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A
Good
afternoon
everyone
and
welcome
to
the
assembly
committee
on
health
and
human
services,
I
will
remind
our
members
to
please
mute
your
microphone
when
you
are
not
speaking
and
try
to
remember
to
unmute
it
when
you
do
want
to
speak.
Also,
please
leave
your
camera
on,
so
we
can
make
sure
that
we
are
maintaining
a
quorum.
Madam
secretary,
will
you
please
call
the
role.
A
C
A
Additionally,
I
see
assemblywoman
black-
I
didn't
hear
her
say
yes
or
no,
but
once
she
arrives
and
turns
on
her
monitor
if
we
can
mark
her
present
as
well.
Thank
you
to
everyone
in
our
audience
joining
us
on
this
virtual
hearing
this
afternoon.
We
have
two
bills
today
and
I
am
just
going
to
get
right
into
it.
A
E
E
I
am
joined
by
officials
from
the
aging
and
disability
services
division
and
a
member
of
the
nevada
commission
on
aging,
we'll
provide
technical
information
on
the
bill
and
discuss
a
friendly
amendment
offered
by
the
division
assembly.
Bill
216
was
recommended
to
the
legislative
committee
on
senior
citizens,
veterans
and
adults
with
special
needs
during
the
2019
to
2020
interim
session.
The
bill
mandates
that
the
state
plan
for
medicaid
include
coverage
for
cognitive
assessments
and
care
planning
services
provided
to
persons
with
symptoms
of
cognitive
impairment.
E
Believe
it
or
not.
Alzheimer's
disease
is
the
single
most
expensive
disease
in
the
united
states,
outpacing.
The
cost
of
cancer
and
heart
disease
analysis
by
the
alzheimer's
association
calculated
that
the
direct
cost
posed
to
caregivers
totaled
305
billion
dollars
in
2020
alone.
They
also
estimated
that
medicare
and
medicaid
covered
67
percent
of
the
total
cost.
E
E
In
fact,
the
milken
institute
released
a
report
showing
that
early
diagnosis
in
the
mild
cognitive
impairment
stage
could
create
cost
savings
as
much
as
7.9
trillion
and
u.s
health
and
long-term
care
expenditures
by
enabling
better
planning
management
and
care.
The
centers
for
medicaid
and
medicare
services
cover
cognitive
evaluation
and
care
planning
for
medicare
recipients
in
2018.
E
The
cms
added
current
procedural
code
99483
to
pay
physicians
an
average
of
242
dollars
to
perform
early
intervention
treatments.
Unfortunately,
medicaid
does
not
offer
the
same
coverage.
Ab216
seeks
to
provide
these
life-saving
services
to
medicaid
recipients
by
funding
assessments
and
care
planning.
We
can
get
ahead
of
cognitive
decline
to
ensure
those
suffering
and
their
caregivers
can
manage.
E
The
devastating
effects
of
cognitive
impairment
as
introduced
ab216
would
require
the
state
plan
for
medicaid
to
cover
the
non-federal
share
for
cognitive
assessment
and
care
planning
services
for
persons
with
cognitive
impairment,
symptoms
for
families
with
members
who
have
alzheimer's.
This
bill
will
ensure
support.
Services
are
in
place.
E
This
type
of
advanced
care
planning
can
prevent
acute
hospitalizations,
which
can
be
traumatic,
traumatic
for
individuals
and
their
families,
as
well
as
generate
unnecessary
expenses
to
the
health
care
system.
I
will
now
hand
it
over
to
aging
disability
services
division
to
discuss
the
need
further
and
present
their.
F
F
The
amendment
is
pretty
minor
in
section
one
number
one
just
replaces
the
words
who
exhibits
with
experiencing
the
the
change
just
ensures
language
would
not
preclude
anybody
who
was
self-reporting
from
receiving
this
particular
service
in
section.
One
number:
two
changes
in
this
section
are
just
meant
to
align
the
definition
of
cognitive
impairment
with
medical
terminologies,
and
so
that
is
removing
d
judgment,
as
it
relates
to
safety
awareness
and
also,
in
section
two
add
ore
between
areas
of
deficiencies,
to
clarify
that
someone
could
have
any
one
or
all
of
these
deficiencies.
G
Good
afternoon,
chairman
ewan
and
members
of
the
committee,
my
name
is
mary
liberati,
I'm
a
retired
social
worker,
and
I
serve
on
the
nevada
commission
on
aging
services,
but
actually
sorry,
it's
the
nevada
commission.
On
aging.
I
also
sit
on
these
the
asso,
the
alzheimer's
association
board
of
northern
california,
northern
nevada.
But
today
I
will
only
be
speaking
on
behalf
of
the
nevada
commission
on
aging,
as
you've
already
heard,
it's
vitally
important
that
people
have
access
to
early
detection
and
care
planning.
G
So
I
wanted
to
just
hit
a
few
high
notes
that
you
may
know
already.
But
if
you
don't
for
the
record,
dementia
is
not
just
a
disease
for
older
people
and
seniors,
it's
normally
associated
with
those
over
65,
but
the
alzheimer's
association
estimates
that
five
percent
of
those
with
dementia
are
younger
onset
formed
and
that
currently
there
are
approximately
200
000
people
across
the
united
states
that
have
the
younger
onset
form.
G
So
how
prevalent
is
cognitive
decline
in
nevadans
under
65?
Well,
according
to
a
2015
survey
conducted
by
the
nevada
department
of
health
and
human
services,
it
showed
that
sixteen
percent,
or
one
in
six
nevadans
aged
45
to
64,
reported
worsening
confusion
or
memory
loss.
That's
we
call
that
subjective
cognitive
decline
or
scd.
G
My
own
personal
experience
is
that
my
father,
one
night
believed
there
were
intruders
in
his
home.
He
called
the
police,
the
police
showed
up,
and
then
he
didn't
believe
that
they
were
the
police.
So
we
had
to
have
a
trusted.
Neighbor
come
over
and
convince
my
father
that
it
really
was
the
police,
as
it
turned
out.
Of
course,
there
was
no
intruder
in
the
house.
G
However,
I
got
called
that
evening
and
I
immediately
called
a
friend
of
mine
with
the
alzheimer's
association,
and
she
said
he
said
mary.
Dementia
does
not
come
on.
Suddenly
it's
a
gradual
process
in
most
cases
for
alzheimer's
disease,
although
some
dementias
may
have
a
more
a
more
quick
progression,
so
she
said
mary
you've
got
to
get
your
dad
to
the
doctor.
We
got
my
dad
to
the
doctor.
The
doctor
ran
some
tests
and
he
found
out
that
my
dad
had
a
urinary
tract
infection
that
was
causing
his
confusion.
G
So
as
soon
as
he
was
able
to
get
the
medicine
and
to
get
hydrated
again,
he
was
able
to
the
confusion,
went
away.
So
it's
so
important
that
we
know
that,
because
sometimes
dementia
confusion
appears
to
be
dimension.
It
may
not
be
early.
Inaccurate
diagnosis
can
also
give
the
patient
and
the
family
more
time
to
make
important
decisions
about
financial
and
legal
issues.
G
In
addition,
it
also
allows
individuals
to
apply
for
disability
insurance
and
supplemental
security
income
benefits
from
the
social
security
administration
and
of
vital
importance.
It
allows
individuals
across
the
country
to
access
critical
clinical
trials
that
we
know.
Research
is
the
only
thing
that
we're
going
to
find
the
only
thing
that
will
help
us
find
a
cure
for
this
terrible
disease.
