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From YouTube: 5/27/2021 - Assembly Committee on Ways and Means
Description
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
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C
A
Chair
carlton-
and
I
am
here-
thank
you
very
much
with
that.
Let
me
make
sure
I've
got
everything
I
need
okay,
so
you
see
a
lot
of
bills
that
are
posted
and
that's
that's
typical
for
this
time
of
year.
Whatever
we
don't
get
to
today
will
roll
till
tomorrow.
A
The
first
things
on
the
agenda
today
are
to
finish
the
couple
of
abs
that
are
still
left
hanging
because
those
still
have
to
make
it
through
the
second
house,
so
we
have
to
prioritize
them.
First,
we
have
the
cip
and
paybill
that
we
need
to
move
to
make
sure
that
that
gets
to
where
it
needs
to
be
so
we
can
fund
government,
and
then
we
have
what
we
call
our
parking
lot
bills:
the
senate
bills
that
we've
already
heard
we
passed
k-12
last
night.
A
We
can
now
shove
all
those
senate
bills
back
out
so
that
they
can
get
finalized,
and
then
we
will
start
processing
individual
members
bills.
I
plan
on
trying
to
take
it
from
the
top
of
the
order
as
much
as
possible.
I
know
the
senate,
chair
of
human
resources,
has
a
number
of
bills
here
in
in
here.
We'll
try
to
get
us
a
couple
of
those
done
and
then
we
might
have
to
roll
a
couple
till
tomorrow.
A
We
only
have
a
little
less
than
two
hours
this
morning,
because
we
have
to
be
on
floor
at
time
certain
for
a
presentation,
a
presentation
today.
So
with
that
I'm
going
to
go
ahead
and
do
the
work
session
first,
so
we
can
get
things
processed.
A
D
Thank
you,
madam
chair,
send
me
bill
for.
D
A
E
Hearing
good
morning,
madam
chair
members
of
the
committee
for
the
record,
howard
watts,
representing
assembly
district
15
in
clark
county,
I
am
happy
to
present
assembly
bill
432
to
you
today,
which
expands
our
automatic
voter
registration
system
in
the
state.
Essentially,
there
are
two
aspects
to
the
bill:
one
is
expanding.
The
agencies
that
will
or
can
become
automatic
voter
registration
entities.
Currently
we
have
the
dmv.
E
E
That
change
was
also
made
to
help
align
this
policy
with
the
implementation
of
the
top-down
voter
registration
system,
which
this
committee
handled.
I
believe
yesterday
with
that.
I
know
that
the
secretary
of
state's
office
still
has
a
fiscal
note.
I
see
mr
applausion
is
on
the
line
and
that's
my
summary,
I'm
glad
to
answer
any
questions
that
you
may
have
and
we'll
let
mr
wilashan
speak
to
the
secretary
of
state's
fiscal
note.
A
F
Thank
you
good
morning
share
carlton
and
members
of
the
committee
mark
colashan,
deputy
secretary
of
state
for
elections
for
the
record,
and
this
fiscal
note
identifies
the
cost
of
personnel
required
to
develop
and
implement
the
system
similar
to
the
implementation
of
the
dmv
avr
project,
similar
to
the
other
fiscal
notes
submitted
by
the
office
and
the
secretary
of
state.
It
reflects
not
a
worst
case
scenario
or
nor
best
case
scenario,
but
the
most
realistic
scenario.
Given
the
information
we
added
time
available
at
the
time
of
drafting.
F
F
Yes,
ma'am,
certainly
the
fiscal
note
identifies
a
requirement
really
just
for
personnel.
Again,
the
bill
identifies
the
requirement
for
the
office
of
the
secretary
of
state
to
create
a
similar
portal
to
the
one
that
had
been
established
for
the
dmv.
It
will
have
to
be
a
different
portal,
and
the
idea,
as
someone
watson
mentioned
just
a
moment
ago,
is
to
integrate
the
system
into
the
top
down
voter
registration
system
that
is
also
again
underway.
The
implementation
of
this
bill
specifically
calls
for
two
permanent
fte
employees,
as
well
as
a
number
of
contracted
employees.
F
In
order
to
meet
that
implementation
date
of
january
1st
of
2024,
the
two
fte
positions
that
we've
identified,
one
is
an
it
position.
It's
a
business
process
analyst
and
the
other
is
a
program
officer
to
monitor
the
system.
On
a
full-time
basis,
again
that
those
both
of
those
positions
were
identified,
based
on
our
experiences
with
the
dmv
abr
project,.
A
A
That's
a
good
thing.
Sometimes
it's
not
we'll
go
we'll.
Consider
this
a
good
thing
right
now.
So
with
that,
thank
you
very
much
for
the
presentation.
We
will
go
ahead
and
open
it
up.
As
the
hearing
part,
this
is
the
hearing
for
ab432,
so
we'll
go
to
support
opposition
in
neutral.
Is
there
anyone
in
the
room
in
support
of
ab432?
C
C
A
H
C
Good
good
morning,
chairwoman,
carlson
committee
members,
for
the
record,
my
name
is
emily:
prasad
zamora,
I'm
the
executive
director
of
silver
state
voices
and
I'm
here
in
strong
support
of
assembly
bill
432,
funding,
more
methods
in
which
eligible
voters
may
register
to
vote
is
imperative
in
order
to
ensure
that
we
are
welcoming
greater
participation
in
our
electoral
process.
Among
all
nevadans,
we
ask
that
you
invest
in
our
democracy
by
voting
yes
on
ab432.
A
A
F
A
Okay,
thank
you
very
much.
Anyone
in
neutral
on
the
phone
line
please.
H
H
C
A
E
Yes,
thank
you,
madam
chair
members
of
the
committee,
howard
watts,
for
the
record.
I'll,
be
very
brief.
I
would
just
note
that
again
with
the
implementation
timeline
being
pushed
out
two
years,
I
I
don't
see
there
being
a
need
for
the.
I
agree
that
there
is
a
need
for
staffing
to
implement
this
project.
E
A
Thank
you
very
much,
mr
watts.
We'll
go
ahead
and
close
the
hearing
on
assembly
bill
432,
so
committee
members
last
night
a
bill
was
taken
from
ledge,
ops,
ab65
and
it
was
referred
to
our
committee.
It's
my
understanding
that
there
is
an
amendment
trying
to
make
its
way
from
the
first
floor
to
the
third
floor,
so
we
won't
be
discussing
ab65
until
we
actually
have
the
amendment,
because
I
believe
the
amendment
does
a
lot
of
changes.
A
So
there
would
no
be
no
reason
to
have
conversation
about
it
until
we
can
review
the
amendment
and
have
a
thorough
conversation
so
ab65
for
those
that
are
listening.
If
we
get
the
amendment
I'll
be
happy
to
put
it
on
the
agenda
for
tomorrow,
but
I
have
not
seen
the
amendment.
We
really
can't
talk
about
it
till
we
do
get
the
amendment.
A
A
Empty
okay,
with
all
the
confusion,
we
need
to
do
hearings
on
those
so
rather
than
do
hearings
at
this
moment,
those
we're
in
good
shape
with
those
right
now,
let's
just
get
the
parking
lot
emptied
out
to
make
sure
all
these
senate
bills
get
to
the
assembly
floor
and
get
finalized.
A
So
with
that
ms
kaufman,
if
you'll
just
walk
us
through
and
committee
members,
we
heard
these
a
while
ago,
but
these
are
the
ones
that
I
told
you
were
going
into
the
parking
lot.
Okay,
so
with
that.
D
Let's
go.
Thank
you
madam
chair
senate
bill
410
makes
a
general
fund
appropriation
of
18
million
643
998
dollars
to
the
central
repository
for
the
nevada
records
of
criminal
history
for
the
department
of
public
safety
for
the
continued
cost
of
modern
modernization
for
their
nevada,
criminal
justice
information
system,
otherwise
known
as
insigius
fiscal
staff
worked
in
consultation
with
the
agency
in
the
governor's
finance
office
and
identified
three
million
dollars
available
in
reserves
that
could
be
applied
towards
the
modernization
project.
G
A
I
Thank
you,
madam
chair,
and
so
this.
C
Is
direly
needed
this?
The
system
is
outdated.
A
A
D
The
next
bill
is
senate.
Bill
411
makes
a
general
fund
appropriation
of
379
thousand
five
hundred
forty
one
dollars
to
the
department
of
public
safety
for
the
replacement
of
computer
hardware,
for
both
their
division
of
parole
and
probation,
as
well
as
the
investigations
division.
No
amendments.
A
Amendments
no
adjustments,
so
this
would
be
a
due
pass.
Any
conversation
before
I
accept
a
motion
seeing
none
I'll
take
a
motion
from
miss
monroe,
moreno,
second
from
speaker,
fryerson,
any
comments
hearing,
none
all
in
favor,
please
signify
by
saying
aye
any
in
opposition
hearing.
None
motion
passes
next
bill.
Please.
D
Adam
chair,
the
next
bill
is
senate
bill
412.
It
makes
a
general
fund
appropriation
of
fifty
three
thousand
five
hundred
fifty
dollars
to
the
department
of
agriculture
for
new
laboratory
equipment
and
maintenance
contracts
related
to
veterinary
medical
services,
and
there
are
no
amendments
recommended.
A
So
with
that
committee
members,
any
questions,
questions
not
seeing
any
questions.
This
would
be
a
do.
Pass
I'll,
accept
a
motion
from
ms
monroe
moreno,
a
second
from
dr
titus
comments.
Hearing,
none
all
those
in
favor,
please
signify
by
saying
aye
any
in
opposition.
No
opposition
passes
unanimously
the
member's
president
next
bill.
Please.
D
Thank
you.
Madam
chair
senate
bill
413
appropriates
five
million
four
hundred
nine
thousand
six
hundred
nineteen
dollars
to
the
nevada
gaming
control
board
to
fund
the
continued
cost
of
the
alpha
migration
project,
replacement
and
modernize.
