MINUTES OF THE MEETING OF THE

LEGISLATIVE COMMISSION’S SUBCOMMITTEE TO

STUDY THE STATE PROGRAM FOR PROVIDING

SERVICES TO PERSONS WITH DISABILITIES

September 23, 2002

 

The minutes of the Legislative Commission’s Subcommittee to Study the State Program for Providing Services to Persons With Disabilities (created by S.C.R. 32 of the 71st Session), was called to order by Senator Dina Titus, Chairman, at 9:33 a.m. on September 23, 2002 at the Grant Sawyer Office Building, 555 East Washington Avenue, Room 4401, Las Vegas, Nevada, and via simultaneous video conference at the Legislative Building, 401 South Carson Street, Room 3137, Carson City, Nevada.  Exhibit A is the Meeting Notice and Agenda Packet; Exhibit B contains the Attendance Record.

 

COMMITTEE MEMBERS PRESENT IN LAS VEGAS:

 

            Senator Dina Titus, Chairman

            Senator Raymond D. Rawson

            Assemblywoman Vonne S. Chowning

            Assemblyman Jerry D. Claborn

 

COMMITTEE MEMBERS PRESENT IN CARSON CITY:

 

Senator Randolph J. Townsend

 

COMMITTEE MEMBERS EXCUSED:

 

            Assemblywoman Sharron E. Angle

 

LEGISLATIVE COUNSEL BUREAU STAFF PRESENT:

 

            Bob Guernsey, Principal Deputy Fiscal Analyst, Fiscal Division

            Jim Rodriguez, Program Analyst, Fiscal Division

            Leslie Hamner, Principal Deputy Legislative Counsel, Legal Division

            Carol Thomsen, Interim Secretary, Fiscal Division

 

EXHIBITS:

 

EXHIBIT A:            Meeting Notice and Agenda Packet.

EXHIBIT B:            Attendance Records.

EXHIBIT C:  Memorandum dated September 11, 2002 to Donny Loux, Coordinator, Nevada Task Force on Disability,  regarding the proposal for the Nevada 2-1-1 Information and Referral System.

EXHIBIT D:  Booklet entitled, “The Simplified Version.”

 

Chairman Titus announced that she would call the meeting to order; however, no action would be considered pending arrival of additional members for a majority of both houses.  She indicated the work session would be the final meeting of the subcommittee, and she thanked members for their hard work and input regarding a difficult, but very important, issue.  Chairman Titus also thanked Legislative Counsel Bureau (LCB) staff for their work, and Michael Willden, Director, Department of Human Resources (DHR), who had done an exemplary job in assisting the subcommittee, as well as members of the Nevada Task Force on Disability for their assistance to the subcommittee.

 

Chairman Titus said the subcommittee had been given a difficult task and had received a great deal of information regarding the complex issues at a time when resources were minimal and would continue to decline rather than grow.  The subcommittee would review recommendations regarding which issues could be addressed during the 2003 Legislative Session and which issues would be considered over the course of the ten-year plan. Chairman Titus believed that the subcommittee had made substantial progress, and she was glad that the Legislature had become a part of the study, as opposed to simply being an observer and receiving information after policy had been set. 

 

Chairman Titus advised that the subcommittee would hear general summaries from persons who had provided recommendations and would then review those recommendations, focusing first on the statements of intent and policy direction, which could be included in the subcommittee’s report.  The focus would then narrow to more specific issues that might require bill draft requests (BDRs) and, finally, the subcommittee would review those issues that would require funding, in an attempt to prioritize issues that might be funded during the 2003 Session and those which might be included in the long-range ten-year plan.

 

Approval of Minutes from the August 6, 2002 Meeting

 

After roll call, Chairman Titus called for a motion to approve the minutes of the August 6, 2002 meeting.

 

ASSEMBLYWOMAN CHOWNING MOVED TO APPROVE THE MINUTES OF THE AUGUST 6, 2002 MEETING OF THE LEGISLATIVE COMMISSION’S SUBCOMMITTEE TO STUDY THE STATE PROGRAM FOR PROVIDING SERVICES TO PERSONS WITH DISABILITIES.

 

ASSEMBLYMAN CLABORN SECONDED THE MOTION.

 

THE MOTION CARRIED. (Senators Rawson and Townsend and Assemblywoman Angle were not present for the vote.)

 

Work Session – Discussion and Action on Recommendations

 

Chairman Titus invited Mr. Willden, Director of the Department of Human Resources (DHR) to address the subcommittee.  Mr. Willden said he would provide general comments regarding the process and discuss recommendations from the department.  He thanked those persons who had worked toward completion of the Nevada Strategic Plan for People with Disabilities, which would dovetail with the subcommittee’s work.  Mr. Willden asked that the subcommittee keep in mind that the strategic plan was not solely his work, but was a combined work, with tremendous effort put forth by many people.  During the public hearing process, over 400 people had attended, testified, or otherwise taken part in the plan development.  Mr. Willden recalled that he had informed the subcommittee at a previous meeting that DHR had encountered difficulty with the original contractor during the process, and he was very proud of the work completed by the team composed of staff from DHR, the Department of Employment, Training and Rehabilitation (DETR), the Office of Community Based Services (OCBS), the contractors, and the many people who put in long hours and hard work in an effort to produce the final product.

 

According to Mr. Willden, the strategic plan was not yet final, and the record would be left open for an additional two weeks for possible further testimony and input, along with fine-tuning.  He indicated that no additional work needed to be done, but rather it would be left open for review of issues toward final editing.  Mr. Willden indicated the document should go to print prior to October 11, 2002, and DHR would distribute the final plan.

 

Mr. Willden explained the strategic plan would dovetail with the other plans DHR had been working on, i.e., the plan for seniors; the work on disabilities; the plan on rural issues; and the review of number of rates. 

 

Mr. Willden indicated he would present portions of the plan containing pertinent information for the subcommittee's consideration. The study contained many recommendations based on a number of findings from the Task Force, which were pared down to 77 findings and recommendations from the over 250 that were presented.  Mr. Willden referenced a piece in the plan that was extremely important, which was the way the plan related to the Olmstead U.S. Supreme Court decision. The DHR had contracted with Tony Records, president of Tony Records and Associates, a human services consulting firm, as the Olmstead consultant; Mr. Willden believed he was a very valuable resource to Nevada and the entire disability issue. 

 

Mr. Willden advised that the strategic plan contained several hundred pages, which described the existing Nevada service delivery system and covered the areas of responsibility for state agencies, non-profit groups within counties, and various other agencies.  Also contained in the plan were examples of how people with disabilities were impacted by the state’s policy decisions. Mr. Willden indicated the plan contained the fiscal impact of the recommendations, which would be an area of focus, and delineated the costs associated with those recommendations.  He reminded the subcommittee that the cost estimates associated with the recommendations would need to be fine-tuned, but they would provide a good starting point for future estimates. 

 

Mr. Willden referenced the September 17, 2002 letter from DHR to Chairman Titus regarding the department’s priorities, as contained in Exhibit A, Tab Vb, page 85. The first recommendation of note was to recognize the Nevada Strategic Plan for People With Disabilities as Nevada’s Olmstead plan.  There might be those who disagreed with the request to recognize the strategic plan as the Olmstead plan, and Mr. Willden pointed out that he was certainly not an expert regarding the Olmstead decision.  Nine representatives from the state of Nevada had recently attended the National Conference of State Legislatures (NCSL) session entitled, “The Olmstead Decision: Moving Forward with Implementations,” in Naples, Florida, September 13‑15, 2002.  Mr. Willden had been unable to attend; however, Bob Guernsey, Deputy Fiscal Analyst, LCB, and Senator Townsend had been members of the Nevada delegation to that conference.  The finding of that group was that Nevada needed to create an Olmstead plan, which should be contained within one document.  Mr. Willden believed the strategic plan would comply with that finding, and Mr. Records also felt the plan captured the essence of what should be done to comply with Olmstead requirements.  Obviously, stated Mr. Willden, Nevada needed to work on several areas, including waiting lists and people with disabilities who resided in institutional settings that should be moved into the community.  Mr. Willden reiterated that he believed the strategic plan could serve as Nevada’s Olmstead plan.

 

Mr. Willden advised that his second recommendation would be adoption of the 2‑1‑1 access line, or No Wrong Door system, which encompassed a number of things.   He referenced the memorandum of September 11, 2002 to Donny Loux, Coordinator of the Nevada Task Force on Disability from the United Way (Exhibit C), which explained the program.  Mr. Willden explained the 2-1-1 national abbreviated dialing code was the first component of the plan, and it would enable persons with disabilities to access the system on a “hassle‑free” basis.  Individuals could dial 2-1-1 for free access to health and human services information and referral services.  Mr. Willden explained that along with the phone system, the second component to the program would be the ability to access information on available services via the Web.  Disabled individuals could utilize computers in their homes, which would be an excellent resource through which to access services.  According to Mr. Willden, the third component of the program would be to physically prepare DHR to answer all inquiries and provide accurate direction to individuals needing services.  The fourth component would encompass a cultural change process that would require DHR to train its staff to recognize that when an individual presented himself for services, assistance would be offered by trained staff prepared to provide the specific needs of the disabled.  Mr. Willden noted that a recommendation to adopt the 2‑1‑1 system would encompass a great deal of work that was yet to be done.

 

Continuing, Mr. Willden said the next general recommendation was to establish an Office of Disability Services within DHR.  He believed it was extremely important for DHR to review its organization as it moved forward with the strategic plan.  There were two departments within state government that addressed disability issues, primarily DHR and DETR, in addition to the Governor’s Office of Consumer Health Assistance.  Mr. Willden reiterated that he believed organizational change was needed in preparation of providing services to persons with disabilities. 

 

Mr. Willden said his recommendations to the Governor would stipulate that if a service was not employment-related, it should fall under the auspices of DHR.  The initiation of the 2-1-1 No Wrong Door program could be better addressed if services were organized within one department.  Mr. Willden believed that the program would provide a long-term opportunity to review divisions within the department and to better organize how services were provided to disabled persons.  For example, the Aging Services Division provided services to seniors with disabilities; similarly, the Office of Medicaid Services, DHR Community Connections, and programs available through the Health Division all played a significant role in the delivery of services to seniors with disabilities. 

 

Recommendations from the Task Force included additional staff that might be needed, i.e., an ombudsman for persons with disabilities and a cabinet-level position.  Mr. Willden said he was unsure whether the cabinet-level position would be necessary.  While he understood the recommendation and need to make a high-priority or high‑visibility office to ensure that goals were met, if offices were organized within DHR and remained committed to the issues, the department could handle the job.

 

Mr. Willden said the next component would address adequate funding for waiting lists, which was a significant order of business throughout the strategic plan, specifically in the financial sections.  The strategic plan identified a number of waiting lists where funding would be needed to ensure that the lists moved in a timely manner.  Mr. Willden explained that the goal should be 90 days, which was a basic requirement of the Olmstead decision as a reasonable time on waiting lists, and the state should strive to at least meet that requirement. 

 

Mr. Willden added that full implementation of S.B. 174, the Nevada Personal Assistance Services Act passed by the 2001 Legislature, would address personal assistance services and specifically target individuals with severe needs.

 

Continuing, Mr. Willden said the next component would be continued involvement of persons with disabilities in the policy development process.  There were many individuals committed to making the important changes that were needed, and Mr. Willden felt those persons should continue to be involved in the process. 

 

The final component was data collection, which was not unique to DHR.  Mr. Willden said the department simply did not have sufficient data, and the reliability of the data systems was often in doubt, including how persons were counted on a waiting list, and the fact that persons who might require more than one service were often removed from the list after one service was provided.  Mr. Willden emphasized that an information system that would accurately collect data was needed, which was a common request throughout the helping organizations within the state.  The fiscal notes delineated the methods that might be used to construct such a system, possibly starting with a feasibility study over the next biennium to determine how the current systems were operating, where gaps occurred, and how to move forward with a system to collect the needed data.  Mr. Willden stated that those were the recommendations from DHR and that the Task Force would be making additional recommendations.

 

Chairman Titus instructed members of the subcommittee to number the recommendations delineated under Tab Vb, Exhibit A, in order to clarify the six recommendations for voting purposes, as follows:

 

Page 85, Exhibit A:

 

1.      The recognition by the Legislature of the Nevada Strategic Plan for People with Disabilities as Nevada’s Olmstead plan. 

2.      The adoption of a 2-1-1 access line/No Wrong Door program.

 

Page 86, Exhibit A:

 

3.      The establishment of an Office of Disability Services within the Department of Human Resources.

4.      Adequate and continued funding to reduce waiting lists and provide necessary waivers.

5.      Involvement of persons with disabilities in policy development and program monitoring.

6.      Ongoing collection of data.

 

Approval of Minutes from the August 6, 2002 Meeting

 

Chairman Titus noted that the subcommittee now constituted a quorum, and she asked for a second motion to approve the minutes of the August 6, 2002 meeting.

 

ASSEMBLYWOMAN CHOWNING MOVED TO APPROVE THE MINUTES OF THE AUGUST 6, 2002 MEETING OF THE LEGISLATIVE COMMISSION’S SUBCOMMITTEE TO STUDY THE STATE PROGRAM FOR PROVIDING SERVICES TO PERSONS WITH DISABILITIES.

 

ASSEMBLYMAN CLABORN SECONDED THE MOTION.

 

THE MOTION CARRIED. 

