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A
Wonderful
good
afternoon,
everyone,
I
will
now
call
to
order
the
assembly
committee
on
health
and
human
services
members
before
we
begin.
Please
turn
on
your
cameras
and
mute
your
microphone
when
you
are
not
speaking
just
to
minimize
some
background
noise,
I'm
mostly
reminding
myself
when
I
tell
everyone
on
the
committee
this,
because
I
still
forget
to
unmute
myself.
A
C
A
A
Here
we
do
have
a
quorum.
I
would
note
that
assemblywoman
benitez
thompson-
if
I
ask
the
secretary
to
please
record
the
member
present
when
she
arrives
and
with
that
we
will
go
ahead
and
get
started.
A
Welcome
to
our
audience
joining
us
on
this
virtual
meeting
today
we
do
have
two
bill
hearings
and
before
we
begin,
I
just
make
several
housekeeping
announcements.
Agenda
items
may
be
taken
in
a
different
order
than
listed.
This
is
a
virtual
meeting
format.
Please,
you
may
members
of
public
may
provide
written
testimony
within
48
hours
of
this
hearing.
A
They
can
also
call
in
on
public
comment
or
during
support,
opposition
and
neutral
of
any
of
the
bills
that
we
are
hearing
and
with
that
we
will
go
ahead
and
just
get
started
today.
We
again,
we
have
two
bill
hearings.
This
afternoon,
I've
allocated
equal
time
for
testimony
and
support
opposition
in
neutral
after
the
bill
has
been
introduced
to
be
specific,
each
person
providing
testimony
will
be
allowed
a
maximum
of
two
minutes.
A
Staff
will
be
timing,
each
member
and
each
speaker
to
ensure
everyone
is
given
a
fair
opportunity
to
speak
and
with
that
we
will
turn
our
sites
on
the
hearing
for
assembly
bill
181.
This
bill
revises
provisions
relating
to
mental
health.
I'm
going
to
turn
this
over
to
our
very
own,
vice
chair,
peters,
to
begin
when
you
are
ready.
D
Thank
you
chairwin
and
committee
members.
Thank
you
for
hearing
ab-181
related
to
mental
health.
Today,
these
there
are
two
parts
to
this
bill
and
they
were
brought
to
me
separately.
The
first
piece
of
the
bill
relates
to
the
collection
of
mental
and
behavioral
health
data
from
hospital
providers,
and
the
second
piece
of
the
bill
is
related
to
mental
health
parity
data
collected
from
insurance
providers.
D
To
be
clear,
the
focus
of
this
bill
is
on
the
people.
The
patients
who
are
in
need
of
the
services
provided
by
both
sides
of
the
equation,
overwhelmingly
data
presented
to
date
regarding
mental
and
behavioral
related
deaths
by
suicide
and
overdose,
have
increased
at
alarming
rates
during
the
covid
pandemic.
D
I
don't
think
there's
a
single
person
in
this
room
who
could
say
that
suicide
is
not
a
concern
in
the
state
of
nevada.
We
have
consistently
been
identified
as
having
some
of
the
highest
rates
of
suicide
among
most
demographics
published,
including
vulnerable
populations
such
as
veterans,
lgbtqia,
teens
and
others.
D
The
data
gap
identified
by
the
division
of
public
and
behavioral
health
exists.
At
the
moment
a
patient
cries
for
help
and
services
are
initially
provided.
This
means
the
moment:
a
patient
exhibits,
suicide,
ideation,
self-harm
or
other
suicide
risk
indicators.
That
is
where
we
need
this
data
data
is
complete.
Sorry
excuse
me.
Data
on
completed
suicide
or
attempted
suicide
show
that
we
are
already
too
late
with
providing
intervention
services.
D
This
bill
proposes
collection
of
data
prior
to
suicide
attempt
and
that
identifies
those
patients,
those
family
and
friends
who
need
help.
Today,
I
have
with
me
here
dr
stephanie
woodard
senior
advisor
on
behavioral
health
with
dhhs,
who
will
briefly
discuss
this
portion
of
the
bill,
and
then
I
will
discuss
the
second
portion.
E
I
am
good
afternoon
and
thank
you
assemblywoman
peters
good
afternoon,
madam
chair
and
members
of
the
committee.
Again,
my
name
is
stephanie
woodard
and
I
am
the
department
of
health
and
human
services
senior
advisor
on
behavioral
health.
I
am
also
joined
by
kyra
morgan
department
of
health
and
human
services,
chief
biostatistician,
who
will
be
available
later
for
questions
I'm
here
to
present
to
you
on
sections
one
through
six
of
assembly,
bill
181,
which
establishes
statutory
authority
for
the
division
of
public
and
behavioral
health
to
require
health
facilities
to
report
suicide.
D
Nationally,
this
is
assemblywoman
peters.
I
apologize,
so
we
have
submitted
a
draft
amendment
conceptual
amendment
regarding
this
piece.
I
would
just
direct
members
on
to
nellis
to
see
that
amendment.
For
me,
it's
under
exhibits,
it's
the
very
first
exhibit
sorry,
dr
woodard.
Please
proceed.
E
Thank
you,
stephanie
woodard
again
for
the
record
nationally,
an
individual
dies
by
suicide,
every
11
minutes
more
than
10
nevadans
die
by
suicide
every
week
and
that's
more
than
one
person
every
day.
According
to
the
cdc
nevada
has
ranked
in
the
top
10
states
for
deaths
by
suicide,
and
while
certainly
progress
has
been
made,
there's
still
a
need
to
do
more
for
several
years,
the
primary
data
source
that
we
have
used
to
develop
our
suicide
prevention
efforts
has
been
fatality
data
as
well
as
hospital
billing
and
claims
data.
E
E
E
Similar
legislation
was
passed
as
the
opioid
crisis
was
surging
and
we
recognized
we
needed
to
gather
more
timely
data
to
detect
changes
in
non-fatal
overdoses
happening
across
the
state
and
in
our
communities.
Using
this
data,
we
have
been
able
to
develop
interventions,
including
mobile
recovery,
outreach
teams
to
support
individuals
following
a
non-fatal
overdose.
E
E
E
D
Thank
you
so
much
dr
woodard
for
the
importance
giving
us
some
background
on
the
importance
of
this
bill.
I
would
now
like
to
go
to
the
second
part
of
this
bill
which
gets
on
another
issue.
We
see
mental
health
coverage.
This
is
related
to
insurance
coverage.
Some
of
the
most
overwhelming
conversations
I
have
had
with
people
are
not
about
their
heart
medication,
access
to
vaccines
or
ability
to
schedule
a
surgery.
It
is
about
access
to
mental
and
behavioral
health
services
that
patients
need.
Today.
D
D
Mental
health,
parity
and
addiction
equity
act
of
2008..
I
really
apologize
for
that
name
butchering.
D
This
act
is
currently
mentioned
in
our
statute.
However,
there
is
a
lack
of
clarity
in
the
health
and
insurance
industry
as
to
what
parity
metrics
are.
What
makes
up
parity
and
consistently.
I
hear
from
constituents
and
patients
that
their
coverage
misses
the
mark,
we're
not
proposing
a
prescription
to
remedy
this
parity
ambiguity
today.
We
are,
however,
requesting
that
the
division
of
insurance
have
the
authority
to
proactively
review
parity
metrics
from
insurance
providers
in
the
state,
including
cabin
medicaid,
to
determine
what
the
baseline
of
parity
is
in
nevada.
D
I
have
heard
from
the
insurance
industry
that
parity
reporting
is
required
by
the
federal
government.
However,
the
federal
government
is
not
the
folks
on
the
ground,
hearing
the
complaints
from
constituents
and
trying
to
assess
and
determine
parity
violations.
That
burden
already
falls
to
the
state,
and
even
then
it
is
not
proactive.
D
These
individuals
have
to
submit
a
complaint
with
supporting
evidence
to
the
insurance
commission
for
review
of
their
case.
This
is
usually
done
when
the
patient
learns
that
the
service
they
are
looking
for
are
not
being
covered
and
not
accessible
with
their
for
their
immediate
needs.
This
bill
requests
that
this
activity
be
completed
proactively
rather
than
on
the
backs
of
the
patients
already
in
need
of
support.
