COMMITTEE BRIEF

SENATE COMMITTEE ON HEALTH

AND HUMAN SERVICES

February 2017

TABLE OF CONTENTS

Introduction .................................................................................................... 1

Jurisdiction ..................................................................................................... 2

Bill Statistics from the 2015 Legislative Session ........................................................ 4

Health and Human Services Issues from the 2015-2016 Interim ..................................... 4

Session Deadlines ............................................................................................. 8

Relevant Reports .............................................................................................. 9

Concluding Remarks ........................................................................................ 12

Appendices .................................................................................................... 13

Appendix A: Contact Information ..................................................................... 13

Appendix B: Common Health and Human Services Acronyms .................................. 18

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COMMITTEE BRIEF

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

— 79TH SESSION OF THE NEVADA LEGISLATURE —

Prepared by Megan Comlossy, Committee Policy Analyst

Research Division, Legislative Counsel Bureau

February 8, 2017

INTRODUCTION During each legislative session, the Senate Committee on Health and Human Services considers numerous bills and resolutions on topics related primarily to mental health, public health and safety, public welfare, food, drugs, and cosmetics, among other issues. This Committee Brief explains the jurisdiction of the Committee, sets forth the schedule for the 2017 Legislative Session, and includes a list of topics expected to be heard by the Committee. It also provides contact information for key government officials, associations, agencies, and organizations. Staff services for the Committee during the 79th Legislative Session are provided by the following individuals: • Megan Comlossy, Committee Policy Analyst, Research Division, Legislative Counsel

Bureau (LCB);

• Eric Robbins, Committee Legal Counsel, Legal Division, LCB; • La Niesha Dawson, Committee Manager; • Martha Barnes, Committee Secretary; and • Debbie Carmichael, Committee Secretary. Additional assistance is provided by Janet Coons, Manager of Secretarial Services, Research Division, LCB.

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JURISDICTION Except for prefiled bills, bills are referred to the Committee by a vote of the Senate according to guidelines prepared by Senate leadership. In past sessions, the Committee has considered issues relating to alcohol and drug abuse, cancer, controlled substances, cosmetics labeling, food and food establishments, foster care, medical facilities, mental health, persons with disabilities, protection of children from abuse and neglect, public health, public welfare, recreational parks, sanitation, services and facilities for children, and services to aging persons and persons with disabilities, among others. Pursuant to Senate Standing Rule No. 40, the table below provides the general jurisdiction of the Committee by Nevada Revised Statutes (NRS) title and chapter number:

NRS Title NRS

Chapter Description

38—Public Welfare

422 422A 424 425 426

427A 428

430A 432

432A 432B

Health Care Financing and Policy Welfare and Supportive Services Foster Homes for Children Support of Dependent Children Persons With Disabilities Services to Aging Persons and Persons With Disabilities Indigent Persons Family Resource Centers Public Services for Children Services and Facilities for Care of Children Protection of Children from Abuse and Neglect

39—Mental Health

433 433A

433B 433C 435

General Provisions Admission to Mental Health Facilities or Programs of

Community-Based or Outpatient Services; Hospitalization

Additional Provisions Relating to Children Community Mental Health Programs Persons with Intellectual Disabilities and Related

Conditions

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40—Public Health and Safety

439 439A 439B 440

441A 442 444 446 447 449 450

450B 451 452 453

453B 453C 454 455

455A 455B 455C 457 458

458A 460

Administration of Public Health Planning for the Provision of Health Care Restraining Costs of Health Care Vital Statistics Infectious Diseases; Toxic Agents Maternal and Child Health; Abortion Sanitation (NRS 444.002 through 444.430) Food Establishments Public Accommodations Medical Facilities and Other Related Entities County Hospitals and Hospital Districts Emergency Medical Services Dead Bodies Cemeteries Controlled Substances Drug Donation Programs Good Samaritan Drug Overdose Act Poisons; Dangerous Drugs and Hypodermics Excavations and High-Voltage Lines Safety of Participants in Outdoor Sports Recreational Parks Boilers, Elevators and Pressure Vessels Cancer Abuse of Alcohol and Drugs Prevention and Treatment of Problem Gambling Human Blood, Blood Products and Body Parts

51—Food and Other Commodities: Purity; Standards; Weights and Measures; Marketing

583 584 585

Meat, Fish, Produce, Poultry and Eggs Dairy Products Food, Drugs and Cosmetics; Adulteration; Labels;

Brands

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BILL STATISTICS FROM THE 2015 LEGISLATIVE SESSION During the 2015 Legislative Session, 84 bills were referred to the Senate Committee on Health and Human Services. Of those measures, the Committee approved 69 bills. Fifty-eight bills were reported to Governor Brian Sandoval. This means that 84 percent of the bills approved by the Committee became law. In addition, one Senate resolution was referred to the Committee. The following table shows these figures.