 

Work Session – Discussion and Action on Recommendations (Continued)

 

In continuance of the work session, Chairman Titus asked representatives of the Nevada Task Force on Disability to come forward and address the subcommittee regarding the Task Force recommendations.  Donny Loux, Rehabilitation Chief, Department of Employment, Training and Rehabilitation (DETR) and coordinator of the Task Force, introduced Thomas B. Pierce, PhD., Special Education Department Chair, College of Education, University of Nevada Las Vegas (UNLV), who would present a brief overview of the goals and recommendations that would require legislative action in the form of bill draft requests, resolutions, or appropriations.  Ms. Loux explained that some of the figures contained in the draft provided to the subcommittee under Tab Va, Exhibit A, were incorrect and would be corrected.  Ms. Loux indicated that recommendations for the special segment of children’s goals, previously reviewed by the subcommittee, were not all contained in the recommendations, as many would require Executive Branch legislation.  She asked members to keep those goals in mind during the upcoming legislative session, as they were very important to families and children with disabilities.

 

Dr. Pierce indicated he would provide a brief overview regarding the mission and reason for the Task Force, its goals, and exemplary strategies that met those particular goals.  While there were 77 goals in total from the original 275 goals, Dr. Pierce explained the Task Force had tried to incorporate as many of the goals, objectives, and strategies as possible and still be responsible to the state.  The plan for persons with disabilities focused on four major purposes:

 

1.      Assure the availability and accessibility of a continuum of services that would appropriately meet the basic needs of people with disabilities in Nevada including, without limitation, people with autism.

2.      Support the ability of people with disabilities in Nevada to lead independent and active lives within their community in accordance with the plan.

3.      Continue the effort of the state of Nevada to provide community-based services that match the need of the client and provide choices among appropriate services.

4.      Ensure that people with disabilities in Nevada received the services they were entitled to receive pursuant to state and federal statute, and case law.

 

Dr. Pierce stated that by way of background, in 1999 people with disabilities and their advocates provided testimony before the Legislative Interim Committee on Health Care about the need to develop a statewide Olmstead plan.  After the publication of the U.S. Supreme Court’s decision in 2000, states learned that they would be required to provide community-based services for people with disabilities who would otherwise be institutionalized.  Dr. Pierce went on to say that in 2001, the Nevada Legislature appropriated $150,000 to develop a long-term strategic plan.  The Task Force on Disability was charged with developing the strategic plan for people with disabilities and creation of a plan that would meet the five principles of the Olmstead decision:

 

1.      Stakeholder partnerships, which would assist people with disabilities to remain in the community without unnecessary institutionalization.

2.      Provide comprehensive assessment and planning that would prevent institutionalization, and if an individual were institutionalized, that setting neutral assessments would be completed.

3.      Promote community capacity or build the supports needed in the community to assist individuals to remain in the community.

4.      Information and choice would provide for up-to-date, accurate information regarding services available in the community and provide efficacy to utilize those services.

5.      Quality assurance and infrastructure would provide quality community environments to prevent unnecessary institutionalization.

 

Dr. Pierce further apprised the subcommittee that throughout the plan submitted by the Task Force, all five of those principles had been met.

 

Chairman Titus inquired whether Dr. Pierce agreed with Mr. Records, the Olmstead consultant, that the strategic plan would meet the requirements of Olmstead, and Nevada would not need an additional plan to address those needs.  Dr. Pierce replied that he believed those conditions would be met by the plan.

 

Continuing, Dr. Pierce reported that in addition to the principles that were embedded throughout the plan, Task Force members had received specific training from Mr. Records, the national expert and consultant to the Office of Civil Rights for the past two years on issues surrounding Olmstead.  The Task Force assigned a special technical assistance group to issues surrounding Olmstead.  According to Dr. Pierce, those activities were done to keep the Task Force’s focus on meeting Olmstead guidelines. 

 

Dr. Pierce indicated the Task Force would recommend nine major goals with 77 strategies to meet those goals, and he explained that his review of the goals would not include a discussion of strategies because of time constraints.  Dr. Pierce stated he would provide information regarding one or two exemplary strategies.  Included in the appendix of the Nevada Strategic Plan for People with Disabilities would be all of the recommendations developed by the Task Force over the past year.

 

Dr. Pierce proceeded with an explanation of the goals:

 

Goal One:

 

The first goal addressed social policy, program structure, regulations and planning to affect the lives of children and adults with disabilities.  The goal set the stage to increase and sustain involvement and representation of people with disabilities on policy boards, commissions, and policy-making bodies.  The Task Force believed that a procedure should be developed by which under-represented or under-served populations would have the opportunity to develop strategies of inclusive participation. 

 

The goal recommended that all state agencies providing disability services should regularly consult with adults with disabilities and their families, and that those persons should be critically involved in all policy making, which included persons in rural areas and those living on reservations, whenever budgets were being planned, and in the development of services or policy technology.  Formulating policies that affected children and adults with disabilities in state and county agencies should be guided by respect for the Indian tribal self-government and its sovereignty.  The Task Force believed a Native American summit should be conducted, with a follow-up session of tribal and state government leaders to explore and implement mutually effective communication policy planning and service delivery strategies.

 

Goal Two: 

 

The second goal addressed service provision to people with disabilities in the most integrated and appropriate settings to assure the application and resulting service plans were individualized, set neutral assessments, and expedited service entry.  The goal focused on neutral setting assessments through collaborative interagency efforts to provide services for individuals rather than what was available at the setting in which they currently received services.  For example, in the field of special education, there might be a school that indicated a child probably needed speech therapy, but no therapist was available at the school, so that child was not recommended for speech therapy.  Another example would be a person living in a nursing home who needed mobility training, or a deaf interpreter, and if there was not a qualified person available, the service tended not to be recommended.  Setting neutral assessments would address those problems. 

 

The strategies included in the goal required detailed and specific discharge planning, targeted service coordination, and transition services.  In addition to setting neutral assessments, the goal emphasized that children and adults with disabilities be provided services in the most integrated setting, and in the most efficient manner.  Bringing Nevadans home from out-of-state placements; providing access to urgently needed medical services for children and adults; and providing outsource local outreach units for veterans, homeless people, people with mental illness, and families in crisis were all strategies that were developed under goal two. 

 

The Task Force believed that persons in institutional care who could be served in the community needed to be identified and transferred from the institutional environment back into the community.  In order to accomplish that goal, the following would need to be initiated:

 

1.            Develop assessment grants similar to the Centers on Independent Living to evaluate current community placements.

2.   Train nursing home staff, so that staff would be familiar with services that were available in the community.

3.   Provide comprehensive case management services.

4.   Provide start-up funds to individuals leaving institutions for the most basic necessities, such as buying pots and pans, providing first and last month's rent, and security deposits.

5.            Develop a rider program to the Medicaid budget based on the Texas model, which was a “money follows the person” pilot program.

6.   Track results for large-scale implementation.

 

Goal Three:

 

Goal three was adopted to ensure that children and adults with disabilities of all ages receive services expeditiously and in the most integrated environment.  There are currently over 2,000 individuals with disabilities on various waiting lists in Nevada.  The Task Force discovered through its research that 2,000 was a very conservative number.  The Task Force believed the number might be significantly higher because some service providers did not maintain waiting lists.  Goal three sought to remedy the lengthy waiting list game by requiring that a 90‑day limit be instituted for those services that were critically needed to remain in an integrated or independent setting.  The Task Force was impressed by testimony and by data collected of the critical need for respite, personal assistance, and medical services for children.  Most notable were issues that surrounded children and adults in need of critical medical services, immediate mental health intervention, and family crisis intervention. It was found that there were critical training needs for parents and professionals in positive behavioral supports to avoid unnecessary institutionalization.  Strategies included ensuring waiting lists of not more than 90 days, and training for at least 1,500 families in positive behavioral support networks to avoid institutional placement of children.

 

Goal Four:

 

This goal addressed the issue of children and adults with unique needs obtaining services in a timely and appropriate manner.  The Task Force heard testimony on the ineffectiveness of para-transit systems, as well as a lack of qualified individuals training for mobility specialists.  In addition, there were coordination problems within the deaf community because of the lack of statewide coordination and the lack of deaf interpreter training sites.  Nevada had begun a positive step toward development of personal assistance services to allow persons to remain independent.  The Task Force heard testimony on the lack of training that occurred for personal assistance to people with autism and other low-incidence disabilities.  The Task Force recommended that the waiver programs be expanded to include a cognitive impairment waiver to include people with autism, brain injury, and other pervasive developmental disabilities. 

 

Goal Five:

 

The purpose of goal five was to decrease the risk of disability institutionalization in the general disability population by improving and protecting critical health care needs.  Training was needed for families and other primary caregivers to support individuals with disabilities.  Monitoring and reporting to the Legislative Committee on Children, Youth and Families of special education self-improvement plans under IDEA, Parts B and C, and under the Department of Education’s Project IMPRV were required.  Because of the unique needs of some individuals with disabilities, development of a fast-track system for individuals with terminal illness would be required and necessary. 

 

Goal Six:

 

Goal six addressed children and adults with disabilities not being placed at the risk of institutionalization while living independently.  The Task Force had raised issues about obtaining reliable information from state, local, and non-profit agencies, and believed development of a 2‑1-1 universal access line would be a positive solution for up-to-date and accurate information on services such as support networks and life planning.  That system would support the No Wrong Door concept.  The establishment of an Office of Disability Services based on the New Jersey model was one of the cornerstones of the plan.  The program would support a single point of entry for individuals who were not eligible to meet the requirements of disability-specific programs.  One of the primary responsibilities of the program would be to provide statewide coordination of agencies and counties, including a housing coordinator at the state level.  The Office of Disability Services would serve as a liaison for the 2-1-1 access line, act as a clearinghouse on information and issues, and review the community capacity section of the Olmstead plan. 

 

Goal Seven:

 

People with disabilities and families of children with disabilities would knowledgeably and appropriately choose and direct their services.  Inherent throughout the plan was the conceptual framework of individuals directing their services to support self‑empowerment.  Consumer-directed planning, training family members to support transition from school-to-work options, and development of infrastructure to support post‑secondary education activities, were all critical elements to promote consumer choice.  One such example of supporting self-empowerment activities was the notion of a family micro-board, which would act as an individual’s board of directors to provide information from which the individual could make decisions, act as a circle of support, achieve individual goals and preferences, and support the enhancement of a quality to one’s life. 

 


Goal Eight:

 

Goal eight addressed the state’s system of service delivery in long-term care in order to  manage and monitor services so they would be provided in the most integrated setting possible.  The Task Force heard testimony from numerous sources on the isolationism of disability policies, i.e., one disability might have one policy while another might have no policy.  The goal would support the notion of development of statewide coordination of supported living arrangements across disability categories.  The Task Force noted that some individuals with severe disabilities were in desperate need of critical services, but were not eligible for those services because of income eligibility requirements.  One of the most troubling aspects of development of the plan was the lack of coordinating data systems that reviewed, collected, or reported accurate data.  There was no systematic policy on development of a common data set by which accurate information could be collected, reported or analyzed.  The Task Force recommended two studies on agency outsourcing and data system review be conducted.

 

Goal Nine:

 

Goal nine dealt with issues associated with providing independent in-state monitoring and mediation of Olmstead, and the Americans with Disabilities Act (ADA).  The implementation of many of the items in the plan, as well as the services provided to people with disabilities, required effective and routine monitoring.  The Task Force recommended that a disability ombudsman position be created to serve and protect the rights of low-income persons with disabilities and uphold rights under the ADA.  Establishment of a cabinet-level position to coordinate planning across systems, agencies, and disability populations; monitoring implementation of strategic planning goals; and ensuring compliance with Olmstead and the ADA were desperately needed.  The Task Force noted that when there had been some coordination of disability policy through the state, it had depended on the director of DHR, a position which held a great deal of power and influence with regard to disability policy.  That was the reason the Task Force requested establishment of a cabinet-level position. 

 

Dr. Pierce concluded his report to the subcommittee, saying he would be glad to answer questions. 

 

Chairman Titus advised that the list of recommendations for the subcommittee’s consideration, contained in Exhibit A, Tab Va, had been derived from the nine goals reviewed by Dr. Pierce.  She instructed members to number those recommendations in order to simplify the voting process, as follows:

 

Page 43, Exhibit A:

 

1.      Establish, by legislative resolution to be renewed by every succeeding session of the legislature, that general legislative initiatives impacting children and adults with disabilities include consideration of the potential effects such legislation may have on their lives and access to services.   

2.      Develop a rider to Medicaid budgets based on the Texas model concept that “money follows the person.”

3.      Assure all eligible at-risk children and adults quickly receive the assessments and Medicaid services they need through a single eligibility application for SSI and Medicaid. 

4.      Implement a statewide system of outsourced mobile units to be used for outreach, assessment and referral of children and adults with disabilities who are homeless and in crisis.

5.      Require examination and reporting of the impacts and cost savings of assessments provided during the biennium to each session of the legislature.

6.      Ensure waiting lists for services critical to community integration and avoidance of segregated service environments move at a reasonable pace, not to exceed 90 days.  Those services are identified as medication clinics and treatment for mental illness, Home and Community Based Services (HCBS) waivers, and personal assistance.

7.      Provide a continuous allotment, through the 10 percent disability designation of Tobacco Settlement Funds, to: ensure families providing primary care to a severely disabled family member receive respite-care services within 90 days of filing an application; provide permanent funding for the state’s Positive Behavioral Supports Network at a level that, at a minimum, will support adequate training and service delivery to 1,500 families with children with autism and brain injury and others in need of such interventions; and provide home and environmental modifications to allow community access and/or return from institutional care.

