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A
Thank
you
good
afternoon
welcome
to
the
assembly
committee
on
health
and
human
services
members
before
we
begin
just
make
sure
you
mute
your
microphone
when
you're
not
seeking
to
minimize
any
background
noise
and
also
please
turn
your
camera
on
and
leave
it
on
during
the
the
entirety
of
the
committee
hearing
and
at
this
time
we're
ready
to
go
so.
Madam
secretary,
will
you
please
call
the
role.
C
C
A
B
A
A
So
I'd
like
to
welcome
our
audience
joining
us
on
this
virtual
meeting
today
we
have
two
overview
presentations
on
nevada's
children's
mental
health
consortia
as
well
as
an
overview
of
medicaid,
and
we
also
have
one
bill
hearing
on
assembly
bill
26.,
just
as
some
general
housekeeping
announcements.
Before
we
begin,
I
would
like
to
just
note
that
agenda
items
may
be
taken
in
a
different
order
than
listed
two
or
more
agenda.
Items
may
be
combined
for
consideration
and
that
item
may
be
removed
from
this
agenda,
or
discussion
of
an
item
may
be
delayed
at
any
time.
A
A
We
are
asking
that
all
public
comment
be
kept
to
two
minutes,
so
everyone
interested
in
speaking
can
be
accommodated
and
we
can
ensure
we
get
through
this
agenda
in
a
timely
fashion.
Additionally,
we
will
limit
the
overall
length
of
each
public
comment
period
to
20
minutes.
Speakers
are
urged
to
avoid
repetition
of
comments
and
may
submit
any
additional
comments
in
writing
within
48
hours
of
the
meeting
adjournment.
A
Finally,
you
may
see
many
members
looking
at
multiple
screens
or
electronic
devices.
Please
know
that
they
are
not
trying
to
be
disrespectful,
we're
all
working
in
this
virtual
setting,
trying
to
refer
to
documentations
or
other
presentations
or
other
written
documentation
that
we
have
on
various
devices
kind
of
looks
like
a
gaming
center
in
most
of
our
offices.
So
we
would
just
like
it
the
public
to
know
that
as
well
and
with
that
we'll
move
on
to
our
first
agenda
item.
A
This
is
an
overview
of
nevada's
children's
mental
health
consortia.
As
an
introduction,
we'll
start
with
welcoming
back
dr
megan
freeman,
the
clinical
and
policy
advisor
on
children's
behavioral
health,
the
division
of
child
and
family
services.
If
you
would
go
ahead
and
make
sure
that
you
remember
to
introduce
yourself
for
the
record
anytime
that
you
speak,
and
I
will
turn
the
presentation
over
to
you.
D
Thank
you
chairwin
dr
megan
freeman,
with
the
division
of
child
and
family
services
for
the
record
good
afternoon,
and
thank
you
for
having
us
back
and
providing
us
with
this
opportunity
to
follow
up
on
my
presentation
from
last
wednesday
on
children's
mental
health.
Today
we're
going
to
describe
our
children's
mental
health
consortia
in
nevada
and
how
they
shape
our
children's
mental
health
system.
I'm
just
going
to
share
my
slides
quickly.
D
D
Each
each
consortia
conducted
a
needs
assessment
in
its
region
and
submitted
a
10-year
strategic
plan
outlining
the
priorities
for
its
region
and
the
strategies
that
would
be
used
to
achieve
its
goals.
Status
updates
are
provided
to
the
director
of
health
and
human
services
and
the
commission
on
behavioral
health
in
odd
number
years.
D
D
There
is
time
set
aside
at
each
meeting
to
hear
parent
concerns,
in
addition
to
individuals
with
lived
experience.
Each
consortia
consists
of
a
representative
from
dcfs
or
dpbh,
depending
on
the
region:
nevada,
medicaid,
the
region's
child
welfare
agency,
the
board
of
trustees
of
the
school
district,
the
local
juvenile
probation
department,
the
local
business
community,
a
provider
of
mental
health
care,
a
provider
of
foster
care
and
a
provider
of
substance
use
treatment.
E
Madam
chair
and
members
of
the
committee
for
the
record
jacqueline
kleindler
chair
of
the
washoe
county
children's
mental
health
consortium.
Thank
you
for
this
opportunity.
I
would
also
like
to
thank
dr
freeman
for
her
recommendation
to
hear
from
the
children's
mental
health
consortia
today
I
have
been
a
professional
in
washoe
county's
mental
health
community.
For
over
18
years
it
has
been
my
honor
to
chair
the
washoe
county,
children's
mental
health
consortium
for
nearly
three
years
in
march
of
2020,
the
consortium
finalized
our
current
10-year
strategic
plan,
as
required
by
nrs.
E
We
identified
three
overarching
goals
to
guide
our
conversation
activities
advocacy
and
our
local
and
statewide
data
review
strategies
in
our
effort
to
begin
the
path
towards
realization
of
our
shared
vision
of
equitable
and
compassionate
mental
health
care
for
all.
We
established
our
first
goal
to
address
multiple
ongoing
and
projected
community
needs.
In
the
coming
years,
we
have
started
conversations
around
what
increased
access,
decreased
barriers
and
least
restrictive
environments
really
look
like
and
what
it
would
truly
take
to
make
resources
with
these
characteristics
available
to
youth.
E
Achievement
of
this
goal
requires
expansion
of
interrelated
systems
from
private
and
public
service
agencies,
for
example,
for
our
school
district
to
succeed
in
its
efforts
to
co-locate
services
in
their
schools
and
increase
collaboration
with
community
partners.
Multiple
local
and
state
stakeholders
must
work
together
to
provide
the
necessary
resources
to
meet
agreed
upon
objectives.
E
E
E
Through
this
very
process.
We
have
come
to
understand
that
teachers
and
educators,
some
of
the
key
adults
who
we
rely
upon
to
guide
and
teach
our
children,
are
themselves
overwhelmed
with
the
stressors
and
demands
of
educating
during
the
pandemic
and
many
are
experiencing.
What
can
be
characterized
as
toxic
stress?
E
E
E
F
F
He
he
received
treatment
for
approximately
six
years
and
it
was
very
extensive
and
confusing.
As
a
nurse,
I
wanted
to
help
others
experiencing
the
same
difficulty,
so
I
decided
to
volunteer
with
the
rural
children's
mental
health
consortia
in
the
last
two
years.
The
consortia
has
offered
has
had
the
highest
meeting
participation.
F
We
offered
a
virtual
platform
before
the
pandemic
and
we
have
representation
from
across
rural
nevada.
The
rural
consortia
has
five
goals
that
I
would
like
to
briefly
discuss.
The
most
successful
effort
we
have
made
is
what
we're
referring
to
as
community
discussions.
Before
the
pandemic.
We
held
two
events,
one
in
winamaka
and
one
in
tonopah.
F
We
asked
community
participants
about
mental
health
efforts
in
their
community.
They
addressed
their
successes
and
challenges.
Our
goals
were
developed
around
the
community
concerns
goal.
One.
The
consortium
members
are
participating
in
the
dcsf
system
of
care.
Grant.
The
partnership
is
helping
to
improve
and
expand
mental
health
services,
specifically
in
rural
communities.
F
Some
of
these
expansions
include
respite
care,
increased
psychiatric
services
and
early
childhood
mental
health
services.
We
also
work
closely
with
peer
support
groups,
including
youth
move,
nami
and
parents.
Educating
parents
goal
two:
there
are
limited
providers
in
rural
communities
and
we've
facilitated
partnerships
such
as
school
social
workers
to
promote
early
detection
in
schools.
