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From YouTube: 3/24/2021 - Senate Committee on Commerce and Labor
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A
C
D
A
Here,
let
the
record
reflect
that.
We
are
all
here
today
and
I'd
like
to
take
care
of
a
couple
of
housekeeping
items.
Before
we
begin
today
we
will
be
hearing
senate
bill,
190,
198
and
229..
A
However,
there
are
various
ways
of
the
public
that
the
public
can
engage
with
us
and
participate
throughout
the
process.
These
include
registering
to
participate
through
nellis,
where
you
have
the
opportunity
to
testify
on
a
bill
or
provide
public
comment.
During
the
meeting
you
may
submit.
Written
comment
to
the
committee.
A
Just
to
note
that,
while
meeting
registration
is
required
to
participate,
it
does
not
guarantee,
you
will
be
able
to
speak
similar
to
previous
sessions.
Comment
and
public
comment
may
be
limited
due
to
time
constraints,
and
I
will
announce
the
time
frame.
That
is
how
many
minutes
for
each
response,
or
against
and
neutral.
A
It
will
be
helpful
if
more
than
one
person
in
your
organization
wishes
to
comment
to
remember
that
ditto
is
a
good
response.
When
someone
has
already
covered
your
points,
this
will
allow
more
people
to
comment
during
that
time
frame
when
you're
on
the
phone
line.
Please
pay
attention
to
which
bill
is
being
considered
and
follow.
The
verbal
prompts
provided
by
the
bps
staff
so
that
you
know
which
keys
to
press
to
raise
your
hand
or
unmute
yourself.
A
A
A
In
addition,
any
person
proposing
an
amendment
to
a
bill
being
heard
by
the
committee
must
first
talk
to
the
sponsor
and
let
them
know
that
you
intend
to
submit
an
amendment.
I
will
not
entertain
any
amendments
if
the
bill
sponsor
is
not
aware
of
the
amendment
proposed.
Amendment
must
be
submitted
in
writing.
24
hours
prior
to
the
meeting,
please
include
the
bill
number
statement
of
intent
and
your
contact
information
when
testifying.
A
A
person
who
knowingly
does
so
is
guilty
of
a
misdemeanor.
The
chair
and
any
member
of
the
committee
may
request
a
testifier
to
submit
documentation
supporting
their
testimony
committee
members
for
these
virtual
hearings.
When
an
intended
item
is
called
for
a
vote,
our
committee
will
be
using
roll
call
to
do
so.
A
A
F
A
A
G
Thank
you,
madam
chairwoman,
and
members
of
the
committee
I
appreciate
being
here
with
all
of
you
in
commerce,
my
first
appearance
of
this
legislative
session,
which
feels
a
little
strange
as
this
is
a
committee
that
I'm
pretty
familiar
with
from
the
last
two
sessions.
So
thanks
for
having
me,
we've.
G
Well
thanks
so
again,
thank
you.
Thank
you,
madam
chair
and
members
of
the
committee.
For
the
record.
My
name
is
nicole
cannazzaro.
I
currently
serve
as
a
senator
from
senate
district
six
in
the
northwest
portion
of
the
las
vegas
valley
and
also
as
the
senate
majority
leader,
and
I
am
so
pleased
to
be
here
with
you
this
morning
to
present
to
you
senate
bill
190,
which
will
allow
women
to
access
birth
control
in
the
state
of
nevada
without
a
prior
prescription
from
their
doctor
and
while
being
covered
by
their
insurance.
G
Some
of
you
may
remember
hearing
this
bill
in
part
from
last
session.
It
was
a
senate
bill
last
session
that
this
committee
heard
and
that
the
senate
was
able
to
get
through,
but
we
lost
time
in
the
end
of
the
legislative
session,
and
so
I
am
back
again
for
a
second
time
to
try
to
act
to
try
to
improve
access
to
essential
health
care.
For
women,
as
I
mentioned,
birth
control
is
what
we
would
consider
essential.
G
G
Other
women
may
lack
regular
access
to
transportation
to
go
to
and
from
doctor's
appointments,
limiting
their
ability
to
obtain
a
prescription,
and
for
so
many
nevada
women.
The
barrier
lies
in
juggling
multiple
roles,
including
providing
care
for
family
members
working
and
assisting
with
their
kids
education,
and
all
of
these
I
mentioned
because
these
are
reasons
for
why
it
is
so
essential
that
we
open
up
access
for
women
to
get
what
we
know
to
be
safe.
Forms
of.
G
Birth
control
empowers
women
to
make
decisions
that
are
right
for
our
own
bodies.
Medical
research
also
supports
this,
and
I
would
note
that
we
do
have
a
number
of
exhibits
that
I'll
touch
on
very
briefly
that
have
been
uploaded
to
nellis
for
the
committee's
perusal
and
for
the
public
as
well
from
treating
acne
to
ovarian
cysts.
Birth
control
has
been
prescribed
to
millions
of
women
to
benefit
our
health
and
over
the
course
of
decades.
Research
compiled
shows
that
access
to
birth
control
has
a
direct
link
to
reduced
infant
and
maternal
mortalities.
G
This
is
part
of
the
reason
why
the
american
college
of
obstetricians
and
gynecologists
supports
allowing
pharmacists
to
dispense,
contraceptives
in
order
to
increase
access,
and
this
is
also
why
I
am
here
today
to
present
senate
bill
190..
This
bill
is
the
result
of
hours
of
conversations
with
medical
experts
from
across
the
state
and
country.
One
of
those
experts
is
dr
sandra
koch,
an
obstetrician
with
over
30
years
of
medical
experience.
H
In
its
review.
The
fda
found
that
hormonal
contraceptives
are
very
safe.
Progesterone
only
methods
are
are
really
have
extremely
rare,
contraindications
and
estrogen
containing
methods.
Major
risk
is
an
increase
in
blood
clots.
That
applies
to
a
very
small
subset
of
women.
Multiple
studies
have
demonstrated
that
these
women
at
high
risk
can
use
a
simple
health
screening
questionnaire
in
a
very
successful
manner
to
identify
themselves.
H
Unfortunately,
that
is
a
barrier
and
some
women
can't
obtain
a
prescription
or
they
can't
refill
and
end
up
with
unplanned
pregnancies.
The
fda
has
not
approved
any
hormonal
contraceptives
at
this
time
for
over-the-counter
use.
Allowing
pharmacists
to
dispense.
These
contraceptives
with
the
assistance
of
a
self-administered
screening
questionnaire,
is
a
step
in
the
right
direction.
H
H
Many
some
people
worry
that
women
who
obtain
birth
control
from
pharmacists
won't
get
recommended
preventative
care
if
they
do
not
have
to
see
a
provider
to
get
that
birth
control.
There
was
a
study
done
in
comparing
women
in
texas
to
those
in
mexico.
In
mexico.
They
don't
need
to
obtain
a
birth,
a
prescription,
they
can
just
go
into
the
store
and
purchase
them
and
in
texas
they
need
a
prescription
and
they
showed
that
there
was
actually
good
good
rate
of
receiving
preventative
measures
in
both
health
preventive
health
screens.
H
In
both
populations
we
ob
gyn
still
recommend
that
women
see
their
doctors
regularly
or
the
health
care
providers.
However,
delaying
or
missing
an
appointment
should
not
be
a
reason
for
women
to
denied
to
be
denied
contraception.
I
strongly
support
passing
this
measure
and
giving
women
one
more
tool
to
control
their
fertility.
Thank
you
all
very
much
for
your
time.
G
Thank
you,
madam
chair,
for
your
indulgence,
your
doctor.
With
your
indulgence,
madam
chair.
I
would
like
to
walk
through
some
sections
of
the
bill
at
this
time.
As
you
and
the
members
of
this
committee
are
aware,
senate
bill
190
requires
the
state's
chief
medical
officer
to
issue
a
standing
order
that
allows
pharmacists
to
dispense.
Birth
control
to
women
in
nevada,
currently,
13
states
and
the
district
of
columbia
have
similar
laws
allowing
pharmacists
to
provide
birth
control
without
a
prior
prescription,
whether
through
a
standing
order,
practice
protocols
or
by
expanding
their
scope
of
practice.
G
The
state
board
of
health
must
work
with
the
chief
medical
officer
to
adopt
regulations,
establishing
a
protocol
for
dispensing
these
contraceptives
and
with
the
state
board
of
pharmacy
to
adopt
regulations
prescribing
the
following.
A
risk
assessment
questionnaire
that
may
be
administered
upon
request
to
a
patient
who
requests
such
a
self-administered
hormonal.
Contraceptive
and
the
information
that
must
be
provided
in
writing
to
these
patients.
G
Section
8
also
requires
the
division
of
public
and
behavioral
health
to
post
on
its
website,
a
link
to
the
list
of
pharmacies
that
dispense
contraceptives
as
authorized
by
this
bill.
Going
back
to
section
3.
This
section
allows
a
pharmacist
to
dispense
a
self-administered
hormonal
contraceptive
under
the
chief
medical
officer
standing
order,
regardless
of
whether
the
patient
has
obtained
a
prescription
from
a
practitioner
before
a
pharmacist
may
dispense
a
contraceptive,
they
must
provide
the
risk
assessment
questionnaire
to
any
patient
who
requests
it.
G
Additionally,
pharmacists
must
create
a
maintaining
record
of
each
person
to
whom
a
self-administered
hormonal
contraceptive
is
dispensed,
including
the
name,
the
drug
dispensed
and
other
relevant
information
required
by
the
protocol.
Pharmacists
must
also
inform
patients
of
proper
administration
and
storage
of
the
contraceptive
potential
side
effects
and
the
need
to
use
other
methods
of
contraceptive
if
appropriate.
G
Certain
written
records
related
to
the
request
or
dispensing
of
self-administered
contraceptives
must
also
be
provided
to
patients,
regardless
of
whether
a
contraceptive
is
dispensed.
Finally,
any
pharmacy
wishing
to
dispense
self-administered
hormonal
contraceptives
is
required
to
notify
the
state
board
of
health
sections.
