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A
A
Here
and
if
we
can
mark
assemblyman,
hayfin
and
assemblywoman
black
absent
excused-
and
I
know
our
other
members
are
coming
as
they
are
trickling
in
if
we
can
mark
them
present
as
they
arrive,
and
I
will
try
my
best,
madam
secretary,
to
make
sure
I
note
it
for
the
record
when
I
see
them
come
in
myself
today.
A
Welcome
to
our
audience
joining
us
for
this
meeting
online
in
person
or
by
phone,
looks
like
we
have
a
couple
people
here
in
the
room
today,
and
I
know
we
have
some
people
on
the
zoom
today
we
have
one
bill
hearing
and
before
we
begin,
I
just
make
a
couple
several
housekeeping
announcements
again
for
individuals
present
in
our
room,
including
myself.
Please
mute
your
computers,
see.
Look
I'm
doing
it
right
now.
A
Your
phones
as
well,
if
you
are
on
the
zoom,
if
you
can
make
sure
you
unmute
yourself
and
always
clearly
state
your
name
before
speaking
just
so,
we
have
a
clear
record
of
who
is
making
the
comments
at
any
given
time.
That
would
be
greatly
appreciated.
Additionally,
for
members
of
the
public,
you
may
provide
testimony
in
a
couple
of
different
ways.
All
of
which
are
listed
on
the
agenda.
You
can
submit
that
public
writing
in
either.
C
C
Thank
you
so
much
chairwin
members
of
the
committee,
my
name
is
sarah
schulhagian
and
I
serve
as
the
executive
director
for
nevada's
patient
protection
commission
today.
Joining
me
for
this
presentation
is
a
deputy
attorney
greg
ott
from
the
attorney
general's
office
and
deputy
administrator
dwayne
young
from
the
department
of
health
and
human
services.
C
It's
an
honor
to
come
before
you
today
to
present
senate
bill
5,
which
originated
as
a
recommendation
for
the
patient
protection
commission
as
one
of
its
priorities
for
this
legislative
session.
The
goal
of
this
measure
is
to
promote
increased
access
to
care
and
to
make
telehealth
flexibilities
that
were
granted
during
the
covid19
public
health
emergency
into
law.
This
bill
is
an
effort
to
recognize
long-term
recovery
and
a
new
normal
for
patient
access
to
care.
C
I
will
start
by
providing
an
overview
of
the
main
provisions
of
the
bill
and
I'm
happy
to
take
any
questions
or
perhaps
go
section
by
section
if
that
is
preferred
so
chairwin,
if
permissible
by
you,
I
will
just
start
with
the
first
provision
relating
to
equitable
access.
C
Okay,
great
so
sections
one
two,
three
five
and
six
relate
to
equitable
access
and
they
require
dhhs
to
the
extent
that
resources
are
available
to
establish
a
data
dashboard
that
allows
for
the
analysis
of
data
relating
to
access
to
telehealth
by
different
groups
and
populations.
In
this
state
section,
1,
subsection
2
outlines
those
parameters
for
the
dashboard.
C
There
are
no
provisions
relating
to
a
mandated
data
collection
effort,
and
rather
the
intent
is
to
utilize
existing
data.
This
is
a
first
step
to
measure
telehealth
access
and
there
is
a
requirement
and
section
2
subsection
1h
for
the
state
to
review
the
dashboard
and
evaluate
policies
to
make
such
access
more
equitable.
C
This
is
also
required
for
other
health
policy
boards
in
the
state,
specifically
the
commission,
on
behavioral
health
and
the
regional
health
policy
boards.
In
addition,
there
is
also
provision
that
requires
both
dhhs
and
the
patient
protection
commission
to
make
this
data
dashboard
publicly
available
and
posted
on
a
website
for
public
access
and
viewing.
C
A
D
A
Can
also
address
this,
I
don't
know.
I
know,
there's
been
some
talk,
that
there
was
an
amendment
and
I
don't
know
if
there
is
a
new
amendment
or
if
that's
just
some
miscommunication
on
the
part
of
the
committee,
but
go
ahead
and
begin
with
the
rest
of
your
presentation.
C
Okay,
thank
you,
sarah
shalhagian,
for
the
record.
Thank
you
chairwin.
I
will
proceed
with
the
remainder
of
the
presentation
that
outlines
the
intent
of
this
measure
and
then,
when
I
conclude
with
the
second
portion
of
it,
I
will
highlight
the
adopted
amendment
from
the
senate
house
what
it
did
and
where
it
stands,
but
the
adopted
amendment
did
not
change
the
intent
of
the
outline
of
this
measure,
so
the
second
part
of
this
measure
relates
to
expansion
of
services
and
access
it
primarily
in
sections.
C
Audio
only
service
is
excluded
from
this
reimbursement
provision,
but
the
technology
is
recognized
as
an
allowable
modality.
The
commission
voted
to
recognize
that
reimbursement
should
be
kept
on
par
with
in-person
care,
to
give
reluctant
providers
a
reason
to
try
telehealth
and
spur
widespread
adoption
with
a
goal
to
increase
access.
C
This
legislation
will
encourage
providers
and
patients
to
use
virtual
care
alternatives
as
a
way
to
increase
access
to
care,
as
chairwin
mentioned
this
bill
in
the
reprinted
version
includes
adopted
amendments
from
the
senate,
and
it
would
be
adopted
amendment
number
174,
which
was
passed
unanimously
out
of
the
senate
house,
and
it
includes
several
provisions.
C
First,
there
was
an
amendment
from
dhhs
which
would
which
removed
their
fiscal
concerns
related
to
the
creation
of
the
data
dashboard,
really
just
providing
clarity,
that
there
wasn't
an
intent
to
have
an
unfunded
mandate
and
recognizing
that
there
are
resources
that
need
to
be
made
available
in
order
for
the
department
to
comply
with
this
request,
and
so
the
amendment
from
them
that
which
was
adopted
addresses
those
social
concerns,
and
there
is
no
fiscal
impact
considered
to
the
state
on
this
measure.
C
The
other
adopted
amendments
are
four,
the
first
one
would
be
just.
There
was
a
revision,
and
these
were.
There
was
a
revision
to
telehealth
to
provide
that
the
term
includes,
without
limitation,
the
delivery
of
services
from
a
provider
of
health
care
to
a
patient,
a
different
location
through
the
use
of
synchronous
and
asynchronous
door
and
forward
interaction.
C
The
second
one
was
a
replacement
of
the
term
standard
telephone
to
reference
audio.
Only
the
third
one
is
a
provision
that
prohibits
health,
professional
licensing
boards
from
prohibiting
licensees
from
establishing
a
patient
provider
relationship
via
telehealth
when
it
is
clinically
appropriate
to
do
so
and
authorizes
the
board
to
establish
regulations
prescribing
requirements
governing
a
process
for
establishing
a
patient
provider
relationship
via
telehealth
that
new
provision
can
be
found
in
section
8,
subsection,
4.
C
and
then
the
fourth
amendment
was
an
attempt
to
carve
out
workers
comp
from
this
mandate,
and
it
was
a.
There
was
no
focus
on
the
commission
in
their
deliberations
on
workers
comp
and
instead
it
was
an
inclusion
from
the
drafting
decision.
So
chair
ratty,
requested
in
a
conceptual
amendment,
to
remove
provisions
relating
to
workers
comp
in
order
to
comply
to
carve
them
out
of
the
requirement
to
for
payment
parity.