F
We
have
helped
providers
provide
items
to
rural
providers,
such
as
art
supplies
to
carry
out
the
goals
of
the
youth's
treatment
plan,
goal
three:
we're
supporting
the
expansion
and
continued
funding
of
the
rural
children's
mobile
crisis
response
team.
This
service
is
now
24
7
and
is
often
the
point
of
entry
for
youth
and
families
in
fiscal
year.
21
rural
mobile
crisis
has
had
an
84.3
hospital
diversion
rate,
meaning
that
84.3
of
the
youths
that
we
had
contact
with
were
able
to
be
stabilized
in
their
own
home
communities
goals.
F
Four
the
consortium
supported
enjoying
the
system
of
care
and
offering
training
to
over
70
rural
clinicians
and
becoming
certified
health
care.
Health,
telehealth
providers
we're
also
working
on
a
plan
to
bring
health
equity
training
to
rural
communities
goal
five.
The
consortia
has
completed
a
memorandum
of
understanding
with
the
nevada
system
of
care
to
serve
as
as
a
designated
point
of
contact
for
youth
families
and
other
provider
input
we're
also
working
with
behavioral
health
policy
boards
for
the
rural
and
frontier
counties.
F
The
impact
of
the
pandemic,
the
severity
of
symptoms
seems
to
have
increased
in
2020..
Youth
are
reporting
more
lethal,
violent,
suicidal
thoughts
such
as
hanging
jumping
into
traffic
and
firearms.
This
is
possibly
due
to
the
increase
in
isolation,
but
also
this
increased
screen
time
during
the
covid
restrictions.
F
Families
are
needing
more
intensive
case
management.
They
are
struggling
to
provide
the
basic
necessities
such
as
food,
clothing
and
shelter,
and
these
financial
stressors
are
associated
with
coping
for
youth
needing
to
be
hospitalized
for
safety.
Rural
mobile
crisis
reports
seeing
longer
wait
times
in
the
emergency
room.
Perhaps
one
of
the
issues
was
coped
with
testing
before
transporting
and
a
rapid
test
not
being
always
available.
F
F
F
This
expansion
has
helped
mental
health
services
and
rural
nevada
flourish
during
the
pandemic.
The
consortium
is
hopeful.
This
expansion
will
continue
even
after
the
pandemic.
It
is
our
hope
that
this
overview
of
our
efforts
demonstrates
the
importance
of
providing
children's
mental
health
services
in
all
areas
of
the
state.
F
D
G
Good
afternoon,
madam
chair
members
of
the
committee
dan
musgrove,
I
am
the
chair
of
the
clark
county,
children's
mental
health
consortium,
and
many
of
you
know
me
I'm
a
legislative
advocate
vice
president
with
strategies
360,
and
I
also
serve
as
the
business
community
representative
on
the
clark
county,
children's
mental
health
consortium.
G
I've
been
working
on
mental
health
issues
locally
and
with
the
state
legislature
for
over
20
years
now,
and
I
think
it
was
my
advocacy
that
caused
members
of
the
consortium
to
ask
me
to
serve,
and
I
started
in
2014
and
I've
been
the
chair
for
the
last
five
years,
and
so
what
I'd
like
to
do
is
call
your
attention
to
slide
nine,
which
is
our
strategic
plan,
overarching
goals,
and
there
are
six
of
them
and
I
won't
go
through
them
at
great
length
with
you
right
now.
As
you
can
see
them.
G
But
I
just
you
know
it
was
the
wisdom
of
the
legislature,
as
dr
freeman
mentioned
back
in
2001.
That
brought
created
these
consortiums
and
we
also
have
a
statewide
consortium
where
I
get
to
work
with
jacqueline
and
pam
and
and
the
members
of
both
washoe
and
rural,
and
we
behind
the
benefit
of
going
last,
is
that
you
know
so
much
of
what
you've
already
heard
from
washoe
and
rural
is
is
absolutely
happening
in
in
clark
county
as
well,
just
probably
to
a
to
a
greater
degree
just
because
of
our
sheer
population.
G
And
if
I
can
dr
freeman's
or
whoever
run,
go
ahead
and
switch
to
slide
10,
because
I
think
it's
important
that
I'd
like
to
focus
on
kind
of
the
progress
of
our
top
four
priorities
of
the
clark
county
consortium
and
particularly
numbers
three
and
four
and-
and
I
I
wanna
just
make.
I'm
not
sure.
That's
been
mentioned
to
you
all.
I'm
sure
that
you're
you're
aware
of
it.
But
there
is
a
department
of
justice
investigation
going
on
currently
dealing
with
it's.
G
And
I
think
when
you
look
at
our
items,
three
and
four,
those
are
absolutely
issues
that
we
have
seen
for
a
number
of
years
that
we
believe
could
could
have
helped
in
dealing
with
some
of
these
issues,
and-
and
let
me
tell
you
the
benefit
of
having
these
consortiums-
is
the
folks
that
we
have
the
membership
and
it
goes
from
state
agencies,
county
agencies,
the
school
district
parents,
and
I
can
tell
you
every
one
of
them
are
absolute
tremendous
advocates
on
behalf
of
children
but,
as
we
know,
dealing
with
budgets
and
and
restrictions
and
and
sometimes
just
an
inability
to
to
to
move
the
needle.
G
You
know.
Sometimes
things
get
out
of
hand,
and
I
I
think
we
have
an
issue
of
over
hospitalization
as
well
as
we
don't
have
capacity
here
in
the
state
of
nevada.
You
heard
pam
talk
about
acute
care,
but
when
it
comes
to
long-term
residential
treatment,
not
that
we
want
children
to
have
to
access
long-term
treatment,
you
want
to
see
wrap
around
care.
You
want
to
see
issues
where
you
can
do
the
residential
treatment.
You
can
do
the
wrap
around
the
system
of
care.
Those
are
all
items
that
we
hope
would
keep.
G
Kids
and
mobile
crisis
has
been
mentioned,
would
keep
kids
out
of
those
those
facilities
and
but
again
for
clark
county.
We
don't
have
a
lot
of
beds
here
in
in
clark
county,
the
majority
of
beds
are
in
reno
or
out
of
state,
and
so
that
doesn't
good
doesn't
do
kids
or
families
any
better
at
any
bed
any
well
at
all,
and
so,
as
you
can
see
in
our
items,
three
and
four,
the
more
service
array
options.
You
know
we
haven't
seen
progress
and
you
know
the
2015
session
of
the
legislature.
G
There
was
ab-307
that
was
passed
unanimously
in
both
houses.
That
attempted
to
address
many
of
these
issues,
and
it
was
a
pilot
program
that
would
have
looked
at
intensive
care
coordination
services
for
those
children
with
behavioral
health
needs
that
reside
in
clark
and
washoe.
And
you
know
the
funding
just
was
never
there
and
it
was
it
was.
It
was
a
bit
disappointing
that
ab
307
never
really
got
the
chance
to
to
get
implemented
and
tried,
and
because
maybe
we
would
have
seen
some
some
some
help
in
those
in
those
areas.
G
G
A
Thank
you
and
for
our
members
when
I
asked
the
children's
mental
health
consortia
to
present,
I
asked
them
to
highlight
some
of
the
key
issues
and
priorities
for
their
regions
and
they
have
done
an
amazing
job
in
the
short
amount
of
time
that
I
gave
them
to
present.
So
I
would
encourage
any
members
to
reach
out,
but
I
do
know
that
we
have
a
several
questions
from
our
members,
so
I
will
start
with
assemblywoman
summers.
H
Can't
hear
me,
I
thought
I
was
online.