D
Finally,
an
amendment
to
this
bill
will
request
that
the
patient
protection
commission
take
these
two
data
streams
and
use
them
to
assess
and
determine
adequacy
of
coverage
from
both
the
services
and
insurance
sides
for
patients
in
nevada.
Although
this
bill
request,
excuse
me,
I'm
going
a
little
fast
apologize,
although
this
bill
requests
data
directly
from
industry.
This
is
a
patient-centric
bill,
focusing
on
the
two
sides
of
the
sword
representing
the
burden
of
mental
health
care
in
our
state.
D
I
sent
one
out
shortly
before
the
committee,
but
I
don't
believe
it
it
was
accessible
on
nellis
when
we
started,
I
will
send
that
around
and
make
sure
that
gets
sent
around
to
members
so
that
you
can
see
the
conceptual
amendment
that
I've
been
working
on
with
the
division
of
industry
to
create
a
less
prescriptive
nrs
around
this
issue
and
also
to
include
the
patient
protection
commission
directives
to
to
get
this
data
from
these
two
data
streams.
D
I'm
not
going
to
go
directly
or
through
the
sections
of
this
bill,
but
I
do
want
to
notice
that
there
has
been
recent
federal
legislation
related
to
the
reporting
requirements
of
insurance
companies
and
have
been
working
with
the
division
of
insurance
to
ensure
that
our
language
in
this
bill
allows
the
division
of
insurance
to
incorporate
those
federal
requirements.
While
it
was
also
meeting
the
desired
parity
outcomes
proposed
through
adoption
of
this
bill,
the
amendment
will
modify
section
seven
through
nine
to
remove
that
prescriptive
language.
D
D
Thank
you,
assemblywoman
peters,
and
thank
you
chair
for
hearing
this
bill
today.
As
the
assemblywoman
mentioned,
this
bill
does
require
a
more
proactive
approach
to
compliance
with
the
mental
health
parity,
an
addiction
equity
act.
I
think
I
got
all
those
letters
right
from
2018
to
2020
13
other
states
have
passed
legislation,
that's
largely
identical
to
av-181,
requiring
insurers
to
submit
the
analyses
to
state
regulators
showing
their
compliance
with
the
provision
provisions
of
the
federal
parity
act.
D
I
don't
want
to
restate
what
the
assemblywoman
said,
but
I
I
do
want
to
give
a
little
anecdote,
an
on-the-ground
story
of
here
in
nevada,
so
we
know
there's
been
cases
in
the
new
york
times
and
in
national
news
of
big
insurance
companies
who
are
not
compliant
with
federal
parity
law,
but
we
don't
always
hear
about
it
happening
in
our
our
home
state
in
july
of
2019,
an
npa
member
physician,
I'm
so
sorry,
I'm
here
on
behalf
of
the
nevada
psychiatric
association
and
that's
what
npa
stands
for
so
in
july
of
2019,
an
npa
member
physician
noticed
that
the
behavioral
health
summary
of
services
for
a
managed
care
company
included
processes
that
were
applied
more
stringently
than
processes
for
medical
surgical
benefits.
D
D
Thank
you
miss
case,
and
at
this
point
I
would
entertain
questions
as
members
have
them,
and
I
have
leah
sorry
miss
case
on
the
phone,
dr
woodard,
on
the
phone,
and
I
believe
that
commissioner
richardson,
with
the
division
of
insurance,
is
also
available
for
com
questions.
A
Thank
you
vice
peters,
for
that
presentation
on
assembly
bill
181.
I
just
wanted
to
note
for
the
record
that
assemblywoman
benitez
thompson
is
present.
In
fact,
I
think
she
was
able
to
hop
on
right
as
we
were
starting
your
bill
presentation.
So
I
know
she
was
present
there.
I
we,
I
do
have
one
person,
that's
indicated
they
have
a
question
and
that
is
assemblywoman
titus,
so
go
ahead
and
you
can
go
directly
to
the
soup.
F
Thank
you,
madam
chair,
and
thank
you
vice
chair
peters,
for
bringing
this
forward.
I
think
I
think
we
can
all
agree
that
that
suicide
is
an
incredibly
important
issue
that
we
need
to
deal
with
and
and
we've
seen
even
more
of
that
during
this
pandemic.
My
question,
I
have
a
number
of
questions.
Actually,
I
think
the
first
one's
going
to
be
for
dr
woodward
ordered
I'm.
You
talk
about
the
timely
data
collection
and
that's
one
of
my
concerns
about
this.
F
Sometimes
it's
actually
a
corner
is
a
case,
as
you
know,
if
they
die
within
so
many
hours
to
come
to
the
er,
they're,
all
corners
cases,
and
so
some
of
that
information,
there's
there's
a
delay
in
so
what's
a
reasonable
expectation
about
timely
notification.
E
Thank
you
for
the
question
chair
through
you
to
assemblywoman
titus.
It's
a
it's
a
great
question
and
actually
I
think
it's
something
that
we
would
like
to
discuss
during
the
regulatory
development
process.
Currently
the
billing
and
claims
data
that
we
have
would
potentially
provide
this
information
to
us,
but
because
of
the
lag
we're
getting
that
data
90
to
120
days
out,
so
certainly
anything
sooner
than
that
would
be
major
progress.
E
It's
an
incomplete
data
set
because
we
are
only
getting
about
80
of
the
reporting
through
syndromic
surveillance,
but
we
we
intend
to
use
the
syndromic
surveillance
really
for
that
timely
recording
so
that
we
can
have
a
finger
on
the
pulse
of
what's
happening
statewide,
but
when
we
use
syndromic
surveillance,
we
know
that
we
are
sacrificing
accuracy
for
timeliness
just
because
of
the
way
that
that
data
is
pulled
from
the
emer
from
the
ehrs.
E
So
we're
really
looking
for
this
other
data
set
to
be
able
to
really
balance
against
the
syndromic
surveillance
data
set.
So
we
recognize
that
we
may
be
sacrificing
some
of
that
timeliness,
but
we'll
then
be
able
to
get
the
accuracy.
F
Okay,
follow-up
question,
madam
chair,
so
that's
kind
of
a
segue
into
what
my
next
question
was:
was
a
surveillance
set
and
that
data
information
do
all
hospitals
have
access
to
that.
One
of
the
problems
I
see
here,
one
of
the
delays
is
the
amount
of
reporting
that
hospitals
are
required
to
do
and
you're
not
asking
the
provider
to
do
this.
You're
asking
the
medical
facility
to
do
this.
So
I'm
wondering
who
are
the
other
folks
that
are
have
to
report
this
kind
of
kind
of
data.
F
I
think
it's
important
that
you
know
we
have
it
we're
where
mandatory
reporters
providers
are
for
many
different
levels
of
things,
and
I'm
just
wondering
now.
This
is
yet
another
level
of
reporting
that
the
hospitals
already
have
to
do.
They
have
extensive
reporting
that
they
have
to
do.
Are
they
using
the
same
computer
system?
You
mentioned
electronic
medical
records
and
one
of
the
things
is
that
we
know
many
of
these
electronic
medical
records
don't
communicate
with
each
other
and
so
how
what's
a
good?
F
A
Oh
and
before
you
answer
that
dr
woodard
and
the
same
with
assemblywoman
titus,
I
know
that
there
are
so
many
acronyms
and
there's
so
many
like
terms
of
art
that
are
very
specific
to
the
hhs
world.
But
if
we
could
try
some
excuses
to
use
some
of
the
actual
terms.
Just
because
I
know
a
lot
of
our
members
are
trying
to
keep
up
and
learn
really
a
whole
new
language.
Something.
F
So
the
emrs
electronic
medical
records
that
are
all
mandated
to
you
know
we
all
use
electronic
medical
records
and
none
of
them
communicate
or
very
few
do
they.
You
know
communicate
with
each
other.
So
I'm
worried
about
that
process
of
communication,
timely
data.
I
think
the
data
is
important.
I
like
what
you're
trying
to
do.
I
think
it's
critical,
but
I'm
just
worried
about
a
process
here.
E
Stephanie
woodard
for
the
record,
through
you,
chair
to
assemblywoman
titus,
the
hospitals
actually
currently
for
the
overdose
reporting,
have
three
different
pathways
to
be
able
to
report.
The
first
is
probably
the
easiest,
because
it
allows
for
a
data
extraction
to
occur
directly
from
the
electronic
health
record.