G
G
With
this
code,
clinicians
have
the
time
to
do
thorough
evaluations
of
the
patient's
cognition
and
also
to
provide
a
comprehensive
set
of
care
planning
services
to
people
with
cognitive
decline
and
their
caregivers.
This
billing
code
was
added
to
medicare
and
tricare
programs
in
2018,
as
assemblywoman
gorlo
had
also
already
mentioned.
G
We
have
other
states
are
using
this
code.
There
are
16
other
states,
medicaid
programs
that
are
currently
using
that
code
in
their
states.
As
we
said,
it's
so
important
that
this
could
prevent
future
cost.
It
could
provide
future
cost
savings
and
prevent
high
cost
in
medicaid
and
our
other
health
care
services.
G
The
social
security
administration
has
added
younger
onset
alzheimer's
to
the
list
of
conditions
under
the
compassionate
allowance
initiative,
which
means
that
that
gives
this.
Those
with
this
disease
expedited
access
to
not
only
social
disability,
insurance,
ssdi,
but
also
supplemental
security
income
ssi.
G
This
can
lead
to
significant
cost
savings
for
nevada
medicaid.
After
a
two-year
waiting
period,
individual
individuals
on
ssi
can
become
eligible
for
medicare,
and
this
shifts
medical
costs
from
nevada
medicaid
to
the
fully
federal
pun,
funded
medicare
program,
and
we
believe
that
that
will
lead
to
savings
in
nevada
in
future
biennial.
G
E
A
E
C
H
Thank
you,
chairwayne.
Thank
you,
assemblywoman
golo,
and
thank
you
to
the
committee.
My
name
is
nikki
ruba.
I
am
the
regional
director
with
the
alzheimer's
association
here
in
northern
nevada
and
on
behalf
of
the
49
000
nevadans
over
the
age
of
65,
who
are
already
living
with
alzheimer's
disease.
We
thank
you
all
so
much
for
your
time
here
today
for
your
consideration
of
ab216.
H
The
vast
majority
of
nevadans
impacted
today
are
women
and
a
disproportionate
number
of
people
of
color.
I
would
like
to
share
some
findings
from
the
current
alzheimer's
association,
facts
and
figures
report
and
outline
the
importance
of
diagnosing
younger
onset
alzheimer's
disease,
as
well
as
the
value
of
care
planning
and
the
ways
we
envisage.
This
legislation
will
help
bring
about
cost
savings.
H
We
know
there
is
a
modest
financial
cost
associated
with
this
request.
However,
according
to
the
genworth
cost
of
care
survey
of
2019,
the
average
cost
for
a
one-year
stay
in
a
memory
care
setting
in
nevada
is
estimated
at
51
000
and
the
cost
for
nursing
home
claims.
Placement
for
the
same
period
of
time
is
estimated
at
127
000.
H
If
detailed
care
plans
can
take
place
at
the
appropriate
time,
we
know
we
can
help.
Individuals
remain
in
their
homes,
avoid
unnecessary
trips
to
the
er,
reduce
hospital
stays
and
delay
institutional
placement,
thereby
avoiding
additional
costs.
The
already
heavily
burdened
healthcare
and
medicaid
systems
of.
I
H
The
valdens,
with
alzheimer's,
made
83
300
visits
in
2018
and
the
hospital
readmission
rate
for
people
with
dementia
25.8
one
out
of
four
end
up
right
back
in
the
hospital,
but
prior
to
discussing
care
planning.
I
would
like
to
address
the
need
to
diagnose
alzheimer's
and
other
events
for
in
individuals
under
the
age
of
65..
H
As
mary
said
nationwide
about
200
000
people
know
they
are
living
with
younger
onset
disease.
Many
of
them
are
in
their
40s
and
50s.
They
have
families,
careers
or
even
caregivers
themselves.
Since
physicians
generally,
don't
look
for
alzheimer's
disease
in
younger
people.
Getting
inaccurate
diagnosis
can
be
a
long
and
frustrating
process
ruling
out.
Other
conditions
is
important,
as
is
connecting
individuals
with
clinical
trials
and
possible
treatments
that
might
help
ease
symptoms,
improve
quality
of
life
and
save
other
healthcare
costs.
H
H
Those
plans
can
include
making
connections
to
services
such
as
those
offered
by
the
alzheimer's
association
workshops
and
education
classes,
support
groups,
early
stage,
engagement
programs
and,
of
course,
access
to
respite
care.
If
care
planning
can
happen
early
on,
we
can
also
anticipate
a
decrease
in
costs
further
along
in
the
disease
process.
H
H
We
sometimes
hear
from
people
who
are
living
with
alzheimer's
or
other
dementia,
but
they
are
much
more
than
their
diagnosis.
We're
urged
to
look
beyond
the
label
to
see
the
vital
vibrant
human
being
they
still
are.
If
we
can
empower
people
with
younger
onset
make
decisions
about
their
own
future
care
needs,
including
their
legal
and
financial
plans.
Early
on
in
the
process,
then
we
could
also
help
preserve
their
autonomy
and
relieve
a
great
deal
of
stress
all
around.
H
H
A
Assemblywoman
garlow:
do
you
have
any
other
presenters
this
morning
or
this
afternoon.
E
I
think
we
have
one
more
that's
going
to
speak
on
their
personal
story.
Okay,.
A
A
B
Name,
handy,
I'm
amy,
moore
peterson
from
boulder
city
nevada,
and
thank
you
for
your
time.
Consideration
to.
As
you
listen
to
my
story,
I
want
to
introduce
you
to
my
husband
rue
when
he
celebrated
his
47th
birthday.
He
was
living
the
dream
as
a
737
pilot
for
a
major
airline.
B
Excuse
me
with
a
degree
in
engineering
he
owned,
restored
and
maintained
a
collection
of
vintage
airplanes.
He
was
an
accomplished
woodworker.
He
was
an
avid
reader.
In
short,
he
was
brilliant
one
month
after
his
47th
birthday
drew
would
surrender
his
pilot's
license,
knowing
he
could
no
longer
fly
due
to
the
cognitive
decline
he
was
experiencing.
B
I
continued
teaching
for
another
three
years,
but
I
never
knew
what
I
would
come
home
to
would
it
be
dr
jekyll
or
mr
hyde.
The
mood
swings
were
increasing
and
depression
was
setting
in
and
he
was
very
good
at
compensating
and
hiding
his
condition,
and
I
knew
that
alzheimer's
ran
into
his
family,
but
I
never
imagined
it
would
present
itself
in
such
a
young,
healthy
man.
B
B
He
had
alzheimer's
disease,
they
referred
to
it
as
apoe-4,
which
is
a
rarer
form
of
alzheimer's
that
presents
itself
in
younger
aged
onset
and
also
in
familial
cases.
He
was
only
50
years
old.
Now.
I
might
note
really
quickly
that
drew's
mother
was
one
of
eight
children
who
five
of
whom
developed
dementia
in
their
lifetime.
B
B
Now,
after
the
diagnosis
of
alzheimer's,
it
was
a
flurry
of
getting
the
family
trust
in
order
getting
powers
of
attorney
in
place.
Financial
considerations
for
a
man
who
could
no
longer
work
even
at
the
most
menial
job,
and
I
was
unable
to
return
to
the
classroom
because
now
I
was
a
full-time
caregiver
drew,
was
forced
to
take
a
medical
retirement
18
years
before
his
planned
retirement
at
65..