Five
and
six
amend
the
scope
of
practice
of
a
pharmacy
to
include
dispensing
of
self-administered
hormonal
contraceptives
and
authorize
the
state
board
of
pharmacy
to
suspend
or
revoke
a
certificate
to
practice
as
a
registered
pharmacist.
If
the
pharmacist
dispenses
such
contraceptives
without
complying
with
the
provisions
of
section
3..
G
If
the
woman
were
to
get
were
to
go
and
see
a
practitioner
and
receive
that
prescription,
and
so
that's
the
primary
focus
of
not
only
some
of
these
sections
I've
described,
but
also
of
the
the
pieces
that
relate
to
insurance
sheriff
spearman.
This
concludes
my
explanation
of
the
bill
and,
as
I
mentioned
senate
bill
190
is
essential
in
allowing
nevada
women
to
have
easier
access
to
birth
control,
and
I
definitely
urge
everyone's
support.
I'm
happy
to
take
questions
from
you
or
members
of
the
committee
and
before
I'm
sorry
before
that.
G
I
did
want
to
just
note
that
there
are
several
documents
that
deal
with
a
number
of
studies
that
have
occurred:
recommendations
from
different
healthcare
providers
and
and
boards
that
talk
about
what
we're
dealing
with
here
in
terms
of
the
pharmacist
allowing
to
dispense
contraceptives.
G
There
are
several
documents
related
to
those
they're
all
on
nellis
for
everyone,
and
they
are
mentioned
there
with
dr
koch's
name.
Those
have
been
submitted
by
both
herself
and
me
for
the
committee's
consideration
as
some
background
information.
Thank
you,
madam
chair,
and
I'm
happy
to
take
questions.
A
Thank
you,
majority
leader,
I'm
going
to
take
a
point
of
privilege
because
I've
got
to
step
out
to
testify
over
in
the
assembly
metaphorically.
So
I
want
to
take
a
couple
questions
just
before
I
open
it
up
to
the
committee.
One
of
the
things
that
I
imagine
this
can
do
is
help
women
who
are
in
rural
and
frontier
communities.
Can
you
speak
a
little
bit
to
that
in
terms
of
access
continued
access.
G
G
What
senate
bill
190
is
really
seeking
to
do
is
to
remove
barriers
to
access
for
what
we
know
to
be
safe,
usable
hormonal
contraceptives
and
so
for
women
who
are
in
rural
communities
or
who
maybe
have
to
go
a
long
distance
in
order
to
see
a
practitioner
just
to
get
that
prescription
for
or
a
for
a
medication
that
we
know
to
be
safe,
that
we
know
to
be
able
to
be
administered
by
the
patient
and
that
we
know
many
women
are
having
to
make
that
additional
step
for
and
then
also
and
then
also
go
to
a
pharmacy
in
order
to
get
that
filled,
we're
removing
that
barrier
of
access
and
allowing
them
to
have
that
easy
access
to
hormonal
contraceptives.
G
That
would
also,
I
think,
apply
to
women
who
are
in
areas
where
it
is
difficult
to
find
transportation
either
because
of
their
rule
in
nature
or
because
that
woman
lives
in
a
place
where
transportation
is
hard
to
come
by.
Lower
income
areas
definitely
would
fall
into
that
category,
and
so,
by
removing
this
barrier,
we
are
opening
up
that
access
that
it
really
does
play,
I
think,
into
the
overall
women's
health
conversation.
G
We
know
that
this
can
help
to
reduce
and,
as
I
mentioned,
fetal
and
maternal
mortalities,
it
also
allows
for
women
to
have
better
control
over
their
own
health
care
decisions,
and
in
addition,
you
know
one
thing
I
think
that's
worth
pointing
out,
because
this
has
come
up
in
conversations.
Nothing
about
senate
bill.
190
says
that
women
are
going
to
stop
going
to
an
ob
gyn.
G
This
is
strictly
related
to
hormonal
birth
control
and,
as
I
mentioned,
if
there
is
a
complication
or
something
in
the
woman's
history
or
their
health
care
background,
that
would
require
for
them
to
really
see
a
practitioner
before
it
would
be
safe
to
administer
that
hormonal
contraceptive.
That
would
be
flagged
within
those
questionnaires.
A
Okay,
thank
you
for
that
ma'am.
So
I
saw
my
chair
neil's
hand
first
and
I'm
going
to
call
on
her
and
when
you
finish
with
your
question,
I'm
turning
the
gavel
over
to
you.
Okay,.
H
Thank
you,
madam
chair,
so
I
have
a
question
on
the
well.
It's
the
ques.
Well,
there's
two
questions
in
section
three,
the
questionnaire
and
I
looked
at
that
study
that
was
uploaded
in
the
record
in
the
exhibits.
But
what
I'm
not
clear
on
is
the
study
was
done
in
the
uk.
H
G
Thank
you,
madam
vice
chair
through
you
to
the
committee.
That's
a
great
question
and
senate
bill.
190
doesn't
prescribe
the
exact
questions
that
would
be
included
in
the
questionnaire
rather
senate
bill.
190
and
section
8
allows
for
the
state
board
of
health
to
work
with
the
chief
medical
officer
and
the
state
board
of
pharmacy.
That
would
adopt
the
regulations
to
include
what
would
be
contained
within
that
questionnaire.
G
What
information
must
be
provided
to
the
patients
so
that
we
are
asking
the
right
questions
and
getting
that
information,
so
that
is
not
prescriptive
within
the
language
of
the
bill,
but
would
be
left
to
those
with
the
best
medical
expertise
to
determine
how
best
to
word
those
questions,
be
they
open-ended
or
closed
and
at
what
extent,
we're
gonna
be
asking
those
questions
of
the
patient
so
that
we
can
catch
kind
of
all
of
those
different
facets
that
may
play
into
whether
it
is
safe
to
administer
hormonal.
G
H
And
then
the
same,
it's
the
second
question
in
section
three,
which
is
on
line
27..
It
said
this
is
about
the
creating
the
record
of
what
was
dispensed
and
how
it
was
disposed
of,
etc,
but
it
in
that
line
27,
it
says
the
pharmacist
or
his
or
her
employer
shall
maintain
the
record.
So
I
wanted
to
get
an
understanding
on
like
the
employer,
because
in
these
scenarios
that
could
be
a
walgreens
that
could
be
a
cvs.
G
Thank
you,
madam
vice
chair
and
through
you
to
the
committee
and
that's
a
great
question.
We've
added
this
language
because
I
do
think
that
it
is
consistent
with
you
know.
If
you
go
to
walgreens
and
if
you've
ever
had,
for
example,
strep
throat
and
you
got
amoxicillin
from
walgreens
the
next
time
you
go
there,
they
may
have
a
record
of
that
as
well.
So
I
believe
this
to
be
consistent
with
what
is
current
practice.
G
If
you
are
a
patient
there
for
the
pharmacist
to
keep
that
record
and
for
the
pharmacy
to
have
that
and
one
of
the
pieces
and
the
reasons
why
we
wanted
to
make
sure
that
there
was
a
record
was
because
for
women
who
may
be
going
and
refilling
prescriptions
who
filled
out
a
questionnaire
previously,
we
want
to
make
sure
that
we
have
all
of
that
information
so
that
there's
a
comprehensive
record
that
they
can
refer
to
when
deciding
whether
or
not
it
is
safe
to
actually
administer
the
hormonal
contraceptive.
A
Thank
you.
I
saw
senator
hardy's
hand
next
and
senator
scheible
and
then
senator
picker.
D
Thank
you,
madam
chair.
I
I
may
have
misheard,
but
in
testimony
I
heard,
if
there's
a
risk,
then
may
not
dispense,
but
the
language
in
the
bill
is
very
clear,
must
not
dispense
so
the
pharmacist
doesn't
get
trapped
in
a
well.
Please
please,
please.
So
the
pharmacist
should
not
must
not
dispense
if
there's
a
risk
factor.
D
G
Thank
you
and
senator
hardy
through
you,
madam
chair
and
madam
vice,
chair
to
the
senator.
Those
are
both
great
questions.
First,
with
respect
to
the
may
versus
must
that
was
likely
just
my
own
wording
and
the
language
and
the
bill
is,
must
our
intention
in
this
is
that
if
there
is
something
in
that
risk
questionnaire
not
be
safe
for
a
pharmacist
to
dispense
the
hormonal
birth
control,
there
is
no
mechanism
by
which
they
can
then
override
that
and
and
administer
the
hormonal
contraceptive.
G
Rather,
the
mechanism
is
to
refer
them
to
a
practitioner
who
can
do
a
more
thorough
evaluation
of
whether
there
may
be
another
more
safe,
another
safer,
rather
form
of
hormonal
birth
control
or
other
contraceptive.
G
G
We
know
that
from
just
common
practice,
and
so
we
want
to
make
sure
that
that
is
still
the
case
with
respect
to
the
risk
factors
and
how
they
change
currently
with.
I
want
to
say
it
was
in
2017
and
senator
you.
May
you
may
remember
better
than
I
that
we
did
pass
legislation
that
allowed
for
12
months
of
birth
control
to
be
dispensed
at
once
previously
it
had
been
three
months,
so
they
were
talking
about
appointments
every
four
or
every
quarter,
rather
in
order
to
fulfill
that
12-month
prescription.
G
But
we
do
have
legislation
now
that
would
allow
for
that
12
months.
This
doesn't
change
that,
so
they
could
receive
up
to
the
12
months
and
then,
of
course,
we
are
endeavoring
to
ensure
that
that
risk
assessment
is
done
whenever
they
come
in
to
fill
that
prescription.
G
A
Now
and
majority
leader
just
go
direct
and
ask
me
to
regret:
okay.
H
Okay,
so
next
senator
schaible.
Thank
you.
I
have
two
questions.
If
that's
okay
and
also
a
comment
which
is
that
I
love
this
bill,
and
I
think
that
it
is
incredibly
important
and
great
public
policy
to.
