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A
A
Here-
and
I
know
we
have
other
members
that
are
coming
in-
I
want
to
get
started,
though
we
do
have
one
two,
three,
four,
five,
six
seven
here,
so
we
do
have
a
quorum
and
madame
secretary
as
people
arrive,
if
you
can
mark
them
present,
I
see
as
some
of
the
woman
benitez
thompson
has
just
joined
us
as
well.
A
So
if
we
can
mark
her
present
as
well
welcome
to
our
audience
joining
us
on
this
meeting,
either
online
by
person
or
in
person,
and
today
we
have
four
bill
hearings
just
for
some
housekeeping
before
we
begin
members
of
the
public
may
provide
testimony
in
a
various
ways,
all
of
which
are
listed
on
the
agenda
on
nellis.
You
may
submit
public
comment
either
in
writing.
In
addition
to
testifying
or
in
lieu
of
testifying
written
public
comment
may
also
be
submitted
before
during
and
up
to
48
hours
after
the
meetings
adjournment.
A
Finally,
please
put
your
electronic
devices,
especially
cell
phones
and
laptops
on
silent
during
the
meeting
with
that
we
will
move
on
to
our
first
agenda
item
at
this
time.
I
will
also
note
that
it
appears
that
assemblywoman
gorlo
is
now
present
as
well.
So
if
we
can
mark
her
present
as
well,
I
will
open
the
bill
hearing
on
senate
bill
70
and
welcome
to
our
presenters.
A
I
believe
we
have
miss
flood
on
the
zoom
here
and
I
believe
she
is
going
to
be
presenting
along
with
dr
titus,
who
I
believe
is
on
her
way
as
well.
So
I
will
turn
this
over
to
you.
I
remind
our
presenters
and
speakers
to
please
clearly
state
your
name
and
spell
your
name
prior
or
not
spell
your
name
each
time
but
say
your
name
prior
to
speaking
just
so
our
secretary
can
keep
track
of
who
is
speaking
and
this
flood
with
that,
I
will
turn
that
over
to
you.
E
E
I
included
a
few
slides
at
the
front
that
talk
about
the
background
of
the
northern
regional
behavioral
policy
board.
We
started
this
work
in
2017
to
prepare
for
the
2019
session.
We
successfully
passed
ab-85
in
modernizing
and
clarifying
the
mental
health
crisis
hold
process,
and
in
that
process
we
really
had
a
deeper
understanding
of
nrs433a
and
sb70
is
really
a
continuation
of
that
work.
So
I
know
our
time
is
short
and
I'll
skip
those
slides
for
presentation,
but
I
wanted
to
include
them
for
your
reference.
E
Okay,
so
these
are
the
first
slides
that
I
was
just
mentioning
part
of
the
product
of
ab-85.
Was
we
developed
this
brochure
that
we
sent
out
to
all
the
hospitals,
ten
thousand
copies
in
the
last
year,
and
so
I
would
hope
that
that
type
of
work
would
continue
with
sb
70
if
it
were
to
pass.
E
E
At
any
time
after
medical
evaluation
certification
that
individual
may
be
admitted
into
an
inpatient
psychiatric
facility
under
emergency
admission,
if
the
crisis
lasts
longer
than
72
hours,
the
petitioner
needs
to
petition
the
court
for
an
involuntary
court
ordered
admission
into
an
inpatient
psychiatric
facility
for
treatment
for
up
to
six
months,
and
then
I
just
want
to
also
note
that
since
2014
nevada
has
also
had
an
involuntary
outpatient
treatment
mechanism
in
the
law
as
well-
that's
known
as
assisted
outpatient
treatment
and
also
lasts
up
to
six
months.
E
E
We
clarified
and
defined
emergency
admission,
updated
the
involuntary
court
ordered
admission
into
inpatient,
psychiatric
hospitals,
updated
conditional
release
and
then
also
updated,
assisted
outpatient
treatment
and
created
a
more
clear
process.
E
So
I
just
want
to
note
right
here
that
many
of
these
concepts
are
not
likable
per
se,
but
they
are
necessary
and
you
know
sometimes
we
have
legislators
that
have
wanted
to
vote
against
these,
but
really
by
voting
against
this
you're
voting
against
clarifying
the
law.
The
effort
of
sb70
is
not
to
create
any
new
mechanisms
just
to
clarify
and
update
those
mechanisms.
So
we
have
a
more
transparent
process
that
patients
and
families
and
providers
can
understand
we're
trying
to
get
everyone
on
the
same
page.
So
we
really
see
this
as
upholding
patient
rights.
E
So
in
the
process
of
developing
sb
70,
we
have
very
diverse
stakeholder
involvement.
I've
facilitated
a
statewide
mental
health
crisis,
hold
work
group
at
the
request
of
the
northern
regional
behavioral
health
policy
board
since
2017,
and
we've
had
very
strong
participation
from
clark,
county
judge,
jaeger,
washoe,
county's
judge,
lou,
the
public
defenders,
division
of
public
and
behavioral
health,
nevada,
hospital
association,
etc.
E
So
the
bill
is
huge,
70
pages
is
complex,
but
really
it
can
be
broken
down
into
five
elements,
so
it
updates
and
modernizes
the
mental
health
crisis
hold
law.
It
updates,
assisted,
outpatient
treatment,
conditional
release.
We
did
not
create
the
youth
mental
health
crisis
hold
process
that
was
created
in
the
2019
legislative
session.
We
just
adjusted
some
pieces
so
that
it
actually
is
workable
and
is
in
aligned
with
parental
rights,
and
then
we
updated
the
chemical
restraint
definition
as
well.
E
So
I'll
just
walk
you
through
each
one
of
these
processes,
the
first
one,
updating
the
mental
health
crisis,
whole
process
and
defining
terms.
So,
like
I
said
ab-85,
we
made
a
few
changes
that
were
kind
of
low
hanging
fruit,
but
as
we
got
into
nrs433,
we
realized
that
it
was
written
in
1975
and
because
there
haven't
been
any
changes
since
then,
it
reads
like
it's
from
1975.,
so
it
really
reads:
right
now,
like
a
law
enforcement
officer,
detains
an
individual
and
applies
for
emergency
admission
into
an
inpatient
psych
facility.
E
So
it's
a
one-step
process
where
they
detain
and
take
them
into
an
inpatient
psych
facility
for
evaluation.
That's
not
our
current
system.
Our
current
system
is
now
detainment
and
you're
brought
to
either
a
mental
health
crisis
center
or
a
hospital
er
where
you're
evaluated
and
observed
there
and
a
large
percentage
of
people
are
taken
off
of
that
hold
because
they're
found
stable
or
to
not
meet
the
criteria.
E
So
our
proposed
solutions
were
sections
28-32,
updating
the
mental
health
crisis
whole
process
to
align
with
current
practice.
Clearly
separating
like
I
said,
the
mental
health
crisis
hold
from
emergency
admission
in
sections
three.
Through
eight,
we
actually
developed
definitions
for
the
terms
that
were
used
in
the
law
so
that
everyone
can
be
in
the
same
page,
section
26.
We
had
because
we
adjusted
application
for
emergency
admission.
E
We're
now
using
a
more
neutral
term,
which
is
mental
health
crisis
hold
before
the
attorney
general,
would
approve
forms
for
the
admission
of
people
to
impatient
psych,
and
now
we
have
it
that
they
will
approve
the
forms
for
detainment
evaluation
treatment
and
conditional
release
just
to
expand
that
the
added
terms
that
we
developed.
E
We
clarified
the
family
petition
for
court-ordered
pickup.
The
problem
was
that
the
process
that
was
in
law
was
pretty
unworkable
and
vague,
so
we
updated
it
section.
9
develops
the
petition
process
for
court
order,
pick
up
an
evaluation
of
individuals
suspected
to
meet
criteria
for
mental
health
crisis
in
section
36.
E
So
it
removes
the
ability
for
the
spouse,
parent,
adult
children
or
legal
guardian
to
petition
for
straight
admission
to
an
inpatient
psych
facility,
because
we're
always
trying
to
think
so.
It's
nice
to
have
kind
of
screens
and
filters
for
people
to
go
into
inpatient,
psych
facilities,
and
so
with
the
current
process.
Now
it
makes
sense
for
them
to
go
to
a
hospital
er
and
then,
if
they
are
deemed
appropriate
and
based
on
their
insurance,
they
can
go
into
an
inpatient,
psych
facility.
E
We
clarified
the
hospital
in
court
procedure
for
individuals
who
cannot
be
medically
cleared
in
72
hours
again.
That
process
was
really
unworkable
in
the
law
and
we
made
it
so
that
it's
clear
hospitals
didn't
have
a
place
in
the
law.
To
turn
to
to
understand,
you
know
what
what
process
to
take
when
those
individuals
are
not
medically
cleared
within
that
time,
and
so
we
corrected
that.
E
We
also
updated
hospital
times
for
notifying
guardians
in
courts.
Currently,
in
law,
hospitals
are
required
to
provide
a
notice
of
discharge
to
courts
and
guardians
for
patients
who
are
under
involuntary
corrupt
10
days
prior
to
discharge,
that's
actually
a
longer
length
of
stay
than
the
average
length
of
say
that
people
stay
in
inpatient
psychiatric
units,
which
is
now
about
seven
days.
E
E
Patients
were
getting
lost
in
the
system
as
they
were
transferred
between
counties
and
there
was
no
standard
timeline
that
existed
to
ensure
detention
doesn't
extend
beyond
legal
limits
and
so
section
39
requires
a
person
who
submits
such
a
petition
to
notify
court.
If
the
subject
of
the
petition
is
admitted
in
the
facility
and
is
then
transferred
to
another
facility,
so
that
helps
courts
who
have
ordered
people
in
to
keep
track
of
where
these
people
go.
E
Section
section
41.5
clarifies
the
court
transfer
process
when
examining
personnel
are
not
available
and
the
county
of
residence
is
responsible.
So
again,
there's
times
where,
like
esmerelda
county,
does
not
have
the
resources
to
be
able
to
do
this
court
order
admission
by
law,
they're
able
to
transfer
that
to
another
county
and
it
was
vague
in
the
law.
So
we've
been
able
to
clear
to
clarify
it
so
that
courts
can
be
on
the
same
page
with
that
and
then
direct
file
in
the
county
of
treatment.
So
it
allows
this
mechanism
for
the
petitioner.
E
Let's
say
a
rural
hospital
knows
that
the
person
is
going
to
west
hills
in
in
washoe.
They
can
petition
washoe
to
do
the
court-ordered
admission
and
that
way
washoe
can
have
oversight
of
that
patient,
while
they're
in
the
washoe
system,
and
so
that
creates
a
more
streamlined
process
and
also
conforms
to
current
practice.
E
Contin
continuing
this
update
of
the
involuntary
court
order
and
county
transfer
process.
One
of
the
problems
was
that
courts
throughout
the
state
order
patients
into
state
services
without
the
necessary
evaluation
and
acceptance
process.
This
happens
a
lot
with
nams
and
snams,
and
so
we
there
needs
to
be
an
actual
acceptance
process
from
the
hospital
and
following
admission
guidelines.
E
So
we
clarified
that
once
a
person
is
involuntarily
involuntarily
admitted
to
a
mental
health
facility.
The
admitted
court
can't
transfer
the
case
and
the
mental
health
facility
is
required
to
notify
the
court
if
the
person
is
transferred
and
that's
actually
already
in
law
right
like
once,
you
do,
one
court
ordered
admission:
that's
it
you
have
that
court
ordered
admission
and
right
now
what's
happening
is
some
of
the
rural
courts
will
do
the
court
ordered
admission
and
then
try
to
transfer
the
case
to
the
urban
areas?
E
Section
50
of
this
bill
prohibits
the
transfer
of
a
consumer
who
has
been
admitted
to
a
mental
health
facility
or
required
to
receive
assisted
outpatient
treatment
to
another
facility
or
provider
of
treatment
unless
arrangements
have
made
regarding
the
cost
of
treatment
so
again
like
we
just
need
to
be
on
the
same
page
when
there's
transfers
and
work
according
to
the
system
that
we
have
with
insurance
and
such
other
changes
so
section
48
abolishes
the
requirement
that
an
evaluation
team
evaluates
a
person
who's
under
court
ordered
admission
in
a
mental
health
facility
or
required
to
receive
assisted
outpatient
treatment
before
the
person
could
be
unconditionally
released
before
the
expiration
of
the
order
right
now
that
does
not
happen
and
every
all
the
stakeholders
thought
that
that
was
an
unnecessary
step.
E
Section
23.5
updates
the
term
professionally
qualified
in
the
field
of
psychiatric
mental
health,
so
the
term
is
usable
for
both
public
and
private.
This
allows
us
to
have
a
shorthand
term
for
that
type
of
person,
as
opposed
to
continuing
to
list
out
all
of
the
people
that
would
be
able
to
fit
under
that
term.