B
He
was
47
when
he
retired,
fortunately,
a
friend
suggested
ssi
and
it
did
take
a
neurologist
diagnosis
in
writing
and
numerous
psych
tests,
but
he
was
ssi
was
finally
approved,
and
then
he
became
eligible
for
medicare.
That
was
about
a
four-year
process,
drew
eventually
developed
blood
clots,
both
pulmonary
and
dvt,
and
was
becoming
a
wanderer
and
a
fall
risk
and
as
a
caregiver
I
was
sleeping
one
eye
open.
At
all
times.
I
had
cracked
two
of
my
molars.
B
I
was
experiencing
atrial
fibrillation,
so
the
last
18
months
that
drew's
life
were
spent
in
a
very
nice
clean,
safe
group
home.
B
B
So
now
what
everything
happens
for
a
reason-
and
I've
been
fortunate
enough
to
volunteer
for
the
alzheimer's
association
in
the
desert
southwest
chapter
for
about
five
years
now
doing
educational
presentations
and
facilitating
caregiver
support
groups.
I
do
one
at
the
boulder
city
senior
center
and
one
at
the
southern
nevada
veterans
home
and
that's
in
addition
to
a
bi-weekly
grief
group.
My
story
is
not
unique.
The
caregivers
that
I
work
with
repeatedly
share
similar
stories.
B
B
A
A
And
I
will
note
for
the
record
that
assemblywoman
black
is
present,
as
is
assemblywoman
benitez
thompson.
I
know
she
is
having
some
issues
with
her
camera
right
now
so,
but
I
see
that
she
is
present
and
with
that
I
will
go
to
our
first
question
with
us
hold
on
one
second
assemblywoman
peters,.
J
Thank
you
so
much
chair
and
thank
you
for
your
stories
and
for
expressing
the
importance
of
providing
services
for
people
who
either
suffer
from
dementia
or
their
caregivers.
I
have
a
kind
of
two
questions.
I
suppose
the
first
one
is
I'm
hoping
relatively
quick
and
ties
into
the
second
one.
My
first
question
is
how
how
many
other
states
have
adopted
similar
coverage
under
medicaid
and
what
existing
coverage
under
medicaid
is
there?
J
I
think
he
went
a
little
bit
through
some
of
the
existing
coverage,
which
is
like
the
farther
down
the
the
track
of
the
of
the
illness.
But
can
you
just
discuss
that
a
little
bit
more.
E
Thank
you
for
the
question
vice
chair
leaders,
I'm
going
to
have
to
ask
aging
and
disability
if
they
happen
to
know
how
many
other
states
have
this.
If
not,
we
can
get
you
that
in
information,
dana.
F
Schmidt
for
the
record,
so
currently
the
assessment
that
is
allowable
under
medicare
indicates
we
have
an
indication
there's
about
16
other
states
that
medicaid
covers
this.
A
F
So
as
far
as
the
planning-
and
we
have
representatives
from
the
medicaid
division
on
on
the
call
with
us
to
answer
those
specific
questions
in
case,
there
are
because
I'm
not
familiar
with
the
current
services
that
are
covered.
I
know
we
don't
have
currently
covered
this
one,
but
something
similar.
Perhaps
we
could
defer
to
our
medicaid
folks
for
some
help.
A
Oh
who's,
going
to
pop
up.
First,
do
we
have
mr
young.
K
Good
afternoon
sure
gwen
and
committee
dwayne,
young
deputy
administrator
for
the
record
with
me
today,
is
aaron
lynch,
my
chief
over
medical
programs.
This
cpt
code,
as
far
as
I
know,
is
fairly
unique,
and
so
there
are
medical
assessment
codes
that
would
fall
under
the
evaluation
and
management
of
an
office
visit.
But
this
this
cpt
code,
as
I
understand
it,
and
encapsulates
not
only
the
assessment
but
also
the
care
planning
and
is
fairly
unique,
and
so
there
wouldn't
be
anything
comparable
other
than
just
the
assessment
codes.
J
D
Thank
you,
madam
chair,
and
thank
you
assemblywoman
garlow,
for
bringing
this
bill
forward.
D
I
am
super
appreciative
of
it
because
my
mom
before
she
passed,
was
diagnosed
with
dementia
and
just
knowing
before
the
onset,
because
she
had
a
stroke
and-
and
I
believe
that
that
brought
it
on
which
was
amazing
to
all
of
us,
her
her
six
children,
because
you
know
there
were
occasions
that
she
couldn't
remember
subjects
that
if
we
were
talking
with
her,
she
couldn't
remember
names.
D
Of
course
you
know
she
would
go
down
the
list
and
then
finally
would
say
when
she
was
calling
one
of
us
well,
you
know
who
I'm
I'm
I'm
referring
to
so,
but
we
would
just
take
it.
As
you
know,
no
big
issue
and
when
the
onset
of
the
dementia
came
about,
I
started
asking
questions
how
many
of
her
siblings
she
was.
D
One
of
ten
children,
and
just
about
seven
of
them
had
this
terrible
disease
of
memory
loss,
and
I
wanted
to
know
my
question.
Actually.
Are
the
findings
related
to
hereditary?
E
Thank
you,
assemblywoman,
thomas
to
you
through
chairwin.
Yes,
we
do
know
that
it
does
run
in
families.
However,
I
am
going
to
call
my
friends
at
alzheimer's
and
they'll
be
able
to
give
you
some
additional
information
on
causes
of
alzheimer's.
H
A
H
This
is
nikki
roberts
from
the
alzheimer's
association.
Yes,
there
is
a
significant
proportion
of
people
living
with
alzheimer's
disease,
who
have
a
hereditary
or
a
genetic
predisposition
to
develop
the
disease.
That
apoe14-
and
that
you
have
had
mentioned
here
today
is-
is
one
of
those
genes
that
might
predispose
people
to
developing
the
disease.
Copies
of
that.
However,
much
of
the
research
now
is
currently
around
identifying
risk
factors
that
might
be
modifiable
that
might
reduce
people's
risks
of
developing
detention.
H
All
of
those
that
we
know
healthy
heart,
leading
to
a
healthy
brain
such
as
good
cardiovascular,
health,
a
healthy
diet,
good
sleep
and
plenty
of
exercise.
Those
are
all
factors
that
might
be
modified
and
that
might
maya
might
be
modifiable
and
might
reduce
someone's
risk
of
developing
the
disease.
So
those
are
factors
to
consider.
L
Thank
you
manager
and
someone
woman
gorilla.
Thank
you
for
bringing
this
bill
forward,
you're
doing
a
great
job
for
the
health
of
atoms.
So
I
appreciate
you
sponsoring
this
bill.
L
I
have
a
couple
questions
one
and
specifically
to
the
to
the
bill
itself,
and
then
I
have
another
one
if
it's
okay
with
the
chair
on
section
one
that
was
clarified-
and
I
understand
the
amendment
and
and
the
changes-
and
I
looked
at
that-
I
just
have
a
question
on
the
definition
of
short-term
or
and
or
long-term
memory,
loss
or
orientation
to
person
place
and
time.
I've
done
little
thousands
of
mental
health
assessments
on
folks,
especially
in
the
er.
L
Some
folks
are
impaired,
they're
impaired
because
they
have
alcohol
board
or
maybe
perhaps
a
drug
on
board,
perhaps
post-concussion
syndrome
where
they've
hit
their
head
and
they
need
to
be
evaluated.
For
that
and
those
are
questions
that
I'll
ask
them
and
they
don't
pass,
and
so
I
I'm
just
wondering,
is
there
a
time
specific
limit
on
this
is
because
it
that
can
resolve?