The
gaming
control
board's
information
system
over
the
2021-23
biennium
and
there
are
no
recommended
amendments.
A
D
A
Okay,
no
amendments.
Thank
you
very
much.
Miss
kaufman
any
questions
from
the
committee
hearing.
None
I'll
accept
a
motion
from
mr
mourinho.
Second
from
dr
titus
allen
comments
hearing,
none
all
in
favor,
please
signify
by
saying
aye
aye
any
in
opposition
hearing
no
opposition
passes
unanimously.
The
members
present
next
bill.
Please.
D
A
So
there's
no
significant
changes
as
far
as
we're
concerned
do
pass
so
with
that
I'll
to
accept
a
motion
from
ms
monroe
moreno
second
from
dr
titus,
any
questions
or
comments
hearing,
none
all
in
favor,
please
signify
by
saying
aye
aye
any
in
opposition
hearing
no
opposition
passes
unanimously.
The
members
president
next
bill,
please.
A
D
Thank
you,
madam
chair
senate,
bill
426
makes
general
fund
appropriations
of
one
million
seven
hundred
eighty
four
thousand
five
hundred
dollars
to
serve
as
a
loan
to
the
division
of
emergency
information
technology
services
of
the
department
of
administration
for
the
replacement
of
a
contact.
Excuse
me,
content
management
and
portal
platform.
The
bill
requires
the
division
to
provide
annual
installments
of
25
percent
of
the
cost
of
the
replacement
of
the
platform
beginning
july
1st
2023,
and
there
are
no
recommended
amendments
so.
A
Committee
members,
this
would
be
a
do
pass
any
questions
or
comments.
I
would
have
never
thought
we'd
be
spending
this
much
money
on
technology.
This
is
just
amazing.
So
with
that
hearing
no
other
comments,
I'll
accept
a
motion
from
miss
monroe
moreno,
a
second
from
us,
dr
titus,
any
questions
or
comments.
Hearing,
none
all
in
favor,
please
signify
by
saying
aye
any
opposition
hearing
no
opposition
passes
unanimously
at
the
members
president
next
bill.
Please.
D
Thank
you,
madam
chair
senate
bill
427
makes
general
fund
appropriations
tolling
400.
Excuse
me
766
561
dollars
to
the
division
of
child
and
family
services,
the
department
of
health
and
human
services
for
deferred
maintenance
projects
for
summit
view,
youth
center
caliente,
youth
center
nevada,
youth
training
center
and
the
southern
nevada,
child
and
adolescent
service
campus.
There
are
no
recommended
amendments.
A
Thank
you
very
much.
Any
questions
committee
members
seeing
none
the
motion
would
be
a
do
pass
I'll,
accept
the
motion
from
miss
monroe
moreno.
Second,
from
dr
titus
comments.
Hearing
none
all
in
favor,
please
signify
by
saying
aye
any
in
opposition
hearing
no
opposition
passes
unanimously
of
the
members
present
the
next.
Do
we
have
another
one.
A
A
Right
committee,
I
believe
we've
got
the
the
first
wave
done
so
that
we
can
get
those
down
to
the
floor
and
get
those
processed.
There's,
there's
there's
still
a
lot
more,
but
we'll
do
them
a
piece
at
a
time
to
make
it
easier
to
get
them
all
processed
and
just
try
to
keep
an
even
flow
going
to
the
floor.
So
with
that,
I
believe
we
can
go
ahead
and
go
back
into.
A
D
Thank
you,
madam
chair
assembly,
bill
432,
as
amended,
provides
certain
agencies
of
the
executive
department
of
the
state
government.
To
excuse
me,
I'm
sorry.
Let
me
let
me
start
over
again
ab432,
as
amended
provides
that
certain
agencies
of
the
executive
department
of
the
state
of
state
government
are
provided
for
automatic
voter
registration
agencies.
D
It
authorizes
the
governor
to
designate
additional
state
agencies
and
certain
tribal
agencies
as
automatic
voter
registration
agencies
and
sets
forth
the
requirements
of
an
automatic
voter
registration
agency
to
transmit
certain
voter
registration
information
to
the
secretary
of
state,
the
clowning
clerk.
I
would
note
that
there
were
two
original
fiscal
notes:
schicks
the
source
state
health
exchange
originally
had
a
fiscal
note
of
4.1
million
dollars
in
2022
and
937
253
in
2023.
D
D
D
The
division
of
motor
vehicles
indicated
that
they
would
need
forty
eight
thousand
two
hundred
thirty
three
dollars
for
programming
hours
related
to
the
automatic
voter
registration
and
the
secretary
of
state
has
provided
a
fiscal
note
of
736
thousand
three
hundred
ninety
one
dollars
in
fiscal
year.
Twenty
twenty
two
and
three
hundred
forty
six
thousand
four
hundred
thirty
nine
dollars
in
fiscal
year.
Twenty
twenty
three
for
various
positions
related
to
the
maintenance
and
upgrades
of
the
automatic
voter
registration.
A
A
A
We
are
going
to
go
ahead
and
process
it
with
that
fiscal
note,
but
I
believe
there
will
be
future
discussions
as
this
bill
moves
from
the
south
end
of
the
building
to
the
north
end
of
the
building,
and
those
conversations
will
continue
so
with
that
committee
members.
Are
there
any
questions
on
assembly
bill
432
at
this
time,
not
seeing
any
so
with
that.
I
believe
it
is
a.
A
A
Seeing
none
I'll
accept
a
motion
from
miss
monroe
moreno,
a
second
from
speaker,
fryerson,
any
questions
or
comments
on
the
motion,
all
those
in
favor,
please
signify
by
saying
aye,
aye
and
those
in
opposition.
I
have
dr
titus
mr
haven,
miss
tolls.
Mr
lovett
and
mr
robertson
opposition
motion
passes.
A
We'll
go
ahead
and
move
this
to
the
floor
and
go
from
there.
Thank
you
very
much
so
that
takes
care
of
the
work
session
that
we
are
going
to
be
doing
this
morning.
We
can
go
ahead
and
get
into
some
bills
just
a
few
minutes
behind
no
problem.
So
with
that
it
would
be
the
chair's
intent
to
prioritize
sb5.
A
A
A
A
A
D
Thank
you,
madam
chair
assembly,
assembly,
bill
492
is
the
cip
bill
relates
to
pro
projects
of
capital
improvement,
authorizes
certain
expenditures
by
the
state.
Public
works
division
of
the
department
of
administration;
it
loves
it,
a
property
tax
to
support
the
consolidated
bond
interest
and
redemption
and
makes
various
appropriations.
Thank
you.
A
I
A
H
F
Doug
unger
d-o-u-g,
u-n-g-e-r,
unlea
chapter
president
and
southern
nevada,
government
affairs
and
the
faculty
alliance.
F
A
A
A
Thank
you
very
much
so
with
that.
I
believe
we
can
close
the
hearing
on
assembly
bill
492.
It's
the
chair's
intention
to
move
the
bill
right
now.
Are
there
any
questions
and
concerns
on
our
cip
bill?
Seeing
none?
I
would
accept
a
motion
to
do
pass
from
speaker
fryerson,
dr
titus.
Did
you
have
a
question?
A
J
You,
madam
chair,
I
will
support
this
out
of
committee
with
the
right
to
reser
change
my
vote.
Thank
you.
A
Okay,
thank
you
very
much
so
with
that
committee
members
are
there
any
other
conversation
seeing
none
all
those
in
favor,
please
signify
by
saying
aye
aye
any
in
opposition
hearing.
No
opposition
passes
unanimously
of
the
members
at
this
moment
in
time.
So
with
that
we'll
move
on
to
the
pay
bill,
which
is
assembly
bill,
493
493,
I
probably
should
have
been
able
to
guess
that
493.
D
A
With
this,
this
is
the
bills,
how
we
pay
people
for
the
next
couple
of
years.
So
with
that
committee
members,
are
there
any
questions
or
oh?
No?
This
is
the
hearing
on
assembly
bill
493.
So
with
that
I'll
go
ahead
and
open
up
the
hearing
on
assembly
bill
493.
Is
there
anyone
in
the
room
in
support
of
assembly
bill
493.,
not
seeing
anyone
come
forward?
Anyone
on
zoom
in
support
not
seeing
anyone
wishing
to
be
recognized.
Is
there
anyone
on
the
phone
line
in
support
of
assembly
bill
493.
I
I
Over
the
last
10
years,
inflation
has
been
22
percent
and
the
accumulated
cola.
Stakeholders
have
been
12,
so
that's
a
net
10
percent
loss
and
and
purchasing
power,
and
then
the
disparity
between
the
three
percent
cola
for
those
in
bargaining
units
who
reached
agreements
with
the
state
and
the
one
percent
for
all
other
state
employees
will
cause
real
policy
and
compensation
issues
long
term.
I
So
I
just
ask
you
to
fix
that
as
this
process
goes
forward
and
it's
particularly
unfair
for
those
of
us
who
are
excluded
by
statute
and
nrs
288
from
being
in
one
of
the
state
bargaining
units.
So
we
did
not
even
have
the
opportunity
to
bargain
or
reach
an
agreement
with
the
with
the
executive
department
in
order
to
gain
a
higher
cola.
Thank
you
very
much.
H
F
Doug
unger
d-o-u-g,
u-n-g-e-r,
unlv
chapter
president
and
southern
nevada
government
affairs,
representative,
nevada
faculty
alliance.
I
would
like
to
point
out
to
the
ways
and
means
committee
and
to
chair
carlton
that
faculty
salaries
are
now
15
below
the
national
average,
whereas
they
were
in
2008
15
above
the
national
average.
The
one
percent
cola
which
would
affect
ng
faculty
will
in
in
essence,
drive
our
salaries
down
another
two
percent
over
the
next
two
years.
