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From YouTube: 3/24/2021 - Assembly Committee on Commerce and Labor
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A
E
F
A
Here,
thank
you
and
madam
secretary,
please
mark
all
members
present.
I
see
that
assemblywoman
told
is
here
welcome
to
the
audience
tuning
in
over
the
internet.
Before
we
start
I'd
like
to
make
some
housekeeping
announcements,
please
remember
all
exhibits.
Testimony
and
amendments
must
be
submitted
by
noon
on
the
business
day
prior
to
the
committee
meeting
persons
who
wish
to
provide
testimony
or
attend
the
meeting
virtually
must
pre-register
online
at
the
legislature's
website.
The
public
is
strongly
encouraged
to
submit
written
testimony
in
advance
of
the
meeting
by
emailing.
A
The
assembly,
commerce
and
labor
zoomchat
is
reserved
for
committee
business.
Only
members,
please
remember
to
keep
your
camera
on
at
all
times.
This
will
ensure
that
we
have
a
quorum
unless
you
are
stepping
away
from
non-committee
related
business
members
and
presenters.
Please
remember
to
keep
your
microphone
muted
at
all
times.
Unless
you
are
answering
a
question,
then
you
can
unmute
yourself
and
then
promptly
mute
yourself
right
after.
Thank
you,
everyone
let's
go
ahead
and
begin
with
our
first
agenda
item
today.
A
A
Remember
that
a
vote
in
favor
of
introducing
a
bill
drop
does
not
imply
a
commitment
to
support
the
measure
later
pursuant
to
assembly
standing
rule
5,
57,
section
7..
All
this
action
does
is
allow
the
bdr
to
become
a
bill
and
then
go
to
the
floor
to
be
referred
to
a
committee
for
possible
hearings.
I
will
entertain
a
motion
to
introduce
bdr10812
so
moved.
Madam
chair,
I
have
a
first
by
vice
chair
carlton.
A
A
Okay,
see
none.
Madam
secretary,
will
you
please
call
a
roll.
D
G
A
Yes,
motion
carries.
Thank
you.
Members.
Okay.
Next
item
on
our
agenda
is
bill
hearings.
We
have
four
bills
on
the
agenda
today,
starting
with
assembly
bill
180.
I
will
now
open
the
hearing
on
assembly
bill
180,
which
revises
provisions
governing
policies
of
insurance
which
provide
for
the
payment
of
expenses
which
are
not
covered
by
medicare.
I
believe
we
have
assembly
member
alexis
hanson
with
us.
Welcome
to
the
committee
member
hanson
when
you're
ready.
Please
proceed.
H
Thank
you
so
much
chair,
howdy
gee
for
the
opportunity
and
good
afternoon,
and
thank
you,
committee
of
commerce
and
labor
for
hearing
this
bill
today
for
the
record.
I'm
alexis
hanson
representing
assembly,
district
32,
and
it's
in
the
course
of
the
work
that
we
do
as
legislators
that
we
get
the
unique
opportunity
to
be
able
to
meet
with
our
constituents
and
hear
their
needs
and
and
what
we
might
be
able
to
do
here
and
I'm
going
to
let
millie
custer
from
from
humboldt
county.
Tell
you
a
little
bit
about
her
story.
H
If
that's
okay,
chair
when
I'm
done
with
my
opening
remarks,
but
I'm
here
today,
though,
to
present,
as
as
I've
discussed
with
millie
and
her
concerns
and
found
out,
there
are
many
in
the
same
situation
in
nevada
that,
as
I
present
assembly,
bill
180,
which
requires
insurers,
offering
insurance
policies
for
the
payment
of
expenses
not
covered
by
medicare,
to
offer
at
least
one
such
policy
to
provide
certain
coverage
to
persons
with
disabilities.
H
Under
the
age
of
65..
For
americans,
who
become
eligible
for
medicare
upon
turning
65
enrollment
in
medigap
plans
is
guaranteed
during
a
six-month
federally
mandated
enrollment
period.
During
this
time,
all
available
medigap
plans
are
guaranteed
issuance,
regardless
of
a
person's
medical
history.
Medigap
is
a
set
of
standardized
plans
that
supplement
what
medicare
does
not
cover
these
plans.
H
Pay
for
items
such
as
deductibles,
co-pays
and
co-insurance
states
can
create
their
own
rules
to
enable
I'm
sorry
to
ensure
that
disabled
medicare
beneficiaries
under
the
age
of
65
are
able
to
enroll
in
supplemental
insurance
coverage,
and
the
majority
of
states
have
done
so.
Nevada
has
not
enacted
a
provision
to
ensure
access
to
supplemental
coverage
for
those
who
are
disabled
under
65,
and
there
do
not
appear
to
be
any
plans
with
guaranteed
issuance
available
for
this
population.
H
I
would
like
to
walk
through
the
bill
real
quick.
I
won't
say
that
word
simple,
because
we
know
what
that
can
do,
but
in
the
bill
in
section
one
there's
just
the
two
sections
in
section
one.
The
new
language
would
be
that
the
regulations
must
require
each
insurer
offering
such
a
policy
to
offer
at
least
one
such
policy
to
provide
coverage
for
persons
with
a
disability
who
are
less
than
65
years
of
age
and
eligible
for
medicare.
H
There
are
two
friendly
amendments
that
are
up
on
nellis
and
I
also
have
here
today
and
chair
at
your
pleasure.
I
have
millie
custer
from
humboldt
county
from
winnemucca,
my
constituent,
if
she
could
have
a
moment
to
share
her
story
and
the
statement
of
need
that
led
me
to
bring
this
bill
and
also
for
a
resource
for
questions
to
be
answered,
since
this
certainly
is
not
my
expertise.
H
I'm
happy
to
have
heidi
sterner
from
the
nevada
association
of
health
underwriters
with
us,
also
jason,
casey,
medicare
senior
benefits
person
from
reno,
and
then
I'm
grateful
to
have
the
department
of
insurance,
mr
childress
and
miss
ting
here
as
well
so
chair.
If,
if
it's
okay,
we
can
proceed.
However,
you'd,
like
with
my
with
millie
custer
from
winnemucca,
and
then
those
that
are
here
as
well.
H
If,
if
that's
fine
millie,
if
you
would
like
to
please
share
your
story,
we'd
appreciate
it.
B
I
Afternoon,
everyone,
my
name,
is
nelly
kester
for
the
record
from
winnemucca
nevada.
We've
lived
here
21
years,
I've
been
partially
paralyzed
for
36
years
from
a
brain
aneurysm
I'm
on
medicare,
but
due
to
the
fact
that
I'm
under
65
I'm
unable
to
buy
any
supplemental
insurance
to
help
with
the
medicare.
So
I'm
stuck
with
the
20
percent
all
the
time
and
I've
already
done
two
knees.
I
need
two
hips
and
so
on,
and
so
on.
I'm
not
looking
for
a
handout
just
an
option,
one
in
six
states.
I
We
have
one
in
one
six
states
the
data
is,
it
does
not
offer
any
kind
of
a
program.
It
is
not
there's
a
lot
of
people
in
my
vote.
One
or
six
people
that
are
on
medicare
are
under
65
years
old
and
I
would
really
like
to
have
an
option
and
we
can
see
how
to
do
something,
and
I
I
think
that
it's
needed
for
both
parties
and
it's
a
bipartisan
thing,
and
we
should
appreciate,
if
you
guys,
can
help
us
out.
Thank.
A
H
Thank
you
yes,
chair,
miss
sterner
has
a
powerpoint,
a
very
short
one.
I
think
she
told
me
she
could
probably
get
through
it
in
about
three
or
four
minutes,
but
we
thought
it
might
be
a
good
idea
for
us
to
have
an
overview
of
medicare
and
what
we're
looking
at
as
far
as
the
supplements
for
those
under
65
that
are
currently
not
offered
and
what
we're
trying
to
fix
with
this
legislation
so
I'll
turn
the
time
over.
If
that's,
okay,
to
miss
sterner.
A
Absolutely
miss
sterner,
thank
you
for
being
here
with
us
today
when
you're
ready.
Please
share
your
powerpoint
and
you
can
proceed.
F
Yes,
we
are
okay,
so
we're
going
to
talk
about
medicare
supplements
primarily,
but
to
understand
medicare
supplements.
I
think
you
need
to
get
a
little
bit
of
a
view
of
the
parts
of
medicare.
So
first
off
medicare
is
a
federal
program.
It's
available
to
people
who
are
65
or
older,
and
certain
younger
people
with
disabilities
and
people
who
have
end-stage
renal
disease,
which
is
a
permanent
kidney
failure
requiring
dialysis
transplant.
F
There
are
four
parts
of
medicare.
The
two
parts
we're
going
to
primarily
focus
on
are
part
a
and
part
b
part
a
covers.
The
inpatient,
hospitalization
part
b
covers
your
outpatient
care,
such
as
doctors,
visits,
lab
work,
x-rays
and
services
related
to
outpatient,
but
it
does
not
cover
prescription
drugs.
F
Persons
in
certain
certain
areas
of
nevada
have
other
options
and
they
do
have
a
medicare
advantage
option,
which
kind
of
rolls
all
of
that
into
one
plan
and
gives
you
the
part,
a
hospitalization,
the
part
b,
outpatient
services
and
often
the
part
d
prescription
drug
plans
in
one
plan.
There
are
plenty
of
these
options
in
a
couple
of
two
or
three
counties,
but
not
many
in
about
nine
counties
only
have
two
plans
which
may
not
appeal
to
everybody.
So
we're
going
to
focus
on
part
a
and
part
b.
F
Hostilization
part
a
is
a
zero
cost
premium.
If
a
person
has
worked
for
40
quarters
and
paid
into
medicare
payroll
taxes,
there
would
be
a
premium
if
you
have
not
met
those
40
quarters.
For
the
part,
a
part
b,
everyone
who
enrolls
in
part
b
will
have
a
premium.
The
standard
premium
is
148.58
per
year,
that's
the
2021
rate,
and
then
you
have
your
deductibles
and
coinsurance
out
of
pocket
for
part.
F
A
a
person
who
goes
to
the
hospital
would
have
a
one
thousand
four
hundred
and
eighty
four
dollar
per
year,
co-insurance,
deductible
and
then
they're
going
to
pay
co-insurance,
and
you
can
see
that
I've
broken
it
down
here
by
days.
So,
depending
on
how
many
days
they're
in
the
hospital
at
the
151
day
mark,
they
would
be
responsible
for
all
costs.
F
They
also
have
varying
co-pays
by
day
for
skilled
nursing.
There
is
no
maximum
out
of
pocket
if
you
are
in
the
hospital
under
part,
a
under
part
b,
which
is
the
again
the
outpatient
care
for
services
such
as
doctors,
visits,
lab
work,
x-rays,
you
have
a
203
dollar
per
year,
deductible
and
then
once
that's
satisfied,
then
the
member
or
the
beneficiary
would
pay
20
of
all
costs.
That
medicare
does
not
and
they
pay
about
80
percent
of
covered
expenses
and
the
member
would
pay
20
again.
F
There
is
no
maxim
out
of
pocket,
and
this
is
where
medicare
supplement
plans
come
into
play,
they're
also
known
as
medigap
plans,
and
they
help
fill
the
gaps
that
image
original
medicare
does
not
cover
and
they
are
sold
by
private
insurance
companies
and
that
again
would
cover
the
deductibles,
co-insurance
and
co-payments,
for
example,
to
purchase
a
medicare
supplement
plan.
You
have
to
have
original
medicare
parts
a
and
b
it
doesn't
replace
original
medicare.
It
just
is
a
supplement
to
those
two
cards.
F
You
get
them
from
private
insurance
companies
and
there's
a
monthly
premium,
and
this
premium
is
in
addition
to
any
part,
a
or
part
b
premiums.
They
are
guaranteed
renewable
as
long
as
the
premiums
are
paid
and
that
the
plan
also
stays
active
and
generally
they
don't
cover
long-term
care
vision.
Dental
hearing,
aids,
eyeglasses
or
private
duty
nursing,
a
person
can
enroll
during
as
something
women
hanson
said
they
could
enroll
in
the
first
six
months
and
that's
called
your
open
enrollment
period
and
that
typically
begins.
F
When
you
turn
age
65
and
you
enroll
in
medicare
part
a
you
have
medicare
part
a
and
b,
and
then
you
have
that
six-month
window.
It's
guarantee
issue.
You
cannot
be
denied
due
to
your
health
status
during
this
period
of
time
and
you
can
purchase
the
medicare
supplement,
any
any
policy
sold
in
nevada
without
that
health
status
review
outside
of
that
open
enrollment
period.
So
right
around
those
the
time
frame
that
you
turn
65.
F
F
Your
approval
is
not
guaranteed,
the
coverage
can
be
denied
or
you
could
have
a
premium
assessment
attached
due
to
your
health
history
for
people
that
are
under
65,
they
don't
have
that
option
currently
and
federal
law
does
not
require
that
insurance
companies
sell
these
med
gap
policies
to
people
under
age
65.,
so
some
states
so
there's
over
30
states
that
have
the
option
for
people
under
60
age,
65
with
disabilities
to
purchase
a
medicare
supplement
plan.
F
Nevada
is
not
currently
among
those
groups
that
group
of
states
in
2019
and
this
data
is
from
the
kaiser
foundation,
which
is
they
get
theirs
from
cms.
There
were
561
986
nevadans
eligible
for
medicare
467
847
of
those
were
due
to
their
age.
63
717
were
due
to
being
disabled
of
that
561
thousand.
Currently,
ninety
nine
thousand
two
hundred
and
fifty
six
were
enrolled
in
the
medicare
supplement
plan.
A
hundred
and
ninety
seven
thousand
six
hundred
and
nineteen
were
enrolled
in
a
medicare
advantage
plan.
F
The
remainder
would
either
be
the
disabled,
who
are
not
eligible
to
enroll
in
a
medicare
supplement
plan,
for
example,
and
folks
who
are
on
an
employer
plan
and
or
a
union
plan
or
coverage
through
their
spouse.
F
A
J
Yes,
madam
chair,
I
have
a
question
advice,
your
carlton
thank
you,
and
this
might
be
more
for
the
insurance
division.
But
since
this
is
the
underwriters,
I
guess
I
want
to
have
a
conversation
about
whenever
you
open
up
a
new
selection
for
insurance.