Section
3.5.
E
We
applied
the
term
consumer
to
the
entirety
of
nrs433a
so
that
we
could
take
a
step
and
again
trying
to
be
on
the
same
page
with
definitions
and
then
we
closed
the
loophole
prior
to
sb-70.
What's
in
current
law
is
that
it
was
only
courts
would
seal
records,
they
were
mandated
to
steal
records
in
cases
of
court-ordered
admission,
but
not
for
all
these
other
people
that
are
in
the
system
and
they're
still
going
to
court.
E
So
there
would
be
a
person
that
could
go
to
court,
have
their
case
heard
and
the
court
would
deny
it
and
there
was
no
mandate
that
the
court
would
seal
that
record
and
there's
other
cases
like
that.
So
we
just
wanted
to
make
sure
that
there
was
unique
or
their
standardized
privacy
across
the
board
for
assisted
outpatient
treatment.
So
that's
that
court
ordered
outpatient
treatment.
E
These
programs
were
written
into
law
in
2014
and
they
were
specific
programs
funded
by
samsa,
the
federal
funding
arm
for
mental
health,
and
they
were
kind
of
unique
programs,
one
in
clark
and
one
in
washoe
we
had
a
technical
assistance
provider
come
and
tell
us
that
it's
actually
a
generic
kind
of
mechanism
of
treatment
across
the
board.
These
are
not
specialized
programs,
so
we
really
worked
to
develop
a
law
that
allows
for
that
generic
use
in
all
counties,
not
just
washoe
and
clark.
E
We
also
had
an
interesting
part
of
nevada
law.
It
was
the
only
state
that
first
required
that
the
patient
meet
criteria
for
inpatient,
hospitalization
and
then
then
meet
aot
cri
criteria.
So
basically
the
courts
needed
to
find
that
someone
was
a
danger
to
sell
for
others
before
ordering
them
into
outpatient
treatment
in
the
community,
and
so
we
really
made
some
improvements
in
this
with
the
criteria
so
that
people
are
able
to
see
the
specific
criteria
in
the
population
that
this
court-ordered
treatment
would
fit.
E
So
the
proposed
solutions
are
sections
11-21,
20.5,
24
and
develops
assist,
specific
assisted,
outpatient
treatment
criteria
and
program
protocols,
procedures
and
clarifies
and
updates
current
law
for
implementation
in
all
counties.
It
creates
a
separate
aot
process,
so
the
aot
process
was
interwoven
into
the
inpatient
process.
So
now
it's
very
easy
to
read
and
understand
and
then
section
42
moves.
You
would
you'll
see
that
there's
this
requirement
that
the
same
council
must
continue
to
represent
the
person.
We
moved
that
piece
into
the
aot
section
as
well.
E
So
again,
it's
in
one
cohesive
format:
oh
just
a
sec!
Here
we
go
aot
continued.
So
like
I
was
saying
we
created
a
generic
term.
We
think
that
this
creates
a
clear
and
transparent
process.
So
individuals
know
what
aot
is
and
how
to
petition
for
the
program.
It
enables
community
providers
to
provide
aot
services
in
coordination
with
courts.
So
in
my
region
we
have
ccbhc
certified
community
behavioral
health
clinics.
E
Those
agencies
are
able
to
provide
the
services
of
aot,
so
it's
possible
for
us
to
expand
assisted
outpatient
treatment,
at
least
to
my
region,
and
to
other
regions
that
have
ccbhcs
without
needing
state
funding
and
then,
like.
I
was
saying
it
clearly
identifies
the
target
population.
So,
instead
of
just
saying
the
person
is
the
danger
to
self.
For
others.
The
other
person
is
over
the
age
of
18.
Has
a
mental
illness?
E
I
used
to
work
on
one
as
a
discharge
planner,
where
you
get
them
stabilized,
they're,
no
longer
a
danger
to
sell
for
others
they're
under
court-ordered
admission,
but
you
know
that
without
necessary
supports
that
they're
going
to
deteriorate
when
they
leave
and
in
those
situations
it's
hard
to
discharge,
because
that's
essentially
kind
of
a
unsafe
discharge,
and
so
many
hospitals
may
decide
to
keep
that
person
until
the
end
of
the
court-ordered
admission
and
they
still
haven't
really
found
a
great
solution,
and
so
that
person
is
discharged
with
not
great
supports
and
ends
up
deteriorating
as
suspected
would
happen.
E
And
so
what
this
mechanism
creates
is
kind
of
a
discharge
plan
on
steroids,
where
the
hospital,
if
the
individual
is
still
under
inpatient
court,
ordered
involuntary
admission,
can
try
the
individual
out
by
coordinating
with
a
team
in
the
community
and
having
the
individual
agree
to
certain
terms
such
as
you
know,
you're
gonna
go
to
treatment.
E
You
have
people
that
are
constantly
going
all
through
those
hospitals
and
there's
really
just
like
a
whole
bunch
of
recreating
the
wheel
in
every
discharge
plan
every
treatment
plan,
so
the
court
can
serve
as
a
central
entity
in
being
able
to
coordinate
that
care.
So
if
that
individual
comes
back
in
the
court
can
say,
this
is
what
the
last
discharge
team
or
treatment
team
said
worked
here.
Are
the
medications
and
be
able
to
provide
that
to
the
next
hospital
for
continuity
of
care?
E
So
sections
22,
39
47,
clarify
and
update
the
conditional
release
process.
This
was
already
in
the
law.
It
was
completely
unworkable
and
we
think
that
having
more
court
or
oversight
will
provide
more
due
process
for
the
individuals
for
the
youth
mental
health
crisis
hold
like.
I
was
saying
they
were
using
inaccurate
terms
when
the
law
was
written
and
it
the
way
that
the
law
was
written.
Also,
it
was
saying
that
you
know
hospitals
have
to
notify
him
the
parents
of
the
youth
being
detained
on
a
hold
after
24
hours
after
emergency
admission.
E
It's
hoped
that
the
youth
would
never
be
admitted
to
an
inpatient
psych
facility
without
pairing
consent
or
knowledge
or
without
some
other
due
process,
and
so
we
thought
that
what
it's
really
trying
to
say
is
hospitals
have
to
notify
the
parents
20
within
24
hours
of
the
placement
of
the
whole.
So
we
just
made
the
small
changes
like
that,
so
section
33
clarifies
and
changes
the
time.
Hospitals
detaining
a
youth
most
must
notify
a
parent
or
legal
guardian.
Holding
a
youth
under
mental
health
crisis
hold
from
24
hours
to
eight
hours.
E
That
was
a
big
request
from
the
family
advocates
and
we
thought
that
was
reasonable
on
the
hospital
perspective,
because
that's
the
first
thing
that
you
should
be
doing
as
a
hospital
if
a
youth
is
coming
in
without
a
parent
section.
35
also
creates
a
mechanism
for
youth
to
be
released
from
a
mental
health
crisis
hold
to
parent
custody
if
the
gardener,
guardian
or
parent,
agrees
to
treatment
or
accepts
physical
custody
of
the
youth
right
now,
there's
no
place
on
the
forum
for
that.
E
So
we
wanted
to
create
that
option
and
mechanism
and
then
finally
chemical
restraint.
I
think
everyone
sees
chemical
restraint
and
probably
is
concerned
about
it,
but
basically
nevada's
chemical
restraint.
E
Definition
was
developed
in
1975
and
is
outdated
and
doesn't
take
into
account
for
innovations,
new
medications
and
new
fda
approved
uses
of
medications
in
health
care,
and
so
the
solution
was
in
sections:
2,
65,
66
68,
where
chemical
restraint
is
used,
exclude,
modern
fda,
approved
interventions
for
treatment
from
the
definition
of
chemical
restraint,
and
so
this
was
proposed
by
dr
raven,
with
division
of
public
and
behavioral
health,
and
he
works
closely
with
dr
shoot.
E
I'm
so
sorry,
I'm
blanking
on
that
with
the
commission
on
behavioral
health,
the
chair
of
the
commission
on
behavioral
health.
So
we
feel,
like
that's,
a
pretty
vetted,
a
very
vetted
idea,
all
right
and
with
that
I
think
we're
at
the
end
of
the
slides
and
I'm
happy
to
accept
questions.
If
you
have
any.
A
F
F
She's
just
been
stellar,
so
thank
you
jessica.
Those
of
you
who
already
know
me
I'm
rahman,
titus,
district
38
and
yes,
I
have
sat
on
this
board
now
for
two
sessions.
I
assume
that
jessica
gave
you
or
misflag
gave
you
an
overview
of
what
this
board
does.
Hopefully,
that's
been
done
already.
There
are
now
five
boards
that
all
have
representatives
from
the
legislature
on
these
boards.
I
happen
to
sit
on
this
one.
F
Those
who
are
on
this
committee
know
especially
majority
leader
teresa
beatings.
Thompson
know
that
we
have
been
working
literally
for
many
many
many
sessions
on
what
we
know
as
the
original
legal
2000
hold
now,
with
the
mental
health
crisis
hold
trying
to
fix
this
statute,
the
ultimate
goal
was
to
make
sure
that
number
one,
a
person
had
their
rights
upheld
number
two.
They
got
medical
and
mental
attention
in
an
expeditious
manner
and
number
three.
Then
they
also
were
able
to
get
treatment.
F
So,
along
these
many
many
sessions,
we
tried
to
identify
where
the
hiccups
were
on
this,
and
one
of
the
goals
was
to
make
sure
that,
in
that
we
heard
testimony
over
the
years
about
they
would
be
stuck
in
an
emergency
room
because
they
need
this
medical
clearance
or
medication.
And
where
do
you
send
them
and
what
this
process
is.
F
So
hopefully,
if
we
have
worked
on
this,
I
would
give
credit
to
ms
flood,
because
what
she
did
was
engage
every
single
aspect
of
this
large
large
bill,
not
just
from
the
medical
aspect,
which
is
what
we
would
get
hung
up
on,
but
also
the
judicial
aspect
and
whether
it
was
in
the
rules
or
whether
it
was
in
urban
areas,
whether
it
was
a
little
hospital
or
a
big
hospital.
So
the
key
is
trying
to
look
at
what
the
needs
were
throughout
the
state.
F
Making
sure
patients
in
mental
health
crisis
were
treated
both
from
a
medical
aspect
and
making
sure
at
the
same
time
their
legal
rights
were
upheld,
and
with
that
I
just
want
to
again
thank
you
for
hearing
this
bill
and
appreciate
miss
flood
and
taylor
allison,
our
our
chair
of
our
our
committee
so
and
happy
to
have
any
questions,
and
definitely
the
experts
on
this
matter
is
sitting
behind
me
on
this
video
screen.
I
will
tell
you
thank
you.
A
Thank
you,
assemblywoman
titus
and
thank
you
miss
flood.
D
D
D
F
F
For
the
record,
I
would
say
that
they
absolutely
were
not,
which
is
what
was
critical
to
another
piece
of
legislation
that
we
don't
frequently
refer
to
when
we're
doing
one
bill.
But
we
passed
the
crisis
stabilization
centers,
which
were
absolutely
critical
to
looking
at
the
overall
mental
health
of
our
state,
because
we
one
thing
we
identify
as
we
don't
have
adequate
mental
health
through
eleanor
state
and
our
little
hospital,
where
I
practiced
forever
little
eight
bit
hospital.
We
didn't
have
a
mental
health
area
that
we
could
actually
stabilize
patients
in
mental
health
crisis.
F
So
that
was
a
component
that
we're
addressing
throughout
the
state
we're
getting
better
at
it.
But
this
bill
addresses
that
this
bill
says
what
do
I
do
in
the
er
in
my
little
rural
area?
How
long
were
patients
sitting
in
a
big
urban
emergency
room
that
maybe
didn't
have
access
to
adequate
mental
health
within
that,
because
we
weren't
mental
health
centers
and
so
partly
we're
trying
to
address
out
this
legislation
with
some
stuff
that
we've
already
seen
here
so
and
then
miss
blood.
E
Yes,
jessica,
fled
for
the
record,
sorry
yeah,
so,
as
dr
titus
said,
we're
really
trying
to
develop
that
alternate
behavioral
health
crisis
response
system
that
988
legislation,
the
crisis,
stabilization
unit-
it's
pretty
amazing
watching
that
be
built,
but
I
think
we
have
acknowledged
that
hospitals
largely
cannot
respond
to
mental
illness
and
so
creating
those
crisis.
Stabilization
centers
and
that
crisis
call
line
is
essential
to
being
able
to
adequately
respond
to
people
that
are
in
mental
health
crisis.
D
F
F
I'll
start
with
that,
thank
you,
jessica,
robin
titus,
for
the
record,
so
just
for
the
process,
when
we
start
a
mental
health
hold,
there
has
to
be
a
medical
screening
beside
before
they
get
admitted
to
the
medical
facility.
