►
Description
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
Videos of archived meetings are made available as a courtesy of the Nevada Legislature.
The videos are part of an ongoing effort to keep the public informed of and involved in the legislative process.
All videos are intended for personal use and are not intended for use in commercial ventures or political campaigns.
Closed Captioning is Auto-Generated and is not an official representation of what is being spoken.
A
Wonderful,
thank
you
welcome
to
assembly
health
and
human
services.
I
will
call
this
meeting
to
order
on
wednesday
march
24th
2021..
Let's
go
ahead
and
get
started.
Madam
secretary,
can
you
please
call
the
roll.
A
C
D
A
Here
and
we
are
going
to
take
things
a
little
bit
of
out
of
order,
we
are
going
to
start
the
presentation
for
our
assembly
bill
today
and
then
we
are
going
to
move
to
our
work
session
after
the
presentation
and
then
kind
of
come
back
for
some
meetings.
I
know
we
have
some
scheduling
errors,
it's
kind
of
that
time
of
the
session,
where
we're
going
to
try
to
get
as
much
done
as
we
possibly
can.
So
I
appreciate
your
patience
on
that.
A
E
E
Jolina
walker
of
kijiji's
sisterhood
in
southern
nevada,
will
not
be
able
to
join
us
today
because
she
is
attending
to
a
patient.
I'd
like
to
start
this
presentation.
By
sharing
a
personal
story
in
early
1987
I
found
out,
I
was
pregnant
with
my
first
child.
I
was
living
with
my
first
husband
in
fist
back
west
germany.
We
were
stationed
at
an
air
force
forward
operating
location.
E
E
I
didn't
know
it
at
the
time,
but
part
of
the
continuum
of
care
included
a
midwife.
Her
name
was
gisela
busa.
She
was
a
stout
dark-haired,
no-nonsense
woman,
who
spoke
very
little
english,
although
she
had
a
firm
demeanor,
frabusa
exuded,
kindness
and
competence,
just
what
this
first
time,
mom
needed
to
get
through
pregnancy
and
delivery,
while
living
over
five
thousand
miles
from
my
mom,
who
would
not
be
able
to
attend
the
birth.
E
E
Current
best
practice
is
to
have
a
non-medical
doula,
providing
support
solely
for
the
mom,
while
the
midwife
or
physician
delivers
and
cares
for
the
baby.
I
was
lucky
to
have
had
an
extremely
skilled
midwife
who
was
able
to
attend
me
in
the
delivery
room.
If
there
had
been
any
complications,
her
attention
would
have
shifted
and
rightfully
so,
to
the
baby
and
away
from
me.
E
F
F
Part
of
the
mission
of
our
organization
is
to
advocate
for
the
health
and
vitality
of
our
community
members
and
ab256
is
anchored
in
that
intention.
We're
facing
a
national
maternal
health
crisis
in
this
country,
as
the
united
states,
is
the
most
dangerous
place
in
the
developed
world
for
an
expected
parent
to
give
birth.
Let
that
set
in
the
reality
is
even
more
grim
for
black
women
who
die
at
a
disproportionately
higher
rate
than
their
counterparts.
F
43
black
women
die
every
100
000
live
births.
When
I
first
learned
the
statistic
it
devastated
me,
it
devastated
me
because
I
couldn't
help
but
think
of
all
the
new
babies
born
into
this
world
who
wouldn't
have
their
mothers.
I
was
overcome
with
grief
wondering
how
many
new
nevadans
wouldn't
immediately
know
the
fierce
protection
unconditional
unconvinced.
Excuse
me
unconditional
love
and
comforting
warmth
of
their
mama.
F
F
G
F
It
was
in
these
conversations
that
we
learned
of
the
troubling
realities
that
postpartum
has
on
parents,
the
women
and
birth
parents.
We
spoke
to
talked
about
feeling,
stressed
fatigued
and
experienced
issues
with
breasts
or
chest,
feeding,
amongst
other
hardships,
that
a
non-medical
doula
would
be
aptly
capable
of
supporting
a
parent
through.
F
In
these
same
conversations,
nearly
a
third
of
our
participants
reported
not
having
access
to
prenatal
care
or
prenatal
services
at
all.
Finally,
these
conversations
with
our
community
members
revealed
that
doulas
would
be
the
most
helpful
resource
during
the
pregnancy,
alongside
parenting
classes
and
resources
to
help
with
postpartum
depression.
F
Our
research
and
conversations
culminated
in
the
pursuit
of
this
legislation.
Expanding
medicaid
to
provide
for
doula
services
to
expected
parents
and
mothers
is
the
best
way
to
help
mitigate
some
par
earth
outcomes,
ensure
new
nevada
children
are
getting
a
healthy
and
thriving
start
and
serve
as
a
cost
cost.
Saving
measure
for
our
state.
F
Ab256
is
community
driven
policy
that,
at
its
core,
is
about
our
nevada
and
children.
What
kind
of
nevada
do
we
want
to
see
them
born
into?
Hopefully
it's
one
where
we
see
value
in
their
life
before
they
even
arrive.
Hopefully
it's
one
where
we
ensure
that
the
mother
or
birth
parent
has
access
to
any
and
all
the
resources
that
can
not
only
ensure
a
safe
and
healthy
birth,
but
also
ensures
a
postpartum
period
that
is
met
with
support
and
ease
instead
of
trauma
and
stress.
F
H
Hello,
my
name
is
alex
gunter
and
I'm
so
happy
to
be
here.
I'm
representing
the
reno
doula
project
from
northern
nevada,
the
reno
doula
project
was
starting.
It
started
in
2012
as
a
way
to
help
mothers
gain
access
to
doulas
historically
having
a
doula
was
a
thing
of
privilege
reserved
for
the
upper
class.
Through
the
arena,
doula
project
we've
been
able
to
close
this
gap
and
access
to
doulas
by
reducing
the
cost
through
an
income
based
sliding
scale
ensuring
that
women
of
all
income
levels
are
able
to
hire
a
doula.
H
H
More
importantly,
births
attended
by
doulas
have
fewer
nicu
admissions,
higher
rates
of
breastfeeding
initiation
and
a
longer
duration
of
breastfeeding
in
nevada.
Only
21
of
our
infants
are
still
exclusively
nursing
at
six
months
when
breast
milk
can
be
both
life-saving
and
cost-saving
for
nevada
and
families.
We
need
to
do
anything
we
can
to
support
that
in
addition
to
the
reno
doula
project,
I'm
also
the
director
of
postpartum
services
at
a
new
another
doula
company,
bright
heart,
birth
services,
breithart
has
worked
tirelessly
to
make
the
role
of
doula
a
legitimate
role
within
this
field.
H
We
are
not
medical
professionals,
but
we
are
professionals,
careful
attention
to
scope
of
practice,
continued
training
and
commitment
to
our
clients
before,
during
and
after
labor
has
paved
a
path
for
doulas
to
be
well
regarded
within
my
community.
I
am
so
happy
to
testify
in
support
of
more
doulas
and
more
births.
H
This
past
year,
the
reno
doula
project
has
had
the
honor
of
accepting
a
sponsorship
from
anthem
medicaid
to
provide
50
of
their
members
with
doulas
starting
in
2021.
Anthem
has
put
their
money
where
their
mouth
is
both
in
terms
of
considering
doula
support
as
a
cost-saving
measure
and
enriching
service
to
their
members.
H
This
sponsorship
is
an
opportunity
to
further
legitimize
doulas
within
the
field
of
perinatal
support.
People
are
watching
us
because
they
know
what
we
are
capable
of.
I
thank
you
for
your
time
today
and
ask
your
support
in
this
bill
to
include
doula
services
as
a
medicaid
covered
benefit.
Thank
you
and
I'll
pass
this
on
to
lauren.
I
You
all
see
this
okay
yep.
I
got
something:
okay
beautiful,
so
I'm
not
gonna,
go
all
the
way
through
this,
but
I'm
gonna
give
us
some
highlights
here
to
anchor
what
in
the
numbers,
what
we're
actually
talking
about
so,
for
example,
of
the
36
000
births
that
happen
in
nevada
annually
about
a
third
of
them
are
performed
by
caesarean
and
about
10
are
preterm
births,
both
of
which
have
disproportionate
numbers
of
black
women
reflected
in
those
demographics.
I
As
far
as
the
maternal
mortality
crisis,
that
clinton
referenced,
nevada
is
one
of
the
48
states
in
the
united
states
that
over
the
last
20
years
has
seen
a
27
increase
in
our
maternal
mortality
rates,
and
I
think
of
these
numbers.
It's
important
to
note
that
in
a
recent
year
in
nevada,
2018
76
of
the
deaths
were
people
covered
by
medicaid.
I
Black
and
native
american
women
also
have
significantly
higher
maternal
mortality
rates
than
white
women
in
national
averages.
It's
about
two
to
five
times
higher
a
chance
for
a
black
or
native
american
woman
to
die
for
related
to
pregnancy,
related
causes
than
a
white
woman
and
in
nevada.
Specifically,
black
women
have
been
shown
to
be
dying
at
rates
twice
as
high
as
black
women.
I
Similarly,
with
infant,
the
infant
mortality
rates
in
nevada,
our
infant
mortality
rates
increased
six
percent
between
2016
and
2018
and
again
this
is
a
place
where
we
see
a
racial
disparity
and
that
black
women
or
black
babies
are
twice
as
likely
to
die
than
white
babies
nationally
birth.
Also,
it
represents
a
significant
cost
expenditure
here.
So
you
know,
60
61
of
births
in
nevada
are
covered
by
medicaid
and
of
the
20
most
expensive,
hospitalization
conditions
covered
by
medicaid.
Five
of
them
are
related
to
perinatal
experiences.
I
Cesarean
births
are
a
a
huge
piece
of
this
and
that
they
cost
twice
as
much
as
what
a
vaginal
birth
does.
You
know
representing
an
additional
4
500
per
client
who
has
a
cesarean
birth,
and
so
all
of
this
you
know
the
doulas
have
been
shown
to
meet
what
the
department
of
health
and
human
services,
the
national
quality
strategy
is,
calling
the
triple
aim,
which
is
not
only
improving
health
outcomes
and
quality
of
care,
but
also
increasing
cost
savings.
I
We
can
see
some
of
this
here.
This
was
a
cochrane
analysis.
That
was
that
I'll
point
y'all
to
that
shows
that
not
only
are
doula
is
effective
in
decreasing
cesarean
verse,
almost
by
30,
for
example,
and
preterm
births,
as
well
as
other
expensive
and
high-touch
interventions
such
as
vacuum,
extractions
and
epidurals.
I
So
I
hope
that
y'all
will
see
that
there's
extensive
evidence
that
backs
up
this
doulas
as
an
intervention
that
meets
the
triple
aim.
Here.
You
know
the
recent
cochrane
systemic
review
showed
that
all
what
indicated
that
all
women
should
have
continued
support
during
labor
and
that
there
are
no
known
harms
of
dual
care,
as
well
as
the
american
journal
of
obstetrics
and
gynecology.
I
That
did
an
extensive
review
of
41
birth
practices
and
doulas
were
only
one
of
three
to
receive
an
a
grade,
and
so
they
they
recommended
that
continuous
labor
support
such
as
that
provided
by
doulas,
to
be
one
of
the
most
effective
interventions
to
improve
labor
and
delivery
outcomes
and
I'll
leave
you
all
with
that
and
I'll
with
these
references.
And
I
thank
you
all
for
your
time
and
consideration
and
thinking
about
how
this
is
really
an
intervention
that
serves
so
many
purposes
for
the
state
of
nevada
and
the
people
who
live
here.
Thank
you.
I
E
Thank
you
to
clinton
and
lauren
and
to
alex
and
also
to
jolina,
who
could
not
be
here.
I'm
just
going
to
close
this
presentation
with.
I
want
to
share
something
with
you
all,
let's
see
if
I
can
get
my
screen
to
share,
I
don't
know
what
I'm
doing.