We
know
insurance
is
a
pool
and
the
more
people
in
it
the
more
the
dollars
get
divided,
but
also,
if
you
have
folks
that
are
more
high
cost
that
sometimes
it
can
have
an
effect
on
the
premium.
J
So,
by
opening
this
up
to
folks
under
65
who
are
disabled
to
be
able
to
buy
this,
will
it
be
mandated
that
each
insurance
company
sell
this
or
we're
just
giving
them
the
option?
F
Do
you
want
me
to
to
take
that
hi,
the
heidi
starter
for
the
record
from
the
nevada
association
of
health
underwriters
through
the
chair
to
the
vice
chair?
I
am
going
to
kick
that
over
to
the
insurance
commissioner
office,
just
simply
because
it's
dealing
with
rates
and
that's
the
entity
that
would
deal
with
any
rating
factors
with
regards
to
the
insurance
companies
and
their
risk
pools.
A
B
Yeah,
I'd
love
to
my
name
is
nicole
ting
from
the
nevada
division
of
insurance.
Thank
you
very
much
for
your
question.
Vice
chair,
so
I
have
with
me
jack
childress,
who
is
our
medicare.
B
So
if
it's
okay
with
you,
madam
chair,
if
we
could
ask
jack
childress
to
testify.
K
K
Vice
chair
through
to
you,
through
the
chair
right
now
in
our
regulations
through
nac
687
b,
there
are
no
the
only
rating
requirements
we
have
currently
are
the
loss
ratio
requirements
whether
the
policy
is
individual
or
group
basis,
we
don't
tell
the
actuaries
how
to
develop
their
rates
or
how
they're
going
to
pool
their
experience.
So
at
this
time
it
would
be
up
to
them.
J
So
just
to
clarify,
because
we're
doing
insurance
speak
here
and
not
everybody
who's
listening
might
not
actually
know
this
language
of
insurance
speak
that
the
individual
companies
that'll
be
mandated
to
provide.
This
will
do
an
actuarial,
look
at
it
and
decide
where
they
think
their
rates
might
be.
There
won't
be
any
guidance
from
the
state
on
whether
it
should
be
a
separate
risk
pool
or
not.
That'll
be
left
up
to
the
individual
companies.
K
J
A
Thank
you
vice
chair
for
your
questions,
members,
any
other
questions,
I'm
looking
for
a
show
of
hands,
and
I
don't
see
any
okay
at
this
time.
We
will
go
ahead
and
go
into
testimony
in
support
of
assembly
bill
180
broadcasting.
Can
we
please
check
the
telephone
line
for
any
people
wishing
to
testify
in
the
support
position.
E
L
L
Madam
excuse,
madam
chair,
my
name
is
louis
trout,
I'm
a
resident
of
humboldt
county,
I'm
also
a
board
member
on
the
humboldt
county
hospital
district,
although
I'm
speaking
as
an
individual
today,
not
as
a
representative
of
the
district,
the
current
situation
that's
been
described
as
it
is
an
inequity
that
needs
to
be
corrected
during
the
sacred
time
of
the
year,
leading
up
to
passover
and
easter.
As
president
biden
has
made
clear,
we
all
have
a
social
responsibility
to
assist
those
in
need
when
we
can
ab180
provides
such
an
opportunity.
C
A
E
E
A
H
Just
real
quick,
a
thank
you
to
all
of
you
for
your
time.
Thank
you
to
those
who
helped
me
with
understanding
this
and
presenting
this,
and
just
a
reminder
that,
in
the
amendment
we
are
asking
for
the
medicare
guarantee
issue
plan
so
that
these
can
be
affordable
for
those
that
are
disabled
under
65
to
be
able
to
get
this
medigap
insurance.
That
will
help
them
out.
So
again,
thank
you
for
your
time
and
available
for
questions
offline
if,
as
this
bill
progresses,
so
thank
you.
A
J
A
Thank
you
vice
chair
carlton
and
members
of
the
committee
for
the
record.
I
am
assemblywoman
sandra
haudege
proudly
representing
assembly
district
41,
and
I'm
here
with
you
today
to
present
assembly
bill
250,
which
establishes
the
birthday
rule
for
persons
who
are
currently
enrolled
in
the
medigap
plan.
A
The
genesis
for
assembly
bill
250
was
from
my
constituent,
rick
bronstein,
who
you,
who
you
will
hear
from
today
over
coffee.
Mr
bronstein
explained
that
nevada
has
never
had
an
open
enrollment
for
medicare
supplement
plans.
As
you
know,
the
medicare
program,
which
is
administered
by
the
centers
for
medicare
and
medicaid
services,
also
known
as
cms,
is
the
federal
health
insurance
program
under
which
qualified
individuals
receive
health
care.
A
Medicare
does
not
cover
all
medical
expenses
or
services,
and
it
also
does
not
pay
100
of
certain
covered
services.
Although
medicare
pays
for
a
certain
preventative
services
and
covers
most
medically
necessary
services,
the
percentage
of
out-of-pocket
health
care
expenses
for
medicare
beneficiaries
can
be
sizable
and
typically
increases
with
age.
A
Medicare
supplement
insurance,
also
known
as
a
medigap
policy,
is
a
distinct
type
of
insurance
policy
which
is
sold
by
private
companies
to
fill
the
gaps
in
original
medicare
plan.
Coverages
medigap
policies
are
guaranteed
issuance
at
certain
times
for
eligible
beneficiaries,
as
specified
by
state
and
federal
law,
for
example,
at
the
point
where
an
individual
first
becomes
eligible
for
medicare.
There
is
an
open
enrollment
period
when
medigap
coverage
can
be
purchased
without
medical
underwriting.
A
Medigap
policies
are
guaranteed
renewable
as
long
as
the
premium
is
paid
and,
generally
speaking,
cannot
be
cancelled
because
of
a
person's
health
condition
or
for
any
reason,
other
than
non-payment
of
premium
insurers
can,
at
their
discretion,
increase
the
premiums
for
medigap
coverage.
However,
unless
eligible
for
open,
enrollment
or
guaranteed
issuance
medicare
beneficiaries
wishing
to
purchase
medigap
coverage
or
change,
plans
are
subject
to
medical
underwriting
and
can
be
denied
coverage
based
on
their
health
status
or
claims
experience.
A
What
is
so
great
about
the
birthday
rule?
It
provides
an
opportunity
to
enroll
in
a
plan
from
a
company
that
may
offer
better
coverage
to
suit
the
needs
of
the
consumer
without
medical
underwriting.
This
means
that
just
like,
when
a
person
first
signs
up
for
a
supplemental
insurance
policy
during
the
open
enrollment
period,
an
insurance
carrier
is
prohibited
from
denying
coverage
based
on
pre-existing
health
issues.
A
The
open,
enrollment
period
will
begin
on
the
first
day
of
the
birthday
month
of
an
enrollee
and
continue
for
60
days.
This
bill
also
provides
that
30
to
60
days
before
the
beginning
of
the
open
enrollment
period,
an
insurer
must
notify
enrollees
of
the
date
that
the
open,
enrollment
period
begins
and
ends
any
rights
of
the
insured
to
change
to
a
different
plan
and
any
modifications
of
the
current
benefit
assembly
bill
250
offers
nevadans,
who
have
medigap
policies
to
annually
review
the
price
and
coverage
of
their
policies.
A
I
would
like
to
be
clear,
though
this
semester
is
not
a
free
pass
for
people
to
obtain
medi-gap
policies
who
do
not
currently
have
them.
Instead,
it
allows
enrollees
to
consider
if
other
policies
are
available,
that
better
suit
their
needs.
Vice
chair,
I
would
now
like
to
turn
it
over
to
christopher
carruthers,
with
the
health
underwriters
association,
to
give
brief
remarks
followed
by
my
constituent,
mr
bronstein,
to
give
brief
remarks.
M
Great
thank
you,
madam
chair,
and
vice
chair
and
committee.
First
of
all,
my
name
is
chris
carruthers.
I
am
a
president-elect
of
the
nevada
association
of
health
underwriters.
I'm
also
been
in
the
brokerage
business
and
selling
insurance
for
30
years
here
in
southern
nevada,
our
organization
for
the
health
underwriters.
We
are
a
professional
organization
for
our
health
and
insurance
industry
ab250
as
we
call
it.
The
birthday
rule
is
an
important
bill
that
would
help
many
nevadans,
who
are
insured
by
medicare,
with
a
medicare
supplement,
also
known
as
a
medigap
plan.
M
Currently,
anyone
who
has
medical
insurance
has
an
open
enrollment
once
a
year,
regardless
of
their
health
status,
they
can
move
change,
switch
to
another
medical
plan.
This
would
include
nevada
health
link,
medicaid,
small
and
large
employers,
medicare
advantage
plans,
except
those
who
have
medicare
supplement
plans.
M
Everyone
has
an
open
enrollment
to
move
to
a
new
plan,
regardless
of
health
status
again,
regardless
of
health
status,
except
those
who
have
a
medicare
supplement
plan.
This
bill
would
allow
for
those
medicare.
Simple
plans
can
switch
to
another
medicare
supplemental
plan
once
a
year
around
the
birth
month,
as
you
just
heard,
to
another
insurance
company
or
with
the
current
insurance
company
at
new
lower
rates
that
they're
offering
with
no
reduction
in
benefits,
regardless
of
health
status
as
insurance
producers
we've
had
our
clients
receive
rate
increases
every
year,
for
example,
for
their
supplemental
plan.
M
The
clients
contact
us
to
help
us
change
plans.
Yet
we
can't
help
them
change
a
plan
because,
due
to
health
conditions-
and
they
don't
have
to
be
serious
health
conditions,
it
could
just
be
something
that
they're
just
trying
to
manage.
That
is
very
manageable
if
you
will
and
we
just
can't
help
them.
M
Our
association
has
been
discussing
the
birthday
rule
for
some
time
now
and
we've
discussed
with
the
department
insurance
carriers.
We've
had
our
meetings
to
discuss
the
impact
to
our
clients
and
the
passing
this
bill.
We
are
in
support
of
this
passing
this
bill.
Ab250
and
we've
also
submitted
our
recommendations
for
your
consideration.
M
M
M
They
need
choice,
to
have
access
to
doctors
and
that's
what
medicare
supplement
plans
do,
and
so
we
have
limited
these
people
financially,
because
the
rates
keep
going
up
yet
they're
on
the
edge
of
how
do
I
pay
for
my
insurance
and
take
care
of
myself
and
still
seek
the
care?
I
need
from
my
doctors
that
I
trust
so
we're
in
full
support
of
this
ab250.
It's
long
overdue,
and
I'm
here
and
I'm
happy
to
answer
in
your
questions.
Thank
you.
N
Thank
you
very
much
vice
chair
and,
of
course,
the
chair
to
letting
me
speak
about
this,
and
I
come
from
california,
as
probably
90
percent
of
us
do,
and
in
california
the
birthday
rule's
been
around
for
a
while.
It
currently
says
you
can
apply
to
change
your
plan
without
underwriting.
You
can't
go
up
in
benefit
30
days
before
your
birthday,
with
an
effective
date
between
your
birthday
no
earlier
than
your
birthday,
and
you
could
apply
to
60
days
thereafter.
N
It
gives
everybody
that
has
a
medicare
supplement
plan,
including
those
under
65
the
ability
to
not
have
to
overpay
for
their
policy.
I
don't
know
if
you
want
me
to
get
into
this
I'll
go
over
very
quickly.
I
did
some
just
some
quick
rate
comparison,
because
I'm
sure
the
concern,
or
at
least
a
question
by
somebody,
would
be
what
happens
when
what
happens
to
rates
now
we're
going
to
let
people
move
all
the
time
what's
going
to
happen
to
their
rates.
N
So
I
did
a
comparison
with
using
a
zip
code
in
henderson
and
a
zip
code
in
san
francisco
population
in
frisco
is
about
3.3
million
and
clark
county
is
2
million
in
change.
So
it's
kind
of
similar
and
I
looking
at
a
70
year
old,
using
united
healthcare,
not
because
of
the
lowest
price,
but
they
have
the
preponderance
of
business
in
both
states
for
a
70
year
old,
the
rate
is
four
dollars
less
than
san
francisco
for
a
75
year
old
is
11
less
for
an
80-year-old.
N
Even
in
nevada,
one
can
go
a
seven
year
old
to
save
forty
dollars.
A
seventy
old
could
save
60
an
80
year
old
could
save
about
70
a
month
just
switching
from
one
company
to
another,
and
I'm
not
that's
not
even
doing
a
rate
comparison.
It's
the
same
exact
plan
if
they
wish
to
I'll
use
the
word
downgrade
and
have
the
same
plan
to
pay
the
203
deductible,
which
means
going
from
plan
f
to
plan
g
that
70
year
old.
N
N
You,
a
person,
could
save
900
a
year
and
I've
used
female
rates.
California
has
no
gender
rating,
so
I
had
to
keep
some.
I
wanted
to
keep
it
equal.
If
we
look
at
rates
for
men,
it
would
probably
be
even
more
and
in
california
I
have
many
many
clients
that
could
otherwise
not
qualify,
but
I
was
able
to
get
them
a
much
lower
price
because
of
the
birthday.
Well,
it's
not
fair
that
somebody
buys
a
policy
from,
and
I
won't
even
mention
the
company
from
one
company
that
keeps
changing
their
their
pool.
N
Every
couple
years
starts:
a
new
company
closes,
the
old
company.
Healthy
people
can
leave
people
that
are
not
healthy
have
to
stay
at
ever
increasing
rates
with
no
options.
I
have
a
client
who
is
76
years
old
he's
got
an
illness
that
would
keep
him
from
getting
insurance,
but
he's
never
had
treatment
for
over
20
years.
N
It's
not
going
to
happen
to
him
if
he
was
in
california,
I
could
have
saved
him
eleven
hundred
dollars
same
benefits,
no
difference,
beneficiaries
and
clark
and
washout,
and
a
few
other
com
counties
at
least
have
the
option
to
go
into
medicare
advantage,
despite
the
fact
that
they
have
a
limited
network
and
may
or
may
not
get
the
treatment
that
they
need.
N
But
what
about
rural
areas?
These
people
really
have
no
options
if
they
can't,
if
they
buy
a
medicare
supplement
when
they
turn
65,
and
it
goes
up
in
price
to
the
unaffordable
stage.
