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A
Thank
you
at
this
time
I'm
going
to
call
to
order
the
assembly,
health
and
human
services
committee.
It
is
134,
madam
secretary,
will
you
please
call
roll.
A
A
C
E
A
Thank
you
and
I
see
a
note
here
from
assemblywoman
titus,
so
if
we
can
just
mark
her
our
show
her
present
when
she
arrives,
I
think
she
is
somewhere
else
right
now,
so
I
know
that
she
is
running
a
little
late
or
is
presenting
in
another
committee,
so
we
can
do
that
and
the
same
thing
with
assemblywoman
krasner
at
this
time.
I'd
like
to
welcome
our
audience
to
join
us
for
this
virtual
meeting.
Today
we
have
three
bills,
including
the
first
one
that
I'm
going
to
present.
F
A
Thank
you
vice
chair
peters
and
members
of
the
health
and
human
services
committee
for
the
record.
I
am
assemblywoman
rochelle
nguyen
and
I
represent
assembly
district
10.,
and
I
am
here
to
present
for
your
consideration
assembly
bill
358,
which
improves
access
to
medicaid
for
people
who
are
recently
released
from
prison.
A
I
had
actually
submitted
a
health
and
human
services
committee
bill
that
did
the
same
thing
so
when
I
saw
that
speaker,
fryerson
had
also
submitted
this
bill,
I
like
to
think
that
great
minds,
think
alike.
Today
with
me.
I
have
richard
whitley,
who
is
the
director
of
the
department
of
health
and
human
services,
suzanne
biermann,
the
administrator
of
the
division
of
health
care,
financing
and
policy,
as
well
as
richard
thompson,
the
deputy
administrator
for
the
division
of
welfare
and
supportive
services,
and
they
will
be
helping
me
with
the
presentation
today.
A
It
is
to
improve
care
transitions
to
the
community
for
incarcerated
individuals
who
are
eligible
for
medicaid,
and
let
me
give
you
again
some
background.
Individuals
that
are
incarcerated
often
have
significant
physical
and
mental
health
care
needs.
For
example,
they
may
experience
chronic
and
infectious
diseases
such
as
hepatitis
c.
They
may
suffer
from
severe
mental
health
and
substance
abuse
disorders
and
some
of
those
physical,
other
physical
health
issues
associated
with
mental
health
and
substance
abuse
disorders,
and
they
occur
at
a
much
higher
rate
than
our
general
population.
A
Currently
we
have
many
individuals
in
our
criminal
justice
system
who
do
qualify
for
medicaid,
especially
since
nevada,
expanded
eligibility
for
lower
income
adults
through
the
affordable
care
act.
Medicaid
has
a
key
role
in
providing
support
to
these
individuals
and,
as
you
know,
people
are
incarcerated,
they're,
often
disproportionate,
disproportionately
poor
and
people
of
color.
This
bell
also
helps
create
and
address
some
of
those
health
care
inequities,
while
advancing
health
care
and
racial
equity
in
our
state.
A
As
of
2019
43
states,
so
we
would
be
asking
to
join
those
43
states
that
already
have
a
policy
or
have
enacted
policies
that
suspend
medicaid
eligibility
for
an
individual
person,
while
in
prison
and
42
states
had
a
policy
to
suspend
eligibility
for
an
eligible
person
while
they
are
in
jail.
Six
additional
states
are
considering
this
policy
in
2020,
including
us
here
today
with
assembly
bill
358
again,
this
bill
provides
that
same
policy
to
suspend
medicaid,
while
someone
is
incarcerated,
rather
than
terminate
them
from
medicaid
when
they
are
sent
to
prison.
A
At
this
time,
I'm
going
to
give
you
kind
of
a
brief
summary
of
some
of
the
sections,
and
then
I
will
turn
this
over
to
some
of
my
co-presenters
who
have
been
working
in
this
field
and
know
it
inside
and
out
so
section.
One
of
the
bill
requires
the
department
of
health
and
human
services
to
suspend
again
rather
than
terminate
medicaid
eligibility
of
an
individual
who
is
incarcerated
if
an
individual
is
not
eligible
for
medicaid
or
if
that
eligibility
was
terminated
prior
to
incarceration
incarceration.
A
He
or
she
can
now
apply
for
medicaid
up
to
a
half
a
year
before
his
or
her
scheduled
release
date,
and
I'm
sure
my
presenters
will
also
talk
about
the
cost
savings
that
we
will
have
in
order
to
get
them
in
there,
as
well
as
the
continuity
of
their
medical
care
upon
their
release
from
prison
upon
the
release
from
prison.
The
department
shall
reinstate
or
reissue
institute
eligibility
for
and
coverage
under
medicaid
to
a
person
as
soon
as
possible
if
the
person
otherwise
meets
eligibility
requirements.
A
At
that
time,
section
two
of
the
bill
requires
that
the
director
of
the
department
of
corrections
to
complete
the
medicaid
application
paperwork
for
an
individual
who
is
incarcerated
as
soon
as
practicable
after
the
individual
is
authorized
to
enroll
in
medicaid,
as
outlined
in
that
section
one.
As
you
can
see,
the
bill's
provisions
aim
to
improve
access
to
medicaid
for
a
person
who
has
just
been
released
from
prison.
Ideally,
a
person
will
have
medicaid
coverage
on
the
day
of
his
or
her
release
from
prison
without
any
gaps
in
that
coverage.
A
A
Connecting
these
people
to
medicaid
early
on
can
facilitate
their
integration
back
into
the
community
by
increasing
their
ability
to
address
their
health
needs.
This
bill
will
contribute
to
greater
stability
in
their
lives
and
provide
broader
benefits
to
all
of
our
communities
and
help
reduce
recidivism
within
this
population.
I
urge
you
to
support
this
bill
and
madam
vice
chair
now,
with
your
permission,
I
would
like
to
turn
over
my
time
to
director
whitley
and
his
staff
for
additional
remarks.
G
Thank
you
and
thank
you
chairwin
for
the
opportunity
to
speak
on
behalf
of
this
bill.
Dhhs
does
see
this
as
good
policy.
If
you
look
at,
I
guess
for
evidence
of
why
legislation
is
needed.
If
you,
if
you
go
to
dhhs.nv.gov,
backslash,
analytics
and
scroll
down
to
the
corrections,
outreach
dashboard,
we
actually
have
been
collecting
for
some
time,
information
on
inmates
that
are
being
discharged
and
then
matching
it
to
identify
if
they've
been
enrolled
in
medicaid
and-
and
we
don't
do
a
good
job-
we
we
definitely
can
do
better.
G
I
I
think
we
do
a
good
job
in
our
detention
facilities
in
clark
and
washoe
county
with
getting
inmates
that
are
leaving
enrolled,
but
we
could
do
better
in
corrections,
and
so
this
legislation
we
do
feel
with
the
combination
of
enrollment
and
suspension,
will
will
go
a
long
ways
to
to
make
those
improvements.
I
think
the
chair
also
identified
the
benefits,
the
continuity
of
care
being
the
big
one.
G
The
other
element
is
the
department
of
corrections
currently
pays
for
with
general
fund
30
days
worth
of
discharge
medication,
and
we
believe
there
would
be
a
savings
by
the
enrollment
in
medicaid
upon
exit
the
day
they
leave,
they
would
be
enrolled
in
medicaid
and
that
pharmaceutical
cost
could
be
covered,
drawing
down
a
federal
match
for
that
which
would
result
in
a
savings
for
the
state.
So
those
are
the
two
drivers.
The
third
is.
G
You
might
recall
from
presentation
from
administer
administrator
biermann
that
in
the
urban
areas,
clark
and
washoe,
medicaid,
primarily
utilizes
a
managed
care
model,
we've
included
in
the
rfp
for
managed
care,
a
a
highlight
of
the
criminal
justice
involved
population,
with
scoring
actually
on
strategies
for
transition
to
be
included
in
the
response,
and
so
that
rfp
is
currently
out,
and
we
are
very
much
looking
forward
to
innovations
from
the
managed
care
companies
to
assist
us
with
the
with
the
transition
from
facility
to
community
and
we'll
be
scoring
those
applications.
G
Based
on
on
the
response,
and
so
that
concludes
my
remarks
on
on
this
bill.
Again,
I
think
it's
it's
good
legislation
and
I
have
with
me
a
sim
administrator
biermann
and
deputy
administrator
thompson
from
the
welfare
division
to
answer
any
questions.
A
A
With
that
vice
chair
peters,
we
are
ready
for
any
questions.
The
committee
might
have.
F
Thank
you
chair
and
director
whitley.
I
do
have
a
question
from
assemblywoman
chandra
summers:
armstrong
excuse
me
before
we
go
into
questions,
though
I
did
want
to
make
for
the
record
make
sure
the
secretary
knew
that
assemblywoman
krasner
has
been
here
since
we
started
the
committee.
She
just
had
mic
issues.
So
if
we
could
just
mark
her
as
present,
please
that
would
be
great
assemblywoman
summers.
Armstrong!
Please
go
ahead
with
your
friend.