Maybe
it
can
resolve
in
a
month
a
day,
48
hours.
L
They
have
to
do
these
testing
sometimes
to
participate
in
sports
again
after
a
concussion
somebody
sobers
up
and
they
know
exactly
who
they
are.
They
may
not
know
initially
or
where
they
are,
they
probably
always
oriented
to
person,
but
maybe
not
the
time
or
place
where
they
are,
and
so
I'm
just.
I
just
need
some
clarification
because
I
don't
see
it
here
and
I
don't
know
if
it's
defined,
although
we're
in
statute,
I
don't
understand
what
you're
trying
to
get
to,
but
there
are
other
cases
where
they
fall
under
that.
E
Thank
you,
assemblywoman
titus,
to
you
through
chairwin,
and
thank
you
for
that
question.
You're
right.
There
are
a
lot
of
other
conditions
that
can
also
show
some
memory
lapse.
So
I
think
I
would
need
to
talk
to
legal
and
get
their
clarification
on
that.
A
Unfortunately,
we
don't
have
legal
on
the
line
because
they're
busy
trying
to
draft
all
of
our
remaining
builder
after
class.
However,
I
would
encourage
you
to
reach
out
to
legal,
and
I
know
we
have
our
policy
analyst
on
here,
patrick,
so
I'm
sure
he
can
also
kind
of
take
some
notes
and
see
if
we
can
get
that
message
out
as
well.
L
L
I
was
wondering
if
medicaid,
maybe
mr
young,
if
you
have
and
or
if
you
don't
have,
it
could
get
back
to
us-
the
number
of
folks
that
we
have
on
medicaid
in
an
extended
facility
now
with
the
diagnosis
of
mental
impairment
or
cognitive
impairment,
because
we
have
certainly
I've
taken
care
of
folks
under
my
where
I'm
was
where
I
was
the
director
of
long-term
care
and
they
were
there
because
they
had
they
qualified
for
medicaid
and
they
had
some
significant
mental
impairments.
L
K
Wayne
young
deputy
administrator
for
medicaid
for
the
record
chair
gwen
through
you
to
assemblywoman
titus.
We
do
not.
Currently
I
do
not
currently
have
that
information.
I
will
get
back.
I
will
let
you
know
that
our
fiscal
impact
was
we
looked
at.
There
was
a
data
provided
to
us
about.
Eight
percent
of
nevadans
are
roughly
in
this
cognitive
decline.
However,
we
looked
at
an
age
range
of
55
to
64
year
olds.
K
K
So
we
can
look
at
the
numbers
of
of
those
who
actually
in
our
facilities
and
if
you
would
so
like,
we
could
look
at
what
that
would
do
in
terms
of
the
relation
of
the
fiscal
note
for
those
individuals
if
they
were
caught
earlier
or
the
length
of
time
that
they've
spent
in
our
facility.
L
Right
and
thank
you
for
that-
I
know
this
is
a
policy
committee
and
I
really
like
the
policy.
I
just
feel
we
need
to
clarify
who
we're
going
to
be
covering
and
then,
of
course,
when
it
gets
into
the
money
committees
we'll
we'll
need
those
numbers.
So
that
would
be
very
helpful.
Mr
young
and
I
thank
you,
madam
chair
and
again
thank
you,
assemblyman
gurlo,
for
bringing
it
forward,
and
I
want
to
also
acknowledge
all
those
who
have
reached
out
to
me
on
their
personal
stories
and
the
ones
who
testified
today.
A
A
I
will
ask
broadcast
services
to
get
ready
to
take
testimony
in
support
of
assembly
bill
216..
I
would
just
like
to
remind
everyone
to
please
clearly
state
and
spell
your
name
and
limit
your
testimony
to
two
minutes.
We
will
be
timing
each
speaker.
I
know
that
we
have
quite
a
few
people
on
the
line
to
testify
in
support
of
assembly
bill
216..
A
So
I
would
encourage
you
if
there's
no
problems
with
saying.
Yes,
me
too.
I
agree.
I
support
this
submitting
your
statement
if
it's
longer
or
your
story
or
your
experience
in
writing.
I
know
that
all
the
members
of
this
committee
are
very
diligent
and
do
review
and
read
all
of
those.
So
I
would
just
do
that
and
with
that
we
will
begin
testimony
in
support
of
assembly
build
216
broadcast
services.
Can
we
have
our
first
caller.
M
N
C
N
The
director
of
government
relations
for
aarp,
nevada,
aarp
has
public
policy
that
says
we
support
interventions
aimed
at
preventing
or
reducing
cognitive
decline.
Think
about
that
preventing
or
reducing
cognitive
decline.
You've
heard
from
all
the
other
speakers
so
far
about
the
costs,
the
numbers,
the
people,
the
planning,
the
services,
all
that
kind
of
stuff
in
the
assessments
and
that's
all
great.
What
I
want
to
talk
about
is
the
humanity
of
this.
The
human
impact
many
many
many
years
ago.
N
We
all
have
known
people
that
have
had
other
diseases
that
took
them
too
early
and
the
question
is
not
only
for
the
person
involved,
but
for
the
family
members
and
the
caregivers.
What
would
you
give
to
have
one
more
good
day?
One
more
good
time,
one
more
good
day
with
your
family
member,
think
about
that
and
with
this
bill,
let's
talk
about
what
it
does
prevent
or
reducing
cognitive
decline.
N
What
if
you
could
get
three
months
more
good
time
more
good
days,
what
if
you
get
six
months
or
a
year
or
two
years,
more
good
days
or
good
time
with
your
loved
one?
What's
that
worth
and
and
what
would
you
do
for
that
so
aarp
on
behalf
of
our
345
000
members
across
the
state
strongly
support
this
bill,
which
will
help
people
get
intervention
at
preventing
or
reducing
cognitive
decline
to
give
not
only
the
person
but
their
family
members
more
good
days.
Thank
you
very.
M
C
Hello,
my
name
is
marlene
lockhart
l-o-c-k-a-r-d,
representing
the
retired
public
employees
of
nevada,
and
we
support
greatly
support
ab216
today
and
the
testimony
given
by
the
bill
sponsor
and
the
other
presenters,
and
we
think
this
is
a
very
important
legislation
and
urge
your
favorable
consideration.
Thank
you.
M
J
The
goal
is
to
avoid
guardianship
where
possible
and
assessment
and
care
planning
play
a
role
in
that
cognitive
assessments
are
often
required
to
assess
whether
a
client
no
longer
needs
a
guardian,
but
often
doctors
will
not
perform
these
assessments
because
medicaid
doesn't
pay
for
them.
I'll
share
a
quick
example
from
an
attorney
at
the
legal
aid
center
of
southern
nevada.
J
This
attorney
had
a
client
who
had
been
under
guardianship
since
2008..
Eventually,
this
client
wanted
to
challenge
that
guardianship
using
his
own
funds.
He
obtained
a
new
physician
certificate
from
the
same
primary
care
doctor
that
had
originally
diagnosed
him,
indicating
that
there
was
now
no
longer
a
need
for
the
guardianship,
but
despite
that
position,
certificate
being
enough
evidence
to
place
the
client
in
guardianship
in
the
first
place,
it
was
not
enough
to
have
that
guardianship
terminated
and
the
court
required
a
new
cognitive
evaluation.
J
So
this
client
was
required
to
pay
for
this
new
evaluation
out
of
his
already
dwindling
funds,
and
typically
these
assessments
range
from
two
thousand
to
forty
eight
hundred
dollars.