What
are
their
options
if
they're
not
healthy,
they
can't
save
any
money
if
they
drop
their
expensive
supplement,
they
may
be
out
thousands
and
thousands
of
dollars
if
they
need
care
anyway.
This
is
why
I
got
together
with
the
chair,
and
it's
been
almost
two
years
now.
I
think
to
discuss
this
and
immediately.
N
A
Thank
you,
mr
I
share.
I
did
want
to
make.
Let
the
committee
know
that
I
submitted
an
amendment
that's
available
on
alice.
It
was
my
amendment
to
clarify
that
the
that
the
bill
I'm
introducing
is
only
to
apply
to
medicare
supplement
plans.
A
So
I
added
the
supplement
plans
to
the
language
so
that
it
was
clear
that
the
bill
is
only
for
medicare
supplement
plans,
and
I
don't
have
an
amendment
yet,
but
I
am
working
on
an
amendment
when,
with
some
of
the
insurance
groups
to
address
the
notification,
they
did
say
that
a
request
having
it
be
a
mandate
to
require
them
to
send
out
annual
notifications
prior
to
the
open
enrollment
period,
might
increase
cost.
So
I'm
working
with
them
to
see
which
notifications
they
send
out
annually.
A
Now
that
we
can
add
this
on
to
so
that
there's
no
further
costs,
beared
and
translation
increased
costs
to
the
insured.
And
with
that,
madam
vice
chair,
we
are
open
for
questions,
and
I
do
have
mr
carruthers
here
to
help
answer
questions
as
well
as
the
division
of
insurance.
J
Okay,
thank
you
very
much.
Chair,
howdy,
good
presentations
made
things
very
clear.
J
I
think
it
would
have
been
great
if
my
husband
and
I
could
have
talked
to
mr
brownstein
before
we
had
to
make
this
decision
a
couple
of
years
ago
on
what
to
buy
it's
a
very
tough
decision,
the
first
time
you
sit
down
and
look
at
it
and
then
knowing
in
the
back
of
your
mind
that
once
you've
made
that
decision,
you're
kind
of
stuck
with
it
for
a
while,
so
knowing
that
this
just
gives
the
constituent
an
option
and
that's
what
I'm
hearing-
and
I
just
want
to
make
sure
this
just
gives
the
constituent
an
option
to
basically
do
what
we
preach
to
folks
is
shop.
J
A
Yes-
and
I
will
answer
that
and
allow
either
mr
bronson
mr
carruthers
to
come
in
after,
but
yes
and
it's
important
to
know
ms
carlson
it
just,
it
provides
him
now
an
option
to
move
to
an
equal
or
lesser
insurance
plan,
and
I
think
it's
important
that
we
note
that
mr
carruthers
or
bronstein,
I'm
not
sure.
If
any
of
you
have
anything
else
to
add
to
that.
N
Yes,
that's
exactly
what
happens
in
california
if
you
are
on
plan
f,
which
covers
100
of
everything,
all
your
out-of-pocket
costs
and
you
want
to
downgrade.
If
you
will
downgrade
is
in
quotes,
you
can
save
even
more
money
and
you
just
do
the
math.
It
gives
people
the
option
to
do
what
they
think
is
best
for
them
and
it
gives
insurance
agents
the
opportunity
to
to
help
more
people.
It's
to
me,
it's
it's
a!
This
is
not
a
partisan
issue
at
all.
It's
it
helps
the
consumers
in
nevada.
J
Thank
you
very
much,
mr
bronstein,
and
it
was
nice
to
meet
your
puppy
behind
you
also.
So
thank
you
very
much.
We
always
enjoy
a
good
pet
sighting
in
a
hearing.
So
that's
one
of
the
benefits
of
zoom
meetings,
so
committee
members
is
there
anyone
that
has
a
question
for
the
chair
or
from
mr
bronstreen
or
mr
carruthers.
As
far
as
the
particulars
of
the
bill.
E
Yes,
thank
you
vice
chair
carlton.
Thank
you
so
much
for
the
presentation
and
the
overview.
My
question
just
to
clarify
again,
you
said
that
the
bill
only
applies
to
medicare
supplemental
bills.
It's
also
the
ability
to
move
to
an
equal
or
lesser
plan
to
downgrade
in
quotes.
E
My
question
is:
if
you
move
down
or
go
to
a
downgrade,
could
you
later
move
up
again
or
once
you've
made
that
decision?
You
remain
at
that
level.
A
M
First
of
all,
we
didn't
cover
one
thing
that
I
wanted
to
make
sure
was
claire's
that
the
federal
government
standardized
the
supplemental
plans,
a
through
n,
it's
another
alphabet,
and
so
when
a
consumer
wants
to
switch
plans
from
an
f
to
an
f
or
a
g
or
g
being
like
kind
they're,
exactly
the
same
plan.
Essentially,
there
is
no
difference
in
plans.
M
It's
just
different
rates,
different
company,
and
so
the
idea
is,
is
to
be
able
to
allow
people
to
move
to
a
like-kind
plan
equal
to
or
less
than,
and
the
reason
why
we
left
it
generic
in
nature
and
our
thought
process
is
that
what?
If
the
federal
government
decides
to
eliminate
any
of
these
alphabet
plans
and
add
new
alphabet
plans,
so
the
ideas
allow
people
to
be
able
to
move
sideways
to
something
equal
to
or
less
than
is
the
idea.
M
But
to
answer
your
question
specifically:
no,
it's
not
meant
to
upgrade
that's
something
that
that
it's
been
discouraged
in
our
industry
for
years,
because
it's
really
that's
really
unfair
to
the
insurers
on
that
level.
So
we
need
people
to
be
able
to
pay
to
play.
If
you
will
and
then
everyone
benefits
by
it,
but
just
to
jump
back
and
forth
when
you
feel
like
it,
I'm
healthy
now
I'm
going
to
buy
down,
then
oh,
no,
I'm
sick.
I
want
to
buy
up.
It's
really
not
a
fair
thing
to
do.
E
That
makes
sense.
Thank
you
and
sharon
vice
chair
may
I
have
one
other
question:
go
ahead.
Miss
kasama
so
then
also
just
for
me
to
understand
with
clarification
to
the
birthday
rule,
because
we're
also
changing
them.
So
right
now,
there's
just
an
open
enrollment,
let's
say
november
1st
and
that's
what
it
is
for
everybody
and
now
we're
going
to
make
it
so
you
can
do
it
on
or
around
your
birthday
month.
Is
that
correct.
N
Please
proceed.
Thank
you.
The
birthday
rule
is
when
you're
talking
about
the
november
rule
that
does
not
apply
to
medicare
supplements.
N
It
there's
an
open
enrollment
for
medicare
advantage
as
an
open
enrollment
for
the
prescription
drug
plan
and,
of
course,
aca
has
an
open
enrollment.
This
is
specific
to
medicare
supplement
medigap
plans.
They
do
not
have
any
open
enrollment
period
other
than
when
you
first
get
your
medicare
part
a
and
b.
Now
that
you
could
be
65,
you
could
be
70..
Hopefully
you
can
be
disabled.
N
N
E
N
Okay,
that's
that's
pretty
simple.
I
hate
to
use
that
term
and
chairs
howdy.
A
Cause
I
if
I
could
assemblywoman
sandra
houdigi
and
assembly,
remember
kasama
that
presentation
that
miss
sterner
had
I
I
loved
it,
because
it
taught
me
a
lot,
but
it
kind
of
showed
you
how
the
medicare
supplement
supplement,
worked,
how
you
you
can
only
enroll
in
a
medigap
plan
when
you
first
become
eligible
for
medicare
insurance
without
health
underwriting
and
the
reason
the
birthday
rule
is
so
important
is
because,
if
now
with,
without
the
birthday
rule,
you
cannot,
you
don't
have
another
open
enrollment
in
period
where
you
can
change
policies
to
an
equal
or
lesser
policy
without
health
underwriting,
and
so
that's
why
so
right
now,
we
currently
don't
have
an
open
enrollment
period
for
a
supplemental
plan.
A
E
Okay,
I'm
just
I'm
just
thinking
that
right
now,
let's
just
use
november
1st
everybody
signs
up
for
november
1st,
and
if
you
miss
it,
you
have
to
wait
for
november
first
again
versus
your
birthday
month,.
A
Assemblywoman
sandra,
how
did
you
for
the
record?
Thank
you
vice
chair
and
assemblymember
kasama,
so
right
now
there
is
no
november
first
open
enrollment
period
for
supplemental
insurance
plans,
so
they
they
wouldn't
have
to
wait.
So
the
only
I
mean
there
is
no
second
open
enrollment
period,
so
if
they
want,
if
right
now,
if
they
wanted
to,
they
would
have
to
go
through
a
health
underwriting
process,
so
they
that
november
first
open
enrollment
period
doesn't
apply
to
supplemental
plans.
J
H
Thank
you
vice
chair
and
I
think.
B
F
When
they
can
enroll
and
what
all
the
different
plans
are
and
what
they
need,
so
I
think
that
was
a
really
good
intro.
So
I
just
have
two
questions
in
section
one
someone
there
you
put,
we
have
remaining
open
for
at
least
60
days.
I
was
just
curious
how.
B
F
B
A
Thank
you
for
the
question
assemblymember
hardy.
This
is
assemblywoman
center,
how
to
be
for
the
record-
and
I
just
modeled
it
after
current
laws
in
other
states
that
allowed
for
the
60-day
period.
H
F
But
how
do
you
see
that
affecting
the
ability
to
take
care.
H
A
Working
assembly
member
sandra
houdiki
for
the
record,
so
I
think
your
question,
I
is
your
question:
a
miss
hardy
directed
to
in
insurance
brokers.
Are
you
direct?
Are
you
actually
does
that
question
for
the
insurance
companies
well,.
B
B
H
A
That
sounds
like
a
question
that
would
be
directed
to
like
the
health
insurance
groups
like
united
health
group
or
anthem,
and
I
don't
believe
we
have
anyone
here
from
those
groups
to
help
answer
that
question
ms
hardy,
but
I
ca
I
will
reach
out
to
them
and
get
an
answer
for
you
and
for
the
committee
as
well.
Okay,
thank
you.
J
B
A
Curious
thank
you
assembly,
member
different
for
the
record
assembly
woman
sandra
houdiki.
I
am
going
to
turn
it
over
to
one
of
the
experts
I
have
with
me,
mr
bronsteiner,
mr
carruthers,
one
of
you
like
to
take
that
question
from
assembly
member
dickman,
mr
bronstein.
N
Thank
you.
I
would
love
to
using
the
birthday
rule
you
can
switch
within
a
company.
You
can
switch
to
another
company,
whatever
whatever
works
best
for
you,
you
can.
You
can
do
what
you'd
like
it.
It
just
gives
you
the
opportunity
to
to
change
your
plan.
N
If
you
are
healthy
enough
to
pass
underwriting
okay,
you
can
do
anything
in
every
month.
Anytime,
you
want
the
birthday
rule
just
gives
you
a
once
a
year
open,
enrollment
the
logistics
are
not
a
there's,
not
an
issue.
I
can
submit
an
application
for
a
medicare
supplement
for
70
year
old
underwritten
or
if
it's
in
california,
I
can
submit
it
on
their
birthday
rule,
not
underwritten.
It's
the
same
application
and
it's
not
harder
on
anybody.
In
fact,
it's
easier
on
the
companies.
J
J
So
with
that
committee
members
is
there
anyone
else
wishing
to
ask
a
question
at
this
time?
I'm
not
seeing
anyone
asking
to
be.
J
J
J
J
E
E
L
Thank
you,
madam
chair
and
members
of
the
committee.
My
name
is
tom
clark,
I'm
here
on
behalf
of
the
nevada
association
of
health
plans.
First,
and
to
spell
my
name,
it's
t-o-m-c-l-a-r-k
first
I'd
like
to
thank
sarah
hadgie
for
bringing
the
bill
in
for
the
extensive
work
that
she's
done
with
us.
Leading
up
to
the
hearings.
L
As
the
chair
acknowledged,
we
are
working
with
their
own
amendment
that
will
change
the
language
in
ab250,
from
open,
enrollment
to
guaranteed
issue
rights,
kind
of
a
situation
simply
because
the
term
open
enrollment
can
cause
quite
a
bit
of
confusion.
L
J
And
thank
you
very
much,
mr
clark
for
offering
to
answer
those
questions.
We
appreciate
it
and
if
you
would
make
sure
to
share
that
information
with
miss
haudegee,
so
that
all
the
committee
members
can
have
the
opportunity
to
hear
that
answer.
We
would
greatly
appreciate
it.
So
with
that
broadcast
services,
do
we
have
anyone
else
on
the
phone
in
neutral.
A
Thank
you
vice
chair
carlton.
I
just
want
to
thank
you
and
thank
the
committee
members
for
hearing
assembly
bill
250.
I
would
like
to
thank
my
constituent,
mr
bronstein,
who
is
he
correct?
We.
He
first
brought
this
issue
to
my
attention
almost
two
years
ago
over
coffee
and
I'm
happy
that
he
did
because
I'm
I'm
proud
to
be
a
part
of
it
and
proud
to
carry
this
bill.
I
will
make
sure
that
we
do
get
that
question,
that
assembly
member
hardy
had
answered
and
and
shared
with
the
whole
committee
with
that.
J
A
P
B
A
Okay,
perfect,
thank
you
so
much
assemblymember!
Duran,
sorry
that
I
put
you
on
the
spot
like
that,
and
thank
you
for
take
presenting
your
bill
out
of
order
assembly
members.
I
will
now
open
the
hearing
on
assembly
bill
278,
which
provides
for
the
collection
of
certain
information
from
physicians.
We
have
our
own
assembly
member
abe
duran
here
to
present
the
bill.
Assemblywoman
duran
when
you're
ready
the
floor
is
yours.
P
Okay,
thank
you
good
afternoon,
chair
hadiki
and
members
of
the
committee.
I
am
b
duran
representing
assembly
district
11
in
clark
county.
Thank
you
for
your
time
today
and
for
the
allowing
me
to
present
assembly
bill
278,
which
requires
a
physician
to
complete
a
data
request
when
rev
when
renewing
his
or
her
license
or
registration.
P
Today,
I
will
provide
background
information
and
bobet
bond
director
of
public
policy
at
the
culinary
health
fund
in
maya
homes,
health
care,
research
manager
for
the
culinary
health
fund.
Slash
united
year
will
provide
details
of
the
bill
normally
or
excuse
me
nationally.