E
E
G
G
A
E
In
that
is
fine,
thank
you
so
much
I'll
I'll
do
this
after
the
testimony
is
complete.
If
that's
okay,
once
we
are
finishing
up,
that's
fine.
E
Oh
ma'am,
that
is,
it
you've,
heard
our
story,
and
we
appreciate
the
time
that
we're
allowed
to
do
this,
and
I
know
you
have
to
move
on
since
to
some
other
things.
So
we'll
sit
tight
and
and
be
available
for
questions
perfect.
A
So
at
this
time
I'm
going
to
pause
the
hearing
on
assembly
bill
256
and
I'm
going
to
work
and
move
into
our
work
session.
As
you
know,
a
lot
of
people
are
moving
around
presenting
bills
in
other
committees,
so
I
want
to
make
sure
that
we
have
all
of
us
here
when
we're
doing
this,
and
I
will
note
for
the
record
that
assemblywoman
gorlo
is
now
present,
so
we
are
all
present
in
this
committee
at
this
time
I
will
begin
the
work
session
on
assembly
bill
96..
D
Yes,
thank
you
very
much
chairwin
for
the
record,
patrick
ashton,
comedy
policy
analyst
of
the
legislative
council
bureau
just
a
reminder,
as
non-partisan
staff
I
can
neither
advocate
nor
oppose
any
measures
that
you
will
consider
today.
D
Members
of
the
committee,
you
should
have
received
a
work
session
document
by
email
and
you
can
also
find
it
on
nellis.
We
will
begin
the
work
session
with
assembly
bill
96,
which
we
heard
on
march
17th.
The
proposed
amendment
to
this
bill
will
replace
the
contents
of
ab-96.
Hence
I
will
go
straight
to
the
amendments.
D
For
the
sake
of
time,
though
c
attached,
the
proposed
conceptual
amendment
for
ab96,
assemblywoman,
leslie
cohen,
proposes
to
replace
the
contents
of
abe
96
with
the
following
provisions:
amendment
1
add
a
section
authorizing
a
governmental
entity
that
licenses
and
regulates
first
responders
to
enter
into
a
contract
with
a
non-profit
organization
to
carry
out
a
program
to
provide
peer
support
counselling
for
first
responders.
D
This
amendment
then
provides
for
certain
requirements
of
such
a
contract,
as
outlined
in
the
work
session
document.
Amendment
2
required
dpph
to
post
on
an
internet
website
maintained
by
the
division.
Information
concerning
peer
support
services
available
to
emergency
response,
employees
and
amendment
3
required
a
division
to
collect
and
report
certain
information
relating
to
suicide
or
suicide
attempts
by
emergency
response
employees
to
the
chief
medical
officer.
Madam.
A
Chair,
thank
you
so
much
for
that.
Do
we
have
any
questions
from
committee
members
before
we
take
a
motion.
A
E
A
Thank
you.
I
see
a
motion
by
vice
chair,
peters
and
a
second
buy.
I
believe
that
was
assemblywoman
benitez
thompson,
I'm
going
to
give
it
to
her
so,
madame
secretary,
can
we
go
and
take
a
roll
call
vote.
Wait.
Sorry.
We
have
discussion.
Oh
I'm
sorry,
discussion
on
the
matter.
Thank
you.
Thank
you
sure
and
assembly
woman
titus
go
ahead.
J
Thank
you.
So,
although
I
appreciate
certainly
appreciate
what
the
bill
is
attempting
to
do,
I
do
not
think
that
it
reaches
what
is
attempting
to
do
or
even
come
close.
I'm
concerned
that
there's
some
duplication
of
services.
I
also
feel
that
mandating
the
toll-free
hotline
for
first
responders
is
a
duplication
services
also,
and
we
really
need
to
be
concentrating
on
988
hotlines
and
so
for
that
and
several
other
reasons,
I'll
be
a
no
on
this
bill.
A
Seeing
none
last
chance,
okay,
madam
secretary,
can
you
now
take
a
roll
call
vote.
D
A
G
K
A
Yes,
having
received
a
majority
of
the
committee
members,
I
find
that
the
motion
carries
at
this
time.
We
will
move
next
to
oh
and
I
will
sign
the
floor
statement
to
assemblywoman
cullen.
A
Sorry
yeah!
I
forgot
that
last
time.
So
let
me
try
to
remember
this
time.
Next
we're
going
to
move
on
to
assembly
bill
192.!
Mr
ashton,
can
you
go
ahead
and
summarize
this
bill
in
its
amendment.
D
Thank
you
so
much
chairwin
one
moment,
please
auto
record
patrick
ashton
committee
policy,
analyst
legislator
of
council
bureau,
so
we
heard
assembly
bill
192
on
march
10th.
The
bill
requires
a
physician
or
other
person
who
attends
to
a
pregnant
woman
to
examine
and
test
a
woman
for
certain
sexually
transmitted
infections.
Unless
the
woman
opts
out
of
such
examination
and
testing,
I
go
straight
to
the
amendments.
D
D
Amendment
2
removes
provisions
requiring
that
certain
testing
be
done
without
charge.
Commitment
3
clarifies
that
hospital
emergency
departments
and
medical
facilities
must
a
ask
women
of
child-bearing
age
whether
they
are
pregnant
b,
seek
consent
from
the
pregnant
woman
and
commence
treatment
for
syphilis.
If
the
blood
test
results
show,
the
woman
is
infected
with
syphilis
and
if
the
result
is
received,
while
she's
in
the
emergency
department
or
medical
facility
and
c
indicate
a
case
involves
a
pregnant
woman
when
notifying
the
local
health
authority
of
a
confirmed
case
of
syphilis.
D
D
Amendment
5-
and
this
is
what
the
actual
change
happened-
require
health
insurance
provider
regulated
by
the
state
of
nevada,
to
pay
for
the
examination
and
testing
mandated
by
sections.
One
and
two
of
this
bill
verify
that
the
insurer
may
not
be
required
to
pay
more
than
the
lowest
rate
prescribed
by
contract
between
the
insurer
and
the
facility
provider
or
laboratory.
And
you
see
that
change
refers
to
the
facility,
and
you
can
also
find
that
in
a
conceptual
environment,
amendment
6
revised
a
list
of
other
medical
facilities
to
which
requirements
of
this
bill
apply.
A
A
Go
ahead
and
assemblywoman
titus.
Thank
you.
J
Madam
chair,
unfortunately,
I
will
not
be
in
support
of
this
bill.
I
am
part
of
being
on
the
interim
health
committee.
We
did
address
the
fact
that
syphilis
nevada
ranks
number
one
in
neonatal
syphilis,
which
is
not
acceptable.
Unfortunately,
I
do
not
feel
that
this
bill
will
solve
that.
J
Unfortunately,
it
also
may
expand
some
other
concerns
that
that
we
did
not
see
asking
that
these
tests
be
done
in
providers
and
then
finding
them
now
extending
to
not
just
labor
and
delivery
or
emergency
hospital,
but
also
psychiatric
hospitals,
rural
clinics,
mobile
units
that
may
not
have
that
testing
available
on
site
with
them
and
then
finding
them
if
they
don't
get
the
fact
that
these
tests
can
take
days
to
get
back
and
then
holding
someone
liable
for
those
just
is
not
acceptable
to
me.
So,
unfortunately,
I
will
be
a
no
on
this
bill.
A
I
do
know
that
we
have
the
bill
sponsor
assemblywoman
cohen
present
here,
and
I
think
she
has
a
a
discussion
on
it
as
well
or
clarifying
response.
G
Thank
you
chair,
actually,
I,
but
I
believe
we
actually
leslie
cohen
assembly
district
29
and
when
this
came
out
of
interim
committee,
it
was
unanimous
except
for
dr
tardy
and
titus,
and
the
concern
that
they
had
voiced
was
dhhs
and
the
nevada
hospital
association
not
having
an
agreement.
G
In
fact,
they
now
have
come
to
an
agreement
within
a
very
short,
the
last
a
little
while,
which
is
why,
unfortunately,
we
weren't
able
to
have
a
more
fuller
work
session
document
earlier
to
you
and
we
actually
reduced
the
medical
facilities.
We
took
out
a
lot
of
the
medical
facilities
then
compared
to
how
it
came
out
of
interim.
G
F
I
K
A
Yes,
having
received
a
majority,
the
motion
passes
and
I
will
assign
this
floor
statement
to
assemblywoman
cullen
as
well.
Next,
if
we
could
go
to
I'm
actually
going
to
go
back,
I'm
sorry,
I
skipped
it
if
we
could
go
to
begin
the
work
session
on
assembly
bill
181.
Mr
ashton,
can
you
please
summarize
this
bill
and
his
amendment.
D
Thank
you
chairwin
for
the
record,
patrick
ashton
committee
policy.
Analyst
the
committee
heard
ab181
on
march
2nd
before
I
go
into
details
committee
members
please
be
advised.
I
sent
you
by
email,
an
updated
work
session
document
for
a
abe
181
recently,
and
it
is
also
updated
on
nellis
assembly
bill
181
requires
health,
insurers
that
provide
health
coverage
for
their
employees
to
comply
with
the
federal
hall,
wellstone
and
pete
dominici
mental
health,
parity
and
addiction
equity
act
of
2008..
D
This
will
also
require
the
state
board
of
health
to
adopt
regulations
requiring
certain
medical
facilities
and
facilities
for
the
dependent
to
report.
Information
relating
to
suicide
to
the
chief
medical
officer,
and
now
we
go
to
the
amendments.
Dr
woodard
senior
advice
on
behavioral
health
dpbhdhhs
submitted
an
amendment,
and
you
see
also
an
attached
memorandum,
which
is
titled
ab180,
which
is
titled.
D
Sorry
ab-181
proposed
amendment.
So
her
amendment
does
amendment
one.
It
removes
language
in
the
bill
requiring
certain
facilities
to
report
information
relating
to
suicide
to
the
chief
medical
officer.
G
D
D
A
Thank
you,
members
of
the
committee.
Do
we
have
any
questions?
I
know
that
we
have
assemblywoman
peters
here.
I
think
she
would
like
to
make
a
statement
just
about
the
work
session
document
and
some
of
the
amendments
that
are
there.
So
assemblywoman
peters
go
ahead.
L
Thank
you
chair.
This
was
really
a
group
effort
and
then
attacking
the
issues
on
both
sides
of
what
is
the
most
important
piece.
The
patient
and
I
just
want
to
thank
all
of
the
stakeholders
who
worked
with
me
on
this
and
out
of
the
last
couple
of
weeks
and
beyond.
L
I
did
want
to
clarify
that
in
the
amend
the
proposed
amendment
that
was
proposed
by
myself
to
remove
the
nrs
chapter,
287
reference
in
section
9
really
doesn't
affect
the
bill's
efficacy
it
just
comes
into
and
in
line
with
the
parity
act
which
already
exempts
those
programs
anyways.
So
I
just
wanted
to
clarify
that.
J
For
that
assignment
peter
for
the
clarification,
but
I
also
have-
I
need
a
little
bit
of
clarification
on
if
I'm
looking
at
your
amendment,
I
think
that
was
suggested
by
dr
woodard
and
I'm
not
sure
we're
all
looking
at
the
same
amendment,
the
one
that
I
have
has
suggested
language
that
the
green
text
and
it
removes
there's
a
lot
of
stuff
being
removed.
But
then
it
looks
like
we're
moving
existing
language
from
another
nrs
441a
0.120
the
board
shall
adopt
regulations,
control
communicable
diseases.
J
I
believe
the
board
already
has
regulations,
so
is
that
new
statute,
because
it's
in
green,
so
that
would
be
new
wording
in
that
it
also
talks
about
adding
then
the
green
stuff.
About
this
I
mean
the
blue
and
then
about
adding
suicide
statistics
so
re-changing
what
that
chapter
is
because
the
language
looks
familiar,
but
it's
in
green,
so
it
looks
like
new
language.