H
Thank
you
vice
chair
peters
and
chairwoman
nguyen
for
this
wonderful
bill,
and
I
just
have
a
point
that
I
need
clarified
director
whitley
said
we
when
he
spoke
about
the
medicare
cost
in
the
first
30
days
after
release.
Could
we
get
just
some
clarity
on
on
who
was
paying
for
that?
G
G
If
the
meta,
if
the
inmate
were
enrolled
in
medicaid,
we
would
work
with
our
managed
care
organizations
to
cover
the
costs
and
get
the
the
inmate
with
an
appointment
prior
to
the
30
days
of
medication,
running
out.
H
H
Not
only
do
we
have
the
opportunity
to
have
a
federal
match
for
medicaid,
which
would
save
money,
but
we
would
also
have
an
opportunity
to
get
them
an
appointment
with
the
person
who
would
provide
that
continuing
care
so
that
we
can
have
a
better
opportunity
for
them
to
stay,
stable
and
and
carry
on
their
care
and
stability.
Am
I
understanding
this
correctly.
G
Or
the
record
richard
whitley,
yes,
you
summarized
it
better
than
I
better
than
I
originally
told
it.
Yes,
both
of
those
both
of
those
are
the
two
key
pieces
savings
of
funding
of
general
fund
and
then
the
connection
to
an
appointment
prior
to
discharge
prior
to
the
medication
running
out.
F
Thank
you.
We
have
the
next
question
coming
from
assemblywoman
black,
please.
J
G
G
We
believe
that
actually,
in
the
case
of
the
those
that
are
leaving
on
medication,
that
they
may
actually
be
presenting
a
burden
to
our
emergency
rooms
or
having
a
crisis
needing
intervention,
because
of
that,
because
that
continuity
of
care
isn't
currently
as
tight
as
it
could
be
if
they
were
enrolled
in
medicaid,
but
the
their
eligibility
would
already
be
covered
and
they
would
mostly
be
newly
eligibles,
which
is
the
the
higher
federal
match.
So
there
would
not
be
there
so
you're
correct.
G
There
is
no
fiscal
note
on
this,
not
only
for
the
operation
of
of
the
enrollment,
but
for
the
actual
delivery
of
services
under
medicaid.
There
would
not
be
an
additional
cost.
The
enrollments
may
go
up,
but
they
would
go
up,
but
but
we
people
who
are
eligible
for
medicaid
can
apply
at
any
time
and
we
would
not
deny
anyone
who
is
eligible
for
medicaid.
The
enrollment.
J
Okay,
I
mean
I
get
what
you're
saying
you're
saying,
but
is
there
any
way
to
know
roughly
how
many
new
people
this
might
be
because
then,
if
we
don't
automatically
enroll
them,
they
may
never
enroll.
So
you
can't
no,
I
mean
it's,
they
may
get
out
and
never
enroll
in
medicaid.
So
how
do
you?
J
G
For
the
record,
richard
whitley,
I
would
just
add
that
you
know,
as
you
can
see,
on
the
dashboard
that
that
I
made
reference
to
we
would
be.
We
would
continue
that
out
to
actually
show
the
follow-up
services
that
inmates
received.
We
could
match
that
even
with
the
recidivism
or
the
reduction,
we
would
hope
in
recidivism,
but
just
like
any
population,
we
review
their
application
for
eligibility.
G
If
they
get
a
job
and
they
exceed
the
income,
they
would
be
terminated
from
medicaid,
just
like
any
other
population,
but
I
think
the
you
know
to
your
point.
Probably
what
would
be
interesting
to
look
at
is
how
many
people,
leaving
corrections
end
up
in
the
emergency
room,
perhaps
with
uncompensated
care
or
with
a
more
costly
crisis,
because
that
continuity
didn't
continue.
We've
not
looked
at
that,
but
we
certainly
could.
F
Thank
you
director
for
reference
for
the
committee.
The
link
that
director
whitley
was
talking
about
that
dashboard
is
available
on
nellis.
If
you'd
like
to
check
it
out,
it's
pretty
great
assemblywoman
gorlo.
Do
you
have
a
question
as
well.
B
G
Sure
for
the
record,
richard
whitley,
I
I
can
speak
most
comprehensively
on
clark,
county
detention
center
and
the
washoe
county
detention
center.
We
actually
have
eligibility
workers
who
go
in
we.
We
have
a
good
working
relationship
with
the
the
captains
at
each
at
each
of
these
facilities.
G
The
models
are
a
little
different
in
rural
nevada.
It
really
is
relationship
based
with
with
sheriffs
and
whether
or
not
they
want
us.
You
know
in
their
facility.
The
solutions
you
know
in
in
the
jail
are
our
largely
written
applications.
G
You
know
we
continue
to
look
at
at
making
it
as
easy
as
possible
and
certainly
as
less
interruptive
as
possible,
but
I
would
note
in
clark
county
detention
center.
During
covet
we
have
prior
to
covered.
We
were.
We
were
averaging
a
few
hundred
applications
a
a
month
with
covid
and
some
of
the
restrictions
on
our
staff
being
able
to
go
in
and
assist
with
eligibility.
G
Those
numbers
have
had
gone
down,
but
we
we
had
the
captain
teal
with
the
clark
county
detention
center
reached
out
and
said:
we've
got
to
get.
This
is
so
good
for
our
community
they've
directly
seen
a
reduction
in
recidivism
and
asked
us
to
get
this
back
up.
You
know
get
our
our
our
staff,
you
know
with
ppe
and
being
able
to
go
back
in,
and
so
I
I
I
would
aspire
to
to
actually
have
our
state
department
of
corrections
have
outcomes
like
our
large
detention
centers.
G
F
Thank
you
so
much.
I
wanted
to
just
say.
I've
just
asked
if
there
is
quantifiable
data
related
to
that
detention
center
in
clark
county
that
you
were
referencing
director
that
we
could
see
that
may
help
relieve
some
of
assemblywoman
black's
questions
as
well
on
what
kind
of
results
we're
getting
from
the
lack
of
recidivism
and
the
care
provided
through
medicaid
offered
to
those
inmates.
G
F
Thank
you
as
it
relates
to
data.
I
actually
was
wondering
if
you
sorry,
I
you
keep
popping
off
as
I'm
trying
to
catch
you
director,
but
do
you
have
the
dollar
amounts
of
what
is
currently
being
spent
on
those
purchase
of
medications
as
inmates
are
leaving
the
system
for
those
30
days
worth
of
medications
that
they're
getting.
G
For
the
record,
richard
whitley-
I
don't
I
I
believe,
we've
I
believe,
we've
worked
on
that.
I
don't
know
if
in
the
department
of
corrections
budget,
if
they
carve
out
their
pharmaceutical
costs,
that
way
or
not,
but
it
definitely
be
as
we
as
we
have
this
huge
opportunity
for
improvement
in
the
enrollment.
G
I
think
it
would
be
an
important
piece
of
data
to
capture
not
only
for
that
30
day
did
they
get
their
appointment
before
the
30
day,
but
then
that
cost
I
can
follow
up
with
the
department
of
corrections
and
and
ask
that.
F
Question
you
that
would
be,
I
think,
helpful
in
understanding
the
kind
of
win
that
this
would
be
and
also
I'm
sorry.
I
also
have
another
clarification
for
you
on
the
medicaid
match.
Do
you
what
is
the
percentage
of
the
amount
of
medicaid
match
right
now,
or
can
you
give
us
a
dollar
for
a
dollar
on
what
the
state
puts
in
and
how
much
is
met,
matched
through
the
federal
programs.
G
F
Thank
you.
Thank
you
for
the
clarifications.
Are
there
any
from
the
committee,
I
see
assemblyman
haven.
C
Thank
you
vice
chair
peters.
I
did
have
just
a
really
quick
question
that
was
kind
of
came
up
during
the
line
of
questioning
here,
and
it's
actually
the
amount
of
dollars
that
we're.
Currently
the
state
is
currently
spending
on
medication
for
inmates
and
and
it
may
have
a
follow-up
vice
chair
peter's.
If
that's
okay,.
G
For
for
the
record
richard
whitley
yeah,
I
I
think
I
mentioned
before
that
I
don't
have
that
from
department
of
corrections.
So
currently
it's
in
the
department
of
corrections,
budget,
the
health
care
of
the
inmates,
and
that
would
include
their
discharge
medications,
but
I'd
be
happy
to
reach
out
to
them
and
and
get
the
information.
F
So
I'm
going
to
go
ahead
and
move
us
into
testimony.
Can
we
go
ahead?
Do
you
have
anybody
in
on
the
zoom
in
support
testimony
assembly,
woman,
win.
A
G
For
the
record,
richard
whitley,
no,
I'm
speaking
for
our
department
in
support
of
the
bill.
I
I'm
sorry
chair
this
well,
nice
chair.
This
is
assembly,
bill,
343,
correct.
I
K
Thank
you,
chair
nguyen,
and
vice
chair,
peters
and
committee
members.