F
F
A
H
H
A
F
Thank
you,
madam
chair.
I
just
based
on
the
testimony
I
had
a
question
about
how
the
one
percent
versus
the
three
percent
was
going
to
work.
F
I
think
I
understand
enchi
does
not
have
a
cba
and
therefore
they're
at
the
one
percent,
but
if
there
are
individuals
in
an
agency
and
the
agency
has
a
collective
bargaining
agreement,
but
that
individual
is
not
part
of
that,
are
they
subject
to
the
one
percent?
Are
they
subject
to
the
the
three
percent?
As
with
the
whole
agency.
D
Thank
you,
madam
chair.
Those
who
are
in
the
collective
bargaining
unit
get
the
three
percent,
and
those
who
are
not
in
collective
bargaining
would
get
one
percent,
so
you
may
have
instances
where
individuals
are
in
the
same
agency,
but
if
they're,
not
in
the
collective
bargaining
units,
their
their
close
will
be
different.
A
And
as
we
were,
walked
through
yesterday,
all
the
different
categories,
the
three
percents,
the
two
percent
plus
plus
whatever
the
state-
does
those
individual
units
have
gone
ahead
and
bargained
got
their
process
through
the
board
of
examiners
by
the
may
25th
deadline
moving
forward.
There
are
still
others
in
that
process.
They
just
didn't
make
it
by
the
deadline.
So
who
knows
you
all
may
see
some
of
those
next
year
when
we
have
this,
when
you
have
the
same
conversation
so
with
that,
I
believe
we
can
go
ahead
and
process
the
bill.
A
J
Thank
you,
madam
chair.
I
will
be
a
no
on
this.
I
know
we
need
to
pay
our
employees,
but
during
the
hearing
and
again
this
morning,
the
complete
disparity
and
what
I
would
say
is
not
fair
to
our
employees
is
just
very
evident
to
me
on
the
fact
that
we
allow
whether
you're,
pro-union
or
non-pro
unit.
That's
not
the
the
the
conversation.
The
conversation
is
that
some
agencies
can
negotiate
for
their
members.
Others
cannot,
if
it
forces
you
to
join
a
union,
you
may
not
be
for
the
union,
then,
all
of
a
sudden.
J
A
And-
and
thank
you,
dr
titus,
but
I
think
it's
important
that
we
we
clarify,
that
the
issues
that
you
have
a
problem
with
were
in
the
collective
bargaining
bill
not
actually
encapsulated
in
the
pay
bill.
Those
things
were
voted
on,
decided
and
debated
in
the
actual
collective
bargaining
bill
and
different
agencies
and
different
groups
have
had
the
opportunity
to
move
forward.
A
So
that
conversation
really
was
there
not
here
we're
dealing
with
what's
right
in
front
of
us
right
now
and
nobody's
surprised
where
I
come
from,
you
know
if
you
want
to
negotiate,
but
that
bargaining
agreement
and
it
gets
through
the
board
of
examiners.
I
feel
it's
our
responsibility
to
have
a
serious
conversation
about
what
those
numbers
really
are
to
make
sure
that
they
fit
where
we
need
to
go
and
that
we
process
what
has
been
done.
So
with
that.
Where
was
I
with
this
motion?
Second
conversation.
Other
conversation,
mr
roberts,.
C
Thank
you,
madam
chair,
you
know,
and
I
I
was
as
a
government
employee.
I
was
involved
in
collective
bargaining.
You
know
my
whole
career
and
we
had
appointed
employees
and
typically
when
the
leadership
you
know,
we
had
collective
bargaining
agreements.
Typically,
we
would
align
appointed
employees
at
the
discretion
of
the
agency
head
with
those
raises.
This
cola
is.
A
Okay,
thank
you.
So
the
opposition
is
more
about
the
one
percent
for
everyone
else
than
the
three
two
or
three
percent
for
the
actual
bargaining
units.
That's
where
the
opposition
I
just
want
to
make
sure
the
opposition
is
very
clear
that
you're
not
opposed
to
the
actual
negotiation
of
the
three
or
two
percent
you're
opposed
to
the
one
percent
for
everybody
else.
Correct,
okay,
good
just
want
to
make
sure
had
it
on
the
record,
because
we
haven't
heard
that
bill
yet
so
miss
tolls.
A
K
D
B
A
B
A
Strayed
from
work
session,
because.
A
Should
have
been
more
when
we
actually
had
the
hearing
on
the
bill,
I
think
we
made
everything
clear
walked
through
it
enunciated
every
single
category
that
was
getting
it.
Those,
I
believe,
were
questions
more
about
then,
but
if
there's
miss
tolls,
what
what
is
your
actual
question?
It's
it's.
A
A
If
you
are
in
that
category,
you
will
receive
these
dollars,
whether
you
pay
dues
or
not,
but
if
your
bargaining
unit,
if
you
have
not
created
a
bargaining
unit
and
gone
to
the
table
and
negotiated
and
got
it
through
the
board
of
examiners,
then
it
doesn't
exist.
We
are
waiting
for
cat
one
police
officers
to
finish
their
their
process.
We
look
forward
to
that
happening
in
the
next
two
years.
A
A
A
J
A
You're
welcome
and
it
is
the
one
percent
disparity
that
is
the
concern.
That's
I
just
want
to
make
sure
that
that's
where
it
actually
lies.
So
with
that
hearing
no
other
conversation,
all
those
in
favor,
please
signify
by
saying
aye
aye
and
those
in
opposition
would
be
dr
titus,
mr
hafen
miss
tolls,
mr
levitt
and
mr
roberts.
All
right
so
with
that
we'll
go
ahead
and
send
the
pay
bill
down
to
the
we'll
report
that
out
to
the
floor.
L
A
I
believe
we
can
go
ahead
and
go
into
some
commit
some
bill
hearings
ready,
ms
kaufman
okay.
So
with
that
I
indicated
we
would
work
on
sb5,
but
unfortunately,
the
majority
leader
is
not
here
and
she's
very
interested
in
this
bill.
So
we're
going
to
skip
sb5
for
the
moment
and
move
on
to
sb40,
so
we'll
go
ahead
and
address
sb40.
L
Good
morning,
chair
carlton
members
of
the
committee,
my
name
is
sarah
shulhagian,
I'm
here
on
behalf
of
nevada's
patient
protection,
commission
I
serve
as
the
executive
director.
I
will
try
to
keep
my
brief
overview
brief
and
go
straight
into
the
fiscal
note
who
is
joining
me
today.
I
have
miss
sandy
rubilid
on
zoom
and
miss
ellen
crescilius
and
also
in
the
audience
is
miss
laura
rich
from
pebb
senate
bill.
40
is
a
measure
that
is
seeking
to
implement
several
transparency
measures
to
better
help
better
understand
data
trends
in
the
health
care
industry.
L
L
In
addition,
senate
bill
40
requires
dhhs
and
the
division
of
insurance
in
the
department
of
business
and
industry
to
submit
a
report
to
the
patient
protection
commission
and
the
legislative
committee
on
health
care
regarding
the
types
of
reported
data
that
could
be
used
to
analyze
trends
and
the
cost
of
health
care,
consolidation
among
health
care
entities
and
other
issues
related
to
access
to
care.
Last
senate
bill
40
authorizes
the
commission
to
request
not
more
than
two
reports
per
year
concerning
price
cost,
consolidation
and
access
to
care
from
state
or
local
government
entities.
L
Any
of
those
reports
must
be
submitted
to
the
executive
director
of
the
ppc
and
also
to
the
attorney
general
and
is
so
long
as
the
agency
has
the
reces
resources
to
comply,
and
also
so
long
as
the
requested
information
does
not
violate
any
hipaa
laws.
Chair
in
the
second
reprint
of
the
bill.
With
the
adopted
amendment
723
section
19.7
makes
an
appropriation
to
dhcfp
for
the
development
of
napcd,
and
if
there
is
no
further
questions
related
to
the
policy,
I
would
like
to
turn
it
over
to
miss
ellen
crescilius
and
sandy
rubilid.
A
C
Ellen,
would
you
like
to
go
over?
The
fiscal
note
sure
I
can
walk
through
it.
Ellen
crystal
is
for
the
the
record.
So
for
the
fiscal
note,
we
updated
our
previous
analysis
to
pull
out
some
costs
that
we
thought
we
may
be
able
to
live
without
we
pulled
out
the
staffing
costs,
we're
anticipating
that
we're
going
to
be
able
to
cover
the
project
with
current
staff.
Also,
the
medicaid
data
extract
we
pulled
out
because
we
believe
that
we
can
cover
that
with
our
current
budgeted
enhancement
hours.
A
A
Okay,
thank
you
very
much
so
with
that
anyone
else
character.
L
C
Good
morning,
chair
and
members
of
the
committees
for
the
record,
I
am
the
chief
team
manager
for
the
department
of
health
and
human
services,
so
we
have
the
opportunity
to
draw
down
90
federal
dollars
for
the
planning
and
implementation
phase
of
the
project,
because
this
has
been
dedicated
to
the
medicaid
agency
from
the
department.
C
Additionally,
we
have
the
opportunity
to
get
a
grant
for
a
2.5
million
dollars
over
a
three-year
period
period
under
the
no
surprises
act
that
we
believe
will
cover
the
implementation
and
operations
is
also
available
to
be
funded
for
the
percent
of
the
population
that
can
be
attributed
to
medicaid
at
75
percent
federal.
L
Carlton
the
only
thing
I'd
like
to
no
sorry
sarah
hagian
for
the
record
is
the
no
surprises
grant
is
perceived
as
a
non-competitive
grant
and
to
my
understanding
and
sandy
can
confirm
this.
There
is
going
to
be
a
priority
set
on
states
that
have
given
acts
have
allowed
for
erisa
plans
to
that
who
voluntarily
submit
data
into
the
database
to
take
priority
in
the
grant
receivable
process,
and
this
bill
includes
language
that
allows
for
that
volunteer.