J
L
L
It
doesn't
matter
to
me
I'm
sorry.
I
thought
that
was
dr
woodard,
who
was
speaking.
I
Thank
you,
chair
stephanie
woodard,
for
the
record
to
be
clear.
L
The
conceptual
amendment
was
really
not
intending
to
change
existing
reporting.
M
Requirements
under
that
section
of
his
existing
statute,
but
was
to
add
into.
L
For
the
record,
that's
correct:
I
think
that
the
green
language
in
441
120.
A
A
I
see
a
motion
by
actually
assemblywoman
benitez
thompson
and
a
second.
It
looks
like
by
vice
chair
peters.
Any
further
discussion
on
the
motion.
I'm
sure
go
ahead.
Assemblywoman
titus.
J
Thank
you,
madam
chair.
Unfortunately,
I'm
going
to
be
a
no
on
this
bill.
I
I
think
that
there's
a
lot
of
language
in
here
that's
appropriate,
but
premature
and
hasn't
been
really
vetted
and
the
consequences
of
this
language
when
we
never
did
get
a
straight
answer
on
a
certain
timetable
and
I,
as
a
provider,
have
concerns
about
possible
suicide
attempts
versus
accidental
overdoses.
I
understand
what
we're
trying
to
achieve.
I
think
this
bill
does
not
do
that
and
it
may
add
extra
complications
with
false
information
and
false
reporting.
A
Saying
then
we'll
go
ahead.
Madam
secretary,
can
we
please
do
a
roll
call
vote.
C
A
M
A
Yes,
having
received
a
majority,
the
motion
the
motion
carries
at
this
time.
We
will
move
on
to
our
next
assembly
bill,
which
is
assembly
bill
197.
Mr
eschen,
please
summarize
the
bill
in
any
potential
amendment.
A
Sorry,
if
we
can
assign
that
to
by
sir
peter.
D
D
This
bill
also
revises
provisions
that
require
the
state
registrar
to
provide
birth
certificates
to
a
homeless
person
free
of
charge
in
certain
circumstances,
and
then
assemblyman
watts
proposes
the
following
amendments:
to
section
one
of
the
bill
amendment
one
he
plays
mother
with
parent
in
subsection,
1c
of
nrs
129
30
and
amendment
2,
replace
in
a
physician's
judgment
with
in
a
judgment
of
a
provider
of
healthcare
in
subsection,
1d
of
nrs,
129
or
30..
D
Additionally,
china,
jacob
government
affairs
manager
of
clark
county
proposes
an
amendment
mn3
revised
the
bill.
To
add
child
welfare
agencies
acting
as
a
custodian
of
a
child
with
the
intention
to
treat
child
welfare
agencies
the
same
as
a
parent
or
legal
guardian,
and
please
see
also
the
attached
proposed
amendment.
Thank
you.
Chairwin.
A
Thank
you
for
that
summary
of
the
bill.
I
know
that
we
also
have
the
bill
sponsor
here,
assemblyman
watts.
I
appreciate
everyone's
patience.
As
you
know,
a
lot
of
these
bills
came
out
not
necessarily
representing
the
intent
that
I
think
some
of
the
presenters
assumed
they
would
be
so
there
have
been
quite
a
few
amendments
and
they
haven't
been
drafted
in
their
formal
form.
Yet
so
we
do
have
assemblyman
watts
here
and
I
believe
he
wants
to
make
a
statement
regarding
the
bill
as
well.
So
go
ahead
to
some
women
wants.
N
Thank
you
very
much,
madam
chair.
I
just
wanted
to
thank
assemblyman
or
liquor
and
assemblywoman
titus,
whose
suggestions
led
to
the
changes
in
the
proposed
amendments.
One
and
two.
I
also
wanted
to
note
briefly.
I
know
that
there's
been
questions
from
some
of
my
colleagues
about
what
impacts
this
may
have
on
consent
for
abortion
care
and
a
legal
opinion
was
provided.
That
says,
because
nevada's
existing
parental
notification
statutes
remain
facially
unconstitutional,
a
minor
in
nevada,
has
an
existing
constitutional
right
to
obtain
an
abortion
under
nrs
442
442-250,
without
parental
consent.
N
If,
in
the
future,
a
minor
does
not
have
such
an
existing
constitutional
right,
for
example,
if
the
state
were
to
adopt
parental
notification
requirements
that
are
constitutionally
permissible,
then,
under
that
hypothetical
scenario,
ab197
could
potentially
have
some
sort
of
impact,
but,
as
things
stand
right
now,
it
would
have
no
impact
on
the
ability
of
minors
to
seek
abortion
care
with
or
without
the
consent
of
the
parent.
So
I
just
wanted
to
make
sure
we
got
that
on
the
record.
A
Thank
you
and
do
we
have
any
questions
before
the
motion
from
committee
members
questions
go
ahead,
assemblywoman
titus!
Thank
you.
J
Ma'am
taran,
thank
you,
someone
watched
for
that
clarification
and
additional
language.
I
have
a
question
regarding
the
amendment
proposed
by
the
clark
county
and
some
clarification
on
that
particular
amendment.
It's
it
the
way.
I'm
reading
it
says
the
parent
or
parents
of
legal,
guardian
or
custodian
of
a
minor
who
receives
an
examination
of
services
are
not
liable
for
the
payment
for
that
exam,
and
so
I'm
wondering
who
is
liable
for
the
exam
who
does
pay
for
the
cost
of
services
who
will
be
held
accountable.
N
For
that
question,
assemblywoman
howard
watts,
for
the
record,
I
would
defer
to
clark
county
if
they're
available
to
answer
that
question
again.
It's
just
adding
the
the
intent
that
they
provided
during
the
hearing
was
adding
parity
between
custodians
along
with
parents
and
wheel
guardians
under
existing
statute.
G
Thank
you,
madam
chair,
and
to
you
thank
you.
Assemblywoman
titus,
the.
I
think.
As
someone
wats
summarized
our
intent
very
astutely,
it's
not
that
we,
the
intent
of
adding
that
is
to
treat
like
in
that
subsection
seven.
The
parent
would
not
be
liable
for
the
cost.
If
they
did
not
consent,
the
the
guardian
would
not
be
liable
for
the
cost
of
that
consent
of
care.
If
that
was
not
consented
to,
I
think
that's
a
situation.
G
I
can
see
why
that's
the
public
policy
that's
proposed
here,
and
so
we
were
just
asking
for
parity
in
that
sense.
You
know
this.
We
clark
county
child
welfare
does
try
to
cover
the
costs
for
care
of
the
children
who
are
in
our
who
are
in
our
custody.
So
we
do
make
all
efforts
to
do
that,
but
we
do
have
situations
where
we
have
runaways
and
we
have
things
that
we
try
to
work
with
mr
garfurry
and
the
build
proponents
behind
this.
G
We're
hoping
that
this
is
a
very
very
few
occasions
where
this
will
have
to
be
invoked,
but
the
intent
is
just
to
treat
us
just
as
a
parrot
or
legal
guardian.
The
definition
that
is
in
the
amendment
432
b,
o
6
0
for
custodian,
is
actually
defined
as
a
person
or
a
government
organization
other
than
a
parent
or
legal
guardian.
So
it's
just
recognizing
that
legal
status
of
the
custodian
when
we
have
legal
custody
of
the
child.
I
hope
that
addresses
the
question.
J
All
follow-up
madam
chair
can
so
the
reason
and
thank
you
for
that
miss
jacob.
I
appreciate
I
know
I
know
that
your
your
heart
is
in
the
absolute
correct
spot
here.
I'm
just
wondering
I
was
surprised
to
see
it
here
now,
because
the
purpose
of
the
build
for
mice,
what
I
see
is
really
addressing
when
the
miner
doesn't
have
a
parent,
a
guardian
or
a
custodian,
because
then,
if
they
have
those
they
give
the
consent
for
treatment
and
that
this
bill
doesn't
really
address
this
particular
section
of
then
who's
going
to
pay
for
that.
J
N
Thank
you
if
I'm
a
madam
chair,
howard
watts
for
the
record.
I
just
want
to
note
that
this
amendment
was
presented
during
the
original
hearing
for
the
bill
and
there
were
no
questions
on
it
at
that
time
and
this
justification
for
the
amendment
was
provided.
Then
the
situation
that
miss
jacob
has
described
is
particularly
a
runaway
situation.
N
So
again,
if
the
child
is
under
the
care
of
the
custodian,
then
this
would
not
reply
it's
if
the
young
person
has
run
away
and
is
homeless
and
is
is
not
currently
under
the
care
of
a
parent,
guardian
or
custodian.
A
Any
other
further
questions
from
the
committee
thing.
Then
I'd
entertain
a
motion
at
this
time
so
moved.
I
see
a
motion
from
assemblywoman
benitez
thompson.
Do
I
have
a
second
second?
I
have
a
second
from
assemblywoman
gorlo.
Madam
oh,
do
we
have
any
comments
on
the
motion
we
do
if
I
might
manage
her.
J
I
absolutely
appreciate
what
this
is
trying
to
do
and
and
get
health
care
having
been
in
emergency
rooms
so
many
times
where
I
could
not
treat
a
child
that
shows
up
with
a
broken
arm
or
an
injury
until
I
got
parental
consent,
but
at
the
same
time
there
are
some
concerns
that
we
have
regarding
this
bill
with
the
the
question
that
we
asked
of
the
our
legal
council
and
some
other
concerns
regarding
parental
rights,
and
so
for
that
reason,
of
course,
I'm
gonna
have
to
be
a
no.
O
A
O
A
Yes,
having
received
a
majority,
the
motion
carries
next.
If
we
can
move
to
assembly
sorry
assembly
bill,
217,
I'm
going
to
skip
216
and
go
to
217..
Mr
ashton,
can
you
please
summarize
the
bill
in
this
amendment.
A
I
keep
doing
that.
I
see
assemblyman
still
on
here,
so
if
we
could
assign
that
to
assemblyman
watts,
if
he
is
not
available,
can
we
make
assemblywoman
summers,
armstrong
the.
D
Backup,
thank
you
so
much.
Oh
next,
we'll
move
to
assembly
bill
217
for
the
record,
patrick
ashton,
comedy
policy.
Analyst
lcb
ab217
requires
the
administrator
or
other
person
in
charge
of
designated
medical
facilities,
facili
facilities
for
the
dependent
and
other
licensed
facilities
to
ensure
that
each
unlicensed
caregiver
at
the
facility
completes
certain
training,
including
training.
On
the
topic
of
the
control
of
infectious
diseases.
D
A
G
Thank
you
chair,
yes,
leslie
cohen
assembly
district
29,
just
some
information.
This
bill
came
out
of
the
interim
committee
unanimously.
I
don't
have
any
amendments,
but
there
there
have
been
some
stakeholders
that
did
request
that
some
information
be
put
on
the
record.
So
even
though
some
of
it
was
addressed
at
the
hearing,
I'll
just
quickly
go
through
that.
So
just
to
be
clear
when
we're
talking
about
the
unlicensed
workers.
Here
we
are
not
talking
about
friends
and
family
caregivers.
G
There
is
some
some
language
and
some
statutes
having
to
do
with
that.
So,
but
that
is,
they
are
not
at
issue
here.
G
Additionally,
to
be
very
clear:
is
the
intent
of
this
bill
that
the
training
be
for
no
cost
or
a
minimal
cost,
and
then
also
it
is
also
the
intent
of
the
legislation
not
to
add
extra
training
hours,
but
to
help
dhh
dhhs
to
prior
to
prioritize
trainings
to
make
sure
unlicensed
caregivers
are
given
focused
training
based
upon
the
most
recent
surveys
and
citations
available.
G
That's
not
saying
that
the
board
can't
add
add
extra
training
hours
if
they
believe
it's
necessary,
but
we're
not
looking
to
duplicate
any
training
that
people
are
already
receiving.