Private
equity
firms
are
making
a
splash
in
health
care.
P
Private
equity
firms
have
been
at
the
center
of
the
surprise.
Billing
controversy
that
has
taken
the
industry
by
storm
congress
is
looking
at
the
billing
practices
of
physician
groups
that
are
owned
by
private
equity
firms,
which
may
be
behind
the
bulk
of
the
balance
billing
a
practice
which
leads
to
unexpected,
except
excessive
medical
bills.
For
patients,
research
is
limited
to
the
impact
of
the
physician
practices
being
acquired
by
private
equity
firms.
P
Another
national
trend
is
the
consolidation.
When
the
local
hospitals
merge
into
massive
health
systems,
it
can
significantly
affect
the
practices
of
private
physicians.
According
to
the
lawn
institute
from
2012
to
2016,
the
number
of
hospital
acquired
physician
practices
increased
from
35
700
to
more
than
80
000.
P
by
2018
44
of
physicians
were
employed
by
hospitals
or
health
systems
nearly
doubled
in
the
rate
in
2012.
hospitals
often
claim
consolidation
helps
improve
care,
coordination
and
efficiency,
but
research
studies
have
not
shown
consolidation
improves
patient
outcome
rather.
Consolidations
may
lead
to
higher
prices
for
health
care
services,
because
larger
health
systems
command
greater
market
share.
P
Briefly,
278
requires
a
phishing
to
complete
a
request
for
certain
data
when
renewing
his
or
her
license
with
the
board
of
medical
examiners
and
the
state
board
of
osteopathic
medicine.
The
department
of
health
and
human
services
must
develop
the
data
request.
The
confidential
information
obtained
by
the
licensed
board
must
be
sent
to
the
department
which
will
collect
and
maintain
it
assembly
bill.
278
is
initial
effort
to
monitor
health
care
consolidation
and
protect
competition
between
health
care
facilities.
P
We
will
continue
to
see
consolidation
across
all
facets
of
the
health
care
system.
It
is
not
a
question
of
whether
consolidation
is
good,
but
the
question
which
must
be
answered
is
how
investment
and
consolidation
will
provide
patients
access
to
cost-effective,
high-quality
care.
In
nevada,
and
with
that,
madam
chair,
miss
bond
and
miss
holmes
will
discuss
the
details
of
the
measure
and
at
the
conclusion
of
their
remarks,
we
would
be
happy
to
answer
any
questions
regarding
the
bill.
A
I
Great,
thank
you,
chairwoman,
hargie
for
the
record.
My
name
is
maya
holmes
and
I
am
the
healthcare
research
manager
for
the
culinary
culture
I'm
here
today
with
quabet
bond.
As
you
know,
the
phoenical
school
director
also-
and
we
want
to
thank
assemblywoman
duran
for
bringing
this
important
forward.
We
would
also
like
to
thank.
I
A
A
little
bit
so
I
think,
if
you
get
closer
to
the
microphone
it'll
help
with
the
audio
and
hearing
your
testimony.
Okay,.
I
Much
do
I
need
to
go
back,
or
should
I
just
continue?
I
think
you're
good.
If
you
continue
okay,
great.
Thank
you.
So
ownership
of
physician
practices
has
changed
dramatically.
Over
the
last
decade,
american
medical
association
announced
in
2019
that
more
physicians
were
played
the
independent
for
the
first
time,
the
physicians
advocacy
institute
and
avalier
health
conducted
a
study
that
found
44
of
physicians
were
employed
by
hospitals
in
2018
from
25
percent
in
july
2012.
I
I
However,
independent
doctors
have
lower
burnout
rates.
The
employment
status
of
doctors
may
also
affect
patient
employed
physicians.
Typically,
the
fewer
patients
in
a
day
on
average
than
private
faculty
physician
employment
status
can
also
affect
affordability,
hospital
acquisitions
of
physicians,
increased
increased
transmission
prices
on
average
14
33.5
for
cardiologists
and
12
to
20
percent
orthopedic.
According
to
the
research
that
other
studies
have
shown
that
private
equity
ownership
of
physician
practices
also
affair,
physician
ownership
can
affect
referral
cut.
I
A
stanford
study
showed
that
physicians,
increased
referrals
to
the
hospitals
that
employed
them
and
that
patients
were
more
likely
to
be
treated
in
a
high
cost.
Low
quality
hospital
with
their
administration's
practice
is
owned
by
this
bill
would
really
allow
policy
makers,
providers,
patients
and
payers
to
understand
critical
trends
in
nevada's
health
care
market
and
their
impact
on
position,
volume
density
and
practice.
I
Sorry,
specifically,
the
following
would
be
included
in
licensing
whether
the
physician
is
employed
as
part
of
a
hospital.
A
health
system
owned
practice
independent,
if
employed
by
a
hospital
or
health
system,
the
hospital
or
health
system
name,
if
employed
by
another
entity,
the
ownership
legal
entity
name
and
fictitious
firm
name
and
whether
the
physician
is
in
pillow
or
a
single
location,
small
practice
or
multi-special.
I
I
For
example,
we
know
in
nevada
that
the
nicu
and
emergency
president
emergency
room
physician
group
are
now
owned
by
large
private
equity
groups
in
a
number
of
cases,
and
we
would
like
to
see
how
that
price
act
contracting.
That
is
over
fine,
but
without
any
reporting
of
who
owns
these
and
other
practices
in
nevada.
Such
trends
will
be
impossible.
I
The
ten,
the
intent
of
the
legislation
is
really,
to
simply
add
an
additional
data
request
to
already
repair
the
licensing
and
registration
reporting
that
the
information
would
obviously
be
known
to
the
physician.
So
we
don't
believe
it's
an
administrative
burden.
The
information
requested
is
also
already
in
the
public
domain
for
each
provider.
That
is,
if
you
wanted
to
go
and
research
websites
public
filings,
you
could
find
the
information,
but
it's
really
not
available,
currently
collected
or
aggregated
in
a
way
it
is
accessible,
meaningful
and
useful
for
publishing.
C
Thank
you,
madam
chair,
and
thank
you,
maya
and
thank
you
members
for
the
committee.
My
name
is
bob
bond.
Can
you
hear
me?
Okay
now?
Am
I
okay?
Yes,
ms
bond,
we
can
hear
you
thank
you.
You
spell
it
b-o-b-b
e-t-t-e
and
my
last
name
is
bond
like
james
bond
bond
and
I'm
the
policy
director
for
the
culinary
health
fund.
I
really
appreciate
assemblywoman
duran
bringing
the
bill
today.
C
C
C
C
The
nevada
state
board
of
medical
examiners
and
the
nevada
state
board
of
osteopathic
medicine,
but
what
we
wanted
to
do
is
just
create
a
really
quick
and
efficient
funnel
to
provide
this
information
from
the
physicians
into
the
boards
and
then
have
the
board
send
that
vhf
so
that
we
would
be
able
to
see
these
patterns
over
time
and
the
trends
that
they're
creating
without
a
lot
of
new
burden
and
a
lot
of
new
fiscal
note
an
efficient
way
to
do
it,
and
that's
really
all
I
wanted
to
add
and
I'm
happy
to
ask
questions.
A
Thank
you
miss
bond
and
thank
you
assembly,
member
duran
and.
A
And
ms
holmes
for
your
presentation,
ms
bond
and
miss
holmes,
if
you
wouldn't
mind
emailing,
if
you
guys
had
prepared
remarks,
would
you
mind
emailing
those
to
our
committee
manager,
so
she
could
post
them
and
share
them
with
the
committee
members,
there
were
periods
where
we
lost
connection
a
little
bit,
and
I
want
to
make
sure
that
the
members
have
all
of
the
information
that
you
were
sharing
with
us
today.
A
Yes,
okay
and
assembly
members.
We
are
now
going
to
the
question
portion
of
the
bill
hearing.
Do
I
have
any
questions.
J
A
Okay,
we
can
start
with
you
by
sir
carlton.
J
Thank
you.
Thank
you,
madam
chair,
so
I
guess
what
I
I
have
an
idea
of
what
we're
trying
to
do.
Thank
you,
miss
bond
and
miss
holmes.
It's
always
nice
to
see
you
and
work
with
you.
You
guys
are
so
smart
when
it
comes
to
some
of
this
stuff.
I
know
nevada
has
kind
of
a
pseudo
corporate
practice
of
of
medicine.
J
J
C
Madam
chair,
through
you
to
vice
chair
carlton,
if
I
can
just
take
the
first
shot
at
that,
that's
absolutely
right.
We
don't
have
a
lot
of
transparency
in
our
system
around
ownership,
like
almost
none
and
we
do
see
it
in
private
equity,
buying
up
these
practices,
but
we
also
see
it
in
your
first
issue
that
you
raise,
which
is
the
corporate
practice
of
medicine.
C
We
are
unclear
at
this
point
what
the
hospitals
are
doing
with
the
physician
practices,
but
we
know
it
drives
up
cost
when
they
own
the
practice,
because
a
facility
fee
is
then
added
to
the
practice
that
didn't
exist
previously.
So
there's
ways
that
this
is
on
on
generating
a
cost
impact.
It
also
an
access
impact,
also
we're
not
sure
if
it's
having
an
impact
on
the
doctors
themselves,
which
we
so
desperately
need
to
keep,
and
we
don't
have
enough
data
to
even
start
measuring
it.
C
Madam
chair,
again,
I'm
sorry
through
you
too,
to
vice
chair
carlton,
I'm
just
answering
because
because
I
told
I
told
maya
I'd
take
the
questions
so,
if
maya
has
more
to
add
or
if
the
assembly
woman
does
simply
women
durant,
please
interrupt
me,
but
yes,
members,
okay,
yes,
so
the
because
the
physicians
have
to
apply
for
their
licensure
and
then
renew
their
licensure.
C
This
was
the
easiest
place
to
put
it,
but
if
we
agree
that
it
should
be
digital
if
possible-
and
there
might
just
be
fields
that
can
be
added
to
the
digital
applications
rather
than
this
form.
That's
that's
in
this
bill.
Right
now
we
could
amend.
We
could
present
a
commit,
a
conceptual
amendment
that
would
simplify
this
process,
because
if
both
boards
are
operating
digitally,
it
would
be
way
better
and
then
that
electronic
file
could
just
looked
at
the
dhhs
instead
of
another
piece
of
paper
having
to
move
around
okay.
J
E
Thank
you
so
much
chair,
two
questions.
If
I
may,
and
thank
you
for
the
presenters
again,
it's
assembly,
woman,
heidi
kasama
district
2.,
will
we
be
hearing
from
the
physicians
groups
as
far
as
impact
or
if
this
is
can
be
done
or
what
their
input
is
on
that.
A
Assemblywoman
kasama,
I
believe
the
insurance
groups
would
probably
be
in
the
testimony
portion
of
the
hearing.
Okay,.
E
C
C
I
don't
know
that
it's
income
related
and
I
don't
know
if
the
physicians
even
make
more
after
they
sell
their
practice
to
private
equity
and
those
are
all
questions
that
would
be
wonderful
to
have
as
a
policy
program
in
the
state,
but
we're
just
trying
to
start
collecting
the
data
to
see.
If
there's
any
trends.
A
And
ms
bond,
if
you
would
just
identify
yourself
when
answering
questions,
and
then
you
also
go
directly
to
the
member
okay,
thank
you
manager.
Okay,
I
have
assembly
member
tolls
with
questions.
O
C
Bob
at
bond
for
the
record.
Thank
you
assemblywoman
tools
there.
I
don't
see
in
the
bill
that
there's
a
remedy
for
that.
At
this
point,
I
think
that
would
have
to
be
some
discussion
about
how
that
would
be
how
physicians
would
would
be
greeted.
It
seems
like
again.
This
is
an
ideal
process,
because
they're
required
to
complete
their
licensing
application
and
renewal
in
order
to
stay
licensed.
So
it
seems
like
a
simple
way
to
make
sure
everybody's
getting
the
data
in.
O
Thank
you
maybe
that
that
might
be
a
question
for
oh,
it's,
the
licensing
board
right
that
would
collect
this,
the
board
of
medical
examiners
and
the
state
board
of
osteopathic
medicine.
I
just
I
just
wonder
I
I've
looked
at
similar
types
of
proposals.
I
was
actually
going
to
bring
a
different
kind
of
data
collection
proposal,
but
just
wondering
if,
if
they
would
not
renew
the
license,
if
they
didn't
fully
complete
that
or
if
so
maybe
that's
a
question,
that's
better
for
the
boards.
P
If
I
may,
and
I'm
chair.
P
This
is
assembly
of
women
duran
two
assembly,
women
told
us.
We
are
still
going
to
try
to
amend
some
of
the
language
and
and
also
check
without
lcb,
to
see
if
there's
any
other
costs
or
penalties
that
can
occur
with
this.
So
we
don't
want
it
to
be
punitive.
We
just
want
to
collect
data
to
make
sure
that
nevada
is
not
gonna.
You
know
we
need
choices
for
our
doctors,
that's
kind
of
the
bottom
line
for
all
our
family.
P
We
need
quality,
good
health
care,
and
you
know
when
we
don't
have
doctors
that
you
know
are
leaving.
You
know
we
don't
have
much
of
a
choice,
so
I
think
that's
primarily
our
goal
is
to
make
sure
that
nevada
is
still
has
a
choice
for
our
constituents
across
the
state
to
have
a
good
choice
of
doctors.
G
Thank
you
chair.
My
question
is
twofold:
one:
how
many
other
states
have
done
such
a
requirement
and
two
has
it
shown
to
reduce
the
cost
of
health
care?
Slash,
improve
health
care
delivery
to
the
communities,
those
states.
C
C
I
do
think
there
is
a
growing
need
to
understand
how
the
markets
are
changing
nationally
with
the
with
the
private
equity
issue.
A
C
Okay,
I
would
say
that
this,
this
is
about
transparency.
This
legislation
is
about
creating
the
transparency,
but
then
answer
the
next
questions
that
some
of
you,
the
assembly
people,
are
thinking
ahead
of
the
net
impact
later
on.
But
you
need
the
transparency
to
even
see
if
there's
a
relationship-
and
we
can't
even
see
that
right
now.
I
I
Yeah,
I
just
also
wanted
to
add
to
babette's
comments
that
it's
very
clear
in
the
data
and
the
research
that
healthcare
consolidation
is
the
leading,
if
not
the
driving
factor
in
increasing
healthcare
costs,
and
I
think,
as
assemblywoman
carlton
raised
earlier.
