of any patient care is recovery. The recovery room is when a patient is transitioning from being anesthetized to being awake. That care would not change. A patient deemed critical in the recovery room, whether in an acute general hospital or a doctor’s office, would have an anesthesiologist and a physician at their side until the patient became stable. In essence, intensive care is not an issue in relation to patients coming out of surgery. The care for an individual who is going from the operating room to the recovery room would be the same.
Jeff Simmons:
I am Dr. Venger’s partner in this project. We are not doing surgery on patients who are critical. The types of surgeries that normally require admission into an intensive care unit will not be done in our facility. Because of our specialty, we need to have more than an outpatient facility. The length of stay for some of these patients is 1 or 2 days. We cannot take care of Medicare patients unless we have a hospital.
Bill Welch, Lobbyist, Nevada Hospital Association:
What happens if a complication develops after the patient has had surgery, recovered, and is on their way out. There is the possibility a patient will need an intensive care unit. As more of these types of facilities are developed, there will be less need for physicians to be on call for a full-service acute-care hospital. While hospitals are trying to maintain outpatient emergency services, they could find themselves with inadequate numbers of physicians to provide that care. In Clark County we have seen one hospital close their orthopedic services because of an insufficient number of physicians on call. This could further complicate matters. I am not clear why this facility is necessary for the treatment of Medicare and Medicaid patients. Every full-service acute-care hospital in Clark County has neurological services with both Medicare and Medicaid patients receiving treatment. We do not need to develop an additional facility for those patients.
This legislation was originally proposed as a research project. This bill does not narrow it down to merely research. The question I have is, without an emergency room, how will these patients access the facility? The uninsured population will typically access hospitals through emergency rooms. Full-service hospitals are becoming primary care delivery services.
Senator Nolan:
How are indigent patients currently accessing neurological care?
Mr. Welch:
If a hospital is designated as a full-service facility, it is the responsibility of the hospital to have a sufficient number of physicians licensed in that specialty to be available on call. The hospital staff will stabilize and diagnose the patient, and call the specialist who is on call.
Senator Nolan:
The bill is not asking for an emergency room because there are not supposed to be acutely critical ill patients admitted. Do you see something in this that says otherwise?
Mr. Welch:
As these specialty hospitals increase, the physicians are able to develop a sufficient practice to provide the services they choose to offer and will not necessarily need to maintain their emergency room privileges at full-service hospitals. Twelve states have modified their laws, revisiting their licensure requirements because of the affect specialty hospitals have had on full-service hospitals.
Senator Neal:
Does Clark County have such a specialty hospital? If so, you seem to suggest there would be no way to deal with a complication. Is that your testimony?
Mr. Welch:
To my knowledge there is no such specialty hospital in Clark County. The question was asked whether this hospital would have an intensive care unit. A situation could arise in any type of specialty care facility. For example, a patient could pass an embolism which would require more care than originally intended. While the hospital may be capable of handling basic neurological surgery, there is the possibility events could evolve to require something more than neurological attention.
Senator Neal:
Is there a fear specialty hospitals could take patients away from regular full‑service hospitals?
Mr. Welch:
There is concern about the trend of specialty hospitals. The State could end up with few hospitals having full-service emergency rooms.
Chairman Rawson:
I assume you are representing to the committee you would maintain your on call service.
Dr. Venger:
We will absolutely maintain our on call service. Not only do I take between 60 and 80 percent of the neurosurgery calls in southern Nevada, we also have an outreach program. I have five clinics outside of Las Vegas. I am on the staff of all hospitals outside of Las Vegas. When there is a neurological emergency, they call me. I bring those patients into Las Vegas, and none of that will change. I cannot practice without the general acute hospitals.
Chairman Rawson:
The language seems to minimize research. Will that still be a component?
Dr. Venger:
It will be a major component. We plan to go forward with the anatomy and teaching facility. Since our first hearing I have been contacted by representatives of companies that do not do neurosurgery. They are interested in utilizing the facility on a regional, national, and international basis. We are committed to research, and I will be happy to come back and report to the committee.
Chairman Rawson:
In general, how would this facility be accessed?
Dr. Venger:
The facility would generally be accessed through referrals.
Senator Mathews:
How many states have these kinds of hospitals?
Mr. Simmons:
All of the Western states and 15 states east of the Rocky Mountains allow these facilities.
Senator Nolan:
The Legislature is the only body able to grant an exemption to allow this type of facility. I believe the Legislature should have the ability to repeal an exemption if it is demonstrated the intent of the facility is not as presented. I am in favor of the concept before us and I feel it is a benefit to the community. I am sensitive to the issues the hospital association has raised. I feel it would be incumbent upon the committee to establish tests. When we grant these types of exemptions, facilities would be required to report patient outcome information, the average length of stay, average cost of stay, and the nature of complaints.