This
data
extraction
is
then
placed
in
a
file
which
is
then
sent
to
the
division
of
public
and
behavioral
health.
The
the
other
two
ways.
The
first
is
through
facts.
E
We
recognize
that
not
all
electronic
health
records
have
the
capabilities,
nor
maybe
the
sophistication
to
be
able
to
develop
and
extract
the
data
file.
So
the
the
fax
is
an
option
that
actually
several
hospitals
continue
to
use
for
the
overdose
reporting,
and
then
we've
also
worked
with
clarity
that
focus,
which
is
a
vendor
who
other
hospitals
do
use
to
report
into
the
homeless
management
information
system.
F
Thank
you
and
manchester.
Can
I
have
one
more
question?
Yeah.
That's
fine
go
ahead!
Thank
you.
Thank
you.
This
is
actually
looking
at
the
bill
itself
and
I
did
make
a
copy.
So
thank
you
vice
chair
peters,
for
posting
those
amendments.
So
we
could
look
at
those
and
I
did
download
a
copy
of
the
of
your
proposed
amendment
about
section,
seven
through
nine
and
that
to
remove
the
prescriptive
language
related
to
the
data
collection.
F
F
Believe
me,
it's
very
frustrating
when
we
get
try
to
get
the
prior
authorization
and
they
say
nope,
that's
not
covered
or
no
that's.
No.
They
can't
have
that
you
have
to
do
a
b
and
c
first,
and
so
I
I
understand,
I
think
I
understand
what
you're
trying
to
achieve
here,
but
I'm
wondering
about
do
they
do
is
currently
in
statutes,
and
maybe
legal
can
tell
us,
I'm
not
sure.
Maybe
you
already
know
this:
do
we
have
other
mandatory
descriptions
when
insurance
companies
deny
a
service?
If
we
is
that
listed
anywhere?
F
Would
this
be
a
unique
thing
to
the
mental
health,
as
you
mentioned
parity
and
some
of
these
other
things
I
want
to
know,
are
we
asking
insurance
companies
to
do
something
they
already
do
and
then
add
that
to
their
list
of
reporting
when
they
deny
something
or
are
we
just
looking
at
having
them?
If
they've
denied
a
mental
health
service
and
then
the
part,
the
other
part
of
that
would
be,
they
have
to
do.
F
They
have
to
disclose
that
that
wasn't
part
of
their
original
insurance
contract
anyway,
so
I'm
trying
to
clarify
what
they
would
have
to
report.
Thank.
D
You
for
the
question,
dr
titus,
so
the
language
that
came
out
in
the
original
bill
was
much
more
prescription
prescriptive
than
intended,
and
I
apologize
sarah
peters
for
the
record.
The
in
intention
at
this
time
is
to
get
a
general
baseline
for
what
those
parity
metrics
are
in
existing
insurance
coverage.
D
One
of
the
difficulties
that
we
have
is
is
the
interpretation
of
parity
is
inconsistent
and
we
want
to
see
in
nevada
what
parity
metrics
are
being
met
by
these
individual
insurance
companies
in
order
to
do
to
see
the
picture
that
patients
are
are
in,
such
as
what
you
said,
whether
they're
being
denied
service
because
of
insurance
coverage,
whether
that's,
equitable
or
not,
inconsistent
with
industry
parity.
D
So
the
revisions
to
this
section-
and
I
just
got
the
proposed
revisions
from
the
division
of
insurance-
would
allow
for
the
division
of
insurance
to
promulgate
regulations
requiring
that
data
collection
piece,
but
not
necessarily
create
the
enforcement
mechanisms
that
you're
describing
that
would
be
really
a
blessing
to
this
industry
right.
That's
one
of
the
biggest
complaints
that
I
hear
is.
I
need
the
service
and
I
can't
get
it.
My
insurance
won't
cover
it.
D
It's
too
expensive
on
my
own
or
my
child
has
special
needs,
and
I
need
them
to
be
in
this
facility
rather
than
this
facility,
and
I
can't
get
there
because
I'm
forced
to
go
here.
Those
kinds
of
things
will
come.
I
think,
at
a
later
time,
once
we
have
a
better
idea
of
what
those
those
metrics,
those
parity
metrics,
will
look
like.
F
Great,
thank
you.
Thank
you
for
the
clarity,
thank
you
for
bringing
the
bill
and
thank
you,
madam
chair,
for
all
the
questions.
G
Thank
you,
madam
chairwoman.
My
question
is
on
the
amendment
and
I
guess
for
the
legislative
intent
changing
it
from
generally
chapter
or
49
to
specifically
441.
G
I
guess
I
would
read
it
to
think
that
the
intent
would
be
reporting
on
suicide
attempts
and
suicide
completion
specific
to
opioids,
just
because
it's
in
you
know,
we've
got
it
in
the
infectious
disease
and
and
then
all
the
reporting
on
kind
of
opioids.
And
so
I
guess
I
imagine
that
you're
not
just
looking
for
that,
but
having
it
in
the
communicable
disease.
Part
to
me
kind
of
feels
like
it
would
narrow
it.
I
imagine
you
would
still
want
to
know
about
that.
E
So
stephanie
woodard
for
the
record
and
I'll
ask
kyra
morgan,
also
from
dhhs
to
chime
in,
but
through
you
chair
to
assembly
with
benitez
thompson
441a.
E
Allow
includes
all
communicable
diseases
to
be
reported,
as
well
as
the
overdoses
from
ab474
from
2017.,
and
this
would
then
also
allow
us
to
collect
and
analyze
that
data
as
it
relates
to
suicide.
You
know
it's.
It's
been
an
interesting
journey.
We
went
through
the
same
debate
when
we
put
forward
the
legislation
in
ab474
related
to
the
overdose
reporting
when
it
comes
to
behavioral
health
statutory
authority
to
establish
these
kinds
of
reporting
regulations,
we
don't
have
them,
and
so
we
really
do
have
to
look
to
established
authority
within
the
public.
E
Health
side
and
441a
has
been
the
the
area
of
existing
statute
that
seems
to
fit
best
when
we're
looking
at
collecting
population
health
data
like
this.
H
This
is
kyra
morgan
for
the
record,
if
I
could
also
just
add
on
to
that,
I'm
the
state
biostatistician
for
ghbs
441a
is
also
where
we
have
all
of
our
real-time
reportable
conditions
that
require
individual
follow-up.
So,
by
fixing
the
overdose
regulation
variant
he's
17.
H
The
idea
was
that
those
were
cases
that
potentially
would
require
that
really
quick
follow-up
by
a
disease
investigator,
and
so
we
wanted
to
mirror
the
regulation
for
the
suicide
reporting
to
be
similar
to
overdose
reporting,
so
that,
if
we
wanted
to
have
that
real-time
communication
disease
investigation,
it
would
fall
in
line
with
how
we
do
that
for
communicable.
G
Thank
you
so
much,
and
I
I
believe
that
you
answered
it
mostly
and
dr
titus's
questions,
but
I
just
want
to
make
sure
I
heard
it
right
so
right
now
you're
able
to
extrapolate
the
data,
but
you
have
to
do
it
kind
of
in
an
indirect
way,
and
so
the
goal
is
to
make
sure
that
you're
getting
the
data
much
quicker.
G
E
So
stephanie
littered
again
for
the
record
through
you
chair
to
assemblywoman
benitez
thompson.
We
currently
have
billing
and
claims
data,
so
there
is
a
data
set
that
pulls
all
of
the
emergency
room
and
hospital
billing
claims,
and
that
data
set
typically
has
a
90
to
120
day
lag.
So
as
kyra
morgan
had
mentioned
just
a
moment
ago
that
this
allows
us
to
do
some
of
that
follow-up.
We
would
hope
that
we
would
be
able
to
get
this
data
in
a
much
more
timely
way
than
looking
at.
E
You
know
three
to
four
months
out
exactly
what
that
time
period
is,
would
need
to
be
determined
during
that
regulatory
development
process
and
that's
where
we
would
really
be
engaging
with
stakeholders
to
figure
out
what
would
be
a
reasonable
time
frame
for
us
to
be
able
to
expect
to
get
this
data.
G
All
right
perfect
so
and
then
put
for
the
record
the
clarification,
because
right
now,
if
you're
you're
looking
for
when
a
provider
has
a
known
interaction
with
a
person
and
then
knows
that
person
attempted
or
completed
suicide.