That's
where
our
er
would
come
in,
that's
where
they
would
bring
them
to
me.
I
have
to
evaluate
them
that
make
sure
that
their
mental
health
crisis
is
not
due
to
a
medical
reason
as
their
blood
sugar
low
did.
They
stop
some
medications
or
some
other
medical
reason
before,
but
then
yeah.
E
D
Thank
you
when
you
were
referring
to
item
number
three,
the
conditional
whole
release.
D
A
I
deemed,
what's
the
word,
I'm
trying
to
look
for
releasing
you
know,
because
I
don't
understand
that
where
a
doctor
can
actually,
you
know
a
psycho,
a
psych,
a
psychologist,
I'm
sorry,
I'm
spitting
words
out
right
now,
but
a
a
doctor
can
determine
whether
or
not
this
person
is
able
to
be
released.
D
E
Jessica
plug
for
record.
Thank
you
for
your
question,
so
I
can
clarify
this.
So
the
courts
don't
give
approval
for
that
discharge.
The
hospitals
do
decide
the
discharge
and
really
the
courts
are
just
notified
that
the
conditional
release
has
occurred
and
they'll
get
that
form
that
the
hospitals
have
done
with
the
community
providers
so
that
they
can
kind
of
be
that
central
repository
of
coordination.
G
Thank
you,
chairwin.
Thank
you
for
the
presentation.
I
appreciate
the
antenna
the
bill.
I
just
have
a
quite
a
lot
of
questions,
so
an
involuntary
mental
health
crisis
hold.
You
know.
First
of
all,
the
word
involuntary
scares
me
here.
Obviously,
in
the
united
states
we
value
our
individual
rights
and
liberties
under
the
constitution,
our
freedom
of
movement
so
involuntary
hold.
You
know
it
should
give
all
of
us
pause.
G
And
I
understand:
there's
people
who
really
are
going
through
a
mental
health
crisis
and
and
who
really
do
need
this,
but
as
legislators
we
always
have
to
be
thoughtful
and
think
about
an
odd
case
or
a
worst
case
scenario
when
somebody
is
taken
against
their
will
on
this.
Involuntary
mental
health
crisis
hold
for
72
hours
and
really
doesn't
belong
there.
So
my
first
question
is
at
every
point
along
the
way
during
the
72
72-hour
extended
hold,
and
if
somebody
decides
that
they're
gonna
go
for
an
extended
hold.
G
E
Great,
thank
you.
So
much
jessica
fled
for
the
record.
Yes,
so
they
do.
We
have
habeas
corpus
in
nrs433a,
where
the
the
individual
can
petition
the
court
at
any
time,
and
actually
that
was
why
we
started
this
work
in
the
first
place
is
that
the
the
law
is
not
well
understood,
and
so
patients
were
not
really
able
to
understand
what
their
rights
were
and
so
prior
to
ab-85.
E
E
We
clarified
all
that,
so
we
could
start
creating
education
and
that
pamphlet,
that
I
showed
you
talks
about
your
right
to
go
to
the
court
at
any
time
and
have
a
hearing
on
that.
There's
also
the
nevada,
disability
and
advocacy
law
center
that
works
on
or
that's
able
to
advocate
for
individuals
with
mental
illness
in
those
situations
and
then
the
aclu.
So
those
are
definitely
why
those
pieces
are
in
place,
but
there
is
due
process
for
anyone
who
requests
it.
E
G
Does
the
is
the
person
is
the
adult
or
child
given
notice
that
they
are
entitled
to
a
phone
call
within
three
hours
in
in
nrs,
section
171.153,
a
person
who
is
arrested
again
they
are
their
liberty
is
taken
away,
their
freedom
of
movement,
the
law
states.
They
must
be
allowed
to
make
a
phone
call
or
or
more
than
one
reasonable
phone
call.
That's
an
local
phone
call
within
three
hours
in
your
bill.
I
don't
see
that
and
I
really
think
that
should
be
added.
I
I'd
sure
appreciate
it.
G
I'm
wondering
what
your
thoughts
are
on
that
allowing
somebody
to
be
notified
that
they
can
make
a
phone
call,
whether
it's
an
adult
or
a
minor
within
three
hours
of
the
time
they
are
taken
against
their
will.
Your
thoughts
on
that
please.
E
Yes,
thank
you.
Jessica
fled
for
the
record,
so
in
nrs
433a
we,
the
patient,
does
have
right
to
access
the
telephone,
not
even
just
within
three
hours,
but
during
their
entire
stay
at
a
hospital.
So
when
we
created
that
brochure,
I
would
love
to
share
that
with
you.
It
has
all
of
these
rights
listed
out
in
there.
I
I
I'd,
be
open
to
your
thoughts
if
we
needed
to
add
the
three
hours,
but
I
think
just
even
just
having
that
blanket
access
to
telephone
through
the
entire
stay
is
really
important.
G
Thank
you
and
and
another
follow-up,
so
also
in
your
presentation,
did
you
state
that
your
recent
addition
is
that
a
minor
now,
a
person
under
18
who
has
taken
involuntarily
it's
no
longer
going
to
be
within
24
hours,
that
the
parent
or
guardian
must
be
notified?
It's
going
to
be
within
eight
hours.
Did
you
know?
G
E
Thank
you,
jessica
flood
for
the
record.
I
think
your
request
is
reasonable.
That
makes
a
lot
of
sense.
I
mean
as
a
hospital
like
I
said
it
should
be
happening
as
soon
as
a
child
comes
in.
If
law
enforcement
brings
a
child
in
you
think
the
first
thing
the
hospital
will
want
to
do
is
try
to
get
a
hold
of
that
parent.
E
You
know
with
this
diverse
stakeholder
group
there's
a
lot
of
push
and
pull
intention
correct,
so
there's
got
there's
the
hospitals
that
are
like
is
that
gonna?
Are
there
these
situations
where
we
won't
be
able
to
do
that,
and
then
you
have
the
parent
and
family
advocates
who
say
it
should
be
like
you
said,
within
three
hours,
I
think
that's
reasonable.
I
I
don't
know
what
the
stakeholders
think
about
that,
but
I
I
would
be
open
to
seeing
what
the
stakeholders
think
about
that.
A
Assemblywoman
kresner,
I
will
ask
you
to
probably
follow
up
with
her.
I
know
that
she
is
speaking
on.
Behalf
of
you
know
her
position
as
a
coordinator
for
the
northern
regional
behavioral
health
coordinator.
So
she
probably
has
a
difficult
time
answering
that,
on
behalf
of
all
of
the
stakeholders
that
she
has
been
speaking
with.
G
I
do,
and
I
appreciate
that
I
just
remember
when
this
bill
came
in,
that
that
a
minor
could
be
taken
with
you
know,
without
consenting
the
parents
or
guardian
and
held
for
basically
23
hours
and
and
59
minutes
without
notifying
their
parent
one
of
the
directors
of
the
local
youth
mental
hospital
reached
out
to
me
and
said
they
were
mortified
by
the
bill
and
that
they
thought
it
would
further
traumatize
children
to
not
allow
them
to
have
that
kind
of
contact
or
make
a
phone
call
with
a
parent
or
guardian.
G
So
just
for
the
record,
I
wanted
to
see
if,
if
we
could
put
that
in
there,
since
we
do
give
that
to
people
that
are
arrested,
I
thought
we
could
also
give
that
that
same
right
to
to
people
who
are
taken
against
their
will.
E
Yeah
jessica
fled
for
the
record,
I
think
assemblywoman
chairwin.
I
really
appreciate
that
because
yeah
this
has
been
a
group
effort
with
probably
30
stakeholders,
and
so
I
just
don't.
I
have
my
own
personal
opinions
on
whatnot,
but
you
know
in
terms
of
the
agreement
and
the
process
that
we've
put
in.
G
A
A
I
know
that
a
lot
of
work
went
into
trying
to
do
this
during
the
2019
session
and
a
lot
of
the
work
in
senate
bill,
70
kind
of
plays
off
of
the
corrections
and
the
clarifying
language
that
was
needed
to
further
implement
some
of
that
those
protections
for
patients
as
well.
You
know
within
the
legal
system,
as
well
as
within
their
medical
care.
You
had
mentioned
back
to
the
telephone
access.
A
The
way
I
read
it
is
they
have
access
to
the
telephone
to
make
those
kind
of
calls
and
make
those
requests
for
a
hearing
at
any
time.
You
know
whether
it's
in
the
first
five
minutes
of
them,
you
know
coming
into
contact
with
the
system
or
if
it's
you
know
three
hours
later
or
four
hours
later.
Is
that
correct.
A
Seeing
none
at
this
time.
I
will
open
up
testimony
in
support
of
senate
bill
70..
I
will
start
in
the
room
here
with
testimony
and
support.
I
would
ask
members
to
please
clear
people
testifying
to
please
clearly
state
and
spell
your
name
for
the
record
and
please
limit
your
testimony
to
two
minutes
and
we
will
have
two
at
the
table
at
a
time
and
we'll
begin
when
we're
ready.
I
I
H
Good
afternoon
kendra
burch
with
the
washoe
county
public
defender's
office.
I
also
want
to
thank
all
the
stakeholders
for
meeting
with
our
office
to
try
to
address
the
due
process,
concerns
that
we
had
and,
more
importantly,
for
continuing
to
work
on
this
extremely
important
area
of
law.
Just
by
way
of
context,
my
office
represents
those
individuals
who
are
involved
the
adults
in
the
involuntary
commitment
hearings
and
in
2020
we
had
2185
individuals
who
went
through
that
process.
H
So
we
appreciate
the
work,
that's
been
done
in
the
last
session
and
they
continued
on
here
to
work
on
reworking
our
antiquated
statutes
and
attempts
to
clear
up
the
ongoing
systematic
issues
and
provide
clarity
for
parents,
patients
and
hospitals
about
the
requirements
and
just
to
address
assemblywoman
krasner's
question.
I'm
happy,
I'm
misled
to
work
with
you
to
see
if
there's
anything
else,
that
needs
to
be
done
to
ensure
that
everyone
understands
that
they
do
have
rights
to
reach
out
to
their
parents
or
loved
ones,
so
that
everyone
knows
where
they
are
located.
A
And
do
we
have
anyone
else
in
the
room
to
testify
in
support
of
senate
bill
70,
seeing
no
one
coming
up
to
the
table
broadcast
services
if
we
can
go
to
the
line
again,
I'd
remind
callers
on
the
line.
This
is
testimony
and
support.
Please
clearly
state
and
spell
your
name
and
limit
your
testimony
to
two
minutes
to
testify
in
support.
B
J
B
B
K
A
B
A
A
F
F
Nothing
is
ever
perfect,
which
is
why
we
come
back
all
the
time
for
this,
but
I
think
that
it's
been
really
a
collaborative
effort
with
many
stakeholders
throughout
this
process
and
would
appreciate
you
supporting
this
bill.
Thank
you.
A
Thank
you,
assemblywoman
titus,
and
with
that
we
will
close
the
hearing
on
senate
bill
70,
and
at
this
time
I
will
open
the
bill
hearing
on
senate
bill
158.
A
A
Is
gonna
knock
it
out
of
the
park?
I
will
let
you
begin
when
you
are
ready.
I
I
Amy
hondadale,
representing
the
legal
aid
center
of
southern
nevada,
is
on
the
zoom
with
us
today
and
will
be
available
for
questions,
and
I
will
start
with
just
a
brief
overview
of
this
bill
senate
bill.
158
is
based
on
recommendations
that
came
out
of
the
interim
child
welfare
committee.
I
would
like
to
thank
senator
orrinshaw
for
bringing
this
legislation
forward.
I
I
The
language
matches
the
federal
4e
eligibility
language,
so
we're
not
being
overly
restrictive
with
who
can
access
federal
dollars
because
there's
a
technical,
legal
difference
between
not
possible
versus
not
appropriate,
maintaining
family
community
and
cultural
ties
is
important
for
children.
Adoption
may
not
always
be
the
best
option.
A
child
might
have
a
strong
relationship
with
a
relative
guardian.
Parents
may
not
wish
to
terminate
their
parental
rights.
A
F
Thank
you,
madam
chair,
and
thank
you
for
bringing
this
bill
forward.
I
think
it
is
important.
I
just
had
a
question
specific
to
the
bill
itself
on
section
one
number
c,
and
it
talks
about
the
one
line
where
services
must
determine
that
being
returned
home
or
adopted,
are
not
appropriate
permanency
options
for
the
child.
Would
that
eliminate
this
family?
Member
from
adopting
the
child.
I
A
L
The
way
the
amendment
is
written,
adoption
will
still
be
on
the
table
and
actually
best
practices
for
us
and
the
courts
to
do
what
is
called
concurrent
planning
so
that
two
plans
may
be
worked
with
the
idea
that
we
don't
have
to
wait
for
one
to
be
eliminated
to
get
a
youth
out
of
the
system.