Type of Measure

Referred to Committee

Voted Out of Committee

Reported to Governor

Bills that Became Law

Senate Measures 54 41 31 31

Assembly Measures 30 28 27 27

Total 84 69 58 58

The LCB’s Summary of Legislation 2015 provides summaries of the measures passed during the last session and is available from the LCB’s Publications Office at (775) 684-6835 and online at: http://www.leg.state.nv.us/Division/Research/Publications/SoL/2015SoL.pdf.

HEALTH AND HUMAN SERVICES ISSUES FROM THE 2015-2016 INTERIM A variety of health care issues were discussed during the 2015-2016 Interim, and many of these will likely be considered during the 2017 Legislative Session. Health Care Workforce Nevada continues to face a severe shortage of health care providers. Although the number of health care professionals has grown steadily in recent years, it has not kept pace with increases in demand for care. Increased patient demand is largely due to population growth, an aging population, the expansion of health insurance coverage as a result of the Patient Protection and Affordable Care Act (ACA) of 2010 (Public Law 111-148), and economic growth. Compared to other states, Nevada has some of the worst provider-to-population ratios in the nation. According to John Packham, Ph.D., Director of Health Policy Research, Office of Statewide Initiatives, University of Nevada, Reno, School of Medicine, Nevada ranks forty-eighth in physician-to-population ratio, fifty-first in nurse-to-population ratio, forty-seventh in psychologist-to-population ratio, thirty-eighth in pharmacist-to-population ratio, and thirty-fourth in dentist-to-population ratio. Health care providers also are poorly distributed throughout the State. The workforce shortage is more acute in rural and frontier communities. Approximately one in three Nevadans lives in

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a federally designated primary care health professional shortage area (HPSA), and one in two rural and frontier residents lives in a primary care HPSA. Similar statistics exist for dental HPSAs. In addition, more than one in two Nevadans (53.3 percent) lives in a mental health professional shortage area, and all rural and frontier residents live in areas that do not have sufficient mental health providers. Many factors influence whether health care providers practice in Nevada. These include the availability and capacity of health education and training programs, licensing and regulatory practices and climate, and recruitment and retention programs, among other things. Public Health In Nevada, public health is the responsibility of both State and local governments. Public health is generally concerned with preventing health problems and disease, promoting healthy behaviors, and protecting the health of entire populations—whether neighborhoods, towns, cities, the State, or country. One public health challenge that may be considered during the 2017 Legislative Session is the prevalence of electronic nicotine delivery devices, commonly known as e-cigarettes, vape-pens, or vapors. These battery-powered devices allow users to simulate smoking by vaporizing and inhaling liquid nicotine, flavoring, and other chemicals. Electronic nicotine delivery devices are not currently regulated by the State or federal government, although the United States Food and Drug Administration has proposed regulations. Though research continues, the American Society of Heating, Refrigeration, and Air-Conditioning Engineering Journal concluded in June 2014 “that e-cigarettes emit harmful chemicals into the air and need to be regulated in the same manner as tobacco smoking.” A study conducted by the Johns Hopkins Bloomberg School of Public Health found that e-cigarettes lower immunity to flu viruses and Streptococcus bacteria and that free radicals in the “vapor” they produce are damaging even if the product does not contain nicotine. However, some proponents of the devices argue that they function as a smoking cessation tool. The use of e-cigarettes and similar devices has increased among Nevada high school students in recent years. According to the 2015 Youth Risk Behavior Survey, approximately 25 percent of Nevada high school students report using e-cigarettes, compared to approximately 6 percent of students who use traditional cigarettes. Nationwide, recent decreases in use of tobacco products among youth have been offset by increased use of electronic nicotine delivery devices. Furthermore, a study published in Nicotine & Tobacco Research found that between 2011 and 2013, the use of e-cigarettes tripled among middle and high school students who did not smoke conventional cigarettes. Among those who used an e-cigarette at least once, nearly 44 percent intended to smoke conventional cigarettes—more than twice the rate of those who had never smoked.