Thank
you
so
much
for
this
informative
info
presentation
from
all
of
you.
Thank
you.
I
do
have
a
couple
of
questions
for
miss
johnson.
H
Is
there
a
way
that
you
could
send
us
your
rural
consortium's
goal
list?
You
were
ticking
them
off
and
I
couldn't
write
them
down
fast
enough.
So
if
you
could
send
absolutely,
we
can
do
that.
Okay,
wonderful-
and
I
I
just
want
some
specifics,
if
possible,
about
one
of
a
couple
of
the
things
that
miss
johnson
purported
and
I'm
sure
others
may
be
curious
as
well,
and
that
is
when
you
are
speaking
of-
and
this
is
to
all
of
you
actually,
when
you
are
speaking
to
increases
in
suicidal
thoughts.
H
Are
these
children
that
you
are
that
are
already
in
receiving
services
in
your
consortium?
Are
these
new
children
who
are
now
seeking
help
in
your
through
your
consortium
and
who's,
collecting
and
tracking
this
data?
H
H
The
suit,
thank
you,
miss
johnson.
This
is
chandra
summers,
armstrong
again,
assembly
district
six.
How
is
this
data
this
intake?
Is
there
a
standard
vetting
procedure?
H
And
I'm
asking
this
because
I'm
hearing
here
and
there
and
everywhere
of
the
increases-
and
what
I
want
to
just
make
sure-
is
that
we
are
gathering
this
data
in
a
manner
that
it
is
quantifiable
so
that
we
can
refer
to
it
with
confidence
and
then
be
able
to
find
resources
and
act
on
it,
because
we
have
data
that
has
been
collected
in
a
manner
that
is
consistent
with
some
type
of
metric
that
that
is
accepted
in
the
industry.
Can
you
speak
to
that.
E
E
H
H
Have
you
all
considered
adopting
that
metric
that
that
process,
so
that
each
of
the
organizations
who
are
reporting
to
your
consortium
are
using
the
same
standards
so
that
we
so
that
we
have
something
consistent
to
refer
to
because
we're
hearing
conflicting
things,
I'm
a
brand
new
legislator,
I'm
I
I
am
learning
every
single
day,
but
when
I'm
hearing
data
from
one
hand
and
the
other,
it
is
hard
for
me
on
an
issue
that
is
this
serious
right.
That
requires
action.
H
People
from
different
perspectives
are
putting
forth
their
data
and,
if
it
isn't
consistently
collected
for
me,
I
don't
know
if
that
data
is
being
presented
in
a
manner
that
is,
it
is
for
their
own
personal
or
organizational
benefit,
or
if
it
is
for
the
benefit
of
all.
I
want
the
data
that
we
receive
that
I
receive
to
be
consistent
so
that
I
know
how
this
is
affecting
everyone,
not
an
organization
or
an
entity
that
has
a
motive,
except
that
they
care
about
the
kids
and
and
that's
what
I'm
concerned
about.
D
This
is
dr
freeman.
Can
I
can
I
jump
in.
D
D
D
I
would
be
happy
to
make
sure
that
you
have
a
copy
of
some
of
the
recent
findings
from
that
survey
and
then
also
I
wanted
to
talk
a
little
bit
about
data
from
different
agencies,
including
children's
mobile
response.
So,
usually,
that's
data,
that's
collected
in
the
course
of
routine
clinical
care,
and
so
typically,
that's
collected
in
a
different
way
and
for
a
different
purpose
than
epidemiological
data
like
what's
collected
by
the
cdc.
And
so
the
questions
are
going
to
be
asked
in
a
slightly
different
way,
because
it's
done
for
a
different
purpose.
H
A
You
all
very
much
thank
you,
dr
freeman,
and
also
if
there
is
any
additional
information,
if
you
could
get
that
to
patrick
ashton,
and
he
can
distribute
it
to
the
entire
committee.
I
think
that
would
be
appreciated,
and
next
we
have
a
question
from
assemblywoman
titus.
I
Thank
you,
madam
chair,
and
thank
you
all
for
your
presentations.
I
I
absolutely
appreciate
all
that
you're
doing
and
all
you're
trying
to
do
and
the
challenges
ahead
of
you
just
want
to
make
sure
that
a
couple
questions
about
my
I'm
sure.
First
off.
I
I
might
want
to
make
sure
that
all
these
all
the
consortiums,
whether
it's
rural,
north
or
south,
make
sure
are
communicating
with
the
other
mental
health
consortiums
so
that
we're
not
operating
in
silos,
and
so
I
hadn't
really
heard
that
in
any
of
your
presentations,
what
what
you
have,
or
what
joint
ventures
or
kind
of
moving
along
that
pathway.
So
I'd
be
interested
to
hear
at
least
a
confirmation
that
you
are
actually
communicating
with
the
other
behavioral
health
care
board,
the
other
mental
health
boards
and
not
living
in
separate
silos.
G
Someone
with
titus
thank
you
for
the
question
and
you
know
I
can
speak
on
behalf
of
clark
and
probably
some
of
the
other
consortiums
one
of
the
things
that
we
do.
G
We
are
advocates
for
children
as
you
know,
and
we
have
a
responsibility
to
do
these
reports
and
we
provide
them
both
to
the
commission
on
behavioral
health
as
well
as
director
whitley,
so
he's
receiving
all
those
myself
at
least
two
other
members
of
our
clerk
consortium
actually
serve
on
the
clark
county,
regional
behavior
health
policy
board
that
you
heard
about
at
your
wednesday
meeting
and
the
clark
and
a
number
of
the
other
regional
policy
boards
have
kind
of
sus
succeeded
the
the
work
on
children
to
the
consortiums,
and
then
we
report
to
the
to
the
regional
behavioral
health
policy
boards
as
to
what
we're
doing
so.
G
That
way,
they're
not
doing
the
same
work
that
we're
already
doing-
and
I
know
you
serve
on
one
of
the
policy
boards
and
so
I'm
sure
that
hopefully
that
you're
interacting
with
pam
and
others,
but
it
certainly
happens
in
clark
county
in
washoe
and
so
and
the
great
thing
is
we
do
have
a
statewide
consortium,
children's
consortium
where
we
all
come
together
that
I
mentioned
before
so
you're.
Absolutely
right.
G
We
want
to
make
sure
that
that
there
are
no
silos
and
that
all
of
us
are
kind
of
working
off
the
same
sheet
of
music.
I
Great
thank
you
for
that,
and,
and
I
I
knew
you
were,
or
at
least
attempting
to
do
so
and
and
obviously
you
know
my
engagement,
the
whole
process
and
I
just
want
to
make
sure
that
there's
not
duplication
of
efforts.
We
have
such
a
limited
supply
and
not
only
limited
supply
of
funds
but
volunteers
and
so
making
sure
that
we're
all
working
together
in
this,
it's
really
a
joint
venture
for
all
nevada.
So
thank
you
for
that.
The
next
question.
I
If
I
follow
another
question,
madam
chair
on
the
washoe
county
consortium,
they
mentioned
the
term
toxic
stress
stresses,
I
believe,
that's
in
slide
number
seven
and
it's
been
kind
of
my
experience
that
we're
kind
of
getting
away
from
those
terms
and
now
using
something
called
aces
which
is
adverse
childhood
experiences.
Have
we
seen
kind
of
a
resurgent
of
that
toxic
stresses
with
the
the
current
covent
pandemic,
or
is
that
still
something
you've
you've
now
kind
of
morphed
into
this
more
general
term
for
adverse
childhood
experiences?.
E
This
is
jacqueline
kleinedler
for
the
record.