H
I
think
that
requiring
a
prescription
for
birth
control
makes
about
as
much
sense
requiring
a
prescription
for
a
condom,
especially
when
I
can
buy
like
a
thousand
pounds
of
ibuprofen
at
a
time
at
a
pharmacy.
So
what
I
wanted
to
ask
is
two
things.
H
First,
I
want
to
check
my
understanding
on
one
of
the
what
I
see
as
one
of
the
advantages
of
this
bill,
which
is
that
if
I
go
to
my
doctor
tomorrow
and
I
say,
hey
the
birth
control
that
I'm
currently
on
isn't
working
for
me,
I
have
to
take
it
every
single
night.
I
don't
remember
to
take
it.
I
need
something
that
is
more
more
flexible
and
I
say
you
know,
I'm
not
sure.
If
I
want
the
ring
or
the
patch,
then
my
doctor
doesn't
have
to
prescribe
one.
H
Have
me,
go,
try
it
come
back,
say:
hey
the
patch
was
itchy.
I
actually
want
to
try
the
ring,
after
all,
prescribe
it
go
back
to
the
pharmacy.
It
would
allow
me
to
go
to
the
pharmacy
and
get
the
patch
and
use
it
for
a
month
or
two,
and
if
I
don't
like
it,
having
already
had
the
conversation
with
my
doctor,
who
agreed
that
I
could
utilize
either
one
I
can
go
back
to
the
pharmacy
by
myself
without
making
another
appointment
with
my
doctor
and
get
the
ring
instead.
G
Thank
you,
senator
schreibel,
for
the
question
and
I
think,
you've,
you've
kind
of
touched
on
a
couple
of
things
that
bring
up
when
folks
have
concerns
about
this
bill,
and
I
I
definitely
appreciate
your
your
understanding
of
some
of
the
some
of
the
things
that
women
go
through
just
trying
to
manage
some
of
their
own
health
care.
I
think
what
we
are,
what
we
are
endeavoring
to
do
with
this
and
one
of
the
things
I
think
you
touched
on,
which
is
important
to
note.
G
G
Where
maybe
it's
not
it's
just
that
you
can't
remember
to
take
it
at
the
same
time
every
single
day,
which
is
not
necessarily,
if
there's
an
issue
with
the
prescription,
but
that
there
may
be
an
issue
where
that's
just
not
feasible
for
the
patient
and
their
lifestyle,
but
or
instances
where
you
mentioned,
for
example,
having
received
the
patch.
Maybe
it's
itchy
and,
and
you
might
be,
having
an
allergic
reaction.
G
I
think
that
would
be
the
kind
of
event
that
would
trigger
within
the
questionnaire,
and
we
would
hope,
would
trigger
within
the
questionnaire
to
have
a
woman
go
and
talk
with
their
practitioner
just
to
get
that
additional
follow-up.
But
in
essence,
if
a
woman
were
to
maybe
not
go
see
their
practitioner
wanted
to
get
on
birth
control.
That
is
something
where
the
pharmacist
can
certainly
dispense.
G
That
and,
of
course,
some
of
this
is
going
to
be
regulated
with
respect
to
the
questionnaire
and
the
pharmacist
being
able
to
feel
comfortable
in
what
it
is
that
they
are
prescribing
as
well.
So,
obviously,
I
think
one
of
the
most
important
pieces
of
this
bill
is
this
does
not
in
any
way
if
you
are
a
woman
who
does
go
to
their
ob,
gyn
or
a
prescription,
and
that
is
where
you
would
like
to
get
your
prescription.
G
You
can
do
that
if,
on
the
other
hand,
you're
going
to
your
ob
gyn
you're,
getting
your
pap
smears
you're,
getting
your
your
other
tests
that
are
done
with
your
ob
gyn
to
check
your
general
health,
but
you
at
some
point
decide
you
would
like
to
go
into
hormonal
birth
control.
You
can
absolutely
walk
into
the
pharmacist
without
a
prescription
fill
out
that
questionnaire
and
absent
any
red
flags
that
come
up
with
your
own
personal
health
history.
That
would
be
immediately
dispensed
to
you
without
having
to
then
schedule
yet.
H
And-
and
you
brought
up
another
point
in
answering
my
question-
that
I
you
maybe
think
that
also
means
that
if
I
go
back
to
las
vegas
during
session-
and
I
forget
my
birth
control
up
north,
I
can
go
to
a
pharmacy
down
south
and
pick
up
a
new
one
and
not
miss
three
four
days
of
treatment
and
and
risk
an
unplanned
pregnancy.
G
Thank
you
senator
scheibel.
Yes,
that
there's
nothing
in
the
bill
that
would
prevent
you
from
that
would
be
intended
to
prevent
any
woman
from
seeking
that
birth
control
from
the
pharmacy.
H
My
last
question
has
to
do
with
the
the
future
of
this
standing
order
for
the
medical
officer,
the
chief
medical
officer,
and
what
happens
in
you
know.
Future
years
we
have
a
different
administration.
There's
someone
else
in
that
position.
Is
this
subject.
G
To
change,
thank
you
senator
tribal
and
that's
a
great
question
that
has
come
up
in
these
conversations
and
through
our
work
last
session
and
and
this
session.
That
has
been
a
point
that
we've
looked
into
and
that's
why
the
language
and
the
bill
requires
for
this
state
for
the
standing
for
the
chief
medical
officer
to
have
the
standing
order
so
that
we
know
this
is
policy
that
the
legislature
supports
that
we
want
here
in
the
state
and
even
with
a
change
in
administration,
that
standing
order
would
still
be
required.
B
B
B
B
C
A-N-N-S-I-L-V-E-R
and
I
serve
as
the
ceo
of
the
reno
sparks
chamber
of
commerce
good
morning
vice
chair
and
members
of
the
committee
on
commerce
and
labor.
Our
organization
fully
supports
senate
bill
190
as
part
of
its
long-standing
commitment
to
the
rights
of
women
and
their
abilities
to
secure
contraceptives
without
a
lengthy
and
often
intimidating
process.
C
By
making
access
to
contraceptives
easier
and
more
efficient,
women
will
be
better
able
to
continue
multitasking
as
parents
by
choice,
professionals
and
effective
community
participants.
We
thank
senate
majority
leader
canazero
and
all
the
sponsors
of
this
legislation
and
urge
swift
passage
of
senate
one
senate
bill
190
as
evidence
of
your
support
for
women
in
nevada.
Thank
you
for
your.
B
C
C
C
B
C
Good
morning
and
thank
you
chair
for
the
record,
this
is
liz
davenport,
l-I-z-d-a-v-e-n-p-o-r-t,
the
legal
intern
for
the
aclu
of
nevada
here
in
support
of
sb
190..
Thank
you
majority
leader
canazarro,
for
bringing
this
bill.
Removing
barriers
to
accessing
birth
control
has
broad
positive
impacts
in
economics
and
educational
opportunities
in
racial
justice
and
others.
Difficulty
accessing
birth
control
disproportionately
affects
black
women
and
other
people
of
color.
C
Additionally,
bloomberg
business
week
has
listed
contraceptives
as
one
of
the
most
transformational
developments
in
the
business
sector
in
the
last
85
years.
It
has
helped
narrow
the
wage
gap
between
men
and
women.
Removing
barriers
to
accessing
birth
control
removes
barriers
to
education,
jobs
and
health
care.
We
support
sb
190..
Thank
you
and
that
concludes
my
testimony.
B
C
V-I-C-T-O-R-I-A-R-U-I-Z
hyphen
m-a-r-I-n,
I
am
a
community
organizer
with
planned
parenthood
votes,
nevada
and
a
member
of
the
community
in
las
vegas
planned
parenthood
votes.
Nevada
is
in
favor
of
senate
bill.
190,
allowing
pharmacists
to
prescribe
birth
control
is
crucial
to
increasing
access
to
a
foundational
component
of
sexual
and
reproductive
health
care.
Birth
control
has
been
key
to
improving
women's
health,
social
and
economic
conditions
and
preventing
pregnancy
since
its
inception.
C
C
Access
to
birth
control
helps
mitigate
the
barriers
for
communities
of
color
and
low
income,
who
already
experience
disproportionate
maternal
mortality
rates
and
health
disparities
that
the
kova
19th
endemic
has
exacerbated.
Allowing
pharmacists
to
prescribe
birth
control
will
help
give
nevadans
autonomy
over
their
health.
I
urge
to
support
senate
bill
190..
This
concludes
my
testimony.
Thank
you.
B
C
having
easy
and
affordable
access
to
birth
control
is
important
for
everyone,
especially
victim
survivors
of
domestic
and
sexual
violence.
Accessing
health
care
is
a
challenge
for
many
nevadans
and
for
victim
survivors
who
are
constantly
surveyed
by
their
perpetrator.
Accessing
a
healthcare
professional
to
get
access
to
a
birth
control
prescription
is
not
always
feasible
or
safe.
C
In
some
instances,
perpetrators
will
accompany
the
victim
survivor
to
every
doctor,
appointment
to
assert
power
and
control
and
to
sabotage
their
use
of
birth
control
being
able
to
access
birth
control
over
the
counter
at
a
pharmacy
may
allow
a
victim
survivor,
the
much
needed
accessibility
to
be
able
to
access
birth
control
and
to
prevent
unwanted
pregnancies
with
their
perpetrator,
allowing
people
to
access
birth
control
from
pharmacists
directly
will
greatly
increase
barriers
for
so
many
nevadans
and
can
have
positive
and
important
impacts
for
victim
survivors.
Thank
you.
B
C
Sorry
about
that,
my
name
is
caroline
mello
roberson,
I'm
the
southwest
regional
director
for
neural
pro
choice:
america,
that's
c-a-r-o-l-I-n-e,
m-e-l-l-o
r-o-b-e-r-s-o-n!
I
am
gonna.
I
submitted
comments
on
the
record
so
if
folks
can
check
it
out
on
nellis
I'll,
just
summarize,
since
a
lot
of
what
I've
said
has
already
been
covered,
but
neral
pro-choice
nevada
is
very
proud
to
be
in
support
of
sb
190
as
we
were
in
2019.