This
is
nick
chipek,
n-I-c-k-s-h-e
p-a-c-k,
representing
the
aclu
of
nevada,
formerly
incarcerated
individuals
suffer
disproportionately
from
health-related
problems
and
can
pose
health
risks
to
their
family
members
and
the
communities
prisoners
experience
infectious
diseases
such
as
hiv,
aids,
hepatitis
c
and
tuberculosis
at
a
rate
of
five
times
higher
than
those
of
the
general
public,
and
many
are
many
suffer
from
a
variety
of
mental
illnesses.
Some
very
severe
health
problems
can
also
hinder
a
formerly
incarcerated
person's
ability
to
secure
employment.
K
Medicaid
expansion
under
the
aca
has
offered
an
unprecedented
opportunity
for
formerly
incarcerated
people
to
gain
access
to
health
care.
There
are
many
barriers
for
formerly
incarcerated
people
that
make
it
difficult
to
enroll
upon
release
for
one
they
are
dealing
with
other
urgent
issues
such
as
housing
or
employment,
and
may
not
have
the
time
or
the
bandwidth
to
seek
health
insurance
post
release.
K
The
henry
j
kaiser
family
foundation,
using
data
from
the
annual
medicaid
budget
found
38
states
are
working
with
prisons
and
32
were
working
with
jails.
To
help
facilitate
medicaid
enrollment
prior
to
an
inmates
release
date.
Additionally,
in
37
states,
medicaid
benefits
are
suspended
rather
than
terminated
upon
being
incarcerated
in
prison.
Half
of
states
also
report
that
they
are
working
to
enroll
parolees
in
medicaid
by
ensuring
that
all
eligible
parties
are
enrolled
in
medicare
or
medicaid
upon
release
from
prison.
K
F
Thank
you
broadcast
before
we
go
on
to
the
next
person.
I
just
want
to
to
restate,
because
I
forgot
to
before
we
open
it
up
for
support
testimony,
that
testimony
is
limited
to
two
minutes
per
caller.
You
are
always
welcome
to
send
in
written
testimony
up
to
48
hours
after
the
committee
hearing,
and
we
will
be
taking
a
testimony
period
of
20
minutes
for
support
broadcast.
If
we
can
see
if
there's
another
caller
in
support.
I
C
C
A
lot
of
fast
and
drug
crime
is
driven
by
untreated
mental
health
problems
or
drug
abuse
by
ensuring
that
people
have
access
to
mental
health
treatment
and
drug
counseling
immediately
upon
their
release,
we've
reduced
the
likelihood
that
they
will
reoffend.
This
is
better
for
the
people
involved
and
better
for
the
community
as
a
whole.
I
E
We
first
want
to
thank
the
sponsor,
as
well
as
by
our
chair
nguyen,
for
bringing
this
important
bill
forward.
This
committee
and
the
legislative
body
passed
last
session
ab236,
which
the
whole
purpose
of
that
was
to
enhance
our
criminal
justice
system
and
provide
individuals
with
services
to
ensure
that
they
don't
enter
into
the
criminal
justice
system.
In
the
first
place.
E
As
of
2019
43.
Other
states
have
already
implemented
these
suspension
policies
for
some
prisons
and
over
42
states
have
done
the
same
for
jails,
currently
a
cost
in
the
clark
county,
public
or
detention
center
190
dollars
per
day
for
healthy
inmates
to
be
housed
there
in
washoe
county.
It's
between
130
dollars
and
I
may
be
wrong
on
the
low
end,
but
up
to
300
or
500,
depending
on
the
medication
needs
of
that
individual,
unfortunately,
because
of
the
lack
of
housing.
E
Sometimes
our
clients
are
stuck
in
custody,
waiting
for
a
bed
space
or
waiting
for
other
services,
because
their
medicaid
has
been
terminated
and
that's
time
in
custody
that
we're
spending
for
where,
if
we
had
the
ability
to
provide
them
with
resources
quicker,
then
they'd
be
able
to
reintegrate
sooner
to
save
us
money
in
the
long
run,
as
well
as
reduce
recidivism.
So
thank
you
again
for
this
bill
and
thank
you
for
your
time.
I
L
J
P,
a
r
r,
a
g
a-
and
I
just
wanted
to
say,
ditto
to
it,
as
everyone
else
has
mentioned,
everyone
pretty
much
covered
the
reasons
why
we
support
this
bill
and
we
really
want
to
thank
assemblywoman
wynn
for
bringing
this
forward,
especially
at
a
time
when
not
just
in
prison,
but
especially
when
folks
get
released.
Healthcare
access
is
more
important
than
ever
during
a
pandemic.
So
thank
you
again
assemblywoman
for
bringing
this
forward
and
we
ask
for
everyone's
support.
Thank
you.
F
Thank
you
for
the
call,
and
just
for
the
record
I'd
just
like
to
let
the
secretary
know
that
assemblywoman
titus
is
here.
Can
we
move
on
to
the
next
caller
and
support.
I
With
the
caller,
with
the
last
three
digits
261,
three
slowness
doesn't
spell
your
name
for
the
record.
You
have
two
seconds
for
two
minutes
and
may
begin.
E
E
E
L
I
A
All
right
excuse
me,
one
second,
I'm
having
some
technical
difficulties
here.
I
I
don't.
I
don't
know
if
director
whitley
has
any
closing
remarks.
I
know
that
this
has
been
something
that
he
has
been
working
a
lot
with
local
jails
to
get
people
covered.
I
do
see
this
as
a
cost
savings
from
our
general
fund.
The
idea
that
we
are
paying
for
medication
for
people
that
are
eligible
for
this.
Essentially,
it
sounds
like
a
one
to
nine
federal
match.
A
It's
crazy
to
me,
especially
during
a
time
where
we
are
trying
to
do
more
with
less,
and
I
think
this
puts
us
in
line
with
four
together
43
other
states
in
preventing
recidivism
or
decreasing
recidivism.
I
should
say:
saving
our
state
money
and
also
continuing
the
continuity
of
care
for
people
that
are
incarcerated
that
are
trying
to
reintegrate
successfully
into
our
communities
director
whitley.
Do
you
have
anything
you'd
like
to
say
in
closing.
G
A
A
That's
okay!
Thank
you.
I
I
didn't
tell
you
so
that
that's
my
bad,
so
I
apologize
for
not
being
clear
about
potential
people
on
the
zoom,
but
thank
you
and
again
I
would
ask
everyone
to
support
assembly
bill
358.
F
A
Thank
you,
and
with
that
we
will
get
started
with
our
next
couple
of
bills
that
we
have
going
on.
I
will
open
the
hearing
on
assembly
bill
343
at
this
time.
Assemblywoman
thomas
this
bill
provides
a
walking
audit
of
urbanized
areas
and
I
will
let
her
further
explain
what
that
means
and
what
her
bill
does,
and
so
I
will
turn
it
over
to
you.
Assemblywoman
thomas,
when
you
are.
A
N
N
We
americans
have
come
to
appreciate
the
link
between
urban
planning
and
the
health
of
our
citizens
being
able
to
walk
to
stores
and
restaurants,
serves
the
dual
purpose
of
improving
our
health
and
reducing
greenhouse
gas
emissions
by
making
cities
safe
and
accessible
for
children,
older
adults
and
persons
with
disabilities.
We
improve
the
quality
of
life
for
all
of
us,
walking
paths,
bike
lanes,
safe
crosswalks
and
curb
cuts,
give
us
a
chance
to
get
outside
and
move
or
commute
to
work
without
a
car.
N
There
are
initiatives
in
states
all
over
the
united
states
that
recognize
this
link
between
pedestrians
and
bike,
friendly
communities
and
the
improved
public
health
outcomes
that
follow
nationally.
The
cdc
and
aarp,
along
with
many
land
use
and
transportation
planning
organizations
have
endorsed
the
use
of
walking
audits
to
better
understand
a
community's
needs,
our
own
regional
transportation.
N
N
N
One
of
the
amendments
I
am
exploring
is
whether
there
are
other
agencies
better
suited
to
conduct
or
organize
the
audits,
such
as
the
regional
planning
agencies
or
regional
transportation
commissions.
Another
aspect
would
be
the
incorporation
of
geographic
information
system
or
gis
mapping
as
a
way
to
make
the
data
from
the
audits.
More
broadly
available
with
that
background,
let
me
briefly
go
over
the
key
provisions
of
the
bill.
Section.
One
lays
out
the
requirements
for
the
district
health
department
to
conduct
walking
audits
of
urbanized
areas
within
their
jurisdiction
every
three
years.
N
Nevada's
division
of
public
and
behavior
health
would
be
tasked
with
conducting
the
audits
in
urbanized
areas
not
covered
by
the
two
district
health
departments
in
clark
and
washoe
counties.
The
audits
will
be
organized
by
census,
districts
and
urbanized
areas
to
determine
whether
the
physical
environment
contributes
to
the
health
of
the
community
or
detracts
from
it
section.
One
further
provides
that
audit
results
will
be
submitted
to
the
city
council,
county
commission
and
any
planning,
commission
or
regional
entity
with
jurisdiction
over
the
area.