So
thank
you
for
that.
Chair.
A
Do
I
sorry,
I
see
a
motion
from
assembly
woman
benitus
thompson
looks
like
I
have
a
second
also
from
vice
chair
peters,
and
do
we
have
any
comments
on
the
motion.
G
G
G
I
I
A
Yes,
having
received
a
majority,
the
motion
carries
at
this
time.
I
would
have
liked
to
assign
the
floor
statement
to
assemblywoman
cohen,
if
she's
not
able
to.
I
would
assign
it
as
a
backup
to
assemblymen
foreign
liquor
at
this
time.
If
we
can
move
to
our
next
bill
on
work
session,
I'm
going
to
kind
of
go
back
up
to
assembly
bill
216..
D
Thank
you
chairwin
for
the
record,
patrick
ashton
committee
policy.
Analyst
ab216
requires
the
director
of
the
department
of
health
and
human
services
to
include
a
statement
for
medicaid
coverage
for
cognitive
assessment
and
care
planning
services
for
persons
who
exhibit
signs
or
symptoms
of
of
cognitive
impairment,
and
we
heard
this
bill
on
march
15th
in
a
schmidt
administrator
of
aging
and
disability
of
the
aging
and
disability
services.
D
A
Saying
none
do
I
have
a
motion
to
amend
and
do
pass
too
sick?
I
have
a
motion
by
assemblywoman
titus.
Do
I
have
a
second
second?
I
see
in
a
second
from
I
think
that
was
assemblywoman
black.
Do
we
have
any
discussion
on
the
are
any
comments
on
the
motion.
A
G
A
Thank
you
and
I'm
sure,
assemblywoman
gorlo
appreciates
that.
Do
we
have
any
other
our
comments
on
the
motion.
N
I
I
A
Yes,
the
motion
passes
carries
and
if
we
can
assign
this
floor
statement
to
assemblywoman
gorlo
and
finally,
if
we
can
go
to
our
last
bill
assemblybill228.
Mr
ashton,
please
summarize
the
bill
on
its
amendments.
D
Thank
you,
children
for
the
record,
patrick
ashton
committee
policy.
Analyst
lcb,
though
we
heard
assembly
bill
228
on
march
17th.
It
provides
for
the
establishment
of
children's
advocacy,
centers
and
requirements
governing
the
credentialing
and
operation
of
such
centers
are
specified
in
the
bill.
D
Bill
also
requires
the
governing
body
of
each
county
and
each
child
welfare
agency
to
ensure
that
children
who
are
victims
of
abuse
or
neglect
have
access
to
a
multi-disciplinary
team
through
a
children's
advocacy
center,
and
it
creates
the
account
to
support
children,
advocacy
centers
in
the
state
general
fund
amendments
jesse,
bought
the
chair
of
the
legislative
task
force
from
the
children's
advertising.
Centers
of
nevada
proposes
the
following
amendments
and
see
also
the
attached
proposed
amendments
commandment,
one
subset
subsection
1b
of
section
6.
D
Amendment
2
clarify
in
subsection
4
section
6
that
children
do
not
have
to
be
victims
of
abuse
or
neglect
in
order
to
access
services
of
a
children's
advocacy
center.
Also
clarify
that
access
to
services
are
not
limited
to
a
multi-disciplinary
team
membrane
3
revise
the
bill
to
ensure
all
child
welfare.
Information
can
be
shared
with
every
member
of
a
multi-disciplinary
team
to
support
a
child's
case,
including
cases
with
allegations
of
sexual
assault
by
a
child's
relative
who
is
not
a
caregiver.
D
Next
amendment
is
from
the
nevada
chess
justice
association
amendment
four
revised
section
six
to
provide
that
a
member
of
a
children's
advocacy
center's
multidisciplinary
team
is
only
immune
from
civil
liability
for
any
communication
within
this
team.
The
immunity
provisions
in
the
bill
for
an
employee
or
officer
of
a
children's
advocacy
center
are
not
modified
by
this
amendment.
D
A
Thank
you
and
I
believe
we
have
assembly
woman
miller
here
to.
I
think
she
has
some
comments
to
make
regarding
some
of
the
amendments
that
were
recently
added,
so
assemblywoman
miller
go
ahead
when
you're.
G
Ready
we
can't
hear
you.
Thank
you
yes,
chair.
Thank
you
so
much.
I
just
want
to
thank
everyone
involved.
There
were
all
of
the
amendments
are
friendly
after
a
lot
of
hard
work
that
went
in
with
multiple
parties,
so
the
amendments
are
friendly
and
there
will
be
one
more
amendment
submitted,
but
that
amendment
will
only
be
to
add
additional
signers.
A
Thank
you.
Do
we
have
any
other
comments?
It
looks
like
we
have
one
from
assemblywoman
titus
go
ahead.
Oh
thank
you.
J
I
I
have
just
a
question
and
thank
you
because
I
I
do
support
again
this
concept
and
I
think
it's
important
and
I
appreciate
all
bodies
reaching
out,
and
it
was
very
excellent
advocates
on
this
bill.
J
My
question,
though
this
scene,
this
one
from
the
proposed
by
the
nevada
justice
association,
section
six
number
two,
where
an
employer
officer
of
a
children's
advocacy
center
or
a
member
of
multi-disciplinary
team
is
immune
from
civil
liability
for
any
action
or
mission,
if
they're
in
good
faith,
you're
striking
that
out
and
only
going
to
give
them
civil
liability
protection
for
an
intra-team
communications
made,
is
there
statutes
otherwise
anywhere
else?
J
That
would
give
somebody
that's
in
their
best
interest,
trying
to
do
the
right
thing
for
these
kids
and
you
from
civil
liability.
Are
we
opening
up
a
potential
litigation
avenue
for
this
nevada
justice
association?
I'm
half
concerned
now
that
I'm
seeing
this
amendment
right.
G
Thank
you
for
the
question.
No
we're
not
what
it
actually
is
is
limiting
because
it
and
that's
where
the
word
intra
comes
from,
so
that
the
people
that
are
within
the
actual
advocacy
team
are
protected.
It's
when
we
start
going
outside,
say,
for
instance,
if
we
brought
in
another
social
service
or
another
agency,
or
even
licensed
healthcare
professionals
who
all
are
covered
under
their
own
protection
and
insurance
as
well.
So
what
it
was
was
to
to
reign
it
in
on
because
again
the
challenge
of
the
definition
of
good
faith.
G
Good
faith
covers
a
multitude
of
things,
but
it
was
to
keep
you
know.
We
want
everyone
in
the
children's
advocacy
center
to
be
protected,
to
do
the
reporting
that
they
need
to
do
to
have
the
privileged
conversations
and
communications
that
they
need
to
do
unless
by
court
order,
but
to
make
sure
that
it's
specific
to
those
that
are
trained
and
working
within
this
multiplinary
disciplinary
team.
So
I
hope
that.
J
That,
well,
as
a
teacher,
you
know
you're
a
mandatory
reporter
for
certain
things
and
as
a
physician,
I'm
a
mandatory
reporter
for
certain
things
and
if
I
do
it
in
good
faith,
I'm
protected
from
that
family,
then
I
I
report
because
I
suspect
child
abuse.
I
report
that
and
but
I
I
then
I
do
it
in
good
faith,
because
I
see
a
broken
arm
in
the
er
turns
out.
J
That's
you
know
I
reported
mandatory
reporting
back
and
say
you
know
you
accused
us
of
being
child
abusers,
not
true,
I'm
protected,
because
I
did
in
good
faith.
I
just
want
to
make
sure
that
folks
who
work
at
the
the
advocacy
center
and
that
team
are
protected,
so
I
just
needed
some
clarification
on
that.
Thank
you.
Yes,.
G
And
thank
you
for
that
doctor
because
that's
exactly
the
same
example
I
kept
using
in
negotiating
these
amendments
that
again
it
sometimes
it
comes
back,
it's
unsubstantiated,
but
that
you
know
civil
and
criminal
liability
can't
come
against
us
for
doing
what
you
know.
In
best
faith
we
followed
our
protocol.
So
thank
you
for
that.
A
Do
we
have
any
other
questions
for
assemblywoman,
miller
or
legal?
Regarding
the
amendment.
A
D
J
So
I
absolutely
am
going
to
support
this
and
vote
this
out
committee
with
my
right
to
change
my
vote.
If,
after
I
do
because
again,
I'm
just
kind
of
looking
at
these
and
having
some
questions
and
again,
I
support
it
conceptually.
I
just
want
to
make
sure
that
the
amendments
haven't
really
changed.
Any
of
that.
So
definitely
I'm
going
to
support
it
out
of
committee
with
the
reserve.
My
right.
G
J
A
Yes
and
the
motion
carries
and
I
will
assign
that
floor
statement
to
assemblywoman
miller
if
she's
not
available,
I
will
give
a
backup
to
assemblywoman
krasner
and
this
time
I'm
going
to
end
the
work
session
and
we
are
going
to
travel
back
in
time
to
unpause
assembly
bill
256.
A
E
Thank
you,
chair
nguyen.
I
am
ready
for
questions
from
the
committee
if
they
are
forthcoming.
Thank
you.
J
N
I
thank
you,
madam
chair.
Thank
you
assemblywoman
for
the
presentation
on
the
bill.
I
was
just
wondering
if
you
could
tell.
O
Us
have
other
states
adopted
this
and.
G
N
E
A
F
Absolutely
thank
you
chair.
Oh
yes,
I'm
unmuted!
Okay,
so
to
you,
chair,
win
through
you,
chair
went
to
the
assemblyman
assemblyman.
Yes,
this
has
passed
and
nearly
two
dozen
states
this
particular
piece
of
legislation
is
actually
modeled.
After
what
has
transpired
in
oregon,
and
since
this
has
passed
in
oregon,
they
have
been
able
to
see
significant
cost
savings
to
the
state
and
a
reduction
in
syrian
deliveries.
So,
yes,
this
has
passed
in
other
states.
A
J
Thank
you,
madam
chair.
Thank
you
for
your
personal
story,
islamic
woman,
for
presenting
this
bill
and
and
sharing
with
us
some
of
your
personal
events.
It's
always
good
to
know
how
these
bills
get
started
and
and
why
my
questions
were
results
around
the
cpt
coding
and
wondered,
and
these
other
states
and
and
medicaid
reimburses
for
this,
and
if
so,
the
federal
government
is
okay
with
that
and
then
I'll
have
follow-up
questions.
E
Thank
you,
assemblywoman
titus.
Yes,
that
has
been
done
in
other
states
and
I
do
believe
we
have
a
representative
from
hhs
who
can
speak
to
how
that
process.
A
Works,
I
think
we
have
mr
young
on
the
line.
I
saw
him
light
up
so
go
ahead.
If
you
can
answer
that
question.
O
Fair
gwen
through
you
to
the
minority
leader
assemblywoman,
robin
titus,
dwayne
young,
for
the
record
deputy
administrator
for
the
division
of
healthcare
financing
policy.
I
don't
have
the
specific
cpt
codes.
There
are
a
variety
of
cpt
codes.
Other
states
have
set
this
up
as
either
billing
under
the
medical,
professional
or
a
separate
provider
type
much
like
community
health
workers.
Our
thinking
has
evolved
over
the
years,
and
so
we
would
create
this
as
a
separate
provider
type
and
whose
codes
would
be
used
in
tandem
with
the
supervising
care.
Physician.
J
I
thank
you
for
that
follow-up
question.
Madam
chair.
Go
ahead,
assemblywoman
titus!
So,
and
thank
you
for
that.
Mr
young,
do
you
know
or
is
there
a
set?
Is
there
like
one
fee
for
the
services
and
you
can
start
it
six
months
prior
to
delivery
and
does
it
follow
for
a
year
after?
So
what
is
that
scope?
Look
like.