C
B
C
M-A-R-C-O-S
l-o-p-z
marcos,
lopez,
americas
for
prosperity,
nevada.
We
are
in
support
of
sb
190.
It
will
definitely
increase
access
for
birth
control,
for
individuals
who
do
lack
health
insurance,
a
primary
care
doctor,
and
it
will
save
taxpayers
money.
The
cost
of
unintended
pregnancies,
cost
taxpayers
around
102
million
dollars
annually
and
currently
are
already
13
states
in
dc
that
already
empower
pharmacists
to
do
this.
C
Ideally,
the
fda
would
allow
these
birth
control
products
to
be
sold
over
the
counter,
something
that
the
majority
of
countries
in
the
world
already
do,
but
sp
190
will
do
great
benefits
to
both
women
who
lack
health
insurance
live
in
rural
areas
where
they
might
have
less
access
to
health
care
or
vygns.
Everyone
knows
that
pharmacy
checkups
visits
are
quicker,
easier
and
more
accessible
than
scheduling
a
doctor's
appointment.
C
There
is
a
2016
study
that
was
a
survey
that
was
published
in
national
library
of
medicine
that
showed
that
nearly
a
third
of
women
reported
difficulty
obtaining
prescriptions
and
the
number
one
reason
they
said
it
was
scheduling
getting
to
their
appointments.
So
we
hope
that
everyone
please
support
this
legislation.
Thank
you.
B
B
B
D
Hello,
madam
chair
spearman,
and
the
senate
and
commerce
and
labor
committee.
My
name
is
ken
conkey
k-e-n-k-u-n-k-e,
and
I'm
here
today
representing
the
nevada
pharmacy
alliance.
We
are
an
organization
that
represents
pharmacy
professionals
that
work
all
over
our
state.
We
are
excited
to
expand
our
ability
to
be
able
to
take
care
of
patients,
and
I
am
here
to
show
our
support
of
senate
bill
190.,
nationally
68
percent
of
women
report
barriers
to
acquiring
contraceptive
care
in
the
united
states.
D
This
doesn't
surprise
me:
pharmacists
are
the
most
accessible
health
care
professional
and
they
are
able
to
provide
services
like
this
to
patients
throughout
nevada.
Ninety
percent
live
in
a
five
mile
radius
of
a
pharmacy
and
patient
consultations
are
a
normal
part
of
a
pharmacist's
day.
Today.
I
ask
you
to
also
show
support
in
passing
senate
bill
190
so
that
pharmacy
teams
can
start
providing
access
to
hormonal
contraceptives
in
nevada.
H
I
H
I
Thank
you
for
the
record.
Adam
porter
nevada,
society
of
health
system
pharmacists.
I
am
in
support
of
this
bill,
as
ken
just
said,
I
think,
from
the
pharmacist's
perspective,
we
are
ready
and
willing
to
help
in
this
space.
There
was
a
survey
done
nationally.
Over
85
percent
of
pharmacists
are
interested
in
providing
this
sort
of
service
for
our
patients.
So
I
strongly
support
this
bill.
B
Absolutely
we
are
currently
in
support
of
sb
190
to
testify
and
support.
Please
press
star
9
now
to
take
your
place
in
the
queue.
B
B
C
Good
morning,
good
morning
my
name
is
v-a-s-u-d-h-a:
last
name:
gupta
g-u-p-t-a,
I'm
an
associate
professor
at
roseman
university
college
of
pharmacy
and
a
board
certified
clinical
pharmacist
at
a
federally
qualified
health
center
in
henderson,
I'm
representing
the
nevada
pharmacy
alliance
and
we
fully
support
senate
bill.
190.
pharmacists
have
a
doctorate
degree
focused
on
medication.
Management
are
highly
trained
professionals,
but
unfortunately,
are
underutilized.
C
Pharmacists
being
able
to
prescribe
safe
and
effective
hormonal.
Contraceptive
medications
will
significantly
improve
access
to
care
to
women
who
want
to
prevent
pregnancy.
Along
with
allowing
pharmacists
to
have
discussions
about
patients
about
safe
sex
practices,
sb
190
will
help
to
reduce
unintended
pregnancies
and
decrease
the
burden
on
our
health
care
system.
The
most
important
thing
that
I
wanted
to
mention
that
has
not
been
touched
upon
so
far
is
insurance
coverage.
C
I
can't
tell
you
how
many
times
I
have
dealt
with
this
personally
as
a
patient
and
as
well
as
a
health
care
provider
with
our
health
care
system,
insurance
provider
coverage,
changes
constantly
and
medications
are
often
not
covered.
What
typically
happens
is
one
prescription
is
sent
to
the
pharmacy,
it's
not
covered,
and
then
the
patients
have
to
call
the
provider
back
and
then
check
back
with
the
pharmacy
to
see
whether
that
cover
that
medication
is
covered,
and
this
may
occur
several
times
before.
C
Finally,
determining
which
medication
is
actually
going
to
be
covered
by
the
insurance
provider,
which
could
delay
access
by
weeks
for
the
patient
and
cause
unnecessary
burden
to
both
patients,
as
well
as
the
provider
offices,
if
the
entire
process
is
done
at
the
pharmacy,
it's
easy
for
the
pharmacist
to
determine
which
prescription
will
be
covered
and
it
can
be
dispensed
then,
and
there
for
the
patient
to
make
the
process
a
whole
heck
of
a
lot
easier.
I
appreciate
the
opportunity
to
speak.
Thank
you
so
much.
H
B
B
H
B
C
Morning,
chair
and
members
of
the
committee,
my
name
is
tess
opterman,
that's
o-p-s-e-r-m-a-n
speaking
on
behalf
of
the
nevada
women's
lobby.
First,
I
want
to
thank
senator
canada
for
her
hard
work
on
such
important
legislation.
We
echo
what
those
before
me
have
said
this
morning.
Fb
190
is
critical
to
creating
easy
access
to
birth
control,
ensuring
women
are
able
to
make
decisions
about
their
bodies
and
their
futures,
allowing
pharmacists
to
distribute
birth
control
means
women
can
easily
access
their
necessary
preventative,
birth
methods,
without
doctors,
appointments
and
without
insurance.
C
B
B
B
C
Good
morning,
for
the
record,
my
name
is
monique
mccloud
l-a-n-I-q-u-a
last
name
mccloud
mcc
l-o-o-u-d.
I
want
to
thank
everyone
and
I
just
wanted
to
say
that
I'm
in
support
of
the
current
bill,
ab-160
as
if
it
applies
to
us
having
more
options
and
availability
with
getting
contraceptives
over
the
counter.
I
believe
that
it
is
solely
in
our
best
interest
that
women
have
that
personal,
optional
choice
and
that
was
kind
of
that
power
has
given
back
to
us
as
women.
So
I
want
to
thank
you
and
I
hope
you
will
be
in
support
as
well.
B
C
Yes,
good
morning,
my
name
is
karen
bowman
k-a-y-l-y-n-n
b-o-w-m-a-n,
and
I'm
here
representing
myself
as
a
licensed
pharmacist
practicing
in
nevada
for
14
years.
The
legislation
proposed
in
this
bill
will
improve
timely
and
equitable
access
to
hormonal
contraceptives
to
women
in
nevada.
Pharmacists
are
trusted.
Members
of
the
healthcare
community,
easy
accessible
and
readily
available
to
meet
patient
needs
for
not
just
medications
but
for
other
health
care
needs.
How
will
the
senate
bill
for
prescribing
hormonal
contraceptives
in
the
pharmacy?
C
C
When
a
young
college
student
does
not
have
a
provider
or
health
insurance
and
is
seeking
information
on
how
to
get
care,
I
can
get
her
started
on
her
normal
contraceptives
and
give
her
a
provider
referral
when
a
woman
is
out
of
retail
it's
the
weekend.
I
can
then
provide
her
with
additional
medication,
thereby
reducing
the
chance
from
this
doses.
C
B
C
Morning,
members
of
the
committee
for
the
record,
my
name
is
annette
magnus
and
I'm
here
today
in
support
of
sc
190.
I
am
also
the
executive
director
of
battleborn
progress,
but
today
I'm
here
in
my
personal
capacity
just
last
weekend,
I
had
an
experience
with
my
own
birth
control,
where
I
was
not
able
to
renew
my
prescription.
C
I
cycle
my
pills
because
I
have
horrific
periods.
I
have
horrific
migraines
and
I
have
to
take
myself
differently,
as
prescribed
by
my
doctor.
I've
been
doing
this
for
years
to
control
my
migraines
to
control
my
periods
and
my
cramps,
and
last
weekend
my
birth
control
ran
out.
I
called
the
pharmacy
to
renew
my
prescription
and
because
of
the
way
I
take
my
pills,
I
always
run
out
of
my
prescription
early
and
my
insurance
won't
cover
more,
and
so
I
have
to
call
my
doctor.
I
have
to
get
it
reauthorized
by
the
insurance.
C
I
have
to
go
through
a
hundred
different
steps.
Now
I
am
lucky.
I
have
the
privilege
to
know
those
steps.
I
I
worked
for
a
health
care
provider,
so
I
understand
the
process,
but
another
woman
might
not.
She
might
not
have
that
privilege
that
I
have
to
navigate
that
system
and
I'll
tell
you,
because
I
had
to
navigate
that
system.
C
I
then
missed
almost
five
days
of
pills
and
I
was
not,
then
I
started
my
period
and
had
a
horrific
migraine
and
there
is
no
medical
reason
for
any
of
that
that
I
should
have
had
happen.
I've
been
doing
this
with
my
pills
for
years,
I
should
have
been
able
to
walk
into
the
pharmacy,
have
the
pharmacist
renew
my
prescription
and
have
that
conversation
directly
with
the
pharmacist,
so
I
didn't
have
to
go
through
the
things
that
I
did,
and
so
my
ask
of
you
today
is
to
pass
this
bill.