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Currently, neither advertising nor access to minors is regulated by the State or the federal government. Between 2013 and 2015, 97 calls to the Nevada Poison Center were related to nicotine poisonings. Sixty-five percent of those calls involved children under 5 years old. Medicaid Reimbursement Rates During the 2015-2016 Interim, the Legislative Committee on Health Care (LCHC) heard testimony from numerous entities and individuals at multiple meetings regarding Medicaid reimbursement rates and their influence on health professionals’ willingness to enroll in Medicaid and provide services to Medicaid recipients. Testimony indicated that low reimbursement rates influence provider participation in Medicaid, which directly affects the size of Medicaid’s provider network and patient access to care. According to the Division of Health Care Financing and Policy (DHCFP), Department of Health and Human Services (DHHS), rates are calculated using different methodologies outlined in the Medicaid State Plan. Most fee-for-service rates are based on a percentage of Medicare rates. Significant rate changes are developed during budget planning and rates are reviewed on a five-year rolling basis. If an interim rate adjustment is needed, it can be made only if funding is available within the existing budget. As of the LCHC meeting on April 20, 2016, the following proposed rate changes were in process: • Special care rates for behaviorally complex skilled nursing facility recipients;

• Multiple encounters for federally qualified health center providers;

• Pediatric enhancement for surgical codes (30000–39999);

• Emergency medical response for fire districts;

• Neonatal intensive care unit tiered rates;

• Community paramedicine reimbursements; and

• New residential treatment centers. Behavioral Health Nearly one in five adults in Nevada (18.5 percent) had a mental illness in 2014, according to the Substance Abuse and Mental Health Services Administration. Of those individuals, more than 4 percent had a serious mental illness, which includes certain mental disorders that result in substantial impairment in carrying out major life activities. The State also faces a severe shortage of behavioral health professionals. All but one of the State’s counties are federally designated as a mental health professional shortage area. Prior to the 2010 federal ACA, the State provided most mental health care for the severely mentally ill in Nevada. Following implementation of the ACA, the number of insured individuals increased and so too did demand for services, as well as the complexity and acuity

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of needs. Because more individuals now have insurance, demand for services provided by the State at Northern Nevada Adult Mental Health Services and Southern Nevada Adult Mental Health Services has decreased as patients seek services from private providers in the community. The behavioral health workforce shortage presents a serious challenge for individuals across the State. It is especially acute in rural counties—many of which do not have any behavioral health care providers. Individuals with mental illness in rural Nevada often end up in jail or in a rural hospital’s small emergency department. In addition, while shortages exist across behavioral health professions, accessing psychiatric care and specialty psychiatry is especially difficult for forensic patients, patients with co-occurring disorders, those dually diagnosed with intellectual and developmental disabilities and behavioral health disorders, geriatric patients, and children. Health Profession Licensing Boards In Nevada, 20 boards license and regulate health professionals. Although each board’s powers and duties are slightly different, they are generally responsible for establishing licensure requirements, processing applications, granting and renewing licenses, developing and enforcing standards and regulations, investigating complaints, and taking disciplinary action. Health profession licensing boards serve as the gateway between the pool of potential health care providers and the pool of licensed health care professionals available to serve Nevadans. They are in a position to facilitate the licensure application process while ensuring adherence to standards and regulations and protecting patient safety. Each board is an independent body. Members are appointed by the Governor of the State of Nevada, but neither the Executive Branch nor the Legislative Branch has direct regulatory or administrative oversight of the boards. In addition, in many cases, the only recourse applicants and licensees have to appeal adverse decisions by a board is to go to a hearing of the full board or file a lawsuit in court. For some applicants or licensees, the cost of such action is prohibitive.

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The following deadlines for the 2017 Legislative Session are particularly important to the Committee’s work, including the dates by which measures must be passed from one house to the other.

Date Deadline

Monday, February 6 Legislators’ prefile or withdraw bill draft requests (BDRs)

Monday, February 13 Legislators’ BDR requests

Monday, February 20 Joint Standing Rule No. 14 BDR requests

Monday, February 27 Joint Standing Rule No. 14 BDR details

Monday, March 20 Introduction of bills by individual legislators

Monday, March 27 Introduction of bills pursuant to Joint Standing Rule No. 14

Friday, April 14 Bills must pass, if at all, out of committee of reference in house of origin

Tuesday, April 25 Bills must pass, if at all, out of house of origin

Friday, May 19 Bill must pass, if at all, out of committee of reference in second house

Friday, May 26 Bill must pass, if at all, out of second house

Monday, June 5 Sine Die A bill may be exempt from these deadlines if it contains an appropriation or if the Fiscal Analysis Division of the LCB determines it authorizes certain expenditures by State agencies, creates or increases a significant fiscal liability of the State, implements a budget decision, or significantly decreases State revenue. To be exempt, a policy committee must take action by the deadline for first house committee passage (April 14). The bill must then be rereferred to a money committee by the deadline for first house passage (April 25).

