Lawmakers recommend millions in health-care improvements

The Legislative Committee on Health Care voted Monday to recommend a nearly half-billion dollar wish list of health program improvements for the disabled, seniors and all residents in rural parts of the state.

The proposals were contained in a series of four master-plan documents prepared by the Department of Human Resources.

The largest single chunk would go to enhance senior services -- $372.87 million between now and 2010. And two-thirds of that -- $268 million -- would expand services to seniors who have too much income or assets to qualify for Medicaid and move seniors from institutional settings into community or home-based services.

That was the theme throughout the presentations: moving people into less restrictive, home and community settings rather than keeping them in institutional settings.

The most sweeping changes were proposed provider rates in three-dozen existing programs. Medicaid Administrator Charles Duarte said most of those changes would sharply increase costs, especially those for the Community Training Center, and Supported Living. He said new programs for the autistic would be expensive.

Duarte said behind the rate increases for the different rehabilitation, personal assistance, parent and family support and others is "a new model for care delivery."

He said the plan would base support for different services on what they cost and provide cost of living adjustments.

More importantly, he said, it would allow the disabled and others receiving the services to select which services they most need and pay for them.

While he declined to give a specific dollar total for the changes, Human Resources officials conceded that full funding of the recommendations would be in the tens of millions.

"Obviously, the most difficult portions of our recommendations will be funding them," Human Resources Director Mike Willden told the committee.

The subject of rural health issues came up several times during the meeting, first in a discussion of the rapidly diminishing OB-GYN services available outside Nevada's urban centers.

Terry Murphy of the Clark County OB-GYN Task Force and Carolyn Ford, deputy dean of the Nevada Medical School, both said malpractice insurance and the high percentage of patients unable to pay are driving doctors willing to provide prenatal care and delivery out of rural areas. And the problems OB-GYNs are having, Ford said, are reducing the number of medical students willing to specialize in those fields.

The committee voted to support a bill draft that would seek up to $6 million to help OB-GYNs pay their medical malpractice insurance in rural areas and those where more than a certain percentage of their patients are medically indigent, qualified for Medicaid or other support.

"In essence, we are talking about an obstetrical access program," said committee Chairman Ray Rawson, R-Las Vegas.

"I realize we all have concerns about the revenue, but we have to at least lay this on the table," he said.

Similar problems were raised for health care in general in the rural areas of Nevada. The committee agreed the size and low population in rural Nevada "make sustaining an economically viable health-care delivery system impossible without the commitment of public resources and local and state levels."

The committee's support for the different programs will be carried back to Gov. Kenny Guinn as he prepares the administration's biennial budget for 2004-05.