C
C
They
need
this
medication
to
be
able
to
control
their
fertility
and
control
their
medical
needs,
and
so
I'm
asking
you
today
to
pass
this
bill
for
the
millions
of
nevada
or
sorry
for
the
thousands
of
nevadans
who
are
counting
on
you,
because
this
is
this
is
medicine
and
and
they
need
access
to
it.
Thank
you
so
much
and
thank
you
to
senator
canrizaro
for
bringing
this
bill.
It's
very
personal
to
me.
B
B
H
Okay,
thank
you
for
that.
Anyone
who
has
called
has
called
in
in
neutral
position.
H
Ok,
thank
you
for
that
members.
Do
you
have
any
final
questions
before
we
close
out
this
hearing
on
sb190.
H
So
majority
leader
ken
azar,
I
just
have
one
quick
question
on
the
bill,
so
pharmacists
have
an
mpi
like
they're
actually
listed
as
providers.
H
Will
this
allow
pharmacists,
who
are
now
engaging
in
extra
activity
to
have
a
profit
or
as
a
provider
as
they
dispense
these
medications
or
will
it
go
into
their
employer's
fee?.
G
Structure.
Thank
you,
madam
vice
chair
for
the
question.
I
am
not.
I
don't
know
that
I
have
an
answer
on
that.
I
guess
I'll
touch
on
two
different
things.
One
the
build
would
allow
for,
obviously
the
pharmacist
to
have
that
expanded
scope
of
practice
to
allow
them
to
describe
the
birth
control,
I'm
not
sure
what
effect
that
would
have
on
on
your
on
your
direct
question.
G
One
thing
I
would
note
about
this
bill
is,
and
we
were
careful
certainly
in
crafting
this
and
had
several
conversations
about
this
was
not
attempting
to
charge
an
additional
fee
for
the
or
the
pharmacist
to
provide
the
birth
control.
G
H
Okay,
thank
you
for
that,
and
I
see
senator
hardy's
hand
senator
hardy.
D
Thank
you,
madam
chair.
I
appreciate
all
of
the
testimony.
Obviously,
the
the
phraseology
is
any
patient
and
hopefully
there's
some
kind
of.
D
Able
to
have
a
period,
but
I
I
think
it's
optimistic
that
we
will
have
patients
still
continue
to
have
pap
smears
and
other
screenings
done
as
often
as
they
do
now.
D
But
nonetheless,
I
think
the
overall,
in
the
balance,
will
create
an
ability
for
people
to
access
care
and
prevent
other
things
that
will
require
them
to
have
adverse
effects
on
their
health.
So,
in
the
balance,
I
think
it's
a
good
thing,
but
there
are
downsides
to
it
that
I,
I
think
all
of
us
are
probably
going
to
be
aware
of.
Thank
you
and
advice.
H
G
Thank
you,
madam
vice
chair,
and
I
will
briefly
just
address
senator
hardy's
comments,
because
I
think
that
that's
something
that
we
we
definitely
hear-
and
I
will
say
this-
we
as
women,
go
to
the
obgyn
for
a
variety
of
reasons,
not
the
least
of
which
is
to
obtain
birth
control,
and
certainly
some
forms
of
birth
control.
G
Even
under
this
bill,
will
have
to
be
administered
with
the
consultation
and
with
going
to
your
obgyn
things
like
an
iud
that
require
that
physical
component
are
not
what
a
pharmacist
would
be
prescribing
or
or
inserting
into
a
patient.
So
you
know
this
bill
is
not
meant
to
say
that
we
don't
want
people
to
continue
to
see
their
obg
lands
for
regular
checkups,
and
I
think
what
we
need
to
do
a
better
job
of
not
only
as
a
legislature
but
as
a
society
and
in
our
communities
is
trusting
women
with
their
own
health
care.
G
Such
that
we
can.
We
can
make
sure
that
the
message
about
making
sure
you
get
pap
smears,
making
sure
that
you're
getting
breast
exams
making
sure
that
you
are
taking
care
of
your
health
in
those
ways.
In
addition
to
having
easier
access
to
birth
control
are
still
paramount.
We
trust
patients
all
the
time.
If
you,
if
you
have
a
cold
and
get
theraflu
from
the
local
walgreens,
we
don't.
We
don't
believe
that
those
patients
aren't
going
to
go
and
see
a
doctor
if
they
get
sick
a
second
time
from
something
right.
G
G
I
think,
if
anything,
when
you
have
barriers
to
birth
control,
it
doesn't
necessitate
that
women
are
going
to
see
their
ob
gyn.
It
sometimes
just
means
they
go
without
health
care,
so
if
we
can
remove
one
of
those
barriers,
I
think
that's
that's
the
important
crux
and-
and
I
definitely
appreciate
senator
hardy,
bringing
that
to
light,
because
I
think
that's
an
important
point
that
we've
definitely
heard
in
the
course
of
this.
This
conversation.
In
closing,
I
just
wanted
to
thank
members
of
the
committee
for
allowing
me
to
present
this
bill
again.
G
I
I
very
passionately
believe
that
this
is
something
that
we
must
do
to
help
expand
access
to
women's
care
and
it's
something
that
really
can
help
to
not
only
allow
women
to
make
those
choices
for
themselves.
This
is
something
that
we
know
to
be
safe.
This
is
something
that
we
know
can
be
administered
properly
by
our
pharmacists.
This
is
something
that
I
think
is
going
to
reduce
those
barriers
and
help
with
fetal
and
maternal
mortalities.
G
It
is
going
to
help
address
some
of
the
issues
that
we
have
with
unintended
pregnancies,
and
so
these
are
the
kinds
of
questions
that
I
think
are
at
the
forefront
of
this
bill
and
what
is
an
it
is
intended
to
get
at,
and
I
appreciate
the
committee
allowing
me
to
be
here
today
to
present
this.
H
G
G
I
represent
senate
district
six
in
the
northwest
portion
of
the
las
vegas
valley
and
also
serve
as
a
senate
majority
leader,
and
I'm
grateful
for
the
opportunity
to
be
here
with
you
today
to
talk
about
what
I
believe
to
be
an
important
topic
of
conversation,
which
is
contained
within
senate
bill
198,
where
we
are
seeking
to
regulate,
earned
wage
access
providers
by
limiting
their
ability
to
not
only
sell
personal
information,
but
also
ensuring
that
there
are
sufficient
consumer
protections
or
consumers
who
may
wish
to
be
utilizing
these
types
of
applications.
G
G
But
even
before
that,
we
know
that
there
are
so
many
nevadans
that
really
do
live
a
check
to
paycheck
for
these
workers
the
slightest
unplanned
event.
Often,
common
life
occurrences
could
upend
their
financial
stability.
A
child
gets
sick
and
needs
to
go
to
the
hospital.
A
prescription
needs
refilling,
a
car
breaks
down
or
gets
a
flat
tire,
and
so
for
nevadans
living
on
a
tight
budget.
G
Everyday
events
like
these
will
be
difficult
to
navigate,
particularly
if
they
find
themselves
in
the
middle
of
a
pay
period,
having
grown
up
in
a
family
where
we
definitely
lived
very
much
paycheck
to
paycheck.
Having
done
that
myself
prior
to
getting
to
a
point
of
my
current
career,
it
can
be
very
devastating
for
even
the
smallest
life
event,
and
sometimes
it
is
the
difference
of
asking
for
just
a
little
bit
of
money
from
folks
in
order
to
not
overdraft
your
checking
account.
G
I
have
definitely
been
in
that
situation,
and
I've
watched
my
parents
in
that
situation,
where
we've
asked
for
change
to
literally
go
to
the
bank
and
fill
up
a
bank
account
just
to
avoid
getting
an
overdraft.
These
are
the
kinds
of
things
that
everyday
nevadans
face
and
one
of
the
ways
in
which
they
are
seeking
to
solve.
This
is
with
some
of
these
earned
income
applications.
G
G
Thus
far
earned
wage
access
began
with
the
development
of
the
gig
economy,
but
this
interest
has
spread
to
employers
and
employees
in
what
we
would
refer
to
as
traditional
businesses
in
2018,
for
example,
walmart
rolled
out
an
earned
weight
access
service
and
more
than
250
000
of
their
employees
used.
The
retailer's
earned
wage
access
application
in
just
the
first
year.
G
Certainly,
one
of
the
ways
that
workers
are
seeking
to
solve
the
issue
when
they
are
in
between
pay
periods
cannot
make
bills
have
an
unexpected
life
event
is
to
turn
to
things
like
high
interest
loans
in
order
to
make
it
buy
or
simply
overdraft,
their
bank
accounts
having
to
make
it
through,
whatever
life
has
thrown
their
way.
G
There
are
different
types
of
earned
wage
access
programs.
There
are
in-house
programs
where
employers
offer
the
earned
wage
access
through
existing
payroll
services
and
partnerships.
Under
these
programs,
the
employer
could
fund
the
earned
wage
access
services
and
has
complete
discretion
over
the
amounts
and
frequency
of
employee
paychecks.
G
Third,
there
are
third
party
vendor
programs
where
employers
or
employees
select
a
third
party
to
provide
earned
wage
access.
Generally,
third-party
vendor
programs
reduce
the
employee's,
earned
wage
access
amount
from
his
or
her
net
pay
on
the
employer's
schedule.
Payday,
however,
some
30
third-party
vendors
have
very
little
involvement
with
the
employer,
providing
the
service
directly
to
employees
and
requiring
the
employee
to
repay
the
amount
to
the
vendor
on
payday,
while
earned
wage
access,
pay
may
offer
benefits
to
both
employers
and
employees.
G
There
are
consumer
protections
that
I
think
we
must
consider
and
is
the
primary
reason
why
I
think
senate
bill
198
is
so
necessary
at
this
point.
In
nevada
we
lead
on
consumer
protection.
One
of
our
most
sacred
jobs
is
legislators
is
to
protect
nevada
consumers
from
unscrupulous
and
dangerous
products
and
services,
and
we
have
a
long
history
of
thoughtful
but
balanced
financial
regulation
in
the
state.