O
So
the
majority
of
the
states
that
we've
looked
at
have
actually
a
bundled
version
of
visits,
and
so
we've
looked
at
that
analysis
separately.
We
haven't
really
landed
as
to
where
we
will
actually
go
if
we
will
do
those
as
separate
visits
or
do
one
bundle
payment
for
both
the
prenatal
and
postnatal
services.
Ms
lynch
will
testify
a
little
bit
later
to
some
of
the
ideas
that
we
have
in
policy,
but
we
haven't
landed
on
what
that
methodology,
but
most
states
do
do
a
bundle,
payment.
J
Thank
you
for
that
additional
question.
Madam
chair.
Go
ahead,
that's
fine,
and
so
with
obstetrics
and
delivery.
It's
one
of
the
issues
with
ob
and
delivery
eye
as
a
provider
literally
delivered
hundreds
of
babies
and
the
biggest
risk
for
us
is
liability,
insurance
and
outcomes.
So
are
they
going
to
be
mandated
to
have
liability
insurance
under
this
practice?
Who
who's
going
to
be
responsible
for
liability
for
bad
outcomes.
O
Doing
young
deputy
administrator
for
the
record,
I
will
do
my
best
to
answer
this
question.
We
may
have
to
ask
some
of
our
friends
at
division
of
public
and
behavior
health.
There
is
a
provision
in
the
bill
language,
as
is
written,
that
medicaid
would
be
the
regulatory
authority,
that's
not
something
that
we
typically
do.
O
So
we
have
spoken
with
assemblywoman
schumer's
armstrong
about
transferring
that
provision
to
dhhs
as
a
whole,
and
so
hcqc
most
likely
would
have
that
oversight,
and
then
that
would
really
be
based
on
their
practice
model.
Perhaps
you
know
lauren
or
alex
could
speak
to
that,
how
they
carry
liability
insurance
in
their
model
now,
but
that
would,
I
do
not
believe,
would
fall
directly
under
the
provision
of
dhhs.
J
And
so
would
would
that
be
part
of
will
the
dhs
establish
like
the
scope
of
practice,
I
mean:
are
you
going
to
be
mandated
that
you
do
urinalysis
for
proteins
and
all
of
those
other
things
or
this
can
be
liable?
They
suspect,
preeclampsia
and
all
of
those
things
I
mean
who
will
set
that
scope
of
practice.
O
Dwayne
young
again
for
the
record,
assemblywoman
titus,
this
the
scope
of
practice
will
really
be
defined
by
the
cpt
codes
for
what
they
can
build
medicaid
now
there
will
be
certain
provisions
of
the
practice
that
will
not
be
in
billable
cpt
codes
or
are
not
covered
services,
but
those
would
not
be
reimbursed
by
medicaid,
and
so
those
cpt
codes
are
careful
not
to
overstep
or
conflict
with
anything
that
the
physician
or
aprn
nurse
midwife
is
doing,
but
they're
very
specific
and
defined.
E
Madam
chair,
if
I
might
thank
you,
madam
chair
chandra
summers,
armstrong
assembly
district,
six,
if
I
could
ask
lauren
to
speak
to
the
scope
in
the
exhibits
that
we
put
in
nellis,
there
is
a
beautiful
one
with
giving
a
side-by-side
of
what
these
the
role
of
the
doula
is,
and
I
think
that,
if
lauren,
if
you
are
still
here,
if
you
could
please
quickly
speak
to
that.
I
I'd
be
happy
to
this
is
lauren
calagradas
for
the
record
so
like
we
said
that
we
are
not
doulas
are
not
medical
professionals,
and
so
it
is
strictly
out
of
scope
for
us
to
be
doing
anything
like
urinalysis
for
proteins
assessing
for
signs
of
preeclampsia.
We
don't
we
don't.
You
know,
do
blood
pressure,
we
don't
do
cervical
checks.
No
medical
tests
are
within
our
role.
It's
really
about
the
emotional
support.
It's
about
providing
resources
and
referrals
to
extra
care.
I
So,
for
example,
if
we
notice
a
client
reporting
to
us
signs
that
could
be,
you
know
like
swelling
in
their
legs
or
feeling
headaches
or
dizzy.
We
might
say
you
need
to
call
your
provider.
This
is
something
that's
potentially
risky
and
you
need
to
assess
with
your
provider,
and
so
that's
a
little
bit
about
our
scope
of
practice.
It's
it's
strictly.
Without
out
of
our
scope
of
practice,
I
will
say
as
far
as
liability
and
coverage
is
that
many
doulas
do
carry
their
own
professional
liability
coverage.
I
Cmf
is
a
common
company
that
offers
coverage
for
doulas
independently,
and
that
has
more
to
do
with
things
like
you
know.
If
they
come
to
our
office
space
for
a
prenatal,
you
know
and
they
trip
and
fall
like
you
know
those
kinds
of
things,
but
it's
still
not
about
you
know:
medical
birth
outcomes.
I
hope
that
clarifies.
J
Women
titus,
so
thank
you.
So
that
brings
up
another
question.
So
I
appreciate
that
and
thank
you
again
coaching
and
having
somebody
made
my
life
easier.
If
somebody
was
with
the
person
in
labor
to
to
coach
them
and
had
that
always
recommended
couples,
go
get
some
education
and
birthing
classes
and
all
that
and
having
somebody
by
your
side,
whether
it's
your
best
friend
your
mom,
your
auntie,
whatever
is
always
great,
but
then,
when
you
start
hiring
somebody,
that's
now
a
professional
coach.
That's
where
that
that's.
E
H
Yeah,
I
actually,
when
anthem
sponsored
us
to
provide
doula
coverage
for
the
50
of
50
of
their
members.
I
actually
realized
we
had
a
gap
in
our
code
of
conduct,
and
so
I
put
together
and
I
can
actually
share
my
screen.
H
H
We
are
not
mandated
reporters,
but
again
reporting
is
important
and
then
further
down
here,
expectations
of
conduct,
so
we're
reminding
all
of
our
doulas
that
we're
not
medical
professionals.
We
are
not
to
perform
medical
tasks
and
even
beyond
that,
if
there
is
an
emergency,
we
are
responsible
for
calling
911..
So
if
any
doula
in
our
association
were
to
act
outside
of
this,
we
have
now
processes
to
expel
them
from
our
association.
H
I
would
hope
that
other
doula
associations,
with
the
reputation
similar
to
what
rdp
has
would
follow
a
similar
course
of
making
these
very
clear
writing
these
out,
and
it
wouldn't
surprise
me
if
under
medicaid,
if
we
are
a
covered
service,
this
would
be
required
for
more
doulas
to
have
agreements
with
associations
and
and
with
medicaid
themselves.
L
Thank
you
chair
and
thank
you
so
much
for
bringing
this
bill.
I
cannot
tell
you
over
the
last
eight
years
as
I
had
my
three
children
and
watched
my
friends
have
their
children
how
important
this
service
doula
services
were
to
the
well-being
of
the
moms.
In
those
cases,
not
everybody
has
a
great
relationship
with
their
mom
or
their
sister
or
their
aunt,
or
even
has
them
left,
and
sometimes
you
just
need
that
support.
I
know
it
was
invaluable
for
me.
L
I
have
my
sister
in
my
case,
but
I
don't
know
what
I
would
have
done
without
that
support
in
my
three
births.
My
question
has
to
do
with
with
the
kind
of
training
standards
that
already
exist.
Doulas
go
through
a
process
of
learning
how
to
be
effective
in
the
space
that
they
offer
services
in.
So
can
you
talk
a
little
bit
about
what
those
training
standards
look
like
look
like
and
what
the
breadth
of
service
that
doulas
use
or
are
are
hired
for,
can
look
like.
E
H
H
So
it's
a
multi-day
workshop
where
we
talk
about
what
to
cover
during
prenatals
how
to
stay
within
scope
of
practice
during
labor
how
to
act
and
conduct
yourself
in
it
during
hospital,
birth
and
during
a
home
birth,
also
knowing
that
we're
not
doing
unassisted
birth,
so
there's
always
a
medical
professional
there
and
then
also
going
over
red
flags
for
postpartum.
H
When
doulas
first
came
about
in
the
united
states
again,
it
was
very
historically
for
the
white
and
privileged,
and
so
newer
associations
have
created
trainings
that
cover
racial
disparities,
their
trainings
by
black
women
for
black
women
and
other
women
of
color,
and
so
now
there
are
even
more
trainings
available.
H
So
it
would
be
hard
to
say
only
one
training,
or
only
these
trainings
are
acceptable.
Certification
is
similar
so
because
doulas
are
not
regulated,
there's
no
way
to
know
what
a
certification
truly
means
so
again
making
sure
that
whatever
training
associate
association,
a
doula
is
in
at
least
cover
scope
of
practice
and
at
least
covers
certain
aspects
would
be
more
important
than
making
sure
that
each
individual
doula
is
certified
or
making
sure
that
the
trainings
themselves
are
regulated.
H
L
That
that's
really
important
to
talk
about
is
that
not
every
person
means
exactly
the
same
thing
and
it's
not
like
a
math
equation.
It
is
really
about
those
personal
relationships
interviewing
your
provider
for
that
service.
Just
like
any
other
service
that
you
would
ask
for
in
the
spectrum
of
your
life,
you
know
it's
not
a
one.
Size
fits
all
for
everybody
and
I
think
that
that's
really
valuable
to
have
in
the
community.
L
H
Sure
so,
a
typical
model
of
care
would
be
two
prenatal
appointments,
not
including
the
interview
so
an
interview,
two
prenatal
appointments,
the
birth
itself
and
then
one
postpartum
visit
and
it's
one
postpartum
visit
to
a
minimum.
You
can
of
course,
add
more.
The
postpartum
visit
typically
happens
about
a
week,
or
hopefully,
two
weeks
after
after
the
birth,
because
doulas
are
not
medically
trained,
and
some
of
us
are
lactation
professionals,
but
we're
not
all
lactation
professionals,
again
we're
trained
to
notice
red
flags
and
to
refer
out
so
a
lot
of
times
that
friendship.
H
That
relationship
that
you
create
with
your
doula
has
them
checking
in
on
the
mom,
more
often
via
text
message
or
phone
conversations,
but
depending
on
if
what
the
mom
wants.
Typically,
it
is
one
postnatal
visit
which
happens
usually
before
the
postnatal
visit
with
the
obstetrician.
L
So
I
think,
what's
important
about
this
conversation
is
that
the
that
doulas
provide
a
unique
and
individualized
service
to
people
depending
on
what
they
need
to
to
expecting
parents
depending
on
what
they
need,
and
that
can
be
a
wraparound
service.
That's
complementary
to
the
medical,
health
and
medical
providers,
services
that
are
also
regulated
and
taken
into
account
and
paid
for
through
insurance
processes.
During
that
birthing
process,
I
think
that's!
That's
really
important.
L
One
of
the
pieces
that
we,
you
know
are
are
kind
of
just
starting
to
fully
acknowledge
in
the
birthing
community
is
the
importance
of
mental
health,
postnatal
mental
health
of
moms
and
of
the
other
parents,
and
and
without
somebody
who
can
identify
that
or
is
trained
to
identify
that
it
really
leaves
our
populations
vulnerable
to
those
unexpected
like
senses
of
depression
that
I
I
know
from
experience
you
don't
always
see
from
the
inside.
G
I
think
I
I
thank
you.
I
appreciate
this
and
I
have
to
admit
that
I'm
really
naive
as
to
what
a
doula
is
and
what
they
do,
and
so
I
really
appreciate
this.
This
is
really
informational
for
me,
I'm
learning
a
lot,
so
I
guess
I
think
I
heard
it
said
that
right
now,
doulas
exist
and
that
there's
a
certification
process
for
them.
So
I
I
guess,
does
the
I'm
assuming
then
that
the
the
the
community
self
regulates
and
the
community
self
identifies.
Is
that
how
that
is
right
now.