Thank
you
assembly,
women
titus,
for
your
question.
The
way
that
we
have
conceptualized
those
two
concept
concepts
is
as
complementary,
and
so
when
we're
describing
toxic
stress
in
our
tenure
plan
and
in
our
forward
goals,
what
we're
talking
about
is
the
stressors
that
children
face
that
are
chronic
that
are
ongoing
and
that
require
buffering
or
resiliency
factors
or
protective
factors
to
be
introduced
in
order
to
prevent
that
toxic
stress
from
creating
long-term
effects
for
that
child.
I
Okay,
thank
you
and
just
for
members
that
may
not
know
that
the
whole
toxic
stress
rankings
and
that
conversation
came
out
about
2010
or
something
like
that,
and
it
involves
positive
stresses,
tolerable,
stresses
and
toxic
stresses,
and-
and
I
was
just
wondering
if
we've
seen
obviously
in
this
world
right
now-
maybe
some
additional
toxic
stresses.
And
so
it's
interesting
conversation
and
thank
you
for
clarifying
that.
And
I
appreciate
again
what
you're
doing
and
thank
you
for
the
question
manager.
A
No
problem
and
because
we
have
another
presentation
in
the
bill
hearing
I'm
going
to
go
to
one
last
question
with
assemblywoman
gorlo.
B
B
D
D
A
Well,
I
just
wanted
to
thank
you
guys
all
for
your
presentations
and
again
I
encourage
any
of
the
members
if
you
have
any
follow-up
questions
or
concerns
or
comments.
Please
follow
up
with
our
individual
speakers,
and
so
thank
you
and
with
that
I'm
going
to
move
on
to
our
next
presentation.
This
is
probably
one
of
the
most
important.
I
know
we
have
a
lot
of
new
members
and
new
people
that
are
new
to
the
healthcare
world,
so
I
would
encourage
you
to
all
pay
attention,
ask
questions
and
follow
up
after
the
presentation.
J
K
And
good
afternoon,
I'm
robert
thompson
for
the
record
deputy
administrator
of
the
division
of
welfare
and
supportive
services
with
me
online
is
my
administrator,
steve
fisher
and
acting
deputy
administrator,
joe
garcia.
K
Robert
thompson,
for
the
record,
this
is
a
joint
presentation,
because
the
division
of
welfare
and
supportive
services
operates
the
application
and
eligibility
side
of
nevada
medicaid
for
thousands
of
nevadans
a
year.
But
once
a
person
is
found
eligible,
we
transmit
that
data
over
and
our
partners
have
nevada
medicaid
that
take
over.
J
Thank
you,
mr
thompson,
deputy
administrator
thompson,
suzanne
biermann
for
the
record,
so
the
division
of
healthcare,
financing
and
policy
is
the
pair
we
currently
are
serving
over
810
000
nevadans,
which
is
quite
a
significant
increase
from
pre-covered
days
and
medicaid,
is
a
health
insurance
program
provides
coverage
for
low-income
children
and
adults,
seniors
and
people
with
disabilities
in
challenging
economic
times,
medicaid
provides
temporary
help
for
people
who
lose
a
job
or
become
too
sick
to
work
on
all
nevadans
who
meet
eligibility
requirements
are
guaranteed
coverage
under
medicaid
nevada,
medicaid
also
functions
in
many
ways.
J
J
Okay,
this
is
a
slide
that
we
use
pretty
often
in
all
of
our
presentations.
So
you
may
see
this
anytime.
We
can
present
it's
one
of
our
standard
slides,
but
we
think
it's
really
important
and
provides
a
high
level
overview
of
some
of
the
impact
of
the
program
for
nevadans,
so
here
I'll
just
hit
a
couple
of
these
definitely
don't
want
to
read
from
the
presentation
and
the
slides,
but,
as
I
mentioned,
we've
seen
such
a
an
increase
in
our
enrollment.
That
nevada
medicaid
now
covers
one
in
four
nevadans.
J
J
J
I
did
also
just
want
to
note
that
nevada
medicaid
covers
services
that
aren't
always
covered
by
other
commercial
insurance
programs
or
even
medicare.
So
here
back
to
the
point
of
nevada,
medicaid
being
the
the
primary
payer
for
long-term
care
services,
that's
because
many
other
commercial
insurance
and
outside
of
a
certain
date
limitation,
medicare,
don't
reimburse
for
those
services,
so
just
another
way
that
medicaid
really
serves
as
a
safety
net
for
for
the
state
next
slide.
Please.
J
I
mentioned
before
our
enrollment
has
definitely
changed
due
to
the
public
health
emergency
in
the
covid19
pandemic.
It
did
just
want
to
spend
a
little
bit
of
time
on
this
slide,
which
is
pretty
pandemic,
but
it
points
out
that
nevada
does
have
a
higher
rate
of
uninsured
than
the
average
across
the
united
states,
and
so
while
we
do
note
that
this
has
changed
during
the
pandemic,
I
do
think
it's
just
important
to
note
that
historically,
nevada
has
had
a
higher
rate
of
uninsured
compared
to
the
rest
of
the
nation.
J
Okay,
this
slide
shows
our
current
medicaid
caseload
as
of
january
2021,
and
also
the
trends
over
the
course
of
the
last
year.
So
you
can
really
see
that
uptick
due
to
the
copen
19
public
health
emergency,
and
you
can
see
that
we
have
continued
to
see
increases
in
our
enrollment,
however,
not
at
as
deep
of
a
rate
as
earlier
in
2020.
J
So
these
sorts
of
increases
in
the
medicaid
program,
as
the
economy
worsens
aren't
surprising.
Medicaid
is
what's
called
a
counter
cyclical
program,
and
that
means
when
the
economy
worsens.
Caseload
goes
up.
We're
certainly
seeing
that
here
and
it's
an
expected
trend
in
medicaid
programs,
as
states
face
tough
economic
times.
J
I
also
wanted
to
point
out
here
that
a
piece
of
federal
legislation
that
was
passed
in
early
2020
has
some
implications
for
our
caseload,
and
that
is
the
family's
first
corona
virus
response
act,
which
has
brought
some
additional
federal
funding
to
the
state,
but,
along
with
that,
have
come
maintenance
of
effort
requirements
for
eligibility
which
basically
require
continuous
medicaid
eligibility
during
the
time
of
the
public
health
emergency.
So
just
wanted
to
note
that
one
we
do
expect
to
see
these
types
of
trends
as
the
economy
worsens
into
another.
J
Contributing
factor
to
our
increasing
caseload
is
due
to
that
requirement
of
the
family's
first
coronavirus
response
act.
I
also
just
wanted
to
note
that
almost
half
of
our
recipients
are
parents
and
children,
then
adults
and
about
20
percent
are
in
other
eligibility
categories,
including
individuals
with
disabilities.
K
Thank
you
next
slide,
please
robert
thompson
for
the
record,
so
the
next
few
slides
we're
going
to
talk
about
how
nevadans
access
medicaid
and
they
apply
for
medicaid
through
processes
within
the
division
of
welfare
and
supportive
services.
Now
you
might
be
wondering
why
there
are
two
different
state
divisions
that
administer
medicaid.
K
It's
common
in
other
states
to
see
one
state
agency
that
handles
both
the
eligibility
determinations
for
the
public
and
the
works
for
the
payers.
However,
in
nevada,
the
division
of
welfare
and
supportive
services
does
more
than
just
determine
eligibility
for
medicaid
nevada
is
somewhat
unique
in
our
approach
to
administering
medicaid,
often
in
states
where
medicaid
is
a
single
agency.
