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From YouTube: 5/3/2021 - Assembly Committee on Commerce and Labor
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A
A
Here,
thank
you,
mr
secretary.
Please
mark
any
members
not
hear
absent
excused
and
please
mark
members
present,
as
they
arrive,
welcome
to
our
audience,
both
in
person
and
those
tuning
in
over
the
internet.
Before
we
start,
I
would
like
to
go
through
our
normal
housekeeping
announcements.
A
Please
remember
all
exhibits,
written
testimony
and
amendments
must
be
submitted
by
noon
on
the
business
day
prior
to
the
committee
meeting
persons
wishing
to
provide
testimony
or
attend
the
meeting
in
person
or
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,
the
assembly,
commerce
and
labor
members
and
presenters,
and
those
here
in
the
audience.
Please
remember
to
silence
your
electronics
also.
Committee
members
are
using
electronics
to
view
exhibits,
amendments
and
the
bills.
A
Please
note
it's
not
a
sign
of
disrespect
or
inattention
presenters
on
zoom
and
those
wishing
to
testify
on
zoom.
Please
remember
to
be
muted
at
all
times
and
please
keep
your
cameras
on
that's
the
only
way
we
can
see
you
that
you
are
with
us.
Thank
you,
everyone
and
let's
go
ahead
and
begin
with
our
first
agenda
item
on
today's
agenda.
We
do
have
four
bills
for
bill
hearing.
A
I
will
be
taking
those
in
numerical
order
for
those
of
you
who
are
watching
and
would
like
to
know
and
where
your
bill
will
be
heard
with
that
we
will
open
the
hearing
on
senate
bill
184.
I
believe
we
have
senator
hardy
here
to
present
it
senate
bill
184
revises
provisions
relating
to
the
practice
of
medicine.
Welcome
senator
hardy
when
you're
ready.
C
senate
bill.
184
is
designed
to
get
more
access
and
that's
kind
of
one
of
the
things
that
we're
interested
in
doing
so.
It
basically
does
two
things:
it
allows
a
physician,
md
or
deal
to
apply
for
licensure
in
the
state
of
nevada
after
two
years
of
postgraduate
medical
education
and
then
for
foreign
graduates
other
than
canada,
because
u.s
and
canada
are
pretty
similar
three
years
of
postgraduate
medical
education,
the
other
parts
of
the
bill
are
largely
dealing
with
physician
assistance
and
what
they
would
propose
to
be
doing
so.
The.
C
So
what
the
bill
does
then
is.
It
allows
the
physicians
to
have
a
volunteer
aspect
of
it
and
I
go
back
to
what
the
emergency
declaration
of
the
governor
did
where
he
invited
he
opened
the
door
basically
for
all
medical
practitioners
and
mental
health
practitioners,
and
that
was
a
huge
opportunity
that
we
have
to
recruit.
C
D
And
thank
you,
madam
chair,
so
dr
hardy,
if
you
could
just
expand
on
why
you
think
the
two
years
of
postgraduate
rather
than
the
three,
because
I
actually
remember
when
we
did
the
three
when
we
had
conversations
about
the
three
years
so
and
I
noticed
you're
keeping
it
three
for
those
outside
the
country,
but
two
for
in
so
is
there
a
difference
in
the
educational
level?
Do
they
complete
more
classes
within
those
two
years?
Why?
D
Why
are
we
changing
it,
you're
proposing
to
change
it
to
two
years.
C
D
And
and
dr
hardy
is
there
anything
in
this
legislation,
and
I
I
tried
to
read
through
it
that
changes
the
supervision
level
of
pas.
C
Interesting
what
we
did
is
we
looked
at
what
the
pas
do
in
reality
now,
and
so
all
of
the
things
that
are
numbers
and
how
many
and
how
you
do
would
be
up
to
the
boards
more
than
it
would
be
in
this
statute.
So
this
statute
looks
at
the
boards
being
able
to
make
those
decisions
about
how
many
pas
a
person
supervises.
C
And
to
your
point:
yes,
the
thing
that
we're
finding
with
pas
is:
they
are
probably
as
well
as
trained
as
well
educated
as
some
of
our
other
practitioners
and
we're
looking
at
the
reality
of
what
can
a
pa
do
and
the
training
and
the
ultimate
responsibility
is
on
the
doctor.
Who
is
the
one
going
to
be
supervising
them.
D
Well,
dr
hardy,
you
just
lost
me
there
because
that's
been
an
issue
in
this
building
for
probably
as
long
as
I
have,
and
I
have
real
concerns
about
handing
over
handing
that
over
to
a
board
we've
seen.
Some
boards
have
some
real
issues
and
I
I
really
think
the
the
legislature
should
still
set
some
type
of
parameter
for
public
safety's
sake,
because
we
have
had
folks
come
in
here
and
say
that
they
want
to
supervise
folks
and
they
could
have
been
100
miles
away.
D
So
I
I
just
have
some
concerns
about
that.
I'll
have
to
have
more
conversations
with
the
boards
on
that,
just
to
kind
of
see
where,
where
they're
going,
but
that's
that's,
really
opening
up
a
big
door,
the
one
I'm
confused
about
is
section
11,
you've
got
630.047
and
that
the
chapter
does
not
apply
to,
and
I
believe
that
refers
back
to
the
practice
act
and
then
you're,
including
the
performance
of
medical
services
by
a
student.
D
So,
in
essence,
does
this
state,
under
section
11,
on
page
six
item,
l,
that
medical
students
pa
medical
students
will
not
be
under
the
supervision
of
a
board
if
they're
performing
something
in
an
educational
realm?
Are
they
going
to
be
giving
treatment
to
the
public
and
not
be
under
the
board's
jurisdiction?
What
does
what
are
you
actually
trying
to
fix
with
that
particular
section.
C
This
we're
fixing
it
both
in
the
do
section
and
in
the
md
section
this
one
that
you're
talking
about
is
the
md
section.
D
So
the
physician
assistant
will
still
have
to
be
under
the
supervision
of
an
actual
doctor
or
they'll
just
be
under
the
supervision
of
the
educational
program,
because
I
know
in
the
past,
we've
had
conversations
about
pas
going
out
and
doing
volunteer
work
at
remote
area,
medical
things
along
that
line
and
not
having
that
direct
supervision.
So
will
they
still
have
direct
supervision
under
this.
D
E
Thank
you,
chair
and
good
to
see
you
senator
thanks
for
bringing
this
bill
forward.
I
actually
had
a
constituent
reach
out
to
me
and
an
appreciation
for
this
bill,
so
I
always
left
getting
that
direct
contact.
I
wanted
to
direct
our
attention
to
section
16..
If
you
could
just
sort
of
walk
us
through
to
clarify
make
sure
my
understanding
is
correct.
E
We
have
a
two
new
editions
of
an
application
for
the
issuance
of
a
simultaneous
license
as
physician
assistant
at
two
capped
at
200
and
then
the
biennial
simultaneous
registration
of
a
physician
assistant
capped
at
400.
Would
that
be
in
addition
to
the
initial
licensure
as
a
physician
assistant,
or
is
that
instead
of
is
that
today
currently
would
they
have
to
pay?
You
know,
for
example,
two
four
hundred
dollar
fees-
and
this
is
just
saying,
if
you're
adding
on
the
second
one,
you
get
a
discounted
rate
at
200.
E
C
A
Members
any
other
questions.
Okay,
I
do
have
a
couple
questions
senator
hardy
that
just
triggered
a
question.
What
my
colleague,
assemblymember
told
asked
so
so
we're
giving
them
two
boards
for
half
the
price.
C
They're
in
statute
now,
madam
chair
and
joe
hardy
for
the
record
they're
in
statute
now,
but
they're
basically
twice
as
much
so
if
you
went
to
one
board
it
would
be
400
if
we
went
to
the
other
board,
it'd
be
800
and
that's
my
understanding.