H
Alex
yeah,
I
would
say
we
we
do
self-regulate
and
it's
fairly
important
to
self-regulate,
because
we
can
be
as
individuals
kicked
out
of
a
hospital
and
and
said,
do
not
come
back
as
a
doula,
and
we
could
also
negatively
impact
the
reputation
of
the
association
we're
under.
So
again
we
don't
want
any
doulas
from
your
association
because
you
break
rules,
you
do
xyz,
so
it
is
very
important
that
we
are
recognized
as
professionals
and
to
not
overstep.
H
You
know,
of
course,
if
we
were
to
to
try
to
do
a
medical
procedure,
try
to
assess
cervical
dilation
tell
the
doctor
they're
wrong
or
to
stop
in
the
middle
of
a
medical
procedure.
We
could
be
trespassed
from
the
hospital
and
asked
to
leave.
So
we
are
very
self-regulating
to
make
sure
that
we
don't
ruin
the
reputation
of
those
who
are
trying
to
do
very
important
work.
G
Yes,
okay
as
a
follow-up
question,
then,
if
it's
okay,
madame
chairwoman,
I
was
gonna,
ask
so
like,
for
example,
I'm
a
a
licensed
social
worker,
and
this
isn't
calling
for
licensing
it's
calling
for
registration,
but
for
most
folks,
where
you
would
you'd
have
licensure
you're
not
allowed
to
represent
yourself
as
being
a
member
of
the
profession
unless
you
were
licensed
such
so,
regardless
of
your
education
or
you
know
your
master's
degree
or
your
trainings,
and
something
unless
you're
licensed.
G
H
I
I
can
see
a
situation
where
being
a
registered
doula
will
be
very
important,
but
in
terms
of
a
certified
doula
that
really
depends
on
the
educational
body
you
attended,
so
there's
a
lot
of
for
some
associations.
There's
fees,
yearly
fees,
certain
follow-up,
continuing
education,
that,
for
some
women,
especially
lower
income,
women,
who
are
trying
to
make
their
living
as
a
doula,
can
can
be
prohibitory
in
remaining
a
certified
doula.
H
I
personally
never
certified
as
a
birth
doula,
and
I
consider
myself
to
still
be
an
expert
in
this
area,
so
having
registered
doulas
within
the
state
of
nevada,
so
that
we
can
get
reimbursement
from
medicaid
sounds
completely
reasonable,
but
in
terms
of
requiring
certification
from
the
many
different
training
bodies,
I
think
that
that
is
because
we're
not
regulated
like
a
social
worker
like
a
clinical
psychologist
it
it
does
not
look
the
same
way.
So
I
don't
think
it
would
have
the
same
effects.
F
And
madam
chair,
I
could
just
jump
into
piggyback,
I'm
sorry!
I
don't
need
to
interrupt
simply
from
the
benitez
thomas.
I'm
sorry.
F
L
I'm
sorry
chair
and
clinton
I'm
having
a
really
hard
time,
understanding
what
you're
saying
I
don't
know
if
it's
the
microphone
or
I'm
just
like
missing
most
of
what
you
said:
okay,.
E
F
Okay:
let's
try
this
now
quentin
savoie
for
the
record:
okay,
fantastic!
I
just
wanted
to
be
very
clear
about
the
language
that
we're
using
that
we
are
as
part
of
the
registration.
What
we're
saying
is
that
we
want
doulas
in
the
state
to
provide
training
and
they
want
them
to
provide
documentation
of
training
and
the
training
that
alex
described
the
multi-day
training,
where
they
are
taught
how
to
identify
things
that
would
need
to
be
escalated
to
a
medical
professional.
But
again,
this
is
a
non-medical
role.
F
That's
providing
education,
advocacy,
emotional
support
and
all
things
that
we
would
be
doing
for
our
friends
for
our
family,
just
in
a
dynamic
where
you
are
having
to
coach
an
expected
parent
or
mother
through
their
pregnancy
process.
I
just
wanted
to
be
very
clear
about
the
language
that
we're
using
as
to
not
confuse
the
intention
of
the
bill.
E
And
madam
chair,
if
I
might
just
interject
another
personal
story,
I
had
my
last
child
in
a
hospital
setting
with
folks
who
were
certified
and
registered
and
had
all
the
everything
surrounding
had
a
standard
usa,
birth
and
my
youngest
son
was
born
healthy.
We
thought,
and
those
folks
who
were
certified
and
trained
were
supposed
to
take
care
of
me
and
him
set
us
up
in
a
room
that
was
freezing
cold
and
he
ended
up
in
under
a
heat
lamp
for
six
days
because
he
got
hypothermia.
E
This
is
a
support
person
for
the
mom
she's,
not
a
medical,
professional
and-
and
we
don't
see
anywhere
any
need
for
her
to
be
he
or
she
to
be
certified,
but
registered
some
type
of
process
set
up
so
that
there
is
training
that
is
both
culturally
competent
that
it
that
completely
covers
the
scope
of
what
we
want
birth
doulas
to
do.
E
G
And
I
thank
my
questions,
probably
from
miss
gunter,
you
were
talking
about
something
about
doulas
being
able
to
help
with
diagnosing
postpartum
or
mental
health.
Can
you
expand.
H
Sure
so
again,
we're
not
qualified
to
give
an
assessment,
but
we
can
point
women
into
the
direction
of
assessments.
So
there's
a
few
different
like
the
edenberg
postpartum
depression
scale,
for
example.
We
can
say
why
don't
you
fill
this
out?
If
you
you
know
test
in
a
particular
way,
it
might
be
important
to
have
a
conversation
with
your
provider
about
this.
We
are
trained
to
recognize
different
types
of
perinatal
mental
health
issues,
and
so,
if
we
do
notice
something
we
are
also
able
to
to
point
out.
H
You
know
this:
isn't
this
isn't
necessarily
normal?
Do
you
think
you
need
help
in
this
area
or
do
you
think
perhaps
getting
in
touch
with
a
therapist
or
getting
some
group
therapy?
Some
support
circles
could
help
you
in
this
area,
so
again
we're
being
very
careful
in
our
language.
When
we
speak
to
moms
to
not
diagnose,
to
not
say
it
seems,
like
you
have
depression,
we
can
say
you
know
this
isn't
not
necessarily
normal
postpartum
depression
is
something
that
could
be
happening
in
the
situation.
H
A
I
see
ms
lauren
has
also
unmuted
go
ahead.
If
you
have
an
answer
to
that
question
as
well.
I
Yeah
I'd
be
happy
to
speak
to
that.
That
is
the
exact
intersection
of
a
lot
of
my
work,
because
I
am
a
clinical
social
work
intern.
So
I
work
as
a
perinatal
psychotherapist,
treating
clients
with
perinatal
mood
and
anxiety
disorders,
anxiety,
depression
and
also
I
work
as
a
doula,
and
so
the
way
that
I
might
describe
the
difference
between
the
two
is
that
they're
not
dying
they're,
not
diagnosing,
but
they're,
noticing,
red
flags
and
the
beauty
of
a
doula
is
that
they're
oftentimes
in
the
home
oftentimes.
I
We've
done
a
lot
of
work
recently
with
thrive
wellness,
particularly
in
establishing
really
strong
and
swift
referral
systems
between
doulas,
between
rdtp
and
breithart
and
other
doulas
in
the
area
with
our
mental
health
providers.
And
so,
for
example,
you
know
if
we
see
something
escalating
quite
quickly
or
if
the
doulas
see
something
escalating
quite
quickly,
they
can
reach
out
and
say
you
know,
we
need
some
intervention,
some
mental
health
intervention
swiftly.
I
You
know,
20
20
of
people,
will
experience
a
prenatal
mood
and
anxiety
disorder
and
that's
quite
underreported,
so
the
quicker
we
can
get
into
care
the
better
chance.
We
have
at
intervening
to
protect
the
bonding
and
attachment
experience
between
parents
and
children,
because
that
is
so
crucial
and
can
kind
of
escalate
very
swiftly
into
the
number
of
ace.
You
know
first,
childhood
experiences
that
we
see
related
to
untreated
perinatal
mood
and
anxiety
disorders.
E
Thank
you,
assemblywoman
krasner
lauren.
Would
you
please
you've
worked
both
here
and
in
new
york
in
this
space?
Would
you
please
speak
to
the
scope
of
of
training
that
you've
seen
in
both
locales?
Thank
you.
I
Sure
I'd
be
happy
to
thank
you
so
as
far
as
the
scope
of
training
topics
that
are
generally
covered
as
sort
of
standard
practice,
so,
for
example,
donut
international
is
one
of
the
largest
gula
training
organizations
in
the
country.
It's
one
that
oftentimes
doesn't
have.
I
You
know
I've
done
some
research
on
it
in
the
last
few
years,
and
one
of
the
downsides
of
an
organization
like
that
is
that
it
oftentimes
doesn't
have
the
culturally
humble
lens
and
the
culturally
sensitive
lens
that
is
so
rooted
in
community
issues,
particularly
in
terms
of
the
maternal
mortality
crisis
for
women
of
color.
Things
like
that,
but
just
because
there's
sort
of
like
differences
and
topics
reflected
in
the
different
training
orgs.
For
example,
in
new
york,
I
trained
under
the
org
called
ancient
song.
I
Doula
services
ancient
song
covered
all
of
the
same
things
as
a
donut
international,
so
things
like
comfort
measures,
things
like
positions
of
the
baby
and
uterus
things
like
education,
about
common
common
scenarios
in
labor
and
helping
people
think
through
what
their
birth
preferences
would
be.
You
know
basics
of
breastfeeding
things
like
that
and
then
in.
I
You
know
more
and
so
part
of
the
specifics
about
kind
of
some
states
trying
to
not
like
narrow
in
and
saying
like.
We
need
you
to
certify
under
this
one
doula
training
organization.
Is
that
sometimes
there's
a
risk
of
not
meeting
the
whole
needs
of
the
community,
and
I
think
that's
what
folks
were
kind
of
speaking
to
earlier.
I
As
far
as
the
piece
around
referring
like
the
risk
of
like
referring
someone
who
doesn't
might
not
actually
have
a
perinatal
mood
and
anxiety
disorder,
I
think
I
would
just
it's
about
preventative
care
in
a
lot
of
ways
too,
and
so
it's
not
it's
not
there's
actually
not
a
detriment
in
the
way
that
I
see
it
as
a
mental
health
care
professional
that,
if
someone's
getting
to
us
part
of
what
our
job
is
to
do
the
assessment.
You
know
it's
not
the
doula's
job.
It's
our
job
to
say:
do
you
need
case
management
services?
I
Do
you
need
wic?
Do
you
need
you
know,
outpatient
therapy?
Do
you
need
intense
outpatient
therapy,
that's
sort
of
with
our
scope
of
practice
as
a
mental
health
professional,
and
we
welcome
people
getting
them
to
us,
even
if
the
person
actually
isn't
sort
of
in
a
full-blown
perinatal
mood
and
anxiety
disorder
stage?
If
that
makes
sense.
E
Excuse
me,
thank
you,
madam
chair,
and
an
assemblywoman
krasner
she's
speaking
about
her
role
as
a
social
worker
being
able
to
do
the
diagnosis,
that's
her
role,
she's
interested
in
and
and
encouraging
the
role
that
the
doula,
who
has
a
relationship
with
that
mom
to
be
able
to
see
that
there
are
issues
that
may
need
to
be
addressed
and
to
have
that
relationship
built
that
she
can
move
her
into
the
space
of
a
healthcare
professional
to
get
them
what
they
want.
What
they
need.
I
mean.
E
I
think
we
also
need
to
remember
too
that
when
we
were
talking
about
the
scope
of
the
doula
service,
that
doula
is
going
to
see
that
mom
within
the
first
or
second
week
after
the
baby
is
born.
Generally
speaking,
the
post
birth
appointment
with
the
doctor
is
weeks
out,
and
many
things
could
happen
as
far
as
mental
health
or
any
other
situation
in
between
there
and
that
doula
has
access
to
that
mom.
