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A
C
B
D
A
Thank
you
please
note
we,
I
did
see
assembly
woman
titus
online.
I
don't
see
her
actively
right
now,
but
if
she
oh,
it
looks
like
we
have
both
members,
assemblywoman,
titus
and
assemblyman
haven
coming
in.
Please
mark
them
present.
If
you
would
and
then
mark
other
members
present
as
they
arrive,
if
you
would
chirwin
is
currently
presenting
in
another
committee,
so
I
will
be.
A
We
have
three
bill
hearings
on
the
schedule
for
today,
a
couple
of
housekeeping
items
before
we
get
started
with
our
first
bill.
I
would
like
to
make
oh
excuse
me
agenda.
My
agenda
items
may
be
taken
in
a
different
order
than
listed
two
or
more
agenda.
Items
may
be
combined
for
consideration
all
individual
present
in
our
meeting
room.
Please
always
keep
your
face
covering
on
and
maintain
social
distancing.
A
This
in-person
and
online
meeting
format
helps
to
keep
everyone
safe
during
covet
19
pandemic
members
of
the
public
may
provide
testimony
in
a
variety
of
ways,
all
of
which
are
listed
on
the
agenda.
You
can
provide
public
comment
by
registering
to
participate
by
phone
or
in
person
on
the
nevada,
electronic
legislative
information
system
or
nellis
on
our
legislative
website,
and
you
are
welcome
to
send
your
comments
to
the
assembly,
health
and
human
services,
email,
which
is
asmhhs.
A
We
may
ask
you
for
documentation
to
support
your
testimony
and
if
you
would
provide
that
to
the
committee
secretary,
that
would
be
helpful.
So
all
of
our
committee
members
may
receive
that
anyone
who
would
like
to
receive
electronic
notification
access
to
committee's
agenda
minutes
and
final
reports
can
do
so
by
signing
up
on
nellis.
A
You
may
also
submit
public
comment
in
writing
either.
In
addition
to
testifying
or
in
lieu
thereof,
written
public
comment
may
be
submitted
before
during
or
up
to
48
hours
after
the
meeting
adjournment,
and
finally,
please
put
your
electronic
devices,
especially
cell
phones
and
laptops
on
silent
mode.
During
the
meeting
with
that,
we
will
move
on
to
our
first
agenda
item.
A
As
I
said,
we
have
three
bill
hearings
this
afternoon
and
now
we
have
allocated
equal
time
for
testimony
and
support
opposition
in
neutral
after
the
bill
introductions
to
to
be
specific,
each
person
providing
testimony
is
allowed
to
speak
for
a
maximum
of
two
minutes.
Staff
will
be
timing,
each
speaker
to
ensure
everyone
is
given
a
fair
opportunity
to
speak.
A
E
E
E
That
means
that,
despite
having
a
checking
or
savings
account,
they
rely
on
non-bank,
alternative
financial
services
like
check,
cashers,
payday
lenders
or
pawn
shops
to
make
ends
meet
senate
bill.
188
aims
to
help
low-income
nevadans,
accumulate
assets,
become
more
financially
literate
and
achieve
specific
financial
goals.
E
E
E
If
the
program
is
established,
section
21
provides
qualifying
criteria
to
be
an
account
holder.
Specifically,
a
person
must
be
a
resident
of
nevada,
12
years
of
age
or
older,
a
tentative
housing
project
in
the
state,
a
medicaid
recipient
or
foster
care
provider
who
creates
an
account
for
a
child
in
his
or
her
care.
E
Sections
5-14
of
the
bill
creates
the
nevada
statewide
council
on
financial
independence.
The
council
is
responsible
for
developing
statewide
priorities
and
strategies
to
help
people
who
receive
public
assistance
or
social
services
to
increase
their
financial
independence,
coordinating
with
certain
state
agencies
and
overseeing
the
ida
program
if
it
is
established.
E
Finally,
section
33
requires
the
state
treasurer
to
ensure
that
instruction
and
training
in
business
opportunities
and
any
benefits
available
to
certain
business
enterprises
are
provided
to
tenants
or
local
housing
authorities,
the
nevada
re,
the
nevada,
rural
housing
authority
and
certain
nonprofit
organizations
to
help
the
treasury
accomplish
these
goals.
Sb
188
in
section
32
authorizes
the
office
of
the
state,
the
state
treasurer
to
appoint
and
employ
a
deputy
of
financial
literacy
and
security.
E
E
What
this
bill
is
designed
to
do
is
to
provide
for
them
as
well
an
ida
that
will
help
them
or
someone
who
wants
to
help
them
deposit
money
into
this
account,
and
so,
when
they
age
out
of
the
system,
they
have
some
money,
they
can
get
an
apartment,
they
can
go
to
community
college,
they
can
go
to
four-year
college,
they
go
to
trade
or
technical
training.
All
of
those
things,
the
people
that
this
bill
is
designed
to
help
are
people
right
now
who
want
to
do
better
in
their
lives
and
for
their
families.
E
E
Now
I
hear
people
a
lot
of
times
saying
things
about
those
who
are
on
quote
welfare
and
I
hate
to
use
that
term,
but
low
wealth
individuals
who
are
who
are
in
need
of
some
type
of
social
service
and
many
times
you
will
hear
people
like
us,
begrudge
them
and
say
things
like:
oh
well,
they
don't
want
to
do
this
or
they
don't
want
to
do
that,
and
they
should
do.
They
should
do
well.
E
This
bill
is
designed
to
help
them
do
exactly
what
people
say
quote
they
should
do
if
people
want
to
buy
a
house
difficult
to
save,
when
you
can't
have
a
savings
account,
this
bill
will
allow
them
to
do
this.
If
you
want
to
start
a
small
business,
but
you
can't
have
a
savings
account
difficult
to
do.
This
bill
will
help
them
do
that.
E
E
F
Thank
you
vice
chair,
it's
so
nice
to
be
here
in
front
of
you
today
for
the
record,
I'm
eric
jimenez
and
I'm
here
on
behalf
of
the
treasurer's
office.
I
think
senator
spearman
did
a
really
good
job
mentioning
this
in
her
testimony.
But
individual
development
accounts
or
idas
are
matched
savings
accounts
that
allow
residents
with
lower
incomes
to
save
for
a
defined
goal
without
losing
access
to
essential
programs
like
medicaid
and
housing
services
throughout
the
country.
F
Ida's
have
helped
to
increase
the
financial
literacy
and
management
skills
for
people
in
disadvantaged
communities,
while
also
helping
them
build
pathways
out
of
poverty.
We
know
that
in
the
42
states
that
have
programs
like
this
around
the
country,
participants
are
35
percent,
more
likely
to
own
a
home
twice
as
likely
to
attend
an
institution
of
higher
learning,
whether
that
be
a
two-year
four-year
or
trade
school
and
84
percent,
more
likely
to
start
their
own
business
in
the
treasures
office.
F
This
program
that
we
operate,
the
able
program
is
literally
life-changing
for
people
when
we
set
up
accounts
for
them
when
people
know
that
they
can
save
for
a
defined
goal
and
not
lose
access
to
their
benefits,
possibilities
are
really
endless
for
them.
Sb
188
would
further
the
impactful
work
that
our
office
is
engaged
in
every
single
day.
F
Similarly,
by
ensuring
that
these
individuals
don't
lose
access
to
these
benefit
programs,
we
can
provide
pathways
out
of
poverty
while
still
maintaining
that
vital
social
safety
net.
I
want
to
thank
my
friend
from
senate
district
1
for
her
tireless
efforts,
along
with
the
nevada,
the
southern
nevada
legal
aid
center
and
the
nevada
bankers
association
for
working
on
this
bill
with
us.
It's
been
about
two
years
in
the
making,
but
we're
really
really
excited
so
with
that
do
we
have
anyone
else,
we're
happy
to
take
any.
A
G
Thank
you
both
for
the
presentation.
I
think
this
is
an
interesting
program
and-
and
I
like
the
concept,
but
it
seems
like
if
you
want
to
help
people
lift
themselves
out
of
poverty.
You'd
want
to
start
as
as
soon
as
possible.
Obviously
I
think,
in
my
opinion,
so
why
restrict
this
only
to
post-secondary
and
not
k
through
12.
E
G
E
G
I
understand
what
you're
saying
it
just
seems
to
me
like,
if
you
maybe
struggled
in
k
through
12,
which
I
know
a
lot
of
these
school
districts
are
struggling
and
the
children
that
are
coming
out
of
them
are
struggling.
It's
going
to
be
hard
to
get
them
into
a
trade
school
or
a
college.
So
to
me,
it
just
seems
like
you'd
want
to
give
them
a
jump
start
earlier
on
than
in
college,
but
just
a
question.
E
Thank
you,
and
vice
chair
through
you
to
assemblywoman
black.
Some
of
my
colleagues
are
meeting
in
room
2134.
E
E
E
A
A
Sorry,
I'm
gonna
I'm
gonna
interrupt
here
because
I
think
we're
talking
about
two
different
issues:
one
that's
being
dealt
with
by
a
couple
of
other
bills
and
one
that
we
have
presented
today
and
I
do
think
that
all
of
us
are
here
to
ensure
that
our
students
are
getting
the
best
education
that
they
can
wherever
they
end
up.
But
that's
a
different
issue
than
what
we're
talking
about
today.
So
I'm
going
to
move
on
assemblywoman
summer's
armstrong.
H
Thank
you
vice
chair
peters,
and
thank
you
senator
spearman,
for
bringing
this
very
thoughtful
legislation
and
mr
jimenez,
it's
good
to
hear
that
we
have
support
from
the
governor's
office
on
something
like
this
excuse,
my
ignorance.
But
could
you
tell
me
the
difference
between
what
this
bill
will
do
and
what
the
able
program
does.
F
Thank
you
for
the
question
assemblywoman
eric
jimenez
for
the
record,
so
what
this
bill
is
trying
to
do.
Assemblywoman
is
essentially
create
a
similar
type
of
structure
that
is
currently
available
for
people
with
disabilities,
having
the
ability
to
save
without
losing
access
to
benefits,
providing
a
similar
program
for
medicaid
recipients,
tenants
of
low-income
housing
and
foster
youth.
So
the
goals
here
are
pretty
similar
where
this
would
differ,
and
I
think
we're
trying
to
do
something
with
a
bill
that
you
all
passed
ab62.
F
H
Thank
you,
mr
jimenez.
Madam
chair,
may
I
follow
up.
Thank
you.
So
I
will.
I
would
guess
that,
with
the
able
program
you
already
have
a
group
of
non-profits
or
organizations
that
help
with
that
program.