But
there
are
times
when
adoption
may
not
be
what
the
child
desires
if
they're
an
older
youth,
for
example.
But
you
know
adoption
would
still
be
on
the
table
it
just.
F
A
D
Thank
you,
madam
chair,
and
thank
you
miss
block
for
bringing
this
bill
forward,
and
I
I
have
a
vested
interest
in
it
number
one.
I
visited
the
facility
and
actually
it's
in
north
las
vegas
and
one
of
the
things
that
I
had
a
conversation
about.
I
have
had
a
relative
that
actually
had
to
take
on
her
three
grandchildren
because
the
mother
had
died
and
she
did
not
receive
any
help
from
the
state
in
order
to
take
care
of
these
children
and.
D
Meaning
that
if
I
would
have
taken
the
children,
I
could
have
received
foster
care
monies
and
I'm
hoping
that
this
bill
will
eliminate,
because
this
was
a
grandparent
or
an
aunt,
or
you
know
a
relative
that
that
relative
can
actually
receive
monies
from
the
state.
Is
this
what
is
happening
with
this.
I
L
Thank
you
again.
This
is
amy
hanadel
for
the
record
this.
Actually,
all
relatives
are
eligible
for
financial
assistance.
When
they
take
children
in
they
are
able
to
become
licensed,
foster
parents.
There
is
a
shortened
class
requirement.
It's
called
a
kinship
licensing.
This
bill
doesn't
affect
that.
What
we
are
hoping
to
do
going
forward
in
other
areas
is
to
best
you
know,
help
with
the
department
of
family
services.
Tcfs
washoe,
I
believe,
will
also
be
working
on
this.
L
Is
that
making
sure
that
relatives
are
given
information
very
early
on,
because
it
is
a
significant
financial
undertaking
when
they
take
on
relatives
kids,
but
this
bill
won't
affect
that.
This
bill
in
fact
requires
those
relatives
to
become
licensed
before
we
do
before
the
case
does
get
referred
for
kinship
guardianships.
D
Okay,
I'm
not
fully
understanding
that
because
it
just
seems
like
there
is
maybe
misunderstanding
on
my
part
that
a
grandparent,
because
they
either
have
to
adopt
that
child
or
reunify
with
the
parent,
that
they
would
receive
assistance.
L
Okay,
thank
you
again
for
the
record.
This
is
amy
hanadel.
Yes,
I'm
I'm
a
little
confused
about
where
the
confusion
is
coming
from
right
now,
the
way
title,
4e
funding
and
the
foster
licensing
programs
are
written
and
prepared.
Any
person
relative
or
non-relative
can
become
a
licensed,
foster
parent
to
take
care
of
kids.
D
Okay,
thank
you.
So
I
do
understand
you
saying
now
that,
in
order
for
that
grandparent,
I'm
sorry
chair
follow
up.
D
That
the
grandparent
or
relative
would
need
to
be
a
foster.
A
licensed,
foster
care
person
in
order
to
receive
assistance
from
the
state.
L
And
that
is
again
amy
hanado
for
the
record
that
is
correct,
and
that
is
regardless
of
what
the
plan
is
for
the
child.
If
the
child
can
be
going
home
can
be
adopted
that
doesn't
affect
that
relative's
eligibility
to
become
enlightened,
so
you
know,
there's
short
requirements
to
become
licensed,
because
we
want
these
people
to
be
supported
when
they
have
this
unexpected.
B
F
B
And
it
sounded
good
too.
So,
when
you
know
a
lot
of
these
things
happen
so
quickly
right,
they
could
be
death.
It
could
be
anything
right.
How
much
time
right
I
mean
just
as
as
an
example,
I
I'm
when
I
leave
here.
I
work
full
time
right.
Where
do
I
find
the
time
to
become
this
licensed,
foster
care
person,
and
if
I'm
getting
my
licensing
under
nrs424.030,
is
there
online
classes?
Do
I
have
to
go
someplace?
If
I
don't
do
it
fast
enough?
Are
you
gonna
take
my
grandbaby
from
me?
B
C
Thank
you,
bailey
bortolin
for
the
record
yeah,
it's
a
scary
process
for
everyone
involved,
so
I
want
to
pull
back
a
little
bit.
Kin
gap
is
a
federal
assistance
program
for
to
assist
financially
families
who
are
relatives
who
take
in
their
children
for
the
foster
care
system.
C
I
believe
the
agency
works
with
you
and
works
around
that
timeline,
because
we
do
have
a
preference
for
working
with
family
members
in
the
law
right
to
ensure
that
we're
putting
children
with
their
relatives
whenever
possible.
So
amy
may
be
able
to
add
to
what
that
timeline
realistically
looks
like.
C
But
what
I'll
say
is
what
this
bill
is
fixing
to
put
a
finer
point
on
the
question
you
are
asking
assemblyman
thomas
is
everyone
could
agree
right
now
in
the
state
of
nevada,
in
a
child's
child
welfare
case
that
the
most
appropriate
placement
is
to
have
this
permanency
plan
of
guardianship
with
a
relative?
And
so
that's
why
we
have
this
federal
kin
gap
program,
because
a
lot
of
families
can't
afford
to
just
pull
back
and
have
no
financial
assistance
and
have
the
case
closed
under
a
guardianship
with
grandma.
C
She
she
needs
that
financial
assistance,
so
the
federal
king
gap
program
that
exists
closes
that
loophole
by
providing
that
funding.
But
the
way
that
we
currently
have
interpreted
that
eligibility
standard
in
the
nrs
is
more
restrictive
than
the
4e
federal
funding
actually
requires
us
to
be
so
by
saying,
not
possible.
C
Everybody
wants
the
permanency
plan
to
close
this
case
and
be
guardianship
with
grandma,
but
if
it's
determined
that
it's
possible
to
adopt
the
child,
then
that
could
restrict
access
to
that
federal
funding
and
so
by
changing
that
to
appropriate
it's
where
everyone
agrees
in
the
child's
life
that
this
is
the
best
case
forward,
and
we
don't
have
to
have
legal
arguments
about
it's
possible
for
grandma
to
adopt.
So
if
grandma
wants
the
kids,
she
should
adopt
the
kids
and
that
will
come
with
an
adoption
subsidy
and
we
get
into
in
a
narrow
set
of
cases.
C
We
get
into
a
legal
argument:
that's
unnecessarily
restrictive,
just
because
of
the
way
it's
currently
drafted
in
nrs,
so
this
will
allow
us
to
just
whenever
it's
possible
and
appropriate
to
get
these
families.
The
federal
funding.
This
slight
tweak
in
the
nrs
will
ensure
that
we're
giving
that
those
families
that
federal
funding.
A
Thank
you
for
that
clarification,
miss
borderland,
so
just
to
further
clarify
this
actually
makes
it
a
lot
easier
in
situations
that,
like
with
grandma,
where
assemblywoman,
thomas
and
assemblywoman
summers,
armstrong
kind
of
mentioned,.
M
Thank
you
so
much,
and
I
think
where
one
of
the
pieces
might
be
coming
in
is.
I
believe
that
there
still
is
a
the
program
is
run
through
tanf.
I
believe,
and
so
I
want
to
say
that
there's
a
threshold
of
income
so
for
some
people
might
not
be
eligible
for
it
just
because
they
they're
not
meeting.
I
want
to
say
it's
a
certain
percentage
of
poverty,
275
of
poverty,
or
so
I
think,
is
what
the
qualifying
guideline
is.
M
So
not
necess
everyone
who
qualifies
financially
and
is
taking
in
their
relative
or
kin
right
and
how
he
defined
kin
can
get
this.
But
if
there
are
people
who
are
out
there
who
aren't
getting
it,
it's
just
because
there's
that
there's
still
an
eligibility
piece,
and
so
that
might
be
a
consideration
for
people
who
have
incomes
higher
than
what
that
federal
probability
level
is
calling
for
on
this
and
then
also,
I
believe,
further
down
in
the
statute.
M
C
Bailey
borland
for
the
record.
Yes,
thank
you
majority
leader
for
explaining
that
more
artfully,
so
there
there
are
a
lot
of
considerations
that
go
into
this
we're
just
in
this
bill.
Looking
at
one
consideration
where
we
have
found
that
the
nrs
in
some
cases
has
just
been
interpreted
to
be
unnecessarily
restrictive,
but
you
will
still
have
to
otherwise
qualify
for
the
program,
but
the
unfortunate
situation
that
we've
seen
happen
is
everyone
agrees
that
grandma
should
take
the
child,
and
that
is
the
plan
and
that's
what
all
parties
involved
want.
C
So
the
funding
is
not
necessarily
indicative
of
whether
or
not
the
guardianship
will
be
granted
it's
just
whether
or
not
the
guardianship
will
come
with
financial
assistance,
and
so
this
will,
in
those
cases,
help
the
family.
Members
have
access
to
that
additional
support
when
appropriate
and
when
they
otherwise
qualify
through
the
program.
M
I
could
probably
mention
that
I
think
the
longest
piece
of
becoming
licensed
is
typically
the
fingerprint
background,
so
you're
waiting
for
the
you
know
that
kind
of
process
to
play
through,
and
I
would
say,
probably
be
tricky
to
try
to
adjust
that
or
undo
that,
because
it
has
all
kinds
of
implications,
but
it
can
either
be
90
days
or
three
months.
Whichever
comes
faster.
A
Thank
you,
assemblywoman
benitez
thompson.
Do
we
have
any
other
follow-up
questions
or
any
original
questions
from
committee
members?
At
this
point,
seeing
none?
I
will
begin
testimony
in
support
of
senate
bill
158.
I
will
first
turn
to
the
room
here.
We
will
take
two
at
a
table
if
we
could
do
so
and
remind
everyone
to
please
clearly
state
and
spell
your
name
for
the
record
and
limit
your
testimony
to
two
minutes.
I
Good
afternoon
and
thank
you
chairwin
and
committee
members,
my
name
is
kendall
lyons,
I'm
the
director
of
health
policy
with
children's
advocacy
alliance,
for
the
reasons
that
have
already
been
stated.
We
already
have
our
support
on
the
record,
but
I
just
wanted
to
reaffirm
that
support
here
with
you
today.
H
H
I
had
several
cases
where
we
had
this
issue
where
everyone
wanted
the
grandparent
or
the
relative,
the
aunt
uncle
sibling
to
still
have
that
child,
where
it
was
best
for
the
child
to
remain
with
a
family
member,
but
because
the
plan
had
to
be
guardianship
and
there
was
no
financial
support
that
added
a
lot
of
angst
and
issues
for
the
entire
family.
So
I
urge
your
support
of
this
bill.
Thank
you.
N
Good
after
good
afternoon
sharon
members
of
the
committee
joanna
jacob
on
behalf
of
clark
county,
we
worked
with
legal
aid
and
stakeholders
on
this
bill.
In
the
interim
leading
up
to
this
legislative
session,
I
did
want
to
put
on
the
record
clark
county.
We
have
a
large,
we
have
a.
We
have
a
great
degree
of
our
foster
care,
kids
with
relatives
and
in
relative
placement.
As
of
march
2021.
I
just
actually
pulled
this.
While
we
were
having
this
discussion,
we
had
over
1100
children
who
are
staying
with
their
relatives.
N
It
is
a
something
that
clark
county
supports.
I
also
did
want
to
put
on
the
record
that
really
what
we're
talking
about
here
is
the
subsidy,
and
it
was
important
to
clark
county
that
we
have
the
language
in
this
bill,
mirroring
the
federal
4e
language
so
that
we
can
get
financial
assistance
to
our
relative
placements.
N
We
do
need
them
to
be
in
that
placement
you'll
see
in
the
bill
that
they
have
to
be
with
that
relative
for
six
months
and
then
during
that
time,
during
we
work
with
our
relatives
to
get
them
licensed.
We
do
have
expedited
licensing
procedures
if
the
licensing
is
delayed.
It
delays
the
subsidy.
We,
it
is
not
a
situation
where
we
would
remove
the
child
from
that
family
placement.
We
do.
We
want
to
avoid
disruptions
to
the
fullest
extent
that
we
want
to.
N
So
I
just
wanted
to
say
that
for
the
record,
we
appreciate
legal
aid's
goal
in
in
working
on
this
bill
because
of
the
language
that
was
in
the
statute.
There
were
some
issues
with
how
that
language
was
being
interpreted,
and
so
that's
what
why
we
worked
with
them
on
this
bill
to
mirror
the
federal
4e
language
which
will
enable
us
to
get
the
financial
support
to
our
families
and,
of
course,
to
assemblywoman
thomas
to
someone
when
summer's
armstrong.
N
A
A
B
I
Thank
you,
chair
I'll,
just
reiterate
that
this
bill
simply
makes
a
small
change
to
a
narrow
piece
of
the
nrs
to
ensure
that
the
eligibility
requirements
are
not
more
restrictive
than
federal
requirements
and
just
creates
and
expands
more
opportunities
for
for
families
and
children.