They
have
a
relationship
that
doula
can
assess.
E
Just
you
know
the
differences
they
have,
that
type
of
core
training
and
and
now
move
that
mom
along
to
a
professional
so
that
they
can
intervene
before
it
becomes
a
crisis.
So
thank
you
for
the
question
and-
and
I
really
appreciate
that.
A
G
Thank
you,
madam
chair,
and
hopefully
my
question
will
be
brief.
I
think
we've
had
a
really
good
discussion
this
afternoon.
In
I
know
it
was
stated
that
there's
approximately
two
dozen
other
states
that
are
doing
this
reimbursement-
and
you
may
not
have
this,
but
if
you
don't,
could
you
provide
us
with
a
breakdown
of
which
states
are
requiring
the
register
doula
versus
the
certified
doula?
G
E
F
Add
quentin
sabot
for
the
record,
darwin,
I'm
sorry
through
you,
chair,
ran
to
assemblyman
haven.
I'm
we're
happy
to
follow
up
with
the
entire
committee
with
the
information
that
you
requested
assemblyman.
I
want
to
clarify,
though,
that
the
we're
using
a
lot
of
terms-
and
I
don't
want
the
intention
of
the
legislation
to
the
registration
that
we're
discussing
is
for
the
purposes
of
the
nevada
state
medicaid
office
for
purposes
of
accountability,
of
how
the
funds
are
being
spent.
F
Okay,
so
registration,
as
used
with
this
legislation,
is
just
talking
about
registering
with
the
office
of
medicaid
with
within
dhhs.
Other
states
have
set
forth
other
provisions
that
have
required
us
to
be
certified
or
licensed.
That
is
not
what
we
are
proposing.
There
has
been
litany
of
research
that
has
proved
that
when
you
create
additional
barriers
to
entry,
it
does
lack
cultural
competency
and
the
trainings
associated
to
help
black
and
brown
women
and
native
women.
It
proves
that
consistently
across
all
of
the
studies.
So
again,
I'm
happy
to
research
and
follow
up
with
the
committee.
G
I
just
want
to
make
sure
that
my
question
is
very
clear:
in
section
one
subsection
one,
we
are
actually
directing
the
director
to
address
the
registered
doulas,
and
so
in
there
it's
very
specific
that
this
is
for
the
registered
doulas.
And
so
my
question
is:
what
are
other
states
doing?
Are
they
doing
the
registered
doula
or
are
they
doing
the
certified
doula
and
that's
the
information
that
I'm
I'm
requesting?
And
so
thank
you,
madam
chair,
for
the
follow-up
and
the
clarification
on
my
question.
A
Thank
you
and
I'm
sure,
assemblywoman
summers.
Armstrong
will
get
that
information
to
patrick
ashton,
our
committee
policy
analyst
and
he
will
distribute
to
the
rest
of
the
committee
and,
lastly,
I'm
going
to
go
to
vice
chair
peters.
Before
we
get
started
with
testimony
and
support
opposition
in
neutral.
L
Thank
you
chair.
I
really
appreciate
this
conversation
and
discussion
around
the
variety
of
of
services
doulas
provide
and
how
that
functions.
I
do
think,
though,
that
it's
really
important
to
acknowledge
that
doulas
are
hired
to
focus
on
the
mom
and
everyone
else
is
focused
on
the
baby
right.
When
you
give
birth,
your
obstetrician
is
focused
on
the
baby's
health
and
your
body's
health
they're
focused
on
your
need
to
go
to
a
pediatrician
they're
focused
on
the
baby's
health.
L
No
there's
nobody
who
is
exclusively
there
to
focus
on
the
mom's
well-being,
and
I
know
as
a
mother
of
three
kids,
I
was
never
asked
in
the
first
three
days
after
my
babies
were
born.
How
are
you
doing?
It
was
always
about
the
baby
and
having
a
doula
who
is
specifically
there
hired
by
the
mom
to
support
her
and
those
those
traumatic,
sometimes
and
vulnerable
moments
is
so
important
for
the
for
the
health
and
well-being
of
both
mom
and
baby
in
the
long
run.
So
I
just
want.
A
Thank
you,
mr
peters.
At
this
time
I'm
going
to
end
questioning
and
we
are
going
to
hear
testimony
and
support
opposition
and
neutral
of
assembly
bill
256.
I
would
remind
our
callers
to
please
clearly
state
and
spell
your
name
for
the
record
and
please
limit
your
testimony
to
two
minutes.
Again.
Staff
will
be
timing,
each
speaker
to
ensure
everyone
is
given
a
fair
opportunity
to
speak,
and
so
at
this
time
broadcast
services.
If
we
will
begin
testimony
in
support
of
assembly
bill
256.
M
M
K
K
I
am
also
a
black
mother
of
five
children
who
have
had
double
traumatic
pregnancies
and
birthing
experiences
due
to
the
lack
of
education.
Empathy
during
the
birthing
process
and
care
that
I
have
should
should
have
received
during
and
after
pregnancy,
lying
on
a
table
to
give
birth
to
a
precious
life
can
be
mentally
daunting.
When
thoughts
include,
will
I
live
and
will
my
child
live
alongside
the
emotional
and
mental
abuse
to
endure,
while
being
threatened
by
a
white
male
doctor.
C
K
On
the
table
with
a
cesarean
section
is
told
if
I
don't
hurry
and
push
the
baby
out
soon
after
two
hours
of
me
pushing
and
only
receiving
comfort
from
the
nurse
on
duty,
my
fiance
and
mother,
had
I
had
a
doula.
This
most
likely
would
have
gone
a
different
way.
Ab256
is
about
our
mothers
and
their
children
and
ensuring
they
have
a
wholesome
and
healthy
start
in
their
life.
Doulas
play
an
essential
role
in
providing
care,
support
and
advocacy
to
mothers
and
birth
parents
before,
during
and
after
the
pregnancy.
K
My
personal
experiences
often
left
me
advocating
for
myself,
even
during
the
most
difficult
part
of
the
process,
to
push
and
deliver
the
baby.
As
you
can
imagine,
during
that
time,
one
is
extremely
exhausted
and
filled
with
anxiety.
Statistics.
Statistics
show
that
preterm
birth
rates
for
black
women
are
especially
higher
than
that
of
their
white.
M
Collar
you
seem
to
have
pressed
the
mute
button
on
your
phone
you're
clear
on
our
end,
but
we
can't
hear
you
anymore
hello.
We
can
hear
you.
Okay,
thank.
K
You
ab256
is
the
start
of
improving
birth
outcomes
for
mothers
and
birth
parents
in
nevada.
This
bill
is
community
driven
public
policy
that
tackles
the
racial
and
reproductive
injustices
that
black
women
and
other
communities
of
color
face
in
states
that
have
passed.
Legislation
similar
to
ab256
they've
shown
cost
savings
to
the
state
by
reducing
the
amount
to
c-section
birth
as
well
as
birth,
parents
reported
improved
birth
outcomes
and
overall
experiences
in
conclusion,
again
as
a
black
mother.
First
and
foremost,
I
urge
the
committee
to
support
and
pass
ab256.
M
C
C
My
first
birth
ended
in
a
cesarean
section,
because
I
did
not
know
what
my
rights
were
as
a
patient,
and
I
did
not
know
what
to
expect
in
labor
those
two
factors
not
only
led
to
my
caesarean
birth,
but
also
led
to
massive
struggles
in
breastfeeding,
postpartum
depression
and
thick
scar,
adhesions
growing
in
my
abdomen,
that
need
to
be
scraped
out
in
a
major
abdominal
surgery
where,
before
they
grow
to
the
point
of
cutting
off
circulation.
To
my
organs,
medicaid
will
be
covering
that
surgery.
C
I
became
a
doula
because
if
I
had
a
doula
support
during
my
first
birth,
I
would
have
been
able
to
avoid
the
multiple
costly
health
issues
that
were
born
from
my
ignorance
in
the
labor
process.
Doulas
provide
that
information
as
one
of
the
core
competencies
of
our
work.
My
story
is
not
unique.
The
informational,
physical
and
emotional
support
that
we
are
trained
to
provide
statistically
improve
birth
outcomes,
mental
health
and
save
money.
C
Considering
the
abysmal
statistics
america
has
in
maternal
and
infant
mortality,
providing
doula
support
for
families
makes
sense
both
morally
and
economically
on
behalf
of
struggling
new
parents
too
overwhelmed
to
testify
for
all
the
parents
who
are
mourning
the
loss
of
their
babies
and
for
the
babies
who
are
mourning
the
loss
of
their
parents.
I
implore
you
to
please
vote
yes
on
ab256.
M
K
As
a
mother
of
six,
I
had
do
love
with
my
last
child.
Doodles
are
not
only
important
for
to
be
part
of
just
the
healthcare
system,
but
also
a
part
of
the
child's
life
as
well.
My
my
sick,
my
last
child,
which
is
my
one-year-old.
We
had
to
do
it
throughout
our
pregnancy
and
I
received
very
good
care
and
because
of
my
doula,
I
was
able
to
fully
recover.
My
baby
was
very
healthy.
K
This
was
are
effective
and
effective
part
of
the
health
care
system.
The
cultural
competence
of
doulas
are
to
provide
support
and
care
to
provide.
You
know
doing
the
birth
and
outcome
of
women.
The
data
showed
that
doulas
assisted
mothers
throughout.
You
know
four
times
more
likely
to
have
low
birth
weight
babies
two
times
less
likely
to
experience
birth
complications
involving
themselves
and
their
babies
less
likely
to
receive
cesarean
sections,
and
you
know
it
just
helps
with
the
breastfeeding
process
as
well.
K
They
are
there
to
support
and
with
my
sixth
child,
I
was
able
to
have
that
support
and
with
my
seventh
I
plan
on
having
the
support
as
well.
Medicaid
coverage
for
doulas
will
ensure
that
the
future
nevada-
you
know
future
nevadans,
regardless
of
their
family's
economic
status,
are
born
with
the
best
possible
outcomes,
and
we,
you
know,
I
encourage
you
to
support
senior
bill
256.
M
K
K
If
I
had
that
support,
then
I
think
that
I
would
have
known
what
questions
that
I
could
have
asked.
They
would
have
been
able
to
recognize
things
that
were
not
correct
and
I
also
had
an
issue
with
my
three-year-old.
K
I
did
not
receive
any
postpartum
care
here
in
nevada
and
I
was
I
was
distressed
and
I
wasn't
able
to
care
for
my
child.
I
was
threatened
with
my
kids
being
removed
from
my
home
because
I
wasn't
able
to
properly
care
for
them,
because
my
mental
capacity
was
not
where
I
needed
to
be
after
reaching
out
to
my
health
care
providers
multiple
times
asking
for
a
prenatal
appointment
with
them,
responding
that
they
were
simply
overbooked
had
a
doula
been
available.
K
M
If
you
have
recently
joined
the
call
and
would
like
to
to
testify
in
support
of
assembly
bill
256,
please
press
star
9
now
to
join
the
queue.
M
C
Hello,
my
name
is
tara.
Raines
t-a-r-a
reigns
r-a-I-n-e-s.
Thank
you
so
much
for
the
opportunity
to
speak
in
support
of
ab256,
I'm
speaking
first.
In
my
capacity
as
a
black
mother,
I
was
fortunate
to
be
able
to
afford
doula
care
when
delivering
my
daughters,
given
what
I
knew
about
the
black
maternal
health
crisis
and
the
outcomes.
It
was
important
to
me
that
a
black
woman
was
present
at
my
birth
to
advocate
on
my
behalf.
For
me,
her
support
was
invaluable.
C
C
After
my
birth,
my
julie
came
to
the
home
to
help
us
the
task,
ranging
from
prepping
meals
to
swaddling
the
baby,
to
helping
me
figure
out
how
to
use
the
new
moby
wrap
carrier
that
I
really
struggled
with
in
those
early
days.