H
Are
you
looking
to
have
those
same
folks
help
with
this
program,
or
are
you
looking
to
broaden
that
and
have
other
organizations
if
there
are
any
help
you
to
manage,
because
one
of
the
things
that
I
found
very
interesting
when
I
read
it
is
the
financial
literacy
proportion
and
when
the
senator
speaks
about
people
being
non-bank
services,
we
know
how
detrimental
that
can
be
in
poor
and
underserved
communities,
and
I
find
that
extremely
helpful
and
I
know
I'm
making
a
statement,
but
I
I
do
have
a
question.
I
did
ask
it
first.
H
H
Personal
financial
literacy
is
not
something
that
we
just
pick
up
on
the
sidewalk.
We
have
to
be
taught,
and
I
I
think
that
that
is
so
critical
and
I'd
love
to
know.
If
you
have
any
organizations
identified
already
and
what
the
structure
of
that
education
you
plan
for
it
to
look
like.
F
I
think
that
is
an
exceptional
question,
assemblywoman
eric
mendes
for
the
record
one
to
answer
the
first
part
of
your
question.
I
think
this
is
a
different
program
and
it's
going
to
require
kind
of
an
all
hands
on
deck
approach.
That's
why
I
think
the
the
section
establishing
the
council
on
financial
independence
is
so
important.
F
There
is.
There
are
sections
of
the
bills
that
reference
a
fiduciary
organization
that
would
be
a
non-profit
that
would
be
selected,
so
they
would
differ
from
the
types
of
organizations
that
we
deal
with
on
the
able
side.
So
that's
to
answer
the
first
part
of
your
question.
F
So
the
the
goal
here
is
not
only
are
you
saving,
but
are
you
having
access
to
the
financial
literacy
services
that
exists
to
make
sure
that
you're
maximizing
your
ability
to
do
so?
I
don't
think
that
the
curriculum
for
that
has
been
determined.
I
think
a
lot.
A
lot
of
that
will
rest
with
the
council
on
financial
independence,
but
any
suggestions
that
you
have
on
what
that
may
need
to
look
like
we're
happy
to
to
make
that
happen.
A
Thank
you
assemblywoman.
I
have
assemblyman
matthews
next.
I
Thank
you
chair
good
afternoon,
senator
mr
jimenez.
Thank
you
for
the
presentation.
I
I
think
this
was
somewhat
covered
by
what
I
saw
the
woman
summers
armstrong
just
asked.
I
was
going
to
ask
about
section
25
sub
1,
where
it
spells
out
the
responsibilities
of
the
fiduciary
organization,
including
providing
that
instruction
on
financial
literacy.
I
F
Yeah-
and
I
don't
have
a
great
answer
for
your
question-
assemblyman
air
committees-
for
the
record-
I
think
the
the
types
of
financial
literacy
may
differ
based
on
the
population
being
served.
We
thought
it
was
very
important
when
we
we
started
to
craft
this
bill
to
make
sure
it
was
as
broad
as
possible
to
ensure
that
if
we
had
buckets
of
funding
that
came
in,
we
could
help
serve
defined
groups.
So,
right
now,
there's
federal
funding
for
ida
programs
for
medicaid
recipients
who
are
also
refugees.
F
There
are
buckets
of
funding
available
for
tenants
of
low-income
housing
for
foster
youth,
so
I
think
the
financial
literacy
curriculum
is
going
to
depend
on
what
what
organization
is
being
served
and
that
may
be
a
different
fiduciary
organization
for
each
of
those
populations.
We
don't
know.
I
do
think
it
is
important.
F
We
worked
with
senator
ki
keffer
in
the
last
committee
on
health
and
human
services
to
kind
of
flesh
out
the
roles
and
responsibilities
of
that,
we're
primarily
concerned
with
making
sure
that
there
are
enough
assets
in
the
accounts
to
in
the
the
trust,
essentially
to
make
sure
you
could
cover
the
matching
funds.
But
I
think
also
part
of
that
would
be
a
thorough
vetting
by
the
treasurer's
office
and
then
bringing
it
to
the
council
on
what
that
financial
literacy
curriculum
looks
like.
E
And
if
I
can
just
add
one
thing:
that's
not
going
to
be
codified
in
the
statute.
What
we
want
to
do
is
the
financial
literacy
council
to
look
at
the
population.
As
mr
jimenez
says,
what
do
they
need?
Population
over
here
may
need
more
information
on
housing.
Someone
who's
trying
to
start
a
small
business,
may
need
more
information
on
that,
and
so
we're
providing
the
template
and
everything
inside
is
fluid.
K
Thank
you
so
much.
I
appreciate
it
so
I
have
questions.
I
have
a
couple
of
medicaid
questions
and
then
some
questions
just
about
how
the
accounts
would
operate
and
then,
where
can
be
managed?
So
I
think
I
heard
you
mentioned
that
there
are
special
programs
where
refugees
it
sounds
like
can
do
savings
and
then
that
income
isn't
reflected
as
income.
They
have
to
report
for
the
loss
of
benefits
from
medicaid.
K
F
So
error
command
is
for
the
record
and
I
think
if
we
need
to,
we
can
get
hhs
in
here
to
to
verify
this,
but
the
assets
in
the
account
and
including
the
matching
would
not
go
against
someone's
medicaid
eligibility
here
assemblywoman
there
are
some
federal
statutes
governing
individual
development
accounts.
This
bill
is
moder
modeled
after
that,
so
we're
not
trying
to
go
above
and
beyond.
What's
allowable
under
federal
law,
currently.
K
Okay,
so
that
so
it
would
be
then,
on
that
asset
portion,
not
all
assets
but
specific
to
if
they
had
this
particular
type
of
savings
account,
so
not
other
kinds
of
savings
account.
It
would
have
to
be
specifically.
This
idea
savings
account.
Then
that's
the
piece
that
federally
medicaid
doesn't
have
to
count
when
they're
looking
at
your
eligibility
or
your
ongoing
eligibility.
E
Thank
you,
assemblywoman
senator
pat
spearman,
for
the
record.
Here's
an
illustration:
someone
is
in
public
housing
and
the
ceiling
for
their
income
is
five
hundred
dollars.
E
So
the
account
is
for
them
to
be
able
to
save,
to
pull
themselves
up
and
out
and
in
the
housing
organizations
that
they
are
part
of
or
medicaid.
They
don't
even
consider
that
this
this
doesn't
even
exist
as
far
as
eligibility
concerns,
and
we
wanted
to
do
it
that
way,
because
if
we
don't,
if
there's
a
disincentive
to
save
because
many
of
the
social
services
that
you
need
just
like
those
who
are
differently
abled,
if
you
make
two
cents
above
that-
and
you
lose
that
you
have
no
safety
net.
K
Yeah,
it's
an
absolute
poverty
line.
It's
what
we
call
that
fpl,
it's
an
absolute
poverty
line
yeah,
so
I
get.
I
guess
what
I
because
I
want
to
make
sure
that
we
have.
You
know
there's
whenever
we
talk
about
medicaid
and
whenever
we
talk
about
those
programs,
there's
so
much
the
state
can
do
and
then
so
much
that
the
federals
allow
us
to
do
so.
K
A
We
have,
I
believe
we
have
miss
finney
with
the
medicaid
on
the
zoom.
If
she
is
available
and
able
to
answer
this
question,
maybe
hi
miss
vinnie.
L
Hello
hi
good
afternoon.
Thank
you
so
much
for
thinking
of
me.
I
will
point
out
that
medicaid
eligibility
is
actually
managed
by
the
division
of
welfare
and
supportive
services
and
they
have
a
whole
branch
that
is,
in
fact
experts
on
this.
It
is
my
understanding
that
this
bill
was
created
to
work
within
those
federal
regulations
that
are
in
existence,
but
I'd
be
happy
to
contact
our
partners
that
handle
our
eligibility
and
get
them
on
the
line.
If
that's
helpful
to
you
thank.
A
You
I
actually
am
looking
at
my
list
and
it
looks
like
I
have
a
mr
deshawn
with
children's
safety
and
welfare
policy.
Would
you
be
available
and
willing
to
answer
the
question?
Oh,
they
said
they
would
be
in
the
room
and
I
did
not
see
them
and.
K
And,
madam
chairwoman,
because
these
are
more
like
technical
questions
on
medicaid,
so
if,
if
someone
from
the
department
of
health
and
welfare
services
becomes
available,
I
can
wait
to
ask
them,
because
I
had
some
questions
like
do.
We
need
to
ask
it
on
the
application
and
then,
if
it's
asked,
is
it
just
we
you
they
might
have
to
indicate
that
they
have
it,
but
would
they
need
to
disclose
an
amount
or
not?
K
Or
would
they
just
double
check
it
on
the
back
end
system,
with
the
treasures
just
having
you
know,
as
a
licensed
social
worker?
Having
sat
with
people
getting
through
that,
you
know
16
to
20,
page
medication,
application
and
knowing
all
the
stuff
that
they
ask
you
about
and
then
income
that
can
be
counted
or
not
counted.
It's
it's
a
tricky
equation,
so
I
just
had
questions
about
how
that
might
look
on
the
front
end,
but
I
have
other
questions
about
the
board
that
I
could
probably
ask
the
bill's
sponsor
for
legislative
intent.
M
K
Perfect
thanks
all
right
so
on
the
board.
I
think
I've
got
it
right,
so
11
members
correct-
and
there
were
some
of
the
the
members
board.
Compositions-
are
always
fascinating
to
me,
as
you
know
senator
so
I
guess
talk
to
me
a
little
bit
more
about.
K
K
E
That's
correct.
I'm
sorry,
senator
pastor
pyramid,
senator
joshua
one
through
you
vice
chair.
That
is
correct.
K
E
K
K
And
I
guess,
since
these
are
individual
accounts,
I
guess
at
what
point
can
an
individual
make
withdrawals
from
the
account?
Typically,
these
dollars
are
leveraged
for
investments,
and
so
I
don't
have
an
idea
of
how
fluid
or
not
these
are
going
to
be
or
whether
or
not
there's
a
you
know
the
time
frame
for
them
to
access
the
account
and
then
when
they
access
them
allowable
usages.
Typically,
when
we
see
able
accounts
or
when
we
say
prepaid
or
529,
those
type
of
savings
account
come
along
with
very
specific
usages
for
withdrawals.
F
Yeah,
thank
you
for
the
question
assemblywoman
eric
jimenez
for
the
for
the
record.
I
think
it's
important
to
note
how
these
these
ones
differ
a
little
bit
from
able
accounts.
So
when
someone
goes
to
a
fiduciary
organization
says,
I
want
to
set
up
an
individual
development
account
when
they
set
one
up
it's
for
a
defined
goal
so
that
either
tenant
of
low-income
housing
or
medicaid
recipient
or
foster,
youth
would
have
to
say
I'm
saving
for
a
car
or
I
want
to
buy
a
house
or
I
want
to
start
a
small
business.