A
C
C
A
Okay-
and
I'm
just
going
to
ask
one
last
question:
so
do
you
with
the
with
the
states
of
27
states-
and
I
don't
know
if
this
is
information
that
you
have
that
have
reduced
to
the
residency
to
one
year?
Have
they
seen
greater
numbers
of
doctors
heading
that
heading
in
that
direction
coming
to
their
state,
as
opposed
to
the
five
states
with
three
years
or
the
14
states,
with
two
years.
C
Thank
you,
madam
chair
joe
hardy,
for
the
record.
There
are
some
states,
for
instance,
I
think
it's
in
missouri
kansas
on
that
border,
that
have
what
we
call
assistant
physicians,
where
they
just
take
the
physician
out
of
medical
school
and
under
the
direction
of
a
physician,
have
that
person
with
a
license.
C
C
So
I
don't
think
other
states
are
going
back
to
one
year
as
much
as
they
as
we
in
california,
arkansas
maine,
south
dakota
at
latest
count
went
to
three
years,
so
the
the
majority
of
states
are
at
one
year
of
graduate
medical
education
and
then
there's
a
significant
number
at
two
years,
which
is
what
I'm
proposing
and
the
three
years
is
for
the
minority.
The
vast
minority
of
states.
A
Okay-
and
I
know
I
said
that
was
my
last
question,
but
I
do
have
one
more:
it
was
three
years
for
residency.
We
were
proposing
to
take
it
down
to
two
years.
What
was
it
for
those?
It
was
three
years
for
post-graduate
residency
training
for
foreign
schools.
What
was
it
before.
C
I
all
the
time
have
somebody
say:
do
you
recommend
a
doctor
and
I
may
recommend
a
doctor
and
they'll
say:
well,
the
doctor's
filled
up
and
they're
not
accepting
new
patients,
and
I
hear
that
over
and
over
and
over
and
the
reality
is
they
may
not
be
able
to
get
into
a
doctor,
but
they
have
other
options
that
they
pursue
nurse
practitioners,
so
it
it.
It
is
a
a
time
where
we
need
more
doctors,
and-
and
this
is
one
venue
to
do
it.
A
And
I
just
don't
think
I
asked
my
question
correctly
for
the
section
2b,
where
it's
requiring
three
years
of
residency
for
those
who
made
it
maybe
did
their
schooling
outside
of
the
united
states.
What
was
it
before?
Has
it
always
been
three
years
residency
as
well,
for
those
who
maybe
received
their
education
outside
of
the.
A
C
A
C
A
A
G
G
B
On
behalf
of
our
clients,
the
nevada
academy
of
physician
assistants,
founded
in
1977
apple's
goal,
is
to
not
only
improve
the
quality
of
health
care
by
increasing
accessibility
throughout
the
state,
but
to
also
give
a
voice
to
the
physician
assistant
profession
through
education
and
advocacy
over
1200
pas
working
in
every
facet
of
the
medical
industry,
we're
determined
to
bring
high
quality
health
care,
health
care
to
nevada
as
front
line
workers
during
the
covenanting
pandemic.
Now,
more
than
ever,
do
we
need
to
take
swift
action
to
improve
our
health
care
system.
B
One
solution
we
see
is
passing
legislation
on
position
assistance
as
a
rapidly
growing
profession.
We
firmly
believe
that
sb
184
streamlines
pa,
licensure
and
best
practices.
This
legislation
will
pave
the
way
for
additional
regulations
that
will,
in
turn,
better
the
health
care
system
in
the
state
of
nevada.
B
G
H
Sorry,
good
afternoon,
chair
and
members
assembly
committee
on
commerce
and
labor
for
the
record,
my
name
is
carmela
downing,
I'm
a
practicing
physician
assistant
and
an
active
member
of
the
nevada
academy
of
pas.
I
am
testifying
today
in
support
of
senate
bill
184.
I
have
been
practicing
medicine
for
almost
13
years.
Since
then,
my
love
for
health
care
and
patient
care
has
only
grown
as
a
front
care
worker
or
excuse
me
a
frontline
worker
during
the
coven
19
pandemic.
H
Now
more
than
ever,
we
need
swift
action
to
improve
our
system.
One
solution
is
passing
legislation
on
physician
assistance.
I
firmly
believe
that
sb
184
streamlines
pa
like
licensure
and
best
practices.
This
legislation
will
pave
the
way
for
more
regulate
regulations
that,
in
turn,
better
the
health
care
system
in
the
state
of
nevada.
G
B
Good
afternoon,
chair
and
members
of
the
committee
for
the
record,
my
name
is
david
davlich
d-a-z-l-I-c-h,
director
of
government
affairs
for
the
vegas
chamber,
we'd
like
to
thank
senator
hardy
for
bringing
this
bill
and
for
all
the
long
hours
of
work
he
put
in
on
the
southern
nevada
forums
committee
on
healthcare.
This
bill's
response
to
one
of
the
identified
priorities
from
the
forums
committee
on
healthcare,
namely
expanded
access
to
care
providers
within
the
state
of
nevada.
B
A
G
A
I
I
I
Physician
assistants
they've
put
their
licenses
on
inactive
status,
so
that'd
be
an
eight
thousand
dollar
hit
to
to
our
budget,
but
if
that's
the
the
will
of
the
committee
we'll
learn
to
adjust.
Thank
you.
A
D
For
you
from
vice
chair
and
thank
you,
miss
fisher,
so
on
the
the
board
side
of
this.
Currently,
how
many
pas
can
a
osteopathic
physician
currently
supervise.
D
I
D
But
under
this
legislation
you
would
the
board
would
be
allowed
to
change
that
number
without
input
from
the
legislature.
So,
as
a
legislature
we're
looking
for
an
answer
of
how
would
you
decide,
would
it
be
five?
Would
it
be
ten?
What
would
the
proximity
be?
I
mean,
what
type
of
criteria
would
the
board
start
to
look
at
in
in
changing
it
from
3
and
what
was
the
philosophy
behind?
D
Well,
the
legislature
set
3..
If
you're,
if
you
were
going
to
change
it,
what
type
of
criteria
would
you
come
up
with
to
be
able
to
make
sure
the
public
safety
was
was
still
there.
I
Susan
fisher
for
the
record,
I
can't
answer
that
because
I'm
not
in
our
board
members
heads,
but
I
will
tell
you
in
conversations
and
I
sit
in
on
all
of
our
meetings
and
in
the
conversations
that
I've
heard
they're
very
firmly
set
on
the
number
three
and
have
discussed
have
had
proposals
come
before
the
board
to
expand
the
number
and
they've
been
adamantly
opposed
to
it.
They
do
they
have
discussed
direct
supervision,
they're
very
emphatic
about
having
direct
supervision.
I
There
are
times
sometimes
in
in
rural
situations,
where
the
physician
may
not
be
right
on
the
facility,
but
that's
where
the
chart
review
is
a
very
important
piece
of
it
and
that's
one
area
of
the
the
proposed
bill
that
senator
hardy
did
make
a
concession
for
us
when,
because
it
was
limiting
the
chart
review
and
we
didn't
want
that
limited,
they
should
be
checking
charts
all
the
time
all
the
way
through,
not
just
for
a
certain
time
period
on
pas.
D
A
A
J
Excuse
me
good
afternoon,
madam
chair
members
of
committee
keith
lee
here
on
behalf
of
the
board
of
medical
examiners.
I'd
submitted
my
statement
in
neutral
and
didn't
wasn't
intending
to
come
forward
but
be
happy
to
try
to
answer
any
questions
you
or
members
of
the
committee
may
have.
A
D
You,
mr
levicer,
guess
which
questions
I'm
going
to
ask
mr
lee,
so
it's
currently
set.
So
what
what
number
does
the
medical
board
currently
have?
As
far
as
pas
go
as
supervision.
J
Keith
lee
for
the
record,
madam
vice
chair-
I
I
believe
it's
the
same
as
the
osteo
board,
but
I
I
will
get
back
to
you
on
that.