So,
thank
you
so
much
for
hearing
sp158
today.
A
O
O
I
have
been
trying
to
tackle
a
couple
of
diseases
that
are
considered
invisible
diseases.
Last
session.
I
tackled
sickle
cell
this
session.
I
was
going
after
lupus
because
it
is
one
of
the
diseases
that
is
hard
to
diagnose
and
it
is
predominantly
women
and
it
is
predominantly
affecting
women
of
color
hispanic
and
african-american.
O
A
O
It
is
you
today,
that's
fine
all
right,
so
there
are
a
couple
of
things
in
your.
It
should
be
in
your
exhibits.
There
was
data
around
the
emergency
visits
and
inpatient
admissions
from
department
of
health
and
human
services,
which
gives
you
the
specific
data
on
nevada,
and
then
there
was
a
second
document
that
was
uploaded
for
the
national
public
health
agenda
for
lupus
the
blueprint,
and
so
the
reason
why
I
put
those
two
exhibits
in
there
because
number
one.
O
The
bill
helps
us
to
align
with
the
national
policy
agenda
around
lupus
number,
two:
the
lupus
related
department,
visits
which
break
down
demographics
and
and
sex,
and
it
lays
out
the
number
of
visits
roughly
about
1500
total
visits
of
admissions,
because
this
is
the
data
that
we
currently
have,
and
this
bill
would
expand
that
data
set
and
allow
us
to
grow
in
terms
of
the
variance
that
we
would
be
able
to
identify
so
getting
into
sb
175.
O
So
if
you
look
at
pretty
much
sections
two
through
twelve
give
definitions,
but
section
four
is
super
important
because
lupus
and
its
variants
are
super
important
because
there
are
four
types
of
lupus,
and
so
this
bill
would
be
able
to
get
documentation
on
systemic,
lucid,
lupus,
cutaneous,
lupus
drug
induced
lupus
and
then
neonatal
neonatal
lupus,
which
actually
affects
newborns.
O
O
The
chief
medical
officer
is
responsible
for
conducting
a
comprehensive
epidemiological
survey
of
lupus
evaluating
the
appropriateness
of
the
measures
for
the
treatment
of
lupus
and
its
variants,
and
then
it
also
includes
what
hospitals
and
medical
laboratories
and
other
facilities
how
they
they're
part
of
this
reporting
scheme,
because
they
are
in
the
front
line,
providing
screening,
diagnostic
and
therapeutic
services
to
patients
with
respect
to
lupus,
and
they
shall
report
their
information
to
the
state
board
of
health.
O
And
it
also
says
in
section
five
that,
inter
inter
provider
of
health
care,
who
diagnoses
or
provides
treatment
for
lupus
and
its
variants,
except
for
cases
directly
referred
to,
the
provider
must
also
report
their
information
when
you
get
to
section
6.
This
is
the
prescription,
which
kind
of
lays
out
the
information
that
is
required
to
be
kept
based
on
sb
175.
So
the
state
board
of
health
shall,
by
regulation,
prescribe
the
manner
in
which
information
will
be
maintained.
O
O
This
I
want
to
just
pause
there
for
just
really
quickly,
because
the
reason
why
the
diseases
are
are
important
is
because
there
can
be
several
offshoots.
You
can
end
up
with
a
cardiovascular
disease,
stroke,
rashes,
painful
joints,
there's
inflammation
fatigue
and
some
cognitive
issues.
When
I
met
some
patients
over
the
summer
and
in
the
presentation
on
the
senate
side,
there
is
a
clear
case
of
based
on
the
women
that
they
are
being
misdiagnosed
when
they
go
into
the
hospital
miss
calvina.
O
O
If,
if
the
doctors
had
had
their
way,
they
would
have
given
her
medication,
which
probably
would
have
ultimately
caused
her
death,
because
what
was
really
happening
was
that
she
was
having
a
lupus
related
incident
that
needed
to
be
diagnosed,
and
it
turned
out
that
there
was
only
one
doctor
who
happened
to
pass
her
while
she
was
laying
in
the
hallway
who
then
identified
her
symptoms
and
then
was
able
to
treat
her
and
then
she
is
now
living
with
us.
Today.
O
I
ran
into
women
who,
when
they
are
encountering
issues
with
their
primary,
well
really
their
rheumatologist,
and
there
are
only
a
few
rheumatologists
in
the
state.
They
are
then
challenged
with
the
care
model
that
is
being
presented
to
them,
because
they're
being
told
that
they're
not
really
sick,
they
don't
really
have
lupus,
but
yet
they've
been
diagnosed
for
10
years.
O
And
so
she
is
now
in
a
pickle
because
they're
saying
that
she
is
a
problem
patient
rather
than
listening
to
her
and
understanding
that
she
knows
her
care
better
than
anyone
else
and
that
she's
trying
to
tell
the
doctor
exactly
what's
going
on
with
her.
But
yet
he's
not
hearing
her.
And
now
she
is
in
a
state
of
panic
because
she
needs
to
find
another
doctor
who
can
take
care
of
her.
But
she
is
worried
about
the
absence
of
the
medications
because
he
removed
those
medications
from
her.
O
O
O
O
It's
very
important
because
this
section
is
going
to
assess
the
trends
and
the
usage
of
an
access
to
health
care
services
by
the
patients
with
lupus
and
its
variants
in
a
particular
area
or
population.
It
will
also
be
important
for
this
section
to
be
applied
because
they
will
advance
research
and
education
concerning
lupus.
O
There
are
several
organizations
that
are
already
in
play
on
the
national
level.
The
cdc
has
actually
been
running
surveillance
projects
in
a
couple
of
other
states.
It
would
be
nice
if,
once
we
pass
this
bill
and
get
aligned
with
the
national
standards,
that
we
could
become
a
part
of
a
surveillance
project
and
actually
start
to
be
able
to
develop
and
lift
up
these
patients,
so
we
can
identify
their
associated
disorders
and
the
variants
and
the
access
to
care
issues
that
they're
facing
further
on
in
section
8.
O
This
is
important
because
the
continuity
of
care
is
important
for
a
young
person
who
may
have
been
diagnosed
before
18
and
what
that
continuity
of
care
will
be
from
rheumatologists
to
rheumatologists
or,
if
they're,
coming
from
another
state.
This
will
also
allow
them
to
at
least
have
some
kind
of
connection
to
build
that
transition.
This
language
was
similar
to
an
issue
I
dealt
with
with
the
sickle
cell
patients
because
they
literally
had
a
drop
off
at
18
and
because
of
the
drop
off
at
18.
O
The
information
pursuant
to
sections
five,
six
and
seven
and
then
in
sub
two
of
nine,
the
chief
medical
officer
or
designee,
will
determine
if
there
is
a
trend
that
exists
in
the
usage
and
access
of
health
care.
And
so
this
is
important
because
it
it
lays
out
that
after
they
do
that
determination
that
they
are
supposed
to
then
work
with
appropriate
government
educational
research
entities
to
investigate
the
trend
and
advance
the
research
in
the
trend
and
facilitate
the
treatment
of
lupus
and
its
variants
and
associated
disorders.
O
In
section
10.
It
allows
the
division
to
apply
for
and
accept
grants,
gifts
and
donations
to
carry
out
the
sections
two
through
twelve
and
then
it
continues
to
discuss
how
they
are
going
to
coordinate
and
administer
any
other
state
programs
related
to
you
lupus,
because
I
wanted
to
make
sure
that
this
bill
tied
them
into
any
federal
activity,
any
state
activity
that
was
going
on
and
so
that
they
were
coordinating
at
every
chance
they
possibly
can
with
other
states
to
move
themselves
ahead.
F
Thank
you
assemblywoman
or
senator
neil.
Do
you
need
to
take
a
big
breath
because
you
put
through
that
presentation
pretty
fast?
So
I
appreciate
you
bringing
this
forward
and
I
absolutely
appreciate
your
passion
and
your
caring
for
your
constituents
in
all
of
nevadans.
So
thank
you
for
that.
A
couple
technical
questions
on
the
bill
itself
under
section
six
number
or
I'm
sorry,
I
apologize
section
five
number
three,
when
you
mention
hospitals,
medical
labs
and
other
facilities,
provide
screening,
etc.
You
have
to
give
that
information
unless
it's
been
done
through
somebody
else.
F
O
So
senator
dina
neal
for
the
record.
That
will
be
a
key
piece
that
I
think
the
department
will
have
to
deal
with
right
now
for
the
data
we
just
are
using
the
icd-10
codes
in
order
to
identify
whether
or
not
they
hit
the
emergency
room
or
have
inpatient,
and
so
there
is
an
absence
of
data,
and
so
this
this
would
be.
O
The
this
bill
would
help
in
refining
and
making
sure
that
we're
not
double
getting
information,
because
we
don't
have
the
full
set
of
data
that
we
need
in
order
to
do
the
analysis
and
to
determine
the
access
to
care
and
the
treatments
around
the
variants.
And
so
that's
what
I
thought
was
unique
when
I
started
looking,
it
had
to
have
been
last
year,
because
I
know
it
wasn't
in
the
summer,
and
I
started
asking
what
data
do
you
actually
have
on
lupus?
And
can
you
send
me
anything
that
you
have
from
the
biostatistician?
O
And
so
and
this
that's
why
I
uploaded
what
what
I
did
receive
in
the
exhibits,
because
we
need
to
actually
collect
data.
So
I
can't
tell
you
that
it
won't
be
duplicated
because
we
actually
need
to
just
get
in
the
fray
and
find
out
what's
there
and
then
pull
it
from
all
of
the
areas
and
then
do
the
analysis
and
then
from
that
benchmark,
make
sure
that
the
standard
of
the
information
that's
being
recorded
is
actually
just
coming
from
those
one
entities.
F
Follow-Up
medium
chair
go
ahead,
so
thank
you
for
that
as
a
primary
care,
doc
family
practice
doc.
I
have
seen
many
patients
who
thought
they
might
have
lupus
or
subsequently
I
diagnosed
lupus.
So
it's
not
something
that's
just
limited
to
to
women
of
color.
I
I
will
say
it
is
throughout
the
spectrum,
and
I've
seen
it
in
in
many
different
folks,
but
especially
women,
but
I
would
say
they
had
getting
into
that.
Rheumatologist
is
the
x
factor.
You
know
we
have
to
do
all
these
tests
prior
to.
F
As
you
already
mentioned,
we
have
so
few
rheumatologists
in
the
state
and
before
I
could
refer
a
patient,
I'd
have
to
send
them
all
the
stuff
that
I
did
the
test
that
I
ordered
using
and
in
order
to
use
to
obtain
a
test
or
get
permission
from
their
insurance
companies.
I'd
have
to
use
an
icd-9
code
to
justify
the
test,
and
so
you
know
I
just
wanted
some
clarification
on.
F
You
know
how
they're
reporting
duplication
of
reporting,
but
certainly
understand
your
comment
that
in
order
to
even
start,
we
have
to
have
some
sort
of
template
to
get
started
with
the
data.
Then
we
can
maybe
go
through
it
later.
Next
question
is:
there
are
any
other
states
that
have
this
model?
Would
nevada
be
the
first
state
that
does
this,
or
are
you
using
some
other
state's
successes.
O
So
I
I
pretty
much
built
this
bill
off
of
my
sickle
cell
bill,
but
they
are
doing
it
in
california
and
it's
my
understanding
that
they're
also
doing
some
work
in
new
york.
O
It
and
I
believe
georgia
is
one
of
the
other
states.
They
in
2011
illinois
passed
lupus
education,
awareness
act,
2014,
georgia
created
a
council
on
lupus
for
education
awareness,
so
they've
they've
done
different
variations,
but
they
focus
more.
California
has
been.
The
surveillance
project
has
been
with
the
cdc,
but
illinois
and
georgia
focus
more
on
education
awareness,
and
so
I
actually
watched
a
couple
of
videos
that
the
it
was
a
representative
in
georgia
because
she
had
lupus
and
then
she
took
it
on,
but
they
were
doing
more
of
an
education
piece.
F
D
D
O
Senator
dina
neal
for
the
record.
Thank
you
for
that
question.
I'm
going
to
do
two
things
I
want
to.
I
want
to
acknowledge
assemblywoman
titus,
because
it
is
true
that
if
you
look
at
the
data
lupus
affects
88
percent
women
and
to
get
to
your
question,
I
have
not
considered
giving
it
to
the
legislature
because
actually,
in
the
reverse,
reports,
sit
on
the
legislature's
desk.
O
If
it
went
to
the
legislature,
you
would
see
it
as
a
report
which
there's
many
of
reports
that
we
have
and
unless
you
go
specifically
looking
for
it,
it
has
no
value
only
to
the
person
who
is
seeking
it
out,
and
I
won't-
and
I'm
not
going
to
say
this
in
a
negative
way,
because
we
do
we
do.