SESSION DEADLINES

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This section highlights key reports on health and human services issues, including reports produced by legislative committees or at the direction of a legislative committee, published by the LCB, and mandated by statute. 2015–2016 Interim Committee Bulletins • Legislative Committee on Health Care (Bulletin No. 17-15)—The LCHC

(NRS 439B.200) oversees a broad spectrum of issues related to the quality, access, and cost of health care for all Nevadans. The Committee was established in 1987 to provide continuous oversight of matters relating to health care.

• Legislative Committee on Child Welfare and Juvenile Justice (Bulletin No. 17-11)—The

Legislative Committee on Child Welfare and Juvenile Justice (NRS 218E.705) is a statutory committee that reviews and evaluates issues related to child welfare services and juvenile justice and makes legislative recommendations to the Legislature.

• Legislative Committee on Senior Citizens, Veterans and Adults with Special Needs

(Bulletin No. 17-12)—The Legislative Committee on Senior Citizens, Veterans and Adults with Special Needs (NRS 218E.750) reviews, studies, and comments on issues relating to financial and physical wellness, abuse, advocacy, home- and community-based services, appointment of guardians, and long-term care for these populations.

• Subcommittee to Conduct a Study on Postacute Care (Bulletin No. 17-3)—The

Subcommittee to Conduct a Study of Postacute Care (Assembly Bill 242 [Chapter 306, Statutes of Nevada 2015]) is required to conduct a study relating to postacute care in Nevada, including a review of the quality and cost of postacute care; alternatives to institutionalization; cost savings of home- and community-based waiver programs; the impact of alternatives to institutionalization on the quality of life of a person receiving postacute care services; and State and national quality measures and methods for funding postacute care.

• Regionalizing the Mental Health System in Nevada: Considerations and Policy

Options (Bulletin No. 17-6)—At its April 4, 2016, meeting, the Legislative Commission (LC) directed the LCB to study factors that may influence regionalizing the behavioral health system in Nevada. Commission members requested LCB staff to work with the DHHS, local government entities, and community advocates to report on: (1) issues the Legislature may wish to consider in proposing legislation to regionalize mental health in Nevada; and (2) examples of states that have regionalized their mental health system, including successful and unsuccessful strategies and the advantages and disadvantages of transitioning to a regionalized behavioral health system.

RELEVANT REPORTS

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LCB Publications The Research Division of the LCB produces various publications on specific health and human services issues in Nevada. Reports range from in-depth Policy and Program Reports to shorter briefs and fact sheets. Policy and Program Reports • Health Care and Health Insurance (April 2016)

• Human Services (April 2016)

• Senior Citizens (April 2016) Research Briefs and Fact Sheets • Electronic Cigarettes and “Vaping” (January 2016) • Nevada Medical Marijuana Program (January 2016) • Health Care in Nevada: Statistics and Rankings (December 2015) • Telehealth in Nevada (February 2016)

Legislative Audits The Audit Division of the LCB conducted audits on the following health and human services issues during the 2015–2016 Interim. Complete copies of the audits are available online at: https://www.leg.state.nv.us/Division/Audit/Full/execfulllist.cfm. • Review of Governmental and Private Facilities for Children, January 2017 (LA18-06) • Department of Health and Human Services, Aging and Disability Services Division

(LA18-04) • Department of Administration, Division of Human Resource Management, Information

Security (LA16-15)

• Nevada State Board of Dental Examiners (LA16-14) • Review of Governmental and Private Facilities for Children, May 2016 (LA16-13) • Silver State Health Insurance Exchange (LA16-12)

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• Department of Health and Human Services, Division of Child and Family Services (LA16-11)

• Department of Health and Human Services, Division of Health Care Financing and Policy

(LA16-02) Statutory Reports The Legislature requires various State and local entities to provide reports to the Legislature, LC, Interim Finance Committee (IFC), and other legislative committees. Reports that may be of interest to the Committee include:

Entity NRS Subject of Report Submit to Date Due

DHHS 232.320 Master plan concerning human services

Legislature Beginning of regular session

Board of County

Commissioners

244.2962

Information concerning transports by the fire department or ambulance service of sick or injured persons to a medical facility