There
are
other
separate
agencies
for
social
services
that
serve
the
similar
populations
in
other
states.
G
K
90S
nevada
integrated
these
systems
to
remove
the
administrative
burden
away
from
the
public
and
put
the
burden
on
the
state
to
provide
one
streamlined
process
to
access
multiple
benefits
for
persons
or
families
in
need
in
nevada.
We
have
organized
our
access
so
that
several
other
major
social
services
programs
can
be
accessed
at
the
same
entry
point.
K
These
other
programs
include
supplemental
nutrition
assistance
program,
the
temporary
assistance
for
needy
families,
our
energy
assistance
program
and
our
child
care
development
program.
In
addition
to
administering
these
programs,
the
division
also
is
the
state
level
child
support
enforcement
authority,
and
we
also
have
provided
administrative
support,
the
homeless
to
housing
court
commission.
K
This
was
done
in
an
effort
to
create
a
one-stop
shop
for
persons
in
need,
while
many
of
people
receiving
medicaid
a
snap
and
tanf
can
and
do
work
for
those
who
are
not
employed.
The
division
also
administers
workforce
development
programs
to
create
pathways
for
people
so
that
they
can
meet
their
potential
and
contribute
to
their
communities
for
individuals
on
snap,
the
workforce
program
is
called
snap.
Employment
training
or
you
may
hear
us
refer
to
it
as
snap
ent
for
individuals
on
tanf.
K
The
workforce
development
is
called
new
employees
in
nevada
are
also
referred
to
as
neon.
So
you
might
imagine
that
these
additional
programming
features
and
given
the
complexity
of
medicaid's
financial
reporting
obligations,
it
being
became
necessary
to
divide
the
duties
for
medicaid
into
two
different
divisions,
and
that
was
changed.
That
change
was
made
by
the
nevada
legislature
back
in
the
90s.
K
K
The
the
first
way
is
through
referrals
and
the
majority
of
our
referrals
come
from
nevada
health
link
also
referred
to
as
the
health
exchange,
nevada,
health
link
reviews
all
marketplace,
applications
to
see
if
anyone
applying
for
coverage
may
be
eligible
for
medicaid
or
nevada
checkup,
depending
on
the
income
limits,
and
if
an
applicant
appears
to
be
eligible
for
medicaid.
The
application
is
referred
to
us
for
processing,
with
no
additional
application
required
from
the
person.
Applying
these
applicants
then
receive
correspondence
about
their
case
from
us.
K
Another
referral
system
is
for
hospitals
to
apply
on
behalf
of
a
patient,
and
a
hospital
can
temporarily
approve
benefits
through,
what's
known
as
hospital
presumptive
eligibility.
This
method
does
require
people
to
follow
through
with
an
additional
regular
application
if
they
want
to
maintain
their
coverage.
It
also
requires
that
hospitals
meet
quality
control
measures
to
limit
potential
fraud.
K
I'm
sorry
there's
additional
quality
control
measures
that
the
welfare
division
puts
in
place
to
make
sure
that
those
claims
are
being
paid
appropriately
and
there
are
no
fraudulent
claims.
Customers
can
also
apply
directly
with
us.
We've
heard
we
refer
to
this
as
clicking
call
in
mail
in
or
come
in
the
most
efficient
way,
and
we
encourage
all
of
our
customers
to
apply
online
through
access
nevada,
it's
the
most
efficient
system
for
them
and
us,
but
customers
can
also
verbally
apply
over
the
phone
for
our
call
center
and
a
lot
of
people.
K
K
We
have
set
up
many
access
points
that
were
non-traditional,
such
as
in
homeless,
shelters,
family
corps,
community
centers
and
in
some
cases,
even
the
detention
centers,
and
we
do
plan
to
reactivate
those
postcode
next
slide.
Please.
K
So
getting
approved
once
dwss
receives
the
application
for
assistance.
We
have
to
evaluate
the
household
circumstances
to
determine
if
they're
eligible
medicaid
is
approved
at
no
cost,
while
nevada
checkup
has
quarterly
premiums
the
primary
eligibility
determinations
are
always
we
look
at
gross
income,
citizenship,
household
composition,
residency
and,
in
some
cases,
depending
on
the
program
they're
applying,
for
we
do
have
to
look
at
their
resources
and
assets.
K
Those
are
primary
eligibility
reasons.
There
are
multiple
factors
in
eligibility,
but
I
wanted
to
give
just
a
quick
snapshot.
We
do
use
these
charts
a
lot
in
our
presentations
and
we've
shown
a
snapshot
of
a
different
eligible
income
categories
and
if
you
look
at
this
snapshot,
just
taking
a
household
of
one,
for
example,
if
we
were
looking
at
a
single
adult
without
children
not
pregnant
and
able-bodied,
not
disabled
and
just
a
single
person
that
their
income
level
falls
at
138
percent
of
poverty.
K
So
as
long
as
they're
making
under
1
483
a
month,
they'd
be
eligible
for
medicaid.
A
second
example
could
be
a
single
parent
with
two
children.
So
we
would
look
that
as
a
household
of
three
and
because
there's
children
in
the
home,
we
look
all
the
way
up
to
205
percent
of
poverty,
so
up
to
37
dollars
a
month
of
growth,
income
would
remain
eligible
for
medicaid
assistance
and
that
205
is
for
nevada
checkup.
K
At
this
point,
our
agency
would
approve
the
case.
We
transmit
the
data
over
to
madam
medicaid
and
they
take
over
the
case
from
there.
They
issue
the
medicaid
cards
and
they
become
the
enroller
and
the
payer,
and
at
that
point
we
turn
the
case
back
over
to
suzanne's
team
and
I'm
going
to
turn
the
presentation
back
over
to
suzanne.
J
Thank
you,
suzanne
biermann,
for
the
record.
So,
as
deputy
administrator
thompson
mentioned
once
dwss
has
approved
an
application
for
medicaid
dhcfp
then
begins
the
medicaid
enrollment
process,
nevada,
medicaid,
nevada,
medicaid
uses
two
different
service.
Delivery
models,
managed
care
and
fee
for
service
managed
care
is
the
primary
model
covering
72
of
the
recipients
in
the
state
it's
available
in
the
urban
counties
of
clark
and
washoe
and
to
all
eligibility
groups,
except
for
the
age-blind
and
disabled
nevada.
Medicaid.
Currently,
contracts
with
three
managed
care
organizations
to
provide
care
under
this
model.
J
Individuals
can
choose
among
these
three
organizations
as
part
of
their
eligibility
application
process
and
the
selected
managed
care
organization
will
then
provide
a
welcome
packet
with
information
about
insurance
coverage
to
the
nevada
medicaid
member
in
the
instance
that
a
recipient
doesn't
choose
among
the
three
managed
care
organizations.
There
is
a
process,
then,
for
auto
assigning
those
members
to
one
of
the
three
managed
care
plans.
J
He
for
service
is
the
other
service
delivery
model.
That's
used
by
nevada
medicaid
in
this
model.
Dhcfp
performs
many
of
the
same
functions
and
activities
as
a
commercial
insurance
plan
would
such
as
provider,
enrollment
and
claims
processing
fee
for
service
covers
nevadans
in
rural
areas
and
the
age-blind
and
disabled
population.
J
Next
slide,
please,
okay.
On
this
slide,
we
have
an
overview
of
some
of
the
benefits
and
services
provided
by
nevada
medicaid.
I
want
to
say
from
the
beginning
that
this
isn't
the
full
list.
It's
just
for
illustrative
purposes,
and
really
one
of
the
key
points
here
is
to
describe
one
element
of
the
federal
state
framework.