 

Page 44, Exhibit A:

 

8.      Require monitoring and reporting to each session of the legislature of the status of county-paid nursing facility residents to ensure that people eligible for Medicaid services by virtue of being institutionalized and having their care paid with 50 percent county match monies, will be assured equal opportunity for services paid with 100 percent state funds should they choose to live in the community.

9.      Fully implement the provisions of Senate Bill 174, the Nevada Personal Assistance Services Act, for efficacy in avoiding unnecessary enter into, and transfer from, skilled nursing facilities.

10.  Draft and support legislation allowing state funds allocated to the personal assistance programs administered by Aging Services and the Office of Community Based Services to be carried over into the next fiscal year so funding is not lost due to unanticipated hospitalization.

11.  Provide training within personal assistance programs to ensure people with autism, other pervasive developmental disabilities and brain injury (who have a high need for a consistent and predictable environment) will obtain caregivers who understand and are trained in their individual particular characteristics and needs.

12.  Develop a Medicaid HCBS Cognitive Impairment Waiver to assure delivery of the complex and costly array of behavioral services needed by people with brain injury, autism, and other pervasive developmental disabilities and mental illness for their unique behavioral and independent living needs.

13.  Continually expand Nevada’s Medicaid Buy-In Program to equitably provide, by 2008, medical insurance coverage or wraparound to all people with disabilities who, by virtue of becoming employed, have established an income above poverty level, but cannot obtain the health care coverage and services required to terminate reliance on public benefits

14.  Expand funding to the Homeless Mentally Ill Outreach initiative (H.O.P.E. – Homeless Outreach Pilot Education) program to implement ongoing programs providing intensive outreach and case management services, including immediate access to necessary medications and housing.

15.  Establish, by legislative resolution, that effective July 2003, critical health, mental health, nutrition and personal assistance services to children and adults with disabilities, poor children and frail seniors are exempted from budget cutting during economic downturns.

16.  Ensure appropriate provider rates for personal assistance are established, adopted by the Nevada Legislature and implemented for all state programs.

17.  Require annual monitoring and reporting to the Legislative Committee on Children and Families of progress on Project IMPRV, Self Improvement Plans, IDEA Parts B and C.

 

Page 45, Exhibit A:

 

18.  In collaboration with Nevada counties and United Way organizations, establish and fund a 2-1-1 universal access line with a supplementary No Wrong Door website and community-level call centers providing information, referral and resolution assistance for people with disabilities and their families.

19.  Establish a State Office of Disability Services within the Department of Human Resources at the director’s level, based on the New Jersey model.

20.  Develop regulatory change and implement course work leading to an AA degree in Independent Living at the community college and/or university level, which would allow people with mental retardation, pervasive developmental and cognitive disabilities to earn such degrees while benefiting from campus learning experiences that will better prepare them for a life of integration and inclusion.

Provide through legislative resolution:

21.  That budget planning, decision-making and rate setting for one or more disability populations or services do not occur in isolation of the others, e.g., supported living arrangements for people with mental retardation vs. those with brain injury/autism, personal assistance for those with physical disabilities vs. those with mental illness, autism, mental retardation. 

22.  That legislative budget requests and forecasting recognize and include the needs of people with severe disabilities and their families who have incomes above Medicaid limits but are unable to afford the critical personal assistance, respite, health care, environmental modifications and medications needed to avoid family disruption, impoverishment, exacerbation of disability and institutionalization.

Develop legislative bill draft requests to:

23.  Implement a legislative interim study to review, evaluate and recommend improvements in state services and ensure state data systems provide consistent cross-agency information.  This information would provide meaningful client‑specific service outcomes needed for decision-making, planning, budgeting, tracking and monitoring costs and outcomes of disability services provided.

24.   Conduct an independent study to determine which state agency services should be outsourced.  Outsourcing would occur through a community grants and voucher system in which all direct services, care and case coordination to non-profit and private entities, would strengthen and add independence to planning, coordination and quality assurance functions at the state level.

25.  Add responsibility for assessing the quality, effectiveness and/or need for policy/systems change in long-term care and service delivery to adults and seniors with disabilities to the Legislative Committee on Children, Youth and Families. (NRS 439B.200)

 

Page 46, Exhibit A:

 

26.  Add responsibility for assessing the quality, effectiveness and/or need for policy/systems change in long-term care and services to children with disabilities and their families to the Legislative Committee on Children, Youth and Families.

27.  Utilize the State Disability Consortium to develop and implement uniform statewide quality assurance measures in all state programs serving people with disabilities to evaluate and report impact, outcome, and consumer satisfaction; consistently solicit consumer perspectives for program improvements; and assure service provision in the most integrated setting appropriate to the individual in need.  Report biennium outcomes to Legislative Committees on Health Care and Children, Youth and Families.

28.  Establish a cabinet-level position to coordinate planning across systems, agencies and disability populations.  The position would monitor the implementation of strategic planning goals; ensure compliance with provisions of Olmstead and the ADA; oversee the development of a comprehensive, cross-agency data system; and assure coordination of state and county resources.

29.  Establish an independent, community-based, Disability Ombudsman within one or more legal service entities qualified to receive legal filing fees under NRS 19.031.  As an action of last resort, the Ombudsman would be responsible for mediating “integrated settings issues” related to provisions of the Olmstead decision, the Americans with Disabilities Act (ADA), and the Individuals with Disabilities Education Act (IDEA).

30.  Support passage of legislation to include ADA accessibility guidelines within the State Building Code.

31.  Identify and transfer people in institutional care who can be served in the community and who do not oppose such transfer.

32.  Ensure waiting lists for medically necessary services to children with disabilities move at a reasonable pace.

 

Ms. Loux informed the subcommittee that Jon Sasser and Paul Gowins, who provided Olmstead technical assistance to the Task Force, were present at the Carson City location and would like to address the subcommittee. 

 

Senator Rawson inquired whether the blind were included in the Task Force recommendations, or if the needs of that disability category would be considered separately.  Dr. Pierce replied that all persons with sensory disabilities, both visual and hearing impairments, were included.  Senator Rawson asked whether the medical malpractice crisis in southern Nevada had impacted access for disabled persons, and if that was an issue for consideration by the subcommittee. 

 

Ms. Loux pointed out that one recommendation that had not been included in the material before the subcommittee, but was contained in the Executive Branch package, was the establishment of a single point of entry for physicians providing basic health and dental care needs.  She noted that the Task Force had heard testimony on several occasions, not so much regarding medical malpractice, but rather on the fact that people with disabilities had two major issues: (1) Those persons could not get physicians and dentists to accept Medicaid cards; and (2) Even when a card was accepted or the person was paying for the service, it was difficult to find physicians and dentists who understood the needs of the disabled and could provide the specialty care required by those persons. 

 

According to Ms. Loux, often when a physician or dentist was located who would accept Medicaid, they were not prepared to treat the disabled person for a variety of reasons.  In assembling the plan, the Task Force had been in contact with the Federally Qualified Health Centers (FQHCs), which had seven dental chairs in Reno and a health clinic that was acutely aware of persons with disabilities.  She understood that other FQHCs were very interested in working on those issues, and the Task Force recommended that the dental school and tribal clinics work with the FQHCs in creation of a single point of entry concept throughout the state for basic health and dental services.  Ms. Loux noted it was also recommended that the state review the reimbursement rate to physicians and dentists.     

 

Senator Rawson questioned whether the subcommittee would need to take action to facilitate the recommendation for creation of single point of entry.  Ms. Loux explained that because of the problem DHR experienced with the original contractor, the Task Force could suggest that the state fund one position that would commence working with the dental school, FQHCs, and tribal clinics to devise a plan to present to the Legislature regarding how the single point of entry concept could be implemented.  Ms. Loux stated the Task Force had also discussed the creation of centers for excellence in service to disabilities with the FQHCs, which seemed receptive to that idea.  Because the Development Disabilities Council had funded a position that worked with the issues of dental care for low-income persons with disabilities, and because that funding would soon cease to exist as the council was not allowed to fund ongoing services, the Task Force believed the first step would be to accept the council's proposal to fund a full-time position over the next two years to create a plan for presentation to the 2005 Legislature. 

 

Senator Rawson reported that he served on a homeless task force and wondered about the dual responsibility, i.e., how many disabled persons were homeless, and was that a significant issue?  Ms. Loux replied that was a major issue, and the UNLV survey of persons who were homeless in the Las Vegas area included a section regarding both physically and mentally disabled persons.  The Task Force was surprised to find that an estimated 25 percent of the persons surveyed had a physical disability, and 17 percent indicated they had been diagnosed with a mental illness.  The Task Force had been advised that there were many more undiagnosed mentally ill persons, or those who had suffered traumatic brain injuries, among the homeless population. 

 

Ms. Loux stated two major goals for homelessness were brought forward by the Task Force, the first being mobile outreach vans in Reno and Las Vegas for both the mentally ill and physically disabled.  The Task Force had discovered that clothes were not as problematic; however, shoes were difficult to obtain and were a precious commodity among the homeless community.  The idea of the mobile vans had come about as a recommendation for the mentally ill, and the Task Force wanted to build on that recommendation so that issues such as assessments for assisted technology for people in need of a new prosthesis, diagnosis for brain injury, etc. might be coordinated within the mobile van concept. 

 

The second issue, explained Ms. Loux, was the recommendation to build on the Homeless Mentally Ill Outreach Initiative via the Homeless Outreach Pilot Education (H.O.P.E.) program, which was a highly successful program.       

 

Chairman Titus felt Senator Rawson’s questions and Ms. Loux’s answers illustrated just how large and ongoing the problem was, and perhaps that would be one argument for the recommendation to continue the subcommittee over the next interim to hone in on some of the more specific problems that had been unearthed in the initial study.  The Chair recognized Mr. Sasser and Mr. Gowins in Carson City.

 

Mr. Gowins stated he had acted as chairman of the Olmstead Technical Assistance Committee and was present to speak on the committee’s behalf.  Mr. Gowins noted that he had observed the development of the Olmstead decision from the time the case was filed in 1997, to the time the law came about.  He and other members of the disabled community had approached the former director of DHR regarding Olmstead prior to the 1999 Legislature, knowing that it would be an issue that should be addressed.  The advocates were very unhappy to learn that Olmstead planning would be done through the budgetary process, which they believed was unsatisfactory.  The importance of the Olmstead decision was one of the reasons for development of the strategic plan.

 

According to Mr. Gowins, it was understood that Olmstead would be addressed within the strategic plan, which was not a small issue by any means, but the Task Force did not want to limit the plan to one issue when discussing a ten-year time frame.  However, Olmstead was embedded throughout the plan, and Mr. Gowins stated that Mr. Records had accurately indicated that if the state followed the strategic plan, it would meet the Olmstead obligations, particularly in the area of waiting lists and other issues that would take some courage and funding to address. 

 

Mr. Sasser, Washoe Legal Services, stated he would provide information and answer questions from the subcommittee in terms of the ongoing analysis of the Nevada Strategic Plan for People with Disabilities and how it would comply with the state’s obligations under Olmstead.  Mr. Sasser noted that Mr. Gowins chaired the Technical Advisory Group, which consisted of a broad group that included attorneys from LCB, the Deputy Attorney General that represented DHR, attorneys from the advocacy community, Washoe and Clark County Legal Services, and other advocates from within the community.  Mr. Sasser explained the group was given the opportunity to offer input to the various subcommittees that compiled the strategic plan, to advise regarding the legal requirements of Olmstead, and to ensure that each focused on delivery of services in the most integrated setting, as required by the ADA.  The Technical Advisory Group was quite pleased that Tony Records was brought in as a consultant, as he had worked with 18 different states and the Office of Civil Rights in establishment of Olmstead plans for those states.  Mr. Sasser stated that the advisory group felt Nevada required that level of expertise and assistance to ensure that the job was done correctly.      

Mr. Sasser referred to Tab Va, page 63 of Exhibit A, a memorandum from Tony Records to Brian Lahren, Chairman of the Task Force, regarding the strategic plan and its compliance with the requirements of the Olmstead decision   Mr. Records had conducted an independent assessment of Nevada's current policy regarding institutionalization of persons with disabilities, and community alternatives.  Mr. Records had reviewed the various components of a comprehensive Olmstead plan that had been developed by the Office of Civil Rights, which included plan accountability, involvement of stakeholders, baseline information and assessment process, transition support, review of community capacity, budget and infrastructure information, and quality assurance.  Mr. Sasser said that Mr. Records had determined that the plan contained all the components necessary for a viable Olmstead plan.  Mr. Sasser pointed out that a plan was only a plan, and until it was implemented and funded by the state, it would continue to be vulnerable to challenges under the ADA.

 

In summary, Mr. Sasser said that the strategic plan was a good starting point for the state, and he was pleased that the plan dealt with the issues of waiting lists and the movement of people on those lists to community-based services as a priority.  He believed this was an important aspect of the recommendations from DHR, and it would be a key factor in Nevada's compliance with the Olmstead decision.  Mr. Sasser indicated that he would be happy to answer questions from the subcommittee.

 

Chairman Titus asked Mr. Sasser to remain at the Carson City site while the subcommittee reviewed the recommendations.  The Chair recognized Senator Townsend.

 

Senator Townsend stated the experience that Mr. Guernsey, a number of staff members, Senator Mathews, Assemblywoman Leslie, and he had in attending the recent NCSL session entitled, “The Olmstead Decision: Moving Forward with Implementations,” was one that he felt should be followed in a number of areas.  Top speakers from throughout the country addressed the session, which then broke into groups with participants and colleagues situated in a private setting that allowed independent work on specific problem areas. The session lasted three days, and Senator Townsend felt the experience pointed out the advantage of a small state in rallying resources and opening lines of communication between the Executive Branch and the Legislative Branch.  He felt it had been a very constructive session.