I
believe
that
that
should
continue
with
these
applications
as
well.
That
is
why
I've
introduced
senate
bill
198.
G
However,
with
any
industry,
there
are,
of
course,
good
actors
and
bad
actors,
so
this
legislation
seeks
to
establish
a
full
regulatory
regime
with
built-in
customer
protections
and
requirements
earned.
Wage
access
can
only
be
done
if
the
employer
is
closely
involved.
That
is
the
best
way
in
which
to
ensure
that
consumers
are
not
being
taken
advantage
of
with
the
employer
involved.
It
becomes
a
non-discriminatory
benefit,
just
like
any
other
employee
benefit
and
there's
no
individual
underwriting,
and
this
service
shouldn't
be
based
on
income
level,
skin
color,
gender
or
any
other
demographics.
G
G
G
This
legislation
is
intended
to
ensure
that
there
are
sufficient
protections
to
guard
against
some
of
these
predatory
practices.
This
legislation
requires
licensure,
consumer
protection,
transparency,
employer
verification
and
more,
it
prevents
general
solicitation
of
the
public,
so
the
service
can
be
offered
in
a
way
that
is
secure
and
trusted
by
the
employer
and
employee
away.
G
Madam
vice
chair,
I
would
like
to
go
through
the
sections
of
the
bill.
I
would
also
note
that
we
did
provide
a
conceptual
amendment
that
is
still
very
much
in
a
in
a
working
process
with
some
of
the
other
stakeholders
involved,
including
legal
aid
and
the
fid,
to
ensure
that
we
can
get
the
policy
on
this
right.
G
Section
12
requires
a
person
who
wishes
to
provide
earned
wage
access
services
as
an
employer,
integrated,
earned
wage
access
provider
to
obtain
a
license
from
the
commission
or
financial
institutions
which
will
expire
annually.
The
commissioner
is
required
to
adopt
regulations,
establishing
the
fees
for
issuing
and
renewing
a
license.
G
A
copy
of
the
policy
concerning
the
privacy
of
a
user's
information,
the
schedule
of
fees
proposed
to
be
charged
to
a
user
or
employer
a
statement
from
the
applicant
relating
to
a
possible
child
support
court
order
and
any
information
required
by
regulation
which
may
be
adopted
by
the
commissioner.
Pursuant
to
section
19
of
the
bill.
G
Section
15
requires
an
employer,
integrated,
earned
wage
access
provider
to
submit
a
report
to
the
commissioner
on
or
before
june
30
of
each
year.
The
report
must
contain
financial
statements
of
the
immediately
preceding
year
that
have
been
audited
by
an
independent,
certified
public
accountant
and
a
copy
of
each
complaint
that
has
been
filed
against
the
provider
with
the
better
business
bureau
or
the
consumer
financial
protection
bureau
and
a
description
of
the
resolution.
G
Section
17
provides
that
if
an
employer
integrated
earned
wage
access
provider
is
unable
to
be
repaid,
the
amount
of
money
delivered
to
a
user
absent
fraud
from
the
user.
The
provider
is
prohibited
from
collecting
or
attempting
to
collect
that
money
from
the
user
or
reporting
any
information
regarding
the
inability
of
the
provider
to
be
repaid
to
a
consumer
party.
G
We're
looking
for
limitations
on
what
providers
can
call
fraud,
raising
it
to
intentional
and
willful
fraud,
providing
limitations
on
debiting
authority,
providing
requirements
for
a
new
mechanism
for
fid
to
provide
input
regarding
additional
future
rules
and
regulations.
Should
they
be
warranted
provisions
that
strengthen
fid's
examination,
supervision
and
licensure
authorities.
G
G
E
Thank
you,
madam
vice
chair,
and
and
thank
you
senator
for
bringing
this
bill.
I
I
was
actually
unaware
of
this
as
an
offering
until
I
first
encountered
the
bill
and
your
your
lobbying
team
called
and-
and
we
talked
about
it-
and
I
thought
that
was
very
helpful.
I
appreciate
you
having
that
done
in
advance.
E
I
just
have
a
couple
of
questions,
because
this
is
creating
a
new
licensee
requirement,
a
new
license,
as
I
understand
it,
and
what
happens
if
employers
are
doing
this
on
their
own,
I'm
a
little
unclear
if
they
are
required
to
license
to
be
licensed
to
do
this.
If
they're
going
to
offer
this
as
an
in-house
operation.
G
Thank
you
and
senator
pickard
for
the
question
and
I
think
a
great
question
definitely
with
respect
to
the
in-house,
and
what
we
are
trying
to
do
is
ensure
that
anywhere
where
they
are
offering
this
there
would
need
to
be
a
license,
so
they
would
conform
with
fid.
G
Primarily,
I
think
one
of
the
safest
ways
and
why
we've
we
sort
of
focused
on
this
in
the
language
of
the
bill
is
having
that
employer
integration
with
the
companies,
because
that's
how
you
can
actually
verify
that
there
are
in
fact
wages
to
be
earned.
You
can
verify
that
that
employee,
actually
you
know,
works
at
that
company
and
you
have
all
of
those
checks
and
balances,
so
you're
not
providing
some
sort
of
advance
on
what
they
may
be
getting
for
pay,
but
rather
you're
integrating
with
that
employer
so
for
any
employer.
G
That
would
have
something
that
would
be
more
in-house
depending
on
how
they
set
that
up.
They
may
fall
within
this,
but
primarily,
I
think
the
common
way
that,
even
with
an
in-house
agreement,
is
usually
through
a
cert
through
a
particular
vendor,
and
then
they
set
that
up
with
the
employer
that
vendor
would
need
to
be
licensed.
E
Right-
and
that
makes
all
the
sense
in
the
world
I
I
would
expect
that
if
someone's
coming
in
and
connecting
to-
or
you
know
linking
up
with
a
employer's
payroll
system
and
then
offering
that
through
their
own,
not
the
employer
systems
but
offering
that,
through
their
own,
that
they
would
have
to
have
a
license.
E
My
thought
is
because
my
understanding
was
that
the
the
walmarts
and
targets
of
the
world
they've
actually
brought
this
into
their
payroll
systems,
so
they
are
offering
payment
on
the
go
as
opposed
to
accruing
wages
that
then
are
paid
at
the
end
of
the
period,
but
many
of
the
smaller
outfits,
because
obviously
walmart
and
target
and
the
national
chains
they're
going
to
have
the
wherewithal
to
do
this,
probably
completely
in-house,
or
at
least
with
a
closely
linked
vendor.
My
thought
is,
as
we
get
into
the
smaller
operations
so,
for
example,
my
law
firm.
E
We
have
11
people
working
for
us,
and
so
maybe
we
wanted
to
do
this.
Well,
we
don't
have
we
don't
even
have
internal
payroll
operations,
we
contract
with
a
provider
to
do
the
manual.
You
know
the
the
the
issuance
of
those
those
paychecks,
and
so
I
would
have
to
go
to
someone
outside
to
do
that.
E
If
I
were
then
to
say,
okay,
I'm
going
to
do
this
on
an
internal
basis,
I
am
I
going
to
be
required
to
be
licensed,
or
would
it
be
the
paychecks
that
would
do
it
or
what
happens
if
they're
already
licensed
through
fid
on,
say
I'm
going
through
my
bank
and
they
offer
this?
Do
they
then
have
to
get
a
second
license?
I'm
just
trying
to
figure
out
who
the
licensees
are.
G
Yes
and
thank
you
senator
picker
for
the
question-
and
I
think
there's
a
bit
of
of
confusion
around
this,
so
most
employers,
if
you
were
going
to
set
up
a
different
structure
for
payroll,
let's
say
you
wanted
to
pay
your
employees
on
a
weekly
basis.
Most
employers
don't
right.
Most
employers
do
either
on
the
15th,
30th
or
they'll
do
a
two-week
pay
period,
and
I
think
most
of
us
are
familiar
with
that
as
a
form
of
pay.
G
You're
really
just
in
the
in
the
space
of
this
is
what
your
payroll
service
contract
looks
like
with
your
payroll
company
and
potentially
you
know
you
work
that
out
with
them
when,
for
instance,
target
is
a
great
example
and
I'll.
Let
I
let
matt
mr
popco
jump
in
if
he
has
anything
to
add
as
well,
but
when
other
corporations
are
we're
talking
about
the
in-house
we're
really
talking
about
these
employer
integrated
systems
where
we
are
seeking
to
license
them
to
ensure
that
we
can
protect
the
consumer
that
we're
not
inadvertently.
G
I'm
sharing
information,
public,
personal
or
excuse
me,
personal
information
that
shouldn't
be
shared
and
that's
what
this
bill
is
seeking
to
do.
But
that's
where
there's
employer
integration
such
that
the
employer
is
working
directly
with
the
vendor,
so
it's
not
employee
to
vendor
it's
employer
to
vendor.
So
if
you
were
going
to
set
this
up
as
an
employer,
you're
either
talking
about
something
that
changes
the
way
in
which
you
do
payroll
generally
or
you're.
Talking
about
one
of
these
employer
integrated
systems
and
that's
what
we're
seeking
to
license.
G
Most
employers
are
not
going
to
set
up
their
own
system
to
work
with
the
paycheck
company
to
then
or
with
the
payroll
company,
to
try
to
pay
their
employees.
A
little
earlier
becomes
very
costly
and
I
think
then
starts
to
just
delve
into
a
different
form
of
payroll,
but
these
in-house
services
are
really
more
the
vendor
contracting
directly
with
the
employer
and
that's
what
we're
seeking
to
get
at,
and
I
don't
know
if
mr
copco,
you
had
anything
else,
you
wanted
to
add
on
that.
I
Thank
you,
chair
spearman,
and
members
of
the
committee.
My
name
is
matthew,
kopco
mbf
of
daily
pay
to
you,
chair,
spearman
and
through
you
to
senator
pickard.
Yes,
the
majority
leader
cannizzaro
is
correct.