J
The
program,
of
course,
is
jointly
administered
between
the
state
and
the
federal
government,
and
certain
services
are
mandatory
and
must
be
provided
by
all
states.
Other
services
are
optional,
so
this
slide
right
here.
The
mandatory
optional
service
setup
in
the
medicaid
program
accounts
for
one
of
the
reasons
that
you
see
variation
in
medicaid
programs
across
states.
So
again,
not
a
full
list.
Just
wanted
to
to
note
this
mandatory
optional
distinction.
I
will
say
when
you
look
at
some
of
these.
J
Some
of
the
things
that
are
listed
as
optional
really
don't
seem
optional,
especially
if,
if
you
need
those
services-
and
I
do
think,
every
state
in
the
nation
now
has
covered,
for
instance,
prescription
drugs.
However,
these
are
at
the
states
option,
so
just
wanted
to
make
that
distinction
a
little
bit
more
about
our
benefits
and
services.
J
Nevada
medicaid
does
provide
comprehensive
coverage
for
children.
The
benefit
for
children.
You
can
see
this
acronym
here
on.
The
slide
is
what
we
refer
to
as
epsdt,
and
that
is
early
in
periodic
screening,
diagnostic
and
treatment
services
for
the
medicaid
expansion,
adults,
nevada
medicaid,
does
cover
the
10
essential
health
benefits.
Those
are
the
same
benefits
that
the
affordable
care
act
required
to
be
covered
in
the
by
nevada
health
link.
So
there
is
some
continuity
of
coverage
as
individuals
have
changes
in
their
income
and
may
transition
from
medicaid
to
exchange
coverage,
or
vice
versa.
J
Okay,
we
often
get
questions
about
in
an
instance
that
medicaid
hasn't
reimbursed
for
a
particular
service
and
just
wanted
to
take
a
minute
to
go
through
some
of
the
four
high-level
requirements
for
for
medicaid
reimbursement.
You
can
see
them
on
this
slide
here.
One
medicaid
pays
for
services
for
medicaid
eligible
and
enrolled
individuals.
J
Similarly,
only
providers
who
are
enrolled
in
medicaid
will
be
reimbursed.
Third
is:
is
it
a
medicaid
covered
service?
You
know
back
to
that
optional
list.
Is
this
a
service
that
is
included
in
medicaid's
benefit
package
and
then
last?
Is
the
service
medically
necessary,
so
just
wanted
to
here
provide
some
high-level
information
on
the
requirements
for
for
medicaid
reimbursement
next
slide.
J
Please,
okay,
here
is
something
that
you
may
hear
a
lot
about
as
legislators
and
that's
the
concept
of
waivers,
but
I
did
just
want
to
talk
about
the
program's
overall
authority
and
a
little
bit
again
about
how
this
program
is
is
jointly
administered
between
the
federal
and
the
state
government
and
the
federal
agency
with
whom
we
work
closely
to
administer
this
program
is
the
the
centers
for
medicare
and
medicaid
services,
which
we
often
refer
to
as
just
cms.
J
So
I
did
just
want
to
talk
for
a
minute
about
the
difference
between
state
plan
and
waivers
again.
I
know
that
that
comes
up
in
conversations
and
just
wanted
to
provide
some
context
here
so
to
qualify
for
federal
matching
funds.
States
must
operate
their
medicaid
program
in
accordance
with
federal
law
and
must
file
estate
plan
and
state
plan
amendments
with
the
centers
for
medicare
and
medicaid
services.
J
J
These
waivers
allow
the
state
to
impose
limits
on
program
enrollment
that
are
otherwise
not
allowable
under
state
plan
authority.
So
just
one
example:
there
of
a
waiver
and
those
are
jointly
administered
by
operated
by
the
division
of
aging
and
adult
services,
with
oversight,
responsibility
by
dhcfp,
so
just
wanted
to
mention
those
three
as
waivers
that
nevada
currently
has.
J
In
addition
to
program
waivers,
there
are
also
an
option
for
research
and
demonstration.
Waivers
often
referred
to
as
section
1115
waivers.
These
waivers
allow
states
to
test
program,
features
that
are
otherwise
not
provided
for
or
allowed
under
federal
medicaid
law.
So
these
section
1115,
research
and
demonstration
waivers,
must
advance
the
objectives
of
the
medicaid
program
and
are
subject
to
stringent
budget
neutrality,
requirements
that
require
actuarial
actuarial
analysis
and
they're
generally
approved
for
five
years.
J
So,
if
you
think
of
this
as
a
continuum
kind
of
between
the
like
standard
and
the
the
more
of
an
exception
to
the
general
rule,
you
have
state
plan
and
then
program
waivers,
and
then
there
are
section
1115,
research
and
demonstration
waivers
when
the
the
state
needs
to
work
with
the
federal
government
to
try
to
design
a
program
to
meet
state
needs
in
a
new
and
innovative
way.
So
just
wanted
to
to
spend
some
time
talking
through
the
the
general
framework
there
next
slide,
please.
J
Okay,
this
again
is
just
a
little
bit
of
information
on
how
the
program
is
jointly
administered.
J
J
The
diagram
here
demonstrates
how
this
works
in
the
fee
for
service
model,
where
the
federal
government
and
the
state
pay
providers
in
the
managed
care
model.
The
funding
flows
from
the
state
and
federal
government
to
managed
care
organizations
in
those
organizations
then
pay
the
providers
next
slide.
B
J
Okay,
this
side
is
something
that
you'll
hear
us
talk
about
a
lot,
and
that
is
fmap,
and
that
is
the
federal
medical
assistance
percentage
and
basically
just
additional
information
on
the
percentage
of
the
overall
medicaid
program
that
is
paid
for
with
federal
funds
across
all
of
the
division
services.
The
federal
government
is
paying
anywhere
from
64
up
to
92
percent
of
the
costs.
You
can
see
here
in
this
chart
too,
that
two
of
the
rows
in
this
table
say
with
ffcra.
J
J
So
I
just
wanted
to
provide
that
additional
information
on
how
the
the
federal
funding
piece
of
the
program
works.
It's
really
complicated
a
lot
of
time
talking
about
fmap,
so
I
wanted
to
just
provide
an
introduction
and
orientation
in
today's
101
on
this
particular
issue.
But
in
summary,
just
wanted
to
note
again
that
in
the
time
of
a
global
health
pandemic
that
we're
in
right
now,
nevadans
are
increasingly
relying
on
medicaid.
It
is
the
state's
health
insurance
program
for
low-income
nevadans
and
it
is
a
safety
net.
J
A
B
K
Robert
thompson
for
the
record,
those
poverty
levels
are
provided
by
the
federal
government
to
all
states
based
on
the
federal
property
guidelines.
K
Robert
thompson,
for
the
record,
depending
on
the
program,
most
programs,
we
take
the
current
circumstances
and
project
the
future
circumstances
and
determine
what
their
income
will
be
on
a
month-to-month
basis.
So
if
a
person
was
working
this
month
and
their
income
is
stable
and
everything
is
normal
and
they're
making
under
this
amount,
we
would
approve
them
if
they're
making
over
this
amount
this
month,
but
they
have
verification
with
them,
showing
that
their
income
is
stopped.
K
That
they've
recently
lost
the
job,
then
we
would
project
that
that
income
stopped
so
we're
consistently
looking
at
what
the
current
circumstances
are
and
what
the
future
projected
circumstances
are.
That
is
not
true
in
some
of
the
medical
assistance
for
the
age,
wine
and
disabled
programs.