LCHC and Director,

LCB

Each calendar quarter

DHCFP 422.390 Regulations related to the calculation of disproportionate share payments to hospitals

IFC Quarterly

DHHS 432B.178 Child welfare system evaluation Director,

LCB January 1 odd year

DHHS 439.630 Fund for a Healthy Nevada LCHC and

IFC Each regular

session

Governor 439.970, 439.980, 439.983

Public health emergencies Legislature, LC, or LCHC Varied

DHHS 439A.083 Laws and regulations affecting the cost of health care

Legislature December 31 even years

DHHS 439A.290 Request for the release of certain information - hospitals and surgical centers for ambulatory patients

LCHC July 1 each

year

Hospitals 449.242 Hospital staffing committees Director, LCB and LCHC

Yearly

Division of Public and Behavioral

Health (DPBH)

449.446 Anesthesia services in certain facilities

LCHC and LC

Annually

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DPBH 449.446 Surgical centers for ambulatory patients

LCHC and LC

Annually

DHHS 449.520 Department’s operations and activities for the preceding fiscal year

LCHC and IFC

October 1 each year

State Board of Health

450B.795 Wait times and circumstances for provisions of emergency services to certain persons

LCHC Quarterly

CONCLUDING REMARKS The Research Division is available to assist the Committee and its members on any issue related to matters before the Committee. In addition, the Research Division provides individual members of the Legislature with information and assistance, on a confidential basis, on any topic. The Research Division is located on the first floor of the Sedway Office Building (775/684-6825) and maintains an office in Room 1122 of the Legislative Building. Please do not hesitate to ask for assistance.

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APPENDICES

APPENDIX A: CONTACT INFORMATION The following table provides information on State agencies that frequently appear before the Senate Committee on Health and Human Services. The list is not intended to be exhaustive.

DEPARTMENT OF HEALTH AND HUMAN SERVICES Department of Health and Human Services http://dhhs.nv.gov/ Richard Whitley, M.S., Director (775) 684-4000 nvdhhs@dhhs.nv.gov

Division of Welfare and Supportive Services https://dwss.nv.gov/ Steve H. Fisher, Administrator (775) 684-0500

Aging and Disability Services Division http://adsd.nv.gov/ Edward Ableser, Ph. D., Administrator (775) 687-4210

Office of the State Public Defender http://dhhs.nv.gov/Resources/PD/Public_Defender/ Karin L. Kreizenbeck, State Public Defender (775) 684-1080

Division of Child and Family Services http://dcfs.nv.gov/ Kelly Wooldridge, Administrator (775) 684-4459

Office of Suicide Prevention http://suicideprevention.nv.gov/ Misty Vaughan Allen, M.A., Coordinator, Statewide Program for Suicide Prevention (775) 688-2964, Ext. 249 (702) 486-8225

Division of Health Care Financing and Policy http://dhcfp.nv.gov/ Marta Jensen, Acting Administrator (775) 684-3676

Office for Consumer Health Assistance http://dhhs.nv.gov/Programs/CHA/ Janise Wiggins, Governor’s Consumer Health Advocate (702) 486-3587 (888) 333-1597

Division of Public and Behavioral Health http://dpbh.nv.gov/ Cody L. Phinney, M.P.H., Administrator (775) 684-4200

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DEPARTMENT OF EMPLOYMENT, TRAINING AND REHABILITATION

Department of Employment, Training and Rehabilitation http://detr.state.nv.us/ Don Soderberg, Director (775) 684-3911

Rehabilitation Division http://detr.state.nv.us/Rehab%20pages/rehab.htm Shelley Hendren, Administrator (775) 687-6860

DEPARTMENT OF BUSINESS AND INDUSTRY

Department of Business and Industry http://business.nv.gov/ Bruce Breslow, Director (775) 684-2999

Division of Insurance http://doi.nv.gov/ Barbara Richardson, Commissioner of Insurance (775) 687-0700

SELECTED COUNTY ORGANIZATIONS

Clark County http://www.clarkcountynv.gov/administrative-services/Pages/default.aspx Sabra Smith-Newby, Assistant County Manager (702) 455-3226 (702) 525-7651

Washoe County https://www.washoecounty.us/ Jamie Rodriguez, Management Analyst/Government Affairs (775) 328-2010 jrodriguez@washoecounty.us

Clark County Social Service http://www.clarkcountynv.gov/social-service/Pages/default.aspx Michael J. Pawlak, Director (702) 455-4270

Washoe County Health District https://www.washoecounty.us/health/ Kevin Dick, District Health Officer (775) 328-2415

Southern Nevada Health District http://www.southernnevadahealthdistrict.org/ Joseph P. Iser, M.D., Chief Health Officer (702) 759-1000

Washoe County Department of Social Services https://www.washoecounty.us/socsrv/ Amber Howell, Director (775) 328-2700

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SELECTED COUNTY ORGANIZATIONS (CONT.)