A
Was
a
lot?
No
thank
you
is
mr
ott
and
mr
young.
Are
they
just
available
for
questions
or
were
they
going
to
have?
Oh,
I
see
them
nodding
their
heads.
So
wonderful.
I
will
go
now
to
members.
I
know
we
have
a
question
from
assemblywoman
titus.
So
why
don't
you
go
ahead
with
your
question
when
you're
ready.
D
Well,
thank
you,
madam
chair,
and
thank
you
for
the
presentation
on
this
friday
afternoon.
So
I
have
a
couple
questions
and
I'm
I'm
gonna
just
refer
to
the
bill.
The
amended
version
of
the
bill
where
I'm
going
so
in
section
one
number
one
then,
and
the
parentheses
two
it's
to
allow
for
the
user.
So
who
exactly?
Would
the
user
be.
C
C
You
thank
you
so
much
assemblywoman
titus.
I
appreciate
your
question.
The
user
in
this
context
would
be
the
members
of
the
public,
and
so
the
intent
is
to
have
this
publicly
displayed
and
any
user
would
be
the
public.
D
Okay,
can
I
continue
manager?
Yes,
okay,
so
same
same
paragraph
news,
section
there
or
same
page
going
down
then
from
one
to
number
two
at
the
dashboard
she'll
have
relevant
information.
C
Thank
you
for
the
question:
assemblywoman
titus,
sarah
hagin
for
the
record.
So
I'm
going
to
do
my
best
to
answer
this
kyra
morgan.
Will
the
chief
bio,
statistician
and
head
will
be
heading
this
effort
as
a
part
of
the
office
of
analytics,
and
so
she
is
not
able
to
join
us
today.
D
Okay
and
then
moving
on
under
h
under
number
turning
the
page.
What's
what's
your
definition
of
access
to
to
make
such
access
more
equitable?
Is
it
access
to
the
dashboard?
Is
it
access
to
telehealth?
Is
it
access
to
health
care
in
general?
What
are
you
making
access?
C
Thank
you,
assemblywoman
titus,
sarah
hagian,
for
the
record,
so
the
intent
around
this
request.
When
we
talk
about
equitable
access,
the
commission
really
wanted
to
make
sure
that
they
address
vulnerable
populations
that
may
not
have
a
great
access
to
telehealth
services.
So
when
you
talk
about
the
reference
to
such
access
shall
be
more
equitable.
It
would
be
that
once
you
look
at
the
data
and
if
you
do
see
any
vulnerable
populations
or
service
areas
that
have
lower
utilization
rates
for
the
department
to
then
make
some
considerations
to
make
those
areas
more
accessible,
equitable.
D
All
right
what
I'm,
what
I'm
seeing
with
all
of
the
reasons
I'm
asking
these
questions
is
you're
gonna,
I'm
not
so
sure
by
where
in
the
bill,
then
does
you
take
this
number
one?
What
you
decide
is
relevant.
The
public
goes
on
here,
so
it's
the
user
then,
but
somebody
else
is
you
have
a
user,
but
somebody
else
is
collecting
the
data
and
with
that
data,
somehow
this
platform
is
going
to
make
healthcare
more
equitable,
and
I
just
don't
see
that
pattern,
but
all
right
next
question:
why
is
it
okay?
Next
question?
D
A
section
four
number,
a
you
mentioned
briefly
in
your
presentation
about
the
you're
not
going
to
include
audio
only
and
one
of
the
things
we
were
thinking
about
in
telehealth
for
mental
health.
We
were
looking
at
more
access
and
it's
been
a
real
issue
with
having
only
we're
not
recognizing
that.
Perhaps
we
need
to
have
the
availability
with
just
audio.
Not
everybody
has
a
phone
that
we
are
privileged
to
have
whether
you
know
we
can
do
facetime.
D
We
can
have
that
visual
access,
not
everybody,
has
a
computer
and
sometime
all,
sometimes
all
they
have,
especially
in
my
rural
areas.
We
don't
have
access
frequently
to
the
internet.
We
only
have
access
to
a
phone,
a
landline
phone,
and
so
I'm
curious
as
to
why
you
would
exclude
the
audio
only
component.
C
Okay,
thank
you
for
the
question.
Assemblywoman
titus
there
shall
hagen
for
the
record,
so
I
will
take
your
first
part
and
reference:
the
provision
about
users
looking
at
the
data
that
is
really
aimed
more
at
a
public
awareness
and
transparency
effort
to
make
sure
that
the
user
has
the
ability
to
look
at
these
policies
and
really
keeping
policy
and
honestly
consequences
in
the
public
eye.
C
So,
but
when
you
look
at
the
review
part
and
when
you
go
back
to
section
one,
some
section,
two
h,
it
states
that
the
data
ambassador
is
the
the
key
component
of
that
is
to
review
access
and
then
making
sure
that,
after
the
department
reviews
access
that
they
consider
those
evaluations
in
their
policy
making
decisions.
And
then
the
component
for
the
user
to
see
it
is
really
a
transparency
effort
to
keep
the
public
involved
and
aware
of
those
decisions.
C
And
now
the
second
part
when
it
comes
to
audio
only
and
having
the
carve
out
you're,
absolutely
right
about
making
sure
that
there
is
continued
access
for
patients
to
be
able
to
use
the
telephone.
Which
is
why
the
commission
voted
to
allow
for
audio.
Only
to
be
preserved
access
as
an
allowable
technology-
it
just
did
not
recognize
it
as
a
adequate
platform
to
really
provide
proper
healthcare
services
as
like
changing
the
standards.
So
I
think
there
was
some
discussion
really
around.
Does
it
warrant
the
same
reimbursement
level?
D
Asking
so
last
question
and
well,
I
have
more
but
the
last
question
that
I'm
going
to
put
forward
because
I'm
sure
about
that
at
that
close
to
the
edge
of
the
patient
to
the
chair
here.
D
So
in
your
opening
statement,
you
talked
about
having
some
parity,
perhaps
with
pain,
the
telehealth
providers
with
the
brick
and
mortar
providers,
because
you
want
to
encourage
more
providers
to
use
telehealth
so
that
that
hopefully,
conceptually
you'd
increase
access
and-
and
I
absolutely
have
advocated
since
my
this
is
my
fourth
session
and
every
session
I've
advocated
and
in
my
career
for
access
to
health
care.
So
absolutely
I'm
on
board
with
that.
D
D
The
same
that
now
you're
paying
this
tele
telehealth
person,
who
really
has
no
investment
in
the
community
and
doesn't
really
have
to
pay
employees
in
the
community,
etc.
The
same
I'm
worried
that
you're
gonna
in
the
long
run,
perhaps
do
just
the
opposite
of
what
you're
trying
to
do,
which
is
create
access
to
care
and
if
your
only
access
is
now
telehealth,
because
you've
pushed
everybody
else
out
of
business.
D
C
Thank
you,
assemblywoman
titus,
sarah
hagin,
for
the
record,
I'm
not
sure
if
there
was
a
question
directed
around
but
but
I
mean
so.
I
don't
know
how
to
respond
to
that.
I
can
tell
you
that
during
the
commission's
deliberations,
their
focus
was
driven
on
increased
access
and
providing
a
another
alternative
delivery
model
for
patients
to
receive
services,
and
so
there
was
not
a
deep
discussion
or
deliberation
on
this
modifying
brick
and
mortar
businesses
or
changing
the
economics
of
you
know
some
of
the
other
smaller
providers.