So
ab216
would
help
guardianship
clients
like
this,
who
are
required
to
use
their
already
limited
funds
to
obtain
cognitive
evaluation
when
attempting
to
terminate
a
guardianship.
Thank
you.
M
A
J
K
A
K
A
K
Chair
gwen
and
committee
again
dwayne
young,
deputy
administrator
for
the
division,
healthcare
financing
and
policy
with
me
today
in
support
is
aaron
lynch
chief
of
medical
programs.
So
many
of
this
was
addressed
earlier.
So
I
will
just
summarize
that
this
is
adding
one
cp2
code,
that
is
the
assessment
and
the
care
planning.
It
would
be
added
to
physicians,
advanced
practicing,
registered
nurses
and
physician
assistants
anytime,
that
we
add
a
cpt
code
or
service.
There
is
a
fiscal
note.
K
K
E
Thank
you
chairwin
for
the
record
assemblyman
michelle
gorlow.
I
want
to
thank
everybody
who
presented
today
and
shared
their
story.
As
was
mentioned,
we
all
have
family
and
friends
who
have
had
dementia
or
alzheimer's.
As
a
member
of
the
interim
committee
on
senior
citizens,
veterans
and
adults
with
special
needs.
I'm
glad
to
see
this
measure
is
being
heard.
It's
critical
that
persons
with
cognitive
impairment,
symptoms
and
their
families
access
health
services
as
soon
as
possible.
E
Ab216
delivers
much
needed
support
to
medicaid
recipients
with
a
life-changing
disease.
I
would
like
to
take
a
moment
and
make
a
shameless
plug
that
for
the
last
four
years
I
have
walked
at
the
alzheimer's
walk
and
it
will
be
again
in
october
for
those
who
would
like
to
join
me
or
start
their
own
team,
and
I
urge
everyone
to
support
8216.
A
Thank
you,
assemblywoman
gorlo.
Thank
you
to
the
presenters
that
took
time
to
share
their
stories.
I
know
often
they
are
personal,
but
that
is
what
we
are
here
to
hear
and
I
think
it
is
very
effective
and
impactful
on
the
decisions
that
we're
making
in
this
committee.
So
with
that,
I
will
close
the
hearing
on
assembly
bill
216
and
I
will
open
the
hearing
on
assembly
bill
217,
which
requires
training
for
unlicensed
caregivers
at
certain
facilities
and
welcome
back
assemblywoman
cohen,
I'm
sure
she's
going
to
get
sick
of
us.
A
We
know
that
she
did
a
lot
of
work
during
the
interim
on
a
lot
of
these
health
care,
related
policies
and
issues.
So
welcome
back
and
begin
when
you
are
ready.
O
These
individuals
provide
a
range
of
services
from
helping
with
medication
administration
to
assisting
with
activities
of
daily
living
like
helping
with
bathing
lifting
people,
eating,
helping
helping
people
eat
and
beyond.
The
key
is
that
they
are
unlicensed
so,
for
instance,
we're
not
talking
about
nurses
or
certified
nursing
assistants,
dietitian
or
registered
physical
therapists
or
again
other
people
who
are
licensed
ab130.
O
The
8131
study
built
off
of
a
2017-2018
study
by
the
legislative
committee
on
seniors
citizens,
veterans
and
adults
with
special
needs
which
considered
many
of
the
same
issues.
It
found
that
some
of
the
biggest
issues
that
could
be
could
be
resolved
with
training
related
to
sterilization
procedures,
sanitation
infection
control
and
appropriate
care
and
treatment.
O
Two
breaches
in
isolation
of
infections
of
covet
19
and
three
hand,
hygiene
and
hand
washing
both
the
2017
to
2018
study
and
the
cova
19
pandemic,
emphasized
the
need
for
additional
and
reinforced
training
on
standard
infection,
prevention
and
control
and
the
proper
use
of
personal
protective
equipment.
Among
other
issues,
based
on
this
and
other
supporting
information,
the
committee's
final
recommendation
was
developed
with
input
from
officials
from
the
division
of
public
and
behavioral
health
or
dpbh,
which
is
responsible
for
regulating
these
facilities.
O
We
ultimately
decided
that
the
best
way
to
ensure
unlicensed
caregivers
receive
appropriate
training
is
to
have
the
state
board
of
health
adopt
regulations
prescribing
these
requirements.
This
will
allow
training
requirements
to
be
more
flexible
and
nimble
than
if
they
were
established
in
legislation.
O
So,
let's
go
through
what
ab217
does
it
requires
the
state
board
of
health
to
adopt
regulations
prescribing
mandatory
training
for
unlicensed
caregivers,
who
provide
care
at
certain
medical
facilities,
facilities
for
the
dependent
and
facilities
for
license
facilities
licensed
under
nrs
449.030.
O
O
Sections
2
through
18
of
the
bill
make
conforming
changes
and
section
19
provides
that,
while
the
bill
is
effective
upon
passage
and
approval
for
the
purposes
of
adopting
regulations
and
performing
other
administrative
tasks,
the
requirements
with
which
the
facilities
must
comply
are
not
effective.
Until
january.
1St
2022.
O
with
us
is
margot
chapel,
the
deputy
administrator
regula
regulatory
and
planning
services,
the
division
of
public
and
behavioral
health,
and
before
we
take
questions
madam
chair,
if
it's
all
right
with
you,
I'd
like
to
have
a
deputy
administrator
chapel
provide
her
testimony
for
the
committee.
I
I
That
449.0303
available
for
free
or
minimal
cost
from
a
nationally
recognized
organization
that
provides
evidence-based
training
while
reviewing
statements
of
deficiency.
During
the
pandemic,
we
saw
ancillary
staff
such
as
kitchen
staff
and
those
cleaning
who
didn't
appear
to
understand
the
importance
of
wearing
a
mask
or
keeping
contaminated
cleaning
cloths,
for
example,
separated
from
clean
ones,
although
these
are
required,
trainings
and
statutes,
or
I'm
sorry
excuse
me,
although
there
are
required
trainings
in
statutes
and
regulations
for
unlicensed
caregivers,
depending
on
the
types
of
services
they're.
I
Providing
the
covid19
pandemic
revealed
a
lack
of
knowledge
in
infection
control
and
prevention
by
unlicensed
caregivers.
Therefore,
infection,
control
and
prevention
training
would
be
the
focus
in
the
development
of
the
initial
regulations.
So
that's
what
the
bill
is
trying
to
accomplish.
The
topics
will
then
be
reviewed
annually
and
revised
as
necessary
to
address
new
issues
that
impact
the
health
and
safety
at
designated
facilities
annually.
I
Requiring
evidence-based
training
will
help
ensure
that
the
information
provided
in
the
trainings
will
be
effective.
For
example,
evidence-based
infection
control
and
prevention
measures
have
been
shown
to
prevent
and
control
the
spread
of
the
disease,
and
I
will
just
mention
that
the
centers
for
disease
control
have
developed
some
really
good
ones
during
the
pandemic.
I
One
of
the
concerns
expressed
by
the
industry
when
requiring
trainings
is
the
associated
cost
and
so
we'll
work
to
alleviate
that
concern,
and
we
believe
that
the
way
the
bill
is
written
does
that,
in
addition,
by
utilizing
trainings
from
nationally
recognized
organizations
that
provide
evidence-based
practice,
practices
such
as
the
centers
for
disease
control
and
prevention,
it
allows
individuals
to
access
training
online,
making
it
much
more
easily
accessible.
This
concludes
my
testimony
and
I'm
happy
to
answer
any
questions.