 

Senator Townsend stated that a philosophical disagreement on how to approach Olmstead over the past two years had put the state at risk.  The strategic plan was a much more head-on and appropriate approach to the challenges facing the state.  Senator Townsend had recently attended the President’s Commission on Mental Health, at which time the announcement was made that two institutions for mental health services would be closed, which would subsequently place those persons in the community appropriately and help meet some of the standards under Olmstead for mental health services.  Based on the information presented to the subcommittee this date, Senator Townsend felt much more comfortable with the state’s direction than he did a week ago, and he expressed appreciation for the report.

 

Chairman Titus indicated that a report from the NCSL was included in Exhibit A under Tab Ve, page 99, which summarized the points brought forward by the Nevada delegation under “State Goals (brainstorming),” and most of the listed goals were included in the strategic plans presented by DHR and the Task Force.

 

Chairman Titus informed the subcommittee that it would begin to review the recommendations listed by DHR and the Task Force, and it would also consider further testimony from other persons regarding specific items.  She noted that Anne Cory from the United Way would provide additional information regarding the 2-1-1 system when the subcommittee considered that recommendation. 

 

In considering the various recommendations from different sources, Chairman Titus said the subcommittee would:

 

·        Review the general recommendations that could become statements of intent and goals in the report issued by the subcommittee;

·        Review those recommendations that were more specific;

·        Review those recommendations that would require appropriations; and

·        Determine which recommendations could be addressed during the 2003 Session and which would be categorized as long-range goals.

 

Beginning with the recommendations from DHR (pages 85 and 86, Exhibit A), Chairman Titus referenced numbers 4, 5, and 6 for general recommendations that would not require a significant amount of debate and were not controversial.  Number 4 was also parallel to number 32 on the list of recommendations from the Task Force, and number 6 was parallel to numbers 5, 8, 17, and 27 on the list of recommendations from the Task Force.  Chairman Titus indicated the subcommittee would commence with review of DHR Recommendation Number 5.

 

Chairman Titus noted that it had become very clear throughout the process that people closest to the problems needed to be at the table, as they were the stakeholders and should be included in discussions regarding what the needs were and how best to address those needs.  She was in complete agreement with that recommendation, and could not imagine that a report issued by the subcommittee would not begin with that premise.  Perhaps the subcommittee could lead off with a motion to adopt that recommendation as a statement of intent, providing there were no objections. 

 

Chairman Titus asked Mr. Guernsey about the proper procedure regarding the recommendations and whether each would require a formal motion.  Mr. Guernsey felt it would be advisable for the subcommittee to make a formal motion regarding each recommendation and explained that motions on recommendations requiring specific legislation would assist the Legal Division in drafting BDRs. 

 

Chairman Titus called for a motion on DHR Recommendation Number 5:  Involvement of persons with disabilities in policy development and program monitoring.

 

SENATOR TOWNSEND MOVED TO ADOPT DHR RECOMMENDATION NUMBER 5 AS A STATEMENT OF INTENT.

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED.

********

 

Chairman Titus indicated the next item for consideration would be DHR Recommendation Number 6: Ongoing collection of data.  She believed the subcommittee would agree that data collection should be one of its goals, and also an issue to be supported throughout the upcoming decade.  The Chair opened discussion on the recommendation.

 

Senator Townsend commented that he had often wondered whether the various departments in the University and Community College System could provide assistance in the area of data collection from students who needed work, whether it would be through the various departments that represented professionals in health services or computer sciences.  Senator Townsend did not feel the state should overlook the possibility of such “people power,” and he believed it would provide practical experience for students in the areas they were studying.  At some point, the state should consider utilization of that possible resource, as it could prove to be very helpful in eliminating the standard roadblocks at the money committee level when the issue of data collection was considered because it was low on the priority list. 

 

Chairman Titus concurred that additional partnering between the university and legislature was needed, and noted that Dr. Pierce was a good example of how such partnering could work, as he undoubtedly had students assisting in some aspects of the plan. 

 

Dr. Pierce explained that several of his students had been involved in development of part of the plan, and he approved of the idea of practical experience for students who would eventually be going out into the real world.  Dr. Pierce stated one of the most difficult parts of the collection of data was that systems did not collect the appropriate data; therefore, having people collect data was not so much a problem as the system responding to the unique needs of having data sets to make decisions from.  Dr. Pierce stated the student issue certainly could be a part of data collection, but the state needed to develop the notion of creating a clearinghouse for data. 

 

Senator Rawson remarked that would not seem to solve the immediate problem, and the state should make some resources available for development of data collection.  While Senator Rawson saw the potential and need for student assistance, organization of such a program would not meet the plan's immediate goals.  Senator Rawson opined that in the long run, it might be more costly to develop such a program; however, it was worthy of consideration, as it would create awareness of social work and other programs. 

 

Chairman Titus called for a motion to adopt DHR Recommendation Number 6 as a goal that would be supported by the Legislature.

 

SENATOR RAWSON MOVED TO ADOPT DHR RECOMMENDATION NUMBER 6 AS A LEGISLATIVE GOAL.

 

ASSEMBLYMAN CLABORN SECONDED THE MOTION. 

THE MOTION CARRIED.

********

 

Chairman Titus noted there had been much discussion surrounding DHR Recommendation Number 4: Adequate and continued funding to reduce waiting lists and provide necessary waivers, for establishment of a waiting period of not longer than 90 days, so that disabled persons would not be required to wait a lengthy period of time for services.  The recommendation would face constraints regarding available revenue; however, Chairman Titus asked that the subcommittee adopt the recommendation as a goal. 

 

ASSEMBLYWOMAN CHOWNING MOVED TO ADOPT DHR RECOMMENDATION NUMBER 4 AS A LEGISLATIVE GOAL.

 

SENATOR RAWSON SECONDED THE MOTION.

 

THE MOTION CARRIED. 

 

Senator Townsend remarked the subcommittee should keep in mind that one of the issues most states wrestled with was the individual silos of funding that prevented people from attaining more personalized services.  Persons with disabilities should not be required to search through the various social agencies for program assistance.  Senator Townsend stated there should be a way for individuals to ascertain whether or not they qualified through one central source.  He believed that was a more significant hurdle than the actual dollar amount, and he felt the subcommittee should take the position of continued vigilance toward removal of those individual silos of funding that blocked the effectiveness of consumer services. 

 

Chairman Titus concurred; she felt some of the recommendations would address that perceived problem, such as the 2-1-1 phone system and the Texas model “money follows the person.”

 

********

 

The Chair opened discussion of Task Force Recommendation Number 1: Establish, by legislative resolution, renewed by every succeeding session of the legislature, that general legislative initiatives impacting children and adults with disabilities include consideration of the potential effects such legislation may have on their lives and access to services.  Chairman Titus felt that was a given and should be adopted as statement of intent. 

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 1 AS A LEGISLATIVE RESOLUTION.   

 

ASSEMBLYMAN CLABORN SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Chairman Titus opened discussion of Task Force Recommendation Number 15: Establish, by legislative resolution that, effective July 2003, critical health, mental health, nutrition and personal assistance services to children and adults with disabilities, poor children and frail seniors are exempted from budget cutting during economic downturns.  Chairman Titus noted that the state was currently facing such a situation and was lacking funds for provision of services.  Further budget cuts would make the situation even worse.  She remarked if the subcommittee did not want to indicate “absolutely exempt,” it could certainly express the sentiment that personal assistance services would be among the last to be cut. 

 

Senator Rawson remarked that the Governor had always discussed exceptions for health and safety issues during periods of budget constraints, and he felt it would be a good idea for the subcommittee to institutionalize that concept.  Senator Rawson indicated there might be opposition because it removed options from budget cuts, but he felt it was reasonable for the subcommittee to state that there were certain budgets relative to human needs that should be “above the ax.” 

 

Assemblywoman Chowning concurred that the recommendation would face opposition, but it would actually save money in the long run and would make good fiscal sense.

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 15 AS A LEGISLATIVE RESOLUTION.     

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Chairman Titus stated the subcommittee would next consider Task Force Recommendation Number 21:  Budget planning, decision-making and rate setting for one or more disability populations or services does not occur in isolation of the others, e.g., supported living arrangements for people with mental retardation vs. those with brain injury/autism, personal assistance for those with physical disabilities vs. those with mental illness, autism, mental retardation. She opened the recommendation for discussion.

 

Assemblywoman Chowning pointed out that some disability categories had separate budget accounts, such as Services to the Blind, and she inquired whether the recommendation would eliminate those separate budgets.  She thought that the disabled community would highly disagree with such action, as they would feel they would not receive the appropriate attention by elimination of individual budget accounts. 

 

Chairman Titus stated that repeatedly, through the course of presentations, when the concepts of consolidating, overlapping, and one-stop shopping were discussed, the subcommittee was adamant that it did not want to eliminate current resources, and in fact wanted to enhance resources.  She asked that a representative of the Task Force address that issue.

 

Ms. Loux explained that the intent of the Task Force was certainly not to take away or eliminate any specialized service such as the supplemental program for the blind.  When the Executive Branch was considering a particular service such as supported housing, it should look at the service across-the-board and determine who would need supportive housing, not just the physically disabled, but also the mentally ill and the developmentally disabled.  Ms. Loux stated the concept was to determine what supportive housing was discussed across-the-board, and what type of issues should be considered to make it accessible to everyone.  Personal assistance was a good example, because each program included different rates, and the support necessary to serve persons with autism was not included.  Ms. Loux explained that was the concept behind the recommendation.

 

Senator Rawson believed it was an “apple pie” statement that said the state should be aware and not make decisions in isolation and should take into account all disability populations.  Senator Rawson did not view the recommendation as an attempt to consolidate budget accounts, but rather one that said nothing should be done in isolation.  He explained that services had been built one by one, and when the Legislature added a service for brain injury, it was somewhat isolated; however, that appeared to be the only means to add such a service at the time.  In the process, such action was sometimes detrimental to other services, and Senator Rawson indicated that consideration of adding, adjusting, or developing a service should include discussion regarding how it would affect the entire situation.  He stated he would be supportive of the recommendation with the intent that it would not eliminate existing services. 

 

Chairman Titus suggested that should the subcommittee move to support the recommendation, it should include a statement that made the intent very clear. 

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 21 AS A LEGISLATIVE RESOLUTION, WITH THE CAVEAT THAT THE INTENT WAS NOT TO ELIMINATE EXISTING SERVICES.

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED.

********

 

The next item for consideration was Task Force Recommendation Number 22: Legislative budget requests and forecasting recognize and include the needs of people with severe disabilities and their families with incomes above Medicaid limits, but who are unable to afford the critical personal assistance, respite, health care, environmental modifications and medications needed to avoid family disruption, impoverishment, exacerbation of disability and institutionalization.  Chairman Titus indicated that Recommendation 22 was similar to Recommendation Number 21, and asked Ms. Loux to comment.

 

Ms. Loux noted the particular strategy was aimed at people who were not the “poorest of the poor.” It would target people who had continuously worked and then become disabled, along with children whose families were working and had always worked, but because of the length of time employed or because of family employment, they fell just above Medicaid or waiver service eligibility.  Ms. Loux further explained that the cost to those persons and/or families was astronomical, particularly if the disability involved a brain injury or other severely disabling injury.  The Task Force had discovered that many of those people and families had become impoverished and eventually qualified for Medicaid assistance because they had virtually lost everything.  Ms. Loux stated many such persons were placed in institutional care in order to meet the requirement for personal assistance payment or home modification, etc. (which could have been avoided had they been able to keep their health insurance).  Most of those persons would not need Medicaid if there were a program to keep them from becoming impoverished.

 

Senator Rawson referenced possible funding sources and explained there were a few relatively small funding sources that assisted a limited number of people.  He felt the state should become more aware of the problem and develop additional funding sources, because quite often people who had sufficient income found themselves in catastrophic situations.  Chairman Titus concurred and called for a motion.

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 22 AS A LEGISLATIVE RESOLUTION.

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED.

********

 

Chairman Titus indicated that the remaining recommendations might require discussion by the subcommittee, and she opened discussion of DHR Recommendation Number 1: The recognition by the Legislature of the Nevada Strategic Plan for People with Disabilities as Nevada’s Olmstead plan.  Chairman Titus noted that it had been reported that Mr. Records, Dr. Pierce, and Mr. Willden had reviewed the plan and concurred that it would meet the requirements of the Olmstead decision. 

 

Senator Rawson inquired whether there was any dissention regarding such recognition.  Mr. Willden responded that it appeared the nine-member Nevada delegation to the NCSL conference in Florida came away with the impression that perhaps another plan should be created, as the current plan was not comprehensive enough.  Mr. Willden noted there had not been a chance to debrief the Nevada delegation; however, for the record, he believed the plan would meet the Olmstead requirements of a comprehensive, effective plan. He emphasized that he did not believe another plan would be necessary. 

 

Chairman Titus noted that Senator Townsend was a member of the Nevada delegation to the NCSL conference and asked for his input.  Senator Townsend said there had not been a chance to debrief with staff of DHR and other members of the delegation, and consequently he would be reluctant to support the request.  He felt it would be best if he abstained from voting on the recommendation until other members of the delegation reviewed the report to ascertain whether it would meet the requirements discussed at the conference.  Senator Townsend stated such action did not mean he would not support the recommendation, but simply meant he would not like his vote to be perceived as representing the entire Nevada delegation to the NCSL conference. 