It
really
was
around.
D
Thank
you,
madam
chair,
for
the
questions,
and
thank
you
for
that
and
again
it's
for
other
discussions
that
we've
had
on
a
bill
that
we
heard
just
the
other
day
about
practices
aligning
and
people
leaving
and
signing
group
into
big
groups
and
part
of
this
is
this
global
discussion
of
what
how
we
really
access
care
and
all
these
little
things
that
chip
away
at
that
so
just
wanted
to
bring
it
to
your
attention.
Thank
you,
madam
chair,
for
all
of
the
questions.
E
Thank
you,
madam
chair,
and
thank
you,
miss
shell
hagan
for
your
detailed
presentation,
I'd
like
to
just
expound
a
little
bit
and
and
ask
just
a
a
more
just,
a
different
question.
Regarding
audio
only
in
the
judiciary
committee,
we
had
a
bill
that
talked
about
the
police
being
able
to
use
a
telephone
or
an
ipad,
or
some
type
of
a
electronic
device
to
have
a
person
in
crisis
speak
to
someone
who
was
who
needed
emotional
counseling.
E
Would
the
audio
only
exclusion
affect
that,
because
that
is
a
very
important
portion
of
they're
called
in
las
vegas?
I
think
more
or
more
st
most
teams
and
in
my
community,
where
we
have
a
lot
of
providers
of
homeless
care
and
mental
health
services
in
my
community.
E
C
Thank
you
so
much
assemblywoman
summers,
armstrong
sarah
shalhagan
for
the
record.
I
certainly
understand
I'm
empathetic
to
your
concern
and
I
hope
to
give
you
some
comfort
that
the
audio
only
carve
out
is
specifically
rated
related
to
the
reimbursement
provision.
So
there
is
no
restriction
on
the
use
of
that
modality
to
provide
service.
So
it's
really
only
meant
for
the
reimbursement
portion
on
the
providers
and
payers,
but
not
for
the
utilization
of
an
audio
service
modality.
E
Madam
chair,
may
I
go
ahead?
Could
you
please
just
explain
that
a
little
bit
more
because
you're
saying
it
only
applies
to
the
reimbursement
portion
if
the
police
are
contracting
with
a
with
an
organization
that
is
providing
these
services
and
being
reimbursed
by
medicaid,
I
don't
know
that
they
are,
but
if
they
were,
could
this
interfere
with
that?
Thank
you.
C
Well,
thank
you
so
much
assemblywoman
summers,
armstrong.
Sarah
schulhagen
for
the
record.
What
I
meant
by
the
reimbursement
portion
is
meaning
that
there
is
no
mandated
requirement
that
it
must
be
paid
in
parity
as
in-service
care.
So
it
just
means
that
it
can
be
allowed
to
be
billed
and
reimbursed.
It
just
doesn't
mean
that
it's
automatically
mandated
at
the
same
level
as
in-person
care,
so
it
would
just
warrant
reimbursement.
You
know
at
the
flexibility
of
the
payer
and
provider
discussion,
so
it
can
still
be
allowed.
C
It's
just
not
a
mandate
that
it's
the
same
as
in
person
and
then
perhaps
for
more
clarity
from
people
that
are
a
lot
smarter
than
I
am
in
this
world.
I
can
actually
turn
to
deputy
dwayne
young
to
kind
of
explain
that
from
the
state
side,
so
he
can
walk
you
through
how
that
reimbursement
would
work
if
that's
permissible
chairwin.
F
But
after
noon
chaired
wayne
and
the
assemblywoman
thomas
armstrong
and
the
rest
of
the
committee,
if
you'll
just
indulge
me
in
just
a
moment
to
give
a
little
bit
of
history
so
that
we
can
put
this
on
the
legislative
record
in
this
house
as
we've
discussed
in
the
senate,
when
we
first
went
down
this
path
to
put
this
legislation
working
with
the
ppc,
what
we
determined
was
at
the
time
cms
had
not
made
a
ruling
if
audio
only
communications
for
telehealth
would
continue
outside
of
the
public
health
emergency.
F
This
has
been
an
allowance
under
the
public
health
emergency
cms
has
now
moved
in
the
direction
where
they
have
ruled
that
if
a
provider
is
able
to
maintain
hipaa
and
reasonable
efforts
of
privacy,
then
audio
only
is
included
under
the
definition
of
cm
for
purposes
of
cms
reimbursement
for
telehealth,
as
it
is
chapter
422
that's
outlined
within
this
bill,
does
not
change.
Medicaid
already
had
a
reimbursement
parity
for
terror,
health
with
those
in-person
services.
F
What
this
provision
does
allow
is
some
guard
rails
for
audio,
only
communication,
meaning
that,
even
though
the
division
has
up
till
now
been
paying
pay
parity
for
those
instances
of
audio,
only
communication
through
the
public
health
emergency
that
if
we
were
to
ever
get
into
an
economic
crisis
or
need
to
adjust
medicaid's
budget,
we
would
then
not
have
to
pay
for
parity
for
telephone
only
calls
and
we
could
adjust
the
fee
schedule
and
cost
based
providers
if
necessary
and
need
it,
and
these
are
appropriate.
F
Guardrails
in
other
legislation
has
been
considered
to
expand
audio
only
and
that
the
fiscal
note
has
placed
a
the
division
has
placed
a
fiscal
note
because
of
the
increased
utilization
the
division
would
see
for
audio
only,
and
so
this
is
an
appropriate
guardrail,
as
the
language
is
written
now
to
keep
that
utilization
and
allow
the
division
the
levers
that
it
already
had
existed
in
chapter
422..
F
I
do
just
want
to
if
you'll
further
indulge
me
just
further,
go
back
to
the
assembly
woman's
question
regarding
crisis
services,
crisis
behavioral
health
services
are
and
have
always
been
allowed
through
medicaid
policy
to
to
occur
through
audio.
Only
instances
when
a
person
is
in
a
behavioral
health
crisis
and
they
call
a
crisis
line
and
they
speak
with
a
enrolled
professional.
Those.
Those
professionals
then
can
build
medicaid
for
that
crisis.
E
No,
I
just
appreciate
this
history
and
this
in-depth
explanation,
because
this
is
very
concerning
you
know,
I
think,
to
many
of
us
here.
We
hear
things
in
different
houses
and
in
different
committees,
and
then
you
see
that
there's
a
nexus
and
I
just
want
to
make
sure
that
I'm
not
making
a
mistake
when
I
push
the
button.
So
thanks
so
much
to
all
of
you.
G
Thank
you,
chair
david
orton,
liquor,
assembly,
district
20.,
so
on
the
parity
of
reimbursement.
I
understand
the
goal
of
encouraging
providers
to
use
telehealth,
so
that
makes
sense.
On
the
other
hand,
I
can
see
that
the
cost
of
providing
telehealth
services
is
lower
than
on-site
services,
so
we
might
get
into
an
over-reimbursement
kind
of
setting.
C
Thank
you
so
much
assuming
that
oren
liquor,
sarah
schulhagian
for
the
record.
I
would
defer
to
our
attorney
on
the
line
to
answer
your
legal
question.
I
would
be
hesitant
to
try
to
respond
to
something
that
is
that
legal
and
technical
in
nature.