Chairman Rawson:
In response, we could have them report to the interim committee on health care. We need to evaluate this regularly. If we are opening up these kinds of exemptions, we want to be careful. I would like to establish a period of time to evaluate this before other exemptions are allowed. Four, five or six years might be reasonable.
Senator Nolan
That does help. I am thinking of 4 years if we are looking at 2 years to open the facility and 2 years to demonstrate. That would bring us to the session 4 years from now. We can see where they are after 2 years of operation.
Chairman Rawson:
Let us have the evaluation and go with 6 years as far as granting exemptions to more facilities. I am concerned about opening this wide.
Senator Nolan:
I would like to specify the statistics include the number of indigent patients and the referral sources.
Chairman Rawson:
There is a set of data we can ask for, including indigents served, overall patient information, and the affect this has on other hospitals. We will develop that through the interim committee.
SENATOR NOLAN MOVED TO AMEND AND DO PASS S.B. 156 WITH THE AMENDMENTS PROVIDED, AND AN AMENDMENT TO BE DEVELOPED BY STAFF TO INCLUDE LANGUAGE TO NOT GRANT ANY ADDITIONAL EXEMPTIONS FOR A PERIOD OF 6 YEARS, AND THE PROPONENTS OF THE PROJECT WILL REPORT BACK TO THE INTERIM COMMITTEE ON HEALTH CARE WITH THE STATISTICS STATED BY THE CHAIRMAN.
SENATOR NEAL SECONDED THE MOTION.
Senator Wiener:
Often we use our preamble to satisfy concerns and state our intent. Is there additional preamble language to address to establish what we hope to accomplish?
Chairman Rawson:
We might add one more “whereas.” It is important to have information on which to base future decisions.
Senator Washington:
I appreciate the concept of this bill. I am hesitant to jump on board yet because it does open up a caveat for others although there are safeguards within the bill. I am probably going to oppose the bill.
MOTION CARRIED. (SENATOR WASHINGTON VOTED NO.)
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Chairman Rawson:
We will open the hearing on S.B. 234.
SENATE BILL 234: Makes various changes concerning administrative due process hearings pursuant to Individuals with Disabilities Education Act. (BDR 34-452)
Mr. Sturm:
The proposed amendments for S.B. 234 are described on Exhibit E.
Senator Cegavske:
I felt compelled to give the department the opportunity to consider the changes for hearing officers based on their audit, since they have not given them the opportunity to do so. Additionally, the Individuals with Disabilities Education Act (IDEA) is being restructured. Officials are considering a 3-year statute of limitations in the federal law. I believe the suggested amendment to revise the bill as a whole, ((Exhibit E) is best at this time.
Chairman Rawson:
Are these amendments mutually exclusive? Can we repeal most of the bill and retain the 3-year statute of limitations?
Senator Cegavske:
Yes, we can retain the 3-year time period. If IDEA changes, it will override what we do.
Senator Neal:
Are we limiting the administrative due process hearing for individuals?
Senator Cegavske:
The district is asking for a 3-year statute of limitations, with a provision for an exception if the hearing officer decided it was pertinent to the situation.
Chairman Rawson:
What is the pleasure of the committee regarding the amendments?
SENATOR CEGAVSKE MOVED TO AMEND AND DO PASS AS AMENDED S.B. 234.
SENATOR NOLAN SECONDED THE MOTION.
Senator Neal:
What is the affect of revising the bill as a whole by deleting all sections?
Chairman Rawson:
I believe it effectively directs the Department of Education to do an agency study during the next 18 months, and report back to the Legislative Committee on Education.
THE MOTION CARRIED UNANIMOUSLY.
*****
Chairman Rawson:
We will open the hearing on S.B. 235.
SENATE BILL 235: Revises provisions governing payment of hospitals for treating disproportionate share of Medicaid patients, indigent patients or other low-income patients. (BDR 38-746)
Chairman Rawson:
There are amendments before the committee today (Exhibit F), and the bill will then have to be re-referred to the Senate Committee on Finance.
Mr. Sturm:
The first suggested amendment is a technical correction.