But
but
you
mean
this
to
be
different
than
what
kind
of
cms
and
the
joint
commissions
have
right.
Now
around
sentinel
events
and
those
kinds
of
suicides
right
or
whatever.
E
For
the
record,
yes,
I'm
not
we're
not
seeking
to
find
information
related
to
sentinel
events.
We're
really
looking
to
identify
individuals
who
are
presenting
for
care
in
an
emergency
room
related
to
a
suicide
attempt.
A
Much
okay.
I
have
one
question.
I
know
that,
and
this
is
probably
for
vice
chair
peters.
I
know
that
there
was
an
amendment
that
it
was
initially.
I
don't
think
you
have
the
opportunity
to
fully
review
and
it's
considered
unfriendly
at
this
time
by
mr
clark.
Do
you
have
any
update
on
that.
D
Thank
you,
chair,
sarah
peters,
for
the
record.
I
did
have
an
opportunity
to
talk
to
mr
clark
and
colleagues
earlier
today
and
let
them
know
that
we
were
working
with
the
division
of
insurance
on
an
amendment
to
address
their
concerns
and
we'll
continue
to
work
with
them
as
stakeholders
on
that
process,
to
ensure
that
we
are
preparing
something
that
is
beneficial
to
nevada
and
hopefully
we
can
get
to
a
neutral
place
with
them.
A
Thank
you
for
that
update
and
I
would
encourage
all
of
our
members
to
check
it
looks
like
I'm
looking
at
it
right
now.
All
of
the
conceptual
amendments
that
vice
chair,
peters
referenced
are
now
uploaded
to
nellis
under
exhibits
and
I'm
going
to
before
I
get
to
testimony
in
support
opposition
and
neutral
I'm
going
to
see
if
we
have
any
other
further
questions
here.
Oh
I
see
one
more
from
assemblywoman
danita
thompson
go
ahead.
G
Thank
you
so
much
so
I
do
think
it's
important
to
talk
about
section
7
going
forward,
but
but
I
guess
I
think
it
might
make
the
most
sense
to
wait
until
we
see
what
those
amendments
might
look
like
or
how
it
reads.
So
I'm
assuming
right
now
that
for
me
to
ask
questions
on
section
7
forward
as
it's
written,
would
probably
be
they'd
be
erroneous.
It
makes
the
most
sense
to
wait
to
see
what
kind
of
final
language
we
come
with
right.
D
Thank
you
assemblywoman
for
the
question,
sarah
peters,
for
the
record.
Yes,
we
are
essentially
gutting
those
sections
so
asking
questions
on
the
language,
as
it's
added
as
it's
written
to
today
would
not
be
super
helpful
in
understanding
to
find
the
the
proposed
piece
for
work
session
upcoming
work
section
session
and
if
we
can
get
there,
but
I
will.
I
have
the
division
of
insurances,
a
proposed
amendment
language.
D
It
just
showed
up
in
my
email
box,
so
I'll
have
a
a
chance
to
review
that
and
I'll
send
that
around
to
the
committee
when
it's
ready.
G
And
I
appreciate
that
just
because
I
know
that
there
was
a
conversation
about
this
in
a
separate
committee
last
year,
but
I
didn't
follow
that
conversation
and
so
it's
new
to
me,
and
so
I
I'll
be
interested
to
make
sure
to
see
you
know
kind
of
what
the
conversation
is
and
so
I'll
I'll
look
forward
to
that.
Thank
you.
C
Thank
you.
Chairwind
there's
been
some
discussion
about
various
modes
to
share
this
data.
Has
there
been
any
discussion
about
a
singular
software
or
singular
data
point
a
data,
entry
area
where
the
data
can
be
input,
everybody
uses
it
and
then
it
it
can
be
more
easily
extrapolated.
C
Is
that
part
of
this
discussion
has
there
been
any
discussion
about
that
being
a
maybe
a
private
industry,
because
I
know
we're
strapped
for
money.
That
is
there
a
possibility
that
for
there
to
be
a
private
industry,
software
or
or
portal
that
could
be
shared
across
the
different
providers.
That
would
help
facilitate
this
a
lot
faster.
Thank
you.
D
Thank
you,
simple
woman.
Sarah
peters,
for
the
record,
this
bill
does
not
get
at
that
particular
issue.
You
if
you've
sat
in
at
another
committee
where
I've
presented
data
is
one
of
my
my
big
callings
and
and
trying
to
get
it
fixed
in
the
state
of
nevada.
But
in
this
particular
case
we
haven't
talked
about
that
as
part
of
the
bill
language.
D
Here,
however,
I
do
know
that
the
department
of
health
and
human
services
has
been
working
with
stakeholders,
including
the
hospitals
on
how
to
make
that
data
that
that
line
of
data
go
as
streamlined
as
possible,
so
we're
not
creating
an
overburden
on
one
side
or
the
other
one
of
the
beautiful
pieces
about
creating
a
a
kind
of
raw
database
is
that
you
can
assimilate
that
data
in
a
variety
of
ways,
and
I
believe
that
that's
being
discussed
in
other
areas
and
was
presented
through
the
patient
protection
commission
or
the
interim
health
committee.
D
I
think
as
a
a
database
discussion,
but
that's
not
a
piece
of
what
we're
talking
about
today.
I
don't
know
if
dr
woodard
wants
to
discuss
any
more
about
what
she's
been
working
on
with
stakeholders.
So
I'll
pass
it
on
if
she
would.
E
Sure
stephanie
woodard
for
the
record
and
thank
you
for
the
question.
E
There
are
three
different
ways
that
hospitals
can
currently
report,
and
so
we
don't
have
a
preference
either
way
we
really
want
to
make
it
as
least
burdensome
as
possible,
so
for
those
those
organizations
that
would
prefer
to
use
a
manual
input
database,
we
do
have
a
database
that
we
use
currently
for
the
overdose
reporting
that
is
being
re-engineered
to
be
able
to
collect
all
of
the
data
related
to
av-181,
and
then
providers
could
also
fax
a
report
or
they
can
do
a
data
extract.
E
The
data
extract
seems
to
be
the
least
burdensome
because
it
will
allow
that
data
to
be
pulled
directly
from
their
electronic
health
record
and
then
be
batched
in
a
data
file
that
can
then
be
analyzed
by
dhhs.
E
C
C
I
keep
forgetting
to
say
that
so
I'm
going
to
guess
or
and
make
an
assumption
that
whether
someone
is
reporting
with
the
fax
document,
whether
they
are
using
the
data
extract
or
whether
they
are
using
the
third
option,
the
the
input
that
the
questions,
the
answers,
the
data
is
all
consistent,
no
matter
what
and
that,
when
that
data
goes
in
it's
the
same
and
the
end,
and
then
you
can
extrapolate
that
data
to
get
the
most
accurate
answers
for
yourself
is.
Am
I
right
there.
E
C
Thank
you.
I
really
appreciate
this
information.
Madam
sure,
if
I
may,
I
think
all
of
us
are
really
concerned
about
mental
health
right
now.
It's
it's
come
to
the
fore.
I've
I'm
seeing
more
discussions
about
mental
health
crises,
whether
they
are
deaf,
whether
they
are
connected
with
substance
abuse
or
just
in
general,
in
the
african-american
community
than
I've
ever
seen
before.
C
We
are
seeing
examples
of
folks
seeking
help
in
prime
time
television.
I
don't
know
if
you
all
are
big
fans,
but
I
love
black,
lightning
and
another,
show
all
american
and
and
they're
making
it
normal
and
x
and
okay
for
folks
in
our
community,
which
has
had
such
a
stigma
about
mental
health
issues,
and
it's
important
that
this
data
and
anything
that
we
can
do
to
help
people
you
know
find
a
a
way
to
get.
Help
is
really
really
important,
and
I'm
I'm
really
appreciative
of
this.
C
I
don't
know
what
you
I
don't
know
how
you
speed
up
the
process.
I'm
sure
you
all
are
working
on
that
and
I
hope
that
this
legislation
will
help
you
do
that
and
I'm
looking
forward
to
reading
all
the
amendments-
and
I
appreciate
you
assemblywoman
peters-
for
bringing
this
forward.
Thank
you.