We
tie
ourselves
to
legislative
reports
because
we
believe
the
legislature
is
this
esteemed
body
where
people
will
be
like.
Oh
my
god,
if
I
do
wrong
the
legislature
knows
about
it.
O
Well,
unless
you
are
totally
engaged
in
making
sure
that
that
happens,
meaning
following
your
legislation
to
say:
hey,
you
saw
the
report,
you
saw
the
data
and
you
didn't
perform
and
then
act
upon
those
agencies.
That's
the
only
value
of
the
legislative
report.
You
have
to
actually
make
what
the
legislature
is,
which
is
the
esteemed
body
that
it
is
have
the
power
and
authority
to
then
go
to
the
other
person
and
say
you
have
not
responded
to
this
data,
and
I
need
you
to
respond
to
this
data,
and
so
I'm
for
now.
D
Thank
you
senator.
I
appreciate
that,
but
I
also
had
a
a
vested
interest
when
you
mentioned
neonatal
lupus.
I
am
very
concerned
about
that.
Thank
you.
O
P
Yes,
thank
you
chair.
Thank
you
senator.
I
appreciate
the
question
from
assemblywoman
titus.
I
was
sort
of
had
some
curiosity
along
those
same
lines.
I
think
you
said
in
response
that
california
is
the
state.
That's
got
a
registry
along
these
lines
and
I'm
wondering
if
you
could
just
speak
to
what
are
they
doing
with
that
information
has
led
to
policy
changes,
policy
changes
in
the
works,
any
changes
or
improvements
and
health
outcomes.
P
O
So
there
so
there's
a
couple
of
things.
I'll
start
with
this,
so
california
attempted
legislation
twice
a
they
attempted
in
2011.
P
O
Then
it
didn't
pass
and
then
they
tried
again
in
2014
and
then
they
got
connected
with
the
cdc
and
it's
my
understanding
that
the
work
that
they've
been
doing,
which
is
a
part
of
the
national
lupus
patient
registry.
They
have
managed
to
get
consecutive
funding
from
congress
about
9.5
million
dollars.
O
They
have
also
managed
to
fund
10
million
dollars
for
lupus
research
program
in
which
the
california
and
I
believe
georgia
is
a
part
of
the
cdc
surveillance
project
and
then,
in
addition,
in
2020,
because
of
the
work
that's
been
happening
where
they've
been
giving
the
information
to
this
cdc
in
this
national
group,
they've
been
they've
managed
to
get
two
million
dollars
for
the
lupus
program
at
the
office
of
minority
health.
O
It
was
an
increase
of
over
750
000
from
the
fiscal
year
2020
and
then
in
national
institute
of
health
was
then
given
an
increase
of
1.25
billion,
which
is
the
largest
public
funder
of
research,
and
so,
since
the
work,
it's
my
understanding
since
the
work
of
roughly
2014
they've
been
just
building.
This
national
lupus
patient
registry
and
they've
been
able
to
leverage
funding
and
create
research
programs
in
order
to
help
other
states,
and
so
I
wanted
sb
175
to
become
a
part
of
this
national
work
and
that
nevada
actually
get
in
play.
O
I
didn't
find
out
that
we
were
behind
the
times
until
I
got
this
actual
document
from
director
whitley,
who
then
told
me
that
sb
175
aligned
with
2015
agenda
that
around
lupus
work,
and
so
I
said:
okay.
Well,
it's
20
21.!
Let's
get
in
the
game,
we're
six
years
behind
and
start
playing
in
this
national
work.
A
P
P
Changes
in
policy
beyond
that
we're
kind
of
they're
kind
of
still
in
the
phase
of
bringing
in
assistance
or
financial
funding.
For
this
at
this
point
is
that
correct.
O
Senator
dean
o'neill.
What
I
would
say
is
that,
based
on
the
center
for
disease
control,
the
latest
report
said
that
they
were
able
to
document
16
000
new
cases
per
year,
and
I
think
that
the
registry
has
helped
them
to
reach
that
16
000
per
year.
And
so
I
I
wouldn't
say
that
they're
in
they're
in
the
forming
stages,
because
what
they
have
they,
they
probably
started
at
an
infant
stage
around
the
2014
2015
and
then
they
have
successfully
grown.
O
I
just
want
nevada
to
be
a
player
because
we
have
a
lupus
population
here
that
feels
like
they're
drowning
and
that
they're
that
they're,
not
a
part
of
the
care
and
the
woman
miss
calvina
williams,
has
been
she
created
her
own
organization
in
order
to
do
the
work
in
vegas
and
she's,
doing
it
all
on
her
own
just
reaching
out
to
women.
H
Thank
you,
madam
chair.
Let's
see
mike
and
thank
you
for
being
bringing
this
bill.
We
have
a
familial
connection
with
lupus
and
it
is
a
pretty
terrifying
disease
with
the
unknowns
and
some
of
the
ways
that
it
expresses
itself,
and
I
think
the
the
information
around
it
is
is
not
super
readily
available,
and
it
can
be
really
scary
in
that
diagnosis
piece.
My
question
about
the
reporting
expectations
in
the
bill.
I
just
want
to
clarify
on
the
record:
are
you
expecting
that
the
reporting
be
defined
through
the
regulatory
structure?
H
Okay
and
then
from
there
are
you
expecting
that
the
regulations
will
ask
for
reporting
per
case
or
on
an
annual
basis
and
by
which
provider
either
the
individual
private
provider
or
the
the
facility
in
which
the
provider
works.
Just
wanting
to
get
on
the
record
the
intent
there.
O
H
Thank
you
and
do
we
think
that'll
be
like
an
annual
thing,
or
is
it
more
important
to
get
it
up
front
and
and
see
it
as
it's
hap,
as
the
diagnosis
is
happening,
it's
supposed.
O
To
be
happening
upon
when
they
go,
and
so
that
timeline
of
that
six
month
window,
so
they
should
be
reporting
it's
not
annually,
but
they
should
be
reporting
when
those
cases
come
through
and
then
there
should
be
a
compiling
moment.
So
when
I
view
that
six
month
piece
where
it
says
the
manner
no
later
than
six
months,
the
division
then
abstracts
the
information.
And
then
we
have
the
analysis
that
occurs
so
we're
collecting
and
then
we're
going
to
abstract
the
information
and
then
we're
going
to
do
the
analysis
to
determine
if
there
are
trends.
A
Do
we
have
any
other
questions
from
members
looking
around
seeing
none
at
this
time,
I
will
begin
testimony
in
support
of
senate
bill
175,
I'm
gonna
look
to
the
room,
seeing
no
one
coming
up
to
the
table
at
this
time.
Broadcast
services
can
we
go
to
the
phone
line
for
any
testimony
in
support
of
senate
bill
175.
B
B
B
B
Thank
you
so
much.
I
was
supposed
to
been
earlier
and
I
was
trying
to
work
with
this
phone
and
couldn't
work
with
it.
Senator
dina
neal.
Thank
you
so
much
and
I'd
like
to
thank
health
and
human
services.
I
I
I'm
just
I'm
pleased,
but
one
of
the
things
I
have
lupus-
and
I
have
also
lucas
of
nevada
and
our
agency
is
advocacy
and
educational
awareness
and
one
of
the
things.
One
of
the
things
we
want
to
see
with
the
sb
175
is
accountability.
B
The
reporting
process
in
this
when
our
lupus
individuals
go-
and
this
has
been
over
17
years
in
nevada,
doing
this-
our
lupus
people
will
go
into
the
doctors
and
they
will
come
out
with
no
answers.
No
answers
at
all.
The
second
thing
I
would
like
to
have
is
the
demographics
of
this.
This
is
what
we
really
wanted.
You
know
to
hold
that
accountable,
so
the
registry
could
get
their
hands
on
it
and
we
can
fight.
B
We
can
actually
fight
to
get
those
grants,
but
we
don't
know
how
many
people
in
the
state
of
las
vegas
in
nevada,
that
has
it
and
our
people
are
calling
me
daily
complaining
about
the
fact
that
they
went
into
their
doctor
went
to
california
diagnosed
16
years.
They
moved
here
about
six
months
ago.
One
of
the
physicians
told
them
they
didn't
have
lupus,
took
all
their
medicine
away
and
now
they're
told
them
to
get
on
tylenol
and
that's
it.
B
We
need
accountability
with
this,
because
if
these
individuals
have
been
on
their
medications
for
16
years,
we
need
to
figure
out.
What's
going
on,
we
really
do,
and
now
this
individual
with
lupus
does
not
have
any
doctor
the
doctor.
She
won't
go,
see
the
doctor
so
she's
just
out
there
she's
trying
to
find
a
primary
there
in
in
las
vegas
now,
and
I
get
concerned
about
it
and
agitated,
because
I'm
a
major
advocate
for
this,
and
we
need
your
help
and
this
bill
is
going
to
do
it.
B
For
us,
it's
going
to
set
boundaries,
standards
determined
by
the
misappropriation
of
the
diversity
of
the
people
that
do
have
it
on
revere.
In
west
side
of
the
south
southwest
a
lot
of
people
aren't
going
to
the
doctors,
because
they're
not
going
to
get
the
outcomes
that
they're
expecting
to
get.
A
B
A
And
do
we
have
any
testifying
any
anyone
testifying
in
neutral
in
the
room,
seeing
no
one
in
the
room
to
testify
neutral?
I
think
we
may
have
someone
on
zoom.
Do
we
have
anyone
on
zoom
to
testify
in
new
patrol?
If
you
are
here
to
testify
in
neutral
on
senate
bill
175
I'd,
ask
you
to
unmute
and
turn
on
your
camera.
A
B
O
Senator
dina
neal
for
the
record.
I
want
to
thank
the
committee
for
hearing
sb
175.
Thank
you,
chair
for
scheduling
this
bill.
If
this
bill
gets
out,
it
will
do
really
good
work
for
patients
that
have
an
autoimmune
disease
that
really
want
to
have
proper
care
and
transparency
around
their
disease.
Thank
you
for
your
time.
A
P
Thank
you,
chairwin
and
good
afternoon
to
the
members
of
the
assembly
committee
on
health
and
human
services.
It's
always
a
pleasure
to
be
here
for
the
record.
My
name
is
fabian
donate
and
I
represent
senate
district
10
in
the
heart
of
las
vegas.
I
come
before
you
today
to
speak
on
senate
bill
318,
which
makes
various
improvements
in
language
access
to
services
provided
by
our
governmental
agencies.
P
Covet
19
has
shown
to
us
just
how
valuable
information
access
can
be
for
those
who
may
not
have
the
adequate
education
or
resources
to
understand
and
take
part
of
relevant
health
information.
Failing
to
prioritize
information,
access
can
result
in
public
health,
disinformation
and
distrust,
which
is
in
direct
alignment
to
an
environment
that
could
foster
vaccine
hesitancy.
P
Vaccine
hesitancy,
as
in
the
refusal
of
vaccines
despite
the
availability
of
these
services,
is
a
very
real
problem
here
in
nevada
that
will
become
apparent
within
the
next
few
weeks,
especially
as
we
begin
to
expand
our
reach
to
marginalized
groups
that
have
been
abused
and
neglected
for
years
in
public
health.
We
use
the
term
health
literacy
to
describe
a
person's
ability
to
find,
understand
and
use
information
and
services
to
inform
health,
related
decisions
and
actions
for
themselves
and
others
around
them.
P
Health
literacy
is
an
important
thing
to
consider
in
developing
programs
that
improve
the
community's
health
status,
mostly
because
it
acknowledges
any
present
limitations
and
emphasizes
the
ability
to
use
health
information,
not
simply
to
just
understand
it
to
make
well-informed
decisions.
Health
literacy
skills
are
needed.
This
means
that
the
wide
range
of
our
population
must
have
the
adequate
foundational
knowledge
of
a
health
problem
before
even
considering
the
implications
that
may
arise
as
legislators
and
public
servants.
P
The
reality
of
this
pandemic
is
that
we
have
not
done
our
best
with
how
this
response
has
taken
shape,
mostly
because
we
didn't
have
the
right
infrastructure
in
place
to
carry
out
a
good
response.
If
we
want
to
fix
the
disparities
observed
in
communities
of
color,
we
have
to
take
the
right
step
to
invest
in
a
public
health
services
that
will
achieve
good
outcomes.
K
Thank
you
senator
and
chair
members
of
the
committee,
thank
you
for
hearing
sb
318
and
allowing
me
the
opportunity
to
speak
to
this
critical
proposal.
My
name
is
olivia
white
lee
and
I'm
the
western
states
advocacy
officer
for
the
refugee
advocacy
lab.
As
the
senator
mentioned,
I
will
provide
an
overview
of
the
development
of
this
bill
components
of
the
bill
and
make
a
short
remark
related
to
the
outcomes
of
the
bill
over
the
past
several
months.