I'm
not
I'm
not
absolutely
confident
about
that.
I
remember
one
time
there
was
a
discussion
or
there
were
some
least
some
some
back
and
forth,
going
on
about
increasing
it
above
three,
just
maybe
as
many
as
nine,
but
I
think
that
never
went
anywhere.
D
I
think
we
set
these
parameters
for
a
reason.
So
I'd
like
to
understand
the
medical
board's
view
on
this,
if
they've
take,
if
they've
taken
an
opinion
on
this
and
where
they
think
they
might
go
in
the
future,
if
this
were
to
pass.
J
Thank
you,
man
and
vice
chair
keith
lee
for
the
record.
I
don't
know
again,
I
will.
I
will
talk
with
with
the
members
of
the
board.
I
know
that
in
some
discussions
I've
had
with
with
staff
people
over,
not
particularly
with
respect
to
this
bill
right
now,
but
over
the
over
the
time.
It's
the
regulatory
process
in
determining
such
matters
as
we
were
discussing
here,
which
is
in
this
case
the
number
of
pas
that
would
be
directly
supervised
by
a
physician.
What
should
that
number
be?
J
I
mean,
I
think,
that
I
think
it's
fair
to
say
that
that
that
the
the
overall
approach
is
the
lesser
the
better
again
because
and
I've
I
will
say
personally,
if
I
may,
I've
had
great
experience
with
pas
with,
with,
with
a
couple
of
my
my
doctors,
I
one
of
them
I'm.
I
can't
even
tell
you
when
the
last
time
I
consulted
with
my
doctor,
I'm
very
comfortable
with
my
pa.
J
I
think
she
does
a
terrific
job,
but
again
it's
it's
a
question
of
what
is
the
appropriate
number
for
supervision
and-
and
I
think
it's
fair
to
say
that
the
fewer
the
better
just
because
the
quality
of
health
care
at
the
end
of
the
day,
the
most
important
aspect
of
everything
that
we're
trying
to
do
here
in
chapter
630
and
633
and
the
other
title
54
boards
with
respect
to
medical
license
with
respect
to
medical
providers,
is
to
make
sure
that
we
provide
a
quality
of
care.
J
C
J
A
G
G
C
Thank
you,
madam
chair.
I
think,
like
any
other
board,
it
comes
with
the
regulation
process
that
the
regulations
are
made
only
with
open
meeting
laws
and
with
involving
stakeholders
and
people
who
are
interested
and
those
obviously
come
through
the
legislative
commission
in
order
to
get
final
approval.
If
that
gives
anybody
any
solace
to
how
the
process
can
be
used,
but
bottom
line
is
right.
Now
we
have
not
looked
in
this
bill
to
increase
anything
or
decrease
anything,
but
to
allow
the
pas
to
have
opportunities
to
do
two
boards
at
once.
A
K
Lang
when
you're
ready,
thank
you
so
much,
and
thank
you
for
having
me
here
today
good
afternoon,
chair
howdy
and
committee,
I'm
roberta
lang
representing
senate
district
7
in
clark
county
and
thank
you
for
the
opportunity
today
to
present
senate
bill
196
a
bill
that
seeks
to
prohibit
health
care
providers
from
conducting
pelvic
exams
on
patients
without
their
conformed
consent.
K
Health
healthcare
providers
are
required
to
obtain
informed
consent
from
patients
to
provide
medical
treatment.
However,
currently
state
law
does
not
prohibit
providers
or
medical
students
practicing
under
their
supervision
from
performing
pelvic
exams
on
anesthetized
or
unconscious
female
patients,
and
well
it
may
be
surprising.
This
is
common
practice.
K
In
a
new
york
times,
article
published
on
february
17
2020,
a
nurse
in
arizona,
outlines
her
unsettling
experience.
After
being
admitted
for
stomach
surgery,
the
nurse
who
had
a
history
of
sexual
abuse
reported
having
panic
attacks
and
triggering
traumatic
memories
after
she
learned
that
a
resident
had
conducting
a
pelvic
exam.
While
she
was
unconscious
this,
after
explicitly
telling
her
physician
that
she
did
not
want
medical
students
to
be
directly
involved
in
her
surgery.
K
In
fact,
this
issue
is
so
pervasive
that
women
have
begun
sharing
their
stories
with
the
hashtag
metoo
pelvic,
while
medical
teaching
is
crucial
and
training
medical
professions
to
identify
normal
and
abnormal
anatomy
is
necessary.
Some
exams
by
their
very
nature,
are
intimate
and
invasive.
A
study
published
by
the
lancet
foundation
found
100
of
women
reported
quote.
They
would
prefer
to
be
asked
before
their
pelvis
is
used
as
a
teaching
tool.
K
A
pelvic
exam
performed
without
a
woman's
consent
in
any
other
context,
is
considered
sexual
assault
senate
bill
196
does
not
prohibit
performing
pelvic
examinations
when
they
are
necessary,
nor
does
it
prohibit
instruction
of
medical
students
to
perform
this
exam.
Instead,
the
bill
requires
obtaining
the
informed
consent
of
the
patient
in
section.
One
of
this
bill
prohibits
that
health
care
providers
from
performing
or
supervising
pelvic
examinations
they
are
not
appropriately
licensed,
certified
or
registered
to
perform,
or
that
are
not
within
the
scope
of
their
practice
section.
K
One
also
prohibits
health
care
providers
from
performing
or
supervising
public
examinations
on
an
anesthetized
or
unconscious
patient
without
first
obtaining
the
patient's
informed
consent.
Unless
the
pelvic
examination
is
when,
within
the
scope
of
surgical
procedure
or
diagnostic
examination,
to
which
the
patient
has
given
informed
consent,
two
the
patient
is
unconscious
and
incapable
of
providing
prior
informed
consent
and
the
pelvic
examination
is
required
for
diagnostic
purposes
and
is
medically
necessary
or
three.
The
patient
is
unconscious.
K
Thank
you,
chair,
howdergee
committee
members,
for
the
hearing
on
senate
bill
196.
This
is
important
legislation
that
has
the
support
of
many
medical
professionals.
Currently,
15
states
have
banned
unorth
unauthorized,
public
examinations
and
seven
states
have
introduced
similar
legislation
in
2021..
K
A
D
Thank
you,
madam
chair,
so
senator
you
you're,
citing
chapters
6
29
through
641c,
so
this
provision
is
to
apply
to
all
of
those
chapters.
Am
I
reading
that
correctly?
Yes,.
K
D
Okay,
so
when
I
look
at
629
it
goes
from
alcohol
and
drug
and
gambling
counselors
athletic
trainers,
audiologists
autism,
behavioral
interventionist
and
I
won't
go
through
the
whole
list,
but
it
has
a
a
number
of
different.
I
believe
chapters
in
there
that
I'm
not
sure
if
you
were
just
trying
to
sweep
everybody
in
or
what
the
actual
thought
process
was
to
having
this
put
into.
D
Let's
say
the
dispensing
optician
chapter
or
the
emergency
volunteer,
health
practitioners
or
marriage
and
family
therapist.
I
just
you've
got
a
music
therapist.
You've
got
a
very
long
list
in
this
chapter,
so
I'm
just
trying
it
seems
to
me
this
should
probably
be
a
little
more
focused
to
a
certain
type
of
health
care
provider.
So
I
just
want
to
understand
the
thought
process
behind
that.
K
Thank
you,
madam
vice
chair,
so
in
in
I
appreciate
your
input
in
the
bill.
We
I
worked
with
senator
hardy
in
the
senate.
Being
a
physician
himself,
we
tried
to
narrow
the
types
of
physicians
and
physician
assistants
that
could
be
supervisors
in
this
instance,
because
in
how
that
was
written
before
a
dentist
or
an
eye
doctor
or
other
people
could
do
public
exams
and
they
could
happen
without
the
consent
of
a
woman,
and
so
we
tried
to
narrow
it
down.