A
Ms
o'krent,
are
you
on
the
line
and
may
be
able
to
respond
to
that
question,
or
do
you
need
some
additional
time
to
do
some
research
I'll
turn
it
over
to
you
to
answer.
I
C
So
I
can
answer
that
question
now.
As
the
bill
is
currently
drafted,
they
would
have
to.
G
A
J
I
have
a
couple
of
questions
related
to
the
intention
of
certain
languages
in
here.
If
I
may,
the
first
is
really
a
clarifying
question
around
just
the
data
privacy
and
security
of
the
dashboard,
ensuring
that
it
meets
with
confidentiality
standards
and
all
of
that
and
just
wanted
to
check
and
make
sure
and
get
that
on
the
record.
J
And
then
the
other
piece
is
the
the
definition
of
different
groups
and
populations.
And
it
looks
to
me,
like
you,
outlined
some
of
that
in
section
1
sub
1,
a
2,
but
just
wanting
to
make
sure
that
we
have
a
clear
understanding
of
what
your
intention
of
these
like
reviewing.
The
access
for
different
groups
and
populations
mean.
C
Thank
you
so
much
assemblywoman
peter
sarah
hagian
for
the
record.
What
I
can't
say
to
you
and
again
I
would
defer
to
miss
tyra
morgan,
just
I'll
do
some
additional
follow-ups,
I'm
answering
to
the
best
of
my
ability,
but
because
there
is
no
mandated
new
data
collection
requirements
in
this
bill
really
all
of
the
privacy
and
concerns
are
already
embedded
in
their
current
operations
and
process
and
would
just
align.
C
So
this
data
dashboard
would
be
created
is
intended
to
be
created
with
utilizing
existing
resources,
so
so
the
securities
would
follow.
What's
already
in
place
to
answer
your
question
about
the
different
demographics,
the
commission
wanted
to
make
sure
that
they
captured
all
of
the
right
demographics
to
look
at
any
potential
vulnerable
populations
and
so
that
language
really
was
con
was
provided
by
drafting.
So
the
specificities
of
that
and
and
the
feedback
that
I
received
from
the
commission,
commission
members
were
generally
in
agreement
that
it
captured
their
intent.
J
Thank
you
thank
you
for
those
responses
and
would
appreciate
any
follow-up
information
to
come
to
the
committee,
so
that
we
can
all
see
that
my
next
question
has
to
do
with
kind
of
the
second
part
of
the
bill.
Your
definition
of
telehealth,
you
use
the
words
audio
dash,
visual
and
I'm
wondering.
J
Or
do
you
mean
like
the
the
best
intent
at
that
I
mean
I
just
want
to
make
sure
that
we're
not
we're,
not,
incidentally,
excluding
certain
practices
or
incidental
actions
right.
If
someone
is
blind
and
can't
see
the
the
video,
if
someone
is
deaf
and
needs
to
use
the
texting
mess
mechanism
of
zoom
those
kinds
of
things.
C
Thank
you
so
much
assemblywoman
peter
sarah
schulhagen.
For
the
record.
I
will
ask
for
deputy
administrator
dwayne
young
to
opina
on
this
part,
but
I
can
tell
you
that
the
intent
of
the
definition
was
to
be
all-inclusive
of
all
the
appropriate
modalities
and
there
was
not
an
intent
to
exclude
any
one
technology,
but
I
will
defer
to
him
to
explain
that
in
a
more
practical
way
than
I
can
address.
F
Young
dwayne
young
for
the
record
sure
gwen
threw
you
to
assemblywoman
peters.
The
intent
in
the
language
in
422
originally
focused
on
audio
visual
impact
of
telehealth,
as
I
mentioned
earlier,
audio
only
was
really
only
allowed
in
the
instances
of
behavioral
health
crisis
or
case
management
and
not
through
other
means.
Since
then,
during
the
public
health,
emergency
audio
only
was
allowed,
and
so
this
language
was
crafted
as
a
response
to
fixed
state
law,
but
not
supersede
federal
law.
F
That
regulation
through
the
office
of
civil
rights
has
been
reversed
and
cms
has
reversed
course,
and
so
audio
only
is
allowable,
and
so
this
language
really
only
speaks
to
the
reimbursement
portion,
but
does
encapsulate
both
the
existing
language
and
framework
of
chapter
422
and
the
new
provisions
that
will
allow
audio
only
as
as
allowable
by
the
federal
government.
J
Thank
you.
I
have
one
more
if
I
may,
madam
chair,
this
has
to
do
with
section
eight
and
the
establishing
regulations
that
allow
a
doctor
and
patient
relationship
via
telehealth
is
there?
Are
there
existing
models
of
this
in
other
states,
or
are
we
creating
something
from
scratch
within
those
regulations?.
C
Thank
you
so
much
assemblywoman
peter
sarah
hagian
for
the
record.
I
don't
believe
that
nevada
is
creating
anything
new,
and
this
edition
of
the
proposed
amendment
was
provided
through
discussions
with
the
american
telemedicine,
association
and
teledoc,
and
so
what
I
would
like
to
do
is
really
circle
back
with
you
in
the
entire
committee
to
make
sure
I'm
answering
that
correctly.
But
I
believe
this
was
model
language
that
has
been
provided
through
the
association
for
nevada
to
consider.
J
Great,
I
was
really
thinking
about
the
time
it
takes
to
adopt
those
regulations
and
if
the
drafting
is
coming
up
with
brand
new
language,
that's
never
been
used
before
wondering
the
timeline
of
that,
but
it
sounds
like
we
may
have
something
to
start
with,
while
getting
into
that
regulatory
like
process.
So
thank
you,
madam
chair,
for
the
indulge
indulgence.
K
Thank
you,
madam
chair.
Thank
you,
miss
chalhagian,
and
thank
you
to
our
other
presenters.
This
afternoon.
I
was
a
question
on
on
broadband
access.
You
know
with
there
being,
in
some
cases,
limited
broadband,
I'm
wondering
if
we'll
be
looking
at
the
limits
on
broadband
for
some
of
our
urban
and
rural
areas.
K
C
C
What
could
they
do
to
increase
broadband
access
to
vulnerable
populations,
but,
being
mindful
of
the
economic
climate
at
the
time,
did
not
want
to
put
forth
a
measure
that
created
some
unfunded
mandate
to
increase
broadband
access
and
really
just
expressed
their
intent
to
try
to
increase
access
where
appropriate,
and
I
think
in
this
piece
of
legislation
what
you
will
see
is
you
may
find
the
answers
as
soon
as
you're,
starting
to
collect
some
of
the
telehealth
access
and
data
and
then
providing
that
dashboard.
K
So
a
quick
follow-up
chair,
if
I
may
so
just
to
make
sure
I
understand
you're
right
then
as
part
of
the
data
collection,
you
anticipate
that
will
include
data
on
the
need
for
providers
and
and
access
and
and
making
sure
that
we're
able
to
to
provide
these
services
and
some
of
these
instances-
that's
do.
I
understand
you
correctly
that'll,
be
part
of
the
data
collection
to
address
that.
C
Thank
you,
assemblyman
matthews
for
the
record,
sarah
shalhavian,
yes,
but
not
necessarily
data
collection,
it's
more
data
analysis
and
so
they're
gonna
use
data
that
they
already
have
and
they're
already
collecting
within
the
state,
but
when
they
are
analyzing
access
points
and
identifying
vulnerable
populations,
I
think
in
the
discussions
of
potential
solutions
for
further
policies,
the
thought
about
increased
broadband
access
to
enhance
equitable
access
would
be
a
part
of
those
deliberations.