Chairman Rawson:
We have intergovernmental transfer and disproportionate share money that goes to various hospitals. Last session a formula was developed that sends the bulk of the money to University Medical Center. There was $1,500,000 to be divided between Lake Mead Hospital and Sunrise Hospital. There have been changes, and some rural hospitals have dropped out of the formula. We studied this issue in the interim, and came back with a new formula that would include the rural hospitals, but not at the expense of University Medical Center. The remaining private hospitals in southern Nevada would be placed in a separate group, and the money would be allocated. This bill would basically split the remaining money between Lake Mead Hospital and Sunrise Hospital. It would be divided two-thirds to Lake Mead Hospital and one-third to Sunrise Hospital. We do not know what the final amount will be.
Robert A. Ostrovsky, Lobbyist, Lake Mead Hospital (Tenet Health Care):
It is my understanding the ratio is five-sixths to Lake Mead Hospital and one‑sixth to Sunrise Hospital. That is a number Lake Mead Hospital is willing to accept. I do not know the dollar number. Under the previous formula, Sunrise Hospital would not receive any money. Approximately 40 percent of Lake Mead Hospital’s total business is for uncompensated care. I think the hospital is going to be sold; it is a hospital that is right on the brink of staying in business. We appreciate anything this committee can do to divert disproportionate share money to us.
Chairman Rawson:
As we worked with the consultants who developed the original formula, there was an attempt to fairly distribute the available money and to follow the patients receiving the care. I believe everyone agrees Lake Mead Hospital needs to be included or we are apt to lose them.
Lynn Fulstone, Lobbyist, Sunrise Hospital and Medical Center:
I appreciate the effort that has been made to include Sunrise Hospital and Medical Center. The hospital should be included because we provide the second highest amount of indigent and Medicaid care than any other hospital. We are hoping there will be some effort made to allow the money to follow the patient rather than basing it on the cost of care for 15 hospitals. Our concern is the formula based on cost of care could inadvertently reward hospitals that are not being as efficient as others. Ultimately, this could jeopardize the indigent and Medicaid patients.
Senator Neal:
Does Sunrise Hospital and Medical Center receive payment for their Medicaid patients?
Ms. Fulstone:
I believe that is correct. They also have a high percentage of uncompensated care.
Chairman Rawson:
Sunrise Hospital and Medical Center has a very large dollar volume of uncompensated care. It depends on how you want to look at it.
Denell Hahn, Lobbyist, Sunrise Hospital and Medical Center:
If you look at the amount of uncompensated care based on the cost of that care, Sunrise Hospital and Medical Center has a high percentage. We are an efficient hospital and those dollars purchase more care than an inefficient hospital with the same or higher dollars.
Michael R. Alastuey, Lobbyist, University Medical Center:
I just came from a hearing in the Assembly concerning Assembly Bill 297.
ASSEMBLY BILL 297: Revises provisions governing payment of hospitals for treating disproportionate share of Medicaid patients, indigent patients or other low-income patients. (BDR 38-885)
Mr. Alastuey:
The policy and financial concerns in putting together the possible amendments to S.B. 235 (Exhibit F) were derived after speaking with the consultant. Our approach was to hold University Medical Center harmless from the level expected this year, and try to maintain some level of pro-rata parity among the remaining hospitals. The result holds the State harmless at the level they are now receiving.
Chairman Rawson:
We need to re-refer this exempt bill to the Senate Committee on Finance. There is a fiscal implication. Do you agree we should go forward using amendments numbered 1 and 2 (Exhibit F) as a starting point?
Charles Duarte, Administrator, Division of Health Care Financing and Policy, Department of Human Resources:
We received a number of options, and concerns were pointed out. Moving this to finance is appropriate.
Chairman Rawson:
What would this amendment do to the Governor’s budget?
Mr. Alastuey:
The first year of the biennium I believe approximately $1,200,000, and in the second year approximately $1,000,000 would be added to the Governor’s budget.
Mr. Duarte:
Our concern would be the impact on the Governor’s budget and the intergovernmental transfer account. All of those funds are used to support Medicaid services throughout the State, and we would have to find a way to restore that.
Chairman Rawson:
The bill, as presented, is defective. We need to deal with the rural hospitals and to establish some basic formulas. With this amendment we will have a starting point in the Senate Committee on Finance.
Senator Cegavske:
I am looking at the amendments where we are striking “may” and inserting “shall.” Why are we strengthening the language?
Mr. Alastuey:
That language refers to adjustments made by the State agency if the amounts differ from those anticipated when the legislation passes. The language, as introduced, has permissive language that could permit, but not necessarily require, the adjustment. We wanted to make it prescriptive so the outcome would be known in all cases.
Chairman Rawson:
The formula would be the same but the dollars may be less.
Senator Cegavske:
The only way you would be able to make any changes if anything were to increase or decrease is to come back to the Legislature.