Submission
too.
A
Thank
you
very
much,
mr
hagin.
We
appreciate
that
so
committee
members.
Are
there
any
questions
of
the
presenters
on
sb
40.,
not
seeing
any
questions?
I've
had
many
encounters
with
the
all
payer
claims
database
this
session,
so
I
got
to
learn
about
it
very
early
by
total
accident.
So
I
don't
see
any
other
questions.
This
is
the
hearing
on
sb40,
so
we'll
go
ahead
and
open
it
up
for
the
hearing
portion
of
the
bill.
So
is
there
anyone
here
in
the
room
in
support
of
sb40,
not
seeing
anyone
else
come
forward?
A
A
A
H
L
Hagian
for
the
record,
I
just
want
to
thank
you
for
your
consideration
and
acknowledge
all
the
tremendous
work
that
has
gone
in
to
this
bill
from
the
inception
coming
out
of
the
patient
protection
commission.
Most
notably
I'd
really
like
to
thank
chair
khan
for
his
efforts
in
his
leadership
and
senator
ratty
for
her
tremendous
leadership
on
the
senate
side
and
for
your
continued
consideration,
sincerely
appreciate
it
and
think
this
will
go
a
long
way
to
help
us
understand
health
care
and
what
we
can
do
to
improve
upon
it.
A
And
thank
you,
mr
hagin,
and
thank
you
for
all
of
your
work
that
you
did
keeping
the
patient
protection
commission
on
track
and
working
through
a
pandemic
cycle,
as
you
were,
trying
to
set
it
up
and
again
I'd
like
to
thank
dr
khan
for
all
of
his
hard
work
that
he
did
to
make
sure
that
this
commission-
it's
it's
it's
very
near
and
dear
to
me.
So
thank
you
for
all
the
work
that
you've
done.
We
do
appreciate
it
so
with
that
we'll
go
ahead
and
close
the
hearing
on
sb.
A
A
L
Thank
you
so
much
tara,
carlton
members
of
the
committee.
My
name
is
sarah
schulhagian.
I'm
here
today
on
behalf
of
nevada's
patient
protection,
commission
I
serve
as
the
executive
director
on
zoom
and
who's
joining
me
today
is
deb
reynolds
from
dpbh
and
deputy
young
deputy
director
dwayne
young
as
well
senate
bill
5
is
a
measure
that
makes
various
changes
to
telehealth
and
it
really
is
an
effort
to
recognize
a
long-term
recovery
and
a
new
normal
for
patient
access
to
care.
L
It
also
temporarily
requires
third-party
payers
to
cover
telehealth
services
and
the
same
amount
as
services
provided
in
person,
except
for
audio
only
interactions
and
third,
it
also
requires
the
department
of
health
and
human
services
to
establish
a
or,
to
the
extent
that
money
is
available
and
resource
resources
are
available
to
establish
a
data
dashboard
that
allows
for
the
analysis
of
data
related
to
telehealth
access
and
chair
carlton.
A
L
M
Certainly
duane
young
deputy
administrator
for
the
division
of
healthcare,
financing
and
policy
for
the
record.
This
refers
to
what
we
typically
call
before
in
nrs
chapter
422,
store
and
forward,
and
this
is
where
messages
are
left
by
the
medical
provider
for
the
recipient
for
the
recipient
to
use
at
another
part
of
their
appointment.
A
M
Synchronous
and
asynchronous
it
was
the
original
language
in
chapter
422
of
the
nrs
when
telehealth
was
passed
in
session,
store
and
forward
is
the
same.
It's
a
little
bit
more
complicated
in
terms
of
the
provider
leaving
you
detailed
messages
and
instructions
that
are
congruent
with
your
health
plan
are
the
plan
of
care.
M
Deputy
administrator
dwayne
young
for
the
record,
so
not
exactly
so
it
would.
The
asynchronous
communication
is
designed
to
have
to
respond
to
the
specific
care
plan,
and
so
it
would
be
detailed
instruction
from
your
provider
that
would
be
based
off
of
some
visit.
So
it
wouldn't
necessarily
be
you
calling
in
and
saying
this
is
my
issue
and
the
doctor
just
sending
you
a
prescription,
that's
not
billable!
In
the
same
equivalent.
A
M
Deputy
administrator
dwayne
young
for
the
record
and
so
glad
for
the
question
assembly
majority
leader
benitez
thompson,
madam
chair
and
committee,
just
want
to
put
this
on
the
record
and
this
side
of
the
house.
As
I
put
this
on
record
in
the
senate
side,
when
we
originally
marched
down
this
path
during
the
public
health
emergency,
the
cfr
that
governed
hipaa
privacy
was
run
through
the
office
of
civil
rights
through
the
department
of
health
and
human
services,
they
had
originally
interpreted.
M
That's
that
cmr
regarding
hipaa
privacy
to
ban
audio
only
communications
as
well
as
such
modern
technologies
such
as
facetime
zoom,
all
those
others,
and
so
the
cms
then
issued
guidance
at
the
onset
of
the
pandemic,
saying
that
they
were.
They
were
suspending
the
hipaa
rules
in
that
rule
governed
by
the
office
of
civil
rights.
M
They
actually
did
not
have
jurisdiction
to
do
that,
and
so
the
office
of
civil
rights
decided
to
just
not
enforce
those
rules,
and
so
we
as
a
state
because
we
had
language
in
the
nrs
specifically
blocking
out
audio
only
telehealth
as
well,
and
we
were
silent
following
the
federal
rules
in
terms
of
hipaa
privacy.
We
released
additional
guidance
through
kovic,
allowing
these
flexibilities
through
the
relation
of
the
public
health
emergency.
M
M
The
office
of
civil
rights
has
released
new
guidance
that
says,
providers
must
maintain
reasonable
amounts
of
privacy
in
order
for
providers,
but
there
is
no
restriction
or
prohibition
on
audio
only,
and
so
the
only
remaining
prohibition
or
restriction
would
be
that
which
is
governed
in
nrs
chapter
422
for
medicaid
reimbursement,
and
so
that's
what
this
bill
seeks
to
do
is
to
align
us
now,
with
that
new
federal
guidance.
G
Thank
you
and
that's
specific
to
where
we
see
language
throughout
the
bill.
That
says
quote
that,
except
for
services
provided
through
the
audio,
only
interaction,
so
that's
where
that
language
is
coming
from.
As
that
conversation
that
you
just
had
the
that
information,
you
just
had.
M
Yes,
correct
that
provision
of
the
bill
again
dwayne
young,
for
the
record
that
provision
of
the
bill
does
two
things
it
one
allow
introduces
audio
only
into
the
text
after
it's
and
strikes
it
out
where
it's
prohibited
earlier
in
the
bill,
and
then
it
also
has
a
requirement
that,
while
the
division
does
pay
at
parity,
because
our
chapter
requires
telehealth
or
medicaid
to
be
paid
to
pay
payment
parity,
it
does
require
payment
parity
for
audio
only
it
does
not
do
that
and
I
apologize
while
we
have
done
that-
and
we
continue
to
do
that.
M
The
provision
allows
us
the
flexibility
to
not
do
that.
Hence
there
is
no
fiscal
note
for
increased
realization
so
that
if
we
ever
end
up
in
a
crisis
like
we
much
were
last
summer
during
the
special
session
and
we
are
deciding
whether
to
take
away
prosthetics
or
cut
rates,
we
have
levers
within
policy
where
we
could
pay
unequally
between
audio,
only
communications
and
other
telehealth
visits.
If
the
division
needed
to
do
that
to
make
itself
solve.
G
All
of
those
sunset
when
the
public
health
emergency
ends-
and
I
think
what
I
see
from
cms
is
that
they
are
doing
some
conscious
thought
around
studying
the
economics
of
this
the
modalities
of
this
and
then
the
patient
specific
patient
interaction
such
as
does
this
make
sense
for
an
initial
visit.
Does
this
make
sense
for
follow-up?
G
But
I
guess
I
don't
see
something
across
the
board
that
says
that
we
have
the
data
and
the
research
to,
and
I
guess
I'm
getting
more
into
the
commercial
insurance
part
of
this
versus
the
medicaid
piece
to
say
this
is
how
we're
going
forward
across
across
the
the
continuum
of
care,
and
so
I
guess,
do
we
see
them
as
saying
something
differently.
Are
they
do?
G
You've
got
time
increments
that
you
can
bill
in,
and
I
guess
you
know
they're
looking
at
you
know
the
what
would
be
the
standard
inpatient
time
increment
that
people
can
bill
for
whether
it's
15
minutes
or
whatever
versus,
if
you're
doing
something
in
telehealth.
That
might
be
seven
or
eight
minutes.
So
are
we
going
to
end
up
in
you
know
overpaying,
because
we
don't
understand
the
the
economics
of
the
modality
in
which
and
the
difference
between
telehealth
versus
an
inpatient
one.
But
is
there
more
data
out
there
to
help
us
understand
that.
M
Dwayne
young,
a
deputy
administrator
for
the
division
for
the
question.
I
don't
chair
through
you
to
the
majority
leader,
assemblywoman
benitez
thompson,
I'm
so
grateful.
You
actually
asked
that
question
because
it
does
allow
me
to
clear
up
clarify
just
some
additional
statements.
The
statements
I've
made
yes
have
pertained
to
medicaid
with
medicare.
What
you
will
see
is
some
national
legislation
moving
forward
to
define
better
parameters
through
medicare
for
telehealth.
M
Many
of
the
prohibitions
that
are
existent
within
federal
regulations
and
federal
statute
are
actually
applied
to
medicare
and
not
medicaid,
and
so
what
you
will
see
is,
and
that
will
have
an
impact
that
will
trickle
down
to
commercial
plans
because
of
those
medicare
advantage
plans
that
are
run
through
commercial
providers,
and
so
you
will
see
you're
seeing
some
movement
in
federal
legislation
to
really
define
further
parameters.