In
addition,
the
audit
results
would
be
posted
on
the
health
districts
and
divisions.
N
A
Thank
you,
and
do
you
have
any
other
people
that
are
presenting
with
you
regarding
your
bill.
N
A
Perfect,
I
am
looking
around
to
see
if
I
have
any
questions
from
our
members
and
it
looks
like
I
have
one
potentially
from
assemblywoman
titus.
O
Thank
you,
madam
chair,
and
thank
you
so
much
woman
for
for
bringing
ab
343
forward.
This
is
a
new
concept
for
me,
and
so
I
was
just
wondering
so
how
many
other
states
have
this?
I
just
certainly
live
in
a
very
rural
area
that
you
have
a
tough
time
walking
in
my
rural
area,
and
I
understand
that
it.
It
addresses,
you
know
certain
population
sizes
and
the
expansion
if
it
does
well.
So
I
understand
all
that,
but
so
can
you
can
you
give
me
some
statistics
or
where
to
turn?
O
Maybe
you
could
for
the
for
the
the
committee
members
on
other
cities
that
have
this
and
the
results
on.
I
understand
certainly
the
intent
I
do
believe
in
getting
out
in
local
communities.
I
do
believe
in
being
part
of
your
community
and
I
do
feel
that
as
a
doc,
who
still
makes
house
calls
nothing
opens
your
eyes
greater
than
actually
going
out
into
your
community
to
see
what
the
realities
are
for
these
folks,
and
so
I
really
much
appreciate
having
some
direction
where
I
can
do
my
homework
and
look
into
this
one.
N
Well,
the
record
assembly
woman,
claire
thomas
through
tier
one,
to
assemblywoman
titus.
N
I
appreciate
that
ma'am.
Thank
you.
Assemblywoman
titans,
just
about
every
major
city
in
the
united
states,
actually
have
a
walkability
audit
new
york,
washington
state,
just
to
name
two,
but
in
our
own
state
here
in
nevada.
N
Back
in,
I
believe
it
was
2005
assembly
bill
231
had
a
walkability
for
our
public
schools,
so
we
actually
have
walkability
audits
when
we
were
doing
with
dealing
with
our
children
in
public
schools
to
see
about
transportation,
whether
two
miles
was
adequate
for
them
to
walk
to
school.
So
this
is
this
concept
that
I'm
imposed.
I
want
to
improve
on
the
one
that
assembly
bill
231,
which
would
be
for
our
general
community,
especially
now
in
2021.
N
N
So
this
is
something
that
you
know
just
by
me,
walking
around
during
a
campaign
noticed,
and
we
have
to
move
to
the
21st
century.
You
know,
as
far
as
having
food
accessibility
to
our
citizens,
that
you
know
if
we
can
have
our
children
walk
two
miles
to
school.
Surely
we
can
have
a
grocery
store
within
two
miles
to
our
communities.
O
Thank
you
thank
you
for
that
and
look
forward
to
having
for
the
more
information
and
some
data.
Thank
you.
A
That
thank
you,
assemblywoman,
thomas.
I'm
sure
that
you
will
and
if
you
could
provide
that
to
mr
ashton,
he
could
get
it
out
to
the
rest
of
the
committee.
If
you
receive
that
documentation.
Is
there
any
other
questions?
I
didn't
receive
any
message.
Oh,
I
see
assemblyman
or
liquor
go
ahead.
M
M
You
also
say
to
include
without
limitations,
so
they
can
look
for
other
things,
and
one
thing
that
occurs
to
me
that
it
might
be
worth,
including
specifically,
is
to
look
for
commercial
operations
that
might
foul
the
air
with
toxic
chemicals
that
they
that
are
produced
at
the
at
the
site,
that
we
know
those
are
more
common
in
minority
and
lower
income
communities.
Perhaps
that's
picked
up
somewhere
else,
but
it's
an
important
thing
for
us
to
know
about
when
we
get
this
information.
N
We
will
do
that.
Thank
you
assemblyman
or
electro.
I
will
I've
jotted
that
down
and
we
will
look
into
that
also.
A
J
You,
mr
madam
chair,
I'm
not
on
skype
for
some
reason,
so
I
have
a
question:
what
is
an
urbanized
area
exactly.
N
Thank
you
for
the
question.
Assemblywoman
black
an
urbanized
area
generally
would
be
what
we
would
consider
the
urban
community
of
of.
Oh
I'm
trying
to
get
a
good
definition
to
you.
J
N
Well,
well,
I
can
get
a
formal
definition
for
you,
but
it's
the
same
thing
for
a
rural
community.
Is
there
a
definition
for
that.
J
N
And
you
are
absolutely
correct:
there
is
a
population
threshold,
as
the
bill
indicates
with
clark
county,
there's,
700
a
population
of
700,
000
or
more
and
in
less
populated
area,
would
be
less
than
hundred
thousand,
which
would
so
that's.
A
Okay,
an
assemblywoman,
thomas
and
assemblywoman
black.
I
think
we
have
miss
carlio
print,
our
lcd
legal
nonpartisan
staff.
I
think
she
might
be
able
to
describe
what
that
means
in
statute.
If
I
can
turn
that
over
to
her
to
answer,
maybe
she
can
we'll
see.
Mr
crest,
can
you
answer
that
question.
B
J
So
so
the
purpose
of
this
is
to
collect
the
data,
and
then
the
data
is
put
on
the
health
department's
website
and
say
that
there
isn't
a
store
where
you
can
buy
healthy
food
we've
just
simply
identified
that
we
haven't
actually
taken
any
steps
to
change
it.
It's
just
that
hey
this
area
needs
is
lacking
this
or
needs
cut-ins
in
the
sidewalk,
but
there's
it's
just
collecting
data.
It's
not
really
just
something,
I'm
understanding
what
the
intent
is.
N
Thank
you
assembly,
woman
black.
To
answer
that
question.
Yes,
the
bill
wants
to
clarify
what
those
areas
are
lacking
and
we
want
to
present
it
to
the
county
commissioners,
as,
as
I
stated
in
my
address
and
other
entities
so
that
we
can
afford
this
change.
But
there's
one
thing
that
we
have
to
remember
too
that
that
urbanized
areas
are
actually
missing
a
lot
of
grant
money
from
the
federal
government.
N
When
you
go
in
and
change
the
way
an
area
is,
and
you
can
document
it,
then
you
can
apply
for
the
grant
and
with
those
grants
you
can
make
changes.
So
you
know
when
we
identify
that
that
certain
areas
are
missing
healthy
food
options.
That's
a
big
thing
and
the
reason
why
we
can
afford
change
is
to
hopefully
get
these
grocery
stores
that
can
give
us
healthy
food
options
to
build.
H
Thank
you
chairwin
and
thank
you
assemblywoman,
thomas
for
your
wonderful
presentation.
This
issue
is
very
near
and
dear
to
my
heart,
as
I
do
represent
a
community
that
is
within
the
urbanized
area
of
las
vegas
assembly
district.
Six,
and
this
information
is
very
important.
The
gathering
of
this
information
for
all
the
reasons
that
she
stated,
which
is
once
a
problem
or
situation,
is
identified.
H
H
My
question
is:
have
you
had
an
opportunity
to
meet
with
anyone
from
our
local,
either
washoe
or
southern
nevada,
regional
transportation
commissions,
to
see
what
they've
gathered
and
how
they
gather
and
whether
or
not
there
is
an
opportunity
to
for
collaboration
and
and
who
would
be
the
lead
for
this
bill
would
be
my
question.
Thank
you.
N
Thank
you
so
much
assemblywoman
summers,
armstrong
for
that
question.
That
is
an
excellent
question
and
we
have
been
in
contact
with
the
transportation
commission.
N
We
this
week
will
be
sitting
down
with
all
the
stakeholders
to
clarify
the
verbiage
or
language
in
the
bill
to
get
all
concern
entities
together
so
that
we
can
get
this
information
because
right
now,
some
of
the
things
that
clark
county
and
washoe
county
representatives,
joanne
jacobs
and
joelle.
N
Excuse
me:
I
don't
have
joelle's
last
name,
but
I
can
get
that
from
washoe.
Their
concern
was
putting
the
weight
on
the
health
district
and
I
agreed
that,
since
we
already
have
a
way
of
of
assessing
the
audits
through
the
transportation,
commission
or
rtc
that
perhaps
we
can
get
together
with
them
and
then
the
costs
would
not
be
burdensome
on
the
health
district,
because
this
is
something
that
they
already
do
and
that
we
can
just
quantify
what
assembly
bill.
N
343
is
looking
to
do
because
they
already
have
a
way
of
auditing
certain
communities.
I
hope
that
answers
the
question.
A
B
N
Well,
looking
at
previous,
like
I
said,
assembly
bill
231,
we
do
got
that
information
from
them
but,
like
I
said,
going
back
to
our
stakeholders
meeting
that
we
will
be
having
we
will
decide
whether
or
not
it's
three
or
five,
and
that
would
would
be
in
conjunction
with
the
transportation
commission
and
or
rtc
when
they
walk
to
get
their
information.