F
So
that's
where
the
fiduciary
kind
of
comes
into
play
and
also
offering
financial
literacy
services.
So
the
the
account
is
not
designed
to
just
exist
in
perpetuity.
Obviously,
anything
that's
saved
by
by
a
person
with
an
account,
while
they're
still
eligible
for
these
benefits,
they're
able
to
be
used,
but
the
goal
here
is
to
have
them
save
for
a
defined
goal
and
then
kind
of
have
a
pathway
out.
F
So
I
think
it
differs
per
account
and
I
think
the
board
can
kind
of
flesh
out
a
lot
of
these
details
in
terms
of
the
float
and
I
think
the
assets
on
it.
I
don't
really
know
how
much
we
expect
at
first
for
assets
to
come
in,
so
I
can
tell
you
it's
not
our
position
here
to
be
using
this
as
a
tool
to
try
to
get
a
lot
of
investment
returns.
F
K
A
follow-up,
if
I
could
so,
let's
say
if
they
said
so,
a
house
is
kind
of
a
bigger
long-term
commitment,
so
that
would
be
the
education
with
the
person
that
okay,
if
we
start
down
this
path,
you
can
you
can't
turn
around
and
pull
out
the
savings
in
a
month
or
in
two
months
you
you
keep
marching
down
this
path
until
that
goal
is
realized.
If
that
goal
isn't
realized,
then
would
there
be
a
date
in
which
the
person
could
pull
their
invest,
their
investments
out
or
their
savings
out.
F
I
think
that's
a
great
question:
assemblywoman
eric
minis
for
the
record.
I
think
that
that's
the
intent
for
them
to
be
flexible,
which
I
think
there's
another
section
in
the
bill
which
is
escaping
me
right
now,
which
designates
the
eligible
uses,
and
you
know
how
able
accounts
have
very
specific
uses
that
they
can
be
used,
for.
F
There
is
a
list
that
can
be
used
for
here,
so
housing
costs
that
includes
rental
rental
costs,
so
maybe
you're
trying
to
move
into
a
bigger
apartment
and
you
need
to
you
know,
try
to
get
some
savings,
so
you
can
do
that
on
a
monthly
basis.
It
could
be
a
transportation,
a
car.
It
could
be
some
sort
of
piece
of
technology
that
will
enable
you
to
to
work
from
home
or
higher
education
costs.
So
I
think
the
intent
here
would
be.
Let's
say
some
unforeseen
circumstance
happen.
F
How
can
the
fiduciary
organization
and
the
non-profit
work
with
that
account
holder
to
make
sure
that
they
could
they
could
find
a
use
for
those
dollars.
K
I
appreciate
that,
and
I
think
that's
section
22,
because
that's
the
one
that
I'm
in
and
so
really
it
would
be
up
to
that
individual
and
their
fiduciary
manager
to
define
out
more
specifically
what
it
means
under
each
one
of
these
in
terms
of
allowable
uses
like
and
I
I
think,
for
some
of
the
more
short-term
uses
like
rent.
K
That's
where
you
know
people
could
pull
out
money
quickly,
right,
I've
saved
up
for
a
year
covet
hits,
and
now
I
need
help
with
supplementing
my
rent,
but
let's
say
that
they
defined
it
as
saving
for
a
house.
I
was
wondering
about
the
ability
for
them
to
pivot,
with
those
savings
to
say.
Well,
that's
kind
of
off,
that's
you
know.
K
Could
I
change
my
plan
from
saving
for
a
house
to
rental
assistance
and
I
guess
the
flexibility
of
the
if
the
the
account
lets
them
do
that
or
no
like
when,
let's
say
like
529
counts
right
which
is
set
up
and
what
you
put
in
is
for
one
purpose
and
one
purpose
only
and
you're
and
you're,
not
you
know,
pivoting
to
different
types
of
uses
is
harder
to
do
so.
I
was
trying
to
gauge
that
out
on
the
record
yeah.
F
No-
and
I'm
super
glad
we're
clarifying
this
for
the
record,
because
I
think
it's
helpful
eric
commands
for
the
record.
I
think
the
intent
here
assemblywoman
and
if
you
disagree,
let
me
know,
but
I
think
the
intent
here
is
to
be
flexible,
because
unfortunate
circumstances
happen.
This.
The
intent
of
this
is
not
to
to
operate
like
a
tax
advantaged
529
account
right.
There
are
reasons
that
is
inflexible,
because
it's
it's
in
the
tax
code
for
this.
F
I
think
you
know
if
it's
a
reasonable
expense
and
in
that
account
holder,
is
working
with
their
provider
and
is
doing
the
financial
literacy.
You
know
they
should
be
able
to
use
that
for
a
different
goal
and
maybe
maybe
their
goals
change
right,
maybe
when
they
got
into
it
and
they
started
saving,
they
may
have
thought
they
needed
one
thing,
but
in
reality
they
needed
a
new
car
to
get
a
new
job,
and
I
think
it's
important
that
we
allow
to
we
kind
of
meet
them
where
they
are.
E
If
I
made
madame
vice
chair,
do
you
two
assemblywoman
benitez
thomas?
E
E
I
think
now,
vice
president
harris
said
on
one
occasion
that
most
families,
if
they
have
a
400
emergency
that
month,
then
they're
going
to
see
a
significant
drop
in
terms
of
their
financial
stability
and
so
you'll,
see
here
throughout
some
of
the
things
that
they
can
use.
We're
really
trying
to
trying
to
provide
some
type
of
financial
stability
for
people
who
really
want
to
do
that,
but
right
now,
they're
operating
in
a
system
that
is
restrictive.
H
H
I
like
it
and
I'll
say
that,
because
I
do
but
I
want
to
know
the
foundation
I
I
heard
you
know
earlier
about
the
inception
of
the
program,
and
I
want
to
know
if
you
had
a
pilot
program
two
years
ago,
or
was
it
just
a
structural
program
and
how
to
the
inception
of
this
this,
how
it's
going
to
work-
and
you
know
I
want
to
know
if
there
was
focus
groups-
anything
like
that.
How
did
you
arrive
at
these
options
and
particularly
the
age
of
12.?
E
Well
I'll
answer
the
first
part.
This
is
a
bill
that
I
bought
last
session,
but
we
couldn't
get
it
out
of
the
senate,
and
I
do
know
that
people
in
poverty
can't
wait
for
a
two-year
study,
and
so
we
looked
at.
I
had
the
idea
I
talked
to
eric
about
it
and
he
knew
of
some
other
states
who
had
done
that
and
so
together
we
looked
at
that
and
tried
to
model
this
bill
after
those
which
were
successful.
E
So
with
respect
to
a
focus
group,
my
focus
group
is
low
wealth
communities
and
just
watching
what's
going
on
and
that
has
been
amplified
during
covet
because
even
those
who
were
not
low
wealth
right
now,
a
lot
of
them
are
struggling
as
well.
E
F
Yeah
and
and
thank
you
assemblywoman
for
the
question,
eric
minus
for
the
record
this
program,
this
type
of
program
is
modeled
after
that
of
42
other
states,
particularly
how
we
got
to
the
eligible
uses.
The
age
requirement
is
based
on
a
lot
of
those
programs,
particularly
the
oregon
program.
F
We
know
this
program
works,
as
I
mentioned
earlier.
In
testimony,
we
know
the
participants
are
far
more
likely
to
own
a
house
to
get
out
of
a
rental
situation
to
start
their
own
business.
So
we
know
these
programs
work,
I
think,
from
our
state.
We
know
that
we
have
different
challenges
and
different
needs,
and
that's
why
last
session
we
had
looked
at
different
financing
mechanisms
to
try
to
do
a
more
robust
program.
I
think
until
we
can
get
the
board
operational
and
get
the
kind
of
this
program
up
and
running.
F
A
Thank
you
senator,
and
I
do
think
mr
jimenez,
you
said
earlier
that
there
are
already
42
states
that
have
this
kind
of
program,
so
the
pilot
programs
have
been
running.
They
just
haven't
been
running
at
a
cost
to
our
state.
So
with
that,
I
do
believe
we
have
somebody
from
dhhs
on
the
line
who
may
be
able
to
answer
miss
assembly.
A
Sorry,
assemblywoman,
benitez,
thompson's
questions.
Mr
thompson,
are
you
available
on
zoom.
A
K
Mr
thompson,
it's
assemblywoman
benitez
thompson
and
I
appreciate
you
jumping
onto
the
call,
and
some
of
my
questions
were
just
to
kind
of
flesh
out
for
the
record,
to
make
sure
we
had
a
good
understanding
of
how
the
accounts
would
work
with
medicaid,
of
course,
you're
the
the
medicaid
brain
and,
I
think,
have
all
7
thousand
policy
manuals
memorized.
So
I
appreciate
the
fact
that
you're
gonna
give
us
a
good
answer
on
this.
K
So
what
I
was
thinking
about
was
it
sounds
like
that
we
don't
run
afoul
of
or
any
concerns
around
federal
rules
for
what
the
the
assets
that
are
contained
in
the
ida
account.
One
of
my
question
was
is
if
there
was
a
ceiling
or
any
any
federal
rules
around
a
ceiling
for
the
amount
of
assets
that
could
be
put
into
the
account
that
we
needed
to
be
aware
of.
N
So
robert
thompson,
for
the
record
there
is,
there
are
no
asset
tests
for
the
magi
budgeting
of
medicaid,
so
there's
never
a
consideration
for
assets
for
magi
budgeting,
for
the
medical
for
the
aged,
blind
and
disabled.
There
are
asset
tests,
but
these
assets
to
my
understanding
are
exempt
from
being
counted
in
the
ida
accounts.
K
Thank
you
so
much
so,
if
someone's
doing
the
medicaid
application-
or
we
have
professionals
who
are
working
with
someone
doing
these
applications
and
they
would
ask
the
person,
do
you
have
an
individual
one
of
these
ida
accounts
and
the
person
replied?
Yes,
then
there's
they
don't
actually
need
to
do.
They
need
to
disclose
that
anywhere
on
the
medicaid
application
or
know
that
the
application
wouldn't
wouldn't
even
ask
them
about
that.
N
Robert
thompson
for
the
record,
the
medicaid
application
is
going
to
ask
them.
Do
you
have
any
assets?
Usually
people
are
going
to
answer
and
they're
going
to
tell
us,
and
then
our
staff
would
go
through
and
not
count
those
assets
or
if
they
specified
that
it
was
an
idea
account.
We
would
just
pass
over
it.
K
Perfect,
thank
you
so
much
and
then
any
dollars
that
are
used
from
the
idea
ca
ida
account
properly
for
their
intended
use.
In
no
way
would
those
would
never
come
back
to
be
any
types
of
of
medicaid
fraud
at
all
like
if
or
if
dollars
got
used
improperly
we
wouldn't
have
to.