K
I
have
surveyed
nevada's
resettlement
agencies
and
the
number
one
shared
concern
of
these
agencies
is
language
access,
particularly
for
refugees
that
speak
on
common
languages,
organizations
that
serve
nevada's
refugees
report,
the
qualified
interpretation
and
translation
services
are
often
unavailable
as
clients
interact
with
the
central
state
agencies
and
programs
such
as
small
business
support
or
the
dmv.
These
barriers
have
been
amplified
with
the
onset
of
the
pandemic
as
reliable,
up-to-date
public
health
information
regarding
the
coronavirus
is
continually
needed
to
enable
refugee
and
limited
english
proficient
nevadans
to
protect
themselves
and
their
families.
K
This
bill
was
draft
based
upon
similar
legislation
previously
introduced
in
other
states,
including
alaska,
pennsylvania,
new
york,
michigan,
california,
hawaii,
washington,
illinois.
New
jersey,
virginia
and
new
mexico,
the
department
of
justice's
language
access
assessment
and
planning
tool
and
feedback
from
local
community
groups,
sb
318,
has
two
primary
components.
First
would
be
coded
relief
provisions.
Sb
318
requires
the
division
of
public
and
behavioral
health
and
each
health
district
or
department
to
record
the
preferred
language
of
every
individual
that
receives.
Covenanting
services
provide
limited
english,
proficient
individuals
with
interpretation
services,
either
in
person
or
remote,
translate.
K
Vital
documents
such
as
applications
or
notices
related
to
covid19,
translate
governmental
orders
related
to
covet
19
and
collaborate
with
community-based
organizations
to
ensure
all
local
languages
are
represented.
The
requirements
for
language
services
are
proportionate.
The
number
and
language
of
limited
english
proficient
individuals
served
by
the
division
or
health
district,
ensuring
that
smaller
health
districts
do
not
have
to
provide
services
in
the
same
frequency
or
breast
as
larger
health
districts.
K
Senator
donate
spoke
artfully
to
the
critical
nature
of
these
provisions.
Second,
sb
318
addresses
language
access
for
governmental
services
beyond
covid
by
requiring
state
agencies
to
create
language
access
plans.
Each
executive
agency's
language
access
plan
is
required
to
include
one
an
outline
of
existing
regulations
and
compliance.
Two
demographic
information
on
individuals
served
by
the
agency
three,
an
inventory
of
current
language
services
and
training
resources.
K
Four,
a
review
of
coveted
language
access
measures
and
five
estimates
of
additional
funding
employees
and
resources
necessary
to
meet
identified
needs.
Sd
318
also
requires
a
public
comment
period
for
the
drafted
language
access
plans
to
ensure
that
the
voices
of
interpreters,
translators
and
english
learner
clients
are
adequately
taken
into
consideration.
K
One
point
to
be
clear
on
is
that
sb
318
does
not
require
agencies
to
implement
their
language
access
plans
only
to
develop
and
revise
the
plans.
Section
7.4
of
the
bill
requires
agencies
to
include
implementation
costs
in
their
2023-2025
budget
requests,
allowing
the
legislature
to
consider
the
full
funding
required
for
implementation
during
the
next
session.
Following
the
initial
amendment
of
the
bill,
which
clarified
the
distinction
between
planning
and
implementation,
many
agencies
eliminated
or
significantly
decreased
their
fiscal
note.
Sp
318
is
a
relatively
low
cost
first
step
towards
ensuring
language
access
throughout
the
state.
K
Currently,
there
is
no
state
level
standardized
process
for
ensuring
state
agencies.
Take
reasonable
steps
to
ensure
meaningful
access
to
eligible
limited
english
proficient
individuals.
There
is
no
relevant
statewide
requirement
in
the
nrs
and
there
is
no
mention
of
linguistic
accessibility
in
the
2020
statewide
administrative
manual.
This
prohibits
a
significant
amount
of
nevada's
population
from
accessing
public
goods
services
or
benefits.
According
to
data
from
the
2019
american
community
survey
between
10.7
and
13.8
percent
of
nevada's
adults
and
5.8
of
nevada's
children
speak
english
less
than
very
well.
K
The
implications
of
a
lack
of
statewide
guidance
or
resources
can
be
found
in
the
following
case
study
within
hhs.
The
division
of
child
and
family
services
has
the
most
comprehensive
set
of
publicly
available
language
access
policies,
a
limited
english,
proficient
or
lep
policy
from
2017
and
a
culturally
and
linguistically
appropriate
services
policy
from
2018..
K
K
For
example,
the
culturally
and
linguistically
appropriate
services
policy
defines
an
interpreter
or
translator
as
an
individual
who
has
quote
a
bachelor's
degree
from
an
accredited
institution,
preferably
in
languages
or
linguistics,
and
possesses
at
least
one
year
of
specialized
experience.
End
quote,
while
the
lep
policy
has
no
such
definition
or
qualifications
requirement,
as
both
policies
are
specific
to
the
same
program
area
within
dcfs
children's
mental
health.
This
fundamental
determination
of
who
is
competent
to
interpret
or
translate
treatment
options,
eligibility
requirements
or
medical
conditions
to
parents
whose
children
are
facing
mental
health
difficulties
should
be
standardized.
K
K
The
agency
or
division
an
individual
is
dealing
with
should
not
determine
an
individual's
ability
to
access
essential
information
in
their
preferred
language.
About
programs,
not
only
are
they
eligible
for,
but
are
funded
by
their
tax
dollars,
nor
should
an
individual
zip
code,
it's
possible
and
likely
that
agencies
and
other
divisions
have
additional
policies
and
plans
and
resources
for
ensuring
language
access
that
are
not
readily
publicly
available
or
otherwise
included
on
nellis,
and
this
is
not
intended
as
a
comprehensive
evaluation
of
the
existing
language
access
work
of
nevada's
departments,
but
across
the
state
agencies
and
departments.
K
We've
spoken
with
all
have
expressed
a
very
strong
desire
to
expand
their
language
access
offerings,
but
a
general
lack
of
resources
to
do
so.
Sb
318
provides
a
statutory
basis
for
all
agencies
to
include
funding
to
support
the
implementation
of
their
language
access
plans
in
their
biennial
budget
requests,
which
bridges
the
gap
between
agency
intent
and
the
resources
available
to
each
agency.
K
My
final
remark,
and
perhaps
my
most
important
remark-
is
that
sb
318
is
a
civil
rights
issue
that
underlines
all
other
activities
of
this
committee.
One
primary
objective:
if
not
the
primary
objective
of
the
civil
rights
act
of
1964,
was
to
prevent
the
discriminatory
use
of
public
funds,
ensuring
that
all
who
paid
taxes
were
able
to
access
the
goods
and
services
those
dollars
subsidized
the
act.
Prohibition
of
discrimination
on
the
basis
of
national
origin
was
explicitly
extended
to
language
access
in
the
supreme
court's
1974
lobby.
K
Nichols
decision,
sp,
318
attempts
to
actualize
those
protections
and
that
promise
that
all
nevadans,
regardless
of
language,
can
access
governmental
services
every
bill
program
or
fte,
currently
under
consideration
by
this
committee.
Each
of
those
are
only
a
just
use
of
taxpayer
dollars
if
all
nevadans,
spanish-speaking,
lingala
speaking
kenyarwandan
speaking,
can
understand
the
related
application,
forms,
notices
or
systems
and
have
the
needs
of
their
families,
be
understood
by
staff.
I
humbly
ask
the
committee
members
to
invest
in
this
two-year
civil
rights
planning
exercise
and
I'm
now
open
to
questions.
H
Thank
you.
Chairwin
had
to
step
out
to
do
her
own
presentation,
so
I
will
be
facilitating
questions.
Do
we
have
questions
from
the
committee?
H
Well,
I
had
a
question
related
to
some
of
the
exhibits
that
were
provided
for
them
for
this.
This
meeting
this
hearing,
it
looks
like
most
of
your
fiscal
notes,
have
been
reviewed
or
removed
and
to
be
clear,
this
is
a
policy
committee,
not
the
fiscal
committee,
but
I
am
curious
about
these
removals
post.
The
passage
from
your
your
house
and
if
any
of
those
are
still
retained,
and
if
there's
an
explanation
for
why
the
amendment
didn't
get
everybody
off.
If
you
could
qualify
that
thanks.
P
Thank
you
so
much
chair,
peters,
fabian
ninate,
for
the
record,
so
we
over
the
last
couple
of
months.
We
have
had
extensive
conversations
with
each
of
the
departments
and
agencies
as
to
how
this
would
be
implemented
once
it
becomes
law.
I
think
it's
very
clear
from
our
conversations
with
each
of
the
agencies
and
departments
that
this
is
something
that
they
have
wanted
for
a
very
long
time,
but
the
question
is:
how
do
we
get
to
language
access?
P
Part
of
the
amendment
that
we
submitted
on
the
senate
side
was
to
again
reiterate
that
I
am
not
based
on
this.
Miss
miss
olivia
white
and
I
we
are
not
looking
for
implementation.
P
H
Thank
you.
I
did
look
at
some
of
that
language
and
and
the
and
the
fiscal
note
I
it's
my
understanding
from
your
language
that
you're
not
requiring
a
like
an
additional
person
that
it's
just
somebody
who
may
have
interest
in
this.
You
can
champion
it
through
their
offices.
Okay,
that
makes
sense.
Are
there
any
other
questions
from
assemblywoman
benitez
thompson?
Please
go
ahead.
M
Thank
you
so
much
and
thank
you
for
the
spill,
because
I
think
in
in
previous
conversations
the
intersection
between
language
access
and
health
equity
right.
That's
the
the
new
big
policy
frontier
that
we're
going
to
have
to
battle
moving
forward
and
it'll,
be
you
know,
future
legislators
legislatures
that
will
decide
whether
we
do
that
kind
of
piecemeal
statute
by
statute.
Here
you
know
here
and
there,
but
it's
it's
a
question
that
is,
is,
I
think,
the
next
one
of
the
big
next
big
policy
things
that
we
have
to
tackle
in
this
building.
M
I
want
to
ask
on
section
7
specifically,
so
this
is
dealing
with
the
executive
department
and
a
language
access
plan.
So
I
guess,
could
you
tell
me
a
little
bit
more
about
what
you
would
hope
to
see
as
that
work
product?
Like
I
guess,
when
I
look
at
some
of
these
pieces,
some
of
them
are
are
easy.
M
Readily
some
of
them
have
more
readily
handy
data
that
we
don't
necessarily
have
to
go.
You
know
create
a
new
way
to
pull
out
the
data
like
on
the
b
in
section
7,
the
2b,
which
is
the
relevant
demographics.
M
If
we're
looking
at
health
and
human
services
or
medicaid
or
tanf,
like
lots
of
lots
of
data,
lots
of
lots
of
data
on
demographics
there
so
for
I
guess
for
some
of
the
some
of
the
other
departments,
I
guess
tell
me
just
a
little
bit
more
about
the
type
of
work
product,
you're,
hoping
to
see
from
them.
P
K
Thanks
senator
this
is
olivia
whiteley
for
the
record.
There
are
a
couple
of
outcomes
that
we're
hoping
to
see
from
the
language
access
plans
that
are
required
under
section
7..
The
first
thing
I'll
say
is
that
the
one
of
the
primary
purposes
of
the
creating
the
plan
required
under
section
7
would
be
to
allow
agencies
to
develop
a
robust,
detailed
understanding
of
what
cost
would
be
associated
with
implementing
the
language
access
plan
and
ensuring
that
all
nevadans
can
understand
and
access
their
services.
K
The
bill
does
require
agencies
to
submit
that
fiscal
note
in
the
2023-2025
biennium,
so
that
that
can
be
a
discussion
occurring
in
the
legislature
during
that
period.
So
all
of
the
language,
access
planning
components
are
really
purposed
towards
ensuring
that
agencies
can
then
take
that
next
step
of
implementation.
K
In
regards
to
the
content
of
the
plan,
you're
correct
in
that
first,
it
does
require
agencies
to
gather
demographic
data,
and
this
can
be
done
in
a
couple
of
different
ways.
The
second
thing
it
allows
or
requires
agencies
to
include
in
their
language
access
plans
would
be
an
inventory
of
existing
services,
and
this
inventory
was
based
off
of
the
department
of
justice's
language
access,
assessment
and
planning
tool.
So
it
goes
through
things
like
training.
What
training
is
provided
to
employees
and
it's
fairly
specific
asking
them?
K
Do
you
provide
employees
with
training
on
how
to
talk
with
a
limited
english
proficient
individual
over
the
phone
via
email
in
person?
So
it
goes
through
a
checklist
of
those
existing
services.
The
language
access
plan
also
requires
agencies
to
report
on
ways
where
law
might
need
to
be
modified.
As
you
mentioned,
to
better
serve
limited
english,
proficient
nevadans.