We
want
to
make
sure
that
we're
not
putting
due
pressure
on
them
to
get
another.
N
You
know
we
want
it
all
to
be
concisely
done
together,
so
I
will
be
addressing
that
and
I
will
get
that
answer
for
you.
B
Thank
you
so
much,
and
could
I
have
a
quick
follow-up
chair
go
ahead,
thank
you
and
I
apologize
if
I
missed
this.
I
had
to
step
out
for
a
moment
and
I
might
not
be
clear
my
own
thought
process,
but
I
believe
there
are
some
zones
that
the
federal
government
has
already
established
like
level
three
zones
which
are
economically
disadvantaged
zones,
and
if
you
get,
I
think,
their
sba
loans
in
those
areas.
B
N
Well,
I
haven't
discussed
zoning
or
zones
and
I
will
bring
that
question
up
with
the
stakeholders
this
week.
B
Thank
you
again,
I
might
not
be
putting
those
puzzle
pieces
together.
I
just
remember
some
work
that
I
did
in
in
my
other
job
and
we
were
getting
some
lone
possibilities
and
they
were
talking
a
little
bit
about
those
economically
disadvantaged
areas,
and
so
I'm
thinking
that
this
would
work
wonderful
by
determining
what's
needed
in
those
areas
and
encouraging
investors
to
come
in
and
build
in
those
areas,
so
they
can
get
some
benefits
for
it
as
well
through
the
federal
government.
N
C
C
I
just
headed
up
the
nevada
new
market
job
acts
which
allows
certain
business
entities
to
receive
a
credit
in
certain
communities
if
they
do
these
investments
that
have
kind
of
been
talked
about
today,
but
the
other
question
that
I
had
had
to
do
with
if
you've
actually
talked
to
like
the
clark
county
and
their
planning
department,
to
see
if
they're,
currently
working
on
something
similar.
C
I
do
know
that
in
nye
county
we
did
look
at
this
not
as
extensively
as
this
bill
proposes,
but
some
of
our
recommendations
came
out
to
go
into
our
master
plan
to
expand
for
the
bike
lanes
and
things
of
that
nature.
So
I
just
didn't
know
if
there
was
any
coordination
with
clark
county.
They
may
be
on
the
phone
today
to
answer
that,
but
I'm
just
kind
of
curious.
Thank
you.
A
N
I
appreciated
miss
jacobs.
Thank
you.
A
And
with
that,
I
will
start
testimony
in
support
opposition
and
neutral
again.
I
will
remind
our
callers
to
please
clearly
state
and
spell
your
name
before
you
speak
and
please
limit
your
testimony
to
two
minutes
and
we
do
have
another
one
of
the
assemblywoman
thomas's
bills
that
I
want
to
make
sure
that
we
have
plenty
of
time
to
get
to
as
well.
At
this
time
we
will
begin
testimony
in
support
of
assembly
bill.
A
Oh
I'm
getting
my
numbers
all
mixed
up
assembly
bill,
343.
I
C
Hello
good
afternoon,
chair
and
members
of
the
oops-
sorry,
I
forgot
to
say
my
name
good
afternoon,
chair
and
members
of
the
committee
for
the
record.
My
name
is
jose
silva.
That's
j-o-s-e
s-I-l-v-a
and
I
am
the
environmental
justice
organizer,
with
the
progressive
leadership
alliance
of
nevada.
Here
in
support
of
assembly
bill
343
for
years,
constituents
in
clark
county
have
been
raising
awareness
on
issues
that
add
significant
pressure
to
communities
of
lower
incomes.
Not
everyone
who
lives
in
the
county
is
the
sole
owner
of
a
vehicle.
C
C
One
side
of
the
street
has
a
paved
sidewalk
and
the
other
side
does
not
have
a
paved
sidewalk,
and
this
street
in
general
is
very
dark
during
the
evening.
Creating
a
process
to
help
increase
feasibility
of
pedestrian
travel
would
be
an
important
step
in
raising
quality
of
life.
For
non-vehicle
owning
constituents,
although
this
may
sound
detached
from
the
feasibility
of
being
a
pedestrian,
the
importance
of
reducing
vehicle
contamination
from
our
communities
and
neighborhoods
plays
a
crucial
role
in
maintaining
the
health
of
nevadans.
C
In
addition,
the
american
heart
association
in
2019
ozone
report
ranked
las
vegas
as
the
13th
most
ozone
contaminated
city
in
the
u.s
contamination
can
lead
to
nevadans
becoming
ill.
It
increases
medical
costs
and,
in
worst
case
scenarios
it
takes
lives
away.
I
urge
your
support
of
this
legislation
to
address
the
public
health
impacts
of
our
neighborhood
environments.
I
F
C-H-R-I-S-T-I-D-A-B-R-E-R-A
and
I'm
the
policy
and
advocacy
director
for
the
nevada
conservation
league.
First,
I
would
like
to
echo
the
comments
of
plan.
Nevada
is
ranked
the
11th
most
state,
most
dangerous
state
in
the
u
in
the
nation,
for
pedestrians,
and
we
must
do
more
to
make
sure
that
our
streets
are
safe
for
everyone.
F
A
I
L
I
do
think
there
are
several
things
happening
in
each
of
our
community
communities,
north
and
south-
that
may
meet
some
of
the
assembly.
Women's
needs
for
this
bill
and
I
look
forward
to
a
conversation
with
possibly
the
rtcs
of
northern
and
southern
nevada,
as
well
as
the
the
truckee
meadows
regional
planning
agency
and
the
southern
nevada
regional
planning
agency.
So
I
think
we
can
get
to
a
solution,
and
I
I
want
to
thank
the
bill
sponsor
again
and
look
forward
to
further
conversations.
Thank
you.
I
L
A
L
Yes,
ma'am.
Thank
you
so
much
good
afternoon,
chair
and
members
of
the
committee.
My
name
is
dora
d-o-r-a
martinez,
m-a-r-t-I-n-e-z
and
I'm
calling
in
support
of
sv193.
L
I
am
totally
blind
and
I
have
a
service
dog
and
I
utilize
our
sidewalk.
I
live
in
north
reno,
district
27,
assemblywoman,
benitez,
thompson,
awesome,
lady.
We
have
a
lot
of
sidewalk
and
I
utilize
the
sidewalk
pretty
soon
my
kids
will
be
going
to
military
and
I
won't
have
a
driver
and
I
do
not
want
to
always
depend
on
buses,
sometimes
they're
late,
sometimes
they're
cancelled
due
to
mechanic
and
lack
of
drivers.
L
I
I
C
Good
afternoon,
madam
chair
members
of
the
committee
bradley
mayor
of
our
dental
partners
representing
southern
nevada
health
district
today,
I
just
wanted
to
weigh
in
the
certainly
the
intent
of
this
bill
is
good
for
public
health,
and
I,
I
would
just
share
that
we
are
working
with
the
assembly
woman
we've
been
in
contact
with
her
and
we're
hoping
to
working
on
this
bill
together,
but
we
are.
We
also
at
the
health
district,
are
engaged
in
some.
C
Some
of
these
walking
audits
specifically
like,
for
example,
one
we're
doing
with
the
city
of
henderson,
in
conjunction
with
their
parks
and
recreation
department,
that
also
focuses
on
low-income
census,
tracts
and
then
working
also
with
the
city
las
vegas
unlv,
to
help
develop
a
decision,
support
tool
for
city
public
works
that
use
it's
a
tool
that
planning
public
works
and
transportation
professionals
will
use
to
agree.
Health
safety
and
equity
related
considerations
into
land
use
really
to
support.
You
know:
safe
walkable
bike
loan
connected
communities
so
we're
doing
some
of
this
work.
C
We're
still
evaluating
the
fiscal
and
operational
impact
of
this.
This
bill
came
out
last
week
and
then
of
course
being
heard
today,
and
so
we're
we're
just
looking
forward
to
working
with
the
assemblywoman
as
she
works
on
some
amendments
for
this
bill
ahead
of
work
session.
We
thank
you
for
your
time.
I
D
D
I
did
just
as
a
note
in
neutral
on
this
bill,
because
I
tried
to
work
with
assemblywoman
thomas
last
week
to
try
and
connect
her
to
appropriate
people
at
the
rtc
in
southern
nevada,
because
they
they
are
engaged
in
transportation
planning,
and
that
includes
walkability
for
the
regions
that
they
serve,
including
clark
county.
They
are
really
kind
of.
D
This
is
the
bread
and
butter
of
what
they
do
so
we're
trying
to
help
the
to
engage
in
this
process
as
assemblyman
haven
noted,
our
comprehensive
planning
department
does
assess
this,
and
especially
a
complete
straight
policy,
as
we
are
rewriting
our
codes
right
now.
We
are
engaged
in
in
looking
at
this
in
a
comprehensive
way.
D
We
have
added
bike
lanes
and
sidewalks,
where
feasible,
every
time
that
we
update
a
street
in
clark
county
where
it
is
feasible.