L
Thank
you
so
much.
I
appreciate
the
ability
to
make
sure
I'm
reading
this
all
right.
So
I
think
the
when
we're
looking
at
section
four,
the
director
shell
and
we're
talking
about
specifically
the
state
plan
of
medicaid,
so
just
for
medicaid
and
442-
is
child
and
maternal
health,
so,
where
we
see
this
language,
that's
specific
to
not
the
specific
that
sub
five
on
category
categorizing
a
service
provided
through
telehealth
differently
for
purposes
relating
to
coverage
or
reimbursement.
L
So
that
is
just
going
to
be
specific
to
maternal,
internal,
maternal
and
child
health
programs
through
medicaid.
Is
that
right,
I'm
digging
it's
a
short
bill.
Imagine
if
we
were
touching
every
section
of
health
care,
it
would
be
bigger,
but
is
it
is
it
only
living
in
that
one
spot
or
is
it?
Is
it
more
comprehensive
than
that.
C
Thank
you
so
much
for
the
question.
Assemblywoman
benita
thompson,
sarah
hagian
for
the
record,
so
that
provision
that
you
are
referencing,
I
believe,
is
the
drafting
intent
to
make
sure
that
they
capture
that
telehealth
is
not
treated
any
differently
than
in
person
care.
And
so
it
lives
in
that
provision
under
child
and
maternal
health.
But
it
is
not
specific
to
just
child
and
maternal
health.
Perhaps
if
miss
o'krent
could
opine
on
that.
L
In
person,
care
and
and
thank
you
and
I've
scrolled,
I
scroll
down
further
sorry,
I
had
a
long
meeting
right
before
this,
and
so
then
I
see
it
also
in
616c,
which
is
gonna
once
we
start
getting
into
the
insurance
policies
in
those
chapters.
So
that's
where
it's
applied
then,
through
across
all
providers
of
not
providers
of
healthcare,
insurers
of
health
care,
correct.
C
Thank
you
so
much
for
the
question.
71
benitez
thompson
that
sarah
schnelhagen
for
the
record
that
provision.
C
I
think
it
relates
to
workers
comp
and
it
doesn't
apply
to
workers,
comp
provisions
and
so
you'll
see
that
there's
a
separate
definition
of
telehealth
that
you
find
in
section
7
and
the
intent
for
that
section
is
to
make
sure
that
provisions
requiring
workers
compensation
to
comply
with
the
build
audio
only
and
payment
period
requirements
are,
are
not
applicable
to
workers
comp
programs
so,
but
that
provision
is
applicable
to
all
the
other
insurance
carriers
and
the
remaining
sections.
I
believe,
8
through
16.
L
And
then
I
want
to
make
sure
I've
got
my
kind
of
status
quo
right.
So
right
now,
when
we
talk
about
the
the
the
payment
for
telehealth,
so
cms
has
temporary
regulations
out
through
the
end
of
the
pandemic
that
allow,
for,
I
guess,
specifically,
medicare
and
medicaid.
L
I
think
the
medicare
waivers
the
1135
waiver
and
that's
the
one
that's
living
right
now
and
going
to
carry
us
through
the
end
of
the
federal
government's
formal
emergency
declaration,
and
so
through
that
time,
medicare
and
medicaid
can
bill
would
have
to
have
the
the
parity
and
allow
for
the
telehealth
services
right
or
is
that
this
just
bill?
I
was
trying
to
figure
out
when
I
was
reading
the
1135.
Is
it
just
billing
parody.
C
So,
thank
you
so
much
for
that
question.
Assemblywoman
benitez
thompson,
sarah
schulhagen
for
the
record.
So
when
it
comes
to-
and
actually
I'm
going
to
go
back
to
deputy
administrator
dwayne
young
to
talk
about
medicaid
but
in
2015
medicaid
was
there
was
payment
parity
codified
into
law,
so
they
already
pay
in
parity.
What
the
federal
waiver
did
through
the
public
health
emergency
was
allowed
for
there
to
be
reimbursement
on
the
audio
only
portion
of
it.
But
should
that
end.
C
Then
the
state
would
go
back
to
the
payment
parity,
that's
already
in
place.
So
there's
no
modifications.
L
To
state
medicaid,
okay,
the
other
thing
I
see
in
here
and
I
guess
what
I'm
trying
to
figure
out
is
like
what
what's
the
change
right,
we
brought
the
bill
to
create
a
change.
I
see
lots
of
interested
groups
bringing
amendments
to
this
change,
and
so
I
I
obviously
there's
there's
there's
a
big
shift.
There's
enough
interest
in
this
that
it's
a
big
shift.
L
The
other
piece
I
see
that
I
was
trying
to
figure
out
is
that
on
here
with
the
waiver
that
that
cms
was
not
going
to
go
in
and
be
auditing
for
the
the
that
the
prior
relation
that
the
clint,
the
the
clinician
patient
relationship
had
been
established
prior
to
using
it.
So
I
see
here
that
we're
we're
going
to
kind
of
say
that
we'll
allow
that
patient,
doctor-patient
relationship,
clinician-patient
relationship
to
be
established
by
regs
and
we're
going
to
specifically
tell
boards
not
to
kind
of
you
know.
L
Have
you
know
a
dozen
different
standards
or
a
dozen
different
boards,
so
is.
Is
that
the
bigger
change
here
that
we
are
I'm
trying
to
figure
out
why
we
have
kind
of
these
big
national
groups
submitting
amendments
to
nevada
legislation?
L
C
I
I
totally
thank
you
so
much
assemblywoman
benita
thompson,
sarah
schelhagen
for
the
record,
so
there's
two
parts
to
that.
The
first
one
I
could
say
is
we're
going
to
go
back
to.
I
think,
one
of
the
larger
provisions
of
this
bill
that
relates
to
the
reimbursement
of,
or
that
compels
private
payers,
to
reimburse
on
the
same
level
they
provide
in
person.
So
parity
laws
were
already
established
in
2015,
but
the
reimbursement
portion
of
that
only
applied
to
our
state
medicaid.
C
What
this
bill
does
it
actually
compels
private
payers
to
reimburse
on
the
same
basis
as
providing
health
care
services
in
person.
So
that
is
a
bigger
change
for
the
private
payers.
C
It's
already
the
same
for
the
state
and
so
there's
not
a
modification
to
the
state
because
they
are
already
paying
in
parity
and
the
second
portion
related
to
the
health
professional
licensing
boards,
really
that
when
it
got
national
attention
and
the
request
for
the
modification
was
really
around
making
sure
that
you
protect
access
to
care
and
making
it
so
that
the
patient
provider
relationship
could
still
be
if
it
was
clinically
appropriate,
allowed
to
be
established
via
telehealth.
And
so
I
think
that
does
happen
in
practice.
C
That
provision
just
makes
sure
that
there
is
nothing
in
law
that
could
prevent
that
from
happening.
So
that
was
really
just
maintaining
alternative
access
to
patients
through
telehealth
services
and
being
able
to
establish
that
relationship.
L
Thank
you.
I
appreciate
that
so
my
initial
quick
read:
I
had
it
backwards
because
I
was
thinking
and
when
I
said
what's
this,
I
want
to
figure
out
the
status
quo
on
parity
right
for
your
brick
and
mortar
versus
your
telehealth,
and
I
was
thinking
it
am.