M
M
Medicaid
has
been
the
nation's
leader
in
telehealth
as
far
as
the
open-endedness
of
its
policies
and
that's
really
built
because
of
our
rural
and
frontier
areas
were
certainly
reliant
on
telehealth,
and
so
we
had
a
very
open
policy
that
allowed
services
as
long
as
they
met
medical
necessity
and
need
and
were
performed
to
the
same
same
standard
and
quality
as
care
as
in-person
services
could
be
performed
via
telehealth,
and
so
one
of
the
things
that
we
are
doing
as
a
state
is
participating
in
the
western
states
compact,
and
we
are
doing
a
study
with
other
states
to
study
this
study
this
within
medicaid.
M
And
how
does
that
translate
to
the
other
markets?
How
does
that
translate
across
other
payers
and
understanding,
first
and
foremost,
that
the
decision
from
telehealth
should
be
a
decision
between
the
patient
and
the
provider?
Patients
shouldn't
be
driven
there
as
a
cost
savings
measure,
but
really
one
out
of
necessity
to
get
them
their
needs
met
and
their
treatment.
Certainly
in
areas
where
there
are
no
providers,
but
also
it
should
have
a
reasonable
standard
of
care.
M
That
applies
that
medical
necessity
and
meets
the
qualifications
of
whatever
cpt
code
that
is
being
performed,
and
so
we
as
a
state
will
continue
to
study
this
in
the
western
states
compact.
You
will
continue
to
see
movement
at
the
federal
level
addressing
medicare
and
the
medicare
advantage
plans,
and
I
think
you
will
see
that
trickle
down
to
the
commercial
plan.
G
Thank
you
so
much
as
I
see
it
and
I'm
looking
at
the
back
half
of
the
bill,
because
the
front
half
is
dealing
with
medicaid,
but
the
back
half
is
in.
I
think
the
commercial,
the
commercial
chapters
isn't
that
right.
So
we
understand
that
there's
been
and
that's
what
the
data
has
shown
us
from
2015
to
2019.
G
Populations
that
are
that
are
rural,
where
you
might
have
an
insufficient
supply
of
medical
providers.
Some
behavioral
health
stuff,
like
those
have
been
studied,
really
really.
Well.
I
guess.
When
can
we
talk
a
little
bit
more
about
when
we
we
broaden
it,
and
we
put
the
the
concept,
this
concept
of
payment
parity
into
the
commercial
insurance
chapters?
And
I
don't
expect
mr
young?
G
L
L
L
The
amendment
also
required
an
exception
for
behavioral
health
services.
If
that
expiration
date
is
before
june,
30th
2022
in
this
case,
behavioral
health
services
provided
through
telehealth,
will
continue
to
be
reimbursed
at
the
same
rate
as
in-person
services
until
june
30th
2023.
G
And
on
the
commercial
side,
that's
all
services.
So
once
again,
when
I
look
at
cms-
and
I
look
at
things-
they're
exploring
that's
surgical,
that's
onboarding!
So
hypothetically
you
could
have
a
patient
go
through
quite
a
bit
of
the
continuum
of
care
completely
through
telehealth
and
and
and
there
would
be
that
financial
incentive
to
do
that.
A
Okay
with
that
other
questions
at
this
time
there
I
did
have
one
more
and
I
just
wanted
to
make
sure
that
I
understood
it,
that
the
initial
visit
can
be
set
up
through
telehealth.
Is
that
only
during
the
public
health
emergency,
or
is
that
ongoing
language?
All
the
way
through
we've
had
a
number
of
discussions
about
that
in
different
bills.
This
session,
relating
to
all
different
types
of
talk
topics,
so,
is
that
initial
visit
through
telehealth
that
limited
time
or
is
it
fully
extended.
M
Deputy
administrator
dwayne
for
the
record,
the
initial
visit,
and
it
really
depends
upon
the
service,
but
if
it
is
a
primary
care,
initial
visit,
most
behavioral
health
initial
visits
that
can
be
established
through
telehealth,
where
we
have
had
a
divergent
discussion
is
when
we
are
introducing
someone
into
opioid,
assisted
medication,
assisted
treatment
and
so
how
to
handle.
That
initial
visit
has
a
different
set
of
guidance,
but
that
initial
visit,
whether
through
telehealth
or
initiated
in
person,
that
choice
has
always
been
available
in
nevada,
medicaid.
A
J
Thank
you,
madam
chair.
I'm,
mr
young,
thank
you
for
being
here.
Thank
you,
the
the
presentation.
I
definitely
I
still
have
some
concerns
about
the
process
of
audio.
J
Only,
and
would
you
clarify
because
out
in
the
rules
most
folks
don't
have
that
smartphone
or
if
they
do,
it
doesn't
always
work
in
their
home
or
in
their
community,
and
I've
been
reading
through
where
clarifies
because
it's
a
pay
issue,
whether
they
get
the
the
provider
gets
reimbursed
for
the
audio
only
and
I'm
seeing
that
they
would,
but
it
can
it
be
the
old-fashioned
dial-up
phone
still,
so
it
doesn't
have
to
be
a
smartphone
where
they
can
interact.
J
It
could
be
the
old
dial
phone
which
we
still
have
in
my
community,
and
some
people
still
know
how
to
use
it.
Well,
they
get
reimbursed
for
that.
M
Dwayne
young
for
the
record,
madam
chair,
through
you
to
the
assembly
minority
leader,
dr
titus.
Yes,
the
language
originally
in
chapter
422
that
was
struck
that
has
been
struck
out
by
this
build
replied
to
standard
telephone,
but
audio
only
is
just
a
better
term
to
encompass
that,
so
it
doesn't
have
to
be
a
smartphone.
It
can
be
your
standard
landline
that
that
visit
can
occur
through
as
long
as
the
provider
can
establish
some
reasonable
privacy
as
a
way
to
assuring
that
that
patient
is
able
to
speak
free.
J
Well,
just
so
you
know
I'll.
Thank
you
follow
up
on
that
one,
madam
chair,
mr
just
so
you
know
on
the
rules.
We
don't
have
to
use
that
community
phone
where
we
say
hey
maggie.
No
sorry
I
didn't
mean
to
use
that
reference,
but
hey
barbara.
Would
you
just
dial
in
4-1-1
for
me
and
get
that
next
person
down
the
line
that
everybody
in
the
town
would
listen?
We
don't
do
that
anymore,
even
in
my
town,
so
thank
you.
Hopefully
we
can
establish
privacy.
Thank
you,
sir.
A
And
thank
you,
dr
titus.
If
I
could
just
have
one
one
brief
brief
follow-up
in
the
conversation
in
in
thinking
about
what
the
majority
leader
was
asking
and
I'm
thinking
about
some
of
the
seniors
that
I
know
of
and
some
folks
that
may
not
be
technologically
savvy,
I
mean
I
still
have
to
have.
People
show
me
how
to
do
a
lot
of
different
things.
Thank
goodness,
I
have
a
very
young
executive
director
where
I
work
that
can
make
sure
when
I
break
my
computer,
she
can
put
it
back
online
for
me.
A
Are
we
gonna
on
the
commercial
side?
Are
we
going
to
be
forcing
people
to
do
telehealth?
Will
they
still
have
an
option
to
go
in?
Are
they
going
to
be
told
that
they
have
to
do
this
and
what
happens
when
they?
They
can't
figure
out
how
to
do
it
with
the
audio?
Only
even
so
I
I
would
just
hate
to
see
folks
be
told.
A
This
is
the
only
way
you
can
access
your
health
care.
So
if
somebody
could
address
that,
because
I
can
think
of
some
of
my
seniors
they're
not
going
to
want
to
talk
to
some
stranger
on
the
phone
that
they
have
no
idea
who
they're
talking
to
they
want
to
look
that
person
in
eye
to
eye
and
and
and
know
what's
going
on.
So
I'm
just
kind
of
curious
about
that.
L
Sure,
thank
you
so
much
tara,
carlton
sarah
schulhagen
for
the
record.
I
can
tell
you
that
the
intent
behind
this
request
was
really
to
encourage
providers
to
use
virtual
care
alternatives
as
a
way
to
increase
access
to
care.
There
wasn't
a
dialogue
in
switching
saying
that
this
would
take
precedent
over
in
person.
It's
really
allowing
for
greater
access
and
a
another
alternative
way
for
them
to
provide
care
to
all
of
their
patients.
That
specific
question
related
to
providers,
then
using
telehealth
services,
as
our
primary
point
of
care
was
not
something
that
was
discussed.
L
A
Okay-
and
I
would
just
hate
to
see
folks
go
the
other
way
and
not
allow
people
to
make
that
appointment
and
go
in
so
I'm
just
putting
that
that
on
the
the
record
right
now,
I
understand,
during
the
pandemic
and
with
the
health
care
crisis,
we
needed
to
figure
out
how
to
get
things
done.
A
But
there's
something
about
sitting
in
the
chair
across
the
table
from
each
other
in
an
exam
room
that
the
primary
care,
physician
or
provider
can
probably
get
a
lot
more
from
a
person
just
by
looking
at
them
and
having
that
conversation
than
just
by
having
a
phone
call
with
them.
So
majority
leader.
G
G
You
know
through
research,
on
their
website
that
they
cite
one
clinic
in
oregon
that
went
from
a
total
of
1500
telehealth
visits
in
a
year
to
like
you,
know,
20
000
in
a
month
right
or
sorry,
like
15
000,
that
much
in
one
month,
and
they
don't
understand
the
economics
of
it.
So
if
it
costs,
if
a
provider
is
going
to
be
reimbursed
just
as
much
for
a
television
as
they
are
for
an
inpatient
visit
across
the
spectrum
for
every
intersection
of
care
and
every
point
of
care,
then
how
do
the?