Thank
you
for
the
opportunity
again.
A
Thank
you,
miss
chapel
and,
I
believe,
do
we
have
any
additional
presenters,
assemblywoman
cohen.
O
L
L
L
My
question
resolves
around.
I
just
need
some
clarification
that
the
penalties
and
fines
for
not
doing
this
under
sec
on
the
under
this
chapter
on
and
looking
at
the
bill
under
section
two
num,
I'm
sorry
section,
three
number,
four,
those
penalties
are
actually
already
in
existence,
so
this
isn't
a
new
penalty
or
any
new
fees.
It's
just.
These
are
already
penalties
for
not
falling
through
in
this
workplace
place
safety,
and
I
just
want
that
clarification
on
the
record.
L
All
right
great,
thank
you
and
that's
really
my
only
question
and
thank
you
for
bringing
this
bill
forward.
As
I
said
on
that
committee
also,
and
it
was
a
notable
void
that
we
have
and-
and
I
like
the
wording
that
it's
open
enough
as
things
change
in
infectious
disease
healthcare
world,
we
can
change
with
them
and
it
doesn't
always
require
a
new
statute.
So
so
thank
you
for
that
and
thank
you,
madam
chair,
for
the
question.
P
Thank
you,
madam
chair.
Thank
you
assemblywoman
cohen,
for
bringing
this
forward.
I
just
am
a
little
confused
and
not
confused,
but
I'm
just
trying
to
make
a
connection.
P
So
when
I
don't
work
in
the
healthcare
field,
but
I
know
that
where
I
do
work,
there's
required
osha
training
already
that
talks
about
cleanliness,
disease
control,
how
to
deal
with
separating
clean
and
dirty
articles
once
when
someone's
cleaning
a
bathroom
or
a
public
facility,
can
you
tell
me
how
this
is
different
from
osha
training
and
and
why
it's
different?
I
Marco
chapel,
for
the
record,
it
is
different
in
terms
of
that
we
actually
they
might
take
the
same
training
if
it's
from
the
same
source.
However,
osha
doesn't
necessarily
go
into
our
facilities,
we
regulate
them
a
hundred
percent
and
unless
we
have
a
specific
issue
related
to
something
that
osha
manages
or
oversees,
then
we
send
them
a
complaint
as
well,
but
generally
speaking,
we're
responsible
as
the
regulating
agency
for
all
of
that
in
those
health
care
facilities.
Please
let
me
know
if
that
doesn't
answer
your
question.
P
You,
madam
chair
follow-up,
please
go
ahead,
assemblywoman!
Thank
you.
My
next
question
would
be
the
cost
of
training.
You
said
free
or
very
inexpensive
training
is
available.
P
How
do
you
control
that
and
the
second
part
of
that
would
be:
why
isn't
this
expanded
to
those
who
go
into
people's
homes
as
home,
health
care
workers
and
my
question
about
cost
and
that
being
the
responsibility
of
the
employee
would
also
be
the
same?
How
do
you
control
and
ensure
that
these
employees,
who
generally
are
not
making
that
much
money,
don't
end
up
having
to
absorb
costs?
Thank
you
very
much.
I
Thank
you,
margo
chapel
again
for
the
record,
through
you
chairwin
to
assemblywoman
armstrong,
so
there
are
separate
regulations
that
govern
training
requirements
for
personal
care
agency
staff
and
home
health
care
staff
that
you're
talking
about.
We
actually
have
cited
a
couple
of
personal
care
agencies
who
are
not
providing
the
training
at
no
cost
to
their
staff.
So
that's
addressed
in
regulation
already
and
we
can
certainly
when
we
go
to
develop
regulations.
We
can
add
something
like
that
into
this
into
the
regulation
as
well.
P
Madam
chair,
may
I
the
other
portion.
The
first
part
of
the
question
was
regarding
those
who
might
be
subcontractors
at
these
care
facilities.
Howard.
Is
there
any
way
to
make
sure
that
they're
not
having
to
absorb
that
cost?
Thank
you.
I
Again,
margo
chapel
for
the
record.
We
can
add
that
into
the
regulations
when
we
start
drafting
them.
Thank
you.
A
Thank
you,
and
I
have
a
question:
is
it
my
understanding
in
reading
this
that
the
facilities
that
would
be
covered
or
subject
to
this
as
anything
licensed
by
the
state
division?
Is
that
correct
margot.
A
Q
Thank
you
so
much
sorry,
I'm
moving
a
little
bit
slow
today,
but
I
appreciate
thank
you
so
much,
I'm
moving
a
little
bit
slow
today
and
clicking
through
the
screens.
I
did
want
to
clarify
that
last
piece,
because
I
think
when
I
want
to
make
sure
so
when
I
look
at
the
bill,
the
4
4,
I
think
specifically,
it's
4
4,
0,
2
9
3
through
442428
are
the
licensing
facilities
that
we're
talking
about
right.
So
that's
typically.
Q
Oh
gosh,
I
was
just
pulling
up
the
statute
to
look
at
it,
but
I
I
I
think
there
was
a
distinction
between
the
ones
licensed
for
the
state
and
I
saw
in
their
like
supportive
living
arrangements.
I
think
any
of
your
hospices
are
in
there.
Q
I
Q
A
An
assembly
one
vanity
thompson.
I
can
also
have
our
legal
follow-up
with
that.
Just
to
confirm
that
those
are
the
people
that
are
located
in.
If
you
need
me.
Q
I
appreciate
that
I
just
want
to
make
sure,
because
sometimes
when
we
talk
about
defined
medical
facilities,
it
can
be
different
than
than
than
what
we
think
about.
I
think
there's
only
two
carve
outs
in
the
medical
facilities.
I
can't
remember
specifically
what
they
were,
but
I
think
generally
they
cover
like.
We
might
not
necessarily
think
of
halfway
houses
as
a
licensed
medical
facility
or
transitional
living
as
a
licensed
medical
facility.
I
just
want
to
make
sure
that
if
the
statute
covers
all
of
that,
so
that
was
the
in
the
intent
as
well
perfect.
A
Thank
you.
Do
we
have
any
other
questions
from
committee
members.
A
Saying
none
I
will
ask
broadcast
services
to
get
ready
to
take
callers
from
our
public
line
in
support
opposition
and
neutral
of
assembly
bill.
217
again,
I
will
remind
everyone
to
clearly
state
your
name,
sell
it
for
the
record
and
limit
your
testimony
to
two
minutes.
So
everyone
is
given
a
fair
opportunity
to
speak
and
with
that
we
will
begin
testimony
in
support
of
assembly
bill
217.
M
N
Good
afternoon,
madam
chair
members
of
the
committee
for
the
record,
my
name
is
still
barry
gold,
b-a-r-r-y-g-o-l-d,
and
I
am
still
the
director
of
government
relations
for
aarp
nevada,
I'm
very
familiar
with
this
bill
in
the
history.
I
can
remember
in
the
2017
session.
I
believe
it
was
sitting
in
assemblywoman,
cohn's
office
and
talking
about
this,
and
there
was
a
discussion,
lengthy
discussion
among
all
the
stakeholders
about
which
facilities
which
staff,
what
specific
training
who
was
going
to
track
it
and
who
was
going
to
actually
do
the
training.
N
Some
of
the
early
discussions
were
well.
All
this
training
would
be
done
by
a
registered
nurse.
Well,
that's
terribly
problematic,
because
we
don't
have
enough
nurses
to
take
care
of
people
in
facilities,
let
alone
do
all
this
training.