I
This
is
really
about
having
the
data,
so
we
can
begin
to
understand
and
address
what's
happening
and
it's
very
hard
to
make.
You
know
really,
I
think,
informed
policy
that
we,
you
know
want
to
be
in
a
position
to
make
without
that
data
and
just
kind
of
relying
on
anecdote.
G
I
appreciate
you
wanting
to
collect
the
data,
but
I
think
there
would
you
admit
or
say
that
there
could
also
be
other
factors
besides:
consolidation
of
doctors
in
their
practices,
such
as
the
cost
of
medical
school,
the
cost
of
running
a
business,
the
personnel
costs
et
cetera.
Those
could
also
contribute
just
consolidation.
That's
I'm
hearing.
You
say
you
just
want
the
debt
of
consolidation
and
I
think,
there's
probably
other
data
factors
that
could
contribute
to
the
cost
of
health
care.
I
Yes,
chairman
or
through
chairman
harugita
assemblyman
o'neill,
I
agree,
I
think,
there's
probably
multiple
factors.
I
think
the
research
has
just
shown
that
consolidation
is
such
a
critical
factor
and
that's
a
piece
we
don't
have
so,
but
I
definitely
agree.
Healthcare
is
complex
and
there
are
a
lot
of
factors
so
we're
just
trying
to
pull
the
information
together.
So
we
have
a
full
picture.
G
A
Thank
you
assembly,
member
o'neal,
for
your
questions,
assembly
members,
any
other
questions,
I'm
checking
the
chat
and
I
don't
see
any
there.
So
I'm
gonna
look
at
the
screen.
If
there
are
any
questions,
just
raise
your
hand,
okay,
seeing
none
we'll.
We
will
move
into
the
testimony
portion
of
the
bill
hearing.
We
will
start
with
testimony
and
support
broadcasting.
Can
we
check
the
telephone
line
for
anyone
wishing
to
testify
and
support.
E
E
E
B
Hi,
my
name
is
stacey
sasso,
I'm
the
executive
director
for
the
health
services
coalition.
The
coalition
represents
25
employer
and
union
sponsored
health
plans
in
southern
nevada
with
an
estimated
300
000
life.
Our
focus
has
always
been
on
bringing
quality,
affordable
health
care
to
the
lives
we
represent
and
we
are
testifying
today
in
support
of
ab278.
B
We
feel
transparency
in
the
healthcare
market
will
continue
to
ensure
patients
in
our
state
have
access
to
providers.
Understanding
the
changes
in
the
marketplace
will
help
patients
navigate
their
health
care
and
make
informed
decisions
on
where
they
seek
care,
often
times
change.
Changes
in
ownership
take
place
without
notice
and
cause
unexpected
consequences
to
patients
and
payers.
We
appreciate
the
work
that's
being
done
on
this
issue.
Thank
you.
A
E
E
B
B
B
He
was
the
doctor
who
diagnosed
me
with
my
diabetes
and
explained
the
diabetes
to
me,
prescribed
me
medicine
and
gave
me
a
sheet
of
paper
with
suggested
foods
that
I
should
eat.
I
was
able
to
lose
40
pounds
under
his
care,
my
health
improved
so
much
under
his
hair.
I
felt
great.
He
was
kind
caring,
encouraging
doctors.
B
I
would
even
have
to
drive
30
minutes
each
way
to
see
him.
Everything
was
going
great
until
I
found
out
that
I
could
no
longer
see
him
and
I
never
found
out
why
it
felt
like
a
setback
and-
and
I
had
to
build
a
relationship
with
a
great
doctor
and
then
all
of
a
sudden.
He
was
no
longer
available
as
a
patient.
B
I
am
concerned
about
rising
health
care
prices
and
our
access
to
quality
doctors.
Doctors
are
changing
hands
all
the
time.
Sometimes
they
get
bought
out
by
big
hospital
systems
or
large
corporations,
and
I
am
worried
about
how
that
impacts.
My
health
care
patients
should
have
information
on
what
is
happening
with
our
doctors,
who
owns
their
practice
and
how
changes
impact,
how
the
changes
will
impact
our
health
care
process,
quality
and
price.
B
E
L
Good
afternoon
my
name
is
jim
sullivan
j-I-m-s-u-l-l-I-b-a-n
and
I'm
representing
the
culinary
union.
The
culinary
union
supports
ab278,
because
healthcare,
affordability,
quality
and
access
are
critical
concerns
for
60
000,
culinary
union
members
and
their
families.
The
culinary
union,
through
the
culinary
health
fund,
is
one
of
the
largest
healthcare
consumers
in
the
state.
The
culinary
health
fund
is
sponsored
by
the
culinary
union
and
las
vegas
areas,
employers.
L
This
information
is
critical
for
the
state
policy
makers,
employers
payers
and
patients,
because
market
for
forces
can
reshape
health
care,
and
we
should
have
data
to
understand
what
is
happening
and
the
impact
the
culinary
union
urges
the
nevada,
nevada
legislators
to
support
and
pass
ab278.
Thank
you.
E
A
E
L
For
the
record,
my
name
is
jim
adams,
w
a
a
I'm
here
today.
Speaking
on
behalf
of
the
nevada
hospital
association
in
opposition
to
ab-278,
we
have
just
experienced
under
the
leadership
of
governor
sislak,
a
declaration
of
emergency
for
the
covet
19
pandemic,
and
all
of
us
have
witnessed
the
incredible
resourcefulness
of
medical
professionals
from
physicians
to
nurses
and
other
health
staff.
L
We
are
concerned
that
this
bill
places
a
significant
burden
upon
the
very
people
we
lot.
We
rely
upon
for
our
health
care
in
terms
of
additional
reporting
potential
encroachment
on
on
personal
information,
and
we
are
concerned
that
this
may
discourage
the
investment
in
our
health
care
system
that
is
so
critical
as
we
face
this
pandemic.
L
A
A
E
Q
Begin
good
afternoon,
madam
chair
members
of
the
committee,
this
is
keith
lee
keith
last
name
lee
lee,
I'm
here
today
on
behalf
of
the
board
of
medical
examiners.
Q
The
question
is:
if
the
applicant
for
renewal
does
not
even
attempt
to
fill
out
the
questionnaire,
do
we
the
board
of
medical
examiners,
immediately
deny
relationship
or
is
there
a
grace
period,
and
I
would
refer
while
the
bill
itself
does
not
mention
what
the
remedy
is.
The
lcb's
digest
suggests
that
as
the
board
of
medical
examiner's,
current
existing
law,
nrs
630.3065.
Q
Empowers
the
board
of
medical
examiners
to
deny
licensure
if
a
knowing
or
willfully
failure
to
perform
any
statutory
obligation
is
presented
itself.
So
I
think
that
at
least
according
to
lcb's
digest
the
the
remedy
would
be
a
specific
denial
of
the
of
the
re-licensure
and,
and
so
we
would
seek
clarification
on
that
additional
questions.
If
the
applicant
for
renewal
submits
the
question,
there
was
not
answer
all
the
questions.
Q
Do
we
deny
on
a
denier
licensure?
Likewise,
who
is
the
entity
that
would
determine
if
the
submission
of
the
answers
is
sufficient
to
meet
the
statutory
requirements?
And
finally,
we
would
prefer
we.
The
board
of
medical
examiners
would
prefer
not
to
be
the
recipient
of
the
answers,
but
merely
to
be
a
middleman
to
assist
in
in
getting
the
questionnaire
answered,
and
I
would
suggest
an
answer
to
vice
chairman
vice
chair
carlton's
questions.
Q
We
can
provide
a
link
that
would
directly
go
to
the
dhhs
questionnaire
and
have
the
answer
go
to
directly
to
hh
dhhs,
and
that
would
be
then
we
would
only
be
the
facilitator
to
have
those
questions
answered
and
the
beauty
of
this
new
application
process
is
if
the
applicant
for
re-licensure
fails
to
click
on
that
link
to
open
the
questionnaire,
then
the
applicant
cannot
proceed
further
with
the
application
and
it
will
be
an
incomplete
application
for
re-licensure.
Q
In
order
to
maintain
the
confidentiality
of
this
information,
we
would
ask:
do
we
need
to
amend
nrs,
630.220
or
andor
630.339,
to
provide
for
specifically
for
the
confidentiality
of
this
of
this
information?
Q
Finally,
madam
chair
members
committee,
we
look
forward
to
working
with
all
the
interested
parties
on
this
bill
and
to
resolve
some
of
these
questions
that
we
have
and
any
other
matters
that
might
expedite
the
the
fulfilling
of
the
statutory
obligation
presented
in
ab278.
Thank
you,
madam
chair.
A
J
Thank
you
very
much,
madam
chair,
and
thank
you,
mr
lee,
and
thank
you
for
being
a
half
a
step
ahead
of
me
on
the
the
digital
side.
As
as
far
as
the
concerns
about
you
know,
filling
out
the
form
and
the
licensure.
J
We
ask
folks
on
a
lot
of
different
forms
to
fill
things
out
and
if
they
don't,
they
all
have
to
comply
with
the
standard
repercussions
of
that.
So
I
I
would
assume
that's
where
we're
going,
but
I
look
forward
to
you
being
able
to
work
with
the
sponsor
on
the
bill
and
make
sure
that
we
answer
that
as
far
as
the
the
digital
goes.
So
if
you
could
explain
to
me
right
now
exactly
how
folks,
because
I
know
there's
questions
about
the
burden
of
being
able
to
fill
this
out.
J
Q
Q
Q
In
other
words,
if
the
applicant
did
not
click
on
the
link
to
the
questionnaire
and
and
to
dhhs,
the
application
for
relicensure
would
be
incomplete
until
the
applicant
did
that.
So
that
would
be
the
assurance
that
at
least
the
applicant
clicked
on
the
link
to
go
to
the
questionnaire
to
assure
that,
for
re-licensure
purposes.
J
So,
by
clicking
on
the
link,
they
would
be
able
to
fill
it
out,
but
on
the
back
side
of
that
they
could
fill
it
out
and
put
in
a
bunch
of
x's
and
a
bunch
of
dashes
and
not
answer
the
questions,
but
they
would
still
get
their
license
because
they
clicked
on
the
link
and
filled
something
out.
So
there's
really
not
an
accountability
factor
there.
Q
Madam
chair
keith
lee
for
the
record,
that's
correct:
there's
not
an
accountability
built
into
the
statute,
but
we
can.
We
can
build
in
in
a
different
several
different
ways.
We
can
put
a
certification
in
that
application
for
realization
that
the
person
has
not
only
clicked
on
the
link
but
has
answered
the
question.
We
can
also
provide
some
method
and
I'm
not
quite
sure
how
we
do
it,
but
a
method
with
ehhs
that
they
would
confirm
back
to
us
that
the
application
or
that
the
questions
the
questionnaire
has
been
filled
out.
Q
So
I
think,
there's
a
there's
a
method
to
do
that.
I
would
suggest-
and
I
did
a
little
bit
of
research
on
this
last
session-
219
session
sb
171,
which
ultimately
did
not
pass
but
has
a
provision
similar
to
what
we're
talking
about
here.
Where.
E
I
I
was
I
apologize
chair
I
was
not
able
to.
I
don't
have
a
record
of
what
the
last
three
were.
So
I
I
don't
have
that
in
hand.
I
apologize.
J
Offline
and
and
thank
you,
madam
chair,
very
much
and
I
be
because
the
board
was
in
neutral
and
because
they're
the
ones
that
are
going
to
have
to
implement
this.
I
just
wanted
to
get
a
feel
for
myself
and
for
the
committee
on
what
the
what
the
ramifications
of
and
how
this
would
work.
So
it
was
very
helpful
in
what
he
was
answering.
The
only
other
question
that
I
had
was
on
the
confidentiality
side,
but
I'm
sure
he's
going
to
be
reaching
out
to
the
sponsor
of
the
bill
and
to
the
other
members.
J
I
understand
confidentiality
to
what
I
think
he's
trying
to
get
at,
but
we
don't
want
it
so
confidential
that
we
can't
get
the
data
and
really
study
what's
going
on,
so
I
think
there's
going
to
be
a
real
balancing
act
there
and
I'm
I'm
sure
the
sponsor
and
the
proponents
of
the
bill
will
be
working
with
the
board
to
make
sure
that
we
get
good
public
policy.
So
thank
you
very
much,
madam
chair.
A
E
B
Thank
you.
Thank
you,
madam
chair,
for
the
record
susan
fisher
s-u-s-a-n-f-I-s-h-e-r
with
mcdonald
carano
speaking
today
on
behalf
of
the
nevada
state
board
of
osteopathic
medicine,
like
the
board
of
medical
examiners.
We're
are
neutral
on
ab278,
but
we
do
have
concerns
as
well.
I
don't
have
an
official
position
while
I
say
that
I'm
neutral,
because
our
board
has
not
had
an
opportunity
to
review
this
in
an
open
meeting,
subject
to
the
open
meeting
law
so
we're
I
am
speaking
in
the
neutral
position
right
now.
B
This
means
that
we
will
possess
the
information
in
our
computer
system
first
and
then
send
it
to
the
dhhs,
so
it
our
initial
thoughts
are
that
we're
a
little
bit
uncomfortable
having
that
information
if
it
was
provided
in
an
exterior
in
a
link
that
just
goes
directly
to
dhhs,
that
would
give
us
a
little
bit
better
comfort
level.
B
A
E
Q
Begin,
madam
chair
keithley
again
I
apologize
for
something
I
apparently
I
dropped
off
in
answer
to
vice
chair
carlton's
question.
Let
me
see
if
I
can
pick
that
back
up
right
now.
We
could.
We
suggest
that
there
be
a
link
right
directly
to
dhhs
and
I
believe
the
question
was:
how
do
we
confirm
that?
In
fact,
the
link
was
clicked
on
and
the
answer
and
answers
were
given
and
there's
a
couple
of
ways
to
do
that.
Q
One
we
can
include
in
our
app
license
free
license
application,
a
certification
that
the
applicant
has
not
only
clicked
on
the
link
but
answered
the
questions,
or
we
can
also
go
back
and
and
confirm
with
dhhs
that
the
questionnaire
has
not
only
been
clicked
linked,
clicked
on,
but
has
been
answered
to
the
satisfaction
dhhs,
and
I
I
refer
to
bill
from
last
session-
219
session
sp
171,
which
did
not
ultimately
pass
but
in
which
we
dealt
with
a
similar
issue
with
information
from
the
from
the
application
applicant
to
the
university
of
nevada,
and
we
developed
a
system
through
that.