Some
of
those
programs
use
actual
income
at
a
retroactive
basis.
B
Thank
you
and
I
had
one
more
quick
question:
how
often
do
you
redetermine
somebody's
eligibility.
K
Robert
thompson
for
the
record
recovered
we
determine
eligibility
annually
for
all
of
our
programs.
Customers
are
required
to
report
to
us
if
there
is
a
change
in
circumstances.
K
If
their
income
is
to
go
up,
they
are
required
to
report
that,
but
we
do
touch
base
and
do
a
full
analysis.
At
least
once
a
year.
C
Thank
you,
madam
chair.
I
want
to
thank
both
of
our
presenters.
I
wanted
to
come
back
to
the
portion
of
the
presentation,
the
deal
with
medicaid
case
load.
You
know
the
increase.
The
reasons
for
that
is
obvious
enough,
but
I
wanted
to
ask
you
know
given
that
we're
at
a
point
now
where,
for
at
least
a
few
months,
we've
been
kind
of
trending
in
this
recovery
period,
most
of
the
economic
indicators
are
starting
to
move
the
right
direction.
C
You
know
we've
seen
state
unemployment
rates
go
down
kind
of
consistently
month
after
month.
Obviously
the
case
load
continues
to
go
up,
which
may
well
be
understandable,
but
I'm
wondering
if
I
know
it's
always
dangerous
to
play
the
projections
or
predictions
game,
but
I'm
wondering
if
there's
a
sense
internally
predict
or
projections
of
when
and
where
you
know
those
case
low
numbers.
May
you
know
finally
peak
where
we
may
see
some
movement
in
the
other
direction,
as
things
start
to
stabilize
further
in
our
economy?
Thank
you.
J
Suzanne
biermann
for
the
record,
a
fantastic
question.
Thank
you
for
that,
mr
layman.
Matthews.
It
is
difficult
to
predict
and
we
do
work
closely
with
dhcfp's
office
of
analytics.
They
work
on
predicting
and
projecting
caseloads
for
the
department
we
have
just
met
with
them
recently
to
take
into
account
the
recent
news
from
the
biden
administration
that
they
do
plan
to
continue
extending
the
public
health
emergency
throughout
the
course
of
this
calendar
year.
For
that
reason,
we
think
that
we'll
continue
to
see
pretty
high
caseloads
through
2021.
J
Certainly
all
of
the
maintenance
of
effort
for
eligibility
protections
that
come
along
with
the
family's
first
coronavirus
response
act
will
be
in
place
through
that
time
period,
so
really
plan
to
see
our
current
levels
stay
about
where
they
are.
You
know,
with
the
the
kind
of
same
steady
increase,
but
not
back
to
early
2020
rates,
but
don't
anticipate,
seeing
any
dramatic
decreases,
at
least
through
the
period
of
the
public
health
emergency.
C
I
Thank
you,
madam
chair.
A
couple
questions
back
on
slide
number
six
and
miss
biermann.
You've
heard
me
ask
this
question
before,
but
I
I
have
to
ask
it
again:
you
continue
to
show
supplies
of
increasing
medicaid
applicants
and
potential
recipients.
My
question
is
where's
the
site
that
shows
that
you
have
increased
medicaid
providers.
J
Thank
you
for
the
question:
assemblywoman
titus.
With
your
permission,
I'm
going
to
defer
to
deputy
administrator
cody
fenney,
she
oversees
our
provider
enrollment
activities,
and
I
believe
that
they
have
done
some
analysis
on
this
particular
issue.
Recently.
L
Good
afternoon,
deputy
administrator
for
dhcfp
cody
finney
happy
to
be
with
you
here
this
afternoon.
Thank
you,
dr
titus,
for
that
really
fascinating
question.
We
have
done
some
research
on
that
through
our
provider
enrollment
unit
and
we
are
seeing
some
increase
in
providers-
would
be
happy
to
send
that
data
over
to
you.
L
It
was
actually
more
encouraging
than
I
expected
it
to
be,
as
you
know,
we're
having
people
lose
their
employment
and
therefore
their
health
insurance,
but
not
necessarily
expecting
more
that
more
providers
are
coming
here
or
you
know
that
there
would
be
other
reasons,
but
we
are
seeing
some
increase
in
that
enrollment,
which
I
can
only
attribute
to
the
fact
that
there
are
more
people
whose
costs
are
reimbursable
by
our
program
and
therefore
perhaps
providers
are
interested
in
participating
more
fully,
but
we'll
again
be
happy
to
send
that
information.
I
I'm
sure
the
whole
committee
and
the
chair
would
like
to
see
that
too,
because
I've
frequently
referred,
the
increase
in
medicaid
applicants
to
to
giving
more
bus
passes,
but
not
no
more
buses,
and
so
I'm
great
to
hear
that
there's,
maybe
some
shift
in
the
positive
direction
again,
because
it's
again
access
to
care
and
how
long
are
people
waiting
get
that
appointment
with
that
provider?
I
So
if
you
could
send
the
committee
that
that
I'm
sure
the
chair
would
like
that
too,
because
I
think
it's
all
relevant
next
question
I
had,
if
I
might,
madam
chair,
ask
another
on
on
slide
number
eight.
I
think
mr
tom
snippy
administrator
thompson
talked
about
presumptive
eligibility
and
then
he
went
down
the
list
of
all
the
kinds
of
criteria
for
that
and
reaching
out
to
folks-
and
I
think
I
heard
you
say-
citizenship-
that's
one
of
the
criteria,
even
including
presumptive
eligibility.
K
Robert
thompson,
with
the
record,
when
I
was
listing
off
the
eligibility
criteria,
I
was
naming
the
the
five
main
things:
five
main
criteria
that
can
impact
eligibility,
our
medicaid
programs.
There
are
a
few
dozen
medicaid
programs
that
we
trickle
down
through
and
citizenship
impacts
coverage
type
as
we
move
through
those.
So
I
did
not
mean
to
imply
that
citizenship
would
turn
on
or
turn
off
full
eligibility.
But
it
is
one
of
those
things
that
we
evaluate
and
it
does
impact
the
type
of
cases
that
we
can
approve.
I
Well,
thank
you
for
that,
because
one
of
our
biggest
concerns
or
my
biggest
concerns
anyway
and
I
think
others
share.
This
concern-
is
kind
of
disparities
in
health
care
and
especially
sometimes
in
the
prenatal,
realm
and
pregnancy
issues,
and
I
I'm
wondering
about
when
you
mentioned
they
could
sign
up
over
the
phone
I'm
concerned
about
that
access
and
wanting
to
make
sure
that
that
application
process
is
bilingual.
Do
they
have
other
interpreters?
I
just
want
to
make
sure
it's
available
to
all
the
folks
that
truly
need
it
and
are
eligible.
K
Robert
thompson
for
the
record,
our
call
center
previous
to
me,
being
in
the
in
this
position,
we
utilized
case
managers
that
were
bilingual
and
what
we
found
was
that
we
couldn't
keep
the
call
wait
times
equal
if
we
had
too
many
colors
coming
in.
That
spoke
spanish
boy
and
not
enough
agents
that
day
it
threw
everything
off.
K
So
what
we
did
is
we
set
up
an
internal
translation
team
and
we
have
a
very
efficient
internal
translation
team
so
that
we
can
connect
our
case
manager
with
the
translation
team
that
speaks
spanish
at
any
time
with
no
weight,
so
the
weights
are
the
same.
Any
customers
that
call
in
that
speak
any
other
languages.
We
do
have
a
contract
with
an
outside
agency
that
will
connect
with
just
about
any
language.