I
you
know
by
reading
it
that
it's
pieces
of
medicaid,
but
not
all
of
medicaid
right,
because
that's
where
we
saw
the
reference
of
the
child,
the
statute
on
child
maternal
health,
but
then
I
also
see
statutes
on
private
on
the
private
insurance.
L
So
it's
actually
reverse
of
what
I
thought.
Medicaid
is
doing
it,
but
private
insurance
plans
aren't
required
to
do
it.
So
that
is
a
really
significant
change
and
I
think
to
dr
titus's
point.
So
we
were
we've
both
been
in
in
the
building
right
when
we
were
standing
up
and
had
those
big
initial
hearings
in
this
room
on.
Do
we
do
telehealth,
and
you
know
the
sky
is
falling.
If
we
do
telehealth
and
we'll
have
horrible
care
and
ultimately
know
it
was
a
way
to
go
and
for
for
areas
of
our
state.
L
L
So
that's
kind
of
the
way
that
it
it's
been
conceptualized
in
statute,
and
the
one
thing
I
would
just
say
from
my
perspective
is
that
if
you're
we're
gonna
mandate,
all
insurers
with
that
parity
piece,
then
and
then
we're
gonna
at
the
same
time
talk
about
what
a
patient-client
relationship
means
in
combination
with
those
two
things.
L
We
are
just
drastically
changing
how
health
care
will
look
in
this
state,
and-
and
so
I
just
want
to
make
sure
that
I
felt
like
I
was
understanding
that
or
if
I
wasn't
but
to
me
that
that
really
would
change.
I
mean
the
data
collection.
Stuff
is
great
and
fine,
but
I
worry
about
those
two
pieces
coming
together
at
once,
and
I
worry
about
not
being
able
to
understand
how
that
will
really
impact
our
health
care
market,
because
I
think
to
dr
titus's
point
that
we
were
just
talking
about.
L
Having
worked
in
healthcare
for
a
decade,
you
know
10
years
ago
I
worked
for
a
little
tiny
hospital.
Where
not
that
recently
there
were
still
nuns
doing
health
care
in
the
hospital,
then
the
nuns
got
kicked
out
and
then
it
got
sold
and
then
it
was
a
western
market
conglomerate
that
owed
it
owned
it
and
then
a
year
and
a
half
later
it
got
sold.
L
And
then
it
went
to
you
know
kind
of
a
western
united
states
and
now
it's
a
national,
corp
and
and
so
I've
I've
seen
that
acquisition
of
healthcare
and
I've
lived
that
acquisition
of
healthcare
for
every
year
and
a
half
they
say:
okay,
we're
going
to
keep
the
name
the
same
so
that
people
in
the
community
recognize
the
name
and
think
we're
the
same.
But
your
ownership
is
constantly
changing
and
it's
always
going
broader
and
up
it's
never
getting.
L
You
know
we're,
not
de-evolving,
and
so
I
just
wonder
what
this
will
look
like
for
telehealth
when
we
say
that
your
health
can
be
provided
by
an
investor
group.
That's
managing
a
telehealth
corp.
So
I
just
that's
my
thought.
C
Thank
you
so
much
assemblywoman
denise
thompson,
sarah
schulhagen,
for
the
record.
I
sincerely
appreciate
your
your
perception,
your
perspective
and
understanding
of
the
future
and
what
I
can
say
to
that,
because
it
is
really
that
this
piece
of
legislation-
I
think
you
do-
have
it
and
an
understanding
of
it
correctly,
that
this
was
their
attempt
for
a
long-term
recovery
of
new
normal
and
making
sure
that
the
goal
was
aimed
at
patient
access
to
care
and
really
having
virtual
alternatives
as
a
way
to
increase
that
access.
L
A
Thank
you
and
I
was
going
to
go
to
assemblywoman
krasner,
but
I
know
that
assemblywoman
summers,
armstrong
kind
of
has
a
follow-up
question
related
to
what
assemblywoman
benitez
thompson
was
just
asking.
E
Thank
you,
madam
chair,
and
thank
you
again.
Miss
sherhagen,
and
I
think
this
is
a
good
segue
for
me
to
ask
on
the
record
the
question
that
you
and
I
discussed
yesterday,
which
is
if
we
have
a
provider
who,
if
someone
is
referred
to
someone
for
health
care
and
that
provider
is
all
in
on
telehealth,
don't
have
a
brick
and
mortar
in
nevada
as
assemblywoman
titus
spoke
to
and
that
that
patient
doesn't
want
to
do
their
their
their
healthcare
through
telehealth.
E
Now,
where
are
we
right?
We
are
now
placing
a
patient
in
a
situation
where
they
may
not
be
in
control
of
how
their
health
care
is
delivered,
and
I
think
that
that's
something
that
really
needs
to
be
considered,
and
I
would
really
like
you
to
speak
to
that,
if
at
all
possible,
because
it
really
concerns
me
or
if
that
person
wants
their
care
in
person
and
the
doctor
says
to
them.
E
Well,
I
don't
do
that
right
or
you'll
have
to
wait,
because
this
is
my
my
my
my
new
normal
mode
is,
you
know
telehealth,
you
know
what
happens
to
that
patient
and
how
is
this
increasing
access
if
they
may
not
have
an
option.
C
Thank
you
so
much
assemblywoman
summers,
armstrong
sarah
hagian
for
the
record
again.
I
really
appreciate
your
perspective
and
certainly
understand
your
concerns.
What
I
can
say
is
that
this
piece
of
legislation
is
aimed
at
providing
access
to
care
and
giving
patients
alternative
methods
of
delivery,
and
so
for
your
specific
scenario
in
which
there
may
be
some
mandate
from
a
provider
level
to
a
patient
that
only
says
that
they
have
availability
by
a
telehealth
or
in
person.
C
I
think
that
is
a
real,
valid
concern,
but
this
piece
of
legislation
doesn't
necessarily
address
any
of
those
mandates.
It
really
just
provides
another
option,
so
it
maintains
patients
ability
to
have
an
alternative
method
of
accessing
care.
E
M
Thank
you
sharon.
Thank
you
for
your
presentation,
so
I
I'm
trying
to
understand
this,
and
I
think
I
have
a
few
questions.
If
that's
okay,
the
bill
expands
telehealth
from
audio
visual
and
emergency
audio
to
now
include
audio
only,
but
the
bill
will
not
allow
medicaid
to
pay
in
parity
for
audio,
only
interactions
with
health
care
providers.
C
Correct
thank
you
for
the
question.
Assemblywoman
krasner,
sarah
schelhagen,
for
the
record.
That
is
not
correct.
I
don't
I
don't
know.
If
I'm
understanding
it
there,
there
is
not
a
expansion
of
services
or
expansion
of
a
different
modality.
I
think
your
question
really
relates
to
the
reimbursement
from
the
state
level
on
the
audio.
Only
so,
if
I
can,
I
think
deputy
attorney
dwayne
young
explained
it,
but
I
think
he
would
be
better
equipped
to
answer
your
concern.
C
I
think
your
question
is
related
to
the
reimbursement
of
audio
only
from
the
state
perspective.
F
F
F
Just
for
the
history
of
the
committee
during
the
public
health
emergency,
then
the
trump
administration
lifted
that
ban
on
audio
only
as
a
promotion.