Q
My
recollection
is
that
that
allowed
the
board
of
medical
examiners
to
confirm
that
that
the
questions
that
the
questionnaire
had
been
answered,
so,
I
think,
there's
a
way
to
to
deal
with
a
a
a
confirmation
that
the
the
answers
or
that
the
applicant
has
in
fact
answered
the
questions.
But
we
can
work
with
with
all
all
all
the
folks
involved,
particularly
the
dhhs
folks
and
and
their
their
computer
folks
and
board
of
medical
examiners.
Computer
folks,
to
figure
this
all
out.
A
Thank
you,
mr
lee,
and
I
appreciate
you
getting
back
on
the
line
to
finish
answering
the
question,
so
the
committee
could
hear
it.
Thank
you
broadcasting.
A
P
Yes-
and
I
just
want
to
say
my
part
of
it-
I
thank
you
chair
how
to
get
in
the
committee
for
allowing
us
to
present
abt
78
today.
P
Ab278
is
initial
effort
to
monitor
health
care
consolidation
and
protect
competition
between
health
care
facilities.
There's
not
a
question
whether
consolidation
is
good,
but
the
question
which
must
be
answered
is
how
investment
in
consolidation
will
provide
patients
access
to
cost-effective,
high-quality
care
in
nevada.
P
A
A
R
R
For
instance,
cancer
patients
may
opt
to
receive
fertility
preservation
services
before
undergoing
radiation
and
or
chemotherapy
treatment
which
have
been
linked
to
cause
infertility.
The
alliance
for
fertility
preservation
estimates
that
of
the
125
000
people
under
the
age
of
45
diagnosed
with
cancer
nationwide
about
half
will
receive
treatments
that
will
affect
their
ability
to
have
children.
R
Fertility
impairment
is
often
a
major
concern
for
young
and
reproductive
age
adults
who
would
like
to
have
the
freedom
to
have
a
family
in
the
future.
In
fact,
a
survey
conducted
by
the
journal
of
clinical
oncology
found
that
30
percent
of
breast
cancer
patients
reported
that
infertility
concerns
affected
their
treatment
decisions,
but
no
one
should
have
to
choose
between
cancer
treatments
on
the
basis
of
their
fertility
effects.
Likewise,
no
cancer
patient
should
be
discouraged
from
starting
a
family,
because
pregnancy
is
too
expensive.
R
Ab274
seeks
to
provide
men
and
women
with
health
conditions
the
opportunity
to
access
fertility
preservation
by
mandating
insurers
to
cover
basic
procedures
as
per
the
bill.
In
section
1.5
c
standard
services
for
fertility
preservation
is
defined
as
the
procurement,
cryopreservation
and
storage
of
gametes
embryos
and
other
reproductive
tissue
for
fertility
preservation.
R
The
american
society
for
reproductive
medicine
and
the
american
college
of
obstetrics
and
gynecologists
public
and
private
insurers
alike
would
be
required
to
provide
coverage
to
qualifying
persons
under
the
measure.
This
would
include
insurance
plans
covering
maternal
benefit
societies,
group
and
blanket
health,
health
insurance
for
small
employers,
hmos
individual
health,
medicaid
nonprofit
corporations
and
public
employees.
R
Ultimately,
ab274
is
a
life-affirming
bill.
It
gives
hope
to
people
diagnosed
with
diseases
that
do
everything
to
extinguish
it.
We
have
been
communicating
with
stakeholders
in
the
insurance
market
to
understand
and
work
through
their
concerns.
I
am
now
going
to
turn
it
over
to
lindsey
knox.
Vice
president
of
government
affairs
and
mcdonald
in
carano
she
has
a
developed,
a
conceptual
amendment
that
is
available
on
dallas
for
the
committee's
review
and
which
will
address
also
some
concerns.
R
After
ms
knox
presents,
then
we
will
turn
it
over
to
kendall,
cervino
and
hopefully
followed
by
dr
zucker.
Although
dr
zucker
may
be
gone,
he
has
patience
to
see
this
afternoon.
So
thank
you
very
much.
S
Thank
you
assemblywoman,
gorlo
and
chair
how
to
gain
committee
members
lindsey
knox
with
mcdonald
carano
for
the
record.
As
she
stated,
we
have
a
conceptual
amendment
that
we
have
worked
on
to
try
and
alleviate
some
of
the
concerns
that
insurance
has.
S
So
one
of
the
main
changes
is
the
effective
date.
We
are
going
to
change
that
from
july
1
to
january
1st
2022.
This
will
allow
the
plans
to
properly
prepare
if
this
bill
were
to
pass
another.
Another
part
of
the
amendment
will
also
include
in
the
medicaid
section
a
waiver
now
the
reason
we
did
this
is
initially
we
were
concerned
about
having
medicaid
in
the
bill
due
to
the
recent
cuts
and
putting
an
additional
burden
on
the
state
for
that
coverage.
S
S
And
then
the
last
that
we
currently
have
would
be
for
the
self-funded
plans
providing
an
opt-in
provision,
understanding
that
there
are
certain
self-funded
plans
that
have
truly
struggled
during
the
pandemic
and
to
cause
more
burden
would
just
be
unfair.
So
we
are
working
with
the
health
service
coalition
to
on
an
amendment
in
hopes
that
we
can
come
to
a
resolution
there.
We
know
that
there
will
be
more
issues
coming
and
we
are
happy
to
work
with
all
stakeholders
and
hopefully
come
up
with
again
some
tighter
language
to
make
everybody
happy.
S
I
actually
I
hate
to
to
interject,
but
I
wanted
to
actually
introduce
kendall
myself.
So
I
apologize
kendall
came
to
me
about
sick
back
in
june
of
2020..
S
I
sit
on
the
susan
g
komen
board
here
in
nevada
and
kendall
was
interning
and
kendall,
told
me
her
story
and
asked
me
to
help
her
figure
out
a
way
to
get
fertility
preservation
here
in
the
state.
So
her
story
was
so
touching
to
me
and
I
hope
to
all
of
you
and
so
from
there.
I
will
turn
it
over
to
kendall
and
thank
you
chair
for
allowing
me
to
step
in
and
introduce
her
absolutely
miss
knox.
T
Hi
good
afternoon,
everybody.
Thank
you
lindsay
for
that
wonderful
introduction.
My
name
is
kendall
savino.
I
am
a
first-year
medical
student
at
the
university
of
nevada,
reno
school
of
medicine
and
also
a
breast
cancer
survivor
about
a
year
and
a
half
ago,
during
my
last
semester
of
college
at
unlv,
I
was
diagnosed
with
breast
cancer
receiving
the
news,
as
I
sat
by
myself
in
the
radiologist's
office,
was
the
worst
day
of
my
life.
T
T
So
last
summer
I
became
involved
with
susan
g
komen
through
an
internship,
and
one
of
the
goals
that
I
had
was
to
see.
If
I
could
make
change
on
fertility
preservation
here
in
nevada,
I
was
aware
that
some
other
states
provide
insurance
coverage
for
patients
that
are
undergoing
chemotherapy
like
myself
or
are
receiving
medically
necessary
treatment.
A
D
Hopefully,
you
guys
can
hear
me
good
afternoon,
assemblyman,
gorlo
and
members
of
the
committee.
D
Be
the
image
in
your
mind
as
we
move
forward
with
this
bill,
because
it
really
is
the
most
important
I'd
like
to
take
a
real
quick
moment
of
my
a
lot
of
time
to
introduce
myself,
I'm
third
generation,
a
physician
in
my
family
to
practice,
medicine
in
the
great
state
of
nevada.
My
grandfather
and
father
before
me
have
both
built
incredible
reputations
for
their
exceptional
care
and
patient
advocacy.
D
My
grandfather
in
the
south
and
my
father
up
in
the
north
had
lasting
impact
on
countless
nevada
families
and
both
helped
to
shape
the
landscape
of
medicine
in
the
state.
It's
clearly
clearly
within
my
dna
to
advocate
for
all
of
our
patients
here
in
the
state
of
nevada,
and
that's
why
I'm
speaking
on
behalf
of
the
assembly
bill
today,
number
274..
D
My
purpose
was
simple:
to
provide
safe
and
effective
oncologic
care
and
to
obviate
the
unnecessary
travel,
expense
and
emotional
burden
of
all
their
care.
Our
program
to
date
has
received
national
and
international
recognition.
As
a
member
of
the
children's
oncology
group
and
in
keeping
with
that
original
purpose,
I
really
do
feel
that
we
have
eliminated
a
tremendous
amount
of
stress
and
burden
for
northern
nevada
families
such
that
they
can
concentrate
on
their
care
and
on
their
health.
D
This
is
a
theme
that
you
heard
by
our
last
speaker
and
and
also
one
that
I'll
continue
with
in
the
rest
of
my
presentation.
D
In
my
current
practice,
I
see
patients
ranging
in
age
from
birth
to
25
years
of
age.
Sometimes
I'll
see
patients
up
to
30
years
of
age.
My
patient
population
overlaps
very
nicely
with
the
adult
oncology,
colleagues
that
I
have
in
town
specifically
in
what
we
define
as
the
aya,
which
is
the
adolescent
and
young
adult
population
together.
D
My
patients,
especially
those
who
are
younger
at
the
time
of
their
diagnosis,
will
be
faced
with
long-term
health,
emotional
and
even
financial
burdens
of
their
therapies,
lasting
well
well.
Well,
beyond
the
completion
of
their
therapy,
there
is
a
bright
side
in
that
there
have
been
great
efforts
that
have
been
made
to
mitigate
the
late
effects
of
their
therapy.
D
D
The
risk
of
infertility
varies
with
diagnosis
and
prescribed
therapy.
Nearly
all
patients
who
will
be
receiving
chemotherapy
will
be
at
some
risk
of
sterility
or
infertility,
but
a
majority
of
them,
and
that's
that
50
statistic
that
you
had
heard-
and
I
would
actually
argue
in
my
population
higher-
are
at
risk
for
either
moderate
or
high
or
are
at
moderate
or
high
risk
of
infertility
and
sterility.
D
D
There
is
no
way
around
it
in
that
initial
discussion
of
the
the
cancer
diagnosis,
a
patient
and
or
their
family
loses
control
some
control
over
the
outcome,
and
at
least
that
that
outcome,
the
control
over
the
outcome,
is
tremendously
challenged.
They're
left
feeling
powerless
over
the
disease
and
of
their
future.
D
D
Any
control
over
that
outcome
that
can
be
restored
has
profound
and
positive
impacts
on
patients,
their
well-being
and
even
indirectly,
on
other
healthcare
costs
by
eliminating
those
comorbidities.
The
tone
of
the
conversation
can
immediately
change.
If
we
add
to
the
discussion,
your
life-saving
therapy
may
prevent
you
from
being
able
to
conceive
biological
children,
but
we
do
have
a
solution
and
there
is
a
solution
and
that's
fertility.
Preservation.
Fertility
preservation
is
a
standard
of
care
in
aya
oncology.
D
D
There
are
many
many
many
factors
which
ultimately
influence
a
patient's
decision
to
pursue
fertility
preservation.
The
most
common
barriers
include,
but
are
not
limited
to
the
age
of
the
patient.
If
they're
too
young
to
be
able
to
undergo
procedures
too
young
to
be
able
to
donate
or
bank
sperm,
the
timing
of
their
cancer
therapy,
I'm
often
challenged
with
having
to
start
therapy
life-saving
therapy
on
a
patient
and
balancing
that,
with
the
amount
of
time
that
it
would
take
to
go
ahead
and
proceed
forward
with
fertility
preservation.
D
But
unfortunately,
a
third
barrier
oftentimes
it
comes
up
is
regarding
cost
to
the
patient
of
the
three
barriers
listed.
We
are
left
with
little
option
regarding
the
first
two.
However,
the
third
option
is
one
that
really
we
should
ensure
that
that
cost
is
not
a
deciding
or
dissuading
factor
for
the
patient.
D
I
do
want
to
share
with
you
a
story
of
a
19
year
old
patient
of
mine
who
just
completed
the
process
of
fertility
preservation
and
provided
me
with
the
following
direct
quote:
no
one
decides
to
be
infertile
the
expense
of
already
having
to
deal
with
medical
bills
associated
with
childhood
cancer,
as
well
as
the
physical
and
emotional
trauma
that
has
caused
is
already
more
than
anyone
should
have
to
handle
going
through
fertility
treatment
at
such
a
young
age.
Under
these
circumstances
is
already
stressful
enough
wondering
how
to
pay
for
college
is
already
stressful
enough.
D
It
is
clear
from
the
statement
that
the
fertility
is
or
fertility
preservation
is
a
topic
that
matters
to
our
patients,
especially
our
aya
patients,
especially
our
young
adults.
Infertility
is
associated
with
depression,
low
self-esteem
and
is
often
a
source
of
disruption
in
family
dynamics
and
planning.
D
These
are
not
decisions
that
any
teenager
or
young
adult
should
have
to
make.
So.
In
summary,
fertility
preservation
should
be
offered
and
included
in
the
comprehensive
care
of
our
adolescent
patients
and
young
adult
cancer
patients.
The
number
of
patients
who
will
ultimately
be
appropriate
for
fertility
preservation
is
proportionally
small
and
therefore
the
overall
cost
of
the
service,
too,
is
actually
relatively
small.
D
The
benefit,
however,
to
the
individual
is
great
and
would
be
in
keeping
with
mitigation
of
unnecessary
stress
and
burden
for
this
patient
population
and
again
chairman
as
well
as
assemblywoman
gorlo,
and
thank
you
to
all
the
the
members
for
for
being
able
to
hear
me.
This
is
an
exceptionally
important
subject.
You
just
saw
right
before
your
eyes
a
real
patient,
with
a
real
story
of
why
this
is
so
important,
and
I
encourage
you
to
give
great
consideration
to
this
bill.
A
A
R
A
R
A
Questions.
Thank
you.
Thank
you.
Assemblyman
committee
members,
questions
please
and
chat.
I
see
assemblymember
tools.
O
Thank
you
and
thank
you
so
much
for
the
presentation
for
bringing
forward
this
bill
and
thank
you
especially
and
miss
servino,
for
sharing
your
story
and
as
a
mother
of
two
daughters.