 

Chairman Titus believed that when delegation members reviewed the final plan, they would be satisfied that it met the requirements of Olmstead. 

 

Senator Rawson stated that in the spirit of compromise and in order to move ahead with the recommendation, he would suggest that the subcommittee support the recommendation, recognizing that there might be additions to the plan in the future to address further Olmstead requirements, which would allow delegates to submit their recommendations for changes, if necessary.  He reiterated that the subcommittee should move ahead with the recommendation regarding the plan. 

 

Chairman Titus recalled that Mr. Willden had indicated the plan would remain open for two weeks to facilitate additional comment and/or input, and called for a motion.

 

SENATOR RAWSON MOVED TO APPROVE DHR RECOMMENDATION NUMBER 1, TO SUBMIT THE NEVADA STRATEGIC PLAN FOR PEOPLE WITH DISABILITIES TO THE LEGISLATURE AS NEVADA’S OLMSTEAD PLAN, WITH THE CAVEAT THAT POSSIBLE CHANGES COULD BE MADE TO THE PLAN IN THE FUTURE TO ADDRESS ADDITIONAL REQUIREMENTS.

 

ASSEMBLYMAN CLABORN SECONDED THE MOTION.     

 

THE MOTION CARRIED. 

********

 

Chairman Titus referenced Task Force Recommendation Number 5: Require examination and reporting of the financial impacts and cost savings to each session of the legislature. She asked Mr. Willden to provide an explanation regarding what the recommendation would entail. 

 

Mr. Willden stated that additional funding would not be needed for this function.  He reminded the subcommittee that the strategic plan was a 10-year plan and could not be completed during one biennium; the plan would continue to be discussed, and feedback would be provided to the Legislature.  Mr. Willden did not find annual or periodic reporting requirements to be problematic, and no additional resources would be necessary. 

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 5. 

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

The Chair opened discussion of Task Force Recommendation Number 8: Require monitoring and reporting to each session of the legislature, the status of county-paid nursing facility residents to ensure that people eligible for Medicaid services by virtue of being institutionalized and having their care paid with 50 percent county match monies, will be assured equal opportunity for services paid with 100 percent state funds should they choose to live in the community. 

 

Ms. Loux advised that the Task Force had received substantial testimony regarding the widely held perception within the disabled community that because there were people who received 50 percent county match funds as long as they remained in a nursing home, an institutional bias was created, because should the person move from the nursing home onto a waiver, they would then receive 100 percent funding from the state.  Ms. Loux reiterated the perception was that the situation created institutional bias.  She deferred to Mr. Willden, as DHR had also been discussing the issue.

 

Mr. Willden informed the subcommittee that perception was largely what the DHR was currently dealing with, and review of the actual data did not point to the department biasing a county‑match patient versus a state-only patient.  He agreed that Ms. Loux was correct—when a person was in a long-term county-match program, there was the potential  that the state might have incentive not to place that person in a waiver program.  The issue might become moot, because under A.B. 1, the child welfare integration legislation, there was ongoing discussion regarding the future funding plan of that program, and the state might assume child welfare services in Clark and Washoe Counties in exchange for the state taking over the long-term care costs.  Mr. Willden pointed out that if the “swap” did occur, then the perception and bias would be eliminated, because the state would pay for institutional long-term care or community‑based waiver services.

 

Chairman Titus inquired whether information regarding the situation would be difficult to obtain.  Mr. Willden explained that each long-term care patient was categorized by “A” codes within the DHR system, and it could be determined whether they were a state‑federal paid client or a county-match client.  Therefore, it would be relatively easy to obtain the data and determine whether there was bias regarding acceptance into waiver programs. 

 

Senator Rawson wondered whether the recommendation should be reworded to recommend the elimination of institutional bias by working toward the state payment of long-term care and the establishment of a goal to accomplish that status if possible. 

 

SENATOR RAWSON MOVED TO REWORD THE RECOMMENDATION TO WORK TOWARD THE ELIMINATION OF INSTITUTIONAL BIAS BY REQUIRING THAT THE STATE PAY FOR LONG-TERM CARE IN THE COMMUNITY.

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

Chairman Titus opened discussion of Task Force Recommendation Number 17: Require annual monitoring and reporting to the Legislative Committee on Children, Youth and Families of progress on Project IMPRV, Self Improvement Plans, IDEA Parts B and C.

 

Chairman Titus thought that the Legislative Committee on Children, Youth  and Families would cease to exist in a few years, and perhaps the reporting requirements could be approved as long as the committee existed.

 

Senator Rawson believed the committee would remain in existence for quite some time in order to accomplish its goals.  He questioned the use of the word “require” for annual monitoring and reporting.

 

Mr. Willden did not foresee a problem with a requirement for provision of annual reports to the Legislative Committee on Children, Youth and Families; however, to his knowledge, that committee had not dealt with Project IMPRV, Self Improvement Plans, or IDEA Parts B and C.  Chairman Titus wondered whether there was a more appropriate body for reporting requirements.  She noted that discussion would be held regarding the possibility of continuing the Legislative Commission’s Subcommittee to Study the State Program for Providing Services to Persons With Disabilities for an additional interim because of the amount of work yet to be done.

 

Mr. Willden advised that the department recently submitted the first of its ongoing reports regarding Self Improvement Plans to the Interagency Coordinating Council (ICC), which monitored those plans.  The DHR also had a number of plans to reorganize on those specific issues that would be presented to the Governor as part of the agency requested budget, which hopefully would also be part of the Governor’s recommended budget.  Chairman Titus remarked that perhaps reporting requirements to the Legislative Committee on Children, Youth and Families would not be necessary, since the issues seemed beyond its purview. 

 

Senator Rawson suggested a general provision that would require reporting the progress and development of Project IMPRV, Self Improvement Plans, and IDEA Parts B and C to the appropriate legislative committee. 

 

Senator Townsend informed the Chair that a person at the Carson City location would like to testify regarding the matter.

 

Diedre Hammon of Reno, Nevada, informed the subcommittee that the reason the information regarding education was included for annual monitoring and reporting to the Legislature was because education also fell under the requirements of Olmstead, in terms of segregated classrooms and the number of students served; segregated schools and the number served; and whether students were moved effectively into more inclusive environments when appropriate.  Those were the types of issues that the Legislature, when reviewing the state’s Olmstead plan, should consider and, Ms. Hammon observed, appeared to be the reason the recommendation stipulated reporting requirements to a legislative committee as opposed to the ICC.

 

Chairman Titus thanked Ms. Hammon and suggested that the subcommittee concur with the recommendation proposed by Senator Rawson, i.e., that reporting be made to the appropriate legislative committee after it was determined whether the subcommittee would be continued next interim.  Final action on Task Force Recommendation Number 17 would be held in abeyance until after that discussion.

 

********

 

Chairman Titus opened discussion on Task Force Recommendation Number 27: Utilize the State Disability Consortium to develop and implement uniform statewide quality assurance measures in all state programs serving people with disabilities; to evaluate and report impacts, outcomes, and consumer satisfaction; to consistently solicit consumer perspectives for program improvements; and to assure service provision in the most integrated setting appropriate to individual in need.  Report biennium outcomes to Legislative Committees on Health Care and Children, Youth and Families.

 

Dr. Pierce stated one of the concerns within the disability community was that there were no quality assurance measures from the consumer’s point of view involving persons with more severe disabilities and resultant particular needs.  Standards tended to be set for persons with the ability to speak for themselves, rather than persons who could not and were in the most vulnerable and precarious position, particularly those who were institutionalized.  Dr. Pierce could not recall a survey having been done of people living in institutions, nor had there ever been a survey done of people living in nursing homes or sheltered employment, and whether or not they wanted a “real” job or wanted to remain in sheltered employment.  Dr. Pierce believed that information was needed in order to begin making decisions.  The Olmstead issue dealt with personal preference, i.e., when a person stated that he did not want to be in a nursing home or a particular living arrangement and wanted to be self-empowered to make such decisions.  Therefore, data regarding other such situations would be necessary for review. 

 

Mr. Willden indicated that the strategic plan included discussion of quality assurance, and the bottom line was a recommendation that the Task Force undertake additional work in that area and have a quality assurance plan ready by September 2003.  That plan and effort would be tied to the need for the Ombudsman position referenced in Task Force Recommendation Number 29.  Mr. Willden noted the plan included a process for development of a quality assurance component, which would be ongoing. 

 

Senator Rawson inquired whether the State Disability Consortium was the appropriate body to develop the quality assurance measures.  Ms. Loux replied that regardless of whether the issues of quality assurance measures and consumer satisfaction were brought to the state consortium or a consortium of existing councils, families and people with disabilities should be very heavily involved in the process.

 

SENATOR RAWSON MOVED THAT THE SUBCOMMITTEE MAKE A GENERAL STATEMENT REGARDING TASK FORCE RECOMMENDATION NUMBER 27, THAT AS THE STRATEGIC PLAN WAS DEVELOPED, IT INCLUDE DEVELOPMENT OF QUALITY ASSURANCE MEASURES, AND THAT A BROAD BASED REPRESENTATIVE APPROACH BE USED IN THAT DEVELOPMENT. 

 

Chairman Titus reiterated that Senator Rawson had suggested and moved that the subcommittee support a change in the wording of Task Force Recommendation Number 27, to support the development of quality assurance measures as part of the plan, and to do so in a manner that would bring all stakeholders and consumers to the table.

 

ASSEMBLYMAN CLABORN SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Chairman Titus opened discussion of Task Force Recommendation Number 20:  Develop regulatory change and implement course work leading to an AA degree in Independent Living at the community college and/or university level that would allow people with mental retardation, pervasive developmental and cognitive disabilities to earn such degrees while benefiting from campus learning experiences that would better prepare them for a life of integration and inclusion.  Chairman Titus suggested that the subcommittee reword the recommendation as follows: “Encourage the development of course work leading to an AA degree in Independent Living….,” because the subcommittee would like to see the university and community colleges review those issues.  She felt the idea should be “encouraged” or “recommended” to the Board of Regents.

 

Senator Rawson was supportive of the Chair's rewording, adding that he would make it in the form of a motion; however, he wanted to disclose that he was an employee of the University and Community College System and was simply supporting the goals of the plan.

 

Dr. Pierce echoed Senator Rawson’s disclosure, that he too was an employee of the University and Community College System.  He explained that the recommendation from the Task Force encompassed two issues, one of which would lead to an AA degree, and the other would make postsecondary education options available to people who were in non-degree seeking programs, similar to personal interest courses available at the community college level.  Dr. Pierce hoped there would be a way to address the issue to include a recommendation that postsecondary institutions be accessible and open and provide programs for people with a wide range of disabilities.

 

Senator Rawson commented that in the past, very bright but highly disabled high-school students, who had personal assistance and support, graduated from high school only to find that there were no programs available to them in higher education.  Senator Rawson noted that programs were being developed, but more effort was needed in that area, because the lives of disabled students could have purpose with higher education and would also benefit society. 

 

Ms. Loux stated that after the Task Force had finalized the recommendations to the subcommittee, but before the present meeting, it was discovered the college programs that had been reviewed were somewhat different than the requirements for an AA degree.  The language in the strategic plan had been changed to, “Revise postsecondary entrance and eligibility requirements to allow students with disabilities to qualify for postsecondary learning opportunities, and revise Millennium Scholarship criteria to allow students with disabilities to earn postsecondary certifications.” 

 

Chairman Titus called for a motion to approve the wording submitted by Ms. Loux.

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 20 WITH LANGUAGE AS CHANGED AND WRITTEN IN THE STRATEGIC PLAN.

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION, CONTINGENT UPON THE CHANGE IN WORDING.

 

THE MOTION CARRIED. 

********

 

Chairman Titus opened discussion of Task Force Recommendation Number 23: Implement a legislative interim study to comprehensively review, evaluate and recommend improvements in state disability services and develop an integrated data system for providing consistent cross-agency information and meaningful client-specific service outcomes.

 

The Chairman also opened discussion of Task Force Recommendation Number 24: Conduct an independent study to determine which state agency service provisions should be outsourced. Outsourcing would occur through community grants and voucher systems, in which all direct service, care and case coordination would go to non-profit and private entities to strengthen and add independence to planning, coordination and quality assurance functions at the state level.

 

Chairman Titus believed the subcommittee could discuss the two recommendations together in light of the possibility of continuing the current interim subcommittee into the next interim, in order to follow up on the work it had done; both recommendations might fall under the purview of the subcommittee.

 

Senator Rawson stated that the subcommittee’s work was not done, and he felt it should provide legislative committee oversight that would follow up on the stipulations of the plan.  Reports could be submitted to other committees, but those committees also had heavy charges and were busy, e.g., the Interim Legislative Committee on Health Care.  Senator Rawson indicated the issues were specialized, and he felt the recommendations should be consolidated into continuation of the interim Legislative Commission’s Subcommittee to Study the State Program for Providing Services to Persons with Disabilities.  He supported that concept and would so move.

 

Chairman Titus noted that as the Chair of the Legislative Committee on Health Care, Senator Rawson provided a vital link to that committee, but it was recognized that the Legislative Committee on Health Care was extremely busy and could not provide the same degree of focus on disability issues as the subcommittee. 