There
would
would
or
wouldn't
have
to
be
looked
back
about
whether
or
not
then
that
should
have
been
income.
N
A
Thank
you
so
much
mr
thompson.
First
for
being
able
to
jump
on
the
meeting,
we
really
appreciate
you
and
your
brain
for
for
answering
these
questions,
and
with
that
I
don't
see
any
other
questions
and
we're
going
to
move
on
to
support
testimony.
A
O
I'd
like
to
echo
her
remarks
in
stressing
the
importance
of
helping
low-income,
nevadans
and
other
members
of
our
and
other
vulnerable
vulnerable
members
of
our
community
accumulate
assets,
become
more
financially
literate
and
achieve
their
financial
goals,
and,
as
somewhat
of
an
aside
and
pardon
me,
please
senator
spearman
for
going
down
a
little
bit
of
a
a
rabbit
hole,
but
but
senator
streamer
did
mention
how
many
nevadans
are
underbanked
and
that
that
is
really
important,
because
if
you
have
just
a
few
hundred
dollars
in
your
bank
account
it
can,
it
can
make
all
the
difference
in
the
world
when
the
unexpected
happens.
O
O
We
do
support
efforts
to
establish
this
individual
development
account
program
and
again
for
the
reasons
that
senator
spearman
and
mr
himan
has
focused
on.
We
do
want
nevadans,
who
are
receiving
public
assistance
to
have
the
opportunity
to
achieve
a
higher
level
of
education
or
purchase
their
first
home.
We
believe
that
this
bill
would
help
them
to
work
towards
that,
and
therefore
it's
it's
very,
very
important
and-
and
I
will
say
lastly,
assembly
women,
summers,
armstrong
and
some
of
matthews.
O
We
do
really
appreciate
the
the
interest
that
both
of
you
have
in
in
financial
literacy.
We
believe
it's
it's
critical
and
and
and
this
bill
outlines
par
part
of
the
the
process
to
make
sure
folks
receive
financial
literacy
instruction
we'd
be
we'd,
be
happy
to
be
at
the
table
and
and
help
develop
curriculums
or
or
do
anything
else
that
we
can
again
appreciate
the
opportunity
to
testify
in
support
of
senate
bill
188,
and
we
would
encourage
all
of
your
support.
Thank
you.
A
A
Good
afternoon,
thank
you
vice
chair
peters
and
members
of
the
committee
kendra
burchie,
with
the
washoe
county
public
defender's
office,
I'm
testifying
today
about
behalf
of
my
office
as
well
as
for
john
pirro,
with
the
clark
county
public
defender's
office.
We
want
to
thank
senator
spearman
for
bringing
forward
this
bill.
We
supported
it
last
session
as
well
and
hope
that
it
will
make
it
into
law
this
session.
A
As
many
of
the
many
of
the
members
of
this
committee
know,
we
unfortunately
need
to
protect
our
most
vulnerable
citizens,
especially
those
who
were
previously
in
foster
care,
the
disprop,
the
dyspo
national.
I
cannot
talk
today.
There
is
a
disproportional
amount
of
children
who
are
in
the
foster
care
system
who
then
enter
into
the
juvenile
justice
system
as
well.
A
Those
who
are
do
not
have
the
means,
and
so
we
do
believe
that
this
will
help
prevent
that
foster
care
to
prison
pipeline
and
provide
those
who
need
it,
the
most
our
most
vulnerable
citizens
with
financial
means
and
an
ability
to
hopefully
not
enter
into
the
criminal
justice
system
in
their
future.
So
we
really
appreciate
this
bill.
Thank
you.
A
Thank
you.
Miss
burchie
with
that,
I
think
we're
we
don't
have
anybody
else
in
the
room
for
support
testimony
so
bps.
Would
you
please
queue
up
the
line
for
support
testimonies
of
sb
188.
P
J
B-A-S-H-U-N-J-A-C-K-S-O-N
server
is
the
director
of
children's
safety
and
law
for
policy
with
the
children's
advocacy
alliance.
I
would
like
to
the
children
of
clients
like
to
stand
in
support
of
senate
bill
188,
and
also
thank
senator
spearman,
as
a
former
foster
youth
that
aged
out
of
the
system
in
nevada.
I
believe
that
this
bill
is
essential
to
not
only
the
growth
and
development
of
youth
that
are
transitioning
out
of
the
system,
but
the
sustainability
this
bill
will
provide
them
with
the
opportunity
to
not
only
save
but
bills
for
the
future.
J
Many
foster
youth
as
you've
already
heard
as
they
transition
out
of
the
system.
Don't
necessarily
have
those
supports
that
other
folks
that
have
not
entered
the
system
have
they
lack
financial
stability,
they
oftentimes
lack
family
stability,
and
so
what
this
does
is
it
allows
that
cushion
that
also
allows
for
those
youth
like
myself,
to
have
those
opportunities
that
other
youths
don't
have,
and
that
also
provides
this
safety
net,
which
death
then
prevents
them
from
entering
the
correctional
facility
or
the
homeless
population.
Thank
you
so
much
senator
spearman
and
committee
members.
A
P
D
D
I
am
calling
to
speak
to
some
of
the
earlier
questions
that
arose
during
the
hearing
and
potentially
I
want
to
note
that
there's
a
wide
body
of
research
regarding
what
is
called
benefits
cliffs
and
people
face
benefits
cliffs
when
they
receive
public
benefits
from
the
government,
earn
some
income
and
then
discover
they
make
too
much
to
receive
the
benefits
but
are
not
making
enough
to
sustain
themselves
in
their
household.
D
So
as
we
consider
the
power
of
this
legislation,
I
hope
we're
looking
at
is
impact
for
a
number
of
nevada
households
and
asking
that
we
not
put
folks
in
a
situation
where
they're
trying
to
save
to
get
out
of
poverty
by
either
furthering
their
education
or
preparing
for
housing
stability
by
asking
them
to
choose
between
saving
to
get
out
of
it
and
whether
or
not
they'll
have
current
coverage
or
current
housing,
because
our
policies
are
on
cons.
There
are
in
conflict
and
so
from
a
broader
perspective.
D
I
hope
that
what
we're
considering
as
we
wait
is
is:
can
we
foster
pathways
for
folks
to
really
get
out
of
poverty
because
we're
not
asking
them
to
choose
between
the
financial
literacy
and
its
practices
that
we
hope
that
they
will
more
broadly
adopt
right?
Because
we
say
why
aren't
you
saving,
but
when
they
do
put
them
in
a
situation
where
literally,
they
would
lose
health
care
coverage
or
lose
housing,
because
we
haven't
thought
through
conflicts
in
our
policy
across
systems
or
across
programs.
D
D
There
have
been
a
number
of
other
states
that
have
adopted
approaches
to
mitigate
the
impact,
a
benefits
clips,
including
what
happens
when
you
ask
people
to
save
or
participate
in
training
or
get
a
job
at
a
higher
wage,
and
then
they
lose
things
like
their
housing
assistance
or
medicare
assistance
before
they're
at
a
place
where
they're
fully
dependent
enough
to
not
rely
on
those
resources.
D
So
I
hope
we
will
put
it
in
that
larger
context.
So
I
thank
you
for
any
consideration
you
might
give
to
this
legislation
and
want
to
note
that
this
kind
of
practice
will
go
a
long
way
to
transitioning
folks
from
safety
nets
because
we're
thinking
through
policy
conflicts.
Thank
you.
P
C
Good
afternoon,
thank
you,
chair
members
of
the
committee.
My
name
is
jillian
block,
that's
g-I-l-l-I-a-n
d-l-o-c-k
and
I'm
calling
on
behalf
of
the
nevada
coalition
of
legal
service
providers.
The
legal
aid
center
of
southern
nevada
and
washoe
legal
services
represent
100
of
children
in
the
child
welfare
system.
We
support
fb,
188
and
we'd
like
to
thank
senator
spearman
and
the
treasurer's
office
for
bringing
it.
C
A
Thank
you.
So
much
are
there
other
folks
in
who
are
calling
in
support
of
sb188.
P
C
Good
afternoon
my
name
is
alyssa
cortez
a-l-y-s-s-a
cortez
c-o-r-t-s,
I'm
the
program
associate
for
silver
state
equality,
a
statewide,
lgbtq
plus
civil
rights
organization,
and
we
are
in
support
of
senate
bill.
188,
the
transition
age,
youth
who
age
out
of
or
exit
foster
care,
are
at
a
high
risk
of
experiencing
homelessness.
C
A
A
Thank
you
go
ahead
and
move
on
to
callers
and
to
anyone
in
neutral
in
the
room
not
seeing
any.
I
would
ask
bps
to
ask
for
callers
in
neutral.
P
A
Thank
you
so
much,
and
with
that
I
would
offer
the
presenters
an
opportunity
for
closing
statements.
A
Thank
you.
So
much
senator
really
appreciate
you
being
here.
Let's
see,
I
believe
next
we,
oh
and
with
that
I
will
close
the
hearing
on
sb
188
and
I
will
now
open
the
hearing
on
senate
bill.
309.,
I'm
sorry,
I'm
gonna
call
one
minute
recess.
A
A
Welcome
back
senator
good
to
see
you
it's
good
timing.
Thank
you!
So
much
I
will
bring
us
back
and
to
do
I
have
what
do
I
say.
A
I'm
back
to
order
and
I'll
go
ahead
and
ask
the
senator
if
she
would
go
ahead
and
I
guess
I
will
reopen
the
hearing
on
senate
bill
309.
Please
go
ahead.
Okay,.
M
M
It
actually
had
a
sewer
fee
that
they
were
trying
to
enlist
in
the
bill,
and
I
changed
their
bill
to
make
all
the
local
governments
work
together
to
find
a
plan
for
homelessness
as
a
sb.
309
is
actually
the
result
of
all
of
those
local
governments
cut
getting
together
for
over
the
biennium
in
order
to
come
up
with
a
plan,
and
so
this
bill
reflects
what
they
decided
to
do
was
to
establish
a
reinvestment
advisory
committee
and
get
a
seat
at
the
table
in
regards
to
how
the
mcos
spend
their
money.
M
And
so
that
is
ultimately
what
this
is.
And
then
I
will
turn
it
over
to
joanna
jacobs
to
break
down
the
rest
of
the
bill
and
go
through
why
they
chose
this
as
an
option,
after
not
being
able
to
receive
specified
sewer
funding
that
I
pretty
much
stripped
out
of
their
bill
in
2019..
Q
Thank
you,
chair
peters
members
of
the
committee
joanna
jacob
clark,
county
government
affairs
manager,
and
I
have
to
say
it's
very
I'm
very
glad
to
be
here
in
front
of
you
today.