I
asked
myself
reading
this
bill.
O
You
know
how
I
would
how
I
would
feel
if
they
were
in
that
same
situation
and
and
that
I
would
want
them
to
have
this
option
as
well,
and
so
I
really
appreciate
this
legislation.
I
want
to
give
just
a
get
a
couple
questions
on
the
record.
O
I
did
have
a
chance
to
speak
with
the
proponents
beforehand,
so
I
just
want
to
make
sure
I
get
those
answers
on
the
record,
so
it's
clear
for
others
that
might
have
those
questions
in
the
future.
So
on
section
1,
subsection
5c,
we
have
the
definition
for
standard
services
for
fertility
preservation
and
if
you
could
just
review
what
that
includes,
and
what
that
does
not
include.
S
Okay,
so
lindsay
knox
for
the
record
through
you,
chair
to
assemblywoman
tolls.
So
what
that
covers
is
the
medication,
the
retrieval
and
what
the
appointments
and
then
the
storage.
O
Thank
you
and
I
think,
specifically,
the
question
came
up.
Does
this
cover
in
vitro
fertilization.
O
Thank
you
and
then
the
other
question
that
arose
was,
you
know:
do
we
have
procedures
in
place
or,
unfortunately,
if
the
life-saving
treatment
was
not
successful?
O
What
what
is
the
process
for
what
happens
with
the
you
know,
with
the
stored
embryos
and
and
reproductive
tissues
and
gametes.
S
O
Perfect,
thank
you
and
just
wanted
to
get
that
on
the
record
that
all
the
current
procedures
in
place,
for
you
know
addressing
those
those
concerns
are
already
in
place.
Thank
you.
So
much.
G
I
really
think
I
like
this
bill
and
I
appreciate
ms
garlow
bringing
it
forward.
It's
been
an
interesting
discussion.
I've
heard,
but
I've
got
a
question.
We
talk
so
much
in
with
insurance
payments,
insurance
companies,
retroactivity
or
pre-existing
condition.
G
They
already
have
insurance
or
they
or
you
have
already
I'm
sorry,
you've
already
harvested
the
embryo
or
sperm
they've
already
paid
for
it
to
go
into
storage.
Is
it?
Is
there
any
consideration?
Does
insurance
companies
pick
it
up,
then,
at
that
time?
In
other
words,
for
those
that
have
already
performed
this
act
and
suffered
the
treatment
plans?
Unfortunately,
I
don't
think
they
came
across
well
enough.
S
I
can
help
you
through
your
chair
member
ms
knox.
Thank
you
assemblyman
o'neill.
This
is
lindsey
knox
for
the
record.
Yes,
I
know
what
you're
asking
so
you're
asking
pretty
much
on
retroactivity.
So
if
somebody
were
to
switch
insurance,
would
that
storage
then
be
covered
when
they
switch
it?
Did
I
hit
get
that
right.
S
S
G
That's
why
I
was
looking.
I
appreciate
that
and
I
didn't
hear
cover,
but
can
someone
answer
what
would
be
the
approximate
cost
for
the
procedure
and
then
what
is
storage
run?
Is
it
time
limited
or
is
it
an
indefinite
freezing.
S
Lindsay
knox
for
the
record
assembly
of
minnowneel,
so
we
have,
I
have
a
little
chart
right
here.
Is
the
costs
and
again
you're
going
to
have
different
rates
based
off
of
your
location,
so
for
egg
freezing
you're
looking
at
the
services
cost
between
ten
thousand
and
fifteen
thousand
dollars,
which
storage
costing
between
three
hundred
and
five
hundred
dollars
per
year?
Embryo
freezing
eleven
thousand
to
fifteen
thousand
dollars
storage.
Four
hundred
six
hundred
dollars
a
year,
we'll
shoot
down
to
men,
sperm
banking
service
cost
is
500
to
a
thousand
dollars.
S
G
I
appreciate
that,
did
you
sheriff
you
don't
mind
me?
Would
you
get
that
for
us,
and
so
we
all
have
access
to
that.
Please.
A
J
Thank
you,
madam
chair,
and
I
have
three
different
questions
if
I
may
so
in
the
interest
of
fairness,
this
is
a
question.
I
ask
everyone
who
brings
one
of
these
types
of
bills,
and
you
heard
it
earlier
on
the
first
bill
today,
I'd
like
to
ask
the
sponsor
just
to
clarify
that
this
is
indeed
an
insurance
mandate.
R
To
you
vice
chair
carlton,
through
chair
harugi,
yes,
it
is
an
insurance
mandate.
Thank.
J
You
I
just
it's
always
good
that
we
make
sure
we
we
have
a
clear
record
and
typically
the
mandates
in
the
state
don't
apply
to
every
form
of
insurance.
I
believe
some
of
the
erisa
plans
are
excluded.
R
The
record
assemblywoman
michelle
gorlo
and
to
you
vice
chair
of
the
food
chair,
heidegge,
and
we
are
looking
at
options
to
opt
in
for
some
insurance
groups,
because
we
know
that
it
can
be
a
burden,
especially
with
the
self-funded
groups
and
we're
still
talking
with
other
groups
as
well.
J
Okay
and
and
if
we
could
expand
upon
the
medicaid,
I'm
going
to
put
my
ways
and
means
hat
on.
I
have
to
wear
it.
I
don't
put
it
on
in
every
committee,
but
I
have
to
in
this
one
because
we're
medicaid
was
brought
up,
I'm
just
curious
about.
If
you
could
expand
upon
how
this
would
work
with
medicaid,
I
I
just
have
a
concern
about
the
underlying
costs
that
would
come
to
the
state
for
this.
If
we
were
to
ask
for
the
waiver,
do
we
have
any
numbers?
Do
we
know
if
this
is?
J
R
Thank
you,
chair
heidegge,
and
for
the
record
assembly
one
michelle
gorilla.
I
do
not
have
those
numbers,
but
perhaps
lindsey
knox
might
have
them.
S
Assembly,
one
carlton,
oh,
this
is
lindsey
knox
for
the
record.
We
have
not
seen
a
fiscal
note
yet
from
the
medicaid
office,
so
those
numbers
are
still
unclear
to
us
again.
That's
part
of
the
reason
that
we
were
putting
in
the
waivers
to
give
them
additional
time,
but
I
would
like
to
again
see
that
fiscal
note
and
understand
what
the
impact
would
be
and,
like
I
said
in
my
introductory
comments,
that
is
a
big
concern
to
me.
S
J
J
This
will
be
my
final
question,
so
I
know
since
we
passed
the
affordable
care
act
and
the
insurance
commissioner
at
that
time
was
tasked
with
setting
up
the
essential
benefits,
plans
that-
and
it's
my
impression
and
recollection,
that
any
new
mandate
that
comes
in
after
the
essential
benefits
have
been
established
under
the
affordable
care
act.
There's
there's
a
provision
I'm
going
to
have
to
have
somebody
look
it
up.
J
I
only
have
to
look
at
it
every
couple
of
years
that
the
state
could
be
responsible
for
part
of
that,
because
it's
outside
of
essential
health
benefits.
So
I
just
want
to
put
that
on
the
record
for
our
committee
staff
and
for
ms
knox
to
look
into.
I
believe
there
might
be
some
unintended
consequences
with
adding
a
benefit
outside
of
the
aca
essential
benefits.
So
I
just
wanted
that
on
the
record.
For
the
the
full
conversation
on
the
bill,
as
we
move
forward.
S
Thank
you
assembly,
one
carlton,
again
lindsey
knox
for
the
record.
We
will
definitely
look
into
that
and
I
am
already
receiving
text
messages
that
we
have
an
answer
to
that.
So
we
will
get
that
for
you.
J
And
and
madam
chair,
if
I
could
also
what,
if
we
do,
have
an
insurance
representative
from
the
insurance
commissioner's
office
available
and
or
are
legal,
I
just
want
to
make
sure
that
we
have
all
the
information
when
it
comes
to
that.
Thank
you
very
much.
A
H
Lindsay.
Has
any
other
states
passed
legislation
such
as
this
that
we're
trying.
S
Assembly,
woman
marzola,
thank
you
so
much
for
the
question.
Lindsey
knox
for
the
record.
Yes,
currently
there
have
been
state
ten
states
that
have
passed
this
in
some
form
and
we
currently
have
10
states
that
have
active
legislation.
F
Yes,
please,
I
just
wanted
to
say
thank
you
to
kendall
for
getting
on
today,
sharing
her
story
and
using
her
story
to
make
such.
A
O
Thank
you.
I
believe
this
question
would
go
to
miss
knox
and
it
may
have
already
been
essentially
answered,
but
I
just
wanted
to
confirm
it
from
the
way
that
the
doctor
was
talking.
O
I
would
assume
there
was
a
population
of
patients
who
would
be
eligible
for
something
like
this,
who
are
underage
so
in
that
situation,
I'm
assuming
that
this
would
be
under
their
parents
insurance
and
then,
if
you're,
looking
at
future
storage,
then
at
some
point
that
would
have
to
switch
over
to
when
that
underage
person
becomes
an
adult
and
it
switches
to
their
insurance,
and
knowing
that
this
is
now
in
10
states
has
has
that
process
been
fairly
seamless.
Is
that
already
set
out?
Is
that
something
that
switches
like
that
responsibility?
S
Assemblyman
constantine
this
lindsay
knox
for
the
record.
Thank
you
for
the
question.
It
would
switch
over
once
that
child
became
an
adult
and
carried
their
own
insurance.
S
So
I
there's
a
little
bit
more
to
your
question
and
I
think
we're
going
to
have
to
look
to
do
a
little
bit
more
digging
to
see
if
it's
been
seamless
in
other
states.
I
want
to
make
sure
I
get
you
the
correct
answer
and
I
don't
say
anything
out
of
turn,
so
we
will
be
sure
to
follow
up
with
our
folks
that
we've
been
working
with
that
have
done
this
in
other
states
and
we'll
get
you
that
answer.
A
B
S
Are
paying
premiums
assemblywoman,
dickman,
lindsey
knox
for
the
record?
I
actually
do
have
those
numbers.
So
what
we
are
looking
at
based
off
of,
we
have
a
nevada
utilization
calculation,
which
I
can
also
share
with
the
committee.
So
we
are
looking
at
about
740
people
that
would
actually
be
eligible
for
this
in
the
state
and
again
we
don't
know
the
exact
cost
from
a
nevada
perspective.
S
But
what
I
can
say
is
that
we
have
cost
estimates
that
other
states
have
done
and
what
the
premiums
that
what
is
it
the
per
member
per
month
increase
and
it's
looking
at-
and
this
was
in
california
one
cent
per
month,
which
would
potentially
go
from
one
cent
to
six
cents.
So
in
that
range
and
then
connecticut
was
10
cents
to
24
cents.
J
And
thank
you
assemblywoman
dickman
I'll,
be
stepping
in
for
the
chair
for
just
a
moment.
So,
ms
knox,
if
you
could
provide
that
because
we
need
to
have
those
we
want
to
be
sure
and
have
that
I'm
not
sure
about-
I,
I
didn't
quite
hear
every
single
number,
so
if
you
could
provide
the
document,
that'll
just
make
it
much
easier
for
us
to
be
able
to
look
at
I.
J
I
know
these
these
treatments
can
be
very,
very
expensive,
so
we
just
need
to
to
look
at
be
able
to
do
the
math
on
it
from
there.
So
thank
you.
Of
course,
we
will
get
those
all
those
documents
to
you.
Thank
you.
We
appreciate
that
so
other
members
of
the
committee
with
any
questions
at
this
time.
J
You
don't
believe
I
see
anyone
else
wishing
to
be
recognized
at
this
moment.
So
with
that
we
will
go
ahead.
Ms
gore
assemblywoman
gorilla
we'll
go
ahead
and
go
to
those
in
support,
so
if
we
could
go
ahead
and
open
up
the
phone
lines
and
if
broadcast
services
would
please
queue
up
those
remember
those
folks
in
support.
That
would
be
great.
Thank
you.
E
A
T
We
can
okay.
Thank
you
so
much
good
afternoon.
I
just
want
to
thank
the
chair,
and
vice
chair
and
committee
members
for
allowing
me
to
speak
in
support
of
assembly
bill
274.
T
As
the
executive
director
of
an
organization
called
the
alliance
for
fertility
preservation,
we
are
a
national
non-profit
organization,
that's
dedicated
to
helping
cancer
patients
both
understand
and
also
navigate
the
reproductive
consequences
of
their
cancer
treatment,
but
I
am
also
here
as
a
cancer
survivor
and
had
a
diagnosis
of
cancer
in
my
20s
and
just
as
you
heard
from
kendall,
you
know
it's
a
terrifying
process
and
it's
really
difficult
to
deal
with
that
diagnosis
and
have
a
threat
to
your
life
and
then
learn
that
your
ability
to
have
children
would
probably
also
be
destroyed
by
your
treatments.
T
T
To
cover
all
the
costs
of
doing
a
round
of
embryo
freezing,
so
for
me,
I'm
20
years
out
of
my
diagnosis
and
I
have
healthy
twin
daughters
and
they
were
born
as
a
result
of
that
fortunate
information
that
was
shared
with
me
in
time.
T
So
as
a
result
of
that
experience,
it
really
redirected
my
entire
professional
life,
and
I
was
working
as
a
trademark
attorney
very
exciting,
but
for
the
past
about
15
years
I
have
been
working
in
this
space
and
I
want
to
let
you
all
know
that
I
have
met
hundreds
of
young
cancer
patients,
young
adult
patients,
that
dr
zucker
told
you
about.
I've
met
their
families.
I've
met
their
spouses
and
I've
heard
you
know
just
how
important
this
issue
is
to
them
so
years
ago.
T
You
know
this
was
really
not
an
option
for
patients.
You
know
choices
were
very
limited,
especially
for
women,
so
there
was
really
no
discussion
at
all
about
insurance
coverage,
but,
as
dr
zucker
told
you,
this
technology
has
really
become
standard
and
these
techniques,
especially
in
the
past
decade,
I
would
say-
for
egg
freezing
for
women
have
really
become
accepted.
Efficacious
technologies
that
do
provide
a
solution
for
patients
if
they're
lucky
enough
to
be
able
to
afford
it.