 

Ms. Loux referenced Task Force Recommendation Number 25: Add responsibility for assessing the quality, effectiveness and/or need for policy/systems change in long-term care and service delivery to adults and seniors with disabilities to the powers of the Legislative Committee on Children, Youth and Families (NRS 439B.200), and pointed out the recommendation was incorrect.  It should read that the responsibility would be added to the Legislative Committee on Health Care rather than the Legislative Committee on Children, Youth and Families.  She noted that Recommendation Number 26, which would add responsibility for assessing the quality, effectiveness and/or need for policy/systems change in long‑term care and services to children with disabilities and their families to the duties of the Legislative Committee on Children, Youth and Families, was correct. 

 

Ms. Loux explained the reason for those recommendations was that the disability community strongly felt the support provided by the Legislature over many years was the main reason for the progress that had been made to date.  If the subcommittee were to continue into the next interim, it could provide the oversight of the two recommendations, along with Recommendation Numbers 23 and 24. 

 

Chairman Titus asked if the subcommittee should recommend combining Task Force Recommendation Numbers 23, 24, 25, and 26 with a recommendation that the interim Legislative Commission’s Subcommittee to Study the State Program for Providing Services to Persons With Disabilities be continued into the next interim, to provide follow-up and oversight of Olmstead compliance, along with other program oversight.

 

SENATOR RAWSON MOVED TO COMBINE TASK FORCE RECOMMENDATION NUMBERS 23, 24, 25, AND 26 WITH THE AFOREMENTIONED RECOMMENDATION FOR CONTINUATION OF THE SUBCOMMITTEE.

 

MR. CLABORN SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Chairman Titus advised that several Task Force and DHR recommendations relating to reorganization of state government were similar and could be combined for the purpose of voting. 

 

·        DHR Recommendation Number 3:  The establishment of an Office of Disability Services within the Department of Human Resources.

·        Task Force Recommendation Number 19:  Establish a State Office of Disability Services within the Department of Human Resources at the director’s level based on the New Jersey model.

·        Task Force Recommendation Number 28:  Establish a cabinet-level position to coordinate planning across systems, agencies and disability populations; monitor implementation of strategic planning goals; ensure compliance with provisions of Olmstead and the ADA; oversee the development of a comprehensive, cross- agency data system; and assure coordination of state and county resources.

·        Task Force Recommendation Number 29:  Establish an independent, community-based, Disability Ombudsman within one or more legal services entities qualified to receive legal filing fees under NRS 19.031.  The Ombudsman's office would have statewide responsibility for mediating “integrated settings issues” related to provisions of the Olmstead decision, the Americans with Disabilities Act, and the Individuals with Disabilities Education Act (IDEA) that remain unresolved after exhaustion of available remedies.

 

Chairman Titus opened discussion of the recommendation and invited Mr. Willden to address the subcommittee.

 

Mr. Willden said he believed reorganization was needed to align human resource and disability service-related agencies under the DHR umbrella, and employment-related agencies under the DETR umbrella.  Mr. Willden had discussed the concept in-depth with the Director of DETR, and he believed there was general agreement between the two.  Specifically, the services and programs under the Office of Community Based Services (OCBS) might more directly align with DHR than DETR.  Mr. Willden said he would be discussing that possibility with the Governor during DHR’s budget hearing process. 

 

Chairman Titus inquired whether Mr. Willden felt the Governor would agree with the concept.  Mr. Willden believed the Governor would defer to the recommendations from DHR and DETR and agree with those recommendations. 

 

Mr. Willden explained the next step would be to perform a review of DHR and determine how it might be reorganized; however, all the pieces had not been reviewed.  Regarding the cabinet-level position, Mr. Willden had not discussed that possibility with the Governor, but he certainly understood the need to spotlight the issues and resolve the concerns.  However, he felt those issues could be handled within the department.  Mr. Willden voiced support for the establishment of an ombudsman position, and noted that most other programs included ombudsmen.

 

Chairman Titus wondered if creation of an Office of Disability Services within the DHR would be viewed as an additional budget expense.  Mr. Willden replied that moving OCBS to DHR would not result in a significant budgetary impact, and after that action had been taken, the DHR could be reviewed for possible additional organizational realignment.

 

Chairman Titus felt that the first step would be to approve the creation of the office, with the goal of establishing a cabinet position at a later date after reorganization had taken place. 

 

Senator Rawson remarked action by the subcommittee would make a strong statement that the subcommittee wanted the issues to be important.  He believed the issues were important to the Governor, and he would like to follow through with a strong statement from the subcommittee in favor of the establishment of an Office of Disability Services within the DHR that would provide easy access to the Governor. 

 

Assemblywoman Chowning concurred with Senator Rawson’s statement and indicated that such an office would draw attention to the most needy population.  It should also be noted that the goal would actually save money, because efforts would not be duplicated and efficiency would be increased.  She felt it would actually be a cost-saving measure. 

 

SENATOR RAWSON MOVED TO APPROVE DHR RECOMMENDATION NUMBER 3, AND TASK FORCE RECOMMENDATION NUMBER 19, ESTABLISHMENT OF AN OFFICE OF DISABILITY SERVICES, WHICH WOULD STRESS THE IMPORTANCE PLACED ON THE ISSUES BY THE SUBCOMMITTEE, AND THAT THE OFFICE PROVIDE EASY ACCESS TO THE GOVERNOR. 

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.             

 

THE MOTION CARRIED. 

********

 

Chairman Titus indicated that the recommendation for a cabinet-level position (Task Force Recommendation Number 28) would be held in abeyance at the present time; it could possibly be a goal at a later date.  She opened discussion of Task Force Recommendation Number 29.

 

Ms. Loux explained the ombudsman was not recommended for placement within state government.  The Task Force recommended that an ombudsman be established within the existing legal service entities at a paralegal level that would assist families and people with disabilities when all other avenues had been exhausted in terms of Olmstead and the ADA.  Ms. Loux pointed out that legal service entities were chosen for several reasons, including their independence, their mission to uphold civil rights, and their vigilance in protecting the rights of people with disabilities in terms of ADA issues. 

 

Chairman Titus asked how funds would be generated for the ombudsman position.  Ms. Loux replied that funding would be via a legislative appropriation in the amount of approximately $130,000. 

 

Mr. Willden explained that funding was delineated in the strategic plan and, for the record, he noted that it would not be a single individual, but rather an ombudsman’s office, which would include a paralegal, support staff, and a percentage of an attorney. 

 

Senator Rawson stressed that the Legislature had established an office for hospital patients who were experiencing difficulty with hospital billings, etc., which had proven to be very effective and had been able to resolve many issues.  When the Office of Disability Services was proposed to provide better access to services and information, Senator Rawson felt the role of that office would be to facilitate and assist persons with disabilities, but he also felt that  there was a need to establish the ombudsman office as a last resort for people who had their rights violated or had reached a dead-end.  Senator Rawson added that he would be supportive of both recommendations. 

 

Chairman Titus called for a motion.

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 29 TO ESTABLISH AN OFFICE OF DISABILITY OMBUDSMAN.

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Chairman Titus recommended the subcommittee support Task Force Recommendation Number 30:  Support passage of legislation to include ADA accessibility guidelines within the State Building Code.   She wondered why those guidelines were not already a part of the building code.  Ms. Loux indicated Mr. Gowins would address the recommendation.

 

Mr. Gowins advised that throughout the past legislative sessions, there had been several attempts to ensure that new facilities, whether it was housing or the new Legislative Building, would be accessible to people with disabilities.  The two major counties, Clark and Washoe, had developed fairly acceptable codes, based on the 1997 Uniform Building Code (UBC).  However, those counties did not always perform site checks regarding accessibility issues, and the smaller counties were somewhat behind in the process. 

 

Mr. Gowins testified that the disability community had brought the issue forward to place emphasis on fair housing, along with other issues that would make additional accessible housing available for that community.  As the state considered community services, the failure to address new construction and remodeling would cause a great deal of difficulty if the issues brought forward by the disability community were not addressed.  The aforementioned senior plan contained ideas regarding housing; however, within the disabled community, it was realized that while the codes were adequate, some smaller counties, such as Esmeralda, did not contain building departments to check for compliance with ADA accessibility requirements.  The idea, continued Mr. Gowins, was that the state could develop a guideline similar to what had been done in California, which added a chapter to the UBC codes in its law.  A guideline in the State Building Code would detail what was expected of builders by law, which would give Nevada an opportunity to step up to the plate and assist people with disabilities by increasing housing and accessibility options. 

 

Leslie Hamner, Principal Deputy Legislative Counsel, Legislative Counsel Bureau, advised that the authority of the State Building Code was delineated in NRS 338.180, which required the state of Nevada and each political subdivision, in the design, construction, and alteration of public buildings and facilities, to comply with the requirements of the ADA, certain other accessible design requirements, and the Fair Housing Act.  Ms. Hamner remarked that, judging by Mr. Gowins' comments, perhaps the issue was not to change those provisions of NRS, but rather to deal with other issues.  She indicated that the Legal Division would be happy to work with Mr. Gowins regarding the recommendation. 

 

Mr. Gowins noted that ADA requirements were not the same as those of the Fair Housing Act, which included seven recommended standards that really had no codification and were open to interpretation.  One of the ideas behind adding the ADA accessibility guidelines to the State Building Code would be to address the code so builders would not suffer any grief over the issue.  Mr. Gowins pointed out that although there was a statement that indicated builders would abide by the Fair Housing Act, there was no system to ensure compliance, and with no code, compliance was subjective.  The idea would be to review those issues and take action at the state level so all counties would be required to abide by the same codes.  Currently, explained Mr. Gowins, counties adopted codes as they saw fit, and the larger counties had come up to the most recent codes; however, the smaller counties had not.  It was a fairly significant issue that had been addressed on several occasions, and Mr. Gowins felt any effort surrounding the State Building Code would be appreciated.

 

Chairman Titus suggested that the subcommittee consider the request as a recommendation, with recognition that it was a problem that would require further study over the next interim, at which time recommendations could be made regarding how to amend the current State Building Code to address the perceived problem.  Chairman Titus noted the recommendation could also include a request to make the Nevada Association of Counties (NACO), or representatives of rural Nevada, aware of the problems in an effort to bring the codes in line with the requirements. 

 

Senator Rawson suggested that the subcommittee include Task Force Recommendation Number 30 as one of the issues of concern and request continued development of guidelines.  He was unsure whether he was knowledgeable regarding all the issues, and noted that state acceptance of national building codes had been sharply fought in the Legislature.  However, the State Building Code could certainly be updated without the requirement to accept national standards.  Senator Rawson hesitated to include a recommendation that would suffer opposition, when he believed attention could be increased that would lead to success in accomplishing the desired results.  He believed the recommendation should be included in the subcommittee’s general report, with the request to develop a plan.

 

Chairman Titus concurred and suggested that input from the State Fire Marshal might be of assistance.  She noted that rural counties often reported difficulties with inspections, and the subcommittee should not build-in resistance to the proposal. 

 

Senator Rawson told the subcommittee that a man in a wheelchair had recently come to his house, which had two steps leading up to the front porch where the doorbell was located, and the man was forced to wait for approximately 20 minutes until a neighbor walked by, because he was not able to ring the doorbell.  Senator Rawson said it was embarrassing for the gentleman who was forced to wait until someone could provide assistance, and it really pointed out the problem.  Most people were not aware of the many barriers facing the disabled community, and Senator Rawson felt attention should be paid to the situation. 

 

Tracy Becker, Program Coordinator, Nevada Association of Counties (NACO), remarked that NACO would be happy to work with the subcommittee regarding building code issues in the rural counties.  Chairman Titus stated that would be part of the general recommendation, which would receive further consideration during the upcoming interim.

 

SENATOR RAWSON MOVED TO INCLUDE TASK FORCE RECOMMENDATION 30 IN THE SUBCOMMITTEE’S GENERAL REPORT, WITH THE SUGGESTION THAT A PLAN BE DEVELOPED AND THE ISSUE BE REVIEWED AGAIN DURING THE UPCOMING INTERIM.

 

MR. CLABORN SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Chairman Titus indicated that if anything epitomized the concept of one-stop shopping, it was the proposal for the 2-1-1 access line service, and she referenced the memorandum of September 11, 2002 to Ms. Loux from the United Way, which outlined the program (Exhibit C).  The issue was addressed in DHR Recommendation Number 2:  The adoption of a 2-1-1 access line/No Wrong Door program, and Task Force Recommendation Number 18: In collaboration with Nevada counties and United Way organizations, establish and fund a 2-1-1 universal access line with a supplementary No Wrong Door website and community-level call centers providing information, referral and resolution assistance for people with disabilities and their families.  Chairman Titus invited the representative from United Way to address the subcommittee.

 

Anne Cory, President and Chief Professional Officer, United Way of Northern Nevada and the Sierra, spoke on behalf of the three United Way organizations in Nevada, which also included United Way of Southern Nevada and United Way of the Great Basin.  Ms. Cory advised that representatives from those entities had reviewed and concurred with the proposal contained in Exhibit C.

 

According to Ms. Cory, 2-1-1 was a national abbreviated dialing code for human services information and referral and was a particularly important form of access to services for the disabled population.  One of the important factors of 2-1-1 was that it allowed those with disabilities who were seniors, who had chronic disease issues, or people with disabilities who had childcare needs, to obtain information through a one-stop system.  Mr. Cory explained that the proposal outlined in Exhibit C was for a planning process to implement a 2-1-1 system.  Nevada had many of the pieces, such as an online web-based information and referral system accessible to agencies, businesses, and individuals, already in place.  The system would require upgrading to make it available statewide and would need to be integrated.  Ms. Cory noted that there was one call-in center in Nevada that was available 24 hours a day, 7 days a week, which was the Crisis Call Center in northern Nevada.  She explained that HELP of Southern Nevada, an information and referral program, was part of the discussion, as well as another possible call center. 