It's
an
excellent
introduction
by
senator
neil,
it's
true
that
the
bill
from
last
session
set
up
a
an
interim
working
group
from
that
we
collaborated
on
clark
county
and
our
municipal
partners,
all
of
the
cities
in
southern
nevada,
as
well
as
the
non-profit
service
providers
that
work
in
homelessness
to
come
together
to
talk
about
as
a
region.
Q
What
is
a
plan
for
us
to
address
homelessness?
The
reason
why
you
have
sb
309
before
you
is
that
the
ab-73
report
came
up
with
recommendations
in
six
different
areas.
Realistically,
all
of
the
local
governments,
as
well
as
the
state,
are
fiscally
challenged.
I
don't
have
to
say
that
here
in
front
of
this
committee,
we
are
very
well
aware
of
the
fiscal
challenges,
but
we
came
up
with
a
variety
of
policy
recommendations.
Some
of
them
can
be
addressed
at
the
local
level.
Q
One
of
them,
though
we
felt
was
appropriate
for
this
bill,
was
to
try
and
find
a
way
that
we
can
work
together
with
the
with
the
private
sector
and
try
and
find
ways
to
to
create
and
build
on
private
partnerships
and
with
the
public
sector.
So
what
we
decided-
and
this
was
a
recommendation-
I
will
note
also
for
the
record,
the
ab-73
report
that
the
local
governments
did
was
adopted
by
each
of
our
local
government.
Our
governing
boards
went
to
all
the
clark
county
commission
as
well
of
all
of
our
cities.
Q
So
what
you
had
in
that
report
is
actually
consensus
amongst
the
city
and
the
county
on
kind
of
a
pathway
forward
on
how
we
can
address
this.
This
bill
alone
is
not
going
to
address
homelessness,
and
it's
not
the
only
thing
that
we
need
to
do.
We
know
that,
but
I
will
just
explain
for
context
that
the
medicaid
division
is
currently
putting
out
a
managed
care
rfp
and
we
do
have
cody
finney
on
the
on
the
line
on
the
zoom,
as
you
saw
earlier,
and
she
can
answer
questions
about
that.
Q
Rfp
process
she's
an
excellent
resource,
but
in
that
rfp
there
is
a
provision
for
something
called
community
reinvestment
funds,
and
this
is
a
method
of
collaboration
with
managed
care
and
their
state
partners
that
is
in
place
in
other
states.
For
example,
in
arizona
the
state
does
mandate
that
their
managed
care
invest.
Q
I
want
to
tell
you
why
we've
gotten
some
questions
about.
Why
does
managed
care
want
to
invest
in
homelessness
and
housing
and
I'll
give
you
an
example,
for
I
mentioned
arizona
there.
They
partnered
with
both
the
state
and
the
and
a
non-profit,
to
contribute
some
capital
funding
for
a
housing
complex.
Q
So
the
managed
care
company
provided
the
funding
to
help
the
local
government
build
the
build
the
complex.
Then
they
basically
can
bring
in
case
management
and
care
management
to
the
people
who
are
housed
in
that
facility.
A
portion
of
the
units
at
that
complex
are
set
aside.
Specifically,
20
percent
of
the
units
are
set
aside,
specifically
for
homeless
high
utilizers
of
the
health
care
system.
Q
Q
So
today
about
139
individuals
have
been
served
in
that
program,
and
so
this
type
of
collaboration
and
partnership
is
what
we
had
in
mind
when
we
asked
senator
neil
to
consider
sb
309
walking
through
very
briefly.
The
bill
sets
up
the
reinvestment
advisory
committee
in
clark
county
in
section
three,
and
it
has
members
both
from
the
county
and
from
the
cities
from
the
division
of
welfare
and
supportive
services
with
the
non-profit
sector.
This
is
very
all
the
people
who
are
involved
in
our
ab-73
report.
Q
We
also
included
you'll,
see
in
section
three
subsection
2c,
any
other
members
that
the
director
deems
necessary
appropriate
to
serve
as
non-voting
members.
This
is
actually
language
that
was
suggested
to
us
by
the
managed
care
companies
when
we
heard
this
in
the
senate,
so
that
they
would
have
a
forum
to
be
collaborating
with
this
committee
that
they
cannot
be
appointed
as
non-voting
members.
It
is
very
similar
to
something
that
we
have
in
place
and
have
had
in
place
since
2017
with
the
advisory
committee
on
medicaid
innovation.
Q
Q
We
are
going
to
use
the
committee
to
get
reports
from
the
state
and
from
the
managed
care
vendors
about
the
reinvestment
of
funds
by
the
medicaid
managed
care
organizations
in
the
community,
but
then
we've
also
written
in
two-way
communication,
so
that
the
local
governments
and
those
and
the
non-profits
will
also
inform
the
managed
care
companies
and
the
state
about
what
we're
doing.
We
hear
a
lot
about
silos
in
health
care
and
about
initiatives,
and
this
is
something
that
we
really
wanted
to
break
down
all
together.
Q
It
is
not
managed
care's
responsibility,
nor
can
they
do
it
alone.
The
state,
as
you
know,
cannot
do
this
alone.
The
counties
and
the
local
governments
also
cannot
do
this
alone.
So
together
we
wanted
to
provide
a
forum
where
we
can
talk
about
our
goals
and
priorities
to
make
our
collective
dollars
go
further.
Q
The
other
thing
in
here
is
that
we'll
talk
about
innovative
partnerships
with
the
community
development
organizations
and
about
how
it
could
be
supporting
local
governments,
we
are
a
key
stakeholder.
We
believe
I'm
biased.
I
work
for
clark
county,
but
we
are
the
regional
service
provider
and
we
find
that
we
can
partner,
but
often
we
we
need
a
forum,
I
think,
and
maybe
a
more
formal
way
to
make
sure
that
we
are
all
working
together.
Q
The
important
thing
here
it
too,
is
that
we've
written
in
an
annual
report
to
the
legislature
so
that
you
will
be
informed
as
the
policy
makers
of
the
activities
of
this
committee.
Where
are
these
reinvestment
funds
going
who's?
Who
is
getting
them
and
what
what
efforts
are
being
done?
I
think
we
have
targeted
in
this
committee.
We've
tried
to
keep
it
really
broad
that
the
goal
of
the
committee
would
be
to
address
housing
and
homelessness,
but
also
social
determinants
of
health,
which
housing
is,
is
a
social
determinant
of
health,
also
transportation.
Q
I
will
tell
you
the
effective
date
is
january,
1st
2022,
and
that
was
a
effective
date
that
the
state
we
did
collaborate
with
the
state
on
this
bill
draft
as
well,
and
that
will
align
with
when
they
should
have
the
new
vendors
in
place,
and
so
then,
as
soon
as
the
new
vendors
are
in
place
as
well
as
that
contract
provision,
then
the
committee
will
be
appointed,
and
that
is
my
overview
and
I
can
stand
for
questions
with
senator
neil.
Thank
you.
A
Great
miss
finney,
did
you
have
anything
to
add
here
or
are
you
on
the
line
for
questions
hi.
A
Perfect,
so
I
have
questions
from
the
committee
members.
I
have
a
assemblywoman
benitez
thompson
first
and
then
I
will
come
to
you.
Miss
titus.
K
Thank
you
so
much
for
the
questions
adam
chair.
I
appreciate
it.
So
I
obviously
very
much
remember
the
conversation
from
last
session
and
I
know
that
clark,
county
and
the
local
governments
were
were
wonderful
in
their
creativity
and
that
ultimately,
there
was
a
feeling
that
you
know
that
we
needed
a
better
nexus
between
the
funding
source
and
the
conversation
and
and
that
you
know
the
the
appreciation
by
the
local
governments
to
pivot
to
a
different
kind
of
conversation
was
one
that
was,
you
know.
I
know
we
were
all
appreciative
of.
K
K
Does
it
make
sense
to
have
just
one
county
having
this
conversation,
it's
specific
to
the
county,
and
that
makes
sense,
but
I'm
thinking
of,
like
the
reports
back
and
forth,
that
you
have
that
the
advisory
reinvestment
committee
will
do
kind
of
in
that
that
reciprocal
exchange
of
conversation
that
you
were
talking
about,
miss
jacobs,
that
there
will
be
reports
coming
from
the
state.
But
then
also
reports
going
to
the
state
to
help
inform
policy.
M
Thank
you
for
the
question,
dean
and
neal
for
the
record
to
assemblywoman
benitez
thompson.
Please
feel
free
to
go
straight
to
the
like
to
you
and
through
you,
two
okay.
So
we
had
this
conversation
on
the
senate
side
right
and
the
question
that
was
asked
by
senator
ratty
was
why
can't
we
do
this
in
washoe
or
why
can't
washoe,
participate
and
washoe
doesn't
actually
have
an
interest,
and
I
guess,
moving
down
this
pathway
or
participating.
But
what
you're
saying
is
adding
their
voice
to
the
table?
Now,
that's
a
separate
conversation.
M
I
don't
think
we
asked
them,
because
what
was
asked
was
this
would
work
well
in
washoe.
So
why
don't
you
guys
consider
this
as
well?
So
I
think
that
we
could
probably
ask
that
question
in
regards
to
do
you
at
least
just
want
a
voice,
meaning
a
participant,
because
the
bill,
I
think,
allows
that
because
there's
a
catch-all
language,
if
you
look
in
section
3
sub,
see
line
24
in
my
version
where
it
says
that
other
persons
that
the
director
deems
necessary
appropriate
is
serving
as
non-voting
members.
M
K
I
appreciate
so
much
and
I
appreciate
the
willingness,
because
I
think
one
of
the
things
is
especially
specific
to
these
pot
of
dollars.
Is
we
typically
the
state
level,
don't
really
see
how
they're
being
used?
We
will
see
perhaps
at
the
interim
finance
committee,
a
recommendation
come
through
for
like
a
piece
of
the
puzzle
and
we're
like.
Oh
look.
What
is
this
and
how
is
that
working?
K
And
we
all
seem
intrigued,
but
they
are
otherwise
projects
that
don't
necessarily
fall
on
our
map
and
of
course
we
need
to
one
of
my
favorite
phrases
that
I
use
coming
from
senator
neil.
We
need
to
make
a
penny
sink.
We
need
a
penny
to
be
split,
eight
different
ways
doing
eight
different
things
right.
K
So
if
there's
an
opportunity
to
better
berate
state
resources
and
supports
with
the
local
dollars
and
the
the
managed
care
organization
reinvestment
dollars,
then
we
could
get
some
synergy
for
bigger
products,
but
we
don't
our
bigger
projects,
but
we
don't
see
those
right
now.
So
I
really
like
that
piece.
I
just-
and
I
appreciate
your
willingness
to
say
that
more
voices
at
the
table
will
be
beneficial.
A
Thank
you
assemblywoman.