So
there's
been
several
studies,
as
indicated
before
talking
about
the
who.
N
What
where,
when
how
and
why
and
that's,
really
fabulous
looking
at
this
bill,
this
really
allows
the
department
to
really
look
at
a
lot
of
those
decisions
to
look
at
which
facilities
we
are
talking
about
we're
not
talking
about
the
skilled
staff
in
nursing
homes
are
in
hospitals.
We're
talking
about
these
other
places
where
we
do
have
staff
that
do
provide
some
level
of
care
who
we
really
are
unsure
what,
if
any,
training
that
they're
receiving.
So
that's
really
important,
something
that
I
said
back
then
in
2017
and
I'll
say
again
in
a
hearing.
N
I'll
repeat
it
is.
I
said
that
nevada
sometimes
is
very
good
in
some
of
these
types
of
facilities,
as
we
fingerprint
people,
we
do
background
checks
at
people
and
we
do
fingerprinting.
We
do
background
checks
and
we
do
tv
tests
on
people,
but
sometimes
we
don't
do
a
whole
lot
more
of
that,
and
so
we
really
need
to
make
sure
that
these
people,
if
your
mom
or
your
dad
or
my
father
or
my
grandma,
were
to
go
into
one
of
these
facilities.
N
We
would
be
comfortable
knowing
that
the
people
that
were
going
to
help
take
care
of
them
had
some
basic
level
of
training
on
some
basic
care,
qualities,
and
things
like
that.
So
this
bill
is
really
fabulous
in
terms
of
allowing
those
decisions,
and
there
was
a
lot
of
talk
with
stakeholders
about
the
best
way
to
do
this.
To
allow
that
to
be
done
through
regulations
to
really
pinpoint
who
needs
to
get
it
where
they,
where
these
people
are
and
what
those
specific
topics
are.
N
So
for
those
reasons,
aarp
on
behalf
of
our
345
000
members
all
across
the
strait,
support
this
bill
and
urge
the
committee
to
pass
it.
Thank
you
very
much.
M
M
R
R
R
You
know,
obviously
we're
very
supportive
of
improving
the
quality
of
care
in
assisted
living
and
on
my
nursing
facility
membership
and
we've
we've
been
fighting
cobit
like
everyone
else
in
the
last
year,
and
have
had
lots
of
tough
times,
but
also
have
lots
of
successes
with
infection
control.
Frankly,
we
have
one
of
the
lowest
cover
death
rates
in
the
country
in
long-term
care,
and
so
fortunately
my
members
have
done
a
really
good
job
with
regards
to
infection
control
and
we
appreciate
their
all
of
their
efforts
as
to
ab217.
R
We
feel
like
it
would
be
nice
to
have
a
little
more
clarity
as
to
who
those
unlicensed
employees
really
are
and
how
that
would
apply
with
the
term
provide
care.
It
said,
unlicensed
caregivers
who
provide
care,
maybe
sussing
that
out
a
little
bit
as
to
what
provide
care
means.
R
I
you've
all
sort
of
spoken
to
this
issue
in
advance
of
this,
but
designated
facility
is
very
broad
to
us
and
we
would
like
a
little
bit
of
clarity
as
to
you
know
the
facilities
that
are
included
in
it.
If
it's
all
of
them,
then
that's
that's
good
to
know
the
way
that
it's
written
now
the
designated
facility
language
just
makes
it
makes
it
a
little
bit
confusing
to
us
and
then
the
bill
on
the
the
training
aspect
of
the
bill.
R
But
it's
a
cost
for
employees
when
you,
when
you
train
employees,
there's
always
a
cost
involved
because
of
the
time
factor,
and
so
we
would
like
to
know
sort
of
the
a
little
bit
more
about
the
length
of
the
training
that
it
it
is
being
hoped
for
in
this
legislation
and
then,
if
the
annual
training
is
just
related
to
general
cleanliness
and
sanitation,
like
sort
of
a
restaurant
style
training
or
if
it's
a
cdc
training
for
unlicensed
caregivers
in
a
non-medical
facility.
R
That
causes
us
a
little
bit
of
concern
as
well
on
the
standard
of
care.
And
so
we
would
like
to
maybe
understand
a
little
bit
more
of
the
intentions
of
this
in
real
life.
A
M
M
R
Madam
chair
and
members
of
the
committee,
my
name
is
jim
wadhams
w-a-d-h-a-m-s,
I'm
here
today.
Speaking
in
the
neutral
position
on
behalf
of
the
nevada
hospital
association,
we
have
followed
the
work
of
the
interim
committee.
P
R
This
regard
and
believe
we
understand
the
intent
of
this
legislation
and
are
are
neutral
to
it.
As
the
committee
may
well
know,
hospitals
are
already
covered
under
a
similar
law,
which
is
founded,
nrs
449,
a
300
through
330
that
was
adopted
in
2015.
R
R
Again,
though,
we
we
are
in
neutral,
and
thank
you
for
the
time.
M
C
We
are
in
support
of
this
bill,
but
under
the
rules
we
are
offering
an
amendment
and
so
are
testifying.
In
neutral
we
have
become
aware
of
an
industry-wide
problem
wherein
personal
care
agencies
are
requiring
pca
personal
care
aid
to
pay
for
their
own
annual
training.
This
practice
is
both
very
atypical
in
the
home
care
industry
nationally
and
not
supported
by
nevada
statutes
and
regulations.
C
C
449.39732A
states
that
the
administrator
of
an
agency
is
responsible
for
employing
qualified
personnel
and
arranging
for
their
training.
Furthermore,
nrs
449.093
subsections
five
and
seven
specify
that
employees
have
personal
care.
Agencies
must
receive
training
to
recognize
and
prevent
the
abuse
of
older
persons
before
the
employee
provides
care
to
a
person
in
the
facility
agency
or
home
of
older
persons
before
the
employee
provides
care
to
a
person
in
the
facility
agency
or
home
and
annually
thereafter,
and
that
the
agency
is
responsible
for
the
cost
related
to
the
training
required.
By
this
section.
C
C
A
Up
you
are
at
two
minutes
right
now
and
just
in
the
interest
of
fairness
and
consistency,
I
know
that
you
have
an
amendment.
I
believe
it
has
been
posted
on
nellis.
Yes,
that's
done.
C
Okay,
just
wrap
up
for
an
industry
that
receives
a
median
wage
of
only
eleven
dollars
and
seven
cents
an
hour
and
that's
at
a
time
when
the
glenn
center
is
estimating
we're
going
to
need
an
additional
5
300
personal
care
aides.
So
I
urge
your
support
of
my
amendment
for
seius
seiu's
amendment.
Is
this
bill
and
I'd
be
happy
to
answer
the
question.
A
And
this
lockhart
at
this
time
we
were
doing
testimony
in
neutral
so
based
on
our
committee
rules
and
the
testimony
that
you
presented
it
looks
like
you
are
adding
support
of
the
amendment
that
isn't
currently
on
the
table.
So
I
am
going
to
recategorize
your
testimony
as
opposition
testimony
and
I
would
encourage
you
to
reach
out
to
the
bill's
sponsor
as
we
move
forward
through
processing
this
piece
of
legislation.
M
S
C-O-N-N-I-E-M-C-M-U-L-L-E-N,
representing
the
personal
care
association
of
nevada
on
ab217
pecan,
is
not
opposed
to
caregivers
receiving
more
training,
especially
in
the
areas
of
infection
control.
Currently,
state
law
requires
caregivers,
have
training
before
they
can
even
step
foot
in
one's
home.