D
And
unless-
and
I
may
not
have
read
it
as
as
thoroughly
because
I'm
I'm
looking
at
just
the
overarching
chapters
and
in
section
1,
629
and
629
list
all
those
cross
references,
so
I
just
wanted
to
understand
what
we
were
actually
trying
to
get
to,
because
you
know:
there's
pharmacists
in
there
oriental
medicine,
occupational
therapists.
D
So
if
there's
a
way
for
you
to
do
that,
I
don't
want
to
slow
down
your
bill,
but
it
just
seems
like
it
might
be
a
bit
of
overkill
to
insert
this
language
into
every
single
chapter
unless
you're
just
going
to
insert
it
into
the
overarching
chapter
for
health
care
and
and
go
from
there.
So
I
just
wanted
to
verify
that
I
was
reading
it
correctly.
E
Thank
you,
chair
and
gosh.
I
didn't
mean
to
go
here,
but
that
last
question
just
made
me
reflect
on
a
good
friend
whose
daughter
was
abused
by
a
music
teacher
who
claimed
that
a
certain
type
of
technique
was
going
to
help
her
to
find
her
diaphragm
and
her
voice,
and
so
I
appreciate
that
you're
bringing
forward
this
bill,
and
I
wonder
why
it
took
us
so
long
to
pass
legislation
like
this
and
I'm
wondering
if
you
would
be
amenable
to
amending
on
some
assembly
co-sponsors.
Thank
you.
K
Thank
you,
assemblywoman
told
us
absolutely.
I
would
love
to
have
more
co-sponsors.
I
think
that
this
is
so
important
and
we
can
only
look
to
the
huge
court
case
that
involved
the
university
of
michigan
gymnastics
team
and
what
they
went
through
with
a
licensed
physician
who
told
them
that
they,
he
was
doing
certain
things
that
would
help
them
perform
in
their
gymnastics,
and
you
know
this
is
we
have
to
do
what
we
can
to
protect
the
rights
of
patients
and,
in
this
case,
women.
A
I
I
When
you're
ready
ms
fisher,
thank
you,
madam
chair
for
the
record
susan
fisher
with
mcdonald
carano
representing
the
nevada
state
board
of
osteopathic
medicine.
We
don't
typically
testify
testify
either
in
support
or
opposition
of
bills,
usually
we
say
neutral
with
concerns,
but
we
are
in
full
support
of
sb
196.
We
thank
senator
lang
for
bringing
this
bill
forward.
This
gives
us
some
teeth
for
the
osteopathic
board
to
provide
for
some
severe
penalties.
If
there
are
infractions
of
this
law,
if
it,
if
you
do
so
choose
to
pass
it.
Thank
you.
G
L
We
want
to
first
applaud
senator
lang
for
bringing
this
bill
forward
and
we're
here
today
in
strong
support
of
senate
bill
196,
the
coalition
has
been
working
with
sexual
assault,
advocates
and
programs
throughout
the
state
to
examine
nevada's
sexual
assault
and
associated
statutes
and
consent
is
important
part
of
that
work,
specifically
in
the
context
of
consent.
This
ongoing
work
group
has
had
conversations
around
medical
consent
and
the
unfortunate
victimization
that
occurs
through
uninformed
pelvic
exams,
pelvic
exams,
are
intimate
invasive
and
can
be
very
uncomfortable
and
have
lasting
effects.
L
L
L
A
G
A
G
K
You
so
much,
I
would
just
leave
you
with
this.
Patients
should
have
the
freedom
to
decide
from
whom
they
receive
treatment
and
what
aspects
of
their
medical
care
will
be
performed
by
a
student
or
students,
particularly
if
they
are
not
awake
during
that
treatment.
This
legislation
improves
the
process
for
obtaining
documenting
and
ensuring
consent
for
examination
under
anesthesia
and
supports
patients
freedom
to
make
informed
decisions
about
their
medical
treatment.
Thank
you
so
much
and
I
I'm
available
to
meet
with
anyone
about
this
legislation
anytime,
and
I
hope
that
you
will
support
this
important
legislation.
A
You
and
don't
go
too
far,
because
we
have
you
up
next,
okay,
I
will
now
close
the
hearing
on
senate
bill
190
6.
members.
Our
third
bill
on
the
agenda
is
2
45
and
we
have
senator
lang
with
us
already.
So
I
will
open
the
hearing
on
senate
bill
245,
which
makes
changes
regarding
employment
when
you're
ready,
senator.
K
K
Unfortunately,
this
means
that
when
our
residents
lose
a
job,
sometimes
to
no
fault
of
their
own,
they
do
not
have
the
ability
to
wait
very
long
until
their
next
paycheck
with
us
on
zoom
is
joseph.
I
see
him
right
there,
joseph!
Would
you
please
tell
your
story.
H
H
My
job
involves
seeing
to
the
execution
of
everyone's
job
in
a
timely
fashion.
For
the
success
of
the
show,
this
particular
show
went
off
perfectly
all
elements
of
the
production,
sound
light
staging,
etc,
went
nominally
and
the
audience
went
home,
educated
and
entertained.
The
client
was
satisfied.
The
convention
was
a
success.
H
My
co-workers
and
I
dealt
with
the
consequences
of
no
paychecks
for
weeks
when
we
were
finally
paid
at
the
leisure
of
our
employer,
there
were
no
late
fees
or
penalties
included
with
this
new
legislation
state
bill
245.
I
believe
that
working
people
like
myself,
will
have
an
added
layer
of
protection
if
the
employer
fails
to
pay
in
a
timely
manner.
K
Currently,
when
an
employee
is
fired
or
terminated,
the
employee's
final
unpaid
wages
must
be
paid
immediately
upon
termination.
If
an
employee,
quits
or
resigns
the
former
employee
has
to
make
the
final
payment
available
within
seven
days
or
by
the
next
scheduled
payday.
Whichever
is
earlier
employers
who
miss
the
deadline
owe
their
former
employee
wage
employees
wages
for
each
day.
They
go
without
their
final
paycheck
until
paid
in
full
or
up
to
30
days
senate
bill
245
provides
former
employees
who
are
owed
their
final
paycheck,
a
remedy
to
obtain
these
unpaid
wages
chair
hadagi.
K
May
I
go
through
the
sections
of
the
bill?
Yes,
senator.
Thank
you
section.
One
requires
a
labor,
commissioner,
declined
jurisdiction
of
a
claim
or
complaint
concerning
the
payment
of
wages,
commission
or
other
benefits.
If
a
claimant
is
covered
by
a
collective
bargaining
agreement
that
provides
a
claimant
with
exclusive
remedy
or
relief
for
a
violation
of
its
terms
until
those
remedies,
reliefs
or
appeals
are
exhausted.
The
labor
commissioner
may,
however,
assert
jurisdiction
under
certain
circumstances.
K
Section
1.5
of
the
bill
expands
the
definition
of
wages
to
include
the
amounts
due
to
a
discharged,
employee
or
an
employee
who
resigns
or
quits
and
whose
former
employer
fails
to
pay.
The
employee
by
the
statutory
deadlines
are
considered
wages
if
the
labor
commissioner,
shannon
chambers
on
the
line.
If
you
would,
please
discuss
your
amendment
that
you
gave
us
previously
and
then,
madam
chair,
we
could
open
it
for
questions.
M
Oh
chair
howard,
I
apologize.
I
do
not
have
video
because
I'm
in
another
hearing
right
now,
so
I
do
apologize
that
I
can
hear
you,
and
hopefully
you
can
hear
me
so
for
the
record.
This
is
shannon
chambers,
nevada,
labor,
commissioner,
so
I
worked
with
senator
lang
on
this
bill
senate
bill
245,
to
clarify
when
the
labor
commissioner
would
take
jurisdiction
of
a
claim
or
complaint
if
there
is
a
collective
bargaining
agreement
in
place.