G
How
does
that
affect
health
care,
economics
and
it's
something
we're
always
talking
about?
But
if
with
the
telehealth,
you
don't
have
a
brick
and
mortar
component,
like
you
do
when
you
have
the
inpatient,
and
so
anyone
who
is
in
for-profit
health
care,
will
pencil
this
out
and
will
realize
that
there's
a
financial
incentive
for
their
bottom
line
to
push
more
and
make
sure
they
have
heavy
services
on
telehealth
and,
as
you
know,
I
just
wonder
if
we
are
really
seeing
how
that's
going
to
look,
and
so
that's
why?
G
For
the
private
insurance
side,
I'm
so
concerned
about
this,
because
I
just
you
know
they
cms
has
put
certain
provisions
in
place
specific
to
the
the
health
care
emergency.
Saying
like
this
is
how
we
have
to
pivot.
This
is
urgent,
but
they're
also
saying
full
well,
we
are
going
to
be
looking
at
this
and
studying
at
this.
I
think
that
within
a
year
and
a
half
cms
is
going
to
come
back
and
say:
we've
been
collecting
all
of
this
data.
G
We
know
better
now
where
we,
where
we
want
these
intersections,
to
be
happening
where
data
and
evidence
tells
us
that
it's
happening
the
most
effectively
and
the
most
efficiently
and
then
move
forward
with
plans.
But
with
us
extending
one
year
past
the
end
of
the
health
emergency,
it
we're
going
to
be
out
of
line.
So
if
we,
if
we're
making
decisions-
and
we
say
we
want
them
based
on
evidence
and
science-
I
just
want
to
make
sure
we're
acknowledging
it.
We
don't
have
it
for
that
piece.
Yet.
L
Absolutely
thank
you
so
much
chair,
carlton,
sarah
hagian,
for
the
record
through
you
to
assemblywoman
benitez
thompson.
I
really
appreciate
this
dialogue
and
your
desire
to
make
sure
that
this
is
following
the
intent
of
what
the
commission
wanted
in
the
spirit
and
the
discussion
that
the
commission
had
when
they
were
thinking
about.
This
measure
was
really
around
increasing
access
to
patient
care
for
the
long-term
recovery,
recognizing
that
you
have
seen.
L
Data
driven
pieces
of
access
for
patients,
utilizing
health
care
in
tremendous
numbers
via
telehealth
and
saying
this
is
a
new
normal
and
we
want
to
make
sure
patients
have
continued
access
to
care.
There
were
some
other
parameters
put
in
that
discussion.
For
instance,
the
audio
only
provision
there
was
a
carve
out
to
to
recognize
that
you
want
that
as
an
allowable
modality,
but
there
isn't
payment
parity
for
audio,
only
interactions
and
those
are
some
of
the
safeguards
that
were
discussed
with
the
commission
and
a
part
of
this
request.
L
But
I
do
appreciate
your
perspective
and
desire
to
make
sure
that
it's
good
public
policy
and
making
sure
it
aligns
with
continued
access
for
for
patients
increased
access
for
patients.
So,
thank
you
so
much
and
thank
you.
A
Majority
leader
and
thank
you,
michelle
hagin
and
as
you
started
at
the
very
beginning,
there
isn't
an
actual
fiscal
note,
but,
as
we've
had
this
discussion,
you
can
see
what
the
possible
fiscal
impacts
could
be
to
the
state
and
everyone
else
as
this
would
move
forward.
So
we
thought
it
would
be
very
important
because
when
we
deal
with
pub
and
medicaid
medicaid
one
being
one
of
the
biggest
components
of
our
budget,
knowing
where
we
could
possibly
be
with
that
a
couple
years
down
the
road
having
this
conversation,
I
think
is-
is
very
valuable.
A
Not
not
every
fiscal
note
points
in
one
direction
and
not
every
bill
doesn't
have
a
fiscal
impact
over
the
long
run.
So
we
always
wanted
to
make
sure
have
the
conversation.
I
don't
see
any
other
questions
from
any
other
committee
members
at
this
time.
So
with
that
this
is
the
hearing,
so
we'll
go
ahead
and
open
it
up
on
sb5
for
those
is
there
anyone
in
the
room
here
in
support
of
sb5,
not
seeing
anyone
come
forward?
A
H
H
C
H
C
A
A
Thank
you
very
much
so
with
that.
I
believe
we
can
close
the
I'll
miss
you
in
any
closing
comments.
Thank
you
very
much
for
being
here
today
and
having
the
conversation.
We
do
really
appreciate
it.
So,
with
that
we'll
go
ahead
and
close
the
hearing
on
sb5
and
I'll
go
ahead
and
invite
the
chair
of
health
and
human
services
up,
I
think
we'll
do
sb,
154
next
and
and
just
for
my
my
colleagues
on
the
the
second
floor.
There's
there's
no
reason
to
be
in
the
room,
the
whole
time.
A
I
know
we
all
have
other
things
to
do.
We
can
make
sure
to
give
you
a
heads
up
so
that
you
can
make
it
from
the
second
to
third
floor,
so
we'll
we'll
try
to
get
through
as
many
of
these
and
for
those
who
weren't
here
at
the
very
beginning,
the
ones
that
we
don't
get
through
today
will
be
automatically
rolled
until
tomorrow.
We
just
like
to
stack
a
day
so
that
we
can
get
through
as
many
as
possible,
knowing
some
people
will
pull
them
if
they're
not
ready.
K
You,
madam
chair,
I
appreciate
the
opportunity
this
I
dare
I
say
it:
julia
ready
from
senate
district
13.
Dare
I
say
it?
This
is
a
relatively
straightforward.
I
won't
call
it
simple
bill,
but
it
is
an
incredibly
important
bill
when
it
comes
to
making
sure
that
we
are
meeting
the
needs
of
nevadans
when
it
comes
to
behavioral
health.
K
So
I
want
to
introduce
you
to
a
term
that
is
not
my
favorite
term,
but
it
is
the
institution
for
mental
disease.
This
is
a
federal
term
and
imds
are
agencies
that
serve
individuals
with
serious
mental
illness
or
substance
use
disorder
and
as
a
throwback
to
a
prior
time
when
we
were
trying
to
make
sure
that
we
didn't
have
too
many
people
sitting
in
institutions.
K
It
allows
the
state
to
apply
for
a
medicaid
waiver
and
if
we
can
demonstrate
that
there
is
cost
savings,
then
these
agencies
that
provide
services
to
people
again,
there's
two
different
components
to
the
waiver:
one
for
seriously
mental
ill,
mentally
ill
and
the
other
for
substance
use
disorder.
If
we
can
demonstrate
savings
within
the
medicaid
program,
then,
and
and
that
savings
needs
to
be
demonstrated,
which
is
typical
for
medicaid
waivers
over
a
five-year
period,
then
we
can
have
a
waiver
to
that
and
we
would
be
able
to
have
these
agencies
start
billing
medicaid
for
services.
K
There
would
be
an
odds,
a
cost,
setting
a
cost
saving
associated
with
that
because
what's
happening
now,
of
course,
is
that
folks
don't
get
care
they
escalate
and
they
become
very
expensive
parts
of
our
medicaid
system.
So
with
that
I
have
the
so
the
process
is
we
have
to
pass
this
bill.
Then
we
have
to
do
the
cms
approval
process
and
then
there
will
be
more
beds
for
people
in
our
communities.
That's
the
that's
a
very,
very
significant
oversimplification
of
a
medicaid
waiver
process.
K
With
regards
to
the
fiscal
note,
there
is
a
49
000
impact
to
stand
up
the
process
in
fiscal
year,
2021
22
and
then
anticipated
savings
of
140
000
in
the
second
year.
So
the
savings
in
the
second
year
offset
the
costs
in
the
first
year
and
with
that
I'll,
keep
it
brief
for
you
and
just
stand
for
questions
and,
of
course,
dwayne
young
is
here
to
talk
about
any
fiscal
aspects
for
medicaid
and
dr
woodard
is
here
to
talk
about
any
of
the
behavioral
health
benefits
that
would
come
with
the
imd
waiver.
A
And
thank
you
very
much
and
I
always
found
that
term
kind
of
uncomfortable,
also
it
just
harkens
back
to
a
very
long
time
ago.
So,
committee
members,
are
there
any
questions
of
the
senator
on
either
the
the
overarching
goal
of
the
bill
and
or
the
fiscal
note
that
is
attached
to
the
bill
at
this
time.
A
A
Not
seeing?
Yes,
please
go
ahead,
come
forward.
G
H
C
A
A
K
Julia
ready,
it's
just
gratitude.
I
want
to
make
sure
that
there's
recognition
for
the
nevada
psychiatric
association
and
dr
woodard,
and
and
literally
thousands
of
behavioral
health
and
mental
health
advocates
at
the
national
level,
who
really
pushed
it
for
cms
and
at
the
state
level
we've
been
working
on
this
for
about
a
decade,
I'm
just
lucky
enough
to
be
hopefully
sitting
in
the
seat
when
we
get
it
done.
Thank
you.
Thank.
N
N
This
bill
is
about
step
exceptions
and
for
cancer
and
approximately
16
700
970
new
cancer
cases
will
be
diagnosed
in
nevada
this
year
and
we
are
above
the
national
average
in
cancer
and
people
face
tremendous
financial
burdens
when
they
get
cancer
for
the
medicines
they
have
to
take
and
the
care
that
they
need
to
get
better.
N
Generally,
health
insurers
use
step
therapy
to
lower
the
cost.
I'm
going
to
give
you
an
example
of
step
therapy.
I
think
the
easiest
way
to
understand
it
is
through
an
example
because
it's
very
complex
health
insurance
companies
use
step
therapy
programs
to
lower
their
costs,
and
so,
for
instance,
if
you
had
cancer,
you
went
to
the
doctor
and
you
were
diagnosed
with
cancer.