 

Ms. Cory advised that the United Way organizations were very interested in taking the lead in the 2-1-1 planning process.  One of the reasons that a proposal for full implementation in a shorter period of time had not been presented was that the amount of revenue to connect the system to the various telephone companies in Nevada was not known.  A number of local telephone service providers would incur costs in development of the system and in linking the service providers.  Ms. Cory explained that review of other states that had implemented or were in the process of implementing the 2-1-1 system indicated that costs went from no money to hundreds of thousands of dollars, so the cost in Nevada could not be predicted.  According to Ms. Cory, endorsement of development of a 2-1-1 statewide information and referral system and funding for the planning effort would allow time to upgrade and integrate the appropriate system pieces, and to negotiate and determine the associated costs. 

 

The details of the proposal were included in Exhibit C, and Ms. Cory did not think it would be necessary for her to address those details; however, she would be happy to answer questions from subcommittee members.

 

Senator Rawson believed the potential for the 2-1-1 system was that it would generate more calls than the 9-1-1 system, and thus relieve much of the pressure on the 9‑1‑1 system.  He noted that the Legislature had considered funding for a number of hotlines, e.g., suicide prevention, drug treatment, etc.  Senator Rawson was supportive of the system; however, he believed the planning effort should be comprehensive and thorough.  He advocated that the planning process include a very comprehensive system that would prove extremely useful to the disabled community, including disabled tourists. 

 

Chairman Titus inquired whether the costs associated with the planning effort would be included in DHR’s budget, or if the costs would require a recommendation for additional funding in the amount of approximately $650,000.  Mr. Willden realized that the costs were not included in DHR’s requested budget.  He explained that not many of the recommendations were included in the budget, with the exception of waiting lists and programs traditionally budgeted for DHR.  Mr. Willden again indicated his first opportunity to discuss funding with the Budget Office and the Governor would be on October 10, 2002. 

 

Chairman Titus asked if adoption of a 2-1-1 access line was a DHR recommendation, whether funding would be requested by the department; Mr. Willden replied that funding would be discussed in budget preparation.

 

Assemblywoman Chowning commented that the 2-1-1 access line appeared to be a good tool and aid.  However, in the past, the Legislature had established several hotlines, which were initially successful because of the publicity, but year-after-year, the calls waned away.  She suggested much of that could be blamed on the lack of publicity, or perhaps because the consumer problems for which the hotline was established had disappeared.  Assemblywoman Chowning wondered whether there would be ongoing publicity, so that English and non-English speaking disabled persons could seek assistance.  The question was whether there would be sufficient publicity to keep the access line open and justify the costs.

 

Ms. Cory indicated that in terms of duplicative call-lines, it was the intent to pull the separate issues together under the 2-1-1 system, which was what had been done by those states that implemented the system.  According to Ms. Cory, strides had been made in that direction in the Northern Nevada Crisis Call Center, which had become the repository for a number of separate lines to augment its services.  For example, a northern drug coalition joined with the Crisis Call Center, funded the incremental costs of adding an additional line, and advertised that line for drug and alcohol treatment information.  Ms. Cory explained that the Crisis Call Center also included:

 

·        The suicide crisis line;

·        Nighttime reports of child and elder abuse, with those calls processed into the law enforcement system; and

·        The rape crisis line.       

 

Ms. Cory indicated that the Crisis Call Center could serve as a model to build upon in bringing the various sources together.  It would be important to ensure that there were strong linkages to the 9-1-1 system, which would be part of the planning process in Nevada, as had been done in other states. 

 

In terms of marketing and public information, Ms. Cory said she had reviewed plans of other jurisdictions that had successfully implemented the 2-1-1 line, and it did not seem to be a difficult process.  It appeared that current public information efforts within the communities could be enhanced through organizations such as the United Way, the various private, non‑profit groups, and state programs that served clients.  The effort could also include donated billboards.  Ms. Cory stated 2-1-1 was such a simple code that it would be a bit easier to market than several different numbers that people had to remember for separate hotlines.  Plus, she noted that the linkage would be substantial, and a person who called in for one particular issue could be referred on another.

 

One important point related to marketing and outreach was that the proposal included a plan to develop specialized calling centers, and Ms. Cory believed that would be of particular interest to the subcommittee, because the first call center proposal was for persons with disabilities.  The 2‑1-1 calling center would provide linkages and the first layer of referrals for those clients and/or consumers calling in who required specialized, detailed, in-depth information.  Ms. Cory stated the specialized call center would handle particular issues for persons with disabilities, but in the future, other specialized call centers for the elderly or those with HIV, or other particular issues could be added to the system. 

 

SENATOR RAWSON MOVED TO APPROVE AND ENDORSE DHR RECOMMENDATION NUMBER 2 BY FUNDING THE PLANNING EFFORT TO DEVELOP A 2-1-1 STATEWIDE INFORMATION AND REFERRAL SYSTEM IN NEVADA.

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Chairman Titus opened discussion of Task Force Recommendation Number 2: Develop a rider to Medicaid budgets based on the Texas model "money follows the person" for children and adults assessed to be in unnecessarily restrictive residential environments encouraged by HHS Director Tommy Thompson. 

 

Mr. Willden felt development of such a rider would be feasible, and Chairman Titus inquired whether the subcommittee would be amenable to action instructing the department to move in that direction.

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 2, DEVELOPMENT OF A RIDER TO MEDICAID BUDGETS BASED ON THE TEXAS MODEL.

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

The Chair opened discussion of Task Force Recommendation Number 10: Draft and support legislation allowing state funds allocated to the personal assistance programs administered by Aging Services and the Office of Community Based Services to be carried over into the next fiscal year so funding is not lost due to unanticipated hospitalization. 

 

Mr. Willden explained that action would be part of the Appropriations Act, the last bill produced each session, and would require special language addressing the appropriations for those programs.  Chairman Titus asked if the recommendation would require further review.  Mr. Willden noted three programs that included personal assistance funding had been omitted from the recommendation: Aging Services, OCBS, and Medicaid.

 

Senator Rawson advised that the money committees went “ballistic” with such requests. He suggested the subcommittee consider adding a reserve to the budget accounts, and as part of the budget process, a determination could be made regarding an adequate reserve amount, which might be a way of carrying over some of the funding.  Senator Rawson opined that it was not beneficial to force agencies to spend money rather than let it revert; however, the state’s system was based on reversion of funds that could then be reallocated.  He would support a reserve, if that would adequately address the recommendation.

 

Charles Duarte, Administrator of the Division of Health Care Financing and Policy (HCF&P), stated that in addition to the Medicaid program, there was a waiver program in Mental Health and Developmental Services.  To the extent that entity developed personal care assistance activities, or similar services, those funds would be carried forward as well.  Mr. Duarte indicated that to be inclusive, the recommendation would have to address a number of different programs and agencies.

 

Chairman Titus informed the subcommittee that Task Force Recommendation Number 10 would be held in abeyance, with the possibility for continued exploration by the subcommittee during the next biennium. 

 

********

 

Chairman Titus opened discussion on Task Force Recommendation Number 16: Ensure appropriate provider rates for personal assistance are established, adopted by the Nevada Legislature and implemented for all state programs.  She felt that action could be encouraged and/or endorsed by the subcommittee without an appropriation at the present time, as a goal to work toward in the future.

 

Senator Rawson stated the strategic plan was good, and he would not like to see problems created because of the request for an appropriation.  He agreed with action to endorse the recommendation without appropriation at the present time. 

 

SENATOR RAWSON MOVED TO ENCOURAGE AND/OR ENDORSE TASK FORCE RECOMMENDATION NUMBER 16, WITHOUT APPROPRIATION, AS A GOAL FOR FUTURE CONSIDERATION.

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Chairman Titus noted that the remaining Task Force recommendations would require legislative appropriations, and the subcommittee would take a short recess after hearing testimony from Linwood Gallagher in Carson City.

 

Mr. Gallagher stated that, as a consumer, he wanted the subcommittee to know that he approved of what had occurred during the meeting, and he applauded the subcommittee, along with agency heads and those who had been instrumental in preparation of the recommendations.  Mr. Gallagher's impression was that what the consumer wanted and what agencies were striving to accomplish really were not that far apart.  He noted that many consumers had heard similar statements before, and the reaction was that they liked the rhetoric.  He cautioned the subcommittee to avoid strengthening the feeling among consumers that proposals and recommendations were simply rhetoric they had heard before.  Mr. Gallagher indicated he was pleased to see that some of his past concerns were being addressed by the subcommittee. 

 

Mr. Gallagher reminded the subcommittee of his prior testimony regarding accessible computers in Carson City, which were apparently purchased based on need for persons approved for college educations.  If that was occurring in Carson City, it must also be happening throughout the state, which would amount to a significant sum of money.  There was a mindset in technology that a person had to have the latest and the greatest; however, Mr. Gallagher personally believed that was not always the case, as he worked on an older model computer that ran on DOS.  In view of the state’s financial situation, he strongly urged that existing equipment be located and people be advised where to access such equipment, so the emphasis would not always be on purchasing new equipment. 

 

Chairman Titus thanked Mr. Gallagher for his comments and called a short recess.  Upon reconvening the subcommittee, Chairman Titus stated it appeared that the subcommittee had addressed all the recommendations brought forward by DHR.  The subcommittee would commence with review of Task Force recommendations that required appropriations, which it was certainly supportive of, even though the good ideas contained in those recommendations might have to become long-range goals because of fiscal realities. 

 

Chairman Titus opened discussion of Task Force Recommendation Number 3: Assure all eligible at-risk children and adults quickly receive the assessments and Medicaid services they need through a single eligibility application for SSI and Medicaid.

 

Mr. Willden explained that currently, when a person applied for Supplemental Security Income (SSI), the process could take several months, and once a decision was made regarding the SSI application, that person would then be required to physically apply for Medicaid.  The recommendation would create an automatic incretion to the rolls, and was something that had been recommended and discussed by the Legislature for many years.  Mr. Willden explained that the recommendation would save a tremendous amount of time for both consumers and families; the debate always centered around the approximately 2,500 to 3,000 disabled individuals in Nevada who were approved for SSI, but not Nevada Medicaid.  The question was why, and it appeared it was because there was no medical cost involved.  Mr. Willden felt the system would be improved by a single eligibility application. 

 

Senator Rawson asked whether SSI benefits caused income levels to increase too high to qualify for Medicaid.  Mr. Willden explained that if a person were SSI eligible, he would also be categorically Medicaid eligible. 

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION 3, AND RECOMMEND IMPLEMENTATON OF THE SINGLE ELIGIBILITY APPLICATION FOR SSI AND MEDICAID. 

 

Senator Rawson pointed out that the recommendation included a fiscal note, which would more than likely be the issue that determined whether the process was approved.  The subcommittee could, however, recommend the implementation of the process.

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Chairman Titus opened discussion of Task Force Recommendation Number 4: Implement a statewide system of outsourced mobile units for outreach, assessment and referral of children and adults with disabilities who are homeless and in crisis.  Chairman Titus felt that would be a long‑term goal, perhaps beyond the state’s funding during the 2003 Session; however, it could be included as a recommendation for future action.

 

Senator Rawson commented that a dental bus was currently in service in Clark County, which it was hoped would be rotated through the at-risk school system.  However, when the bus was stationed at the first school, it remained there for half a semester and treated 850 out of the 1,100 students in the school.  In two years, the bus had served ten schools, and the need had proven to be much larger than anticipated.  Senator Rawson noted that through grant money, four buses were now on line, and eventually those buses would treat the homeless and others in need of dental service.  Senator Rawson pointed out that private groups had initiated programs, such as the Classroom on Wheels (COW) bus program, and he believed the subcommittee could recommend approval of the recommendation without funding at the present time, with funding to be added as it becomes available.

 

Senator Townsend stated that he wholeheartedly supported the recommendation, and there were a number of ways to develop such programs, as was currently being done with mobile crisis units at various levels for homeless persons, mentally ill persons, disabled persons, and children at risk throughout the country.  Senator Townsend commented that perhaps placing graduate students in a real work environment on certain evenings, along with a professional, would be beneficial.  The technology to track such programs would be needed to ensure that once persons in need were identified, they would be resourced out.  Senator Townsend indicated a significant amount of research had been conducted surrounding mobile outreach units, and he hoped the state would not ignore the concept.  While funding was always an issue, Senator Townsend hoped that during the upcoming legislative session, at the very least, a mobile unit in southern and northern Nevada could be initiated as pilot programs, which could be refined over time based on the outcome of those pilot programs.  He believed that was an important part of the state’s social service responsibility.

 

Chairman Titus concurred, and felt the recommendation should reflect the need to move forward with pilot projects and research.

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 4, TO MOVE FORWARD WITH POSSIBLE PILOT MOBILE OUTREACH PROJECTS AND RESEARCH.

 

SENATOR TOWNSEND SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Chairman Titus opened discussion of Task Force Recommendation Number 7:  Provide a continuous allotment, through the 10 percent disability designation of Tobacco Settlement Funds, to ensure families providing primary care to a severely disabled family member receive respite services within 90 days of application; provide permanent funding for the state’s Positive Behavioral Supports Network at a level that, at a minimum, will support adequate training and service delivery to 1,500 families with children with autism and brain injury, and others in need of such interventions; and provide home and environmental modifications to allow community access and/or return from institutional care. 