Washoe County Senior Services https://www.washoecounty.us/seniorsrv/ Ken Retterath, Director (775) 328-2575

Senior Law Project of Nevada Legal Services http://nlslaw.net/ George McNally, Attorney (775) 334-3050

SELECTED BOARDS

Board of Dental Examiners of Nevada http://dental.nv.gov/ Debra Shaffer-Kugel, Executive Director (702) 486-7044 (800) 337-3926

State Board of Nursing http://nevadanursingboard.org/ Cathy Dinauer, M.S.N., R.N., Executive Director (775) 687-7700 (800) 590-6726 nursingboard@nsbn.state.nv.us

Board of Medical Examiners http://medboard.nv.gov/ Edward O. Cousineau, J.D., Executive Director (775) 688-2559 (888) 890-8210

State Board of Pharmacy http://bop.nv.gov/ Larry L. Pinson, Executive Secretary (775) 850-1440 (888) 364-2081 pharmacy@pharmacy.nv.gov

OTHER INTEREST GROUPS

AARP Nevada State Office http://states.aarp.org/region/nevada/ Maria Dent, AARP Nevada State Director (702) 938-3238 Barry Gold, Director of Government Relations (702) 938-3236

High Sierra Industries www.hsireno.com LaVonne Brooks, President/CEO (775) 829-7400, Ext. 101 lavonneb@hsireno.com

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OTHER INTEREST GROUPS (CONT.)

Nevada Dental Association http://www.nvda.org/

Robert H. Talley, D.D.S., Executive Director (702) 225-4211 (800) 962-6710

Nevada Disability Advocacy and Law Center http://www.ndalc.org/

Jack Mayes, Executive Director (775) 333-7878 (800) 992-5715

Nevada Health Care Association http://www.nvhca.org/

Daniel Mathis, President/CEO (866) 307-0942 (702) 434-2273 daniel@nvhca.org

Nevada Health Centers, Incorporated https://www.nevadahealthcenters.org/

Walter Davis, CEO (775) 887-1590, Ext. 1114 (800) 787-2568

Nevada Hospital Association https://nvha.net/

Bill Welch, President and Chief Executive Officer (775) 827-0184 bill@nvha.net

Nevada Nurses Association www.nvnurses.org

Carol Swanson, D.N.P., R.N., Legislative Chair (775) 841-2208 swansonc89705@msn.com

Nevada Parents Encouraging Parents http://www.nvpep.org/

Karen Taycher, Executive Director (702) 388-8899 (800) 216-5188 ktaycher@nvpep.org

Nevada Primary Care Association http://nvpca.org/

Nancy Hook, Executive Director (775) 887-0417

Nevada Rural Hospital Partners http://nrhp.org/

Joan Hall, President (775) 827-4770 joan@nrhpi.com

Nevada State Medical Association https://nvdoctors.org/

Catherine M. O’Mara, J.D., Executive Director (775) 825-6788 catherine@nvdoctors.org

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OTHER INTEREST GROUPS (CONT.)

Opportunity Village http://www.opportunityvillage.org/ Robert Brown, CEO (702) 259-3707 bob@opportunityvillage.org Ed Guthrie, CEO Emeritus (702) 259-3700 guthrie@opportunityvillage.org

Planned Parenthood (PP) Nevada Advocates for PP Affiliates www.nevadaadvocates.org Elisa Cafferata, President and CEO (775) 412-2087 info@nevadaadvocates.org

Planned Parenthood Mar Monte (Northern Nevada) https://www.plannedparenthood.org/planned-parenthood-mar-monte Daela Gibson, Director of Public Affairs (775) 321-8702 daela_gibson@ppmarmonte.org

Planned Parenthood of Southern Nevada www.pprm.org Samantha Fredrickson, Public Affairs Coordinator (702) 878-3622, Ext. 200 samantha.fredrickson@pprm.org

Progressive Leadership Alliance of Nevada www.planevada.org Bob Fulkerson, State Director (775) 348-7557 bfulkerson@planevada.org

Retired Public Employees of Nevada www.rpen.org Terri Laird, Executive Director (775) 882-7832 info@rpen.org

University Medical Center of Southern Nevada https://www.umcsn.com/ Mason VanHouweling, CEO Jennifer Gaca, Associate Administrator, Intergovernmental Relations (702) 383-3860

University of Nevada School of Medicine www.unr.edu/med Thomas L. Schwenk, M.D., Dean (775) 784-6001

Additional contact information is available in the Nevada Legislative Manual 2017 “Directory of State and Local Government,” (http://leg.state.nv.us/Division/Research/Publications/Directory/index.cfm) or by contacting the Committee Policy Analyst.