What
cms
later
came
back
and
said
is
that
we
did
not
have
the
authority
to
do
that,
because
we
did
not
get
the
office
of
civil
rights
permission
to
do
so.
The
under
now
the
biden
administration,
the
office
of
civil
rights,
did
not
change
the
regulation.
However,
they
changed
formally
the
interpretation
behind
that
regulation.
F
That
said,
that
audio
only
is
included
in
the
purposes
of
telehealth,
as
long
as
a
provider
can
maintain
reasonable
privacy
standards,
and
so
that
then,
reverse
cms's
course
to
say
that
it
is
allowable
for
reimbursement
from
the
federal
government
for
medicaid
services.
The
language
in
this
chapter
then
removes
that
state
provision
so
that
beyond
the
public
health
emergency
that
is
allowable,
but
it
also
establishes
through
that
one
clause
that
medicaid
will
certainly
could
and
still
does
pay
parity
for
audio,
only
communications
that
it
doesn't
tie
our
hands.
F
We
know
and
to
also,
if
you
indulge
me
to
speak
to
assemblywoman
summers,
armstrong
only
about
quality
of
care.
We
know
in
medicaid
that
if
we
allow
provisions
of
services
of
audio,
only
there
are
providers,
and
while
we
do
our
due
diligence
to
gatekeep
those
providers,
there
are
providers
that
will
set
up
shop
and
not
effectively
provide
care,
and
we
would
be
essentially
chasing
those
providers
to
make
sure
that
they
are
upholding
one,
the
standard
of
quality,
of
care
and
being
good
steward
of
the
state
and
the
federal
government's
resources.
F
And
so
by
not
exchanging
the
existing
language
and
allowing
for
a
non-payment
parody.
It
allows
us
the
appropriate
guardrails
that
one
would.
We
would
not
put
a
fiscal
note
on
this,
because
we'd
be
able
to
control
utilization
and
it.
It
would
allow
us
to
then
hold
those
standards
and
say
that,
while
that
providers
must
meet
those
standards
of
care
and
ensure
that
they
are
actually
serving
the
the
patients
of
nevada
as
they
are
claiming
to
do
so,.
M
Okay,
so
back
to
my
question,
which
is
exactly
what
I
said:
why,
if,
if
a
healthcare
provider
who
provides
in
including
in
here
you're
allowing
them
to
do
the
initial
consultation
with
the
patient
as
well
through
audio
only
through
telehealth
audio,
only
why,
for
purposes
of
reimbursement,
if
medicaid
is
not
going
to
have
to
pay
parity,
if
there's
not
money
to
do
so
for
audio
only,
why
would
a
health
care
provider
even
do
this?
F
Again,
dwayne
young
for
the
record,
so
there
would
be
payment.
It
just
may
not
necessarily
be
the
same
level
of
payment
as
if
they
were
providing
traditional
telehealth,
and
why,
in
establishing
the
policy
based
on
the
legislature's
decision
in
2015,
we
knew
that
there
was
some
infrastructure
cost
in
telehealth,
and
so
I
believe
that
is
why
I
why
I
was
not
in
leadership
at
that
time.
F
I
do
believe
that
is
the
reason
why
hhs
and
medicaid
really
supported
that
provision
without
a
an
extended
fiscal
note,
because
we
knew
that
there
was
some
infrastructure
into
traditional
telehealth
equipment
in
just
using
audio.
Only
we
do
have
providers
that
utilize
audio
only,
and
so
we
have
been
paying
them
at
parity
through
the
public
health
emergency.
But
there
are
some
providers
that
are
receive
a
prospective
payment
system
or
pps
encounter
rate
and
those
are
based
on
their
costs.
F
There
are
other
providers
that
receive
rates
that
are
based
solely
on
their
cost,
and
we
do
know
that
audio
only
has
a
lesser
cost
than
traditional
telehealth
equipment
or
the
infrastructure
of
full,
brick
and
mortar.
And
so
if
those
costs
were
to
reduce
this
would
give
us
the
flexibility
to
make
those
adjustments
based
on
their
reduced
cost.
And
so
it's
not
to
to
discourage
providers
from
doing
audio
only.
But
it
does
one
allow
the
provider
to
make
that
decision.
F
If
the
reimbursement
is
lowered
at
some
point,
they
would
make
that
be
able
to
make
that
business
decision
if
it's
advantageous
for
them.
But
it
also
does
give
the
state
the
leverage
that
it
needs
within
medicaid
policy
to
control
the
guard
wells
appropriately,
so
that
we
don't
have
to
always
come
back
before
the
body
of
the
legislature
and
say:
we've
reached
a
shortfall,
but
we
can
actually
control
the
mechanisms
within
policy
appropriately
to
have
those
appropriate
fiscal
and
policy
guard
rails.
M
And
the
follow-up,
so
I
I
disagree
with
you
respectfully
disagree.
Furthermore,
does
a
healthcare
provider
who
provides
services
to
somebody
via
telehealth
get
sued
for
any
less
amount
for
medical
malpractice,
or
are
they
also
going
to
get
sued
for
medical
malpractice
and
then
not
be
reimbursed
by
medicaid
in
parity
with
this
bill?.
F
A
Mr,
do
you
think
you
can
address
that
question,
or
would
you
like
us
to
go
to
ms
o'krent.
A
Thank
you
and
assemblywoman
krasner.
I
will
I'm
sure
I
know
miss
okay,
we'll
follow
up
with
you.
Do
you
have
any
other
further
questions,
though,.
M
No,
I
just
think
this
is
bad
policy,
but
thank
you,
I
don't
think
we'd
expect
any
other
profession
to
not
be
paid
in
parity
for
doing
their
services
in
an
alternate
fashion
when
there's
a
need
for
such
in
that
state,
and
we
have
already
established
there's
a
desperate
need
in
this
state.
So
thank
you.
That's
it.
A
And
I
know
that
this
is
a
very
important
discussion
that
we're
having
regarding
this
I'm
looking
around
to
see
if
we
have
any
other
additional
questions.
I
know
that
some
people
may
have
some
additional
follow-up
questions
that
they
might
want
to
ask
and
get
on
the
record.
A
No,
no,
okay.
Well
then,
I
will
we
will
begin
testimony
in
support
and
opposition
in
neutral
of
senate
bill
5..
So
at
this
time
I
will
begin
testimony
in
support
of
senate
bill
5,
and
I
will
look
to
the
room
to
see
if
there's
anyone
in
here.
If
you
want
to
testify
and
support,
please
come
up
to
the
witness
table.
B
B
B
B
B
N
N
I
am
here
in
full
support
of
sb5.
Our
members
provide
integrated
primary
behavioral
and
dental
health
care
to
more
than
107
000
nevadans.
The
vast
majority
come
from
low-income
households
and
are
uninsured
or
on
medicaid.
During
the
public
health
emergency
between
15
and
40
percent
of
health
center
visits
have
been
taken
place
over
the
phone.
Our
members
found
that
the
patients
did
not
always
have
access
to
devices
and
data
plans
that
allowed
for
a
video
telehealth
visit
at
first.
These
remote
visits
serve
to
keep
our
patients
and
providers
safe
and
to
conserve
scarce
ppe.
N
N
Patients
agree
that
this
is
an
important
tool
to
increase
access
to
care.
One
health
center
patient
said
she
wouldn't
be
here
today
without
audio
only
visits.