I
also
agree,
I
think,
with
the
transiency
of
our
state.
We
know
that
some
of
our
homeless
population
don't
stay
in
parts
of
the
state
for
the
entire
year,
even
and
often
move
about
the
state.
So
I
think
that
that's
an
appropriate,
an
appropriate
ask
of
the
other
counties
if
they'd
like
assemblywoman
titus,
please,
with
your
question.
B
Thank
you.
Madam
advice,
chair
appreciate
the
opportunity
to
ask
a
question
and
thank
you
for
the
explanation
and
bringing
this
back
with
some
clarity
to
it.
I
I
need
some
more
clarity.
I
guess
on
section
five
number,
a
on
the
bill
itself.
It
talks
about
what
the
committee
is
going
to
do
and
that's
going
to
get
a
review
from
the
vision
of
medicaid
management
organizations
concerning
the
reinvestment
of
funds
by
those
managed
care
organizations.
Do
they
already?
B
Are
they
already
mandated
to
reinvest
a
certain
percent
of
their
profit,
pre
prepayment
type
of
thing,
and
if
so,
what
percent.
M
Q
I'll
defer
that
to
miss
finney,
because
there
is,
I
believe
that
that
is
coming.
And
then,
if
there's
further
questions
about
the
intent
of
section
5
sub
a
I
can
follow
up
after
miss
finney
comments.
L
L
The
mechanism
that
creates
this
is
in
our
manager,
rfp
that
is
currently
out
for
bid
and
would
go
into
effect,
the
first
of
january
2022,
and
that
would
require
the
plans
to
reinvest
three
percent
of
their
profits
that
are
associated
with
this
program.
B
So
and
there's
no
the
rfp,
so
it's
basically
a
provider
tax
so
to
speak,
in
my
view,
that
you're,
in
order
to
bid
to
become
mco
for
our
medicaid
population
under
this
rfp
part
of
that
understanding
will
be
that
you
have.
Three
percent
of
your
profits
will
have
to
go
back
to
this
program,
and
this
program
alone
is
that
correct.
L
Cody
finney
for
the
record,
so
the
contract
is
set
up
to
require
that
three
percent
of
the
profits
would
have
to
go
for
community
reinvestment.
It's
my
understanding
that
those
those
dollars
would
go
directly
from
the
managed
care
organization
to
the
approved
plan.
So
in
the
rfp.
There
are
some
examples
given
about
the
kinds
of
pro
of
priorities
that
our
the
state
is
looking
for
and
that
the
state
would
be
able
to
approve
the
plan
by
that
the
vendors
are
investing
in
okay.
B
So
I
guess
where
I'm
going
with
my
question:
is
it's
assumed
that
these
managed
care
organizations
are
for-profit
and
the
argument
has
been
made
that
we
allow
them
to
be
our
medicaid
managers,
because
in
the
long
run,
even
though
they're
making
a
profit
there's
some
value
to
it,
because
we
feel
in
the
long
term
they
they
save
the
state
money
and
there's
some
argument
on
both
sides
of
that.
B
However,
do
you
have
any
idea,
then,
based
on
the
profits
that
you
have
seen
in
the
past
from
these
medicaid
organizations
how
much
funding
this
revenue
this
would
generate.
L
Cody
finney
for
the
record.
Thank
you
had
this
been
in
place
for
this
year,
and
it
was
not
so
this
is,
could
be
very
different
in
2022,
because
we'll
have
new
contracts
and
those
contracts.
This
rfp
is
set
up
to
allow
some
different
design
of
the
program.
There
could
be
more
vendors,
but
based
on
the
the
information
we
have
today
had
this
program
been
in
place
for
this
year.
We
would
have
expected
it
to
generate
about
seven
million
dollars
in
community
investment.
L
So
cody
finney
for
the
record,
I'm
I
would
certainly
defer
to
jacobs
and
the
senator.
There
is
nothing
in
the
contract
that
limits
good
investment
to
clark
county.
The
advisory
committee
is
limited
to
clark
county.
B
All
right
and
so-
and
I
I
understand
this-
is
an
amount
of
vice
chair.
I
recognize
this
is
not
a
money
committee
and
that
can
be
vetted
out
at
some
other
time,
but
it
is
part
of
the
policy
of
this
bill
is
to
when
we
put
out
these
rfps
in
the
future,
to
support
this
bill,
we're
going
to
require
that
they
pay
three
percent
of
their
profits
back
towards
the
investment
in
this.
B
What
this
bill
does,
and
so
I
just
want
to
make
sure
we
understood
that
policy
connected
with
the
money
and
then
recognizing
that
there
would
potentially
be
a
seven
million
dollar
investment
regarding
that,
if
other
managed
care
organizations
sign
up
for
this
and
the
profits
are
made.
Although
those
folks,
as
a
little
bit
along
the
line
of
questioning
of
our
majority
leader
regarding
profits
and
who,
who
can
benefit
from
this-
and
I
recognize
and
members
know
that
in
rural
areas,
most
of
it,
we
don't
have
necessarily
to
manage
care
organizations.
B
We
have,
you
know
fee
for
service.
So
it's
a
different
role
model.
So
I
understand
why
it
would
be
limited
to
certain
areas
because
their
the
managed
care
organizations
are
not
everywhere,
but
I
too
would
like
some
information
making
sure
that
if
this
goes
forward,
I
have
always
had
anxiety
about
these
managed
care
organizations
making
a
profit
on
our
nevada
medicaid
system.
So
I'm
I
like
the
concept
that
they
give
back
to
the
community
some
of
this
profit
and
invest
into
our
community,
but
certainly
would
like
to
see
the
concept
expanded
throughout
our
state.
K
Yeah-
and
I
think
this
can
be
for
miss
finney,
to
correct
us,
but
I
mean
the
policy
to
to
go
ahead
and
do
a
request
for
proposal.
The
ending
time
of
the
last
set
of
managed
care
organizations
and
all
of
those
those
are
those
are
votes
that
we
have
that
we
have
taken
right.
So
we
already
approved
the
ability
to
go
out
and
to
contract.
I
think
we
actually
did
last
session
the
rfi
the
request
for
information
for
the
division
to
go
out
and
start
talking
more.
K
K
We
took
those
votes
and
gave
them
the
ability
to
go
out
and
now
we're
kind
of,
I
would
say
in
terms
of
how
contracting
goes
on
in
the
home
stretch
of
it
right
where
there
will
be
a
blackout
period
pretty
soon,
we
will
not
be
communicated
or
lobbied
for
by
any
of
the
ones
who
are
bidding,
because
they
have
to
stop
doing
that
at
some
point
and
then
and
then
we'll
have
contracts
coming.
K
You
know
within
early
within,
I
think
it's
2022,
but
it's
kind
of
a
a
long
process
and
I
would
hate
to
confuse
this
bill
with
those
other
wheels
that
we've
already
put
into
motion,
because,
unless
we're
going
to
flip
back
from,
you
know
ending
away
with
mcos,
it's
kind
of
where
we
are
and
where
we've
been
now
for
a
couple
years.
Q
Thank
you,
chair
peters.
I
just
wanted
to
make
just
a
a
comment
in
response
to
assemblyman
titus
and
then
to
assembly
when
benitez
thompson.
Q
I
certainly
assemblywoman
thomas
appreciate
your
comments
and
I
did
want
to
just
emphasize
that
the
state
is
dictating
at
least
I
know
this
from
my
conversations
with
with
miss
finney
certain
priorities
for
community
reinvestment.
Those
will
be
state
priorities.
The
committee
that
we're
setting
up
here
is
advisory.
It
is
not,
and
this
is
one
of
the
questions
and
because
I
had
the
conversation
with
the
managed
care
vendors.
I
feel
very
comfortable
speaking
to
this.
Q
This
is
meant
to
help
them
find
the
vehicle
to
do
the
community
reinvestment
and
to
align
with
the
local
governments
so
that
they're
not
looking
for
those
opportunities
or
that
we
are
working
together
on
that.
It
does
not
mean
that
the
managed
care
companies
have
to
forego
an
opportunity
that
might
come
up
outside
of
the
committee.
It
does
not.
It
is
not
a.
Q
This
is
the
be
all
and
definitive
plan.
I
will
also
note,
though,
and
the
reason
it's
focused
in
southern
nevada.
One
significant
finding
that
we
had
out
of
the
ab-73
report
was
the
amount
of
behavioral
health
medicaid
expenditures
in
the
state.
79.9
of
the
behavioral
health
spend
in
medicaid
is
in
southern
nevada,
that
is
244
million
out
of
the
306
million
that
we
spend
as
a
state
in
southern
nevada.
Q
That
is
why
we
have
a
lot
of
stakeholders.
We
have
a
lot
of
population
that
we
have
to
take
care
of.
That's
why
you
see
a
formal
committee
structure,
assemblyman
benitez
thompson.
I
don't
think
that
this
means
that
washoe
county
is
not
interested
in
in
working
with
the
managed
care,
but
they
didn't.
Maybe
don't
need
this
formal
structure
that
we
have
put
in
place.
That
was
a
priority
for
our
community
that
the
one
that
we
represent.
Q
It's
about
putting
local
government
at
the
table
to
make
sure
that
we're
aligning
when
we
don't
have
that
direct
contractual
relationship,
but
we
are
also
engaged
as
one
of
the
largest
service
providers
in
the
state.
I
will
know
just
because
I
can
see
him.
I
have
assistant
county
manager
kevin
schiller
on
the
phone
too,
if
there's
any
other
questions
about
just
our
clark
county
priorities,
but
this
is
why
it's
set
up
the
way
that
it
is,
and
we
can
certainly
I'll
differ.
If
senator
neil
has
any
other
comments.
M
Thank
you
for
that,
and
so
senator
dean
o'neill
for
the
record.
I
just
because
there
were
a
couple
of
things
and
assemblywomen
titus's
questions.
Slash
comments,
number
one
about
that:
seven
million!
I
it
because
it
sounded
like
when
I
was
listening
to
you.
It
sounded
like
you
were
trying
to
ask
you
know:
how
long
will
this
go?
Will
this
be
in
perpetuity
for
that
three
percent?
M
Or
how
do
you
know
whether
or
not
you
know,
4
million
should
go
to
clark
under
the
re-advisory
goals,
or
should
three
million
goats
to
somewhere
else
where
they
actually
are
housed
mcos,
and
so
the
way
that
and
and
correct
me
if
that
is
what
I
was
hearing
and
but
it
what
the
way
I
understood
it
was
clark
county
is
trying
to
get
a
seat
at
the
table
to
then
drive
the
mco
investment
towards
these
three
key
categories
that
are
in
the
bill:
right:
the
homelessness,
housing
and
then
the
social
determinants.
