State of Nevada ADSD



SMALL BUSINESS IMPACT STATEMENT 2016

PROPOSED AMENDMENTS TO NAC CHAPTER 435

The Aging and Disability Services Division (ADSD) has determined that the proposed amendments should not have a negative financial impact on a small business and in some circumstances may have a beneficial financial impact. The proposed regulations are not expected to negatively impact the formation, operation or expansion of a small business in Nevada.

A small business is defined in Nevada Revised Statutes NRS 233B as a "business conducted for profit which employs fewer than 150 full-time or part-time employees."

This small business impact statement is made pursuant to NRS 233B.0608 (3) and complies with the requirements of NRS 233B.0609. As required by NRS 233B.0608 (3), this statement identifies the methods used by the agency in determining the impact of the proposed regulations on a small business and provides the reasons for the conclusions of the agency followed by certification by the person responsible for the agency.

Background

The Aging and Disability Services Division (ADSD) is in the process of adoption of the Division’s regulations governing Jobs and Day Training services as required by existing law (NRS 435.220). This regulation repeals existing regulations that provide for the regulation of community-based training centers (NAC 435.200-435.350) and instead sets forth the requirements governing the provision of jobs and day training services. The Nevada Legislature repealed the previsions of Chapter 435 of NRS which previously governed the regulation of community-based training centers for the care and training of persons with intellectual disabilities and instead authorized the certification and regulation of jobs and day training services for that purpose.

In addition, ADSD is proposing changes to regulations governing Supported Living Arrangements (SLA) covering NAC 435.3305- 435.339. The major changes to this section of NAC include changing regulations involving background checks of employees or independent contractors, ensuring that all SLA providers are certified by the ADSD, codifying the standards of care that are expected from SLA providers, sanctions that may be applied to SLA providers who fail to meet standards, and lastly, makes changes to certain medications that may be administered by staff in the home.

Further, changes were made to replace the terms “mental retardation” to “intellectual disability”, and the term “related condition” to “developmental disability”. The latter is to be in compliance with AB224 which passed during the 2017 Legislative Session.

1) A description of the manner in which comment was solicited from affected small businesses, a summary of their response and an explanation of the manner in which other interested persons may obtain a copy of the summary.

A Small Business Impact Survey was sent to all Aging and Disability Services Division certified Jobs and Day Training and Supported Living Arrangement providers along with a copy of the proposed regulation changes, in July 2017.

The questions on the survey were:

1) How many employees are currently employed by your business?

2) Will a specific regulation have an adverse economic effect upon your business?

3) Will the regulation(s) have any beneficial effect upon your business?

4) Do you anticipate any indirect adverse effects upon your business?

5) Do you anticipate any indirect beneficial effects upon your business?

Summary of Response[1]

|Summary of Comments Received by Jobs and Day Training Providers |

|(23 responses were received out of 95 small business impact questionnaires distributed) |

|Will a specific regulation have an adverse|Will the regulation(s) have any |Do you anticipate any indirect |Do you anticipate any indirect |

|economic effect upon your business? |beneficial effect upon your business?|adverse effects upon your |beneficial effects upon your |

| | |business? |business? |

|No= 4 |No= 5 |No= 6 |No= 5 |

|Yes= 4 |Yes= 3 |Yes= 2 |Yes=3 |

|No Response/ |No Response/ |No Response/ |No Response/ |

|Unknown=15 |Unknown= 15 |Unknown= 15 |Unknown= 15 |

| | | | |

|Comments: None Received |Comments: None Received |Comments: None Received |Comments: None Received |

|Summary of Comments Received by Supported Living Arrangement Providers |

|(28 responses were received out of 40 small business impact questionnaires distributed) |

|Will a specific regulation have an adverse|Will the regulation(s) have any |Do you anticipate any indirect |Do you anticipate any indirect |

|economic effect upon your business? |beneficial effect upon your business?|adverse effects upon your |beneficial effects upon your |

| | |business? |business? |

|No= 15 |No= 11 |No=14 |No= 15 |

|Yes= 1 |Yes= 5 |Yes= 2 |Yes=1 |

|No Response/ |No Response/ |No Response/ |No Response/ |

|Unknown=12 |Unknown= 12 |Unknown= 12 |Unknown= 12 |

| | | | |

|Comments: None Received |Comments: None Received |Comments: None Received |Comments: None Received |

Any other persons interested in obtaining a copy of the summary may e-mail, call, or mail in a request to the:

Aging and Disability Services Division

3416 Goni Rd. Ste D-132

Carson City, NV 89706

Kate McCloskey: Phone: 775-684-5894; Email: kmccloskey@src.state.nv.us

2) Describe the manner in which the analysis was conducted.

An analysis of the input collected from stakeholders was conducted by Nevada Department of Health and Human Services Aging and Disability Services Division. The inputs collected show that majority of stakeholders felt that the proposed regulation would not directly impact their businesses. There were no additional comments which addressed any specific concerns about the revisions pertaining to the proposed regulation or its possible negative effects. The regulation informs stakeholders about the changes in language used within services related to jobs and day training and supported living arrangements without impacting costs.