I
I
believe
your
question
relates
to
if
you
were
interested
in
building
your
own
on-demand
pay
system
from
scratch
in-house
fully
in-house
I.e
without
the
use
of
a
third-party
vendor.
Again,
most
employers
do
this
through
a
vendor.
For
example,
some
of
the
companies
that
were
mentioned
work
with
our
company
and
some
of
our
competitors.
But
if
you
were
to
do
this
entirely
in-house,
the
regime
under
the
bill
from
my
read
of
it,
would
not
apply
to
you
again.
I
This
is
for
employer
integrated,
on-demand
pay
providers,
I.e
the
provider
of
the
on-demand
pay
service,
an
employer
trying
to
provide
a
similar
service
or
running
payroll
more
frequently
in-house,
just
as
the
majority
leader
stated,
would
have
to
follow
their
own
existing
compliance
procedures,
just
as
if
they
wanted
to
run
payroll
daily
or
run
pay
payroll.
More
frequently
and
again,
the
overhead
and
compliance
of
that
is
part
of
why
they
don't
do
it
and
part
of
why
the
market
is
moving
towards
these
vendor-based
relationships.
E
Right
and-
and
I
think,
you're
you're
you're
almost
there
in
terms
of
my
question,
because
what
I'm
trying
to
do
is
find
the
intersection.
Where
does
the
supply
and
where
does
it
not
apply?
Because,
as
I
read
this,
I
thought
if
I
were,
and
I'd
maybe
using
my
own
firm
was
a
bad
example
because
yeah
with
11
people,
it's
too
too
expensive
to
try
to
do
a
payroll
run
every
day.
But
I'm
thinking
say
you
get
into
the
100
to
500
employees.
E
So
we're
talking
about
a
significant
operation
where
your
economies
of
scale
may
come
into
play
at
what
point
is
a
license
required?
You
know
because
they're,
probably
not,
they
may
still
be
working
with
a
payroll
provider
and
maybe
that
payroll
provider
will,
you
know,
set
up
a
pay
structure,
a
cost
structure
so
that
it
makes
it
so
that
the
employer
can
actually
offer
the
on-demand
type
payment
or
the
frequent
payment.
E
Because,
as
I
look
at
this
in
the
language
of
the
bill,
it's
couched
in
terms
of
how
frequently
it's
paid
not
in
terms
of
you
know
that
the
well
I
shouldn't
say
not
in
terms
of
the
vendor,
because
it
also
implies
that
there's
a
vendor
involved.
So
what
I'm
trying
to
do
is
tease
out.
Where
is
the
line
where
the
bill
applies
and
where
does
the
line
or
where
can
they
stop
and
not?
Have
the
bill
apply?
Does
that
make
sense?
I'm
not
I'm
probably
not
being
very
clear.
Yes,.
I
I
Employers
would
not
have
to
register
under
under
this
bill
and
again,
medium-sized
providers
are
offering
the
service
typically
through
a
peo,
and
firms
like
ours
and
others
actually
tend
to
again,
not
just
work
with
agreements
with
employers,
but
work
with
leading
payroll
providers,
peos
and
others
like
that,
so
that,
through
a
channel
distribution,
the
service
can
be
offered
through
a
technology
integration
through
the
peo,
and
in
that
case
again,
for
example,
you
know.
In
no
case
would
the
employer
be
required
to
be
providing,
because
it's
not
an
employer,
integrated,
on-demand
pay
provider.
E
I
appreciate
that
and
then
just
if
I
may,
madam
chair,
I
know
I've
taken
a
lot
of
time,
just
one
more
question
with
respect
to
section
17,
if
an
employer,
integrated,
on-demand
pay
provider
provides
on
domain
and
is
unable
to
be
repaid,
I
that
tripped
me
up
because
we're
in,
in
my
view,
we're
talking
about
a
payroll,
a
a
more
frequent
payroll
processing
as
opposed
to
a
loan,
because
when
we're
talking
about
employment
in
20,
we're
talking
about
employer
integrated,
on-demand
payment
providers
are
not
considered
loans.
E
But
then,
when
we
go
to
the
third
party,
it
is
a
loan,
and
so
I'm
trying
to
figure
out
how
would
a
a
repayment
be
required
in
any
instance,
when
we're
talking
about
a
payroll.
G
Thank
you,
senator
picard,
for
the
question
and
a
great
one
and
I
think,
an
important
point
of
of
distinction,
and
that
has
to
do
with
instances
where
maybe
there
was
a
a
discrepancy
and
I'll
say
briefly
the
intent
and
then
I'll
turn
it
over
to
mr
cocco,
because
I
think
he
can
walk
through
that
a
little
bit
more
detail.
The
intent
here
is
to
ensure
that
the
consumer,
the
employee,
is
not
being
charged.
G
If
there
was
some
sort
of
discrepancy
along
the
way
that
they
don't
there's
nothing
for
them
to
pay
back.
We're
trying
to
ensure
very
strictly
here,
because
there
are
actors
where
they
may,
they
may
be.
You
know
giving
what
amounts
to
a
loan
and
it
and
or
a
paycheck
advance,
or
something
like
that.
That
would
have
to
be
repaid
and
we're
trying
to
ensure
that
that
is
not
what
this
is
at
all
whatsoever.
G
So
if
there
were
a
discrepancy
they
wouldn't
be,
they
would
not
have
to
pay
that
back
so
that
there
isn't
a
loan,
and
if
mr
conco
has
anything
he
would
like
to
add
to
that.
I
Thank
you
senator
canezzaro,
and
do
you
chair,
neil
and
through
you
to
senator
pickard?
Yes
again,
the
the
majority
leader
is
right.
Second,
section
17
is
really
intended
to
be
one
of
the
key
consumer
protections.
Actually
in
the
bill
which
points
out
that,
to
the
extent
an
employer
is
either
delinquent
or
is
unable
to
make
payroll,
the
provider
cannot
look
to
the
employee
for
recourse.
I
So
this
is,
you
know
essentially
what's
considered
a
non-recourse
section
to
protect
consumers
because,
as
you
can
imagine
from
time
to
time,
employers
in
bad
economic
circumstances
do
not
make
payroll
or
otherwise
in
normal
course
can
pay.
You
know
delayed
payroll,
and
this
is
a
clear
protection
so
that
the
provider
is
not
looking
to
the
employee
for
repayment.
Its
arrangement
is
with
the
employer
as
the
facilitator
of
the
on-demand
pay
services
and
those
any
discrepancies
in
payroll
should
be
resolved
with
the
employer.
E
All
right
so
to
make
sure
I'm
clear
this
isn't
talking
about
repayment
of
a
loan
but
repayment,
if
there's
a
discrepancy
in
the
payroll
processing
where
the
the
employee
is
presumably
overpaid.
Even
though
that
you
know
the
employee
may
have
filled
out
his
time
card
correctly
or
whatever.
E
It's
not
the
fault
of
the
the
employee
that
that's
going
to
be
between
the
third
party
provider
and
the
employer
to
resolve,
but
I'm
assuming,
if
the
employees
overpaid,
if
he
was
paid
more
than
he
earned,
that
that
would
then
at
most
be
offset
against
future
income
so
that
we're
not
paying
an
employee
who
didn't
earn
the
wage
that
would
come
out
of
future
earnings
is.
Is
that
a
fair
statement.
I
Thank
you,
senator
pickard
to
you,
chair,
neil,
through
and
three
to
senator
pickard,
that's
correct
in
normal
course
of
payroll.
As
you
can
imagine
from
time
to
time,
even
employers
have
discrepancies
or
errors
in
the
payment
of
payroll.
So
that's
one
use
case
example.
The
typical
example,
though,
that
was
drafted
for
this
section,
is
really
more
about
a
missed
or
late
payroll
to
really
enshrine
the
concept.
E
H
Thank
you
for
that.
Senator
settlemyre.
D
Thank
you,
madam
chair.
I
appreciate
the
opportunity
to
ask
questions.
I'm
also
very
grateful.
The
gentleman
from
daily
pay
is
here
so
where,
in
the
bill,
does
this
limited
to
only
non-payback
models
and
doing
some
research
on
this?
I'm
still
a
little
concerned
here.
If
we're
going
to
allow
payback
models
to
access
this
potential
licensure
or
are
we
specifically
limiting
it
within
the
bill
in
this?
So
what
section.
I
Thank
you,
senator
settlemyre
to
you,
chair,
neal
and
through
you
to
senator
settlemyre.
The
definition
of
employer
integrated
on
demand
pay
provider
defines
the
service
as
a
provider
who
uses
an
employer,
integration
to
verify,
earned
income,
and
the
bill
is
framed
such
that
only
employer,
integrated
on-demand
pay
providers
I.e.
Those
who
do
not
engage
in
that
debiting
activity
or
the
third
party
repayment
would
be
licensed
under
this
section.
So
it
requires
fundamentally
in
the
definition,
an
integration
with
the
employer
not
just
contractually,
but
through
payroll
and
through
data.
D
Okay,
well
to
me,
we
might
want
to
make
that
a
little
more
clear,
that
this
follows
the
consumer
financial
protection
bureaus
concepts
and
that
this
is
only
applying
to
non-payback
models.
Otherwise,
as
I'm
saying
online,
this
could
get
us
into
all
types
of
problems.
So
I'm
just
saying
we
might
want
to
make
that
a
little
bit
more
clear,
otherwise
we're
getting
this
discussion
of
credit
and
payback.
Thank
you.
H
H
H
I
guess
I
don't
know
what
you
would
call
it
you'll
call
it
an
on-demand
payment,
but
is
there
interest.
I
I
There
are
no
interest
charges,
there
are
no
loans,
there
are
no
rollover
fees
and
there
are
no
other
hallmarks
of
credit
involved,
but
there's
a
requirement
of
transparency
for
all
fees,
of
course,
their
their
their
fees
for
the
the
service,
as
opposed
to
an
interest
which
would
be
more
of
a
concept
in
a
credit
construct.
H
Okay,
thank
you
for
that
senator
lange
yeah.
So
as
an
operations
manager
for
a
small
business.