D
D
Who,
who
are
maybe
the
bottlenecks
in
this
area,
the
better
off
our
communities
will
be,
and
I
I
think
it's
I'll.
I
could
go
on
all
day
and
talk
about
it,
but
thank
you
for
for
bringing
those
those
issues
up
as
well.
A
Thank
you,
everyone,
and
with
that
I
will
go
ahead
and
we
will
start
receiving
testimony
in
support
opposition
and
neutral.
Please
remember
to
clearly
state
and
spell
your
name
and
limit
your
testimony
to
two
minutes
on
staff
will
be
timing.
Each
speaker
to
ensure
everyone
was
given
a
fair
opportunity
to
speak,
and
we
will
begin
with
support
testimony
so
staff
from
broadcast
and
production
services.
If
we
can,
please
add
the
first
caller,
I
will
note
it
is
2
16
and
we
are
starting.
B
I
Okay,
okay,
great
for
the
record,
and
and
thank
you
for
presenting
this
bill-
I
am
a
child
and
adolescent
psychiatrist.
I
run
the
training
program
at
unlv
school
of
medicine,
and
I
think
this
whole
bill
has
a
lot
of
positives,
so
I
want
to
speak
briefly
about
the
importance
of
parity,
especially
as
it
pertains
to
the
kids
that
are
really
struggling
in
our
state.
I
A
recent
report
from
the
millman
institute
shows
that
a
children's
mental
health
office
visit
is
10.1
or
a
thousand
percent
times
more
likely
to
be
out
of
network
than
a
primary
care
out
of
office
visit,
which
is
twice
as
much
as
a
mental
health
office
visit
for
an
adult
and,
furthermore,
children's
utilization
of
inpatient
and
outpatient
facilities
are
500,
more
likely
to
face
out-of-network
charges
for
behavioral
health
care
than
medical
or
surgical
care.
Additionally,
spending
for
mental
health
care
has
not
shifted
and
sits
at
only
2.4
percent
of
the
overall
health
care
expense.
I
B
I
This
is
robin
reedy
r
e
e
d,
as
in
dog
y,
I'm,
the
executive
director
of
nami
nevada,
distinguished
members
of
the
committee
on
behalf
of
nami
nevada,
the
state
chapter
of
the
national
alliance
on
mental
illness.
I
would
like
to
offer
our
support
on
the
provision
in
assembly
bill
181
that
addresses
an
issue
of
extraordinary
significance
to
nevada's
parity
of
health
insurance
coverage
for
mental
health
and
substance
use
conditions
because
of
current
parity
challenges.
I
The
disparities
are
glaring
in
2015
individuals
in
nevada,
received
outpatient,
behavioral
health
care
out
of
network
at
a
rate
of
3.21
times
higher
than
primary
care
services
and
3.81
times
higher
than
specialists
for
other
health
conditions
for
individuals
receiving
inpatient,
behavioral
health
care
out
of
network.
The
rate
is
6.05
times
higher
than
for
other
inpatient
services.
I
This
means
that
nevadans
with
mental
illness
can't
access
or
can't
afford
the
care
they
deserve
when
people
with
a
mental
health
condition
cannot
access,
affordable
mental
health
care,
there's
a
steep
personal
cost
that
delays
individuals
being
able
to
get
well,
but
there
are
also
significant
costs
for
the
state
when
nevadans
cannot
get
appropriate
care.
The
state
faces
increased
health
care
and
other
costs
from
higher
numbers
of
individuals
ending
up
in
jail,
emergency
departments
and
on
the
streets
rather
than
getting
the
help
they
need.
I
Nami
nevada
strongly
supports
the
purity
provision
in
ab-181,
which
would
ensure
health
insurance,
compliance
with
state
and
federal
parity
laws,
state
and
federal
law
mandates
that
mental
health
insurance
coverage
cannot
be
treated
any
differently
than
medical
coverage
and
ab181
would
help
to
make
parity
a
reality
for
the
many
individuals
and
families
in
the
state
who
need
access
to
affordable
mental
health
treatment.
The
people
of
nevada
deserve
the
opportunity
to
experience
health
and
productivity
in
support
of
this
goal.
I
A
Thank
you,
miss
reedy.
If
I
can
just
remind
callers
that
are
on
the
line.
Please
limit
your
testimony
to
two
minutes
and
you
always
have
the
opportunity
to
submit
any
written
comments,
including
those
if
you
read
them
during
the
this
comment
time
period
as
well
so
broadcast
services.
If
we
can
go
to
the
next
caller
and
support.
B
J
Good
afternoon
this
is
dan
musgrove
d-a-n-m-u-s-g-r-o-v-e,
as
you
know,
I'm
the
chair
of
the
clark
county,
children's
mental
health
consortium,
and
we
have
the
opportunity
to
testify
in
front
of
this
committee,
and
I
want
to
thank
you
for
your
interest
in
mental
health,
especially
children's
mental
health.
I
want
to
echo
the
comments
of
dr
durrett,
a
former
member
of
our
consortium
and,
as
it
comes
to
parity,
especially
for
children's
mental
health.
J
While
we
haven't
seen
you
know,
we
want
to
see
how
the
amendments
come
out,
anything
that
we
think
that
can
be
done
to
to
understand
what
is
exactly
those
essential
benefits
for
children's
health
care
is
absolutely
necessary
and
we
thank
you
for
your
support.
A
Thank
you
for
that
broadcast
services.
It
looks
like
we
are
ending
at
2,
25
p.m.
If
we
could
go
to
callers
in
opposition
of
assembly
bill
181
at
this
time,.
B
J
Good
afternoon
my
name
is
tom
clark:
that's
t-o-m-c-l-a-r-k,
I'm
testifying
today
on
behalf
of
the
nevada
association
of
health
plans,
as
was
mentioned
earlier
by
ms
peters,
and
I
very
much
appreciate
her
bringing
this
important
legislation
forward,
but
was,
as
mentioned
earlier.
We
have
put
forward
an
amendment
but
based
on
the
conversation,
the
conceptual
amendment
that
miss
peters
has
brought
forward
and
the
dialogue
that's
taking
place
with
the
insurance.
Commissioner.
J
Our
amendment
may
be
moved,
and
so
we
look
forward
to
working
with
the
sponsor
working
with
the
commissioner
and
all
of
the
other
stakeholders
and
figuring
out,
primarily
the
areas
around
section
9..
So
with
that,
madam
chair,
thank
you
for
allowing
me
to
testify.
B
K
K
Our
main
concern
was
that
a
brand
new
federal
law
that
was
passed
in
january
already
requires
all
the
reporting
foreseen
in
this
bill,
and
so
we
were
worried
about
duplication
of
efforts,
but
we
had
a
very
positive
conversation
with
assemblywoman
peters
this
morning
and
we're
dedicated
to
working
with
her
and
the
division
of
insurance
to
craft
a
solution
that
everyone's
satisfied
with,
and
so
we
look
forward
to
seeing
that
bill
with
amendments
and
again
I
want
to
thank
the
sponsor
for
working
with
us
on
this
bill
and
thank
you
for
your
time.
Madam
chair.
B
D
D
I
would
also,
lastly,
but
not
least
lee
like
to
extend
a
thank
you
to
the
division
of
insurance
and
commissioner
commissioner
richardson
for
working
with
me
and
other
stakeholders
on
the
pending
amendment
and
thank
you
committee
for
hearing
this
important
piece
of
legislation.
D
A
Thank
you,
assemblywoman
peters,
for
your
presentation
of
assembly
bill
181.
I
have
no
doubt
that
you
will
continue
to
work
with
stakeholders.
It's
always
encouraging
to
hear
that
type
of
like
friendly
opposition
testimony,
which
obviously
shows
that
you
put
a
lot
of
work
into
this,
and
I
know
that
we've
been
trying
to
work
on
this
type
of
legislation
for
the
better
part
of
at
least
five
years
that
I'm
aware
of
so
with
that
I
will
close
the
hearing
on
assembly
bill,
181
and
also
from
our
very
own
assembly,
health
and
human
services
committee.
L
L
This
bill
is
sponsored
by
the
legislative
committee
on
health
care
which
considered
a
variety
of
public
health
issues
during
the
interim.
While
I
was
not
a
member
of
the
committee,
its
chair,
assemblywoman,
leslie
cohen,
invited
me
to
carry
this
bill
through
session,
and
I
am
honored
to
present
it
before
you.