We
always
address
ada
compliance,
and
so
this
has
been
something
that
has
been
discussed
at
our
board,
so
assemblyman
haven.
Yes,
we
are
engaged
in
doing
this
work
as
well
on
in
a
comprehensive
planning
way
that
we
do
in
unincorporated
clark
county,
we
so
we'll
we
will
continue
to
work
with
the
assemblywoman
on
this
bill
and
take
part
in
the
stakeholder
group.
Certainly,
madam
chair,
and
assist
where
we
can.
Thank
you.
N
Thank
you,
madam
chair.
I
do
appreciate
the
closing
remark
and,
like
I
stated
earlier,
we
are
working
to
solidify
this
bill
to
make
it
amenable
to
just
about
every
agency
that
has
a
hand
in
affording
the
walkability
for
our
residents.
We
know
that
this
is
something
that's
probably
new
to
the
state
of
nevada,
because
when
I
first
moved
here
in
82,
they
didn't
have
sidewalks,
so
we
are
gradually
moving
to
the
21st
century
and
I
look
forward
to
meeting
with
the
stakeholders
this
week.
Thank
you
so
much.
A
Thank
you
for
that,
and
with
that
I
will
close
the
hearing
on
assembly
bill
343
and
at
this
time
I
will
now
open
the
hearing
on
assembly
bill
344,
which
authorizes
the
establishment
of
a
program
to
facilitate
transition
of
the
care
of
older
persons
and
vulnerable
persons.
And
again
I
will
turn
it
back
over
to
you
assemblywoman
thomas,
to
begin
when
you
are
ready.
N
Good
afternoon
cheerwin
and
members
of
the
committee
for
the
record,
I
am
assemblywoman
claire
thomas
representing
assembly
district
17
in
beautiful
north
las
vegas.
Thank
you
for
the
opportunity
to
present
assembly
bill
344
before
you
today.
This
bill
aims
to
improve
care,
con
coordination
and
continuity
of
care
for
elderly,
nevadans
and
individuals
with
disabilities
following
discharge
from
the
hospital.
N
I
recently
experienced
this
firsthand
when
my
mother
was
in
the
hospital
you
see
after
her
stroke.
No
one
realized
that
this
was
the
onset
of
dementia.
Mom
became
very
confused
and
frustrated
whenever
seeing
her
doctors
and
could
not
remember
what
she
was
advised
to
do.
My
brother
as
her
caregiver
would
ask
to
go
into
the
examination
room
so
that
he
was
able
to
get
the
information
and
assist
mom
with
her
meds
and
other
doctor's
orders.
N
Specifically
subsection
1
of
section
1
of
assembly
bill
344
authorizes
the
division
of
aging
and
disability
services
within
dhs
to
establish
a
program
through
regulations
to
help
older,
nevadans
and
nevadans
with
the
disabilities,
with
the
transition
from
the
hospital
to
their
home.
Currently,
the
bill
refers
to
older
persons
and
vulnerable
persons.
However,
in
working
with
adsd
on
this
bill,
I
am
proposing
an
amendment
to
replace
the
term
vulnerable
person
with
person
with
this
with
a
disability
which
is
language
currently
used
in
nevada,
revised
statutes.
N
N
N
N
We
submitted
two
documents
that
I
believe
he
will
discuss
so
that
everyone
has
a
better
understanding
of
the
type
of
program
we
envision
through
this
bill.
After
his
presentation,
we
would
be
happy
to
answer
any
questions
and
I
believe
cheyenne
pasquale
social
services,
chief
adsd
dhs,
is
available
to
answer
any
technical
questions
from
the
division's
side.
A
That
would
be
fine,
and
I
would
also
remind
members
or
let
them
know
that
the
amendments
that
you've
been
speaking
about
in
your
presentation
should
be
on
nellis.
I
believe
they
were
uploaded
this
morning.
If
you
don't
have
them,
please
let
committee
staff
know
and
they
can
make
sure
they
send
you
an
email
with
us
and
go
ahead
with
your
the
remainder
of
your
presentation.
I
just
remind
your
presenters
to
please
clearly
state
their
name
when
they
prior
to
presenting.
P
For
the
record,
I'm
jeffrey
klein,
I'm
the
president
and
ceo
of
nevada
senior
services,
I'm
a
member
of
nevada's
commission
on
aging
and
chair,
it's
legislative
subcommittee
and
my
thanks
to
assemblywoman
thomas
for
bringing
forth
ab344,
and
my
thanks
to
chairwin
and
vice
chair
peters,
for
the
invitation
to
be
here
today.
Briefly,
the
powerpoint
you
have
is
actually
going
to
have
more
material
in
it
than
I
intend
to
cover.
But
I
thought
it
would
be
useful
reference
information
for
you.
P
So
if
I
I
have
included
some
additional
information
briefly,
nevada
senior
services
operates
two
adult
day:
health
care
centers.
P
We
provide
in-home
respite
home
modifications,
we
do
clinical
geriatric
assessment,
we
have
a
wellness
set
of
initiatives
and
we
are
the
nevada
care
connection,
resource
center
for
lincoln
nye
esmeralda
and
the
majority
of
clark
counties
and
as
you're
about
to
hear
we're
on
the
very
much
ground
floor
of
the
development
of
what
we
call
hospital
home,
which
is
a
care
transitions
programs
for
for
really
some
of
the
most
difficult
populations
that
we
have.
As
you
know,
nevada
is
among
the
fastest
growing
senior
populations.
P
If
that
total
populations
in
the
country
and
with
that
and
comes
the
issue
of
dementia
and
nevada,
has
seen
an
astronomical
increase
in
deaths
from
dementia,
our
alzheimer's
deaths
have
increased
261
percent
since
2000.
P
One
thing
I
might
note
parenthetically
is
that
we're
faced
nationally,
but
very
much
in
nevada,
with
the
fact
that,
while
life's
life
span
is
much
longer,
health
span
is
becoming
more
and
more
problematic
as
we
live
longer.
So
we
have
people
with
multiple
chronic
conditions
which
ultimately
lead
them
to
be
greater
consumers
of
health
care
and
more
likely
to
be
admitted
to
the
hospital
persons
with
dementia.
P
Frail
and
elderly
typically
will
have
also
care
partners,
family
members
who
are
responsible
for
assisting
them
and
maintain
themselves
in
the
community
and
those
folks
can
be
very
stressed
when
family
members
have
chronic
diseases.
We
know
that
dementia,
in
particular
increases
the
burden
on
acute
care
systems.
Any
hospital
executive
will
tell
you
that,
and
I
was
one
for
most
of
my
career.
P
It
creates
excessive
resource
consumption,
higher
complication
rates,
both
in
the
hospital
and
after
the
hospital
and
generally
results
in
poorer
outcomes,
they're
more
likely
to
be
hospitalized
in
the
general
population
over
65
about
25
percent
of
all
hospital
patients.
65
over
have
a
dementia
and-
and
there
are
all
sorts
of
studies
about
the
issue
of
dementia
in
the
record-
and
that
is
very
few
of
the
folks-
are
hospitalized
even
who
have
a
dementia.
P
I
haven't
existed
openly
in
their
hospital
record
and
quote
my
wife's
grandmother.
Don't
let
them
know
how
old
you
are
and
don't
let
them
know
if
you're
having
problems,
thinking,
there's
a
fear
factor
in
seniors
in
particular,
but
also
other
vulnerable
populations
in
having
the
hospital
staffs,
even
be
aware
that
they
have
this
kind
of
a
fragile
situation.
P
Hospitalization
rates
of
persons,
dementia
are
more
than
twice
what
they
are
for:
the
cognitively
healthy,
a
third
of
hospitalized
persons
with
alzheimer's
disease
average
one
and
a
half
to
two
hospitals
days
a
year.
A
couple
of
things
worth
noting
that
people
with
dementia
comprise
40
percent
of
the
total
hospital
readmissions
30
day.
P
Readmissions
hospitals
are
faced
with
a
huge
problem
of
people
who
are
living
alone
at
home
with
dementia,
representing
an
unsafe
discharge
which
clogs
hospital
beds,
because
the
hospitals
have
difficulty
even
discharging
it
and
clark
county,
for
instance,
has
one
of
the
highest
readmission
rates.
P
Nevada
overall,
but
clark
county
in
particular,
has
one
of
the
highest
readmission
rates
in
the
country,
with
over
35
percent
of
medicare
patients
being
readmitted
to
the
hospital
they're
more
likely
to
not
regain
their
health,
so
that
you
have
people
whose
discharge
issues
associated
with
their
ability
to
function.
P
Their
home
gets
negatively
impacted
in
the
hospital
which
makes
them
a
more
complicated
discharge
and
more
dangerous
to
discharge
to
the
home
without
successful,
supports
and
they're
more
likely
to
get
discharged
to
a
nursing
home,
which
we
know
is
not
the
location
of
choice
as
we
found
out
during
the
covid
19
epidemic
and
we'll
talk
about
that
briefly
in
a
minute,
they're
also
three
to
seven
times
more
likely
to
be
living
in
a
nursing
home
three
months
after
discharge,
so
which
really
represents
a
both
a
human
cost
and
an
economic
cost
to
the
state
of
nevada.