Another
credited
this
modality
with
helping
to
manage
their
chronic
disease
and
keep
them
out
of
the
emergency
room.
These
audio
only
services
have
been
reimbursed
by
medicaid
throughout
the
public
health
emergency.
Allowing
this
benefit
to
expire
would
be
taking
existing
access
away
from
our
most
vulnerable
vulnerable
fit
residents.
B
H
Good
afternoon
this
is
kristin
leonard
k-r-I-s-p-y-n
l-e-o-n-a-r-d,
with
silver
state
government
relations.
I'm
speaking
today
on
behalf
of
the
nevada
advanced
practice
nurses
association,
the
association
wants
to
put
their
support
on
the
record
for
sb5,
because
ensuring
the
availability
of
telehealth
services
is
vital
to
increasing
access
to
health
care
in
the
state.
Thank
you.
B
I
Begin
good
afternoon,
madam
chair
and
members
of
the
committee,
my
name
is
marcus
conklin
m-a-r-c-u-s
c-o-n-k-l-I-n,
with
strategy
360
representing
teledoc.
We
want
to
thank
the
ppc
and
sarah
chilhagen
and
chair
ratty
for
working
diligently
on
this
issue
and
with
us
over
these
past
four
months.
We
are
in
full
support
of
the
bill
and
we
also
urge
passage.
Thank
you.
B
H
L-I-N-D-S-L-E-Y
and
I'm
an
organizer
with
planned
parenthood,
boats,
nevada
and
a
community
member
planned
parenthood
votes.
Nevada
is
in
favor
of
sb5,
because
making
telehealth
accessible
through
the
standard
telephone
would
be
a
long-term
investment
in
the
health,
safety
and
well-being
of
nevadans.
H
In
fact,
the
removal
of
restrictions
and
increased
public
and
private
coverage
for
telemedicine
due
to
covid
has
allowed
providers
to
see
more
patients
safely
and
efficiently.
This
temporary
expansion
has
provided
a
demonstration
of
what
innovative
broadened
access
to
telemedicine
can
do,
please.
We
urge
you
to
support
sb5
and
expand
more
equitable
healthcare
access
for
nevadans.
Thank
you
for
your
time.
B
I
I
Telehealth
has
been
expanded
during
the
pandemic
and
we've
seen
more
nevadans
be
able
to
access
their
doctors
via
this
modality
cell
health
should
be
covered
and
access
should
be
increased.
We
should
be
using
technology
to
advance
and
to
assist
nevadans
in
accessing
healthcare
services.
They
desperately
need.
Thank
you
for
your
time.
B
I
Good
afternoon
chairwin,
my
name
is
trey
delaps
david,
easy,
lincoln,
adam
paul
on
behalf
of
naomi
nevada.
The
state
chapter
of
the
national
alliance
on
mental
illness
in
support
of
senate
bill
5.
nami
is
a
grassroots
mental
health
organization,
dedicated
to
building
better
lives
for
the
more
than
400
thousand
nevadans
affected
by
mental
health
concerns.
I
I
just
want
to
note
a
twinge
of
irony
that
I
am
calling
in
to
deliver
audio
only
testimony
via
a
telephone
telephonic
testimony
was
necessitated
by
public
health
crisis
and
we
have
adapted
to
the
capabilities
of
the
state
and
the
public.
I'm
hopeful
that
the
information
I
provide
now
will
be
treated
in
parity
as
if
I
was
delivering
it
in
person,
and
that
is
why
sb5
is
so
relevant
because
it
ensures
that
we
are
meeting
people
where
they
are
based
on
current
realities
in
a
manner
accessible
to
all.
I
I
25
percent
of
calls
come
regarding
treatments
and
20
regarding
support,
encouragement
and
reassurance.
Miami
nevada's
warm
line
has
served
over
600
people
since
october
2020.
for
those
impacted
by
mental
health.
It
is
critical
that
persons
be
able
to
access
assistance
by
any
means
available
to
them.
For
many
people,
a
telephone
with
audio
only
capability
may
be
the
only
way
to
access
information
or
support.
I
That
would
mean
the
difference
between
life
and
death
senate
bill
5
advances
an
essential
piece
of
an
effective
community-based
resource
so
that
all
people
have
access
to
a
basic
human
connection
to
get
the
best
information
or
support
at
the
right
time.
Thank
you
for
hearing
this
bill
and
we
urge
your
support.
A
B
I
Good
afternoon,
madam
chair
members
of
the
committee,
my
name
is
tom
clark,
that's
t-o-m-c-l-a-r-k,
and
I'm
here
today
on
behalf
of
the
nevada
association
of
health
plans,
speaking
in
opposition
to
senate
bill
5.,
we
appreciate
and
have
supported
the
legislature's
telehealth
efforts
in
the
past.
Given
everyone
the
ability
to
be
innovative
with
their
health
care
services,
as
we
continue
to
face
the
ripple
effects
of
the
pandemic,
making
sure
patients
can
access
care
is
our
priority.
I
Telehealth
options
allow
patients
to
do
so
safely
securely
and
conveniently
from
everywhere
we
support
the
sections
of
sp5
that'll
allow
for
the
data
dashboard.
However,
we
oppose
the
payment
parity
provisions
mandated
in
senate
bill
5..
Insurers
must
continue
to
have
flexibility
to
negotiate
prices
to
keep
health
coverage
costs.
Affordable,
telehealth
services
must
be
comparable
to
the
services
provided
in
an
office
visit.
I
Insurers
and
providers
must
be
able
to
establish
different
reimbursement
rates
based
on
the
clinical
effectiveness
and
intensity
of
the
visits.
It's
really
important
that
we
can
develop
value-based
arrangements
with
providers
by
focusing
on
health
outcomes,
not
just
the
volume
of
services
provided
this
bill
prohibits
insurance
companies
from
doing
just
that.
I
A
B
H
Good
afternoon,
this
is
julia
peek
for
the
record,
j-u-l-I
j-u-l-I-a
p-e-e-k,
and
I'm
with
the
division
of
public
and
behavioral
health.
I
just
wanted
to
let
you
know
that
the
division
has
provided
some
testimony
in
neutral,
based
on
amendment
number
174.
We
were
able
to
remove
our
fiscal
note
so
though
it
is
still
reflected
in
nellis.
H
A
C
Thank
you
so
terwyn
members
of
the
committee,
sarah
till
hagian,
for
the
record.
My
concluding
remarks
are
just
a
sincere
gratitude
for
giving
me
the
opportunity
to
come
before
you
and
present
this
important
measure
on
behalf
of
the
patient
protection
commission,
and
I
appreciate
your
consideration.
Thank
you.
So
much.
A
Thank
you,
and
with
that
I
will
close
the
hearing
on
senate
bill
five
at
this
time.
We'll
go
to
our
last
agenda
item,
which
is
public
comment,
and
I
will
see
if
there's
anyone
in
the
room
that
is
here
to
provide
public
comment,
seeing
no
one
just
love
to
watch
hhs
on
a
friday
afternoon,
so
broadcast
services.
If
we
can
go
to
the
call
to
call
line
for
those
in
public
comment.
B
A
Thank
you,
and
are
there
any
comments
from
members
before
we
adjourn
today,
seeing
none
this
can
just
some
housekeeping
and
some
you
know,
lay
the
land
for
the
next
week.
We
will
not
be
having
an
hhs
meeting
on
monday.