This
this
support
should
be
available
to
every
birthing
person
who
wants
it.
The
presence
we
know
of
doulas
reduces
mental
health
crises
after
birth
and
it
increases
breastfeeding,
which
is
important
both
to
bonding,
but
also
has
long-term
nutrition
and
health
outcomes.
C
M
C
E-H-E-R-N-A-N-D-E-Z
and
I'm
here
in
support
of
ab256
I've
been
a
birth
worker
doula
since
2016
in
las
vegas.
During
my
tenure,
I've
seen
the
impact
duelists
provide.
Just
last
year,
a
local
group
of
us
were
able
to
provide
dual
services
via
grant
funding
to
victim
survivors
of
sexual
assault
and
domestic
violence.
We
were
able
to
see
firsthand
what
we
already
knew.
Then
it
made
a
significant
difference
on
the
birth
experiences
and
during
the
postpartum
process.
C
For
our
clients
having
a
doula
is
not
a
luxury,
it
is
a
necessity
and
one
that
all
birthing
people
should
have
access
to.
In
closing,
I
also
ask
that
you
ensure
you
pay
doulas
a
living
wage
and
make
language
inclusive
of
all
birthing
people,
since
not
all
birthing
people
identify
as
women.
Thank
you,
and
I
hope
you
pass
this
day.
M
K
L
K
Old,
I
myself
had
a
doula,
but
I
know
the
importance
of
needing
a
doula,
because
I
know
people
who
didn't
have
it
and
on
my
journey
of
learning
about
what
it
is
to
be
a
mother
to
have
a
child
everything
that
you
need
to
know
before
the
baby
comes.
My
doula
was
able
to
help
me
with
that.
I
was
able
to
take
classes.
K
I
was
able
to
learn
about
the
truths
and
the
myths
about
labor
about
birth,
about
you
know
about
the
child,
about
the
expectancy
of
the
baby
and
what
is
to
come,
and
I
feel
like
it's
very
important.
I
know
that
with
my
first
child
we
had
a
lot
of
I
had
pre-eclampsia,
so
I
had
to
have
a
emergency
c-section
and
it
was
very
scary,
and
if
I
didn't
have
my
dealer
there
to
explain
what
preeclampsia
was
and
exactly
and
make
me
feel
better,
my
doctors
were
very
just
straightforward.
K
They
didn't
care
emotionally
about
me
and
how
I
was
going
to
take
the
news,
because
I
had
a
birth
plan
because
I
assumed
my
pregnancy
would
go
the
way
I
wanted
to
go
and
I
was
planning
for
a
particular
way.
My
doula
was
the
only
person
who
was
able
to
make
me
understand
what
was
the
safe
safest
for
myself
and
for
my
child
why
it
was
the
safest
for
myself
and
my
child.
They
gave
me
the
information
that
I
needed
to
educate
me
about
what
exactly
I
was
going
through
and
what
I
needed
to
do.
K
I
know
that
I
was
working
to
have
a
home
birth
with
my
son
and
I
didn't
get
to
have
that
homework,
so
I
paid
for,
I
was,
you
know,
blessed
enough
to
be
able
to
pay
for
all
of
the
midwifery
clinic
needs,
and
then,
when
I
went
to
the
hospital
I
wasn't
treated
as
a
patient
of
the
hospital,
because
I
didn't
have
a
specific
doctor.
I
was
using
the
doctor
that
was
assigned
to
me
through
that
hospital.
C
K
Okay,
no
problem:
I
just
think
it's
very
important
to
have
a
doula
because
they
are
able
to
help.
You
learn
the
things
that
you
don't
know
and
the
things
you
need
to
know
to
be
comfortable
and
just
for
your
own
mental
health.
Thank
you.
A
Thank
you,
and
at
this
time
we've
been
going
for
15
minutes
and
I
want
to
make
sure
I
allocate
enough
time
for
neutral
and
opposition
testimony
if
you
are
still
on
the
line,
and
you
want
to
present
written
testimony
in
support
of
this
bill.
Please
do
so
in
writing.
You
can
do
so
up
to
48
hours
after
the
conclusion
of
this
hearing,
and
I
would
encourage
you
to
do
that.
A
A
M
C
Decreased
use
of
pain,
relief
medications,
increased
breast
breathing
rates.
So
all
of
these
outcomes
help
improve
health
care
outcomes,
lower
health
care
costs,
increase
quality
of
care
and
even
reduce
health
care
disparities,
so
nevada,
medicaid
utilized
many
doula
studies
and
the
cost
savings
to
medicaid
programs
and
reviewing
all
of
these.
Our
analysis
used
the
cost,
saving
methodologies
in
any
studies,
to
determine
that
there
would
be
a
cost
savings
to
nevada
medicaid
if
we
reimburse
doulas
for
their
services.
C
So
overall,
I'm
just
really
pleased
to
say
that
are
now
that
our
analysis
resulted
in
a
cost
savings
of
over
1.2
million
dollars.
So
that
includes
the
medical
side
of
our
savings
and
then
also
our
system.
Cost
is
like
having
to
create
maybe
a
new
provider
type
and
mapping
codes,
but
overall
it
would
be
a
cost
savings.
C
C
That
would
be
billed
so,
even
though
we
have
not
developed
the
policy
and
cpt
codes
to
be
billed
like
other
states
like
oregon,
who
have
doulas,
they
have
them,
build
their
medicaid
program
based
upon
the
type
of
delivery
so
like
whether
it
was
the
vaginal
delivery
vaginal
which
turned
into
a
cesarean
or
vaginal.
After
previous
cesarean,
all
of
those
have
different
cpt
codes,
and
that
would
allow
like
that
medicaid
program
to
tie
the
doula
to
that
type
of
birth
that
actually
occurred.
C
So
even
though
it
would
have
the
same
type
of
reimbursement,
it
helps
tie
the
the
service
provided
to
the
outcome.
So
overall
that
ends
my
testimony
in
neutral
for
the
division
for
ab256.
A
And
miss
lynch
can
I
go
ahead
and
have
you
stay
on
the
line?
I
know
that
you
were
there
to
provide
neutral
testimony
cost
neutral.
Actually
it
seems
like
cost
savings
pretty
substantially.
Yet
I
know
that
there
have
been
questions
from
committee
members
regarding
that.
Does
anyone
have
any
follow-up
questions
for
her
for
miss
lynch,
since
she
obviously
may
have
some
of
those
answers
or
it
sounds
like
she
may
have
answered
some
of
that
in
her
neutral
testimony.
J
You
just
testified
that
you
are
estimating
a
1.2
million
dollar
savings
based
on
national
data,
or
are
you
using
nevada
data
because
we
already
have
doulas
here?
J
Do
you
have
any
studies
done
in
the
state
of
nevada
so
relevant
to
our
state,
because
we
have
sounds
like
we
have
a
significant
population
of
duels
already
that
are
involved
in
the
process.
So
have
you
any
data
related
to
nevada
on
cost
savings?
Number
one
and
number
two:
do
you
have
a
fixed
number
on
what
you
would
pay
a
a
dollar?
It
sounds
to
me
like
if
they
had
bad
outcomes,
they'd
get
paid
more
like
if
they
ended
up
with
a
c-section
you're
now
going
to
stratify
that
and
pay
them
more.
C
Thank
you
for
the
question.
This
is
aaron
lynch
for
the
record,
and
so
we
looked
at
national
studies
on
medicaid
and
then
applied
those
cost
savings
using
nevada,
medicaid
data.
C
So
if
it
said
that
the
national
study
helped
reduce
medicaid
costs
by
like
1500
per
birth,
then
we
applied
that
to
the
number
of
births
that
occur
in
nevada.
Also,
national
studies
say
that
only
about
six
percent
of
births
are
attended
by
doulas.
So
again
we
applied
that
type
of
percentage
too.
So
it's
kind
of
like
both
we're
using
national
studies
and
then
applying
it
to
nevada,
medicaid
data.
J
So
now
I
hate
to
play
with
this,
but
now
you're
bringing
up
another
question
was
this
studies
done,
and
maybe
you
could
give
this
out
to
the
group-
were
these
studies
done
using
a
doula
versus
a
a
coach,
because,
certainly
if
you
have
a
loved
one,
a
parent
or
a
coach
there
versus
nobody
at
all
or
were
these
I
mean
I
I
always
worry
about.
Well,
we
have
studies
to
show
this,
but
what's
the
end
number
and
how
many
did
it
really
serve?
J
A
Obviously
we
put
you
on
the
spot.
Sorry,
if
you
could
provide
that
information
to
assemblywoman
titus.
Obviously
you
can
look
at
it.
You
know,
obviously,
with
the
data
collection
is
premature
at
this
time
and
I
I
get
that
you
are
trying
to.
You
know,
use
some
of
those
national
statistics
as
well
as
try
to
incorporate
it.
So
if
you
could
get
whatever
you
have
to
the
committee,
that
would
be
helpful.
I
think.
Thank
you
absolutely
thank
you.
Do
we
have
any
other
follow-up
questions
and.
C
Go
ahead
there.
This
is
aaron
lynch.
There
was
a
question
about
the
reimbursement,
so
the
analysis
of
the
analysis
that
we
conducted
was
mostly
based
upon
other
states
such
as
oregon
and
oregon
reimburses
a
bundled
rate
and,
for
example,
their
rate
is
350,
no
matter
what
the
outcome
is,
whether
it's
a
vaginal
birth,
cerium
birth,
it's
a
350
reimbursement
rate.
A
Thank
you
for
that
and
again,
if
you
have
any
other
follow-up
information,
I'm
sure
it
would
be
very
helpful
for
the
committee
members
here
to
be
able
to
review
and
do
we
have
any
and
thank
you,
ms
lynch,
for
staying
on
the
line
and
answering
those
questions
broadcast
services.
Do
we
have
anyone
else
on
neutral
sure.
E
Thank
you
chairwin
and
committee.
I
truly
appreciate
the
you
and
the
members
of
the
health
and
human
services
committee
for
listening
attentively
and
asking
such
pointed
and
deep
questions.
I
would
refer
all
of
the
members
to
the
to
nellis.
There
are
a
number
of
exhibits
from
the
march
of
dimes,
the
nevada
department
of
health
and
human
services,
and
even
an
excerpt
from
the
national
vital
statistics
system
of
these
reports
paint
a
stark
picture
of
maternal
death
in
our
great
state.
E
E
I'm
I'm
not
gonna
touch
it,
I'm
just
gonna.
Let
you
look
at
it.
In
conclusion,
I
didn't
want
to
do
this.
This
is
probably
doulas
and
birth
support.
People
are
not.
They
are
important.
E
E
E
A
Thank
you,
assemblywoman
summers,
armstrong
for
your
presentation
at
this
time
I
will
close
the
hearing
on
assembly
bill
256
and
we
will
be
again
public
comment
as
a
reminder
to
the
public
commenters.
Please
clearly
state
and
spell
your
name
for
the
record
and
limit
your
comments
to
two
minutes.
Again.
We
will
be
timing
to
ensure
everyone
is
given
a
fair
opportunity
to
speak
broadcast
services.
Do
we
have
anyone
in
public
comment.
A
Well,
thank
you,
for
that.
Are
there
any
comments
from
members
before
we
adjourn
today.
A
Seeing
none
this
concludes
our
meeting
for
today
we're
still
working
on
agendas
for
friday,
monday,
wednesday
and
friday
of
next
week.
As
you
know,
we
received
a
bunch
of
bill
introductions
to
health
and
human
services
and
we
are
just
looking
at
scheduling
those.
Obviously
we
have
a
short
period
of
time,
so
we're
going
to
be
hearing
a
lot
of
bills
here,
so
please
keep
it
check
on
your
email
as
we
get
those
agendas
prepared
and
we
get
still
scheduled
for
hearings.
So
at
this
time.
This
concludes
our
meeting.
For
today.