N
Under
the
step
therapy
protocols
by
insurance
companies,
you
would
be
required
to
take
a
step
one
medicine,
even
if
you
were
diagnosed
with
a
step,
four
cancer
diagnosis,
and
then
you,
if
that
didn't
work
and
it
didn't
meet
your
needs.
They'd
move
you
to
a
step
two
and
on
to
a
step
three
or
a
step.
Four,
under
my
bill,
it's
called
a
step
exception
therapy.
N
Six
months
or
generally,
the
average
time
period
is
four
years,
so
I
think
that
this
will
be
a
really
great
opportunity
for
not
only
those
people
that
are
facing
what
could
be
death
to
have
an
opportunity
to
have
a
life,
and
so,
as
far
as
the
fiscal
note
goes,
when
it
came
out
of
the
senate,
it
had
no
fiscal
notes.
Tara
carlton
and
rightly
said
it.
It
didn't
include
medicaid
patients.
N
The
reason
I
didn't
include
medicaid
patients
in
my
build
this
year
is
because
I
knew
our
state
coming
out
of
the
pandemic.
Didn't
have
a
lot
of
funds,
and
I
wanted
to
make
sure
that
we
got
a
start
with
this
bill
and
then
my
intention
was
to
expand
it
in
a
couple
years.
When
I
was
hopeful
that
we,
our
state,
would
be
in
a
different
financial
situation.
I
am
you
know
if
we
could
add
medicaid
patients
earlier.
A
N
And
chair
carlton,
if
I
may
initially
when
the
bill
came
out
of
the
senate,
we
did
not
have
a
fiscal
note
for
pub
the
bill
in
its
original
form.
Had
no
fiscal
note
the
then
we
made
some
changes
because
clark
county
had
asked
for
an
exception,
and
so
we
made
some
changes
and
then
later
found
out
that
we
didn't
need
to
make
those
changes.
So
we
put
the
bill
back
in
its
original
form
and
as
the
bill
came
over
to
the
assembly,
it
picked
up
the
fiscal
note
from
pub.
A
Okay
and
that
fiscal
note
from
pub
is
seven
hundred
and
thirteen
thousand
dollars
is
my
understanding.
So
we
have
the
document
here.
Thank
you
very
much
so
with
that
there
was
a
conversation
in
commerce
and
labor
about
including
medicaid
patients
and
the
the
senator
was
gracious
enough
to
allow
us
to
have
that
conversation.
A
Knowing
the
the
philosophy
of
a
lot
of
us
in
this
building
that,
if
we're
going
to
provide
treatment
for
folks,
we
want
to
make
sure
whether
you
access
it
through
medicaid,
self-insurance,
private
insurance
and
the
health
and
welfare
trust
that
all
cancer
patients
are
treated
equally.
So
I'm
really
glad
that
mr
young
is
here
so
if
we
could
have
a
conversation
about,
I
know
I've
had
a
few
offline
conversations
with
folks
about
the
step
therapy.
A
If
I
remember
correctly,
as
far
as
northern
nevada
goes,
this
is
not
implemented
there,
so
it
wouldn't
necessarily
have
an
impact
there,
but
I
do
believe
it
does
have
an
impact
on
the
medicaid
h
providers
in
in
southern
nevada,
because
it's
through
an
hmo
model.
So,
mr
young,
do
you
have
any
numbers
for
us
as
far
as
what
what
type
of
fiscal
impact
this
would
have
on
medicaid
if
we
included
medicaid
in
this
bill.
M
Dwayne,
young,
deputy
administrator
of
division
of
healthcare,
financing
and
policy
for
the
record.
You
may
allow
me
just
30
seconds
to
just
clarify
and
set
up
our
fiscal
note.
Then
I
will
walk
immediately
into
the
numbers.
I
did
just
want
to
clarify
on
the
record
that
this
does
impact
those
within
the
north
and
the
south
as
managed
care
has
expanded
to
washoe
and
clark
county.
M
There's
would
be
no
impact
to
fee
for
service,
so
certainly
those
residents
within
our
rural
and
frontier
counties,
as
well
as
those
who
are
in
the
traditionally
aged
blind,
medically,
aged
blind
and
disabled
category,
as
well
as
the
waivers
are
contained
within
fee
for
service.
So
this
would
have
no
impact
on
this,
just
those
that
are
within
our
newly
eligible
aid
categories
in
those
two
counties.
The
division
comprised
a
fiscal
note
that
looked
at
the
total
computable
across
fiscal
years,
202
and
three,
because
there's
some
overlap
within
the
years.
M
Just
for
this
committee's
information,
this
note
was
estimated
very
much
in
the
same
manner
that
pebb
did
it
was.
It
was
a
bit
difficult.
We
did
receive
calculations
from
our
largest
mco.
One
mco
did
not
reply
and
the
other
did
not
feel
that
the
provisions
of
the
bill
met
to
them.
We
did
not
agree
with
that
assessment,
and
so
we
aggregated
this
note
across
the
data
of
our
actual
membership
of
our
current
plans.
I
say
this
with
a
caveat.
M
As
you
are
aware,
we
are
going
out
to
rfp
and
the
composition
of
our
mcos
plans
could
certainly
change
in
2022
as
part
of
that
rfp.
There
is
a
provision
that
the
contracts
are
bidding
on
that
calls
for
in
calendar
year,
2023
a
unified
pdl,
which
would
fix
this
problem
in
medicaid,
as
they
would
have
to
follow
the
same
preferred
drug
list,
and
this
calculus
note
is
calculated
off
the
acceptance
of
non-preferred
drugs
over
preferred
drugs.
So
with
that
said,
we
have
provided
to
ms
kaufman
this
data.
M
We
are
looking
at
a
roughly
750
000
in
each
year
of
the
biennium
and
so
a
total
general
fund
contribution
of
1.5
million
over
the
two
years
of
the
biennium.
There
is
no
county
fund
impacts
because
again,
as
I
have
mentioned
earlier,
the
county
waiver
recipients
aren't
fee
for
services,
there's
no
impact
to
the
county
obligation.
This
would
be
purely
general
fund.
A
M
Yes,
it
would
the
total
computable
obligation
again
dwayne
young
for
the
record.
The
total
computable
obligation
would
be
10
million
over
the
biennium
because
of
the
the
varying
reimbursement.
M
A
A
K
L
K
C
C
L
N
Ladder,
thank
you
assemblywoman
for
the
question.
I
think
that's
part
of
the
problem
in
trying
to
figure
out
what
the
fiscal
note
is,
because
we're
not
looking
at
all
cancer
patients
we're
only
looking
at
the
cancer
patients
that
go
to
the
doctor.
I
go
to
the
doctor
today
and
I'm
diagnosed
with
stage
three
or
four.
That's
when
I
would
jump
and
ask
with
my
physician
jump
to
the
stage
three
or
four
those
people
that
go
to
the
doctor
and
they
have
stage
one
would
automatically
go
on
a
stage
one
medicine.
N
If
that
didn't
work,
then
they
put
them
on
and
they
go
through
the
progression.
We're
only
talking
about
the
group
of
people
that
go
to
the
doctor
and
are
initially
diagnosed
with
the
stage
three
or
four
and
need
to
get
to
that
medicine
right
away
without
having
to
go
through
the
current
protocols
that
the
insurance
companies
have.
I
hope
that
answers
your
question.
I.
C
N
So
right
and
I'd
also
say
the
reason
the
insurance
companies
do.
The
steps
is
because
it
saves
them
money
when
you
get
to
the
stage
three
and
four
medications
they're
very
expensive,
which
is
why
we
put
into
the
bill.
If
someone
is
is
gets
to
jump
to
a
stage.
Three
they'd
only
get
a
one
week's
worth
of
prescriptions,
because
sometimes
people's
systems
don't
allow
them
to
take
that
medicine.
It's
so
expensive.
N
F
Thank
you,
madam
chair,
and
so
in
my
understanding
does
this:
does
this
legislation
bypass
the
appeal
process
or
or
attempt
to
eliminate
the
appeal
process.
N
Thank
you.
Some
women
love
it.
No,
it
does
not
so
in
in
my
legislation,
if
you
went
to
the
doctor-
and
you
were
diagnosed
with
the
stage
three
or
four
cancer,
your
doctor-
and
you
could
appeal
to
the
insurance
company
to
be
able
to
jump
steps
one
and
two
and
go
right
to
the
three
or
four
medicine.
F
I
F
Chair,
I
guess
I'm
trying
to
see
the
I'm
trying
to
see
the
benefit.
You
know
having
a
mother
that
passed
away
of
cancer
and
and
and
passed
away
three
months
after
she
was
diagnosed,
an
appeal
process
would
do
her
no
good,
and
so
I'm
trying
to
figure
out
how
that
logistically.
N
F
N
Thank
you
for
that
clarifying
question.
So
if,
if
I
went
to
the
doctor-
and
I
was
diagnosed
with
the
three
or
four
cancer-
the
appeal
process-
the
insurance
com
insurance
company
has
72
hours
to
respond
to
you
once
you
submit
all
of
your
documents,
and
I
too
had
a
father
that
passed
away
of
cancer.
N
They
said
he
was
trying
to
get
those
medicines.
He
was
48
years
old.
They
told
him.
He
wasn't
sick
enough.
He
passed
away
six
months
later.
So
I
think
this
is
really
important
legislation
to
make
sure
people
that
are
diagnosed
with
step.
Three
or
four
cancer
have
the
opportunity
to
get
the
medicines
that
they
need
so
that
they
can
go
on
and
live
a
life.
A
And
thank
you
I'll
go
to
dr
titus,
but
I
want
everyone
to
keep
in
mind
that
we
are
on
the
clock
and
we
do
have
a
time
certain
to
get
downstairs
and
I
want
to
make
sure
that
we
open
it
up
for
public
comment.