This
is
a
pretty
simple
bill,
based
on
a
very
important
principle.
L
L
A
M
N
N
Building
a
healthy
community
is
like
constructing
a
sound
home
state
leadership,
oversees
skilled
professionals
who
design
systems,
assemble
resources
and
assess
needs.
We
will
liberate
costly
resources
when
we
equip
providers
to
hire
the
chw
workforce
like
architects,
doctors
and
nurses
should
not
be
tied
up
in
follow
through
when
trained
craftspeople
can
cut
the
tile
or
ensure
that
patients
make
progress
on
their
health.
N
Chws
are
community
members
who
bridge
the
gaps
in
nevada's
healthcare
system
chw's
come
from
rural
and
urban
communities,
so
they
represent
the
diversity
of
our
state.
Nevada
ranks
50th
in
primary
care
providers.
According
to
the
america's
health
ranking
in
2020,
nevada
began
to
address
our
health
professional
shortage
by
creating
chw
training
and
certification
using
community
health
workers
started
20
years
ago
in
texas
and
has
grown
to
include
all
but
three
states
in
nevada.
This
work
has
been
going
on
since
2014
when
the
nevada
division
of
public
and
behavioral
health
piloted
the
program.
N
N
Minority
and
rural
communities
are
underrepresented
in
healthcare,
workforce
education,
the
chw
model,
creates
leaders
in
those
communities
and
provides
opportunities
for
professional
advancement.
Chws
become
social
workers,
nurses
and
doctors,
who
are
more
likely
to
return
to
the
communities
where
they
grew
up.
N
M
Thank
you
jay
good
afternoon
sherwin
and
members
of
the
committee,
I'm
steve
messenger
policy
director
for
the
nevada,
primary
care
association
committee.
It's
great
to
see
you
all
again
and
thank
you
for
the
opportunity
to
present
ab191.
M
This
is
a
short
bill,
so
I
will
be
short
section.
One
of
this
bill
requires
the
director
to
include
in
the
state
plan
for
medicaid
the
services
of
a
community
health
worker
who
provides
services
under
the
supervision
of
a
physician,
physician
assistant
or
advanced
practice
registered
nurse
section.
Two
of
this
bill
makes
a
conforming
change
to
indicate
that
the
provisions
of
section
one
will
be
administered
in
the
same
manner
as
the
provisions
of
existing
law
governing
the
state
plan
for
medicaid.
M
M
Two
is
a
trained
provider
of
health
care
to
provide
certain
services
which
do
not
require
the
community
health
worker
to
be
licensed
and
three
provide
services
at
the
direction
of
a
facility
for
the
dependent
medical
facility
or
provider
of
health
care,
which
they
include
without
limitation
outreach
and
coordination
of
health
care.
Thank
you
for
considering
this
bill.
I'm
happy
to
take
any
questions
on
the
bill
specifics
now
or
after
the
final
presenters
at
the
discretion
of
the
chair.
A
M
Okay,
thank
you
chair
and
oren
liquor.
We
do
have
one
more
speaker
and
then
I
have
one
more
slide.
Where
I'll
tell
you
how
health
community
health
workers
are
working
in
federally
qualified
health,
centers.
H
H
Our
organization
is
proud
to
participate
in
the
strong
start
initiative
working
to
create
a
statewide
plan
to
connect
pregnant
moms
families
and
children
to
service
providers
that
support
and
enhance
quality,
child
care,
education
and
obstetric
and
pediatric
care.
Community
health
workers
are
an
essential
part
of
the
strong
start
plan
next
slide.
H
Please,
the
strong
start
initiative
is
championed
by
a
coalition
of
over
25
stakeholder
groups,
including
clinicians,
local
and
state
governmental
institutions,
non-profits
and
parents.
Together,
we
have
developed
a
plan
that
relies
upon
chws
to
connect
some
of
our
most
vulnerable
and
underserved
residents
to
vital
services
and
care.
H
Our
collaborative
agrees
that
community
health
workers
are
the
key
to
strengthening,
supports
and
ultimately,
families
in
nevada
next
slide.
Please
vhws
meet
with
families
in
culturally
competent
and
convenient
ways
in
places
like
their
child
care,
centers
schools
or
own
homes
to
provide
education
on
services
and
resources.
H
M
Thank
you,
dr
bungarner,
so
my
association
represents
the
federally
qualified
health
centers
in
the
state,
steve
messenger,
nevada,
primary
care
association
for
the
record.
M
We've
used
community
health
workers
in
various
ways
over
the
past
years,
mostly
again,
because
these
aren't
reimbursed
services
through
grant
programs,
so
one
program
in
particular
was
funded
through
the
department
of
the
public
and
the
division
of
public
and
behavioral
health.
Excuse
me
and
that
went
to
ensure
that
colorectal
cancer
screening
rates
were
improved
in
community
health.
Centers.
M
That
grant
went
to
to
fund
a
position.
Who
would
you
know
a
person
to
call
up
these
folks
and
and
remind
them
and
encourage
them
to
take
these
cancer
screenings
and
those
services
if
this
bill
were
to
pass,
would
now
be
medicaid
reimbursable.
So
we
like
to
think
partially
of
you
know
all
the
money
that
we've
spent
on
grant
funded
community
health
workers
over
the
years.
M
How
much
further
those
grant
dollars
could
have
gone
with
a
program
this
bill
envisions.
So,
in
addition
to
those
colorectal
cancer
screening
chws,
we
also
have
diabetes
educators.
We
have
asthma
risk
evaluation
going
into
the
home
and
evaluating
you
know
what
might
trigger
asthma
and
educate
those
patients
on
how
to
clean
that
up.
M
We
have
cultural
and
linguistic
interpretation,
so
sometimes
community
health
workers
are
actually
visiting
a
provider
with
their
clients
in
order
to
make
sure
that
that
that
care
is
delivered.
You
know
not
only
in
the
language
that
that
person
speaks,
but
in
a
way
that
they
can
understand
this
past
year,
with
the
rapid
expansion
of
telehealth,
we've
found
a
lot
of
our
patients.
M
Don't
have
the
ability
to
to
access
technology
or
they
may
have
the
technology,
but
they
don't
have
the
skills
to
access
it
and
so
sending
a
community
health
worker
is
a
very
efficient
way
to
get
them
connected
to
their
provider,
remotely
where
that's
appropriate,
and
then
our
association
also
has
a
lot
of
family
planning.
We
have
two
grants:
a
teen,
pregnancy
prevention
and
a
title,
10
family
planning
grant,
and
so
we
find
community
health
workers
very
effective
for
engaging
those
populations.
M
O
Good
afternoon,
madam
chair
and
committee,
my
name
is
dwayne
young
and
I
am
deputy
administrator
for
the
division
of
health
care
financing
and
policy.
We
are
grateful
to
assemblyman
linker
for
providing
us
the
opportunity
to
speak
today
on
behalf
of
the
division,
as
this
bill
directly
impacts
medicaid.
O
This
is
a
medical
model
program,
and
so
my
colleagues
have
done
an
excellent
job
of
explaining
how
that
works
in
a
chronic
disease
model.
But
it
goes
without
saying
that
this
is
definitely
a
needed
service
within
the
state.
O
We've
had
these
conversations
many
years
at
the
legislature
and
this
year
the
division
was
able
to
take
some
of
those
return
on
investment
studies,
as
well
as
other
academic
articles
and
apply
that
to
a
conservative
estimate
of
savings,
and
so
there
is
not
a
fiscal
note,
in
fact,
a
projected
savings
that
we
receive,
and
I
think
it
goes
without
saying
during
the
covet
19
pandemic,
that
having
these
types
of
services
for
those
community
health
workers
and
agencies
and
family
qualified
health
centers
that
had
grants
to
use
them
have
found
them
invaluable
to
the
efforts
of
helping
to
protect
nevadans.
A
A
Well,
thank
you
and
thank
you
assemblyman
or
liquor.
I
know
that
you
were
able
to
step
in
and
present
this,
and
I
know
that
you
did
not
do
the
work
during
the
interim,
but
we
appreciate
you
stepping
up,
and
I
know
this
was.
I
believe
your
first
bill
presentation
is
that
correct
so
make
sure
everyone
asks
lots
of
questions
because
I
think
he's
ready
for
it
with.