M
So
this
clarifies
that
the
labor
commissioner
would
only
take
jurisdiction
of
a
claim
or
complaint
if
that
relief
under
the
collective
bargaining
agreement
was
inadequate,
and
that
would
be
a
determination
made
by
the
labor
commissioner
in
the
opinion
of
the
labor
commissioner,
this
is
good
language
and
clarifying
language
to
inform
not
only
the
claimants
but
also
the
different
unions,
traeger
organizations
that
essentially
their
collective
bargaining
agreements,
need
to
comply
with
nevada
labor
laws.
If
they
don't.
There
is
the
potential
for
the
labor
commissioner
to
take
jurisdiction
of
that
claim
or
complaint.
K
And
chair
howard,
if
I
could
have
the
labor
commissioner,
speak
to
one
thing
labor,
commissioner,
if
you
could
speak
to
the
impact
of
an
employee
to
pursue
a
private
right
of
action
as
and
as
it
affects
this
language
that
would
be
terrific.
M
So
again,
thank
you
for
the
question
chair.
How
are
you
members
of
the
committee
for
the
record,
shannon
chambers,
nevada,
labor,
commissioner?
It
is
the
opinion
of
the
labor
commissioner,
that
the
language
proposed
in
senate
bill
245
does
not
impact
a
private
right
of
action.
The
nevada
labor,
commissioner,
has
specific
language
in
our
statutes.
Its
nevada
advised
statute,
section
607,
that
if
a
individual
has
the
ability
to
hire
private
counsel,
the
labor
commissioner
can
decline
jurisdiction
of
that
claim
or
complaint.
M
I
do
not
see
any
language
in
senate
bill
245
that
would
limit
or
prevent
an
individual
from
bringing
a
private
right
of
action.
But
if
there's
there's
folks
out
there
that
feel
differently,
I'm
happy
to
have
that
conversation,
but,
in
my
opinion,
there's
nothing
in
this
proposed
language
that
would
affect
that
right.
A
B
Thank
you,
madam
chair
sam
claus
committee
council.
I
agree
with
the
assessment
of
the
labor
commissioner.
I
don't
see
anything
in
the
provisions
of
this
bill
that
would
limit
a
an
individual,
bringing
a
private
right
of
action
for
these
sorts
of
wage
claims.
A
G
B
B
G
B
G
B
Good
afternoon
rob
benner
r-o-b-b-e-n-n-e-r
with
the
northern
building
trades
we're
calling
in
support
of
sb245.
No
one
should
have
to
wait
weeks
or
months
to
be
paid
or
have
to
go
to
small
claims
court
to
receive
their
pay.
We
strongly
support
this
bill
as
it
would
ensure
help
ensure
timely
payment
for
vulnerable
workers.
Thank
you.
N
N
A
A
G
G
O
Simply
in
that,
we
would
like
to
see
a
slight
amendment
to
ensure
that
it's
clear
that
there
would
be
no
interference
from
this
bill
in
the
ability
of
employees
to
pursue
their
rights
and
remedies
on
their
own
behalf
at
a
minimum,
just
a
clarification
that
the
bill
would
apply
just
to
the
employees
who
have
this
procedure
to
pursue
a
collective
bargaining
through
a
collective
bargaining
agreement
pursue
their
rights.
O
The
reason
is
that
for
more
than
15
years
now,
there's
been
this
delicate
balance.
That's
been
going
on
supreme
court
in
nevada
sometimes
says
that
some
statutes
in
chapter
608
or
chapter
613
say
that
there
is
an
implied
cause
of
action
for
employees
and
some
that
aren't,
for
example,
in
the
baldonado
versus
win
case,
nrs608.160.
O
The
court
has
said
that
there
is
an
implied
right
of
action
and
they've
said
that
for
608.018,
the
state
courts
have
never
reviewed
it,
but
613.200
and
210,
which
is
for
blacklisting
and
when
an
employer
interferes
with
an
employee,
getting
a
job
with
a
with
a
future
employee
employer.
There's
no
private
right
of
action
for
that.
So
any
time
that
there's
a
statute
like
this
that
gets
passed,
that
that
might
upset
that
balance.
O
We
have
to
be
concerned,
and
so
we
would
just
like
to
see
it
be
clarified
that
there
is
no
impact
on
any
other
employees
other
than
the
ones
that
are
intended
here
that
have
the
collective
bargaining
agreement
procedure.
Thank
you.
Oh.
O
A
G
K
Thank
you,
madam
chair.
I
just
want
to
thank
you
and
the
committee
for
your
opportunity
to
present
senate
bill
245.
Thank
you,
jay
stan
and
the
labor
commissioner,
shannon.
We
really
appreciate
the
help
of
everyone
to
make
this
bill
work.
I
urge
your
support.
It
will
help,
especially
during
this
bad
time
when
so
many
people
are
out
of
work
and
it's
a
time
of
financial
insecurity.
A
Thank
you
senator
with
that
I
will
close
the
hearing
on
senate
bill
245.
members.
The
last
bill
on
our
agenda
today
is
senate
bill
269.
I
see
senator
receivers
gancer
here
and
ready
to
present.
So
with
that,
I
will
open
the
hearing
on
senate
bill
269,
which
revises
provisions
relating
to
dental
insurance.
Welcome
senator
sivers
cancer.
When
you
are
ready
the
floor
is
yours,.
P
All
right,
thank
you,
madam
chair
and
members
of
the
committee.
My
name
is
heidi
sivers
gansard,
I'm
the
senator
from
senate
district
15
and
on
zoom,
I'm
joined
by
dr
david
white
and
paul
klein.
Dr
white
provides
family
cosmetic,
dentistry
in
northern
nevada
and
he's
done
so
since
2004.
He
actually
went
to
the
university
of
nevada
reno
for
undergraduate
in
michigan
for
his
graduate
degree
in
dentistry
and
where
he's
indoctrinated
into
their
spirit
and
mission
of
developing
leaders
and
citizens
who
will
challenge
the
president
and
enrich
the
future.
P
Paul
klein
is
with
tri
strategies,
and
he
is
here
on
behalf
of
the
nevada,
dental
association.
So
right
now,
dental
insurance
companies
have
the
ability
to
retroactively
deny
claims
long
after
a
dental
procedure
has
taken
place.
In
some
cases,
patients
have
received
a
claim
of
denial
years
after
the
procedure
is
done
and
in
some
cases
they've
denied
claims
for
people
who've
passed
away.
P
Currently
nevada
does
not
have
a
process
in
place
for
patients
or
dentists
to
challenge
insurance
companies
who
demand
overpayment
after
claim
denial
has
been
made.
There
are
24
other
states
that
have
adopted
legal
provisions
to
limit
this
practice.
Additionally,
insurance
companies
in
nevada
have
the
ability
to
deny
coverage
of
dental
procedures
even
after
prior
authorization
has
been
granted
10
other
states
have
added
measures
in
an
effort
to
protect
patients
and
dentists.
P
From
this
practice,
as
previously
mentioned
senate
bill
269
adds
a
couple
of
sections
to
nrs
that
provides
limits
on
insurance
ability,
insurers
ability
to
retroactively,
deny
dental
procedure
claims
and
to
demand
overpayment
at
a
later
date.
When
you
look
at
the
bill,
section,
4
and
10
of
the
bill
require
an
insurer
to
submit
written
notice
to
a
dentist
of
the
attempt
to
recover
overpayments
and
establish
written
procedures
that
allow
a
dentist
to
file
an
appeal
and
insurers
also
prohibited
from
trying
to
recover
over
payments
more
than
12
months
after
the
date
of
the
original
payment.
P
Section,
5
and
11
prohibit
an
insurer
from
denying
a
claim
after
prior
authorization
has
been
given
prophecy
for
a
procedure
and
something
I
want
to
point
out.
So
these
are
two
problems
with
with
the
overpayment
issue
and
the
prior
authorization,
but
what
happens
is
when
either
of
those
take
place?
The
dentists
are
the
people
who
are
responsible
for
addressing
this
with
patients
and
in
these
situations
the
dentists
are
placed
in
a
very
difficult
situation
that
often
puts
a
strain
on
the
patient
practitioner
relationship
and
which
creates
feelings
of
resentment
and
distrust
for
patients.