P
Our
hospital
home
program
started
originally
with
a
pilot
program
that
was
funded
by
the
nevada
agency
disability
services
division
as
a
subset
of
an
administration
federal
administration
community
living
program.
Grant
we
piloted
what
we
thought
was
an
innovative
approach
to
dealing
with
this
population.
P
So
traditional
discharges
this
population,
as
we
originally
envisioned
it
because
of
the
grant,
was
focused
heavily
on
the
dementia
population,
persons
with
intellectual
developmental
disabilities,
who
are
at
much
higher
risk
for
dementia.
The
frail
elderly
who
are
hospitalized
for
any
medical
condition,
live
alones
and
most
recently
covet
19
related
admissions
and
discharges,
and
we
have
right
now
a
caseload
of
over
150
of
those
persons
right
now
in
clark
county
who
have
either
been
directly
or
indirectly
impacted
by
covid19
and
a
discharge
from
hospital
homes.
P
P
The
collaboration
is
really
important
and
one
of
the
things
that
brings
in
addition
to
the
hospital
collaboration
is
for
the
clients,
a
post
discharge
care
transitions
wrap
around
for
all
the
services
they
need.
The
approach
is
both
these
days
in
person
and
or
californic
because
of
the
whole
over
19
limitations.
P
P
People
crave
autonomy
and
those
of
us
in
the
healthcare
field,
and
even
his
family
members,
crave
safety,
and
so
we're
very
often
inclined
to
sacrifice
the
wishes
of
the
person
who's
trying
to
be
discharged
from
the
hospital
who
is
or
is
complex
in
favor
of
what
we
think
is
going
to
keep
them
safe,
and
that
is
that
push
and
pull
is
really
important
in
hospital.
The
home.
We
start
with
the
desires
of
the
individual,
and
then
we
look
to
see.
P
How
can
we
do
that
in
a
safe
way,
and
it
includes
both
internal
and
external
referrals
for
ongoing
supports.
So
we
start
out
with
this
30-day
program.
We
develop
personalized
care
plans,
we
deal
with
behavioral
and
psychological
symptoms,
and
the
whole
goal
is
to
support
these
folk
folks
to
not
only
make
the
transition
but
to
be
able
to
engage
going
forward
in
access
to
supports
which
keeps
them
safe
in
the
community.
P
We've
added
a
fairly
innovative
feature
to
the
program
called
respite
coaching
and
right
now
we're
kind
of
evaluating
what
the
best
personnel
to
ultimately
long
term
be
delivering
that
service,
we're
starting
to
think
community
health
workers,
which
has
a
special
place
in
nevada
and
but
the
idea
of
the
respite
coaches
is
to
decrease
post,
hospitalization,
stress
and
caregiver
burden,
because
we
know
caregiver
burden
is
likely
to
either
cause
readmission
or,
worse,
long-term
care
placement.
It
provides
a
short-term
intensive
respite,
but
also
allows
us
to
provide
training.
P
The
family
caregiver
on
handle,
what's
going
on
in
their
home
and
to
make
connections
for
long-term
supports
and
these
respite.
Coaches,
which
are
teamed,
are,
are
an
intrinsic
part
of
this
whole
idea
of
care
transitions,
which
is
unique
to
nevada
and
unique
to
our
program,
so
we're
very
excited
about
it.
The
service
delivery
also
ties
into
referrals
to
community
public
and
private
resources.
We
have
social
workers
licensed
social
workers
on
the
team.
P
We
provide
case
management,
long-term
services
and
supports,
which
is
a
natural
for
our
aging
and
disability
resource
center
initiative,
basic
need
programs
and
caregiver
education
and
support,
which
is
really
important.
How
do
we
educate
family
caregivers
to
be
better
navigators
of
the
health
care
system
and
the
social
services
system,
both
coming
and
going,
and
we've
created
a
series
of
workshops
for
the
family,
caregivers
and
for
healthcare
professionals?
P
So,
by
way
of
outcome,
this
is
last
year's
numbers,
as
you
can
see,
and
out
of
363
clients,
participants
who
came
through
the
program,
the
admissions
for
the
same
diagnostic
related
group
was
zero.
P
Let
me
just
say
that
screamingly
one
more
time,
not
one
person
was
readmitted
to
the
hospital,
not
one
and
we're
excited
about
that,
because
not
only
the
human
savings
but
the
financial
savings
of
keeping
people
successfully
in
their
homes
and
having
them
now
bounce
in
and
out
of
the
hospital
there
were
six
out
of
363
were
ultimately
re-admit
admitted
for
a
different
drg,
so
somebody
had
a
stroke
and
then
six
months,
three
months
later,
they
fell
and
broke
their
hip.
P
That's
a
that
was
a
different
admission,
a
couple
of
interesting
things
that
came
out
of
some
of
our
studies.
That,
I
think,
will
help
you
understand
how
the
pragmatics
of
the
program,
how
important
they
are,
is
if
you
take
a
look
at
what
we
call
first-tier
discharge
challenges.
P
Insufficient
support
at
home
is
66
percent
of
the
cases,
and
so
and
you
can
see
the
other
issues
that
drink.
So
we
know
that
this
is
a
critical
factor
and
referrals
for
support
caregivers
support.
76
of
the
people
discharged
required
caregiver
support,
75
percent
respite
care,
which
is
a
topic
for
another
day
with
the
legislature
and
then
home
modifications,
36
percent.
These
are
just
critical
for
wrapping
this
into
this
whole
idea
of
a
successful
discharge.
P
So,
basically,
what's
happened
with
this
program.
Now
it's
become
more
ubiquitous.
We
started
with
dementia
and
then
moved
on
to
broader
cognitive
impairments.
Then
the
covid
and
now
the
broad
arena
of
people
who
are
complex,
have
family
caregivers
or
have
an
array
of
problems
which
make
them
difficult
to
discharge.
P
P
So
it's
been
a
highly
successful
program,
we're
very
supportive
of
the
state
of
nevada
having
a
broad-based
program
to
assist
hospitals,
to
have
this
resource
available
and,
most
importantly,
to
assist
our
seniors
and
those
persons
who
are
at
highest
risk
to
be
able
to
get
back
to
home
and
stay
there
without
readmissions
and
without
possible
utilization
of
services
and
without
the
need
for
long-term
care
placement.
P
So
I'm
happy
to
answer
any
questions
and
once
again,
my
my
great
thanks
to
a
stubbly
woman,
thomas
for
taking
on
this
very
tough
issue
and
one
that
has
a
big
impact
on
a
very
much
aging
and
fragile
population.
N
Thank
you,
mr
klein
and
assemblywoman
when
cheerwine
we're
open
to
answer
questions.
Thank
you.
A
O
Thank
you,
madam
chair,
and
thank
you
assemblywoman
thomas
for
bringing
this
bill
forward
and
mr
klein
for
being
part
of
the
testimony
or
presentation
of
this
bill.
I
have
a
couple
questions
actually:
first,
it
as
a
provider
having
been
administrator
and
director
of
a
long-term
care
unit
and
worked
in
the
er,
literally
thousands
of
hours,
discharging
patients
etc.
O
There's
already
a
mandatory
requirement
that
discharges,
we
have
a
safe,
safe
discharge,
and
so
we
have
discharge
planners
and
we
have
throughout
this
legislative
process,
created
patient
advocates
communications
and
so
that
we
have
to
have
that
that
warm
hand
off
that
safe
discharge,
and
I'm
wondering
what
does
this
build
change
any
of
that
and
and
if
so
number
of
my
first
question
second
question:
is
we're
limited
at
this
now
to
just
persons
with
disabilities
and
I'm
wondering
now:
will
we
not
have
to
have
that
safe
discharge
with
all
the
other
patients
that
I
discharged
and
then
finally,
mr
klein
I'd
like
some
more
details
after
you
answer
those
questions
on
on
on
some
of
the
studies
that
you
did
with
your
group,
because
it
sounds
like
you're
already
doing
this,
and
what
will
this
law
change
that
you're
not
already
doing
so.
O
P
You
to
dr
titus
and
chairwind.
Let
me
just
kind
of.
P
Thank
you,
jeffrey
klein,
for
the
record
to
dr
titus,
and
I
have
to
tell
you
you
raised
several
really
important
questions.
One
of
the
issues
about
this
kind
of
hospital
home
program
is,
it
really
focuses
on
the
most
complex
cases
and
I
think
that
that's
some
that
traditional
discharge
planning
really
just
doesn't
get
to
and
the
example
I
always
give
is
you
know
you
have
a
45
year
old,
gallbladder
surgery
and
the
discharge.
P
Planner
comes
through
the
door
and
says:
when
can
you
person
pick
you
up
you're
going
home
today
and
make
sure
you
take
your
medications
and
get
back
to
your
doctor,
and
if
the
hospital's
got
a
good
care
transitions
initiative,
then
they
follow
up
to
make
sure
you
filled
your
prescription.