H
A
A
Sometimes
those
are
some
of
the
best
things,
because
we're
able
to
do
a
without
getting
into
all
of
these
legislative
terminology
a
deeper
dive
into
some
of
these
issues
during
the
interim
committee
during
that
18
months
between
sessions,
and
so
this
is
one
of
those
bills
and
I'm
asking
committee
staff
again
to
send
out
some
of
those
links.
H
Thank
you
very
much
chairwin.
I
had
a
quick
question
more
of
a
clarifying
question.
If
someone
could
explain
more
of
the
differences
between
a
community
health
worker
versus
a
medical
assistant
and
those
responsibilities
and
duties
that
those
two
professionals
would
perform
versus
other
members
of
a
medical.
H
O
So
this
is
doing
young.
I
will
start
from
a
medicaid
billing
perspective
and
then
perhaps
jay
can
provide
some
additional
information
in
terms
of
model
from
a
medical
billing
perspective
model.
Medical
assistants
are
not
enrolled
separately.
They
facilitate
the
appointment
through
assisting
the
doctor
with
those
medical
issues.
O
The
community
health
workers
job
is
really
to
promotion
of
education,
training,
outlink
outreach
and
linkage,
and
so,
and
it's
also
very
different
from
what
we
would
have
through
targeted
case
management
as
that's
a
different
service
as
well
as
peer-to-peer
counseling.
I
know
this
assembly
has
heard
we'll
hear
bills
that
are
moving
through
the
senate
that
deal
with
peer-to-peer
services
and
so
they're.
I
just
want
to
highlight
they're
different
from
those
services
as
well.
O
H
Great
thank
you
very
much
for
the
clarification.
They
are
very
distinctive
roles
and
used
for
very
different
responsibilities
and
they're
both
very
important.
So
I
appreciate
you
clarifying
that
on
the
record.
F
It's
monday,
assemblyman
or
liquor.
I
have
to
give
you
an
a
plus
for
probably
one
of
the
best
presentations
I've
seen
on
a
bill,
especially
since
you
didn't
own
this
bill
to
start
with
and
how
organized
you
were,
and
all
the
members
that
presented
with
you.
So
thank
you
for
a
well
done
presentation.
F
My
question
is
in
regards
to
the
billing
process,
and
it
really
is
just
a
start
of
the
section
one
number
one:
we
certainly
the
the
people
you've
identified
that
can
order
a
community
health
worker
to
see
a
patient.
I
appreciate
that
you've
included
the
pas
nurse
practitioners
and
and
physicians
because
multiple
sessions,
I've
introduced
bills
to
make
sure
the
language
is
all
inclusive
of
the
provider.
So
you've
taken
care
of
that.
My
question
revolves
around
the
billing
process.
Will
they
all?
F
Is
it
a
national
standard
now
that
everyone,
community
health
workers
are
assigned
an
mpi
number
and
for
those
who
don't
know
that
at
terminology,
it's
a
national
provider,
identifier
standard
that
we
all
have
to
have
in
order
to
build,
and
I'm
wondering
if
that
process
has
already
happened
or
would
the
billing
be
conceptually
under
the
pa,
the
nurse
practitioner
or
the
physicians?
Would
it
be
a
separate
code?
Are
they
you're
looking
at
them
all
getting
mpi
numbers.
O
Deputy
administrator
dwayne
young
from
dhcfp
for
the
record
assembly
minority
leader
titus.
Thank
you
for
the
question.
O
I
think
you
know
you
were
part
of
these
discussions
in
other
sessions
where
we
really
had
discussed
them
billing
under
the
the
position,
the
pa
or
the
aprn,
since
we've
matured
and
our
philosophy
and
our
approach
to
this,
and
we
are
looking
to
actually
have
them
enroll
separately,
and
this
be
a
new
provider
type
under
their
own
mpi
and
part
of
the
reasoning
for
that
is
because
they
will
be
utilized
in
some
of
our
cost-based
providers,
such
as
rural
health
clinics
and
fairly
qualified
health
centers.
F
Great
I'm
happy
to
hear
that
because
I
think
that's
absolutely
what
what
needs
to
have
happened.
So
thank
you
for,
for
or
at
least
clarifying
that
thank
you
and
thank
you,
madam
a
chair
for
the
question.
That's
my
only
one.
I
have.
A
I'm
just
giving
you
a
hard
time.
I
don't
have
anyone
else
in
the
queue,
but
is
there
anyone
else?
That
has
any
questions
if
you
want
to
just
wave.
I've
got
this
on
here.
A
Oh,
it
looks
like
we
are
good
to
go
so
broadcast
services.
If
we
can
go
to
our
callers
in
support
and
I'll
remind
callers
again
that
please
limp
clearly
state
your
name
and
sell
your
name
for
the
record
limit
your
testimony
to
two
minutes
again,
if
you
are
not
able
to
get
through
everything
in
two
minutes
or
you
would
like
your
written
testimony
incorporated
into
the
record
of
assembly
bill
191.
A
I
would
encourage
you
to
provide
that
to
our
committee
staff
and
we
will
make
sure
that
it
gets
uploaded
and
distributed
to
the
committee.
Members
staff
will
be
timing.
Each
member
to
ensure
everyone
is
given
a
fair
opportunity
to
speak
and
again
we
will
start
with
testimony
in
support
of
assembly
bill
191
and
it
is
252,
I'm
going
to
say
253
when
we
start
thank.
B
B
B
I
H
During
normal
circumstances,
saint
rose
has
chws
out
in
communities
and
where
they're
needed
most
giving
classes
and
events
in
both
english
and
spanish
on
a
number
of
important
public
health
topics
and
diseases
going
directly
to
these
populations
and
helping
them
where
they
are
is
such
an
important
part
of
health
equity
during
the
pandemic.
We've
been
doing
a
lot
of
this
virtually,
but
we're
really
looking
forward
to
getting
back
to
our
full
schedule
once
we're
closer
to
herd
immunity.
B
H
Hello,
thank
you
for
the
opportunity
to
speak
today.
My
name
is
hailey
dobbs
for
the
record
h-I-l-e-y-d-o-b-s,
I'm
a
graduate
student
studying
public
health
and
a
member
of
the
rural
nevada
health
network,
as
both
a
student
and
future
health
care
professional.
I
support
this
bill.
Expanding
access
to
community
health
workers
through
medicaid
reimbursement,
community
health
workers
are
trusted
culturally
competent,
cost-effective
trained
and
certified
professionals
who
work
in
a
variety
of
settings
under
different
titles,
in
schools,
as
resource
coordinators,
in
health
centers
as
care
coordinators
or
in
treatment,
centers
food
banks
and
tribal
health
centers.
H
Not
only
could
the
passion
passage
of
this
bill
improve
the
health
of
rural
nevadans
and
all
nevadans
and
minimize
costs
incurred,
but
it
could
also
support
job
growth
as
medical
centers
that
are
already
built,
billing
medicaid
would
be
able
to
hire
community
health
workers.
While
change
is
difficult,
it
is
critical
to
improve
outcomes
and
reduce
cost.
Thank
you
to
everyone
who
has
worked
towards
developing
bdr449
ab191.
B
J
A
good
afternoon
for
the
record,
this
is
eric,
shone
e-r-I-k
last
name
shown
s-c-h-o-e-n.
Thank
you,
madam
chair
and
other
members
of
the
assembly
health
and
human
services
committee
I
have
written.
I
have
submitted
a
letter
of
enthusiastic
support
for
ab191
as
the
executive
director
of
a
nonprofit
agency
that
has
provided
complementary
health
and
human
services
across
many
rural
nevada
counties.
For
the
past
30
years.
I
have
seen
firsthand
the
immense
benefit
that
can
come
from
new
lines
and
community
health
workers
who
are
from
the
communities
that
they
are
serving.
J
Our
resilient
eight
coalition,
a
demonstration
project,
that's
been
federally
funded
more
than
two
years
has
utilized
community
health
workers
as
a
primary
service
delivery
strategy
across
eight
rural
nevada
counties.
They
have
been
able
to
work
with
inmates
in
at
least
two
counties
to
develop
robust
release,
plans
and
linkages
to
needed
services,
provide
dozens
of
trainings
on
the
uses
of
naloxone,
taking
the
lead
on
developing
strategic
plans
for
each
of
the
counties
to
develop
into
the
health
and
human
service
capacity
and
more
as
well.