Mr. Alastuey:
The language contemplated a pro-rata adjustment if the amount were less. Recent experience indicates the amounts have been less than anticipated. Some authority for the administrator should be available to make proportional adjustments and assure the adjustment will be made.
Senator Cegavske:
Do we know the amount that will be paid to Sunrise Hospital and Medical Center?
Chairman Rawson:
The amount is approximately $900,000 to Lake Mead Hospital and $180,000 to Sunrise Hospital and Medical Center. Are there any major objections to using this as a starting point?
Ms. Fulstone:
We want it on the record that we hope new information received since the interim study would be considered in determining a starting point when attempting to come up with a formula.
Chairman Rawson:
Any subcommittee must have Mr. Duarte as a member, because there is a State responsibility.
SENATOR CEGAVSKE MOVED TO AMEND AND RE-REFER TO THE SENATE COMMITTEE ON FINANCE S.B. 235.
SENATOR WIENER SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR WASHINGTON WAS ABSENT FOR THE VOTE.)
*****
Chairman Rawson:
We will open the hearing on S.B. 383.
SENATE BILL 383: Makes various changes concerning reporting of child abuse. (BDR 38-194)
Mr. Sturm:
The proposed amendments provide that failure to report abuse in accordance with current law would lead to automatic forfeiture of a person’s professional license, and limit the scope to regular or long-term volunteers to distinguish from occasional volunteers.
Chairman Rawson:
Automatic forfeiture seems too strong. There has to be a process for taking away a person’s livelihood. There should also be a process to assure people in a position of responsibility meet that responsibility. Is it correct the bill also increases the penalty to a gross misdemeanor?
Mr. Sturm:
That is correct, it increases the penalty for not reporting from a misdemeanor to a gross misdemeanor.
Chairman Rawson:
A gross misdemeanor would mean jail time, and I believe it is too strong. If we process this bill, I believe it should be limited to employees only and cut back on the penalty.
Senator Neal:
I think we should process the bill; however, I believe taking away a person’s employment and a gross misdemeanor is too severe for not reporting abuse.
Chairman Rawson:
We have a proposed amendment which states “Any person who is employed by an entity that provides organized activities for children.”
Senator Nolan:
Volunteer organizations, regardless of whom they employ and in what capacity, working with other people’s children have a responsibility. I agree a gross misdemeanor is too harsh, but whether the position is full-time or part-time, at some point the organization has to spend time to explain to the individual their responsibilities. The supervisors should have the presence of mind to act upon apparent abuse.
Chairman Rawson:
Would the phrase “employed by” or “any person who is employed by an organization or is a supervisory volunteer” cover it? That would get it away from the casual Sunday school teacher who may be substituting occasionally, or the merit-badge counselor who may see a child one time.
Senator Nolan:
I agree with your intent, and maybe take it a step further, “any adult person who is employed … .”
Senator Washington:
If the bill is processed, the suggested amendment stating “any person who is employed by an entity that provides organized activities for children” would suffice. Most adults with any common sense would report suspected child abuse to their supervisor.
Chairman Rawson:
If we accept this amendment, it is a step forward and not a lot of unintended consequences. Senator Neal can you accept the amendment to state “any adult person who is employed”? It is a step forward and can be looked at again.
Senator Neal:
Yes, the amendment would be acceptable.
SENATOR NEAL MOVED TO AMEND AND DO PASS AS AMENDED S.B. 383.
SENATOR NOLAN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR WASHINGTON VOTED NO.)
*****
Chairman Rawson:
We will open the hearing on S.B. 386.
SENATE BILL 386: Revises provisions concerning visitation rights of patients of certain health care facilities and disposition of body of person upon death. (BDR 40-957)
The proposed amendments for the bill are described in Exhibit G.
Chairman Rawson:
We have revised the priority list of the person designated by advance directive to be in the same order on all forms.
Mr. Sturm:
The order of priority in sections 6 and 7 lists the person designated by the advance directive or affidavit first and spouse second in order.
Chairman Rawson:
The amendments are acceptable to Morgan R. Baumgartner and Lucille Lusk.
SENATOR MATHEWS MOVED TO AMEND AND DO PASS AS AMENDED S.B. 386.
SENATOR NOLAN SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
Senator Mathews:
I would like to see how the combining of S.B. 118 and S.B. 458 will look in writing.
Chairman Rawson:
We will bring it back to the committee as S.B. 458. Committee, there are four bills to be heard on Wednesday. We will stand adjourned at 4:07 p.m.
RESPECTFULLY SUBMITTED:
Cynthia Cook,
Committee Secretary
APPROVED BY:
Senator Raymond D. Rawson, Chairman
DATE: