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A
Good
afternoon,
everyone
I'm
going
to
call
this
meeting
to
order
of
the
assembly
committee
on
health
and
human
services
members
before
we
begin
make
sure
you
mute
your
microphone
when
you
are
not
speaking
to
minimize
any
background
noise
and
also,
please
turn
your
cameras
on
madam
secretary.
Please
call
the
roll.
C
A
A
Here
we
have
a
quorum.
Madam
secretary
is
an
assembly
woman,
benitez
thompson
arrives.
Can
we
mark
her
present
when
she
drives
on
to
the
zoom?
I
will
try
to
catch
that
too.
If
I
see
her
join
I'd
like
to
welcome
our
audience
again
for
joining
us
this
afternoon
for
assembly
health
and
human
services.
A
Today
we
have
three
bills,
so
we
are
going
to
try
to
be
as
efficient
with
our
time
as
possible
before
we
begin
again
remember
to
keep
your
camera
on,
we
will
have
the
opportunity
for
the
public
to
provide
comment
on
both
in
support
opposition
and
neutral
to
all
three
of
the
bills
that
are
being
presented.
I
will
be
timing
just
to
make
sure
everyone
has
a
fair
and
equal
opportunity
to
present
their
testimony
again
in
support
opposition
or
neutral
to
all
three
of
the
bills
that
we
are
presenting.
A
I
may
take
the
bills
out
of
order,
but
it
looks
like
I'm
going
to
take
them
right
now,
as
I'm
looking
at
it
as
they
appear
on
the
agenda,
and
with
that
I
will
move
to
our
first
bill
hearing.
So
I
will
open
up
the
hearing
on
assembly
bill
189.
A
This
bill
establishes
presumptive
medicaid
eligibility
for
certain
pregnant
women
for
those
that
have
you
that
have
been
paying
attention.
We
did
introduce
the
committee
bill
that
came
out
of
the
interim
health
committee
and
we
have
decided
they
were
very
similar,
and
so
you
will
see
some
amendments.
A
I
believe
that
assemblywoman
gorlo
has
already
submitted,
and
that
might
be
on
nellis
and
I'm
sure
she
will
talk
about
it
during
her
presentation
of
assembly
bill
189,
but
it
does
incorporate
that
so
rather
than
hear
the
same
bill
twice,
we
are
just
going
to
probably
incorporate
much
of
that
language
and
that
work
that
took
place
during
the
interim
committee
into
assembly
bill
189.
But
with
that
I
will
turn
this
over
to
assemblywoman
gorlo.
Please
get
begin
when
you
are.
E
Ready,
thank
you
so
much
chairwin
a
good
afternoon,
madam
chair
and
members
of
the
health
and
human
service
committee
for
the
record.
I
am
michelle
gorlow
and
I
represent
assembly
district
35.
I
am
also
a
member
of
the
nevada
mch
steering
committee
mch
standing
for
maternal
child
health.
I'm
the
immediate
past,
chair
of
southern
nevada,
mch
coalition
and
immediate
past
co-chair
of
the
state
mch
coalition.
E
I'm
pleased
here
today
to
be
presenting
ab189
8189,
is
about
improving
access
to
health
care
for
pregnant
women
and
because
we
all
know
healthier
moms
mean
healthier
babies
and
lower
costs
for
everyone.
As
chairwin
mentioned,
we
will
be
including
an
amendment
that's
going
to
include
part
of
actually
it's
going
to
include
all
of
ab
193,
which
was
the
committee
bill
that
was
introduced
from
the
interim.
E
E
E
A
preterm
birth
is
divided
into
three
categories
based
on
gestational
age.
We
have
extremely
pre-term
babies,
which
are
those
that
are
born
earlier
than
28
weeks,
very
preterm
babies,
which
are
born
between
28
and
32
weeks
and
moderate
or
late
preterm
babies,
which
are
born
between
32
and
37
weeks.
Each
year
in
nevada
we
have
around
3
800
pre-term
births
the
highest.
I
remember,
seeing
over
the
last
15
years
was
5400
births,
so
we've
done
a
really
good
job
of
reducing
it.
E
However,
our
preterm
birth
rate
is
still
10.7
percent,
which
march
of
dimes
gives
us
a
d
plus
on
their
annual
report
card.
Looking
at
you
know,
the
vast
majority
of
pre-term
births
are
about.
85
percent
are
moderate
to
late
pre-term,
followed
by
about
nine
percent
being
32-37
weeks
and
six
percent
being
extremely
pre-term.
Excuse
me
pre-term.
When
we're
looking
at
the
preterm
birth
rate,
we
break
it
down
to
race
and
ethnicity.
African-American
women
have
the
highest
at
13.7
percent
native
american
women
are
second
and
12.1.
E
Asian
ladies,
are
at
11.0
percent,
and
then
hispanic
and
caucasian
women
are
right.
Around
9.6
to
9.8,
respectively
pre-term,
birth
and
low
birth
weight
are
associated
with
significant
economic,
medical
and
social
costs
as
well.
Printer
birth
is
not
only
the
leading
cause
of
neonatal
mortality
is
also
associated
with
short
and
long-term
disabilities
and
morbidities.
E
A
2007
review
by
the
institute
of
medicine,
estimated
the
economic
burden
of
pre-term,
birth,
united
states
to
be
26.2
billion,
and
that
was
in
2005
dollars
that
averaged
about
51
600
per
pre-term
birth
there's
been
some
updated
calculations.
I've
seen
a
variety
of
them
that
kind
of
averages
preterm
birth
to
be
between
65
000
and
76
000.
E
However,
the
longer
you're
in
the
nicu,
the
longer
that
can
be
a
baby
born
at
about
32
weeks,
averages
about
280
000
a
year,
and
I
was
reading
about
triplets
being
born
at
28
weeks.
They
all
spent
about
two
months
in
the
nicu
at
a
cost
of
four
million
dollars.
E
Well
cost
estimates
vary
studies
consistently
show
that
they
are
the
highest
for
extremely
pre-term
infants,
and
increasing
gestational
age
by
just
weeks
can
result
in
significant
cost
savings.
This
is
intuitive
as
the
early
pre-term
babies
generally
require
most
time
in
the
hospital
in
nevada.
The
average
length
of
stay
for
extreme
preterm
babies
was
anywhere
from
54
to
78
days.
In
the
recent
years,
the
length
of
stay
for
very
preterm
babies
was
slightly
lower
between
49
and
53
days.
E
In
contrast,
the
average
length
of
stay
for
moderate
or
late
preterm
babies
was
only
about
nine
to
ten
days,
and
I
do
want
to
kind
of
compare
that
for
a
full
term.
Infant
who
may
only
stay
one
or
two
days
in
the
hospital
that
cost
is
roughly
five
hundred
to
twenty
nine
hundred,
so
huge
difference
and
just
kind
of
give
you
a
personal
story.
My
son,
who
was
born
in
2006,
spent
five
days
in
the
nicu
and
it
cost
fifteen
thousand
dollars
and
he
was
not
a
super
sick
baby.
E
He
had
some
feeding
issues
some
temperature
control
issues,
but
he
was
not
a
super
sick
baby.
So
what
do
we
do
to
increase
the
gestational
age
of
babies
born
in
nevada?
We
improve
prenatal
care
for
moms
nevada.
Medicaid
is
the
single
largest
pair
of
births
in
the
state
covering
more
than
half
of
the
birth
state
statewide
edge.
Such
is
uniquely
positioned
to
improve
both
maternal
and
child
health
outcomes
assembly
bill
189.
E
As
we
mentioned,
the
amendment
will
improve
access
to
prenatal
care
and
other
health
services
by
expanding
medicaid
eligibility
for
pregnant
women
in
nevada.
E
Specifically,
the
bill
requires
the
director
of
the
department
of
health
and
human
services
to
include
authorization
in
the
state
plan
for
medicaid
for
pregnant
women
to
enroll
in
medicaid.
If
she
is
determined
to
be
presumptive
eligible
by
a
qualified
provider,
a
qualified
provider
is
an
eligible
entity
for
payment
under
the
state's
approved
plan
and
is
determined
by
the
state
to
be
capable
of
making
determinations.
E
The
period
of
medicaid
enrollment
continues
until
the
last
day
of
the
month
after
the
month
of
enrollment,
which,
during
which
a
pregnant
woman,
must
submit
a
full
medicaid
application
for
coverage
to
continue,
and
I
want
to
make
sure
that
this
is
on
the
record.
The
idea
is
that
the
woman
does
not
wait
until
the
end
of
that
second
month.
We
want
that
application
to
be
in
the
process
of
going
through,
while
she's
getting
care,
so
there's
no
lapse
in
care.
E
E
The
proposed
amendment.
This
policy
was
also
proposed
by
the
legislative
committee
on
health
care
during
the
2019
and
2020
interim.
In
fact,
the
committee
voted
unanimously
to
pursue
a
bill
that
not
only
mirrors
this
requirement
but
also
expands
medicaid
coverage
for
pregnant
women
in
three
additional
ways.
The
committee's
bill,
ab193
and
because
of
its
goals,
are
very
similar.
We
decided
to
go
ahead
and
combine
that,
and
that
was
with
the
approval
of
the
assemblywoman
chair
cohen,
who,
as
I
mentioned,
she's
the
chair
of
the
committee
during
the
interim.
E
E
Currently,
lawful
resident
residing
pregnant
women
must
wait
five
years
before
they're
eligible
for
medicaid,
we're
looking
to
waive
that
and
we're
requiring
dhhs
to
apply
for
a
waiver
from
the
federal
government
to
allow
a
pregnant
woman
and
her
child
to
keep
medicaid
coverage
until
12
months
after
the
child
is
born.
She
can
be
taken
care
of
during
the
postpartum
period.
E
Just
so
you
also
know,
the
federal
government
is
also
looking
at
this
being
considered
included
in
the
federal
american
recovery
act.
So
we're
still
looking
to
see
if
they're
going
to
require
that
requirement
as
well.
E
But,
as
I
mentioned,
there
is
a
recovery,
the
american
recovery
act
that
may
be
including
that
also.
So
why
is
early
prenatal
care
important?
E
We
do
have
dr
slotnick,
who
is
prepared
to
speak
on
another
bill,
but
I
have
told
him
that
if
he
would
like
to
speak
on
this,
I
would
love
to
have
him.
But
really
I
want
to
kind
of
talk
before
I
have
dr
slotnick
present
mention
that
early
prenatal
care
is
defined
at
care
during
the
first
trimester
so
up
to
about
12
to
13
weeks
of
care.
The
u.s
average
is
77.6
as
of
2019..
E
E
Late
to
no
prenatal
care
in
the
us
is
6.4.
Nevada
has
9.4
percent.
The
healthy
people
objective
really
would
like
to
see
that
under
five
percent
we
rank
when
we
compare
ourselves
to
other
states
48
out
of
52.
We
had
in
dc
and
puerto
rico.
So
I
know
we
can
do
much
better
than
that.
E
Some
of
the
reasons
that
we'd
like
to
we
want
women
to
have
early
prenatal
care
is
so
that
we
can
first
get
a
due
date.
Know
when
she's
going
to
do.
Is
she
pregnant
with
a
singleton
or
is
she
pregnant
with
multiples?
We
want
to
get
baseline
of
her
vitals.
What's
her
blood
pressure,
normally
what's
her
weight
level,
because
we
don't
want
her
to
gain
too
much
weight
and
blood
pressure?
E
If
that's
starts
spiking
during
her
pregnancy,
it
can
be
an
indication
for
preeclampsia,
which
is
a
condition
that
we
really
don't
know
why
a
woman
woman
has
it
it
just.
She
just
has
it
during
pregnancy,
and
the
only
cure
per
se
is
to
deliver
the
baby,
and
she
definitely
needs
to
be
monitored
because
she
can't
have
a
stroke.
So
those
are
things
we
want
to
check
out.
We
also
want
to
do
testing
for
sexually
transmitted
diseases.
E
A
nevada
is
one
of
the
highest
states
for
congenital
syphilis,
so
we
want
to
make
sure
we
can
test
and
treat
women
for
stds.
We
want
to
do
interventions
for
women
who
may
be
using
alcohol,
tobacco
products
or
drug
use,
both
prescription
and
non-prescription,
and
manage
any
chronic
illnesses
she
may
have.
If
she
already
has
diabetes.
We
definitely
want
to
monitor
that
some
women
will
develop
diabetes
during
pregnancy
and
another
condition
we're
going
to
want
to
monitor.
So
we
want
to
get
her
in
as
early
as
possible.
E
F
Thank
you
michelle.
My
name
is
nathan.
F
I
I'm
a
high
risk,
obstetrician
medical
geneticist.
F
I
was
asked
by
assemblywoman
krasner
to
address
a
specific
genetic
issue
having
to
do
with
pregnancy,
but
I've
been
in
practice
for
many
many
many
years,
and
I
do
want
to
underline
it's
precisely
what
assemblywoman
gorlo
has
just
accentuated,
which
is
the
singular
thing
we
can
do
to
identify
and
treat
and
anticipate
pre-term
labor
is
early
pre-term
pre,
early
prenatal
care,
early
prenatal
care,
absent
prenatal
care
or
compromised
prenatal
care
is
a
four-lane
highway,
basically
to
preterm
delivery
and
if
we're
trying
to
provide
the
best
possible
care
for
the
pregnant
women
of
the
state
of
nevada,
early
prenatal
care
is
the
best
approach
we
can
have.
F
B
E
E
G
Absolutely
thank
you
for
letting
me
speak
to
our
story.
Today.
Our
adoptive
daughter
was
born
at
approximately
33
weeks
gestation,
with
a
condition
called
gastroschisis.
This
is
when
some
or
in
case,
in
her
case
all
of
her
intestines,
were
on
the
outside
of
her
body.
At
time
of
birth,
her
lower
half
was
placed
in
a
protective
sterile
sheet.
Bag
called
a
silo
to
keep
her
safe
from
infection
for
the
first
48
hours
until
the
first
surgery
could
take
place.
G
Unfortunately,
her
intestines
began
to
die
off
and
continue
to
do
so
for
the
first
two
years
of
her
life
as
they
died
off.
She
had
to
return
to
surgery
to
have
them
removed.
Skyler
now
only
has
half
of
the
intestines.
She
should
skyler
spent
the
first
13
months
of
her
life
in
the
hospital.
She
went
from
the
neonatal
intensive
care
unit
to
the
pediatric
intensive
care
unit
to
try
and
discharge
her.
G
She,
however,
was
considered
too
unstable
to
go
home
and
was
sent
to
a
long-term
nursing
facility
until
skyler
was
three
and
a
half
years
old
and
discharged
to
us.
She
lived
between
the
hospital
and
the
nursing
facility,
though
some
children
with
this
content.
This
condition
can
tolerate
food
directly
into
her
stomach
with
boobs.
Skyler
has
not
been
fortunate.
She
is
now
also
dependent
on
a
permanent
iv
that
lives
in
her
chest
to
meet
her
caloric
needs.
G
Even
now,
with
her
home,
she
has
her
iv
nutrition,
14
hours
a
day,
two
pumps
to
infuse
that
emergency
medications
with
us
at
all
times
and
continuous
feeding
tubes
24
hours
a
day.
This
condition
can
happen
naturally,
but
in
schuyler's
case
it
is
believed
to
be
caused
by
biological
mom's
drug
involvement.
Members
of
this
committee.
This
is
why
ab-189
is
so
important
to
pass
and
hopes
to
prevent
or
minimize
this
condition
and
life
circumstances
like
schuyler's
schuyler's
life
could
have
been
very
different
if
help
was
available
for
bio
mom.
Thank
you
for
your
time.
Today.
G
D
D
D
Only
one
in
three
pregnant
women
living
in
laughlin
receive
early
prenatal
care
in
washoe,
one
in
five
receive
early
care,
which
experts
attribute
to
a
disproportionate
lack
of
care
in
its
rural
areas.
No
one
experiencing
the
fear.
I
felt
that
day
should
also
have
to
worry
about
whether
they
can
afford
to
see
a
doctor
find
a
doctor
or
find
a
doctor
that
will
properly
address
their
concerns
and
save
their
baby's
life.
D
The
collaborative
is
alarmed
by
our
state's
maternal
mortality
and
morbidity
rates.
We
know
that
access
to
care
increases
utilization
during
early
pregnancy,
cdc
data
indicates
significant
increases
in
pre-contraception,
preconception
health
conversations
with
providers,
folic
acid
consumption
and
postpartum
contraception
use.
When
women
have
access
to
medicaid,
we
have
established
a
multi-year
statewide
plan
to
increase
medicaid,
enrollment
and
utilization
to
improve
health
outcomes
for
low-income
pregnant
persons
and
babies.
D
Our
goals
include
presumptive
eligibility,
extending
postpartum
coverage,
increasing
the
percentage
of
federal
poverty
level
at
which
pregnancy
is
medicaid
eligible
and
ensuring
lawfully
residing
pregnant
persons
can
access.
Medicaid
data
shows
these
actions
increase
the
likelihood
pregnant
women
will
seek
early
care
and
have
positive
pregnancy
and
birth
outcomes.
D
In
2007,
the
institute
of
medicine
calculated
a
pre-term
birth
typically
resulted
in
a
33
000
bill,
while
a
full
term
birth
cost
about
three
thousand
dollars.
That's
a
difference
of
thirty
thousand
dollars
per
birth.
Thank
you
for
allowing
us
to
speak.
Thank
you
for
not
being
loud
and
disruptive,
and
thank
you
for
your
consideration
of
these
important
efforts
to
protect
moms
and
babies.
E
Thank
you
so
much
for
being
here
today.
I
really
appreciate
you.
I
just
want
to
mention
before
we
go
to
questions.
There
are
about
50
000
women
that
do
live
in
obstetric,
deserts
in
nevada
and
so
again
presumptive
eligibility
can
really
help
a
lot
of
those
women
who
have
to
travel
long
distances
to
get
to
a
doctor.
So
if
we
can
presume
them
eligible
and
they
can
work
on
their
application
at
the
same
time,
we
can
get
them
the
care
that
they
need
and
chair
I'm
available
for
questions.
A
Thank
you
for
your
presentation
assembly,
one
woman
gorlo.
I
love
the
normalizing
of
working
women.
My
children
would
have
been
vomiting
all
over
me
and
probably
screaming
and
pulling
my
hair.
So
I
found
that
quite
impressive
that
you
were
able
to
get
through
that
entire
presentation
so
eloquently
with
your
child.
She
is
an
angel,
so
I
I
also
wanted
to
I'm.
You
know.
A
I
know
that
this
is
a
reason
that
you
got
into
politics,
and
so
I
I
think
we
can
all
see
your
passion
in
your
presentation
of
this
bill
so
and
with
that,
my
other,
like
sentimental,
I'm
having
like
a
mom
moment,
is
it's
just
exciting
during
women's
history
month
that
we
are
sitting
here
in
a
committee
made
up
of
lots
of
women
and
legislative
working
moms
that
are
at
the
table
and
can
have
those
kind
of
conversations.
A
I
don't
think
it
was
too
long
ago
that
it
was
a
different
makeup
of
a
room
talking
about
women's
health
and
pregnancy,
from
someone
who
has
never
had
a
child,
so
I
think
that's
very
exciting,
and
with
that
I
will
entertain
any
questions
that
you
might
have
and
I'd
also
encourage
people
to
look
at
the
interim
committee
work
that
was
found
on
that.
A
I'm
having
our
policy
analyst
patrick
ashton,
send
that
out
to
the
committee
on
this
bill
as
well
as
the
bill
after
this,
so
you
can
review
some
of
the
interim
work
that
was
done
in
preparation
for
this
bill
presentation
as
well,
and
with
that
do
I
have
any
questions.
If
you
guys
can
just
raise
your
hand
if
you
have
anything,
I
see
assemblywoman
titus
and
I
will
have
her
up.
H
Thank
you,
madam
chair,
and
thank
you
assemblyman
garlow
for
this
bill
and
thank
you
for
allowing
me
to
be
a
ghost
a
co-sponsor
on
this
bill.
We
have
been,
and
I
have
been
asking
questions
for
a
long
time
regarding
presumptive
eligibility
and
lowering
medicaid
cost.
H
I
do
appreciate
all
the
testimony
regarding
the
cost
of
premature
delivery,
the
cost
of
taking
these
care
of
these
children.
I
just
want
committee
members
to
understand
that
when,
when
these
babies
are
born,
they're
ours,
and
so
we
have,
we
take
care
of
them,
and
so
I've
been
arguing
a
long
time.
Why
don't
we
take
care
of
why
they're
still
intrauterine
when
and
we
can
make
them
healthier
babies
when
they
come
out
and
so
because
eventually
they're
going
to
be
hours
and
so
I'd?
H
Rather
they
hit
the
healthy
nevadans
and
come
out
with
some
issues
that
we
then
continue
to
pay.
For.
I
think
my
question
would
be
that
to
be
good
for
the
record,
because
I'm
going
to
argue
this
bill
as
being
fiscal.
The
return
on
investment
can
argument
can
be
made
here
for
for
nevadans
and
what
does
it
cost
to
have
these
women
have
prenatal
care?
H
We
heard
about
the
cost
of
taking
care
of
their
babies
after
they're
born
if
there's
a
problem
premature
and
whether
they're
26
weeks
or
you
know
second
trimester,
third
trimester
and
all
those
numbers.
What
will
this
cost
medicaid
by?
Did
we
get
a
fiscal
note
on
this
and
what
what
was
the
cost
estimated
per
per
enrollee
say?
Is
it
a
thousand
dollars
for
the
prenatal
care
or
or
how
does
that
work.
E
Thank
you
assembly,
women
who
you
through
chairwin.
You
know
I
did
just
get
a
fiscal
note
today
and
totaled
it
up
and
it's
about
6.8
million
dollars.
I
would
have
to
look
and
see
what
it
is
per
woman,
but
when
I
was
doing
the
math
at
about
76
000,
that's
90
babies,
that's
it
90
babies.
We
need
to
get
full
term
and
we're
going
to
break
even
with
our
preterm
birth
rate
being
around
3
800.
E
I
think
that's
totally
doable
that's
reducing
our
preterm
birth
by
two
percent
and
with
the
healthy
people
objective
of
having
us
at
around
9.4
percent.
Overall,
that's
more
than
90
birth.
So
our
our
goal
really
is
to
get.
I
have
to
do
the
math
off
the
top
of
my
head
9.4.
We
would
have
so
I'm
trying
to
do
math
in
my
head.
We
have
about
3,
600
or
36
000
births.
10
percent
would
be
3
600,
so
to
get
9
we're
looking
around,
maybe
3
500..
E
H
And
that's
the
point
I
wanted
to
make
on
the
record:
is
that
indeed
it
doesn't
take
us
many
babies
or
many
women
to
to
lower
the
overall
cost
so
hate
to
be
about
numbers
on
this
one,
but
really
medicaid
cost
is
huge,
and
and
with
a
fiscal
note
of
that
that
size,
I
think
we
need
to
keep
it
in
perspective,
because
the
first
response
is
going
to
be
no
it's
too
expensive,
but
I,
I
would
say
not
only
emotionally
and
physically
for
those
who
testified
about
the
health
of
their
child.
H
You
know
that
that
that's
you
know
priceless
right.
We
can't
even
put
a
cost
on
that,
but
in
real
dollars
for
the
state,
I
I
think
we
need
to
document
that.
The
second
thing
is
to
note
that
we
only
do
this
as
allowed
by
the
federal
government
so
again,
and
that
needs
to
be
noted
that
this
we
can't
we
won't
be
doing
this
and
at
risk
of
losing
our
medicaid
dollars.
We
have
to
make
sure
that
we're
in
conjunction
with
the
federal
government
regulations.
B
Thank
you.
A
couple
questions.
I'm
a
little
foggy
on
the
qualified
provider
we'll
decide
or
help
the
patient
figure
out
if
they're
eligible
what
I
understand
the
intent.
But
how
does
that
process?
Look
when,
when
the
mom
comes
in
and
she's
visiting
with
her
provider
is
her
provider?
Gonna
have
to
ask
her
those
qualifying
questions.
E
For
the
record
assembly
woman,
michelle
gorilla
and
to
you
assemblywoman
black,
through
chairwin,
yes,
the
provider
will
have
to
ask
qualifying
questions
to
make
sure
that
the
woman
would
qualify
for
medicaid.
Not
anybody
can
just
say:
oh
I'm
going
to
be
presumed
eligible
and
get
the
care.
If
they
do
not
meet
the
federal
guidelines,
then
they
cannot
be
presumed
eligible.
So
there
will
be
questions
for
the
provider
to
ask
the
pregnant
mom
so
that
we
can
make
sure
that
she
would
normally
qualify
as
her
pro
her
application
is
being
processed.
E
The
idea
is
that
the
provider
will
have,
and
I
apologize-
the
provider
needs
to
have
in
other
states
a
high
acceptance
rate
on
their
medicaid
in
other
states,
it's
usually
between
90
and
95
percent,
that
they
are
accepted
on
medicaid,
so
they're,
not
just
again
accepting
anyone
or
presuming
anyone
eligible.
A
I
Good
afternoon
dwayne
young
deputy
administrator
for
the
division.
Also
here
with
us,
is
lisa
suergen,
who
is
the
chief
of
eligibility
and
payments?
She
can
speak
a
little
bit
more
to
the
actual
process.
What
I
can
speak
to
and
the
assemblywoman
has
done
an
absolutely
phenomenal
job
really
laying
this
all
out,
but
really
the
only
difference
is
that
these
women
would
receive
outpatient,
ambulatory
services
in
the
period
in
which
they
were
eligible.
I
They
would
have
60
days,
and
at
least
it
could
go
into
those
details
to
submit
their
full
medicaid
application
once
being
made
fully
medicaid
eligible.
We
would
go
back
90
days
and
cover
all
those
other
services
that
are
outside
of
the
ambulatory
outpatient
services
related
to
the
breakfast
and
I'll
turn
it
over
to
lisa.
B
Thanks
dwane,
this
is
lisa
swearing
for
the
record,
I'm
the
chief
of
eligibility
and
payments
with
the
division
of
welfare
and
supportive
services.
So
we
currently
have
a
presumptive
eligibility
program
through
the
hospitals
and
that's
a
process
that
we
have
in
place
where
they
they
apply.
They
get
certified
they're
trained.
They
have
to
meet
certain
criteria.
B
We
would
do
that
of
the
same
with
with
this
other
group.
They
would
have
to
go
through
training
be
certified,
and
then
we
have
a
quality
control
group
that
goes
out
and
monitors
to
make
sure
that
they're
meeting
all
the
federal
requirements.
B
These
individuals
are
eligible,
for
we
say
two
months:
it's
actually
the
last
day
of
the
month
following
the
month
of
enrollment,
so
it
could
be
30
days.
If
say
somebody
applied
at
the
30th
of
the
month.
They
would
only
get
to
the
end
of
the
following
month,
so
it's
important
and
assembly
women
gorlo
did
state
earlier
it's
important
that
these
providers
work
with
these
individuals
to
make
sure
that
they
submit
that
medicaid
application
so
that
we
can
get
them
enrolled
sooner
and
make
sure
that
there's
not
a
break
in
service.
B
I
think
they
answered
it,
but
I
just
go
right
ahead.
I
guess
that
that
may
be
where
I'm
misunderstanding,
this
sentence
in
section
one
one
through
the
last
day
of
the
month
immediately
following
the
month
of
enrollment,
without
submitting
an
application
for
enrollment
in
medicaid,
which
includes
additional
proof
eligibility.
B
G
B
Within
that
time
period
they
have
to
submit
a
full
medicaid
application
and
the
verifications
to
be
determined
eligible
for
medicaid
if
they
apply
at
the
end
of
march
that
it's
the
month,
the
last
of
the
month
following
enrollment,
so
that
means
they
actually
only
get
from
march
30th
through
the
end
of
april.
So
that's
what
I'm
saying:
there's
a
kind
of
a
shortened
window
there,
but
we
are,
you
know
stressing
that
they
they
get
those
applications
submitted
as
soon
as
possible
so
that
we
can
get
them
full
medicaid.
A
Looking
out
there,
I
don't
see
any
at
this
time.
Thank
you
for
your
presentation,
and
at
this
time
we
will
go
to
broadcast
services
to
get
ready
to
take
callers
and
support.
It
looks
like
we
have
quite
a
few
people
that
have
registered
to
provide
testimony
on
assembly
bill
189.
A
I
just
remind
our
callers
to
please
remember,
to
clearly
state
and
spell
your
name
for
the
record.
Please
limit
your
testimony
to
two
minutes
again.
I
would
encourage
anyone
to
provide
any
additional
written
testimony
within
48
hours
of
the
close
of
assembly
bill
89.
If
you
would
like
it
to
be
considered
that
way,
we
will
be
timing,
each
figure
just
to
make
sure
we
have
a
fair
opportunity
for
everyone
to
speak
and
with
that
broadcast
services.
J
K
K
I
just
wanted
to
go
on
the
record
today
as
an
s2
in
support
of
8189
too,
had
access
to
great
prenatal
care,
including
many
visits
to
the
high
risk
pregnancy
center,
and
without
that
access
things
could
have
been
very
different
from
my
now
three
and
a
half
year
old
son
jack.
Let's
give
that
access
to
everyone.
Thank
you
and
I'm
available
to
answer
any
questions.
J
I
I
Presumptive
eligibility
serve
the
important
role
of
providing
immediate
access
to
much
needed
health
care
for
pregnant
women,
while
also
putting
them
on
a
path
to
continued
coverage.
The
importance
of
quality,
prenatal
and
postpartum
care
is
well
known
and
we
are
supportive
of
making
it
easier
for
pregnant
women
to
access
these
services.
We
strongly
support
ab189
and
urge
the
committee
too,
as
well.
Thank.
L
J
I
Carowind
members
of
the
assembly
health
committee,
my
name
is
connor
kane
c-o-n-n-o-r-c-a-I-n
and
I'm
testifying
today
on
behalf
of
hca
and
sunrise
hospital
in
support
of
ab189
I'd
like
to
first
thank
all
the
sponsors
of
this
legislation,
but
especially
assemblywoman
gorlo
for
all
of
her
work
on
this
issue.
I
As
many
of
you
are
aware,
sunrise
hospital
is
the
largest
provider
of
medicaid
services
in
the
state.
It's
something
we're
extremely
proud
of,
but
given
that
our
state
ranks
49th
in
medicaid
expenditures
per
capita,
it's
also
challenging
roughly
4
500
babies
are
born
every
year
at
sunrise
hospital
and
about
80
percent
of
them
are
covered
by
medicaid
the
most
vulnerable.
These
babies
end
up
at
at
the
hospital
72
bed
nicu,
which
is
the
largest
and
most
comprehensive
in
the
region.
I
I
K
Speaking
on
behalf
of
the
nevada
women's
lobby.
We
want
to
thank
assemblywoman
gorilla
for
bringing
this
legislation
forward,
which
will
allow
pregnant
women
access
to
critical
care
during
pregnancy
through
the
birth
process
and
through
recovery.
Now
that
is
in
the
top
12
states
when
it
comes
to
the
percent
of
women
who
are
uninsured
during
pregnancy,
please
help
ensure
mothers
and
babies
are
healthy
by
giving
giving
access
to
necessary
insurance
through
pregnancy
by
passing
this
key
legislation.
Thank
you
for
your
time.
J
K
Leah
case
l-e-a-c-a-s-e
here
today
on
behalf
of
the
nevada
psychiatric
association,
npa,
would
like
to
express
our
support
for
8189
as
amended
expanding
postpartum
medicaid
coverage
from
60
days
to
12
months
following
child
birth.
According
to
the
cdc
erased,
maternal
mortality
update
for
the
western
district
mental
health
conditions
are
the
leading
cause
of
preventable
pregnancy-related
death.
I've
submitted
this
information
to
the
committee
secretary.
K
These
deaths,
including
suicides
and
overdoses,
were
more
likely
to
occur
between
43
days
and
one
year
after
giving
birth.
Extending
postpartum
medicaid
coverage
for
a
full
year
will
give
mothers
continuity
of
care
and
access
to
appropriate
treatment
for
any
number
of
postpartum
health
issues,
including
postpartum
depression
and
postpartum
psychosis.
K
J
M
J
M
M
As
a
new
mother
of
two
months,
I
cannot
imagine
having
to
worry
about
health
coverage
during
my
pregnancy,
even
with
medical
coverage,
any
physical
and
emotional
stress
of
pregnancy
can
create
a
hostile
environment
for
the
infant
and
medical
complications
for
the
expectant
mother.
Lack
of
adequate
and
easily
accessible
medical
coverage
is
an
immense
stressor
no
mother
should
have
to
endure.
I
would
like
to
highlight
today
that
pregnant
women
in
nevada
suffering
low
income
status,
often
persons
of
unders
under
served
black
and
brown
communities,
are
already
a
tremendous
vulnerable
population.
M
These
women
are
already
living
under
tremendous
weight
of
significant
disparities
within
our
society,
suffering
from
struggles
with
nutrition
income,
trauma,
etc.
These
women
should
never
have
to
wonder
how
they
will
be
able
to
survive,
childbirth
or
bear
healthy
babies.
They
deserve
the
basic
human
right
of
access
to
quality
medical
coverage
both
during
pregnancy
and
postpartum.
Thank
you.
C
Well,
good
afternoon,
everybody
here
today
my
name
is
lashawn
demar
austin,
l-a-s-h-o-n-d-a,
m-a-r-v-e,
hyphen,
austin
a-u-s-t-I-n,
I'm
here
today
to
support
ab-189
as
it
commended.
I
went
through
postpartum
depression
with
my
daughter.
I
was
not
able
to
properly
care
or
nurse
her.
Having
to
put
her
on
formula
is
something
that
I
didn't
want
to
do
had
I
had
the
opportunity
to
have
extended
coverage
through
medicaid.
C
J
I
Good
afternoon
my
name
is
quentin
savoie,
that's
q-u-e-n-t-I-n,
savoir
s
like
sam
a-like,
apple
v,
like
victor
w-o-I-r
good
afternoon
chairwoman,
wynn,
honorable
members
of
the
committee,
I'm
quentin
savoie
deputy
director
at
make
it
work
nevada.
We
work
alongside
black
women
and
black
families
in
the
areas
of
economic
justice,
racial
justice
and
reproductive
justice.
I
We're
thrilled
that
assemblywoman
gorlo
has
brought
this
bill
to
the
committee
and
that
the
committee
is
hearing
this
measure.
As
we've
long
worked
to
build
power
to
bring
greater
awareness
to
issues
around
maternal
mortality
in
our
country,
the
united
states
has
become
the
most
dangerous
place
in
the
developed
world
for
a
person
to
give
birth.
I
Ab189
is
a
racial
and
reproductive
justice
issue.
That
is
the
first
step
to
shake
the
scourge
of
this
unsettling
statistic.
By
now.
I
know
that
you
all
have
heard
the
research
and
data
about
how
disparate
the
realities
are
for
black
women,
brown,
women
and
other
melanated
parents
during
childbirth.
Their
access
to
resources
are
limited,
they're,
reporting,
subpar
treatment
by
medical
professionals
and,
in
some
cases,
they're
dying.
The
problem
is
so
pervasive
that
we
can
safely
assume
this
is
happening
in
numerous
communities
throughout
our
community
throughout
our
country.
I
The
reality
is
sad
in
and
of
itself,
but
I
can't
help
but
think
about
the
children.
I
can't
help
but
think
about
how
their
lives
would
be
more
enhanced
and
enriched
if
we
were
proactive
in
providing
mothers
and
parents
with
postpartum
medical
visits,
support
and
additional
care
that
is
currently
unavailable
to
medicaid
enrollees
in
our
state.
Current
nrs
provides
for
60
days
of
postpartum
medicaid
coverage.
However,
this
isn't
reflective
of
the
needs
of
the
mothers
and
birth
parents
that
we
organize
and
work
alongside
our
community
members.
I
Frequently
reference
challenges
related
to
fatigue,
breastfeeding
and
added
stress
when
a
new
baby
comes
home,
this
measure
will
expand
the
safety
net
for
our
community
members
that
need
a
little
extra
support
at
its
core.
Ab189
is
about
our
children
and
how
we
intend
to
raise
our
children
in
this
state.
I
It
meets
the
moment
we
find
ourselves
in
in
trying
to
bring
greater
equity
to
communities
that
have
been
historically
overlooked
or
lacked
access
to
care
because
of
restrictive
public
policy.
You
all
can
help
us
continue
making
strides
in
the
right
direction
by
supporting
ab189
make
it
work.
Nevada,
supports
this
measure
and
urges
bipartisan
support.
Thank.
J
K
I
am
a
burst
in
postpartum,
doula,
a
childbirth
educator
and
a
midwife
assistant,
I'm
the
owner
of
right
heart,
birth
services,
which
is
a
small
birth
support
and
education
agency
and
a
co-owner
of
biggest
little
baby,
which
is
a
baby
store
and
family
resource
center
and
the
current
sitting
director
at
non-profit
the
reno
doula
project
and
the
truckee
meadows
birth
network.
I
am
and
have
always
been
incredibly
invested
in
my
community.
K
K
I
personally
interact
with
thousands
of
people
in
our
community
through
my
organizations
and
leadership
through
mentoring,
free
we
offer
free
support
groups
and
also
sliding
scale
doula
support.
A
large
percentage
of
the
people
I'm
supporting
are
either
supporting
medicaid
recipients
or
medicaid
recipients
themselves.
K
We're
often
supporting
these
folks
before
and
after
they're
being
seen
by
medical
professionals.
So
we
are
sometimes
expected
to
shoulder
the
burden
of
things
within
the
medical
scope
and
not
the
role
of
doulas.
Expanding
medical
care.
Medicaid
would
really
be
great
to
include
either
earlier
and
later,
and
both
it
would
improve
outcomes
for
the
parents
and
the
babies
and
their
entire
families,
and
really
get
them
off
to
better
starts
and
more
secure
beginnings
as
nevadans.
J
C
C
Second,
regarding
extending
medicaid
coverage
to
12
months
after
delivery,
this
is
so
critical
to
make
sure
that
birthing
people
have
access
to
the
critical
health
care
services
that
they
need.
We
know
that
the
majority
of
maternal
deaths
are
preventable
and
data
show
that
60
of
the
births
in
this
state
are
covered
by
medicaid,
yet
women
are
losing
coverage
only
60
days
after
delivery.
Ensuring
a
full
12
months
of
postpartum
coverage
is
an
opportunity
to
have
a
major
impact
on
the
majority
of
pregnant
and
postpartum
people
in
the
state.
C
J
C
And
good
afternoon,
madam
chair
and
committee,
thank
you
for
the
opportunity
to
present
my
testimony.
My
name
is
ashley.
Dodson
spelled
a
s
h,
l
e
y
d,
o
d,
s
o
n.
I
am
a
licensed
social
worker
and
representative
of
make
it
work
nevada
in
support
of
ab189,
as
it
is
amended
as
a
black
mother
of
five
and
previous
recipient
of
medicaid.
I
know
the
disparity
first
hand
of
not
having
insurance
coverage
after
the
birth
of
a
child.
C
My
maternal
health
was
at
risk
for
several
factors,
including
the
traumas
being
considered
a
high-risk
pregnancy,
often
after
birth.
Due
to
my
circumstances,
it
was
a
struggle
to
properly
care.
After
my
children
as
the
birth
was
daunting
and
traumatic,
not
only
not
having
access
to
continued
care.
Postpartum
also
prohibited
me
from
getting
my
child
the
proper
care
they
needed
in
their
first
weeks
after
birth
and
the
necessary
will
check,
as
well
as
my
own
health.
C
I
also
ran
into
issues
of
securing
quality,
affordable
child
care,
while
working
or
re-entering
the
workforce.
All
of
these
obstacles
caused
me
to
be
under
increased
levels
of
stress
and
pressure
which
led
to
postpartum
depression
and
anxiety.
I
then
had
to
receive
therapeutic
services,
which
again
I
could
not
have
covered
due
to
lack
of
insurance
and
ability
to
pay
cash
due
to
lack
of
income.
This
caused
me
much
headache
and
heartache
because
I
did
not
have
the
access
to
the
resources
I
need
for
myself,
nor
my
children.
C
My
experiences
did
not
go
as
planned
again
because
of
the
lack
of
insurance
and
proper
care,
with
medicaid
being
expanded
into
women's
fourth
prime
minister.
It
will
decrease
other
injustices,
black
women
face
such
as
paid
equity,
affordable
housing
and
is
mentioned
before
quality,
affordable
child
care,
racism,
classism
and
sexism
have
been
continuously
tied
directly
to
the
health
and
wellness
of
black
mothers
in
this
country.
To
conclude,
black
women
are
three
to
four
times
more
likely
to
have
pregnancy-related
deaths
than
their
white
white
women
counterparts.
C
These
numbers
are
staggering
and
traumatic.
Imagine
being
a
woman
who,
throughout
your
entire
pregnancy
and
birth
experience,
constantly
thinking
and
knowing
the
high
possibility.
You
may
not
get
to
see
your
child
in
the
grand
scheme
of
things.
No
woman
should
experience
this
as
a
result
of
lack
of
care
and
insurance.
This
narrative
has
to
change
so
again.
I
urge
the
committee
to
support
and
pass
ab189
as
a
mandate.
Thank
you
for
your
time.
A
Thank
you
for
your
testimony.
If
we
can
go
to
our
next
caller
and
support.
A
J
A
A
Anybody
anybody,
okay,
then
we'll
just
go
to
the
callers
on
the
line
in
neutral.
J
J
A
You
know
what
I
thought
too
late:
miss
swearingen
she's
on
the
zoom,
so
if
I
could
we
could
go
to
her,
she
can
unmute
and
provide
her
testimony
in
neutral,
we'll
be
ready
for
her
right
now.
B
B
We
do
have
a
fiscal
note
attached
to
the
bill
for
the
syst
for
these
system
enhancements,
but
we
do
look
forward
to
working
with
assembly,
women
gorlo
and
addressing
any
questions
or
comments
that
come
up.
So
thank
you.
A
Thank
you
miss
wearing
jen,
and
with
that
I
will
send
this
right
back
to
assemblywoman
gorlo
for
any
closing
remarks.
E
Thank
you
so
much
chairwin,
as
we've
heard
with
testimony
expanding
medicaid
to
pregnant
women
in
nevada,
is
good
for
moms,
it's
good
for
me.
Babies.
It
will
help
reduce
the
cost
of
pre-term
births,
not
only
in
the
immediate
nicu
cost,
but
long-term
costs
as
well.
I
want
to
take
a
moment
and
thank
dr
slotnick
for
filling
in
at
the
last
second,
to
give
us
a
little
bit
more
information
on
prenatal
care.
Of
course,
christine
hefner
she's
been
a
dear
friend
of
mine
now
for
almost
two
years
when
I
first
met
her
and
her
wonderful
family.
E
A
Thank
you,
and
with
that
I
will
close
the
hearing
on
assembly
bill
189,
and
I
will
now
open
the
hearing
on
assembly
bill
192..
This
revises
provision
provisions
governing
the
testing
of
pregnant
women
for
certain
sexually
transmitted
infections,
welcome
back
assemblywoman,
cohen
to
health
and
human
services.
Additionally,
I
will
have
patrick
ashton.
Our
policy
analyst
also
send
out
a
link.
A
This
was
another
bill
that
came
out
of
an
interim
committee
work
that
assemblywoman
cohen
was
on,
and
so
I'm
sure
she
will
go
into
some
of
those
details,
but
I
will
also
provide
that
link.
So
if
you
would
like
to
see
some
of
the
interim
work
that
was
done
in
consideration
of
assembly
bill
192,
I
would
direct
our
members
to
look
at
that
and
with
that
I
will
turn
this
over
to
assemblywoman
cohen.
N
Thank
you
very
much
chair
and
committee
for
hearing
assembly
bill
192
for
the
record,
I'm
leslie
cohen,
representing
assembly
district
29,
I'm
here
today
to
present
120
192
for
your
consideration,
because
it's
really
important
for
the
health
of
pregnant
women
and
also
for
their
babies.
N
So
a
little
background
information
during
the
2019-2020
interim,
as
you've
heard,
I
chaired
the
legislative
committee
on
health
care
and
two
of
our
priorities
were
public
health
and
maternal
and
child
health.
This
bill
addresses
both
so
before.
I
would
begin
I'd
I'd
like
to
note
that
there's
a
severe
conceptual
amendment
that
should
be
on
nellis
and
we'll
get
into
that
after
we
go
through
the
bill.
N
So
the
problem
that
we're
trying
to
address
is
that,
according
to
the
centers
for
disease
control
and
prevention,
or
as
you
know,
at
cdc,
sexually
transmitted
diseases
or
stds
can
cause
pregnancy
complications
and
result
in
serious
consequences
for
both
mothers
and
developing
babies
in
2019.
The
cdc
identified
newborn
deaths
from
syphilis,
as
quote
the
most
alarming
threat,
end
quote
and
emphasized
the
need
to
test
all
pregnant
women
for
syphilis
in
line
with
cdc
recommendations.
N
This
is
especially
important
in
nevada,
because
in
2018
we
had
the
highest
rate
of
primary
and
secondary
syphilis
in
the
nation.
The
problem
is
especially
acute
in
the
las
vegas
henderson
paradise
region,
which
had
the
highest
rates
of
primary
and
secondary
syphilis
of
all
metropolitan
areas.
That
report
to
the
cdc,
we
also
had
the
second
highest
rate
of
congenital
syphilis,
which
is
when
a
mother
with
syphilis
passes.
The
infection
onto
her
baby
during
pregnancy
and
trends
have
not
been
moving
in
the
right
direction.
N
According
to
the
cdc
nevada
saw,
a
289
percent
increase
in
congenital
syphilis
between
2015
and
2018..
Congenital
syphilis
can
significantly
affect
the
baby's
health.
It
can
cause
miscarriage.
Stillbirth,
prematurity,
low
birth
weight
or
even
death
up
to
40
percent
of
babies
born
to
women
with
untreated
syphilis
may
be
stillborn
or
die
from
the
infection,
as
a
newborn.
N
N
However,
key
to
treatment
and
prevention
are
ensuring
that
moms
are
tested
for
syphilis
and
receive
prenatal
care.
So
with
that,
I'd
like
to
go
through
the
bill
with
you,
because
this
is
where
ab192
comes
in
the
bill
aims
to
align
nevada's
std
testing
requirements
with
cdc
recommendations.
N
Section
one
of
the
bill
requires
physicians
and
other
providers
who
are
permitted
by
law
to
attend
to
pregnant
women
to
ensure
they
are
tested
for
chlamydia,
trachomidis,
gonorrhea,
hepatitis
b
and
hepatitis
c,
as
recommended
by
the
cdc.
The
physician
or
other
person
must
ensure
the
samples
are
taken
from
the
woman
and
submitted
to
a
laboratory.
N
Section
2
of
the
bill
revises
existing
requirements
related
to
syphilis
testing
for
pregnant
women.
It
revises
who
must
conduct
syphilis
testing
to
ensure
it
is
done
and
when
the
state
has
found
an
association
between
lack
of
prenatal
care
and
congenital
syphilis,
and
the
goal
of
the
bill
is
to
reach
pregnant
women
where
they
seek
health
care
so,
regardless
of
whether
they
seek
pregnancy,
related
services.
N
Subsection.
Two
of
section
two
clarifies
when
syphilis
testing
must
be
done,
including
at
delivery
for
pregnant
women
who
should
be
routinely
tested
for
syphilis,
as
recommended
by
the
cdc
live
in
areas
designated
by
the
division
of
public
and
behavioral.
Health
of
the
department
of
health
and
human
services
is
having
high
syphilis
rates
if
they
did
not
receive
prenatal
care
or
if
they
deliver
a
stillborn
infant.
N
However,
over
the
past
week,
I
met
with
the
nevada
hospital
association
and
the
division
of
public
and
behavioral
health
to
iron
out
a
few
amendments
that
should
help
achieve
our
goals
in
a
way
that
the
hospital
emergency
departments
can
implement.
So
let
me
just
pull
up
the
amendment
and
go
through
that
with
you.
N
So
we
replaced
a
reference
to
laboratory
approved
by
state
board
of
health
in
section
one
and
sections
one
and
two
of
the
bill,
with
quote
a
laboratory
license
pursuant
to
chapter
652
of
nrs.
N
N
The
next
amendment
is,
in
section
five,
I'm
sorry.
It's
actually
amending
section,
five
of
nrs
442.01,
to
provide
that
if
a
pregnant
woman
objects
to
the
taking
of
the
sample
of
blood
or
the
serological
test.
For
any
reason,
the
sample
must
not
be
taken
and
the
test
must
not
be
performed
right
now.
The
existing
law
allows
only
an
objection
for
religious
basis.
N
N
Our
next
change
is
revising
the
list
of
medical
facilities
which
to
which
the
requirements
of
the
bill
apply.
So
we
cut
down
the
list
in
the
statute
of
what
is
a
is
a
medical
facility.
Not
actually
let
me
rephrase
that
we
didn't
change
medical
facility
in
nrs.
We
just
cut
down
which
medical
facilities
need
to
comply
with
this,
and
we've
got
a
list
of
that
on
the
amendment,
so
I
won't
read
through
those,
but
you
can
see
that.
And
finally,
we
clarified
that
section.
N
Two
sub
1
c
relates
to
quote
an
emergency
department
in
a
hospital
that
evaluates
or
provides
treatment
to
pregnant
women.
End
quote,
and
this
intent
is
to
have
hospitals
test,
pregnant
women
who
are
evaluated
or
treated
in
the
emergency
department,
not
just
those
who
are
admitted
as
inpatients,
because,
as
you
may
know,
you
can
sometimes
be
in
a
hospital
for
quite
a
long
time,
even
days
and
technically
not
be
admitted
to
the
hospital,
but
still
be
in
the
emergency
room
having
treatment.
N
So
with
that.
I'd
also
like
to
inform
the
committee
that
joining
us
for
the
hearing
are
elizabeth
kessler,
who's,
the
std
program
manager
and
melissa,
peake
bullock,
the
state
epidemiologist
from
the
nevada
department
of
health
and
human
services,
division
of
public
and
behavioral
health
with
that,
if,
if
either
of
them
would
like
to
make
comments,
we
can
take
comments
or
if
they
just
want
to
be
available
for
questions.
B
N
A
You
assemblywoman
cohen,
we
do
have
a
couple
of
questions
in
the
queue
I
I
have
one,
I'm
going
to
start
here
really
quickly.
Does
this
just
match
the
cdc
guidelines,
or
are
we
requesting
that
all
women
be
tested?
A
N
All
right,
leslie
cohen
assembly,
district
29.
Well
so
we
already
have
first
and
third
trimester
in
our
statutes.
But
if
our
stated
epidemiologist
would
like
to
give
a
more
specific
response
to
the
cdc
guidelines.
B
Please
go
ahead
for
the
record
elizabeth
kessler,
the
std
program
manager.
This
aligns
with
cdc
guidance,
and
we
worded
this
in
a
way
that,
for
in
dynamic
areas,
we
can
expand
that
testing
when
necessary,
with
our
state
being
number
one
in
our
primary
and
secondary
syphilis
rates
and
our
congenital
sufficient
rates
being.
Second
in
the
nation,
we
are
identified
by
cdc
as
one
of
the
hot
spots
that
should
not
just
be
looking
at
risk
factor
and
should
be
treat
should
be
screening
all
pregnant
women.
A
Thank
you
for
that
answer.
I
also
have
assemblywoman
gorlo,
who
has
a
question.
E
Thank
you,
chairwin,
and
I
was
just
curious
if,
if
it's
already
being
done
or
we're
just
not
including
it
or
testing
for
hpv,
that
seems
to
be
an
std
that
a
lot
of
women
have
don't
even
know
it,
and
I
know
it
can
cause
some
problems
with
baby.
So
I
was
just
curious
if
that
was
something
was
already
being
screened
for
or
if
that
was
something
that
this
would
include.
H
Thank
you,
madam
chair,
so
just
to
be
clear,
there's
already
existing
language
that
requires
testing
and
certain
various
trimesters
for
syphilis,
and
it
has
been
extremely
troubling
that
nevada
ranks
number
one
in
congenital
syphilis
and
we
during
the
interim
looked
at
solutions
for
this,
and
testing
is
one.
It
may
not
decrease
the
number
of
number
of
cases
of
syphilis,
but
if
we
can
fix
the
number
of
cases
of
congenital
syphilis,
these
babies
born
with
syphilis.
I
certainly
think
it's
it's
wise
to
do
so.
I
have
some
questions
regarding
the
bill.
H
Specifically
though,
and
I
don't
know
if
they've
been
amended
out
or
or
what,
but
we
know
that
I
have
a
question
regarding
the
terminology
in
section:
one
line:
one
acceptance
otherwise
provided
in
some
sections,
three,
a
physician
or
other
person,
is
permitted
by
law.
Currently
are
there
other
persons
who
would
they
be?
Who
are
those
other
persons
currently
in
nevada,
permitted
by
law,
to
attend
a
delivery.
H
And
so
can
I
ask
why
the
terminology
of
other
persons
permitted
by
law
or
as
opposed
to
leaving
out
physicians
and
just
seeing
a
health
care
provider,
which
is
what
we've
been
going
to
because
over
the
last
several
sessions,
I've
had
bills
trying
to
clear
language
on
these
health
cares
regarding
providers-
and
you
know
when
they're
we
have
pas
and
aprns
and
not,
and
we've
been
kind
of
going
to
health
care
provider.
I'm
just
wondering
is
this
anywhere
in
our
stats?
H
N
So,
just
for
the
record
that
was
miss
kessler
answering
before
I
think
we
were
trying
to
just
clarify,
because
certainly
there
are
other
people
who
attend
upon
pregnant
women,
health
care
providers,
and
so
we
wanted
to
make
sure
we
captured
everyone.
However,
I
can
work
with
legal
and
make
sure
that
we've
got
the
phrasing
right
to
encompass
what
we're
trying
to
to
cover.
N
I
actually
did
discuss
it
with
legal
when
we
first
got
the
draft
of
the
bill
and-
and
we
discussed
somewhat-
you
know
who
does
who
does
that
mean
right?
It
doesn't
mean
under
the
under
the
definitions,
it
doesn't
mean
doula,
but
you
know
who
who
is
covered,
but
we
can
continue
to
talk
about
that
and
just
make
sure
that
it's
as
concise
as
possible,
good.
H
Because
again,
you
know
we
continually
fix
these
bills
after
they
go
through,
and
one
of
those
is
the
definition
of
providers
in
which
we've
worked
on
several
sessions
now
to
include
a
pa
and-
and
I
and
and
whether
that's
a
nurse
midwife
and
whether
they're
licensed
to
do
so
or
not,
but
I
just
think
terminology
was
different,
so
I
just
wanted
some
clarification
with
that.
I
would
appreciate
some
follow-up.
H
The
next
question
I
have
is
whether
medicaid
one
of
the
one
of
the
problems
when
we've
heard
these
bills
before
for
quite
a
while,
we're
always
concerned
about
the
cost
of
doing
these
tests
and
who
is
going
to
be
responsible
for
paying
for
these
tests,
and
I
I'm
wondering
if
medicaid
has
said
will
they
cover?
H
Will
they
cover
these
tests?
If,
if
you
draw
them
in
the
emergency
room,
will
it
be
a
recognized
test
that
they're
going
to
are
willing
to
cover
costs.
N
Right-
and
I
think
that
was
something
we
leslie
cohen
assembly
district
29,
we
that
was
part
of
the
the
concerns
that
the
hospital
association
had
was
costs
and
what
they're
responsible
for
and-
and
so
we
are,
my
understanding
is
that
it
will
be
covered
by
medicaid,
so
the
hospitals
will
be
reimbursed
and
or
you
know,
obviously
they'll
be
reimbursed
by
regular
insurance.
N
So
that
was
definitely
something
that
we
did
address
in
the
amendment
to
make
sure
that
we
weren't
leaving
hospitals
financially
in
the
lurch.
With
this.
H
H
A
H
This
is
in
regards
to
section
three
and
the
changing
of
the
wording
for
consequences.
If
a
provider
doesn't
obtain
these
tests,
there's
already
been
a
statute
for
we,
as
providers
are
mandatory
to
do
certain
testing.
It
was
already
in
statute
that
during
this
period
of
time,
there
would
be
a
consequence.
H
You
are
taking
this
out
now
and
adding
a
physician
or
other
person's
attending
a
woman
who
fails
to
perform
this
you're,
adding
some
and
including
a
hospital
medical
facility
and
these
you're
taken
out
as
a
misdemeanor,
but
you
are
now
putting
in
fines.
So
how
did
you
arrive
at
at
that
and
then
I'm
concerned
about
the
the
of
subsection
three
number:
three:
the
enforcement
through
our
attorney
general
or
district
attorneys,
and
I'm
I'm
I'm
concerned
about
the
liability
for
the
providers,
and
I
know
we
want
to
have
a
stick.
H
I
know
we
want
to
make
sure
that
they
do
this,
but
I'm
I'm
very
anxious.
That's
the
one
pushback
I
have.
I
have
a
couple
concerns,
but
that's
a
real
big
pushback
for
me
on
those
those
fines
to
the
providers,
and
so
I
was
wondering
where
you
came
with
the
five
hundred
dollars.
Is
that
a
standard
penalty
is
that
written
somewhere
else?
If
we,
as
a
provider,
don't
do
our
jobs?
Is
there?
Other
penalties?
Is
this?
You
are
unique
to
this
bill.
N
Thank
you,
leslie
cohen
assembly
district
29.
Well,
I
think
again
the
most
important
part
is
that
we
took
out
the
misdemeanor
so
which
it
you
know,
is
an
existing
law,
but
there,
as
you
said
there
does
still
need
to
be.
You
know
a
rod.
We
need
some
way
to
enforce
it.
500
is
an
amount
that's
used
quite
often
in
nrs
for
civil
penalties,
and
so
it
we
just
want
to
make
sure
that
that
we
do
have
an
enforcement
mechanism.
A
And
I
saw
miss
lynch
light
up
a
couple
of
times.
I
don't
know
if
she
wanted
to
have
a
comment
or,
but
I
want
to
give
her
an
opportunity.
O
Thank
you
so
much.
This
is
aaron
lynch
for
the
record,
I'm
the
chief
of
the
medical
programs
unit
at
the
division
of
health
care
financing
and
policy,
and
I
think
assemblywoman
cohen,
did
answer
the
question
about.
Does
medicaid
cover
syphilis
testing
and
in
fact
we
do.
We
cover
it
already
in
the
er
setting
the
clinic
setting
and
even
in
the
inpatient
like
delivery
setting.
That
would
be
already
included
in
the
hospital's
daily
period
rate.
So
overall
medicaid
does
cover
simplistic.
H
Can
I
can
I
respond
to
that?
I'm
sure
go
ahead,
so
you
said
that's
uncovered
in
the
medicaid
per
diem
rate.
So
what
that
bring
the
question
that
I
have
for
that
you
paid
them
a
flat
rate
to
see
a
pregnant
woman,
and
so
now,
if
they
do
the
test,
there's
no
additional
that
you
know
if
you
pay
them
a
flat
rate,
so
really
you're
not
really
reimbursing
them
for
the
syphilis
test,
because
you're
paying
them
this
flat
rate
right.
O
For
all
inpatient
services,
whether
it's
very
little
services
done
to
a
lot
more
services
done
no
matter
what
a
hospital
gets
reimbursed
a
daily
per
day
rate.
H
O
A
Okay,
I
don't
see
anyone
going
once
going
twice.
Okay,
thank
you,
assemblywoman
cohen,
for
that
presentation.
I
will
go
now
to
support
in
testimony
her
testimony
in
support
opposition
and
neutral
of
assembly
bill
192
again,
I
would
remind
all
of
our
callers
to
please
clearly
state
and
sell
your
name
for
the
record,
and
please
limit
your
testimony
to
two
minutes.
We
will
be
timing
just
to
ensure
everyone
is
given
a
fair
opportunity
to
speak
and
with
that
broadcast
services.
If
we
can
go
to
testimony
in
support
of
assembly
bill
192.
J
J
K
Hello,
chair
and
members
of
the
committee,
my
name
is
tess
opferman,
that's
o-p-s-e-r-m-a-n,
speaking
on
behalf
of
the
nevada
women's
lobby.
One
of
the
main
goals
of
the
women's
lobby
is
to
promote
the
health
and
well-being
of
women
and
families,
and
it
is
a
top
priority
of
ours
to
help
promote
access
to
affordable
health
care.
We
are
in
full
support
of
this
legislation,
which
will
help
give
access
to
testing
for
syphilis,
benefiting
both
mom
and
baby.
Thank
you
to
assemblyman
cohen
for
bringing
forward
this
legislation
and
thank
you
to
the
committee
for
your
time.
J
I
Good
afternoon,
madam
chairwoman
and
members
of
the
committee
bradley
mayer,
b-r-a-d-l-e-y
m-a-y-e-r
for
the
record,
I'm
a
partner
at
argentine
partners
representing
the
southern
nevada
health
district
today,
testifying
at
support
nevada,
has
been,
you
know,
really
number
one
or
number
two
in
syphilis
and
congenital
syphilis
in
recent
years,
and
since
2014
cases
have
increased
1333
percent.
I
I
J
L
First,
I
would
like
to
thank
assembly
woman
cohen
for
reaching
out
to
the
nevada
hospital
association
to
prior
to
our
perspective
on
ab192,
I'm
speaking
today
in
support
of
the
amendment
as
being
presented
by
her
on
ab192,
and
we
look
forward
to
working
with
her
and
others
on
the
passage
of
ab192.
J
B
The
washoe
county
health
district
supports
expanding
testing
for
sexually
transmitted
infections
for
pregnant
women,
as
outlined
in
this
bill.
Nevada
like
like
previously
stated,
nevada
ranks
number
two
in
the
u.s
for
congenital
syphilis
cases
and
in
the
and
in
the
top
15
for
states
for
chlamydia
and
gonorrhea,
indicating
the
need
for
more
screening
to
identify
infections.
J
J
J
A
Thank
you,
and
I
know
that
we
have
a
several
people
that
registered
to
testify
in
neutral
and
I
believe
they
are
on
this
call.
So
I
don't
know
if
they
want
to
unmute
themselves
at
this
time
and
present
their
testimony
in
neutral.
It
looks
like
we
have
miss
lynch.
Would
you
like
to
go
ahead?
Please
remember,
to
state
your
name
for
the
record.
O
Yes,
good
afternoon,
my
name
is
aaron
lynch,
I'm
the
chief
of
our
medical
programs
unit
at
the
division
of
healthcare
financing
and
policy
and
the
division
of
healthcare,
finance
and
policy,
otherwise
known
as
nevada
medicaid.
We
already
cover
std
testing
for
pregnant
women,
which
includes
syphilis,
so
we
already
are
syphilis.
Like
I
said
previously,
we
already
cover
it
in
the
emergency
department
setting
in
the
hospital
setting
or
in
the
clinic
setting.
O
But
we
are,
in
mutual
support
of
of
this
fill.
A
A
J
J
A
N
Thank
you,
chair
leslie
cohen
assembly,
district
29.
The
legislative
committee
on
healthcare
chose
to
pursue
this
policy
change
because
it
is
the
potential
to
improve
the
health
of
mothers
and
babies
in
nevada
and
because
congenital
syphilis
is
preventable
and
and
both
syphilis
and
congenital
syphilis
are
treatable.
N
But
we
need
to
do
better
by
aligning
std
testing
with
cdc
guidelines
and
expanding
testing
requirements
to
hospital
emergency
departments
and
other
medical
facilities.
We
hope
to
be
able
to
reach
a
broader
population
of
pregnant
women
and
reverse
these
unfortunate
trends.
I'm
certainly
open
for
more
questions
after
the
hearing.
If
anyone
has
any
also
to
dr
titus's
question
about,
who
was
who
was
a
provider
and
the
circumstance,
I
believe
we
got
that
out
of
442.008.
N
I
will
talk
to
legal
though,
and
get
a
little
more
of
a
clarification,
because
that's
where
it
lists
who
who
does
testing
of
pregnant
women
that
type
of
thing?
So
with
that?
Thank
you
and
again,
I'm
I'm
available
for
questions.
After
the
hearing.
A
Thank
you,
assemblywoman,
colin
and
again
welcome
back
to
assembly,
health
and
human
services,
and
with
that
I
will
close
the
hearing
on
assembly
bill
192..
At
this
time
I
will
open
for
our
third
and
final
build
hearing.
Thank
you
guys
for
being
patient.
I
know
these
afternoon
committees,
especially
after
lunch,
to
be
trying,
so
you
need
to
run
and
get
some
caffeine.
I
get
it,
but
I'm
sure
assemblywoman
krasner
will
wake
us
up
with
her
presentation
on
assembly
bill
198,
and
at
this
time
I
will
open
the
hearing
on
assembly
bill
198.
A
O
O
Prenatal
screenings
are
routine
procedures
during
pregnancy
that
detect
whether
a
fetus
likely
has
certain
health
conditions
or
chromosomal
abnormalities.
Reading
tests
are
not
diagnostic.
They
only
provide
a
probability
that
a
particular
condition
exists.
Nevada
medicaid
is
the
single
largest
payer
of
births
in
our
state
and
in
recent
years
it
covered
approximately
60
percent
of
all
births.
O
Statewide
currently
medicaid
provides
coverage
for
prenatal
screenings,
including
blood
panels,
ultrasound
exams,
amniocentesis,
pvs
and
chorionic
villus
sampling
assembly
bill
198
requires
the
director
of
the
department
of
health
and
human
services
to
include
in
the
state
plan
for
medicaid
coverage,
non-invasive
prenatal
screening
to
detect
birth
defects
in
the
fetus
of
a
pregnant
woman
who
is
40
years
of
age
or
older.
If
requested,
the
intent
of
this
bill
is
to
add
non-invasive
prenatal
screening
to
the
list
of
screenings
that
are
already
available
and
women
can
receive
on
nevada
medicaid.
O
This
is
also
called
cell
free
dna
screening
and
is
considered
non-invasive
because
it
screens
for
certain
chromosomal
abnormalities
in
a
simple
blood
drawn
sample
from
a
pregnant
woman.
In
contrast
with
some
other
invasive
methods
such
as
amniocentesis
or
chorionic,
villus
sampling,
it
carries
no
risk
of
miscarriage
non-invasive.
Prenatal
screening
can
be
conducted
as
early
as
during
the
first
trimester.
O
O
O
F
Sorry
I
was
muted
good
afternoon
and
thank
you
for
the
opportunity
to
speak
to
you
today.
I
have
been
looking
forward
to
this
discussion
for
some
time
before
I
formally
develop.
I
want
to
make
sure
that
I
thank
assemblywoman
krasner
for
her
first
energy,
but
that
allowed
us
to
address
what
I
consider
a
singularly
important
component
of
health
care
for
pregnant
pregnant
families
and
pregnant
women,
one
that
is
frequently
overlooked
by
underwriters
and
by
medicaid
in
the
state
of
nevada.
F
It
was
doctor
it
was
assembly,
women,
krasner's,
contacting
me.
That
really
got
me
quite
excited
for
this
presentation.
F
I
do
also
want
to
mention
that
I
fully
understand
budgetary
restrictions
and
cova
covid
issues
having
to
do
with
inc
the
estate
coffers.
So
I
won't
address
the
issues
of
cost
during
my
presentation
here
today.
I'm
going
to
try
to
share
my
screen
here,
and
hopefully
it's
going
to
work.
B
We
cannot
see
your
shared
screen
broadcast.
K
Could
you
help
the
presenter.
B
F
F
It
is
sending
me
to
a
google
chrome
page
here.
F
B
Was
if
you
want
to
open
that
up?
First.
F
B
F
Very
good
I
apologize,
so
let
me
begin
by
introducing
myself.
My
name
is
nathan
slotnick,
I'm
a
perinatal
geneticist.
I've
been
in
private
practice
in
the
state
of
nevada
since
2003.,
providing
health
care
period,
natal
services
and
genetics
to
the
the
population
of
the
state
and
I've
been
licensed
by
the
state
of
nevada
since
the
year
1990..
F
The
goal
of
our
discussion
today
will
be
to
address
a
particular
area
in
technology
that
is
relatively
recently
come
to
fruition
and
has
tremendous
importance
in
terms
of
our
health
care.
Let
me
begin
by
providing
you
with
a
little
bit
of
my
own
background
here.
I've
had
career
a
long-standing
career
in
academics
and
research
and
teaching
I've
been
involved
in
somewhere
between
70
and
100,
000
nevada
pregnancies,
providing
care
ultrasound
prenatal,
diagnosis.
F
F
F
Screening
means
the
identification
among
apparently
healthy
individuals
of
those
who
are
sufficiently
at
risk
of
a
specific
disorder
to
justify
a
subsequent
diagnostic
test
or
procedure.
This
particular
definition
applies
in
medicine
quite
well,
but
screening
is
is
part
of
human
nature.
Every
time
we
walk
into
a
room
in
our
face
with
meeting
new
people,
we're
in
a
process
of
mode
of
screening
when
we
evaluate
them
identifying
a
patient,
identifying
a
person
evaluating
that
person.
F
Judging
that
person
is
part
of
what
we
do
as
human
beings
in
medicine,
the
issues
of
screening
become
even
more
profound
and
meaningful
in
pregnancy.
Screening
is
a
component
of
the
initial
and
continuing
evaluation
in
pregnancy.
When
I
ask
a
patient
her
age
when
she's
pregnant,
I
know
that
that
is
a
screaming
tool,
allowing
me
to
gain
more
information
about
what
her
potential
risks
for
chromosome
abnormalities
are:
we've
known
for
years
that,
as
a
woman
gets
older,
the
risk
of
a
chromosomal
abnormality
in
pregnancy
goes
up.
F
F
I
know
that
there
are
screening
for
genetic
issues,
implicit
in
that
question
as
well.
I'm
jewish.
I
know
that
as
a
jew,
my
risk
of
having
a
child
with
tay
sachs
disease
is
much
elevated.
So
all
of
these
are
the
components
of
screening
and
they
are
part
and
parcel
of
how
how
we
provide
care
to
our
pregnant
women
and
our
pregnant
families.
So.
K
That's
okay.
We
committee.
We
have
access
to
this
powerpoint.
I
believe
on
nellis,
if
you'd
like
to
follow
along
on
that
it
is
the
non-invasive
prenatal,
screening,
presentation.
F
I
did
yeah,
I
did
send
that
in
a
few
days
ago,
so
we're
we're
now
on
the
let's
see
it
would
be.
The
fourth
slide.
F
Okay,
so
let's,
let's
discuss
what
a
diagnostic
test
is.
A
diagnostic
test
is,
by
definition,
a
high
sensitivity
test
with
a
very
low
rate
of
false
positives
and
a
very
low
rate
of
false
negatives.
A
diagnostic
test
implies
a
diagnosis
will
be
obtained
and
by
definition,
there
is
very
little
overlap
between
the
affected
and
unaffected
population.
F
The
received
diagnostic
tests
we'll
see
that
graphically
in
just
a
moment,
next
slide
next
slide
details.
What
a
screening
test
is
defined
to
be
within
the
context
of
medical
testing
and
what
the
applications
are
now.
Screening
tests
have
a
much
different
application
in
population
there's
a
much
broader
population
application
for
screening
tests
and,
by
definition,
the
sensitivity
and
specificity
of
screening
tests
are
arbitrarily
defined
and
again
I'll
show
that
to
you
in
just
a
moment.
F
The
arbitrariness
of
screening
tests
relates
to
the
definition,
either
by
a
community
or
by
a
another,
defining
agency
that
a
false,
positive
and
false
negative
rates
can
be
determined
and
adjusted
empirically.
F
There
can
be
significant
overlap
between
the
affected
and
non-affected
populations
next
slide.
This
is
that
demonstration,
this
graphical
demonstration
on
the
left.
You
can
see
the
properties
of
the
tests
that
are
used
for
diagnosis,
the
unaffected
population
on
the
left
and
the
affected
population
on
the
right
have
very
little
overlap,
and
so
the
number
of
false
positives
and
false
negatives
are
very,
very
small
for
a
diagnostic
test.
F
A
screening
test,
on
the
other
hand,
can
have
a
great
deal
of
overlap
between
unaffected
and
affected
populations
and
where
you
draw
the
discriminator,
the
dotted
line
that
you
can
see
on
the
right
side
of
the
screen
will
define
what
your
false
positive
and
false
negative
rates
will
be.
You
can
move
that
discriminator
and
can
adjust
it
arbitrarily
and
can,
if
you
choose,
eliminate
your
false
positive
rates
or
eliminate
your
false
negative.
F
Now
what
this
did
when
these
first
definitions
were
applied
to
pregnancy,
it
allowed
us
to
identify
patients
at
risk
for
chromosome
pregnancy,
chromosome
issues
in
pregnancy.
The
first
definition
of
this
was
work
that
we
did
when
we
defined
in
the
next
slide,
the
california
alpha
fetal
protein
screening
program.
F
This
was
defined
by
the
department
of
public
health
in
the
state
of
california,
the
genetics
disease
branch.
At
that
time,
it
became
obvious
that
patients
who
are
carrying
a
pregnancy
affected
with
a
spina
bifida
could
be
identified
by
measuring
in
the
mother's
serum.
A
protein
called
alpha
feeder
protein.
F
But
what
wasn't
anticipated
was
that
the
alpha
frida
protein
test
back
in
the
1980s
also
allowed
us
to
define
patients
or
identify
patients
who
are
at
risk
for
delivering
a
baby
with
down
syndrome.
Now,
since
that
time,
in
the
last
30
years,
we've
gotten
much
much
better
at
identifying
these
patients
using
different
screening
tools.
F
The
the
ability
to
provide
this
to
patients
has
become
routine
and
customary,
and
the
american
college
of
obstetrics
and
gynecology
the
society
from
maternal
fetal
medicine.
The
national
society
for
genetic
counselors
has
suggested
that
all
patients
be
provided
with
the
ability
to
identify
what
the
risks
are
in
pregnancy.
F
F
F
Some
of
the
fetal
dna
indicated
in
white
here
can
be
crossed
into
maternal
circulation
and
we
can
identify
separate
and
sequence.
The
dna
of
the
fetus
from
a
maternal
blood
sample
remember
that
maternal
blood
sample
is
not
a
at
risk
procedure
and
doesn't
put
the
pregnancy
at
risk
at
all
in
this
particular
setting.
We
know.
Fetal
dna
has
a
much
shorter
length
than
maternal
dna
in
circulation
and
our
ability
to
sequence
that
dna
has
become
available
routinely
and
is
offered
to
all
pregnant
women.
F
For
this
particular
reason,
using
this
cell-free
dna
non-invasive
prenatal
screening
tool,
we're
able
to
make
provide
families
and
pregnant
women
with
certain
options.
F
Secondly,
cell-free
based
non-invasive
prenatal
screening
is
extensively
studied
and
has
been
extensively
studied
in
the
general
population,
with
tens
of
thousands
of
patients
studied
and
has
shown
to
have
a
very
high
positive
pricked
predictive
value
compared
to
other
status
quo.
Traditional
screening
tools
number
three:
there
is
a
better
detection
of
the
chromosome
number
abnormalities
that
we
can
identify
than
in
standard
of
care.
Non-Uh
non-um
other
screen
tools
it.
This
therefore
leads
to
fewer
invasive
follow-up
procedures,
fewer
amniocentesis,
fewer
chronic
oil
sampling
and
by
the
by
definition,
fewer
pregnancy,
related
losses.
F
All
major
professional
societies
endorse
or
recognize
this
particular
tool
as
the
clinically
valid
screening
option
for
all
pregnancies
and
as
we
know,
there
is
a
clear
disparity
in
coverage
and
care
for
women
based
on
factors
as
age
location,
insurance
coverage,
we're
striving
for
a
single
standard
of
care.
F
F
Not
only
is
there
a
high
positive
predictive
value,
which
is
on
the
right
side
of
this,
this
right
side
of
the
slide,
but
as
you
notice
in
the
left,
I'm
sorry
the
right
bottom
corner.
There
were
essentially
zero
false
negative
results
of
15
794
patients
tested
in
this
particular
study.
F
F
Now
my
particular
experience
with
cell
free
dna
in
in
testing
in
nevada
is
first
of
all,
it's
very
well
accepted
by
patients
by
providers
and
by
other
clinicians
number
two,
it's
very
easily
utilized,
both
in
private
offices
and
clinics.
One
needn't
drive
all
the
way
to
a
center
to
have
the
testing
done.
It
can
be
provided
in
an
office
in
healy
just
as
easy
easily
as
it
can
be
provided
in
las
vegas.
F
Because
it
is
such
a
great
screening
tool,
as
I
said,
because
if
it
comes
back
negative
it
the
chance
that
it's
wrong
is
very,
very
very
low.
It
is
a
perfect
screening
tool.
We
also
know
that
there
are
risks
associated
with
diagnostic
testing
and
the
cell
free
testing
has
a
very,
very
low
risk
and
leads
to
far
fewer
diagnostic
procedures.
F
A
O
A
A
moment
assemblywoman
krasner,
do
you
have
any
additional
parts
of
your
presentation.
A
So
I
am
looking
out
here
if
you
guys
could
just
wave
if
you
have
any
potential
questions
and
I
will
be
able
to
call
on
you
at
this
time.
Oh
I
see
assemblyman
or
liquor
so
go
ahead.
L
L
One
question
I
have
is
I
see
that
this
the
access
would
start
at
age
40,
and
my
sense
is
that
obstetricians
often
are
typically
offer
this
earlier
than
age
40..
So
how
did
you
pick
the
age
40
threshold.
P
Thank
you
so
much
chairwind
assemblywoman
krasner
for
bringing
this
wonderful
bill
and
dr
slotnick
for
a
really
interesting
presentation.
P
Has
anyone
done
any
research
to
see
if
we,
if
we
stick
with
the
age
of
40,
how
how
many
births
we
would
miss
if
we
hadn't
just
left
it
at
35,
I
mean
do
we
have
any
any
data
to
sort
of
show
us
what
the
difference
is.
I
think
dr
orton
lickers,
I
mean
assemblyman,
doctor
or
lichter.
His
question
is
is
valid.
P
I
had
a
late
in
life
pregnancy,
my
third
time
and
I
had
to
go
through
all
of
this,
but
I
had
an
invasive
test
and
I
know
that
there
you
know
when
we're
talking
all
day
about
discrepancies
and
delivery
in
communities
of
color.
When
we're
talking
about
the
number
of
births
that
are
being
paid
for
by
medicare.
O
A
Women
crowds-
are
you
possibly
covering
up
your
microphone
with
paper
or
something?
It
sounds
like
you're
slightly
muffled.
O
I
don't
I'm
sorry
perfect.
There
we
go
now
we
can
hear
you.
I.
I
asked
dwayne
mr
drain
young
from
medicaid
to
give
me
the
statistics
on
age,
40
and
age
35,
knowing
we're
in
a
budget
deficit
and
for
age
40
for
two
years,
a
little
under
a
hundred
thousand
we're
age,
35
15
years,
600
000.
So
in
hoping
to
get
this
asked
this
question,
I
have
to
degrade
40
just
for
two
years
and
I
do
intend
to
come
back
two.
O
A
F
Okay,
very
good,
the
distinction
there
is
one
between
what's
considered
to
be
high
risk
and
non-high
risk
high-risk
patients
for
chromosome
number
abnormality
has
been
a
cut
off
that
has
been
established
for
many
years
and
is
age
35..
F
F
The
ability
to
provide
service
for
this
particular
non-invasive
test,
though,
lags
in
nevada
for
the
reasons
that
I
address
already,
the
access
of
a
woman
in
elko
is
different
than
the
access
for
the
woman
who
lives
in
reno
las
vegas.
F
What
we're
trying
to
do
is
initiate
the
conversation,
the
appreciation
and
the
definition
and
understand
the
science
and
clinical
medicine
behind
it,
so
that
this
can
be
an
ongoing
and
dynamic
approach
to
improving
the
health
care
for
families
and
pregnant
women
in
the
state.
The
that
won't
stop
here.
It
will
continue
and
we'll
continue
to
discuss
it
as
time
goes
on.
P
You
chairwind
it
does.
I
understand
assemblywoman
krasner's,
thought
process
and
I'm
grateful
that
this
is
going
to
be
a
continuing
conversation.
P
P
If
we
don't
institute
things,
are
we
crunching
the
numbers
to
see
how
much
it
costs
if
we
have,
if
we
don't
address
some
of
these
issues
in
vitro
through
prenatal
and
then
end
up
with
problems
after
birth
and
just
something
to
consider
as
we're
crunching
the
numbers,
but
I
really
appreciate
this
assemblywoman
krasner
and-
and
thank
you
very
much.
A
Okay,
seeing
none
we
will
go
to
broadcast
services
to
begin
testimony
and
support
opposition
and
neutral
of
assembly
bill.
198
again,
I
will
remind
callers
to
please
clearly
statement
your
name
and
limit
your
testimony
to
two
minutes.
Again.
Staff
will
be
timing,
each
speaker
to
ensure
everyone
is
given
a
fair
opportunity
to
speak,
and
with
that
we
will
begin
testimony
in
support
of
assembly
bill
198
staff
from
broadcast
services.
Can
we
please
add
the
first
caller.
J
I
A
I
J
M
M
We
thank
the
sponsor
for
adding
it
and
and
of
course,
while
we
support
testing
so
that
a
parent
can
prepare
for
a
potentially
adverse
diagnosis.
We
are
concerned
that
such
a
diagnosis
could
be
used
to
screen
out
babies
that
are
potentially
less
imperfect,
but
that
is
certainly
not
the
the
point
of
the
bill
and
we
thank
the
sponsor
again
for
her
help.
J
K
Afternoon
my
name
is
hannah.
Baer
h-a-n-n-a-h
b
is
in
boy
a-e-r,
and
I'm
representing
the
coalition
for
access
to
prenatal
screening
to
present
on
the
coverage
landscape
of
prenatal.
Screening
caps
is
a
collaborative
alliance
of
seven
leading
genetic
testing
companies
in
the
united
states
that
seeks
to
improve
access
to
non-invasive
prenatal
screening
for
all
pregnant
women.
K
Non-Invasive
prenatal
screening
provides
the
same
information
through
a
non-invasive,
simple
maternal
blood
draw
and
as
a
safer
and
more
accurate
screening,
a
woman
with
an
affected
pregnancy
may
need
to
deliver
her
baby
in
a
hospital
equipped
with
resources
to
manage
a
high
risk
and
special
needs
birth.
The
information
nips
provides,
helps
to
improve
maternal
health
outcomes.
K
State
medicaid
programs
and
commercial
payers
recognize
non-invasive
prenatal
screening
as
a
sensitive
and
specific
prenatal
screening
tool
that
should
be
offered
to
all
pregnant
women.
Many
of
nevada's
surrounding
states,
including
oregon,
idaho
and
california,
effective
in
2022
cover
the
screening
for
all
pregnant
women.
These
are
three
of
the
18
state
medicaid
programs
that
cover
nips
for
average
risk
pregnant
women.
Five
of
these
18
states
change
following
the
release
of
practice,
bulletin
226
by
the
american
college
of
obstetricians
and
gynecologists
in
august
of
2020,
which
recommends
the
screening
regardless
of
age
or
risk.
K
Furthermore,
25
state
medicaid
programs
cover
the
screening
for
women
considered
high
risk.
In
contrast,
currently,
nevada
medicaid
remains
one
of
only
seven
states
in
washington
dc
that
denies
this
coverage
to
all
pregnant
women.
Even
those
considered
high
risk
on
the
commercial
payer
side,
more
than
65
plans,
nationally,
covering
more
than
200
million
lives
cover
nips
for
average
risk
women.
This
includes
almost
all
blue
cross
blue
shield
plans,
aetna
united
healthcare,
cigna
and
anthem.
K
J
J
O
O
So
everyone
should
have
it's
in
the
exhibits,
the
prenatal
testing
slide
and
I'm
going
to
share
my
screen
and
give
you
a
quick
little
biology.
101.
O
So
hopefully,
everyone
can
see
this
little
slide
on
normal
human
kerotype
and
basically
I
just
want
to
just
to
quickly
show
this
one
piece
before
I
move
on
to
to
my
slide
and
I'm
very
thankful
that
dr
slotnick
is
also
here
because
he's
a
clinician-
and
I
am
not
just
in
case
there's
any
questions
but
for
humans.
We
basically
have
46
chromosomes
and
when
they
are
paired
up,
we
have
23
pairs.
O
Okay,
great
so
I
wanted
to
provide
to
the
committee
what
nevada
medicaid
covers
for
prenatal
testing,
and
so
of
course
these
are
all
optional.
We
don't
force
any
women
to
have
to
get
tested.
Prenatal,
screening
and
diagnostic
testing
is
basically
optional,
and
so
for
screening
and
dr
salatnik
gave
some
really
great
definitions
here
too.
But
screening
identifies
the
potential
chance
that
a
fetus
has
an
abnormal
number
of
chromosomes.
O
A
A
I
think
that
this
probably
was
more
appropriate
during
the
presentation
like
in
case
in
chief.
I
know
that
we
received
your
documentation,
or
at
least
I
did.
I
don't
know
if
other
members
have
received
on
some
of
the
slides
that
you
are
referencing
right
now,
but
I
would
encourage
you
if
you
have
if
it
hasn't
been
provided
and
assemblywoman
krasner.
If
you
could
make
sure
you
get
those
slides
to
the
our
policy
analyst,
so
they
can
be
distributed
to
the
rest
of
the
committee.
I
think
that
would
be
probably
more
appropriate.
O
A
How
many
slides
do
you
have
to
present
I'm
trying
to
pull
it
up
right
now?
Just
this
one
slide:
okay,
I'll!
Let
you
go
ahead
and
finish
it
up.
Obviously,
there
was
some
confusion
in
the
presentation
of
the
bill,
so
go
ahead
and
continue.
I
apologize.
O
So
second
trimester
screen
also
screens
for
the
same
chromosomal
abnormalities,
but
it
also
screens
for
neural
tube
defects,
so
both
first
trimester
and
second
trimester
screens
are
covered
by
nevada,
medicaid
and
obviously
the
nips
test
is
not
covered
and
it
does
screen
for
one
more
trisomy,
which
is
trisomy
13.
O
O
We
are
in
the
process
and
it's
coming
very
soon
to
cover
the
chromosome
microarray
analysis,
also
known
as
the
cna
test,
and
but
we
do
not
cover
like
individual
dna
tests.
O
We
do
allow
for
items
that
that
we
don't
cover
to
be
overridden
with
the
epsdt
admin
exception,
when
it's
medically
necessary
for
pregnant
women
who
are
under
the
age
of
21
and
then
also
at
birth.
Vada
medicaid
does
cover
newborn
screening,
which
screens
for
31
chromosomal
dna
metabolic
disorders
here
in
nevada.
O
Some
of
the
advantages
nips.
What
like
I
said,
nips,
does
screen
for
trisomy
13.
So
it's
an
additional
test
there
and
acog.
The
american
college
of
obstetricians
and
gynecologists
does
recommend
that
all
women
be
offered
prenatal
screening,
regardless
of
age.
So
we
are
currently
only
offering
two
types,
but
this
bill
would
offer
a
third
type
and-
and
you
should
also
have
our
fiscal
impact
on
this
particular
bill
as
well.
F
Yeah
I'll
make
us
real
fast.
There
are
screening
tests
and
there
are
screening
tests
different
currently
available.
First
trimester
screening
test
will
miss
20
of
all
down
syndrome,
pregnancies
and
does
a
terrible
job
with
trisomy,
18
and
13..
That's
why
we're
discussing
this
particular
non-invasive
test,
the
second
trimester
screen?
This
is
even
more
so.
The
whole
point
of
the
process
here
is
to
provide
a
better
and
safer
test
to
the
families
and
pregnant
patients.
Screening
is
not
equal
across
the
board.
F
A
A
Okay,
seeing
none
assemblyman
or
liquor
go
ahead.
L
Sorry,
thank
you,
madam
chair.
I
just
want
to
follow
up
on
something,
dr
slot
that
you
just
said,
which
was
that
the
test
that
we're
not
covering
is
more
sensitive,
more
likely
to
pick
up
abnormalities
than
the
tests
we
are
using,
and
does
that
mean
we
can
substitute
the
tests
we
aren't
using
for
the
tests
we
are
using
and
then
address
some
of
the
fiscal
concerns.
F
That's
that's
the
national
approach
right
now
that
we
should
use
non-advanced.
F
P
Thank
you,
chair
nguyen,
and
thank
you,
dr
slotnick,
for
that
clarity.
Could
we
ask
the
hhs
department
to
give
us
some
numbers
if
this
more
sensitive
test
was
used?
I
believe
it's
in
the
second
trimester
and
we
didn't
use
the
other
less
effective
tests.
A
J
A
No
thank
you
broadcast
services
and
thank
you
for
everything
you've
done.
I
know
you've
been
fantastic
over
on
these
three
braille
presentations
today
and
everyone
on
the
committee.
Thank
you
for
your
patience
as
well.
I'm
going
to
turn
this
back
over
to
assemblywoman
krasner,
for
hopefully
what
is
very
brief.
Closing
remarks
on
assembly
bill
198
before
I
close
the
hearing.
O
Yes,
I'll
be
very
brief.
Chairwind
I
hand
delivered
this
exhibit
to
each
of
your
offices.
It
does
show
the
prenatal
screening
tests
that
are
currently
available.
The
medicaid,
which
typically
is
here
in
nevada,
I'd
like
to
thank
dr
schwab
for
his
excellent
presentation,
and
I
would
really
appreciate
your
support.
A
Thank
you
thank
you,
and
with
that
I
will
close
the
hearing
on
assembly
bill
198.
Additionally,
let's
see
we
will
be
before
I
close
the
meeting
we'll
be
again
public
comment
again
as
a
reminder.
Please
clearly
state
and
sell
your
name
and
limit
your
comments
to
two
minutes.
Staff
will
be
timing.
Each
speaker
during
public
comic
to
make
sure
everyone
is
giving
a
fair
opportunity
to
see
broadcast
services.
Do
we
have
anyone
on
the
line
for
public
comment.
J
A
And
do
we
have
any
comment
from
members
before
I
close
out
today's
meeting
seeing
none?
Our
next
meeting
will
be
monday
march
15th
at
1
30
pm.
We
will
not
have
committee
on
friday.
Thank
you
for
powering
through
today,
so
we
could
avoid
an
unnecessary
meeting
on
friday.
I'm
not
sure
what
our
schedule
is
going
to
look
like,
but
please
keep
track
of
your
email.