An analysis determined that the proposed regulations should not have a negative fiscal impact and may have a beneficial fiscal impact for some providers.

Further, the Aging and Disability Services Division has held several opportunities for stakeholders to provide input and comments regarding the proposed changes in regulation, including the economic impact the proposed regulations may have on industry. A portion of the proposed regulations have been made as a result of the 2017 Legislative Session passage of AB224 changing the term “Related Condition” to “Developmental Disability”. A public workshop will be scheduled allowing for further input by stakeholders and the public regarding the proposed regulations and how they will impact industry. Comments received during the public workshop will also be taken into consideration for possible further revisions to the regulations to reduce the economic impact on facilities.

3) The estimated economic effect of the proposed regulation on the small business which it is to regulate including, without limitation both adverse and beneficial effects and both direct and indirect effects.

It is estimated that there would be no adverse economic effect on small businesses.

4) Provide a description of the methods that the agency considered to reduce the impact of the proposed regulation on small businesses and a statement regarding whether the agency actually used any of those methods.

When drafting the proposed regulation, the ADSD took into consideration several measures to mitigate any financial or administrative burden with the proposed changes to the regulations. The agency did not raise or impose new fees for the certification process and kept consistent with the terms of the current contract that providers have agreed to in the past. Based on initial survey results, it was determined that there would be no fiscal impact. There will also be a public workshop with the final draft of the proposed regulations for final review. Comments received during the public workshop will also be taken into consideration for possible further revisions to the regulations to reduce the economic impact on facilities.

5) The estimated cost to the agency for enforcement of the proposed regulation.

At this time, it is estimated that there would be no additional cost to the agency to enforce the proposed regulations. It is anticipated that there will not be any increase in workload caused by the changes to the certification process. Further, it is estimated that the other provisions in the proposed regulations would not result in an additional cost to the agency.

6) If the proposed regulation provides a new fee or increases an existing fee, the total annual amount the agency expects to collect and the manner in which the money will be used.

This regulation does not have a new fee, or increase in existing fees; therefore there is no impact.

7) An explanation of why any duplicative or more stringent provisions than federal, state or local standards regulating the same activity are necessary.

The proposed changes are no more stringent or restrictive than current federal, state, or local standards. Additional modification to regulation support federal guidance to replace the term “mentally retarded” with “intellectually disabled” and will align with the passage of Nevada AB224 to replace the term “Related Condition” to “Developmental Disability”.

8) Provide a summary of the reasons for the conclusions of the agency regarding the impact of a regulation on small businesses.

After reviewing the proposed regulations, reviewing internal processes and evaluating the feedback provided by different stakeholders it was concluded that the proposed regulations would not have an impact on small business.

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Explanation of Revisions and Effects of Changes on Small Business

Revisions to NAC 435 for Supported Living Services includs replacing Mental Retardation with Intellectual Disabilities and Related Conditions with Developmental Disability, per current NRS, as well as the passage of AB224 in the 2017 Legislative Session. Additional revisions include the addition of specific sanctions because of poor performance on quality assurance reviews and also includes an appeal process if the provider agency/organization has a sanction imposed on them. This revision extends the length of provider certification from 2 years to 3 years depending on the outcome of the certification quality assurance review. This revision also adds to regulations the requirement for criminal background checks for employees and sub-contractors of the organization; requirements for the retention of personnel records, to include criminal background checks and evidence of employee and sub-contractor training, as required by current funding sources, to include the Division of Health Care Financing Policy and the Centers for Medicare and Medicaid Services. This revision revises the standards for the provision of service provision to be in line with current contracts. Finally, this revision to NAC 435 lifts the prohibition for authorized and trained direct support staff staff to administer a substand which is categorized a controlled substand in schedule II by the Office of Diversion Control of the Drug Enforcement Administration, opiod agonist medications. Additionally, this revision adds the provision for trained direct support staff to administer auto-injectable epinephrine for acute or emergency anaphylactic response.

Revisions to NAC 435 for Jobs and Day Training Providers include the requirements for providers to conduct criminal background checks for employees and sub contracts, as is required by the Division of Health Care Financing and Policy and the Centers for Medicare and Medicaid Services. Pursuant to NRS 435, this revision includes regulations and policies required for the certification of providers of jobs and day training providers, including standards to the provision of services, a process of applying sanctions, as well as an appeal process for providers who have sanctions applied.

The Division estimates no significant impact on small businesses, as these are current practices outlined in the Provider Agreement/Contract the provider has signed with ADSD, as well are requirements of the Division of Health Care Financing Policy.

Certification by Person Responsible for the Agency

I, Dena Schmidt, Administrator of the Aging and Disability Services Division certify to the best of my knowledge or belief, a concerted effort was made to determine the impact of the proposed regulation on small businesses and the information contained in this statement was prepared properly and is accurate.

Signature____________________________ Date: ___________________________

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[1] Surveys that indicated they employed 150 or more employees were not included in these results.

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