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APPENDIX B: COMMON HEALTH AND HUMAN SERVICES ACRONYMS

KEY: State Agency

Federal Agency

ACF—Administration for Children and Families

ACO—Accountable Care Organization

ADA—Americans with Disabilities Act of 1990

ADHC—Adult Day Health Care

ADL—Activities of Daily Living

AG—Attorney General

AGCF—Adult Group Care Facility

AHA—American Hospital Association

ALF—Assisted Living Facility

ALJ—Administrative Law Judge

AMA—American Medical Association

AOA—Administration on Aging

APA—Administrative Procedures Act

APD—Advanced Planning Document

ARRA—American Recovery and Reinvestment Act

BBA—The Balanced Budget Act of 1997

BHC—Behavioral Health Center

BHO—Behavioral Health Organization

BIA—Bureau of Indian Affairs

BOE—Board of Medical Examiners

CAH—Critical Access Hospital

CAP—Corrective Action Plan

CBA—Cost Benefit Analysis

CBO—Congressional Budget Office

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CCDBG—Child Care Development Block Grant

CDC—Centers for Disease Control and Prevention

CFR—Code of Federal Regulations

CHAP—Child Health Assurance Program (DWSS)

CHIP—Children’s Health Insurance Program or NV Check Up (DHCFP)

CHIP—Community Home-based Initiative Program (ADSD)

CMS—Centers for Medicare and Medicaid Services

COB—Coordination of Benefits

COBRA—Consolidated Omnibus Budget Reconciliation Act

COLA—Cost of Living Adjustment

CPS—Child Protective Services (DCFS)

CSBG—Community Services Block Grant

CSE—Child Support Enforcement (DWSS)

DA—District Attorney

ADSD—Aging and Disability Services Division

DAG—Deputy Attorney General

DCFS—Division of Child and Family Services

DPBH—Division of Public and Behavioral Health

DD—Developmentally Disabled

DEA—Drug Enforcement Agency

DETR—Department of Employment, Training and Rehabilitation

DHCFP—Division of Health Care Financing and Policy (Medicaid)

DHHS—Department of Health and Human Services

DME—Durable Medical Equipment

DRA—The Deficit Reduction Act of 2005

DWSS—Division of Welfare and Supportive Services

E and P—Eligibility and Payments (DWSS)

EBT—Electronic Benefit Transfer

EFT—Electronic Funds Transfer

EHB—Essential Health Benefits (SSHIX)

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EHR—Electronic Health Record

EITC—Earned Income Tax Credit

EMA—Emergency Medicaid Assistance

EOB—Explanation of Benefits

EPS—Elder Protective Services (ADSD)

EPSDT—Early Periodic Screening, Diagnosis, and Treatment (Healthy Kids) (DHCFP)

EQRO—External Quality Review Organization

ERISA—Employee Retirement Income Security Act of 1974

ESD—Employment Security Division (DETR)

ESRD—End Stage Renal Disease

FDA—Food and Drug Administration

FEIN—Federal Employee Identification Number

FEMA—Federal Emergency Management Agency

FFP—Federal Financial Participation

FFY—Federal Fiscal Year

FHA—Federal Housing Administration

FLSA—Fair Labor Standards Act

FMAP—Federal Medical Assistance Percentages

FOCIS—Facility Outreach and Community Integration Services (Medicaid)

FPL—Federal Poverty Level

FQHC—Federally Qualified Health Center

FTE—Full Time Equivalent

FY—Fiscal Year

GAO—Government Accountability Office

GovCHA—Office for Consumer Health Assistance

HAWC—Health Access Washoe County

HCBW—Home and Community Based Waiver (Medicaid)

HHA—Home Health Agency/Home Health Aide

HIE—Health Information Exchange

HIPAA—Health Insurance Portability and Accountability Act

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HIT—Health Information Technology

HIWA—Health Insurance for Work Advancement (Medicaid)