P
P
Probably
probably
just
questions
and
answers,
but
I'm
sure
that
if
you
need
exact
examples
that
dr
white
could
share
those
with
you
and
then
again,
paul
klein
is
representing
the
board.
He
can
probably
give
you
more
information
as
far
as
the
frequency
and
and
how
these
problems
have
arise.
Thank
you.
Thank.
A
You
members
any
questions,
I'm
going
to
start
with
vice
chair
carlton.
D
I
see
the
first
one
in
the
batter's
box
every
day
today,
senator
so
I
I
guess
what
I'd
like
to
figure
out
is.
Is
there
is
a
difference
between
prior
authorization
and
eligibility?
I
can
get
prior
authorization
for
a
procedure,
but
on
the
day
I
show
up
at
the
dentist
office.
My
insurance
may
not
be
eligible.
I
may
not
have
worked
enough
hours.
I
may
not
have
paid
the
bill
there.
D
May
there
could
be
a
number
of
issues
that
would
address
eligibility
and
it's
my
understanding
that
the
common
practice
for
health
care
providers
is
on
the
day
that
I
show
up.
They
check
my
eligibility,
so
this
almost
seems
to
imply
that
even
if
I
wasn't
eligible
at
that
on
that
day
that
the
dentist
would
still
be
reimbursed
just
because
there
was
a
prior
authorization.
D
So
I
just
and-
and
I'm
reading
this
I'm
trying
to
put
the
pieces
of
this
this
puzzle
together-
and
I
don't
think
that's
clarified
in
here
and
most
folks
don't
understand
the
difference
between
the
two.
So
I
just
want
to
make
sure
that
the
record's
clear.
P
Thank
you
for
the
record.
Senator
heidi
seaver's
concert.
So
if
you
were
to
look
at
section
five,
the
way
that
I
read
it
is
and
first
of
all
I
I
sponsored
this
with
senator
keith,
keffer
and
he's
out
of
town
today.
So
I'm
I'm
substituting
when
I
look
at
section
five
and
it
talks
about
that
has
granted
prior
authorization
unless
and
part
of
that
is
whether
or
not
you
you
were
eligible
at
the
time
of
the
author
is
prior
authorization.
So
I
think
it's
actually
covered
in
here
section
five.
P
When
you
go
under
a
one
and
two
because
if
it
was
authorized,
but
you
weren't
covered
at
the
time,
then
this
wouldn't
apply.
But
if
you
were
covered
or
should
have
been
covered
and
you
were
eligible
at
the
time,
this
would
apply
and
I'll
go
ahead
and
see
if
dr
white
or,
if
paul
klein
want
to
add
to
that
would
like
to
add
to
that.
Q
I'll
go
ahead
and
comment
here
for
the
record,
dr
david
white,
with
the
nevada,
dental
association
council
on
government
affairs,
as
well
as
the
american
dental
association
council
on
government
affairs
through
the
chair
how
to
get
to
vice
chair
carlton.
You
bring
up
an
excellent
point
without
a
doubt.
Q
This
is
a
complicated
situation
and
one
that
patients
don't
quite
understand,
and
so,
when
a
patient
comes
in,
that
person
may
have
had
a
predetermination
for
a
procedure,
and
usually
these
procedures
are
pretty
expensive
procedures
and
that's
why
it
takes
extensive
time
and
building
the
doctor-patient
relationship.
Q
Q
Q
Typically,
we
would
go
ahead
and
proceed
on
with
the
procedure
conduct
the
procedure
get
it
done,
but
then
afterwards
we
would
then
receive
a
notice
that
it
was
a
non-covered
procedure
essentially
or
they've
just
denied
it
retroactively,
and
then
that
cost
is
now
shifted
onto
the
patients.
Q
Both
of
us
received
notice,
the
patient
with
through
obviously
as
well
as
ourselves,
and
then
we
go
ahead
and
have
to
have
that
difficult
conversations,
because
usually
these
costs
are
very
expensive
that
are
now
shifted
entirely
onto
the
patient
oftentimes.
The
patient
would
not
have
even
remotely
considered
this
procedure
had
they
not
if
they
would
have
known
that
it
was
not
going
to
be
covered
and
the
it
would
they
made
that
financial
decision
to
move
forward
with
the
treatment,
but
again
that
it's
that
pre-determination
versus
when
a
patient
first
comes
to
our
office.
Q
We
give
that
quick
eligibility
call
to
make
sure
the
verification
of
benefits
is
essentially
what
we
do
is
we
verify
the
benefits?
Are
you
eligible
at
what
level?
Is
there
a
waiting
period,
of
course,
always
taking?
This
is
so
important
to
patients
now,
because,
obviously,
finances
is
of
the
utmost
concern.
As
being
you
know,
a
provider
nowadays
and
making
sure
that
we
have
that
and
the
format
for
front
of
our
of
of
our
discussion
with
patients.
P
The
insured
was
not
eligible
to
receive
the
dental
care
for
which
the
claim
was
made
on
the
date
that
dental
care
was
provided
and
the
health
care
administrator
is
applicable,
and
so
I
I
think
that
probably
covers
it,
and
this
gets
categorized
sort
of
like
the
er
visits
that
we
had
in
surprise
billing.
So
you
think
you're
covered.
You
think
you
got
the
notification,
you
think
you've
been
had
the
prior
approval
and
then
you
know
later
they
come
back
and
they
say
that
that
that
you
don't
have
that
coverage.
P
D
D
I
think
a
lot
of
it
has
to
go
with
just
timing
here
and
if
it's
not
eligible
and
as
a
patient,
when
I
walk
in
and
check
in
at
the
desk,
I'm
basically
told
if,
if
the
procedure's
going
to
go
forward
or
not,
the
burden
falls
on
the
dentist
to
make
sure
that
I
am
eligible
for
this.
So
I
guess
I'm
just
trying
to
miss
what's
happening
here.
P
P
And
so
it's
not
the
patient,
so
the
patient.
I
think
if
they
get
the
pre-approval
they've
assumed
that
that
the
administrator
or
the
health
carrier
has
has
done
the
homework
to
make
sure
that
they're
eligible
or
they
believe
that
they're
eligible
at
the
time
so
again
back
to
the
patient.
The
patient's
going
to
be
surprised
if
they've
gone
through
the
process
required
by
the
health
carrier
or
administrator,
and
then
they
get
surprised
because
later
it
ends
up
getting
denied.
P
So
I
completely
understand
what
you're
saying,
because
sometimes
eligibility
changes,
but
the
eligibility
really
is
up
to
the
administrator
and
the
health
carrier
to
determine
who
is
eligible
and
they're
the
ones
also
making
the
decision
as
far
as
whether
it
should
be
authorized.
They
have
the
pre-authorization.
D
D
Not
all
of
this
happens
in
in
real
time
and
a
pre-authorization
is
not
an
eligibility,
so
I
guess
I'm
just
still
trying
to
figure
out
how
the
pieces
of
this
puzzle
fit
together
when
you
may
call
the
authorizing
agent
and
they
may
not
know
because
they
may
not
have
the
most
current
data
if
you're
self-paying,
you
can
self-pay
up
to
the
last
day
of
the
month,
so
we
may
not
know
if
someone
is
eligible
or
not,
they
may
have
been
eligible
when
the
pre-authorization
went
through,
but
they
may
not
be
eligible
today.
Q
Explanation
the
record
dr
david
white,
through
chair,
how
to
get
to
the
vice
chair
carlton.
I
I
completely
agree
with
you
ma'am
I,
but
in
this
situation
I
think
where
we're
having
the
most
difficult
situations
are
in
the
patients
that
continue
to
be
eligible
versus
the
patients
who
are
not
eligible,
in
my
case,
all
of
the
individuals
that
say
they
did
not
work
the
number
of
hours
that
they
required.