M
That's
the
first
key
thing
of
anything
that
we
ever
passed:
it
did
it
work
two
and
if
it
did
work,
should
we
continue
this
for
the
next
rfp
cycle
and
if
it
did
not,
then
you
know
the
legislature,
because
it's
statutory
will
then
have
the
power
to
come
back
and
say.
Well,
you
know
you
tried,
it
theory,
didn't
work
and
now,
let's
refine
this
and
let's
change
these
goals,
because,
based
on
the
report,
it
didn't
work
and
the
three
percent
two
percent
or
whatever
it
ended
up.
M
Looking
like
for
clark
county,
didn't
manifest
the
goal
that
clark
county
was
seeking,
but
I,
but
I
do
think
that
this
is
the
first
step
in
order
to
allow
them
to
sit
at
the
table,
because,
typically
you
don't
get
to
tell
an
mco
what
to
do
right.
I
mean.
Typically,
the
hands
are
tied
in
general,
but
now
they
get
a
seat
at
the
table
to
at
least
drive
the
purposes
and
say
hey.
You
ought
to
consider
this.
M
You
ought
to
think
about
this
and
then
there's
money
to
back
it,
and
so
I
know
that
was
a
lot,
but
I
was
trying
to
get
at
some
of
the
things
that
you
were
getting
at,
because
I'm
all
about
effectiveness
right
if
it
doesn't
work,
I
will
be
the
first
person
at
the
table
with
the
strip
out
language
to
sb
309,
saying:
hey,
it's
2023.,
this
didn't
work.
You
no
longer
have
this
ability.
A
H
Thank
you,
man,
advice
chair,
I'm
just
speaking,
and
thank
you
very
much,
senator
neil
for
bringing
this
bill
miss
jacobs
for
being
present
and
those
who
are
on
zoom
quick
question.
So
this
is
not
new
mcos
have
they
or
have
they
not.
I
should
say
that
is
this
a
new
concept
that
mcos
are
supposed
to
be
or
expected
to
be
or
voluntarily
do
reinvestment,
and
if
it's,
if
it's
not
new,
do
we
have
ideas
of
what
they've
done
before?
Has
there
been
tracking
of
what
they've
done
before?
M
Q
Thank
you,
senator
neil,
and
to
you
assemblyman
summers,
armstrong!
No!
I
did
mention
the
arizona
project
in
my
testimony
and
this
is
and
to
their
credit
I
will
say,
the
managed
care
companies
do
voluntarily,
invest
in
housing
projects
across
the
nation
and
they
have
they
have
partnered
with
clark
county.
This
was
something
that
assistant
county
manager,
kevin
schiller
worked
on
with
the
project
that
we
talked
about
in
clark
county
and,
I
think
to
senator
neil's
point.
Q
This
is
about
making
sure
that
when
we
do
invest
that
the
local
governments
we
have
our
own
initiatives,
and
this
and
our
non-profit
partners
do
as
well
that
we
can
work
together
that
and
these
projects
I'll
give
you
another
example
they're
throughout
california,
where
it's
usually
takes
a
place
of
investing
in
housing
where
there's
housing,
but
then
the
counties
are
there
to
provide
they
partner
as
well
to
provide
the
vouchers
or
any
other
thing
that
comes
with,
and
then
everybody
really
can
invest
in
those
interventions
that
will
hopefully-
and
they
do
believe,
the
reason
why
they
invest
in
these
things
is
because
it
drives
better
health
outcomes,
because
once
people's
housing
is
in
place,
then
they
can
focus
on
their
health
and
medication.
Q
L
Cody
finney
for
the
record,
I
would
simply
add
that
what's
new,
for
our
division
is
the
requirement
for
this
participation.
L
Our
current
plans
have
done
some
of
this
kind
of
investment
in
housing
and
other
forms
of
social
determinants
in
the
current
contract
period.
The
only
thing
that's
new
for
from
us
is
a
requirement
for
that
in
the
future.
A
Thank
you
all
and
we're
seeing
no
other
questions
from
the
committee.
We
will
go
ahead
and
go
into
support
testimony.
Is
there
anybody
in
the
room?
I
don't
see
anybody
in
the
room
bps.
Can
we
go
ahead
to
the
phones
for
support
testimony.
P
C
Thank
you,
madam
chair
members
of
the
committee
for
the
record
kelly
crompton
representing
the
city
of
las
vegas,
k-e-l-l-y,
o
m
p,
t
o
n,
the
city
of
las
vegas
is
in
support
of
sb
309
and
the
work
that
the
committee,
the
av-73
committee,
did
over
the
interim
and
would
like
to
thank
the
senator
neal
for
bringing
this
bill
forward.
This
legislation
is
important
to
southern
nevada
to
continue
working
collaboratively
on
addressing
the
needs
of
our
community,
and
we
thank
you
for
hearing
the
bill
and
asking
your
questions.
C
P
P
A
Support
not
seeing
any,
I
would
go
ahead
and
ask
broadcast
to
ask
for
opposition
testimony
on
sb309.
P
M
A
A
I
I
Thank
you,
chair,
peters
and
good
afternoon
to
the
members
of
the
assembly
committee
on
health
and
human
services
for
the
record.
My
name
is
fabian
danate
and
I
represent
senate
district
10
in
the
heart
of
las
vegas,
on
behalf
of
the
committee
to
conduct
an
interim
study
concerning
the
cost
of
prescription
drugs.
I
am
truly
honored
to
be
here
with
you
all
today
to
present
on
the
work
that
was
completed
by
my
predecessor,
senator
ivana
cancella
senate
bill
396
revises
provisions
relating
to
the
purchasing
of
prescription
drugs
under
the
proposed
legislation.
I
Sb
396
would
authorize
public
agencies
of
the
state
to
enter
into
agreements
with
certain
entities
and
other
jurisdictions
for
the
collaborative
purchasing
of
prescription
drugs.
In
essence,
what
we're
trying
to
do
today
is
if
we
combine
our
purchasing
power
collaboratively
with
other
states
or
entities,
the
better
off
our
state
will
be
to
reduce
the
high
costs
of
prescription
drugs
generally
in
the
healthcare
sector.
I
There
are
many
benefits
that
could
arise
with
the
construction
provided
by
a
regional
purchasing
coalition
beyond
the
purchase
power
that
is
facilitated
by
these
organizations.
Participants
of
a
purchasing
coalition
may
benefit
from
data
sharing
and
utilization
networking
best
practice,
communication
and
performance
improvement
through
trend,
identification,
of
course,
to
address
the
increasing
cost
of
prescription
drugs.
We
need
open
and
transparent
conversations
about
the
workings
of
the
entire
pharmaceutical
value
chain.
I
Greater
focus
on
transparency
will
mean
that
all
stakeholders
will
need
to
come
together
seeking
to
find
solutions
to
bring
out-of-pocket
costs
down
for
patients
who
need
it
the
most.
But
to
accomplish
that
goal,
we
need
to
access
every
tool
that
we
can
get
our
hands
on,
whether
it
is
enacted
by
policy
or
accomplished
at
the
community
level.
What
excites
me
most
about
this
legislation
is
how
it
prioritizes
access
to
care
services,
which
is
always
a
conversation
that
is
left
behind
when
addressing
the
rising
costs
of
health
care
throughout
our
nation.
I
If
we
allow
certain
entities
within
with
the
opportunity
to
enter
into
purchasing
coalitions,
we
can
ensure
that
nevada
can
begin
to
influence
and
modulate
supply
chain
costs
and
that
itself
can
provide
employers
and
consumers.
The
right
information
needed
to
actually
address
the
cost
of
a
prescription,
drug
multi-state
and
inter-agency
purchasing
plans
have
a
transformative
impact
to
how
nevada
conducts
its
decision
making
with
regard
to
the
pharmaceutical
industry,
and
in
fact,
now
more
than
ever,
we
recognize
just
how
valuable
our
collective
power
can
be,
especially
when
we
consider
the
ramifications
that
have
occurred
without
this
collaboration.
I
I
We
can
change
this
by
supporting
this
legislation
in
sb
396,
and
at
this
time
I
see
that
we
have
our
my
fellow
colleagues,
so
with
the
permission
of
chair
peters,
I
would
like
to
go
ahead
and
turn
it
over
to
dr
beth
slamowitz
senior
policy
advisor
on
pharmacy
for
the
nevada
department
of
health
and
human
services,
who
can
go
over
the
bill.
Language.
R
Proceed,
thank
you.
Senator
donate
and
thank
you,
chairwoman
and
committee
members
for
the
record.
My
name
is
beth
slamwitz,
I'm
the
senior
policy
advisor
for
pharmacy
for
the
department
of
health
and
human
services,
with
senator
donate's
overview
of
purchasing
coalitions.
R
R
R
allows
a
using
agency
to
join
with
governmental
entities
of
other
states
to
purchase
prescription
drugs,
sp
396,
section
1,
amends
nrs,
42240
and
authorizes
the
department
of
health
and
human
services
to
enter
into
agreements
for
the
purchase
of
prescription,
drugs
for
medicaid
and
the
children's
health
insurance
program
with
private
entities
within
or
outside
the
state
section.
2
authorizes
the
department
to
enter
into
a
contract
with
one
or
more
public
or
private
entities
from
this
state
or
other
states
for
the
collaborative
purchasing
of
prescription
drugs.
R
Existing
law
imposes
certain
requirements,
concern
concerning
transparency,
rebates
and
auditing
on
contract
between
the
department
and
pharmacy
benefit
manager
or
health
maintenance
organization,
subsection,
two
of
section
two,
as
well
as
language.
In
such
section
three
exempt
a
contract
entered
into
for
the
collaborative
purchasing
of
prescription,
prescription
drugs
between
a
department
and
a
pbm
or
hmo
for
those
requirements.
R
So,
in
conclusion,
current
expressed
authority
exists
for
both
public
to
public,
as
well
as
private
to
private.
Whether
intra
or
interstate
sb
396
looks
to
expand
that
authority
to
both
public
to
private
in
intra
and
interstate
purchasing
coalitions
and
with
that
I'll
stop
for
any
additional
questions.
A
Thank
you.
Are
there
any
questions?
Oh
questions
from
the
committee.
Okay,
I
have
assemblywoman
thomas
first
and
then
I
will
go
to
assemblywoman
benitez
thompson.
H
Thank
you
so
much
vice
chair
and
thank
you
senator
dante
and
dr
slammed
for
your
presentation.
I
really
do
appreciate
it.
I
have
just
a
basic
question,
especially
with
what
has
happened
during
this
pandemic,
how
we
were
at
a
loss
for
pharmaceutical
products.
H
I
would
like
to
know
why
we
are
not
collaborating
with
you
know
our
european
governments
of
you
know
for
pharmaceutical
products.