 

Senator Rawson stated that unless there were major objections, it appeared to be a good choice for utilization of the Tobacco Settlement Funds, and he would support the recommendation. 

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 7.

 

MR. CLABORN SECONDED THE MOTION.

 

THE MOTION CARRIED. 

 

********

Chairman Titus opened discussion of Task Force Recommendation Number 9: Fully implement the provisions of Senate Bill 174, the Nevada Personal Assistance Services Act, for efficacy in avoiding unnecessary entry into, and transfer from, skilled nursing facilities. 

 

Ms. Loux explained that the Task Force had included this recommendation as a means to reinforce the importance of the legislation already in place.  She noted that agencies were moving forward with the recommendation, and reiterated that inclusion of the recommendation was for reinforcement.

 

Chairman Titus inquired whether Recommendation Number 9 had been addressed through previous statements of the subcommittee regarding other recommendations, and Ms. Loux replied in the affirmative.  Chairman Titus advised that the subcommittee would not vote on Recommendation Number 9.

 

********

 

Chairman Titus opened discussion of Task Force Recommendation Number 11: Provide training within personal assistance programs to ensure people with autism, other pervasive developmental disabilities and brain injury (who have a high need for a consistent and predictable environment) will obtain caregivers who understand and are trained in their individual particular characteristics and needs. 

 

Dr. Pierce explained that persons with autism and brain injury had very unique intervention needs, and the Task Force had targeted caregivers in those categories for specific training to work with that type of disability.  Dr. Pierce noted that such training did not currently exist.

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 11, TO ENSURE TRAINING WITHIN PERSONAL ASSISTANCE PROGRAMS TO ADDRESS SPECIAL NEEDS.

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Senator Townsend informed the subcommittee that he had been provided with a copy of the booklet entitled, “The Simplified Version,” which was obviously a consumer-driven analysis of the obstacles that people with disabilities faced.  Chairman Titus indicated that members in the Las Vegas location also had copies of that booklet, and it would become part of the record as Exhibit D. 

 

********

 

Chairman Titus opened discussion of Task Force Recommendation Number 12:  Develop a Medicaid HCBS Cognitive Impairment Waiver to assure delivery of the complex and costly array of behavioral services needed by people with brain injury, autism, and other pervasive developmental disabilities and mental illness for their unique behavioral and independent living needs.

 

Dr. Pierce stated that discussions particular to waivers had revealed that a waiver would not be necessary for every disability, and the Task Force wanted to see how many could be included within a Cognitive Impairment Waiver.  He explained that brain injury, autism, and other pervasive developmental disabilities were not included in any other waiver program. 

 

Mr. Willden indicated there was ongoing discussion regarding how to best move forward with the waiver program, whether it would be via one new waiver, expansion of an existing waiver, or multiple waivers.  He advised that the issue needed further review.

 

Chairman Titus suggested the subcommittee recommend that as waiver programs were discussed, special attention be given to persons with those particular needs.

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 12, TO ENCOURAGE, REMIND, AND RECOMMEND THAT THE COMMITTEE DEALING WITH WAIVERS PAY SPECIAL ATTENTION TO THOSE PARTICULAR NEEDS AS WAIVER PROGRAMS WERE RESTRUCTURED OR EXPANDED.

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Chairman Titus opened discussion of Task Force Recommendation Number 13: Continually expand Nevada’s Medicaid Buy-In Program to equitably provide, by 2008, medical insurance coverage or wraparound to all people with disabilities who, by virtue of becoming employed, have established an income above poverty level, but cannot obtain the health care coverage and services required to terminate reliance on public benefits.

 

Ms. Loux advised that this recommendation was submitted to reinforce current Medicaid Buy-in Program authority, and the state was moving ahead with the Medicaid Buy-In Program. 

 

Senator Rawson suggested that the subcommittee require a report sometime in the future, since the recommendation was to continue the Medicaid Buy-In Program until 2008.  He indicated it was an extremely important issue; however, the cost was probably somewhat overstated.

Chairman Titus concurred, and requested a report from the DHR to the interim subcommittee on an ongoing basis in order to monitor the progress being made. 

 

Mr. Jon Sasser stated he had been privileged to work with Mr. Gowins and Senator Rawson regarding S.B. 208, the Medicaid Buy-In Program, and he clarified that the Task Force recommendation was not an indication that action would not be taken until 2008.  There was a large group that required coverage, which would probably occur in stages, and the goal would be to provide coverage for everyone by 2008.  Mr. Sasser believed the program would be phased-in by income group over a period of time.

 

Chairman Titus stated the subcommittee would simply like to receive progress reports regarding Nevada’s Medicaid Buy-In Program.

 

Senator Townsend hoped that as the subcommittee read through the recommendation, “…medical insurance coverage or wraparound to all people with disabilities who, by virtue of becoming employed, have established an income…,” it would be important to suggest that the Legislature determine the best method to encourage businesses to hire disabled persons.  Senator Townsend believed that a person who was willing to get up and go to work every day deserved health coverage, no matter what the income level.  Members of the Taxation and Commerce Committees of both houses should encourage businesses to become involved, so insurance coverage would not fall back on public service. 

 

Chairman Titus remarked that the subcommittee had heard testimony from different businesses that hired the disabled and, if possible, something should be included in the report to encourage businesses to continue to hire the disabled.  Persons who found a job and went to work should not be cut off from needed resources and services which, Chairman Titus suggested, could be included in the recommendation or listed as a separate recommendation.

 

SENATOR TOWNSEND MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 13, WITH REPORTS REQUIRED TO THE LEGISLATURE REGARDING THE PROGRESS BEING MADE IN THE MEDICAID BUY-IN PROGRAM, AND AN ADDITIONAL RECOMMENDATION TO ENCOURAGE EMPLOYMENT OF THE DISABLED.

 

ASEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Chairman Titus opened discussion of Task Force Recommendation Number 14: Expand funding for the Homeless Mentally Ill Outreach initiative (H.O.P.E. – Homeless Outreach Pilot Education) program to implement ongoing programs providing intensive outreach and case management services, including immediate access to necessary medications and housing.  Chairman Titus stated the recommendation aligned with prior discussion of the homeless as an issue that needed to be addressed, possibly not during the 2003 Session, but as a goal for continued work.

 

MR. CLABORN MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 14 AS A GOAL FOR CONTINUED FUTURE WORK. 

 

ASSEMBLYWOMAN CHOWNING SECONDED THE MOTION.

 

THE MOTION CARRIED. 

********

 

Chairman Titus opened discussion of Task Force Recommendation Number 31:  Identify and transfer people in institutional care who can be served in the community, and who do not oppose such transfer, assuring appropriate discharge planning, transitional supports and targeted services coordination in the process. 

 

Dr. Pierce explained that the recommendation was probably one of the most important with regard to Nevada’s compliance with the Olmstead decision, and also to demonstrate that institutional care was not an appropriate setting or not as appropriate as community‑based settings.  Without proper transition or planning into the community, people would not be successful, as had been observed in many disability populations where institution doors were opened and people were left on the streets without proper transition into the mainstream of the community.  Dr. Pierce hoped the subcommittee and Legislature would not put the recommendation off into the future, as action was needed to demonstrate success.

 

Chairman Titus asked Mr. Willden to address the funding aspect of the recommendation. Mr. Willden pointed out that the fiscal note on the recommendation was relatively small at $31,000; however, that amount would be for a one-time assessment of persons in institutions.  Senator Rawson inquired whether there would be the possibility of transferring funds under Title XX.  Mr. Willden explained that Title XX funding was entirely earmarked for other programs, and in order to transfer funds, funding would have to be cut from a current recipient of Title XX funding.  It appeared to be an appropriate Medicaid fundable activity, and Mr. Willden could not explain why Title XX funding was being targeted rather than Title XIX funding, other than it was all block grant dollars rather than state dollars.

 

Ms. Loux explained there was a series of recommendations within Task Force Recommendation Number 31 that would not actually be considered functions of state government.  The Task Force had received testimony from numerous people regarding programs in other states that contracted with either centers for independent living or with agencies within the community that worked with people with disabilities.  Those entities actually conducted assessments of people with disabilities in nursing homes, and then worked to coordinate services such as housing, the purchase of pots and pans, transportation, Medicaid services, etc., that could be utilized by the disabled person for transition into the community.  Ms. Loux stated the recommendations within Task Force Recommendation 31were:

 

1.      Ongoing assessments of 125 people with disabilities per year.

2.      Case management by people in the community, and by those agencies already working with people with disabilities that could assist with community resources.

3.      Creation of a small transfer fund, because persons being institutionalized very often have lost everything and literally do not have pots and pans, clothes, or bedding.  The fund would assist those persons at the rate of $3,000 per person.    

 

Ms. Loux reiterated it was not meant to be an additional state function, but rather a community‑based function.

 

John Duarte, Administrator of the Health Care Financing and Policy Division, explained that there were associated fiscal notes with the recommendation, particularly surrounding the issue of transfers.  Such transfers would require independent reviews, and according to the recommendations made by Mr. Records, DHR should make changes in its assessment tools for persons with disabilities within institutions, and there might be an associate cost with those changes.  Mr. Duarte stated any associated costs should be examined and added to the fiscal note.  Mr. Duarte believed that in relative Medicaid terms, the cost should not be a “budget‑buster.”

 

Senator Townsend asked whether the state was at risk if it identified people in institutions who met the standards, and then did not transfer them to the community.  He asked whether the state would be challengeable under Olmstead at that point. 

 

Chairman Titus stated that Senator Rawson had moved to approve the recommendation, and the subcommittee would proceed with the motion.

 

SENATOR RAWSON MOVED TO APPROVE TASK FORCE RECOMMENDATION NUMBER 31, AS A KEY TO OLMSTEAD COMPLIANCE.

 

SENATOR TOWNSEND SECONDED THE MOTION.

 

Chairman Titus asked legal staff to respond to Senator Townsend’s previous question.  Ms. Hamner explained that there would be problems under Olmstead requirements when the state identified a person who qualified for services in the community and wished to receive those services.  The state would then be required to review its fiscal responsibilities in that case.  She noted that Olmstead also required the state to identify those people, and ignoring the situation as if it did not exist would also present a potential Olmstead problem.

 

Assemblywoman Chowning stated there was something missing from the recommendation, as it stated to “identify and transfer,” but did not specify where the person would be transferred, i.e., to appropriate community services.  Chairman Titus suggested the language should read "to transfer persons currently in care to services in the community or independent living situations." 

 

Mr. Sasser concurred with Ms. Hamner’s statements, and noted if the state were to be sued under Olmstead, the potential defense for the state would be the fact that it had a comprehensive Olmstead plan in place and was implementing that plan.  According to Mr. Sasser, without an assessment piece in the plan, it would not meet the components of an Olmstead plan. 

 

Chairman Titus called for a vote on the motion before the subcommittee.

 

THE MOTION CARRIED. 

********

 

Chairman Titus announced the subcommittee’s review of the recommendations from DHR and the Task Force was complete.  She thanked committee members and all the individuals who had assisted in creation of the recommendations.  As the Legislature moved toward the 2003 Session, it was well known that it was a time of budget constraints.  Obviously, members of the subcommittee would be advocates for the recommendations presented by DHR and the Task Force; however, the Subcommittee would appreciate continued assistance from the disabled community.  Chairman Titus said no one spoke better as a witness than persons who were in need of the services, and she emphasized that disabled persons should help argue for approval of the recommendations.  As pointed out by Senator Rawson, when resources were restricted, the competition became quite fierce, and there would be many people vying for the available dollars. 

 

Senator Rawson complimented the Chairman and staff for the degree of organization during the current work session. 

 

Mr. Sasser stated he wanted to be clear regarding recommendations and whether the subcommittee had adopted items that were, in effect, the Olmstead plan.  In Mr. Records' report, it was mentioned that Olmstead compliance would not only address people in institutional settings for transfer back to the community, but also would be required to deal with people at risk of institutionalization, and divert people who might otherwise be going into institutions into community-based services.  Mr. Sasser indicated in the in‑depth strategic plan, the issue was discussed at great length; however, of the 31 items considered by the subcommittee, he did not specifically see diversion.

 

Chairman Titus stated if it were not specifically included in one of the recommendations, the issue would be addressed in the subcommittee’s overall statement as part of its goals. 

 

Dr. Pierce voiced his appreciation to the subcommittee for the careful, thoughtful reflection it took in regard to the lives of people with disabilities, even though it was not always easy, particularly during tough financial times.  Dr. Pierce opined that people with disabilities could be very proud of the hard work done by the subcommittee in providing them with an open door to walk through.

 

Public Testimony

 

Chairman Titus opened the Public Testimony portion of the agenda;  there was no public testimony.

 

Chairman Titus asked Mr. Guernsey to explain the process regarding the recommendations and BDRs approved by the subcommittee.

 

Mr. Guernsey indicated that he and Jim Rodriguez, Program Analyst, LCB, would work with Ms. Hamner to ensure that the information was correct.  Should questions arise, he would contact Chairman Titus.  He could not address the timeframe necessary to draft the BDRs.  Ms. Hamner explained that committee-approved BDRs were a top priority, and she would complete the drafts as soon as possible.

 

With no further business to come before the subcommittee, Chairman Titus declared the meeting adjourned at 12:50 p.m.      

 

                                                                                     Respectfully submitted:

 

                                                                                                         

                                                                                     _____________________________

                                                                                     Carol Thomsen, Interim Secretary

 

APPROVED:

 

__________________________________   

Senator Dina Titus, Chairman

 

DATE:____________________________