K
It
requires
agencies
to
evaluate
where
areas
that
translators
and
interpreters
certifications
are
not
listed
for
their
particular
agency
activities
and
perhaps
even
what
conjunction
there
would
be
with
workforce
development
opportunities,
as
sometimes
for
these
less
frequently
spoken
languages.
There
is
even
a
lack
of
local
interpretation
or
translation
resources
available
for
an
agency
to
use.
So
it
also
attempts
to
fill
some
of
those
gaps.
M
I
have
already
on
my
calendar
for
june
10th
and
enter
a
meeting
on
the
the
I
tab,
which
is,
I
think,
it's
the
technol
information
technology
assistance
board
where
it's
the
you
know,
the
committee
that
looks
at
the
technology
of
the
state
and
obviously
our
meetings
were
disrupted
during
the
pandemic,
but
that
you
know
in
that
body
or
in
that
committee
is
where
we
talk
about
the
work
just
to
become
ada
compliant,
and
I
know
that
even
since
the
ada's
been
in
place
and
then
we're
talking
about
our
technology
piece
that
we're
still
think
I
want
to
say
the
last.
M
The
last
comment
we
had
on
the
record
about
six
months
ago
was
so
like
more
than
a
decade
away
from
being
fully
ada
compliant
just
on
our
state's
websites.
For
that,
and
so
I
would
say
what
I've
learned
is
wherever
you
can
fit
it
into
different
pieces
as
they're
moving,
then
then
jump
on
it
there
right
as
long
as
we're
having
the
conversation
about
modernizing
some
of
our
systems,
and
we
have
it.
We
talk
about
accessibility
of
language
or
accessibility.
M
We
ought
to
just
make
sure
that
random
language
in
there
as
well,
because
for
those
pieces
that
we're
starting
to
modernize
now
at
least
we
can
look
at
a
language
component,
and
then
you
play
catch
up
on
on
everything
else.
So
as
much
as
I
as
I
as
you
as
you
can
makes,
I
would
say
that
you
would.
I
would
hope
you
would
want
this
section
at
least
to
be.
M
You
know
if
it
isn't
already
like
liberally
construed,
to
make
sure
that
the
executive
branches
aren't
that
where
they
see
an
opportunity
to
do
some
of
this
work
that
they
that
they
can
right
and
that
way
you
you
know
it
might
be.
It's
not
like
a
symmetrical
kind
of
progress.
It
might
be
asymmetrical
where
you
see
certain
departments
moving
ahead
better
than
than
others.
I
think
some
are
more
organically
equipped
and
come
at
this
at
a
different
place
than
others.
M
You
can
tell
by
the
type
of
fiscal
notes
that
we
get
from
some
departments.
When
we
ask
for
culture
change
like
kind
of
systemic
culture
change,
you
know
how
willing
or
not
they
are.
It's
kind
of
the
first
spell
whether
to
whether
who's
interested
in
doing
this
or
not
or
who's,
going
to
put
up
a
fight
and
doing
it
or
not.
So
I
I
think
it's
headed
in
the
right
direction
and
hopefully
it'll
be
work
that
we
see
them
engage
in
in
a
meaningful
way.
M
I
get
that
they're
busy,
but
it
I
it'll
it'll
lead
us
to
a
better
place.
H
Thank
you,
assemblywoman
all
right.
I
have
assemblywoman
titus
next.
F
F
During
this
covid
epidemic,
we
had
significant
issues
reaching
out
to
our
guest
worker
programs
in
my
community,
where
we
bring
in
a
huge
number
of
guest
workers
and
making
sure
that
the
information
regarding
kovid
and
the
need
for
certain
whether
it's
washing
your
hands,
whether
it's
social
distancing,
whether
it
was
mask
whatever
the
comments
were
they
initially
were
not
in
in
spanish
or
which
was
what
the
language
was
mostly
in
in
our
area
that
needed
to
be-
and
I
just
wanted
to
take
on
the
record
right
now-
that
few
may
know
that
I
reached
out
to
assemblyman
flores
and
islamic
woman
taurus
to
help
me
try
to
put
together
some
information
because
they
were
already
doing
that
on
their
own,
even
though
the
state
had
stuff
that
was
out
there,
it
wasn't
really.
F
I
asked
them
well
interpret
this.
What
how
would
you
see
this
and
recommendation
so
having
a
process?
Where
not
only
is
it
in
in
spanish
per
se,
it's
actually
in
a
format
that
somebody
reading
it
would
understand
and
not
be
threatened
by
it.
So
it's
not
really
a
question.
I
just
want
to
thank
you
for
bringing
it
forward.
H
Thank
you
for
the
comment.
Are
there
any
other
questions
from
the
committee
before
we
move
on
to
testimony
seeing
none?
Thank
you
so
much.
We
will
go
ahead
and
move
on
to
support
testimony.
Is
there
anybody
in
the
committee
room
who
is
here
to
testify
in
support
of
sb
318,
seeing
none
I'd
ask
broadcast.
Could
you
please
open
the
lines
for
anyone
in
support
of
three
sorry,
sb
318.
B
B
J
I
run
a
program
called
the
language
bank,
I'm
giving
testimony
in
full
support
of
sb
318,
because
it
is
a
critical
that
each
nevada
state
agency
is
really
able
to
create
their
own
language
access
plan.
This
plan
would
help
state
agencies
meet
the
language
needs
of
nevada's,
experiencing
significant
barriers
to
accessing
state
services
related
to
covet
19.
J
Due
to
the
lack
of
materials
and
information
translated.
I
cannot
say
enough
and
emphasize
enough
about
the
importance
of
providing
appropriate
access
to
language
services,
which
would
provide
much
needed
culturally
and
linguistically
appropriate
language
services
to
our
growing
diverse
communities.
As
many
of
you
have
recognized
today,
nevada
is
an
extremely
diverse
state.
It
is
beyond
spanish.
It
is
beyond
english.
J
There's
a
multitude
of
languages
in
our
state,
so
providing
adequate
services
to
clients,
regardless
of
their
spoken
language,
is
a
crucial
component
in
the
provision
of
trauma-informed,
non-discriminatory,
safe
and
effective
assistance
to
all
members
of
our
communities
throughout
our
wonderful
state
of
nevada.
Today,
the
focus
is
covered
19,
however,
in
the
future,
it
could
be
something
else,
a
disaster
of
some
sort,
another
pandemic
or
a
statewide
emergency.
This
bill
would
allow
each
state
agency
and
personnel
to
make
language
access
plans
appropriately.
J
Furthermore,
this
bill
would
allow
and
help
state
agencies
to
train
their
personnel
so
that
they
can
effectively
communicate
with
limited
english
individuals
and
can
effectively
work
with
language
interpreters.
Lastly,
the
kobe
19
pandemic
has
disrupted
nearly
every
aspect
of
our
lives
and
has
reached
into
nearly
every
community
in
our
state.
Our
ability
to
keep
one
another
safe
and
healthy
depends
on
every
nevada
having
access
to
credible
trusted
information
about
how
to
prevent
the
spread
of
kobe
19.,
the
types
of
supports
and
services
available
and
how
to
comply
with
federal
and
state
and
local
orders.
J
We
know
certain
communities
are
disappropriately
impacted
by
this
pandemic,
and
one
way
we
can
shift
that
injustice
is
to
is
by
meeting
our
obligation
to
communicate
in
ways
that
are
accessible
and
culturally
and
linguistically
relevant.
We
need
sb318.
We
need
it
so
that
to
ensure
that
our
underserved
communities
can
access
life-saving
information
and
care.
Thank
you,
ladies
and
gentlemen,
I
appreciate
your
time
for
hearing
me
today
and
please
support
sb318.
H
Thank
you
so
much
for
your
impassioned
testimony
next
caller.
Please.
B
Q
Luckily,
there
was
a
network
of
community
support
to
ensure
these
materials
were
translated
to
help
folks
connect
with
housing,
health
care,
food
or
other
resource
assistance
that
they
needed.
We
thank
senator
ginate
for
bringing
forward
this
bill
to
provide
information
on
state
resources
in
multiple
languages.
We
support
this
effort
to
make
social,
our
social
safety
net
accessible
to
all
communities,
regardless
of
which
language
they
speak.
So
they
have
accurate
information
on
how
they
how
to
find
what
they
need.
We
urge
your
support
of
this
bill.
Thank
you.
H
K
P
B
H
I
Good
afternoon,
members
of
the
committee
bradley
mayer
b-r-a-d-l-e-y-m-a-y-e-r
partner,
with
argentine
partners
representing
the
southern
nevada
and
washoe
county
health
districts.
Today,
I
just
wanted
to
acknowledge
the
the
sections
of
the
bill
that
apply
to
us.
We
really
appreciate
senator
donate
and
miss
whitley
for
working
with
us
early.
I
He
engaged
us
right
away
when
this
idea
emerged
and
worked
with
us
on
the
bill
throughout
the
the
course
of
the
hearings
in
the
other
house
to
get
it
to
a
place
where
we
can
ensure
kind
of
maximum
effectiveness
from
the
health
district's
perspective
when
execution
of
this,
especially
as
it
relates
to
money
being
available
for
these
services.
So
we
thank
him
and
just
wanted
to
acknowledge
that.
Thank
you.
H
B
B
This
is
for
senate
bill
318.
correct.
I
was
just
checking
in
to
make
sure
that
it
was
me
hi
everyone
good
afternoon,
vice
chair
peters
and
members
of
the
committee
for
the
record,
margarita
salas
crespo
senior
advisor
to
the
governor's
office
for
new
americans,
testifying
in
neutral
for
sb
318..
The
governor's
office
for
new
americans
was
created
to
ensure
the
civic
and
economic
integration
and
inclusion
of
immigrant
and
refugees
in
the
state
of
nevada,
which
account
for
20
of
the
population
in
our
state.
B
In
addition
to
addressing
language
access
for
the
cover,
19
response
section
7
of
this
bill
requires
each
executive
department
of
the
state
government
to
develop
and
binarily
revise
a
language
access
plan
or
lap
as
an
initial
step
towards
ensuring
that
each
state
agency
provides
high
quality
and
appropriate
language
services
to
the
constituency
they
serve.
A
language
access
plan
will
help
in
the
success
of
the
state's
efforts
to
ensure
that
all
negatives
have
access
to
accurate,
timely
and
vital
information
in
the
language
they
understand
and
in
a
culturally
competent
manner.
Thank
you
for
your
time.
H
B
Q
I
just
wanted
to
comment
on
our
fiscal
note.
We
are
neutral
on
the
bill,
of
course,
but
after
receiving
clarification
that
the
bill
calls
only
for
the
formation
of
a
language
asset
access
plan
and
not
the
actual
implementation
of
the
plan.
We
have
determined
that
dmv's
fiscal
note
can
be
revised
to
indicate
a
no
fiscal
impact.
Thank
you.
H
P
The
one
thing
that
I
just
want
to
share
is
that
when
I
first
started
off
in
this
journey
in
the
senate,
trying
to
figure
out
what
bills
I
wanted
to
push
forward,
I
knew
that
language,
access
in
public
health
had
to
be
one
of
those
priorities.
For
the
sake
of
my
family
and
the
greater
immigrant
community
as
a
whole.
P
So
sp
318
is
an
effort
that
can
address
many
of
the
observed
gaps
that
we
see
in
translational
services
and,
most
importantly,
it
reframes
the
conversation
of
increasing
access
for
the
covid19
vaccine
for
public
health,
but
in
reality
it
provides
leverage
to
nevada
families
that
have
been
ignored
or
forgotten
for
far
too
long.
So
thank
you
all
for
your
consideration
today.
H
That
concludes,
I
believe,
the
bills
we
had
on
the
agenda
for
today
and
our
last
piece
of
of
agenda
item
is
public
comment.
We
can
go
ahead
and
become
begin
public
comment
as
a
reminder
to
provide
public
comment
by
phone.
You
must
register
online
via
the
legislative
website.
Information
is
also
available
on
our
agenda.
Please
remember
to
clearly
state
and
spell
your
name
and
limit
your
comments
to
two
minutes.
Is
there
anyone
in
the
room
who
wants
to
testify
under
public
comment?
H
H
Thank
you
so
much
looking
at
the
committee
is
there.
Are
there
any
remaining
comments
from
the
committee
seeing
none?
That
concludes
our
meeting
for
today.
I
believe
we
have
a
meeting
scheduled
for
wednesday,
but
I
would
unclear
if
that
is
at
a
time
we're
at
call
of
the
chair.
Yeah,
okay,
yeah
we're
this
week,
we'll
pl
we're
playing
it
by
college
here.
So
so
you
know
pay
attention
to
to
our
our
chat
boxes
and
we'll
let
you
know
when
to
expect
that
on
wednesday
with
that.
Thank
you.
H
So
much
committee
have
a
nice
rest
of
your
afternoon
and
I
think
I'll
see
you
down
on
floor.