K
I
A
I
have
a
couple
of
questions
here
when
you're
looking
at
the
eligibility
rates
and
incomes.
How
often
do
participants
have
to
have
that
eligibility
reassessed.
K
Robert
thompson,
for
the
record,
when
we
approve
a
person
for
medicaid,
we
notify
them
that
if
their
income
increases
and
we
and
we
give
them
the
amount-
and
we
say
if
your
income
increases
over
this
amount,
you
are
required
to
notify
us
by
the
fifth
of
the
following
month
of
that
change,
so
that
we
can
reevaluate
the
case.
If
we
do
not
hear
from
a
customer,
we
are
required
to
do
a
full
application
on
whether
we
hear
from
them
or
not.
K
We
are
required
to
hear
to
do
an
entirely
new,
full
redetermined
application
annually
to
verify
all
income
income
and
non-income
criteria
to
make
sure
the
household
still
needs
eligibility.
So
at
least
once
a
year.
A
Thank
you
and
then
I
have
another
question.
This
kind
of
comes
from
a
constituent
of
mine.
Actually
who
is
a
provider
and
I'm
just
curious,
because
I've
been
kind
of
watching
him
go
through
the
process
of
applying
to
be
approved
by
medicare
medicaid
as
a
provider?
How
long
does
that
process
usually
typically
take.
J
Suzanne
biermann
for
the
record
again
this
provider
enrollment
question
and
so
grateful
that
we
have
deputy
administrator
cody
finney
on.
I
know
she
can
answer
that
for
you.
So
thank
you.
Thank.
L
You
chair
when
appreciate
the
question
cody
finney,
deputy
administrator
at
dhcfp
for
the
record,
so
the
the
process
to
become
a
provider
for
medicaid
in
nevada
is
a
little
bit
complex
because
we
do
have
our
two
different
delivery
models.
So
the
mechanism
that
nevada
uses
to
meet
regulations
that
require
the
state
to
monitor
our
providers
is
we
have
everyone
enroll
in
our
nevada,
medicaid
program,
every
provider
who
wants
to
be
reimbursed
for
any
service
through
our
regular
program,
which
is
our
fee
for
service
enrollment.
L
If
the
provider
also
wants
to
participate
with
our
managed
care
organizations,
then
those
managed
care
organizations
do
an
additional
credentialing
process.
Some
states
do
that
in
a
centralized
way
where
it's
one
process
in
nevada.
We
have
them
separated,
certainly
happy
to
talk
about
those
opportunities
at
some
point,
but
but
the
enrollment
into
our
fever
service
program
is
within
five
days
that
those
applications
are
processed.
Once
we
get
all
of
the
information
that
is
needed
by
our
contractor,
that
does
that
the
managed
care
applications.
L
Those
can
take
a
little
bit
longer
because
those
are
a
more
in-depth
credentialing
process
to
make
sure
that
standards
beyond
our
fee-for-service
program
are
also
met.
So
the
whole
process
can
take
some
significant
time
generally
it's
within
90
days,
but
there
are
times
when
it
takes
longer
than
that.
A
Thank
you.
We
may
have
other
questions,
but
I
do
want
to
get
to
our
bill
presentation
next.
So
I
want
to
thank
you
both
for
presenting
today,
actually
three
of
you
and
for
the
others
that
were
available
to
answer
any
questions
on
the
phone.
Thank
you
for
being
present
here
and
with
that
I
will
close.
The
testimony
are
the
presentations
for
today
and
I
will
now
open
the
hearing
on
assembly
bill
26..
A
A
K
Madam
chairwoman,
good
afternoon
for
the
record,
I
am
robert
thompson,
deputy
administrator
for
the
division
of
welfare
and
support
and
services
with
online
is
maria
meshberger
social
services,
chief
maria
oversees
our
energy
assistance
program
and
is
really
here
for
technical
questions.
Thank
you
for
allowing
us
today
to
present
assembly
bill
26,
which
is
a
housekeeping
item
that
revises
provisions
governing
programs
of
energy
assistance.
K
The
energy
assistance
program
provides
a
supplement
to
assist,
qualifying
low
income
nevadans
with
the
cost
of
home
energy
advantage.
Energy
assistance
program
has
two
funding
sources:
the
low
income
home
energy
assistance
program.
We
have
federal
block,
grant
the
state
revenue
generated
from
nevada's
universal
energy
charge,
which
you
may
have
seen
that
small
tax.
On
the
back
of
your
power
bill,
that
tax
comes
to
us
to
roll
out
for
the
energy
system.
K
K
K
This
vague
wording
has
caused
conflicts
and
confusion,
as
these
reports
are
utilized
to
distribute
any
remaining
uec
funds.
These
proposed
changes
were
recommended
by
the
legislative
council
bureau
to
clarify
and
specify
the
dates
listed
in
nrs
to
encourage
to
ensure
the
universal
energy
charge.
Funds
are
distributed
as
intended
in
regulation
and
just
remove
any
room
for
interpretation
of
previous
language.
A
Oh,
that
was
so
quick.
You
know
what
I
haven't
had
an
opportunity
to
look
at
my
chat
here,
but
if
you
have
any
questions,
can
I
get
you
guys
to
kind
of
wave
here
on
screen?
Oh
look
at
that.
I
think
it
was
very
straightforward,
mr
thompson,
so
I
don't
see
any
questions
here.
So
at
this
point,
I'm
going
to
open
it
up
for
testimony
and
support
opposition
and
neutral
of
assembly
bill
26
to
provide
testimony.
You
must
register
online
with
the
legislative
website.
A
Registrants
will
receive
a
phone
number
meeting
id
and
instructions
to
join.
The
meeting.
Please
remember
to
clearly
state
your
name
and
spell
your
name
and
limit
your
testimony
to
two
minutes
and
we'll
have
staff
timing
each
speaker
to
ensure
everyone
is
given
a
fair
opportunity
to
speak
and
we
will
limit
the
length
of
every
testimony
to
a
period
of
20
minutes.
So
at
this
time
we
will
begin
testimony
in
support
of
assembly
bill
26.
B
A
And
I
will
refer
back
to
mr
thompson
if
you
would
like
to
make
any
closing
statements
or,
if
you'd
like
to
waive
it.
That's
fine
as
well.
K
Robert
thompson,
for
the
record,
our
only
closing
statements-
thank
you
for
letting
us
present
this
bill
today.
A
Wonderful,
so
at
this
time
I
will
close
the
hearing
on
assembly
bill
26
and
I
will
move
to
public
comment
as
a
reminder
to
provide
public
comment.
You
must
register
online
at
the
legislative
website
and
at
this
time
I
will
ask
broadcast
services.
If
there
are
any
people
in
the
queue
for
public
comment,.
B
A
Well,
if
you
don't
mind
if
we
could
wait
like
a
minute
just
to
see
if
that
person
does
want
to
jump
back
on
the
fact
that
they
were
on
the
entire
meeting
and
when
we
called
them
up,
they
were
not
there.
I
would
just
stand
in
recess
for
one
minute.
B
A
Well,
thank
you
at
this
time.
I
will
close
public
comment.
Do
I
have
any
comments
or
concerns
from
members
before
we
adjourn
I'm
just
putting
on
my
gallery
view
here.
A
I
don't
see
anything
so
that
this
concludes
our
meeting
for
today.
Our
next
meeting
will
be
on
wednesday
february
17th
at
1,
30
pm
and
just
to
give
our
members
and
the
public
some
advanced
notice.
We
will
not
be
having
a
meeting
on
friday
february
19th,
so
you
can
plan
accordingly.