We've
gotten
a
lot
of
information,
we'll
allow
more
latitude
when
we
do
get
to
work
session
on
this.
If
there
are
any
unanswered
questions,
but
we
are
on
a
clock,
dr
titus.
J
Thank
you,
madam
chair.
Just
a
quick
question,
then,
for
me,
it
seems
like
this
bill
is,
is
bringing
forward
some
common
sense
legislation
in
that
it
should
always
be
up
to
your
provider
and
the
patient
on
what
the
best
treatment
is
and
if
we
could
can
alleviate
that
step
that
forces
all
the
prior
authorizations
that
then
delays
care.
It
just
makes
good
sense
to
get
the
treatment
as
expeditious
as
possible
without
having
to
ask
so
much
permission.
J
So
you
know
hopefully,
that
it
will
maybe
clarify
that
in
the
language
that
these
you
know
it
doesn't
prevent
the
doctor
from
using
stage.
You
know
the
first
tier,
if
indeed
that's
appropriate,
but
if
they
at
the
point
based
on
their
medical
education
and
the
patient
sitting
there
looking
at
them,
they
could
go
right
to
stage
four
treatment
or
tier
four,
if
indeed,
that
was
the
most
appropriate
for
that
patient
when
they
walk
when
they
make
that
health
care
decision.
So
hopefully
that
that's
where
you're
going
with
this
an
expeditious
treatment.
N
N
A
And
thank
you,
dr
titus,
and
with
that
committee
members,
I'd
like
to
go
ahead
and
get
to
support
opposition
in
neutral
so
that
we
can
complete
the
hearing
process
and
and
then,
if
there
is
other
questions
or
conversation,
I
am
sure
that
the
senator
will
be
available
and
we
are
investigating
the
the
cost.
As
far
as
it
goes,
there
was
a
fiscal
note
for
pebb.
Do
we
have
someone
from
pebb
available
to
address
that
fiscal
note
at
this
time?
B
Thank
you,
madam
chair.
I
am
laura
rich
executive
officer
of
the
public
employees
benefits
program.
I
I
do
want
to
put
on
the
record
that
we
do
have
a
713
000
fiscal
note
per
year,
as
you
had
mentioned.
The
issue
here
is
not.
I
want
to
clarify
again,
I'm
not
a
I'm,
not
a
pharmacy
expert
from,
but
from
the
conversations
that
I've
had
from
our
or
with
our
pharmacy
benefit
managers.
B
The
the
issue
here
is
not
the
stages
of
cancer.
It's
formulary
versus
non-formulary.
So
if
a
cancer
patient
is,
you
know,
is
diagnosed
and
is
in
is
provided
a
prescription
drug
by
their
by
their
provider
that
prescription
drug
is
potentially
not
on
the
formulary.
It
is
not
on
the
the
the
pbm's
formulary
and
there's
a
an
alternative
which
is
on
the
formulary,
and
so
what
the
pbm
does
in
these
cases
is
requires
the
the
patient
to
try
that
formulary
drug
before
the
more
expensive
non-formulary
drug,
and
so
there
is
a
there's,
an
appeal
process.
B
If
you
know
the
provider
does
not
think
that
that
alternative
drug
is
not
appropriate,
they
do
have
an
appeal
process
in
place
where
that
can
take
place
in
discussions,
I
had
asked
our
pbm
how
many
folks,
actually
when
they
get
this
alternative,
less
expensive
drug,
how
many
stick
with
the
less
expensive
drug
and
how
many
go
to
the
original
drug
that
was
prescribed
and
about
80
percent
of
them
do
stick
with
that
less
expensive
drug.
It
works
for
them,
rather
than
going
back
to
that
the
non-formulary
drug.
A
And
thank
you
very
much.
We
appreciate
you
being
here
to
answer
that
question.
I
I
believe,
that's
probably
true
whether
it's
one
two
or
three
anywhere
in
the
continuum
of
this.
That
would
be
the
same
argument.
So
I
believe
you
would
have
the
same
issue,
no
matter
what
the
diagnosis
and
what
the
drug
was.
That's
just
that
natural
tension
between
provider
and
formulary
so,
but
in
in
looking
at
this
in
the
number
of
patients
that
may
possibly
impact
that's
how
you
derive
the
number
of
713
thousand
dollars
per
year,.
B
A
A
Second,
so
miss
rich.
Here's,
the
60
000
question
for
no,
it's
actually
713
000
question.
Would
you
be
able
to
absorb
this
within
your
reserves
at
this
time,
or
would
this
need
a
general
fund
appropriation
and
I'd
like
to
discuss
that
for
both
years?
It's
not
one
for
all
if
you
could
absorb
it
the
first
year
and
need
the
general
fund
appropriation
for
the
second
year,
if
you
can't
answer
that
at
this
moment
in
time,
not
sideswiping,
you
just
want
to
make
sure
you
know
where
the
question's
coming
from.
B
Laura
rich
for
the
record:
that's
actually
the
30
million
dollar
question
we
do.
We
have
because
of
coveted
suppression
where
people
have
just
not
been
going
to
see
the
providers
they
haven't
been
going
to
see
the
doctor
they
haven't.
Their
people
have
not
been
able
to
seek
services
in
the
last
year,
and
so
we've
had
we've
had
claim
suppression,
so
pebb
does
have
a
significant
bucket
of
reserves
at
this
time.
B
How
much
of
those
reserves
are
we
going
to
use?
You
know,
that's
that's
the
question
that
we,
just
we
don't
know.
We've
we
you
know
covet
is
an
anomaly.
We
didn't
expect
to
have
30
million
dollars
of
access.
You
know,
as
of
we
didn't
expect
to
have
any
excess
as
of
last
year
and
so
now
we're
dealing
with
a
30
million
dollar
access
bucket,
but
I
see
that
as
a
temporary
excess
versus
a
you
know
something
that
we
have
to
draw
down.
So
it's
hard
to
answer
that
question
is
my
answer
to
that.
A
A
We
understand
where
utilization
was,
where
utilization
might
go,
we're
not
looking
at
five
or
ten
million
dollars,
we're
looking
at
seven
hundred
and
thirteen
thousand
dollars
in
each
year,
which
really
is
like
as
a
very
small
bump
in
the
road
for
a
plan
the
size
of
pep,
so
we'll
have
future
conversations
about
it
and
make
sure
that
we
can
do
something
that
we
believe
will
be
very
responsible,
moving
forward
to
not
cause
any
harm
in
the
long
run.
So
thank
you
very
much.
We
appreciate
you
being
here
so
with
that.
A
I
think
we
need
to
go
ahead
and
open
it
up
for
support
opposition
and
neutral
senator
if
you
would
go
ahead
and
step
back.
Thank
you
very
much.
We
appreciate
that
so
anyone
in
the
room
in
support
of
sb
290
and
for
those
others
in
the
room
right
now,
since
we
have
a
time
certain,
we
have
to
go
there'll
be
no
more
bill
hearings.
H
H
F
H
C
A
Thank
you
very
much,
miss
martinez
next
caller
and
support.
Please.
A
A
N
Just
one
quick
comment
chair,
thank
you
so
much.
I
think
this
is
really
important
for
people
that
are
diagnosed
and
I
just
want
to
make
sure
that
everyone
understands
we're
only
talking
about
the
people
that
are
diagnosed
stage,
3
and
4,
not
all
cancer
patients,
because,
if
you're
diagnosed
with
one
or
two
you
go
through
the
step
protocols
already
by
the
insurance
company.
So
we're
talking
about
just
a
step
three
and
four,
and
thank
you
so
much
and
I
look
forward
to
you
supporting
the
bill.
A
Thank
you
very
much
senator
so
with
that
we'll
go
ahead
and
close
the
hearing
on
sb
290.
There
are
future
conversations
that
are
going
to
have
to
happen
and,
as
I
said
earlier,
because
we
did
kind
of
go
through
this
one
quickly
if
there
are
more
questions
that
need
to
be
asked,
we'll
be
sure
to
give
the
committee
plenty
of
time
with
that.
With
that,
the
last
item
on
our
agenda
for
today
is
public
comment.
Is
there
anyone
in
the
room
wishing
to
make
public
comment
at
this
time.
I
Kent
irvin
about
a
faculty
alliance
I'll
make
it
very
quick.
The
the
most
regressive
cuts
to
state
employees,
pay
and
benefits
has
been
the
cuts
to
the
peb
program,
which
we
just
had
the
discussion
about
the
excess
reserves.
Those
arise
from
three
things,
part
is
the
claim
suppression,
but
there's
also
the
fact
that
premiums
for
employees
were
increased
by
about
42
to
24,
depending
on
your
plan
in
this
current
fiscal
year,
so
that
money
came
in
kovud
was
actually
paid
for
much
of
it
by
the
federal
government.
I
That's
the
second
thing,
and
then
the
claim
suppression
is
the
third
thing,
so
that
may
or
may
not
be
a
temporary
and
some
of
it
as
the
excess
reserves
may
or
may
not
be
temporary.
Some
of
it
has
already
been
allocated
by
by
these
committees,
but
for
fiscal
year
2023
with
the
american
rescue
plan
funds,
we
need
a
full
restoration
of
the
peb
benefits.
Thank
you.
H
H
C
C
C
C
C
This
is
not
how
democracy
works.
The
majority
of
people
speak
and
the
legislators
hear
their
intentions.
Where
did
this
breakdown
come
from?
If
you
have
any
compassion
at
all
for
this
issue,
we
are
urging
you
to
move
this
bill
forward.
We
are
still
fighting
and
will
continue
to
fight
for
terminally
ill
nevadans.
C
A
Thank
you
very
much
so
committee
members.
This
is
going
to
be
a
rarity
that
we
actually
adjourn
this
early
in
the
day
so
enjoy
the
rest
of
your
day
and
this
evening,
we'll
all
be
seeing
each
other
again
this
evening.
So
with
that,
we
are
adjourned
for
the.