Q
Those
are
easy
conversations
for
them
to
understand
the
responsibility
for
coverage
for
the
folks
that
continue
to
be
covered,
the
entire
time
and
decide
to
move
forward
based
upon
the
predetermination.
Q
That's
where
the
intent
of
this
bill
is
attempting
to
solve,
because
it's
the
folks
that
continue
to
cover
the
hours
and
continue
to
conduct
themselves
in
a
way
to
stay
employed
that
those
are
the
folks
that
are
then
taking
their
hard-earned
money.
Assuming
that
the
copay
is
accurate
and
then
move
forward
with
the
procedure
only
for
them
to
about
a
month
or
month
and
a
half
come
back
and
have
it
denied
and
then
have
that
cost
very
expensive
cost
shifted
over
to
them.
Q
So
again,
my
difficulty
or
our
challenges
with
the
providers
is
not
within
the
patients
that
are
not
eligible
because
again
they
understand
where
that
responsibility
is
and
then
ultimately
they
understand
where
that
that
breakdown
of
communication
happened.
But
it's
really
within
the
patients
that
continue
to
be
employed.
And
so
that's
I
just.
I
hope
that
provides
a
little
bit
of
clarity
to
the
intent
behind
this
bill.
A
P
Thank
you
for
the
record
senator
heidi
sievers
cancer,
I'm
going
to
refer
to
dr
white
and
de
paul
klein,
because
I
I
know
there's
a
basis
for
that
and
I'll.
Let
them
explain
it.
Thank
you.
Q
The
record
dr
david
white
chair:
how
did
he
absolutely
yes
ma'am
right
now?
We
are
only
able
to
submit
a
claim
12
months
after
the
procedure
has
on
the
date
of
service,
and
so
this
is
an
attempt
to
go
ahead
and
provide
a
very
fair
planning
ground.
If
we
do
not
submit
a
claim
within
that
12-month
window,
then
the
claim
is
automatically
denied
and
we're
not
able
to
to
receive
any
sort
of
reimbursement
for
that
at
this
particular
juncture.
Q
There's
individuals
and
and
dentists
that
are
receiving
these
retroactive
claim.
Denials
years
later
and
at
this
point
we're
forced
to
operate
and
conduct
ourselves
in
a
very
focused
and
specific
way,
and
that's
where
the
12-month
window
is
is
being
put.
A
Okay,
perfect,
thank
you,
okay
and
then
moving
on
to
section
five,
I
know
section
five
is
they
cannot
refuse
to
pay
unless
and
then
it
goes
down
the
bullet
points.
So
five,
one
e
where
it
says
the
dentist
has
previously
been
paid
for
the
procedures
covered
by
the
covered
by
the
claim.
So
what
if
it's
a
like
an
ongoing
procedure,
though
so
say
a
patient
had
a
cavity
filled
and
you
were
paid
for
that
and
then
they
had
to
come
back.
A
Q
Q
White,
yes,
yes,
ma'am
chair:
how
do
you?
Yes?
So
typically,
what
we
have
is
if
a
service
was
performed
on
a
tooth,
then
through
the
eligibility
we
we
we
obtain
the
information
of
when
you
can
conduct
any
more
work.
Q
That
may
be
the
exact
same
thing
done
on
a
tooth,
and
this
is
the
challenging
obviously
situation
with
dental
insurance,
because
if
a
tooth,
if
you
put
a
filling
into
a
tooth
and
then
the
person
has
very
poor
oral
hygiene
or
they
have
immuno
medical
conditions
and
if,
when
the
tooth
or
that
filling
breaks
down
rather
quickly,
there
is
usually
a
12
or
24
month
window,
where
you
cannot
get
reimbursement
for
that
particular
procedure,
and
so
either
you
have
two
scenarios:
either
the
patient
pays
full
price
or
the
contracted
rate
at
that
point,
or
the
dentist
decides
to
do
the
filling
at
no
cost,
which
I
can
say
in
my
office
under
95
of
the
of
the
situations.
Q
Some
plans
that
they're
24
months
that
becomes
a
little
bit
of
a
different
discussion,
but
it
is
entirely
up
to
the
doctor-patient
relationship
and
what's
been
formed
and
what
really
comes
down
to
what
is
fair,
but
typically
within
my
office.
We
just
do
that
again
for
free,
but
absolutely
with
the
insurer.
They
lay
that
out
crystal
clear
for
us
that,
within
a
specific
time
frame
that
same
procedure
will
not
be
covered
on
that
tooth
again.
During
that
particular
time
frame.
A
Thank
you
for
that,
and
I
guess
I
was
just
a
little
confused
as
to
why
you
wouldn't
like
why.
Why
would
this
exemption
be
in
there?
Why
you
would
not
want
to
be
why
you
would
not
want
this
to
be
covered
with
this
procedure
to
be
covered
or
for
the
patient,
while
we're
giving
them
authorization
not
to
pay
for
a
procedure.
If
it's
been.
P
Previously,
thank
you
for
the
record,
heidi
seaford's
cancer.
So
the
way
that
I
read
this
was
that
if
they
already
paid
once
this
potentially
could
be
an
overpayment.
So
if
you
paid
for
a
filling
and
then
they
were
they
paid
again,
then,
because
this
is
the
dentist
has
previously
been
paid
for
the
procedures
covered
by
the
claim.
So
if
they
already
were
paid
for
the
procedure,
if
they
were
paid
again,
then
they
they
shouldn't
or
they
shouldn't
charge
it
again.
That's
the
way
I
read.
A
It
thank
you,
senator,
and
I
think
I
needed
that
clarification.
I
think
I
was
reading
it
just
a
little
different.
Okay.
Thank
you.
Members
last
call
any
questions.
A
G
G
F
F
F
We
have
examples
of
retroactive
claim
denials
that
exceed
a
12-month
period
by
months
and
even
years.
In
addition,
there
is
considerable
frustration
when
approved.
Predeterminations
of
treatment
are
denied
when
a
natural
claim
is
submitted.
These
practices
create
trust
issues
and
unwarded
suspicions
between
patients
and
providers.
F
When
the
patient
is
asked
to
make
up
any
financial
differences,
they
previously
understood
would
be
covered
by
insurance
insurance
only
allowed
for
a
fraction
of
what
was
spent
on
ppe
for
a
short
period
of
time
during
the
pandemic.
A
time
when
claim
submissions
were
greatly
reduced
and
full
premiums
were
still
collected
by
insurance.
In
addition,
ppe
coverage
on
the
most
part
became
what
is
known
as
a
non-covered
service,
meaning
they
can
control
our
billings
all
the
way
down
to
zero.
F
Who
covers
these
costs
providers,
who
do
providers
do
who
have
already
accepted
reduced
fees
for
ppos
and
other
contracted
services
between
the
provider
and
networks
they
belong
to.
Thank
you,
madam
chair.
A
D
And
thank
you
and
and
doctor
did
you
say
that
you
were
billing
for
ppe,
personal
protective
equipment.
F
I
am
being
forced
to
yes
because
I
believe
our
costs
we
figured
out,
I'm
being
told
by
my
accounts,
payable
for
the
record
richard
dragon.
I'm
sorry,
I've
been
told
my
accounts
payable
that
my
monthly
billing
for
ppe
just
gloved
alone
with
400
1600
a
month.
D
Because
dental
offices
use
ppe
on
a
regular
basis
and
a
dental
office
that
I'm
very
familiar
with
that
had
to
close
during
the
pandemic
was
very
gracious
enough
to
donate
all
of
their
ppe
to
a
non-profit
that
I
I
work
with
to
make
sure
that
our
employees
were
safe.
So
I
guess
I'm
trying
to
figure
out
the
day
before
march
18th,
you
weren't
billing,
for
you
weren't
billing
for
ppe
or
I'm
not
sure
what
date
it
was.
D
But
now
you
are
billing
for
ppe
and
is
that
one
of
the
concerns
in
in
the
the
the
back
payments
and
the
eligibility?