T
Unfortunately,
however,
insurers
have
not
kept
up
with
the
standard
of
care
and
they
have
continued
to
label
fertility
preservation
as
a
type
of
infertility,
treatment
like
ivf
and
continue
to
label
it,
something
that
is
elective
and
therefore
excluded,
but
the
loss
of
you
know
fertility
and
parenthood
for
a
patient.
I
just
want
you
to
think
about
as
not
just
a
medical
complication,
but
it's
really
affecting
parenthood
and
reproduction,
which
are
fundamental
life
functions
and
deserve
the
highest
levels
of
protection,
especially
for
young
vulnerable
patients,
but
at
a
minimum.
A
T
Sure,
absolutely
anyway,
as
lindsay
told
you,
there
are
10
states
that
have
passed
this
coverage
and
the
veterans,
health
administration
and,
most
recently,
the
federal
employees.
Health
benefits
program,
is
adding
this
benefit.
So
they're.
Really.
T
This
has
really
been
the
trend
over
the
past
three
years
and
we're
happy
to
share
with
you
any
information,
as
she
said
about
the
costs
which
are
really
pennies
per
member
per
month
when
spread
across
the
whole
population
of
insureds
and
really
take
that
burden
from
the
individual
patients
who
you
know,
may
or
may
not
be
able
to
afford
this.
So
I
respectfully
would
just
ask
that
you
consider
what
we've
discussed
here
today
and
and
pass
this
measure.
Thank
you
for
your
time.
E
B
Wonderful.
Thank
you,
madam
chair,
for
the
record,
my
name
is
amanda
klein
k,
l
e
n
and
I
am
the
founder
of
nevada
fertility
advocate,
which
is
a
coalition
of
organizations
dedicated
to
infertility
and
cancer
patients
in
nevada.
I'm
also
co-chair
of
the
nevada
leadership
board
for
the
american
cancer
society
and
with
mrs
nevada
2020.,
like
kendall,
my
mother
was
diagnosed
with
breast
cancer
during
her
reproductive
years.
My
husband
and
I
are
also
among
the
one
in
six
couples
who
struggle
with
a
disease
of
infertility.
B
After
many
years
of
medical
intervention
and
every
member
of
my
family
contributing
financially
mark,
and
I
were
able
to
welcome
our
beautiful
our
beautiful
daughter
emma
into
the
world
last
year,
but
knowing
firsthand
the
mental,
physical
and
financial
and
emotional
toll
that
infertility
takes
on
families.
I
cannot
imagine
starting
this
journey
with
a
cancer
diagnosis.
B
E
B
B
E
B
Hi,
my
name
is
dr
carrie
bediant
c-a-r-r-I-e.
Last
name
is
beath
and
boy
e,
d's
and
dog
I.e
and
as
a
nancy
t
and
tom.
Thank
you
very
much
for
giving
me
an
opportunity
to
support
such
an
important
piece
of
legislation
for
my
patients
and
their
families.
I'm
a
reproductive
endocrinologist
at
the
fertility
center
of
las
vegas,
a
clinical
assistant
professor
at
unlv,
college
of
medicine
and
ob
gyn
residency,
the
director
of
reproductive
endocrinology
for
the
mountain
view
of
the
gyn
residency
and
co-founder
of
fertility
docs
on
sunfood
I'll,
be
as
concise
as
possible.
B
Regarding
my
professional
experiences
with
this,
when
I
meet
with
patients
who
have
a
fresh
cancer
diagnosis,
the
hurdles
in
front
of
them
are
immense.
They're
dealing
with
a
devastating
life-threatening
diagnosis
that
has
both
physical
and
a
very
intense
financial
set
of
demands
for
tests
and
appointments
needed
to
start
their
life-saving
treatment
that
will
ultimately
destroy
their
potential
to
build
their
own
biological
family.
They
typically
have
two
to
three
weeks
between
their
cancer
diagnosis
and
the
start
of
their
treatment
to
accomplish
both
cancer
testing
and
fertility
preservation.
B
Those
appointments
are
two
to
three
times
longer
than
average,
and
the
tears
at
them
are
very
real
and
very
profuse,
despite
a
willingness
from
the
fertility
clinic
to
drop
everything
to
fit
in
a
patient
with
a
new
diagnosis
of
cancer
and
help
them
get
the
treatment
they
need,
the
patients
frequently
cannot
financially
access
those
services
due
to
a
complete
lack
of
coverage.
My
office
spends
inordinate
amounts
of
time
trying
to
gain
authorization
from
insurance
companies.
B
For
these
patients,
many
companies
will
deny
coverage
because
these
patients
aren't
currently
infertile,
despite
the
fact
that
they're
life-saving
cancer
treatment
is
all
but
guaranteed
to
make
them
infertile
retroactive.
Retroactive
coverage
is
unheard
of.
We
cut
fees
as
much
as
possible
to
cover
just
required
expenses.
B
Cancer
patients
don't
have
time
or
resources
to
petition
their
insurance
company
for
important
treatment.
This
is
unacceptable
as
a
fertility
doctor
and
even
more
importantly,
unacceptable
for
many
patients
who
refuse
or
truncate
their
treatment
in
an
attempt
to
save
their
chance
of
having
their
own
baby.
B
B
I
spoke
yesterday
with
a
26
year
old
man
who
I
froze
sperm
for
four
years
ago,
while
he
was
acutely
hospitalized
with
testicular
cancer
after
a
tremendous
effort
from
him,
his
family,
his
girlfriend
and
our
office,
because
of
those
really
extraordinary
actions
for
something
that
is
relatively
simple,
we
were
able
to
get
enough
sperm
to
help
him
conceive
and
now,
after
three
years
of
remission,
he
and
his
girlfriend
are
now
going
to
start
working
hard
as
they
plan
to
build
their
family.
B
E
B
Thank
you,
madam
chair
vice
chair
and
committee.
My
name
is
connie
monk
that
is
c-o-n-n-I-e
m-u-n-k
and
I'm
the
former
assemblywoman
for
assembly
district
4..
I
support
ab274
because
it's
imperative
that
standard
health
plans
have
coverage
for
persons
going
through
any
type
of
medical
procedure
such
as
chemotherapy
that
could
cause
infertility.
B
As
a
breast
cancer
survivor
myself,
I
know
the
devastating
effects
that
chemotherapy
has
on
the
body.
I
urge
this
committee
to
support
and
pass
274
so
that
patients
who
want
to
preserve
their
eggs
and
sperm
can
be
assured
of
fertility
preservation
through
their
insurance
plans,
and
I
thank
you
for
your
time.
E
B
J-A-M-I-E-R-O-D-R-I-G-U-E-Z,
I'm
the
government
affairs
manager
for
washoe
county.
I
am
here
in
opposition
of
the
bill
not
on
the
policy
behind
it,
but
really
on
the
fiscal
impact
to
it,
and
I
know
that
we
received
official
note
request,
but
it
is
not
yet
posted
on
nellis,
and
so
I
wanted
to
address
that.
We
do
have
some
concerns
regarding
the
cost
surrounding
this
very
much
appreciate
the
assembly
woman
and
their
proposed
amendment,
which
takes
out
the
self-funded
or
allows
for
self-funded
insurance
plans
to
opt
out.
B
However,
that
does
only
cover
a
portion
of
our
insurance
plans
and
we
do
have
some
that
are
not
self-funded
and,
as
a
rule,
washoe
county
has
always
tried
to
create
parity
amongst
our
insurance
plans,
so
allowing
that
service
for
some
of
our
employees
and
those
who
have
insurance
under
the
county
and
not
others,
would
create
some
strong
conflicts
for
us
and
then
determining
how
to
really
fund
that
so
again,
not
here
in
opposition
to
the
policy
behind
it.
But
some
concerns
about
how
we
would
be
able
to
fund
that.
E
K
Thank
you,
madam
chair,
for
the
record
trey
abney
t-r-a-y-a-b-n-e-y
here
today,
representing
america's
health
insurance
plans
or
ahip,
certainly
have
the
same
concerns
as
miss
rodriguez.
I'll,
be
brief.
K
We're
always
concerned
about
the
expansiveness
of
a
bill
like
this,
and
we
try
to
be
a
constant
reminder
that
increasing
mandates
increase
costs
on
every
policy
holder
and,
of
course,
our
position
has
nothing
to
do
with
the
specific
issues
or
policy
we're
talking
about
here,
but
the
the
idea
that
again
mandates
increased
costs,
but
but,
despite
all
that
interest
of
time,
I
want
to
thank
thank
my
good
buddy,
ms
knox,
for
proactively
reaching
out
to
us
on
this
bill.
K
E
L
Thank
you,
madam
chair
members
of
the
committee.
My
name
is
tom
clark.
That's
t-o-m-c-l-a-r-k,
I'm
here
on
behalf
of
the
nevada
association
of
health
plans
and
excuse
me,
I
don't
want
to
take
up
a
tremendous
amount
of
time
this
afternoon
in
opposition
to
the
ab274,
and
we
have
met
with
miss
knox
and
appreciate
her
willingness
to
to
work
with
us
but,
as
has
been
said,
the
mandates
that
are
in
this
particular
piece
of
legislation.
L
You
know
provide
policy
that
has
no
guardrails
and
that's
going
to
lead
to
an
increased
cost
of
health
care
here
in
our
state.
We
have
a
lot
more
questions
than
we've
gotten
answers
so
far,
and
I
think
it's
just
it's
important
for
us
to
put
on
the
record
that
this
builds
approach
creates
mandates
that
are
static
and
incapable
of
reflecting
changes
that
occur
over
time
in
medical
technology
and
practice
and
potentially
leading
to
you
know
a
lower
quality
of
care
for
others.
L
A
E
E
B
For
the
record,
laura
rich
l-a-u-r-a-r-I-c-h,
executive
officer
of
the
public
employees
benefits
program,
I'm
testifying
today
in
the
neutral
position
as
the
pep
board
has
not
had
an
opportunity
to
discuss
this
bill
or
take
a
position
on
it.
Pep
anticipates
a
very
small
fiscal
impact
to
the
program.
The
impact
comes
from
mandated
coverage
for
services
that
are
not
covered
by
the
pebb
self-funded
plans.
Today,
pep
did
perform
an
analysis
on
the
use
of
these
types
of
services
and
determined
that
that
there's,
a
relatively
low
utilization
rate
among
members
participating.
B
A
R
Yes,
thank
you,
chair
hadiki.
I
would
like
to
take
a
moment
and
express
my
gratitude
to
lindsay
knox
kendall,
cervino
and
dr
zucker
for
presenting
with
me
today
and
all
those
who
called
in
for
support
of
ab274
ios
would
like
to
take
a
moment
and
thank
former
assemblywoman
connie
monk
who
originally
originally
had
requested
this
legislation,
and
she
asked
me
to
carry
it.
I
also
want
to
thank
all
those
who
called
in
opposition.
R
A
A
While
we
give
those
listening
over
the
internet
the
opportunity
to
call
in
under
public
comment,
I'm
going
to
read
some
quick
housekeeping
remarks,
I
would
like
to
remind
those
present
or
listening
over
the
internet
that
the
period
for
public
comment
is
an
opportunity
to
discuss
general
matters
that
fall
under
the
purview
of
this
committee.
The
public
has
already
been
given
time
to
support
or
oppose
specific
legislation.
A
We
open
and
close
hearings
on
bills
so
that
we
establish
a
public
record
of
testimony.
Therefore,
public
comment
is
not
intended
to
continue
a
bill
hearing.
I
would
like
to
remind
you
that
we
limit
public
comments
to
two
minutes.
Please
address
your
remarks
to
issues
that
fall
within
the
jurisdiction
of
commerce
and
labor.
If
your
remarks,
if
you
direct
your
remarks
to
issues
over
which
this
committee
has
no
oversight,
I
will
ask
you
to
redirect
your
remarks
or
terminate
them.
You
may
always
submit
written
remarks
for
inclusion
in
the
meeting
record
with
that
broadcasting.
E
K
Again,
hello,
my
name
is
cyrus
hogany.
The
reason
I
called
is
because
I
hear
a
lot
of
people
complain
about
health
care
and
costs
and
everything,
and
we
need
to
start
addressing
the
reason
why
our
health
care
costs
are
so
high.
The
fact
that
ever
since
we
had
the
repeal
of
the
1973
hmo
act,
health
care
costs
skyrocketed.
K
We
need
to
start
addressing
the
root
cause
of
why
it's
going
up
about
solution.
The
affordable
care
act
has
not
overall
reduced
health
insurance
premiums.
When
you
look
at
other
countries,
every
industrialized
country
guarantees
health
care.
So
perhaps
this
is
something
that
we
can
look
into
or
we
can
repeal
the
73
act.
That's
certainly
a
step
forward,
because
health
care
costs
are
eating
up
our
budgets.
It's
even
having
a
significant
impact
on
our
tourism
community.
Our
country
is
very
divided,
increasing
numbers
of
inequality,
lots
of
polarization,
dirty
amounts
of
campaign
contributions.
K
The
people
are
not
being
represented,
and
here
in
the
state
of
nevada.
What
we
have
is
the
casino
fascist
government
where
they
control
the
unions
like
culinary
and
other
interests
like
real
estate
have
incredible
control.
We
need
serious
campaign.
Finance
reform
or
an
idea,
given
the
division,
is
to
break
up
the
country.
That
is
why,
right
now,
I
am
here
passing
flyers
in
the
asian
district.
I
know
there's
a
lot
of
concerns,
there's
a
lot
of
tension
and
I'm
giving
out
flyers
to
consider
breaking
up
the
united
states.
K
So
people
who
have
differences
can
live
in
separate
societies
and
we
reduce
the
tension
and
perhaps
we
need
a
divorce
and
I'm
also
hearing
a
lot
of
people
not
just
on
the
right,
but
even
progressives
are
not
even
happy
with
the
current
administration
and
they
weren't
even
happy
before
all
this
stimulus.
Much
of
the
money,
regardless
of
which
party.
A
Thank
you
so
much
broadcasting
and
thank
you
committee
members
for
sticking
it
out.
I
know
this
was
a
long
day
for
us
in
commerce
and
labor.
You
should
be
getting
the
agenda
for
friday's
meeting
shortly.
Please,
I
would
know
again
just
take
a
look.
At
the
start
time
we
were
going
to
be
agendizing
for
noon
or
upon
the
adjournment
of
floor.
So
thank
you
so
much.
That
concludes
our
meeting
for
today
we
are
adjourned.
Thank
you.
Thank.