J
Consider
expanding
the
pool
of
acceptable
supervisors
for
chws
to
include
other
professions
that
are
already
that
already
make
it
a
practice
to
provide
continuous
supervision,
including
psychologists,
school
psychologists,
clinical
professional
counselors,
marriage
and
family
therapists
and
licensed
clinical
drug
and
alcohol
counselors.
This
will
help
to
support
chws
being
able
to
work
in
a
variety
of
non-traditional
settings
such
as
schools,
non-profit
health
and
human
services
providers,
and
more
thank
you
for
taking
the
time
to
hear
my
thoughts
and
thank
you
for
your
support
of
ab191.
A
B
I
And
chair,
my
name
is
noelle
shanae
and
that
is
called
n-o-e-l
last
name
c-h-o-u-n-e-t,
I'm
calling
in
in
support
of
ab191.
I
am
a
community
health
worker
working
out
in
silver
springs,
nevada
and
I've
seen
first
hand
the
positive
effects
that
community
health
workers
can
have
on
our
community
members.
I'm.
I
I
I
B
J
K
Schools
of
nevada
is
the
fifth
largest
state
office
of
the
nation's
leading
evidence-based
dropout
prevention
organization,
and
we
operate
in
the
clark
elko
humboldt
and
washoe
county
school
district.
We've
submitted
a
letter
of
support
to
the
committee
and
would
just
like
to
highlight
three
reasons
why
the
organization
is
supporting
assembly
bill
191
first
assembly
bill
191
will
expand
reimbursement
of
services
provided
by
community
health
workers,
and
that
will
enable
a
larger
workforce
of
support
for
students
and
families
in
need.
K
And
finally,
health
care
and
social
emotional
support
have
a
direct
nexus
to
academic
achievement
and
are
a
critical
part
of
a
child's
holistic
development
and
more
community
health
workers
being
able
to
provide
service
and
bridge
to
care
for
these
families
will
have
an
impact
on
school
improvement
and
academic
success.
Again,
we've
submitted
a
letter
of
support
for
the
record
that
further
elaborates
why
our
organization
does
support
assembly
bill
191,
and
I
would
be
happy
to
answer
any
questions
that
members
of
the
committee
have
at
this
time.
Thank
you.
B
K
K
When
we
work
with
community
health
workers,
the
first
competency
of
a
community
health
worker
is
individual
connection
with
the
communities
that
they
serve.
This
requires
that
they
are
sourced
from
the
communities
they're
going
to
serve
and
are
acutely
aware
of
the
resources
that
are
available
and
accessible
in
those
communities.
K
Most
often
community
health
workers
are
addressing
issues
of
justice
in
health
care,
access
and
and
equity,
and
they
also
are
critical
to
improving
and
addressing
social
determinants
of
health
and
are
perfect
adjuncts
to
a
clinical
team
for
a
holistic
method
of
care.
Dr
andrew
taylor,
still
the
founder
of
osteopath
osteopathy,
said
defined.
Health
should
be
the
object
of
the
doctor.
Anyone
can
find
disease
and
it's
this
competency
and
connection
to
the
community
that
gives
cuny
health
workers
a
boost
in
their
ability
to
help
patients
become
advocates
for
their
own
health
and
ultimately
realize
good
outcomes.
K
B
I
I
am
currently
a
community
health
worker
instructor
for
the
college
of
southern
nevada,
but
I
am
here
speaking
on
behalf
of
my
own
company
minority
health
consultants,
where
I
too
hire
community
health
workers.
Community
health
workers
are
the
bridge
to
social
determinants
of
health
to
bridging
those
gaps
in
our
communities.
Governor
sislek
has
declared
racism
as
a
public
health
issue,
how
we
can
utilize
community
health
workers
with
this
issue,
is
by
helping
by
hiring
and
supporting
and
paying
community
health
workers,
people
that
come
from
the
actual
communities
that
are
experiencing
these
disparities.
I
People
who
have
the
cultural
competence
of
these
disparities,
people
who
have
the
cultural
competence
of
their
culture
of
their
race,
of
their
people,
who
can
speak
directly
to
health
issues
and
health
disparities
in
our
state.
I've
been
teaching
community
health
work
for
the
past
three
years,
and
so
I'm
super
excited
to
hear
about
this
bill
coming
forth.
I
would
really
appreciate
if
everyone
can
get
on
board
with
supporting
community
health
workers.
I
They
there
are
lots
of
people
on
these
calls
that
have
that
are
in
other
states
who
have
been
doing
this
work
for
a
lot
a
lot
more
time
than
we
have
20
30
years,
and
they
have
given
advice
on
how
we
can
use
community
health
work
and
how
we
can
get
them
paid
through
medicaid
reimbursement.
So
I
am
available
to
anyone
who
may
need
that
information
after
this
call.
Thank
you.
A
A
Thank
you,
and
with
that
I
will
close
testimony
and
support
on
ab
191.
It
is
306
and
if
we
can
go
to
callers
in
opposition
of
the
bill.
B
I'm
sorry
chair
somebody
raised
their
hand
right
when
you
said
we
were
closing
it
and
then
hung
up.
So
if
they
call
back,
we
might
have
somebody
in
support
again.
A
B
B
A
Thank
you
and
with
that
I
will
go
to
the
bill
presenter
assemblyman
ornlicker.
If
you
have
any
closing
remarks.
L
Thank
you,
madam
chair
david
oren
liquor
for
the
record
from
assembly
district
20..
I
want
to
thank
the
legislative
committee
for
all
their
hard
work
and
producing
this
excellent
bill
and
to
my
co-presenters
for
providing
excellent
testimony.
I'll
just
conclude
by
saying
that
we
often
think
that
to
improve
health
quality,
we
have
to
spend
more.
Sometimes
we
can
get
better
quality
at
lower
cost,
and
this
is
one
of
the
important
examples
of
that.
So
I
appreciate
your
consideration
and
I
hope
we
can
move
this
bill
forward.
A
A
We
did
this
last
week
and
I
realized,
after
the
fact
that
I
could
introduce
them
all
at
once,
and
we
could
do
one
vote,
so
I
will
do
that
at
this
time.
Like
I
said,
I
just
received
them
actually
this
morning,
so
I'm
glad
that
we're
able
to
get
them
on
the
calendar
right
away.
A
Please
note
again
that
voting
in
favor
of
introducing
the
bill
draft
request
from
these
interim
committees
does
not
imply
a
commitment
to
support
the
measure
later.
This
action
just
allows
the
bbr
to
become
a
bill,
and
then
it
will
be
referred
to
the
committee
for
possible
hearings
after
introduction
on
the
floor
today
we
have
two
bdrs
for
introduction.
They
are
bdr
38-385,
which
requires
medicaid
to
cover
certain
services
for
persons
with
cognitive
impairments.
A
Additionally,
we
have
bdr40-454,
which
requires
training
for
unlicensed
caregivers
at
certain
facilities.
Do
I
have
a
motion
to
introduce
both
bdr
38-385
and
bdr-40-454
removed,
and
I
believe
that
was
assemblywoman
titus
and
I
saw
a
second
there
I
believe
from
assemblywoman
gorlo.
Is
that
correct,
yes,
sure,
perfect,
and
with
that,
do
we
have
any
discussion
on
this?
D
M
K
D
C
A
Yes,
and
without
the
motion
carries
at
this
time,
we
will
begin
public
comment
as
a
reminder
to
provide
public
comment.
You
must
register
online
at
their
legislative
website.
You
will
please
remember,
to
clearly
state
and
spell
your
name
and
limit
your
comments
to
two
minutes.
Staff
will
be
timing.
Each
speaker
during
public
comment
to
ensure
everyone
is
given
a
fair
opportunity
to
speak
staff
in
our
broadcast
services.
A
Thank
you
broadcast
services.
I
appreciate
that
update.
Are
there
any
comments,
but
from
members
before
we
adjourn
today,
okay,
seeing
none?
This
concludes
our
meeting
for
today
we
will
not
have
a
meeting
this
friday.
Instead,
our
next
meeting
will
be
on
wednesday
march
10th
at
1,
30
pm
and
meeting
at
the
turn.