How
is
how
does
that
fit
into
this
bill?
That
you're
not
able
to
bill
for
ppe.
F
It
may
or
may
not.
I
mentioned
that
as
a
point
of
interest,
and
you
know
I
would
stand
correct
concerning
that
who
does
have
if
you're
more
interested
in
understanding
that
topic
I
could
defer
to
dr
white.
Dr
white
has
information.
That's
national
national
knowledge.
The
reason
is,
is
dr
white
is
also
cga
chair
for
the
american
dental
association,
so
he
actually
sits
in
that
position
nationally.
F
So,
but
yes,
it
has
been
a
concern.
It
was
something
of
issue
and
you're
right.
We
did
not
include
in
the
bill.
I
just
mentioned
it,
and
for
that
I'm
sorry,
oh.
D
No,
I
I
just
wanted
to
clarify
so
is
is
the
issue
that
you're
billing,
the
insurance
provider
for
ppe
and
you're
not
being
reimbursed
for
it.
F
Well,
for
instance,
for
instance,
as
I
remember
correctly
allowed
it
for
two
or
three
months
between
july
and
september,
you
can't
quote
me
on
that
per
se,
but
I'm
in
the
general
ballpark
and
they're
recovering
for
ten
dollars
of
sitting
it's
more
than
that,
and
so
when
we
can't
raise
our
fees
because
of
the
fee
structures
that
are
being
handed
to
us
by
insurance,
as
well
as
other
limitations
that
we
sign
up
for
contractually.
F
D
Okay
and
and
thank
you
man,
I'm
sure
I
just
wanted
to
make
sure
that
I
understood
and
if,
if
that's
an
issue
of
being
able
to
back
bill
on
on
ppe,
I
was
just
a
little
surprised
because
you
walk
into
a
dental
office
and
everybody's
wearing
all
that
stuff
already.
So
I
just
wanted
to
make
sure
that
I
understood
what
was
going
on.
P
Thank
you
for
the
record,
senator
heidi
sievers
cancer.
I
don't
know
if
dr
white
wants
to
respond,
because
I
don't
think
this
bill
addresses
that
at
all,
this
is
really
about
the
broader
issue
of
pre-authorizations
and
then
retroactively
denial
of
claims
and.
A
We
can
have
a
dr
white,
maybe
reach
out
to
vice
chair
offline,
so
we
can
move
through
testimony.
Thank
you,
dr
dragon,
for
staying
on
and
answering
those
questions
on
broadcasting.
If
we
could
move
to
the
next
caller
neutral.
G
I
apologized
here
one
moment:
please.
G
G
A
G
H
Hi,
my
name
is
stacey
sasso
executive
director
for
the
health
services
coalition.
The
coalition
is
testifying
today
in
opposition
of
sb
269..
The
prior
authorization
group
is
tasked
with
determining
if
a
procedure
is
medically
necessary
and
appropriate,
as
determined
by
clinical
professionals,
the
prior
authorization
process
does
not
determine
eligibility
for
services.
H
H
Eligibility
does
change,
as
each
of
our
plans
have
different
eligibility
rules
and
in
some
cases
a
patient
could
pay
for
coverage
and
become
eligible
the
same
day
of
their
appointment.
The
utilization
review
department
cannot
track
that
daily.
We
hope
to
see
an
amendment
deleting
sections
5.1
g
and
section
11,
subsection
1g
to
correct
the
piece
of
the
bill.
Thank
you.
G
N
N
At
this
time
we
are
in
opposition
to
sb
269
over
concerns
regarding
sections
5
and
11,
and
their
subsections
g.
We
are
members
of
the
health
services
coalition
and,
and
we
share
their
concerns.
Prior
authorization
is
a
process,
that's
done
by
clinicians,
to
determine
whether
a
treatment
is
clinically
appropriate.
N
It's
not
about
whether
the
patient
is
eligible
for
services.
Plan
clinicians,
have
limited
capacity
and
cannot
be
expected
to
guarantee
eligibility
providers
are
responsible
for
checking
eligibility
on
the
date
of
services.
Sections
5
and
11
are
at
about
eligibility,
and
plans
cannot
pay
for
patients
who
are
not
eligible,
also
under
federal
law.
Our
plans
are
simply
not
able
to
pay
for
patients
who
are
not
eligible.
N
So
specifically,
we
hope
to
address
these
issues
by
deleting
the
languages
in
section
5g
and
11g
after
the
word
provided
in
line
39
on
page
3
and
line
28
on
page
six,
the
language
is
the
same
in
both
of
these
access
sections
that
apply
to
health
carriers
versus
dental
care
organizations
or
dental
plan.
Administrators
and
part
of
the
reason
we
would
like
to
see
this
removed
is
we're
very
unclear
on
what
the
term
reasonable
care
means
and
we
really
hope
to
be
able
to
work
with
the
sponsors
moving
forward
to
address
these
specific
concerns.
A
Holmes,
if
you
would
do
me
a
favor,
could
you
email
that
over
to
us
in
writing?
A
A
G
G
R
Hello,
my
name
is
helen
foley,
h,
e
l,
e
n
y,
and
I
am
representing
delta
dental.
I
worked
very
closely
with
the
sponsors
of
the
bill,
specifically
senator
key
keffer
on
the
senate
side
on
this
issue,
I'm
in
in
neutral
today,
because
we
wouldn't
mind
if
the
bill
died
completely.
However,
we
felt
that
some
of
our
concerns
had
been
addressed.
I
wanted
to
make
sure
for
the
record
that
this
bill
deals
with
prior
authorization.
R
We
have.
We
have
seen
the
term
used
intermittently
by
dr
white
with
pre-determination
pre-authorization.
The
bill
does
not
deal
with
that.
What
happens
with
dental
plans
is
that
the
very
day
that
you
go
in
for
your
cleaning
and
they
determine
you
might
need
some
other
issues.
Other
things
happening.
R
I
would
estimate
that
only
about
15
to
20
percent
of
the
cases
before
a
dentist
require
prior
authorization,
the
other
pre-determination
or
pre-authorization
can
be
immediate,
and
so
that
stream
streamlines
the
process
if
the
bill
passes
just
the
way
it
is
with
no
amendments.
R
We
do
not
have
opposition,
but
we
certainly
understand
what
the
health
coalition
is
concerned
about
and
want
to
make
sure
that
we
have
a
seat
at
the
table
in
working
closely
with
senator
keith
keffer
and
senator
ganzar
in
trying
to
find
resolution
to
this
issue.
Thank
you
very
much.
P
Thank
you,
madam
chair
members
of
the
committee.
I
appreciate
you
hearing
senate
bill
269
today
and
I
will
work
with
senator
keith
keffer
and
dr
white
and
mr
klein,
as
well
as
those
who
are
on
the
line
to
see
if
we
can
find
a
resolution.
So
again,
I
appreciate
you
hearing
the
bill
and
I
hope
that
you
can
support
it.
Thank
you.
A
Thank
you.
I
will
now
close
the
hearing
on
senate
bill
269
members.
The
last
item
on
our
agenda
is
public
comment.
While
we
give
those
listening
over
the
internet
time
to
call
in,
I
will
go
through
our
public
comment
housekeeping
and
remind
everyone
that
public
comment
is
an
opportunity
to
discuss
general
medals
that
fall
within
the
purview
of
the
commerce
and
labor
committee.
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.
A
The
public
has
already
been
given
time
to
support
or
oppose
specific
legislation.
We
open
and
close
hearings
on
bills
so
that
we
establish
a
public
record
of
the
testimony
on
a
bill.
Therefore,
public
comment
is
not
intended
to
continue
to
be
a
continuation
of
a
bill
hearing.
We
do
take
30
minutes
of
public
comment
and
public
comment
is
limited
to
two
minutes
per
caller,
be
respectful
of
committee
members
and
other
witnesses.
Do
not
comment
on
testimony
provided
by
other
speakers
and
do
not
make
personal
attacks.