Why
are
we
just
relegating
it
to
united
states,
because
you
know
some
of
the
products
are
at
a
lower
cost
actually
in
other
countries,
and
I
was
wondering
why
that
why
are
we
limiting
ourselves?
Thank
you.
A
Dr
slamowicz,
would
you
be
able
to
respond
to
that
question.
R
So
I
think
that
it
is
definitely
something
that
is
being
considered
not
only
at
a
state
level,
but
at
a
national
level.
I
know
that
there
has
been
lots
of
conversation
in
terms
of
importation
from
canada,
and
then
I
know
from
a
federal
level,
there
were
conversations
and
legislation
brought
forward
through
the
trump
administration
to
look
at
aligning
pricing
with
european
pricing.
R
I
think
it's
it's
incredibly
complex
and
I
think
that
there
are,
you
know,
laws
in
terms
of
importation
and
that
need
to
change
and
occur
from
the
federal
level
before
it
would
even
trickle
down
to
a
state
level.
But
I
know
it's
something
that
is
a
constant
conversation
in
looking
at
ways
to
to
decrease
the
price
of
prescription
drugs
in
this
country.
A
G
Thank
you
very
much,
patrick
ashton.
Committee
policy.
Analyst
just
wanted
to
mention
that
the
committee
to
study
the
cost
of
prescription
drugs
had
various
testimony
in
regards
to
that,
and
I
can
certainly
send
the
members
the
link
and
information
about
the
testimony.
What
is
currently
allowed
by
state
government
and
federal
government
for
your
information.
K
Thank
you
so
much.
I
appreciate
the
chance
to
ask
a
question.
My
question
would
be
on
so
I
the
way
I
read
this
is
that
if
we
did
as
a
state
enter
into
these
contracts,
these
collaborative
purchasing
purchasing
agreements-
and
it
looks
to
me
like
they're,
not
going
to
be
subject
to
nrs
422
4056,
which
is
all
of
the
auditing
provisions
and
then
the
posting
of
the
audit.
So
I
heard
you
mention
that
there's
going
to
be
transparency-
and
I
didn't
know
if
there
was
an
another
section-
that's
being
referenced.
K
R
Sure
so,
beth
slumwitz
for
the
record
and
thank
you
for
the
question
and
so
my
understanding
of
their
reasoning
for
removing
that
language
is
to
allow
medicaid
to
enter
into
these
contracts
that
go
beyond
the
state
so
from
one
state
to
the
next.
R
Although
it
may
present
the
language
that
says
that
it's
exempt
within
those
contracts
that
doesn't
stop
that
language
from
being
in
those
contracts,
and
I
can
tell
you
certainly
from
medicaid
perspective
that
any
contract
that
they
would
enter
into,
especially
with
a
pharmacy
benefit
manager
or
a
health
maintenance
organization
in
terms
of
managing
prescription
drugs,
that
audit
rights
would
definitely
be
tied
into
that
contract.
I
think
it
just
removes
it
from
a
nrs
requirement,
but
certainly,
I
think,
by
a
good
contracting
practice.
K
If
I
could
add
to
that,
so
I
think
something
that
we
learned
when
we
started
in
on
managing
the
first
set
of
the
managed
care
organizations
that
we
did
and
we
had.
You
know
two
that
we
did
we've
done
another
round
and
then
there
were
four
and
with
each
time
we've
gotten
more
savvy.
But
I
have
to
tell
you
what
sat
through
lots
of
hearings
where
we
ask
well,
can
we
get
data?
Well?
No.
We
can't
because
our
contract
doesn't
allow
it
well.
Can
we
get
this?
K
Well,
they
say
that's
proprietary,
so
we
can't
get
that,
and
so
we
get
better.
I
think,
as
a
state
at
how
we
we
learn,
how
to
negotiate
some
these
contracts,
but
I
would
still
say
that
we
are
in
a
lot
of
ways
in
the
learning
phase.
K
I
think
one
of
the
things
that
we
were
most
surprised
about
in
some
of
these
conversations
that
I
learned
was
you
know
these
health
care
systems
show
up
with
they've,
got
just
a
room
full
of
lawyers
who
are
negotiating
these
contracts
and
we're
the
state
of
nevada
and
we're
like
hey
waze
committee,
can
you
put
one
more
person
in
the
department
of
administration
to
help
contract
on
these
help
with
these
rfps?
K
So
we
tend
to
be
outgunned.
Quite
frankly,
and
I
like
the
security
of
having
agencies
default
back
to
nrs,
to
say
you
know
it's
got
to
be
in
there.
It's
just
boilerplate
we're
going
to
audit.
We
have.
We
want
the
ability
to
track
down
these
dollars.
So
if
there's,
if
I
would
think
that
it,
they
remain
smart
to
keep
nrs
as
the
backstop
for
requiring
the
the
audit
of
where
our
state
dollars
are
being
used,
regardless
of
how
far
or
how
collaborative
they
are
being
used
and
that
those
are
good
things.
K
R
I
certainly
can
respond,
that's
not
what's
for
the
record,
I
definitely
do
not
disagree
and
I
would
probably
have
to
default
back
to
senator
donate.
You
know
to
go
back
and
look
at
the
reasoning
for
putting
that
language
in.
I
believe
that
there
was
a
some
sort
of
legality
in
it
in
terms
of
allowing
medicaid
to
enter
into
these
coalitions,
and
that's
why
also
nrs4224025
was
involved,
and
so
I'd
have
to
default
back
to
that
and
perhaps
bring
some
information
back
to
the
assembly
woman.
A
Thank
you.
I
don't
know
if
our
legal
would
like
to
weigh
in.
S
K
I
think
we
can
keep
bird
dogging
it.
I
I'm
not
a
lawyer,
so
that's
why
I
always
ask
like:
is
there
another
reference
to
a
section
if
we
take
out
one
reference?
Is
there
something
else?
So
I
think
it's
probably
how
the
chapters
working
together
and
I
could
have
legal
walk
it
through
me
or
walk
walk
me
through
this,
because
I
don't
see
anything
specifically
in.
I
guess
I
would
need
to
know
what
a
422
4056
is
preventing
it
and
if
there's
a
way
to
keep
in
the
audit
provision
without
they
don't
seem
mutually
exclusive.
K
A
H
I
have
thank
you
so
much
senator
and
miss
slumwitz,
and
I
have
to
co-sign
what
my
colleague
is
saying.
I'm
very
concerned
about
that.
We
have
had
similar
issues
on
other
things
that
affect
my
community
and
we've
not
been
we're
not
able
to
ask
for
data,
and
so
I
would
like
you
all
to
please
once
you
figure
it
out
or
get
the
information
to
share
it.
H
A
Thank
you,
I
think
we'll
have
some
follow-up
with
the
committee
before
this
bill
may
come
up
for
work
sessions.
So
are
there
any
other
questions
from
the
committee
seeing
none,
I
would
go
ahead
and
see
if
there's
any
support.
I
do
not
see
anybody
in
the
room.
Is
there
any
support
on
the
on
the
zoom
seeing
none?
I
would
ask
broadcast
to
go
ahead
and
open
up
the
public
line
for
support,
support
testimony
on
sb
396.
P
P
P
P
C
Hello,
can
you
hear
me
now?
Yes,
we
can
hear
you
please
go
ahead.
Okay,
thank
you
good
afternoon.
Vice
chair
peters
and
members
of
the
committee.
My
name
is
mary
liberati
m-a-r-y
l-I-v-e-r-a-t-t-I,
I'm
a
volunteer
with
aarp
aarp
worked
dirt
with
the
interim
committee
on
drug
costs
during
the
interim,
and
we
also
support
this
bill.
C
Americans
should
not
have
to
pay
the
highest
drug
prices
in
the
world.
Life-Saving
drugs
do
not
work.
If
you
cannot
afford
them.
In
some
cases,
people
may
be
forced
to
skip
doses
or
cut
pills
in
half
due
to
the
cost.
We
believe
people
should
not
have
to
choose
between
blind
medicine
or
pain
for
food
and
housing.
C
C
P
P
C
Hi
stacy
sasser
with
the
health
services
coalition
we
are
in
support
of
sb
396..
Creating
a
purchasing
coalition
is
another
step
forward
in
achieving
affordable
health
care
access.
Now
more
than
ever,
the
state
needs
to
make
changes
that
can
positively
impact
the
economy
in
the
budget,
and
we
look
forward
to
sb
396
being
a
vessel
for
that.
Thank
you.
P
C
We
can
hear
you
okay,
sorry
about
that.
I
think
technical
problems
for
the
record.
This
is
maya
holmes
from
the
culinary
health
fund.
It's
m-a-y-a-h-o-l-m-e-s
we're
a
non-profit,
labor
management
trust
fund
that
provides
health
benefits
for
culinary
union
workers
and
their
dependents,
we're
in
support
of
sb
396.
We
think
it's
really
a
sensible
and
needed
path
to
leverage
the
state's
purchasing
power
by
partnering
with
other
public
and
private
entities
in
order
to
secure
prescription
drugs
at
a
reasonable
cost.
C
A
Thank
you
for
your
testimony
broadcast.
Is
there
anyone
else
on
the
line
for
support,
so
there
are
no
more
callers
and
support
at
this
time.
Next,
we
will
hear
testimony
in
opposition
of
sb
396,
I'm
saying
no.
We
have
one
person
in
the
room.
Okay,
no
testimony
in
the
room.
I
would
go
ahead
and
ask
broadcast
to
check
the
lines
for
testimony
and
opposition
to
sb
396.
A
At
this
time,
thank
you
broadcast.
At
this
point,
I
would
like
to
invite
anybody
wishing
to
testify
neutral
on
sb
396.,
seeing
none
in
the
room.
I
would
ask
broadcast
to
please
check
the
lines
for
neutral
testimony
on
396.
A
I
A
A
Oh
I'm
sorry,
I
forgot
to
go
over
our
housekeeping
items
just
for
those
who
are
listening,
maybe
online
as
a
reminder
to
provide
public
comment.
You
must
register
online
through
the
legislative
website
and
select
your
preference
for
providing
public
comment
either
in
person
or
by
phone
registers,
preferring
to
give
public
comment
by
phone
will
receive
a
phone
number
meeting
idea
and
instructions
for
joining
the
meeting.
Please
remember
to
clearly
state
and
spell
your
name
and
limit
your
comments
to
two
minutes.
Staff
will
be
timing.
A
A
I
know
that
there's
still
a
little
bit
of
a
delay
online,
so
I
would
like
to
give
folks,
maybe
a
30
seconds,
to
a
minute
to
see
if
anyone
has
just
caught
been
able
to
call
in
online.
So
if
the
committee
will
just
be
at
rest
for
a
quick
second,
while
we
allow
people
to
call
in
if
they
would
like.
A
A
I
heard
that
as
no
callers
well,
thank
you
so
much
at
this
time.
I.