This
area
does
involve
infection
control
in
many
other
areas
of
importance.
Having
said
that,
this
is
an
area
where
the
scope
of
training
and
skills
taught
should
not
be
a
hardship
to
do
so.
Last
session,
the
much
needed
cultural
competency
training
was
put
into
regulation
this
year.
S
Health
facilities
are
trying
to
meet
that
mandate,
but
the
only
course
being
offered
that
meets
the
criteria
is
nine
hours
and
one
hundred
dollars
a
person
in
the
bill.
Hours
of
such
training
was
never
even
addressed.
We
have
similar
concerns
with
the
languages.
This
bill,
pecan
is
not
opposed
to
more
training,
but
the
scope
of
the
information
must
be
reasonable
in
application
in
these
difficult
times.
We
thank
you
for
your
consideration
of
our
testimony
and
on
behalf
of
some
30
companies
that
I
represent.
S
S
I'm
in
neutral,
I
need
more
clarification
as
to
the
way
the
bill
was
written.
I
don't
think
it's
specific
enough.
A
Thank
you.
Thank
you
for
your
testimony.
If
we,
I
would
just
encourage
you
to
again
reach
out
to
the
bill
sponsor
regarding
any
questions.
You
have
the
language.
It
appears
that
you
have
some
concerns
with
the
language
as
it
has
been
currently
presented.
A
So
at
this
time
I
will
probably
likely
kind
of
re-categorize
your
testimony
as
opposition
under
our
committee
world.
Do
we
have
any
other
people
testifying
in
neutral
on
assembly,
bill
217.
A
And
do
we
have
anyone
on
the
zoom
that
is
testifying
in
neutral
on
this
bill
as
well?
Don't
see
anyone
at
this
time.
I
will
turn
this
back
over
to
assemblywoman
cohen,
for
any
closing
remarks.
O
Thank
you
jared
if
it's
all
right
I'll,
just
make
sure
if
deputy
director
chapel
has
any
final
things
she
wants
to
say.
First.
I
Good
afternoon,
margo
chapel
for
the
record,
I
would
just
the
only
thing
I'd
like
to
say
in
closing-
is
that
a
lot
of
the
issues
that
were
brought
up
related
to
this
bill
can
be
addressed
during
the
regulatory
process
and
generally
are.
For
example,
I
did
get
some
clarification
on
my
end
that
we
are
considering
section
1a,
making
it
applicable
to
all
facilities
designated
in
the
regulations,
including
medical
dependent
care
and
others,
without
statutory
definitions
pursuant
to
499.0303,
which
is
every
facility
we
license.
I
O
O
Each
session
we've
talked
about
cost,
we've
talked
about
who's
included
and
and
when
we
started
in
my
mind,
because
I
didn't
think
about
infectious
diseases
so
much,
we
talked
about
how
how
people's
lives
are
affected
when
they
live
in
these
facilities.
So,
like
the
fact,
if
you've
got
someone
untrained
if
you're,
if
you're
a
senior
and
you've
got
someone
untrained
who's
taking
you
in
and
out
of
the
bath,
you
can
be
injured.
Obviously,
that's
still
part
of
the
issue.
O
Again,
we've
been
doing
this
for
several
years
now
or
a
couple
of
sessions,
and-
and
we
keep
hearing
these
same
concerns-
that
we
are
going
to
be
able
to
address
now
in
the
regulations,
because
it
will
have
more
flexibility
than
what
we
have
in
statute
and
and
with
that
I'll,
just
remind
you
that
we're
talking
about
individuals
who
are
responsible
for
caring
for
some
of
nevada's,
most
vulnerable
citizens
and
they
often
receive
little
to
no
training
as
far
as
as
far
as
cost
that
can
be
addressed
in
regulations.
O
As
I
said
like
everything
else,
but
I
think
we
have
to
kind
of
pull
the
trigger.
We
have
to
get
this
moving
and
get
these
issues
addressed
and
and
not
keeping
pushing
them
punching
them.
You
know,
and
with
that
I
will,
I
will
leave
it
at
that,
except
I
am
open
to
discuss
this
with
anyone
who's
interested.
O
However,
I
will
remind
the
committee-
this
is
an
interim
committee
bill,
so
so,
if
there
are
amendments
that
type
of
thing,
it's
not
really
my
place
to
accept
amendments
or
reject
amendments,
but
certainly
I
will
talk
to
anyone
who
wants
to
discuss
it
and
leave
it
to
the
committee
to
decide
if
they
would
like
to
accept
any
of
the
amendments.
A
Thank
you,
and
with
that
I
will
close
the
hearing
and
testimony
on
assembly
bill
217..
I
will
also
encourage
our
members.
You
can
always
go
back.
I
believe
that
our
policy,
analyst
patrick,
had
previously
sent
out
a
link
regarding
some
of
the
interim
work
that
has
done
on
has
been
worked
on
this
particular
bill
that
came
out
of
that
interim
committee
work.
So
please
review
that
if
you
have
any
further
questions
about
the
intent
and
what
kind
of
work
went
into
the
drafting
of
this
particular
bill.
A
Additionally,
before
that
now
we
will
move
to
public
comment
again.
I
will
remind
everyone
to
clearly
clearly
state
your
name
and
spell
your
name
and
limit
your
comments
to
two
minutes.
Again,
we
will
be
timing
and
I
will
cut
you
off
if
you
are
going
over,
but
I
would
encourage
you
to
also
submit
anything
that
you
have
in
writing.
A
Anything
related
to
the
bills
within
48
hours
and
public
comment
can
always
be
submitted
in
writing,
and
I
know
that
we
have
very
conscientious
members
that
will
review
all
of
that
documentation
as
well
broadcast
services.
Do
we
have
anyone
on
the
line
to
speak
on
public
comment.
A
Before
we
adjourn
I'll,
just
give
you
a
little
update.
Our
next
meeting
is
on
wednesday
march
17th.
If
you
take
a
look
at
the
agenda,
it
is
very
optimistic.
You
know
deadlines
are
coming
up,
even
though
some
of
the
bill
draft
requests
are
still
trickling
in.
We
still
have
to
hear
them
before
something
happens
before
other
deadlines
occur.
We
do
have
three
bills.
Several
of
them
are
from.
A
One
of
them
is
from
an
interim.
It
actually
is
work
that
was
done
in
the
2019
session.
I
am
having
our
pa.
Our
policy
analyst
send
you
a
link
to
that.
So,
if
you
do
want
to
be
prepared
for
that,
we
do
have
a
comprehensive
work
session
that
is
also
on
deck,
so
I
did
send
down
an
email.
I
would
encourage
members
if
you
have
any
questions
to
reach
out
to
those
bill,
sponsors
or
committee
staff,
to
answer
any
of
those
questions.
It
will
make
it
a
much
smoother
process.
If
we
can
do
that.
A
Like
I
said
I
do
have
a
pretty
optimistic
agenda.
I
do
plan
on
hearing
two
potentially
two
bills
on
friday
afternoon,
and
so
please
pay
attention
to
the
agendas
that
are
forthcoming,
because
it
does
look
like
we
will
have
a
committee
hearing
for
hhs
on
friday
afternoon.
A
I
am
aware
that
there
are
limited
flights
on
friday
afternoon
for
those
that
are
traveling
back
to
southern
nevada,
so
I
will
be
conscientious
of
our
time
and
time
management
on
that
friday
meeting
date,
and
with
that
I
will
end
the
meeting
and
during
the
meeting
take
care
everyone.