You
you
booked
your
doctor,
but
to
a
family
caregiver
who
is
so
totally
fried
that
they're
basically
immobile,
because
they've
been
taking
care
of
a
loved
one
for
a
long
period
of
time
and
has
now
ended
up
in
the
hospital.
P
They
just
need
way
more
help
and
supports.
They
have
issues
that
go
way
beyond,
and
I
I'm
not
going
to
drag
you
through
the
long
case
study.
We
submitted,
but
just
to
give
you
an
example,
a
couple
of
highlights.
This
is
a
swat
team
at
work.
P
P
The
other
element,
and
that
I
would
touch
is
that
not
only
is
it
human
but
humane,
but
it
is
financially
beneficial.
Mr.
O
P
Doing
well,
it's
not
available
to
everybody.
It
was
done
originally
through
a
federal
grant
which
is
now
over,
and
so
now
we
are.
We
have
it
available
on
a
limited
basis
through
some
very
minor
funding
that
we
have
available
either
through
the
division
of
aging,
boulder
american
sac
money
or
covet
money
which
will
expire
by
the
way
on
september
30th
of
this
year
or
to
a
limited
number
of
insurers
that
are
willing
to
pay
for
portions
of
the
service.
P
It's
not
yet
covered
by
medicare,
as
we
know
it,
and
it's
not
yet
covered
by
medicaid
as
we
know
it.
So
it
only
exists
to
the
extent
that
we're
able
to
provide
funding
and
do
it
for
free
for
people.
P
Well,
this
would
be
the
aging
disability
services.
Division
would
be
able
to
accept
those
grants
and,
and
then
contract
with
us
or
others
to
help
deliver
the
program.
But,
more
importantly,
I
think
I
hope
it
sets
a
platform
for
medicaid
and
to
cover
the
service
where
it'll
be
cost
beneficial
and,
secondly,
it
encourages
the
hospitals
to
encourage
their
managed
care
partners
to
to
participate
in
it
right
now
we
have
several
managed
care
organizations
that
are
looking
at
it,
but
certainly
encouragement
from
the
state
of
nevada
would
help.
O
A
follow-up
question,
madam
chair:
go
ahead,
so
that
brings
me
back
to
the
statement
you
did
during
your
testimony
and
the
study
that
you
use
that
your
organization
did
regarding
readmissions,
and
you
testified
that
I
believe
100,
I'm
not
sure
what
your
end
number
was.
Maybe
150,
I'm
not
sure
on
my
notes,
but
you
said
that
no
one
was
readmitted
for
the
original
diagnosis.
O
P
Jeffrey
klein
for
the
record
and
to
dr
titus's
question
the
the
study
had
363
people
in
it
over
a
three
year
period
of
time,
really
two
and
a
half
years,
because
the
first
six
months
was
a
planning
cycle.
It
included
a
wide
range
of
diagnoses
from
surgeries
to.
P
Heart
failure,
chronic
obstructive
pulmonary
disease,
the
late
effects
of
diabetes
and
so
on,
so
it
had
a
pretty
raw
wide
range.
The
initial
work
was
limited
to
persons
with
a
dementia,
not
necessarily
diagnosed
dementia,
but
a
perceived
dementia,
if
not,
if
no
diagnosis
was
available
and
later
became
broadly
available
to
complex
families
with
coving.
So
some
of
those
numbers
in
there
are
actually
people
who
had
a
covet
diagnosis
or
were
admitted
to
the
hospital
was
a
suspected
covert
diagnosis.
A
Mr
klein,
if
I
could
just
interrupt,
I
know
that
we
also
have
ms
pasquel
from
the
chief
of
the
aging
and
disability
services
division.
She
might
be
able
to
also
answer
this
question.
I
don't
know
if
you
want
to
unmute
yourself
and
be
able
to
address
that
as
well
on
why
this
legislation
is
needed.
If
we're
already
doing
it
in
some
aspects,.
B
Well,
I
think
to
mr
klein's
point:
they've
piloted
this
program
and
they
were
able
to
develop
a
model
that
can
really
be
replicated
to
scale,
and
this
legislation
offers
adsd
the
opportunity
to
build
the
capacity
across
the
state
and
give
this
type
of
program
but
make
it
available
to
a
broader
audience
for
a
broader
population.
Sorry.
O
It
helps,
but
I
just
see
that
there's
nothing
that
prohibits
it
from
happening
already,
since
we're
already
doing
it
in
some
form-
and
I
I
guess
the
under
the
answer
to
my
question-
is
that
it
enables
them
to
potentially
expand
the
program
and
and
look
at
future
payment
resources
is
what
I'm
hearing,
but
thank
you.
Thank
you
for
all
the
questions.
Madam
chair.
A
A
And
I
I
will
kind
of
follow
up
with
that,
just
see
if
we
can
get
some
clarity
on
the
record,
miss
pasquale,
I'm
sorry.
I
said
your
name
wrong.
The
first
time
would
this
enable
like
us
to
apply
for
different
grants
and
funding,
and
without
this
would
we
not
be
able
to.
B
Thank
you.
It
would
not
prevent
us
from
applying
for
grants
if
we
did
not
have
this
legislation.
What
it
does
do
is
it
gives
us
a
little
more
backing.
I
guess
I
would
say
when
applying
for
grants
to
say
that
this
is
a
priority
for
the
state
of
nevada.
It's
a
legislatively
approved
program,
and
so
I
think
that
can
help
to
make
us
more
competitive
in
our
grant.
Writing.
A
So
am
I
correct
in
asking
if
this
would
just
having
the
legislative,
I
guess
backing
or
support
would
enhance
applications
of
people
that
wanted
to
like
get
into
a
grant
program?
Is
that
correct.
B
A
Thank
you
and
I'm
going
to
look
around
here.
I
haven't
received
any
messages.
Do
we
have
any
other
questions
from
committee
members
at
this
time
before
I
go
to
testimony
and
support
opposition
in
neutral,
seeing
them
broadcast
services?
Can
we
please
begin
on
testimony
and
support
of
this
bill,
and
I
would
remind
callers
to
please
clearly
state
and
spell
your
name
for
the
record
and
limit
your
testimony
to
two
minutes
at
this
time.
We'll
begin
testimony
in
support
of
assembly
bill
344.
I
I
E
E
We
support
increasing
opportunities
for
collaboration
between
hospital
staff
and
caregivers,
to
coordinate
healthcare
and
social
services
for
older
persons
and
persons
with
a
disability
such
as
our
guardianship,
clients,
care
coordination
programs
can
help
help
to
improve
continuity
of
care,
improve
outcomes
and
provide
a
smooth
transition
home
for
people
who
are
most
vulnerable
and
in
need
of
ongoing
support.
Thank
you
very
much.
I
A
N
Remarks,
thank
you
chairwin
and
committee,
and
I'm
hoping
that
you
will
support
assembly
bill
344.
It
is
necessary.
It
is
a
good
program
for
the
most.
N
A
Thank
you
for
that
presentation.
At
this
time
I
will
close
the
testimony
on
assembly
bill
344,
and
at
this
time
we
will
go
to
public
comment
broadcast
services.
Can
we
see
if
anyone's
on
the
line
for
public
comment?
I
would
remind
callers
to
please
clearly
state
and
sell
your
name
for
the
record
prior
to
speaking
and
limit
your
testimony
to
two
minutes.
I
M
Good
afternoon
chairwoman
nguyen
and
members
of
the
committee
for
the
record,
my
name
is
tom
tom
wellman
w-e-l-l-m-a-n
and
I'm
a
resident
of
assembly
senate
district,
one
I've
successfully
retired
from
the
park
county
school
district
and
currently
serving
as
president
of
the
nevada
state
education
retiree
program,
I'm
here
this
afternoon,
to
make
public
comment
regarding
a
very
serious
issue
to
retirees
in
the
state
of
nevada
and
our
retired
members.
Health
care,
one
of
the
major
expenses
that
all
senior
citizens
and
our
members
face
in
retirement
is
the
continuing
escalating
cost
of
health
care.
M
M
Please
consider
as
you
move
forward,
that
active
educators
and
support
professionals
will
also
need
to
have
access
to
quality,
affordable
health
care
when
they
retire
working
together.
We
can
help
solve
this
problem
for
the
employees
that
can
continue
to
handle
these
life-changing
assignments
on
a
daily
basis.
Thank
you
for
your
time.
A
Thank
you,
and
with
that
I
will
open
it
up
if
there
are
any
comments
from
committee
members
before
I
adjourn
the
meeting
seeing
none,
I
will
remind
members
we
have
another
meeting
here
on
wednesday,
we're
trying
to
pack
in
a
lot
of
bill
hearings,
and
I
know
that
we
got
a
lot
of
last
minute
draft
bills
that
received
our
committee
members.
A
So
please
pay
attention
to
your
emails
and
nellis
about
like
last-minute
amendments
as
it
is
that
time
of
session,
and
with
that
I
will
adjourn
the
meeting
and
see
you
all
on
wednesday
at
1
30..