HMO—Health Maintenance Organization

HRSA—Health Resources and Services Administration

HUD—Housing and Urban Development

ICF/IID—Intermediate Care Facility for Individuals with Intellectual Disabilities (Medicaid)

IDT—Interdisciplinary Team

IHS—Indian Health Services

INR—Investigations and Recovery (DWSS)

IRB—Institutional Review Board

ITC—Inter-Tribal Council

JCAHO—Joint Commission on the Accreditation of Healthcare Organizations

KFF—Kaiser Family Foundation

Katie Beckett (Medicaid)

LCSW—Licensed Clinical Social Worker

LIHEA—Low Income Home Energy Assistance

LOC—Level of Care

LOS—Length of Stay

LTC—Long-Term Care

LTD—Long-Term Disability

M+CO—Medicare Plus Choice Organization

MA—Medical Assistance

MAABD—Medical Assistance to the Aged, Blind, and Disabled (DWSS)

MCH—Maternal and Child Health (DPBH)

MCO—Managed Care Organization

MDT—Multi-Disciplinary Team

MDS—Minimum Data Set

MER—Medicaid Estate Recovery Program (Medicaid)

MFCU—Medicaid Fraud Control Unit (AG)

MFT—Marriage and Family Therapist

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MI—Medically Indigent

MOE—Maintenance of Effort

MOU—Memorandum of Understanding

MR—Medical Review

MRI—Magnetic Resonance Imaging

MRT—Medical Review Team

NACO—Nevada Association of Counties

NET—Non-Emergency Transport

NF—Nursing Facility

NGA—National Governors Association

NHQR—Nevada Healthcare Quality Report

NOD—Notice Of Decision

NOI—Notice of Intent

NOMADS—Nevada Operations of Multi-Automated Data Systems (DWSS)

NP—Nurse Practitioner

NPRM—Notice of Proposed Rulemaking

OBRA—Omnibus Budget Reconciliation Act

OIG—Office of the Inspector General

Olmstead Act—Supreme Court decision regarding deinstitutionalization of individuals with disabilities

OMH—Office of Minority Health (DHHS)

OT—Occupational Therapy

OTC—Over the Counter

PA—Physician's Assistant

PACE—Program for All-Inclusive Care for the Elderly

PAR—Prior Authorization Request

PASRR—Pre-Admission Screening and Resident Review

PCA—Personal Care Aide/Attendant

PCCM—Primary Care Case Management

PCN—Primary Care Network

PCP—Primary Care Provider

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PERS—Public Employees' Retirement System

PL—Patient Liability

PMPM—Per Member Per Month

PPACA—Patient Protection and Affordable Care Act

PPD—Permanent and Partial Disability

POS—Point of Sale or Purchase of Service

PPO—Preferred Provider Organization

PT—Physical Therapy

QA—Quality Assurance

QC—Quality Control

QHP—Qualified Health Plan

QMB—Qualified Medicare Beneficiary

RA—Remittance Advice

RD—Redetermination of Eligibility

RFP—Request for Proposal

RHC—Rural Health Center

RSDI—Retirement, Survivors and Disability Insurance (SSA)

RTC—Residential Treatment Center

SAMHSA—Substance Abuse and Mental Health Services Administration

SAPTA—Substance Abuse Prevention Treatment Agency (DPBH)

SED—Seriously Emotionally Disturbed

SFY—State Fiscal Year

SH—Subsidized Housing

SHOP—Small Business Health Options Program

SLMB—Special Low-Income Medicare Beneficiary

SNF—Skilled Nursing Facility

SSA—Social Security Administration or Act

SSBG—Social Services Block Grant

SSD—Social Security Disability

SSI—Supplemental Security Income

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SSN—Social Security Number

SSHIX—Silver State Health Insurance Exchange

SUR—Surveillance and Utilization Review (Medicaid)

TANF—Temporary Assistance to Needy Families (DWSS)

TCM—Targeted Case Management

TPA—Third Party Administrator

TPL—Third Party Liability

UCC—Usual and Customary Charge

UIB—Unemployment Insurance Benefits

UMC—University Medical Center

UPL—Upper Payment Limit

UR—Utilization Review

USDA—United States Department of Agriculture

VA—Veterans Administration

VS—Vital Statistics

WIC—Women, Infants and Children (Health)

*The following roman numerals refer to the titles of the federal Social Security Act.

XIX—Medicaid Program (SSA)

XX—Social Services Block Grant (SSA)

XXI—Children’s Health Insurance Program (SSA)

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