I
can
really
see
the
benefits
to
this,
because
I
did
payroll
for
two
businesses
and
I
always
had
my
employees
coming
to
me
and
asking
me
for
advances
on
their
paychecks,
because
maybe
for
that
month,
rent
was
due
before
they
could
get
their
paycheck
and
such
and
to
me
having
another
person
that
could
do
this.
H
Instead
of
having
to
cut
the
check
figure
out
the
taxes
and
all
that
would
be
really
helpful,
can
you
remind
me
how
much
the
fee
is.
I
Thank
you
senator
lang
to
you,
chair,
neil
and
through
you
to
senator
lang.
Our
typical
pricing
structure
is
a
dollar
ninety
nine
for
the
legacy
transmission,
which
is
called
ach,
which
typically
takes
eight
to
twenty
four
hours
for
the
funds
to
arrive
in
the
employee
bank,
account
and
there's
a
2.99
option,
which
is
our
typical
pricing
for
instant
delivery,
which
is
you
know,
typically
within
about
20
minutes
or
shortly
thereafter.
Other
providers
have
different
models.
I
There
are
some
versions
that,
if
you
use
a
certain
type
of
pay
card
or
other
type
of
system
with
with
the
provider
that
the
trip
the
fees
can
be
less,
including
up
to
free
in
certain
circumstances
and
in
all
cases,
payroll
full
remainder
payroll
on
payday,
whether
or
not
you
use
the
transaction
for
the
service
does
not
have
any
charge
associated
with
it.
So
you.
I
Yes,
employees
can
direct
funds
to
any
destination
account
of
their
choosing
and
again
it's
an
entirely
voluntary,
non-discriminatory
but
non-discriminatory
benefit
to
the
extent
it
is
not
used
in
a
given
pay
period.
There
is
no
charge
of
the
employee
and
again,
in
all
cases,
full
full
net.
Remainder
pay
never
has
any
charge
associated
with
it.
I
We
offer
employers
the
ability
to
subsidize
some,
do
that
typically
takes
the
form
of,
for
example,
one
free
additional
transaction
per
pay
period,
and
we
continue
to
see
kind
of
shifts
in
the
market
where
that's
becoming
more
and
more
common.
But
it's
it's
part
of
structuring
the
system,
and
so
the
we
offer
a
subsidation
option
and
the
employees
or
the
employers,
depending
on
on
the
preference
of
the
system.
D
Yeah
we're
arguing
about
who
gets
to
unmute
the
button.
Sometimes
I'm
not
quick
enough
and
you're
much
faster
than
I
am
that
last
couple
of
questions
kind
of
brought
it
up
so-
and
I
know
I'm
only
talking
to
this
one
gentleman's
company,
but
what
size
does
this
really
work?
I
mean
if
I
have
three
employees
and
I
don't
pay
that
much.
You
know
on
wages
or
what's
a
traditional,
do
you
guys
have
a
cutoff
point
that
if
you
don't
do
this
much.
D
Is
this
just
I
don't
know,
some
of
this
looks
like
it's
almost
like
it's
a
payday
loan
lender
in
some
respects,
so
that's
where
I'm
getting
a
little
bit
confused.
But
what's
the
standard
you
know,
what's
a
cutoff
point
that
you
don't
deal
with
a
small
business
because
I
assume
there
has
to
be
a
certain
point.
You're,
like
you
know
you
don't
guys,
don't
do
enough
quarterly
to
qualify.
I
Yes,
thank
you
senator
settlemyre,
and,
to
you
share
spirit
through
you
senator
settlemyre.
We
we
do
work
with
employers,
large
and
small.
I
I
would
say
our
standard
employer
is
a
thousand
or
more
employees,
but
we
do
have
a
small,
medium-sized
business
sales
division
and
again
the
exciting
thing
about
this
industry
is
that
as
it
matures
we're
able
to
build
all
types
of
apis
to
work
with
all
of
the
payroll
providers
in
the
industry,
all
of
the
peos
in
the
industry,
and
so
we
are
in
circumstances
often
times
where
this
is
kind
of
a
check.
I
The
box
add-on
service
for
a
smaller
medium-sized
employer,
who's
working
with
xyzpeo
and
so
long
as
we're
able
to
write
an
api
and
technology
that
works
with
the
peo.
They
can
distribute
that
as
a
voluntary
offering
again
to
any
of
their
clients.
So
it
is
becoming
increasingly
available
to
smaller,
smaller
business
types
as
the
industry
matures
and
grows.
D
Okay,
that
really
didn't
necessarily
get
into
the
question
of
you
know:
what's
your
your
just
your
industries
or
your
business's
cutoff
point
you
know
like
if
you
do
less
than
ten
thousand
dollars
you
know
a
month
in
payroll.
Does
that
you
know
create
the
limitation
or
do
you
have
any?
I
mean
you
work
with
guys
that
are
small.
As
you
know,
five
thousand
dollars
or
do
you
you
know
I
was
just
asking
specifically
your
particular
business
if
there's
a
point
that
it's
not
economical
to
entering
agreements
with.
I
Thank
you
senator
and
to
chairman
spear
and
and
through
chairman's
chairman
chairman,
just
go
direct
apologies,
yes,
so
so
typically,
the
enterprise
sales
force
is
focused
on
medium
and
large
size,
businesses,
typically
a
thousand
or
more
employees.
But
again
the
exciting
opportunity
for
the
small
medium-sized
part
of
the
business
here
is
that
once
you
create
an
integration
with
xyz
peo
provider,
then
all
of
those
providers,
clients
can
use
them.
So
we
used
to
have
to
build
custom
technology
for
every
new
client
for
our
first
few
dozen
clients.
I
D
All
right,
I
guess
I'm
I'm
just
being
dead,
because
I
don't
hear
an
answer:
they're,
necessarily
what
you
know:
five
thousand
dollar
person,
but
I'll
get
that
one
last
question,
because
it
was
brought
up
about
these
consumer
transaction
fees,
which
you
know
basically
mandatory
if
you
want
to
participate.
So
in
reading
this
other
article.
I
Thank
you
senator
so
so,
as
you
may
have
seen,
I
believe
it
might
have
been
you
who
previously
referenced
the
cfpb
guidance
on
this
matter.
Fundamentally,
the
analysis
of
whether
or
not
this
is
credit
does
hinge
on
that
payback
versus
non-payback
model,
as
you
mentioned,
and
so
typically
when
something
is
credit
fees
of
course
are
interest.
When
something
is
not
credit,
those
fees
are
not
interest,
they
may
be
service
fees,
transaction
fees,
technology
fees
or
something
else,
as
you
may
have
seen
from
that
cfpb
advisory
opinion.
I
There
is
a
broader
framework
for
evaluating
earned
wage
access
providers.
It's
a
narrow
provision
that
alludes
to
either
no
fee
models
or
nominal
processing
fee
models,
but
the
reasoning
and
analysis
in
that
opinion
points
out
why
most
employer-based
services
are
involved
in
a
construct.
That
is
not
credit
in
nature
because,
again,
going
back
to
the
discussion
regarding
section
17,
there
is
not
a
looking
to
the
employee
for
repayment.
It
is
more
like
the
facilitation
of
real-time
payroll.
H
Hey,
thank
you
senator
settlemyre
and
I
see
senator
pickard.
So
so
I
want
to
say
this
because
we
do
have
a
third
bill,
so
we
can
take
two
short,
quick
questions
being
mindful
majority
leader
is
working
on
an
amendment
to
this
bill,
so
we
can
have
two
more
and
then
I
want
to
try
to
go
to
public
testimony.
H
So
then
we
have
time
to
re,
hear
the
third
bill,
which
has
a
little
bit
more
people
in
the
queue
so
senator
pickard
and
then
senator
lange.
E
E
That
were
whether
they
be
fees
or
you
know,
captured
under
some
rule,
but
it
sounded
like
you
were
saying
that
there's
a
dollar
99
here,
299
there
that
were
captured
on
each
transaction.
So
if
we
have
a
thousand
employees
and
you're
doing
a
daily
pay
program,
that's
five
thousand
dollars
a
day
that
you're
making
on
this
that
you're
taking
from
the
payroll
did.
I
understand
that
correctly.
I
I
E
Those
are
paid
out
of
the
the
paycheck.
I
Those
are
transaction
fees
assessed
to
the
typically
to
the
employee,
or
if
the
employer
is
subsidizing
to
the
employer
and
again,
if
they
do
not
access
the
service,
there
is
no
charge.
H
H
I
have
paycheck
and
we're
working
with
your
company
and
someone
wants
to
access
money
and
they'll
get
that
money
out
you'll
work
through
paychecks,
if
I'm
understanding
this
correctly
and
but
because
we
have
paychecks,
even
though
you're
not
charging
a
fee,
they
may
charge
us
a
fee
for
like
putting
this
data
in
their
system.
I
Yeah,
thank
you
for
the
question
senator.
So
there
are
many
integrations
at
play
here.
We
integrate
with
a
variety
of
leading
payroll
providers,
including
ones
like
those
you
mentioned
and
other
large
payroll
providers,
and
then
the
other
critical
part
of
the
system
is
not
just
payroll
but
integration
with
the
time
management
system
in
the
accounting
system,
so
that
net
take-home
pay
can
actually
be
determined
and
calculated,
which
is
again
one
of
the
benefits
of
the
employer-based
system
that
you
have
the
ability
to
actually
limit
this
to
net
take-home
pay.
I
I
I
would
say
the
easiest
way
to
think
about.
This
is
a
technology
layer
on
top
of
all
the
existing
processes,
so
adding
an
on-demand
pay
provider,
at
least
under
our
construct,
does
not
require
you
to
change
your
arrangement
with
paychecks
or
to
get
a
new
payroll
provider
to
get
a
new
time
and
attendance
provider.
I
What
we
do
is
we
contract
with
you,
and
then
we
have
an
integration
with
companies
like
paychecks,
where
we
can
facilitate
with
obviously
the
employer
and
employee
consent
that
live
data
stream
to
calculate
the
net
earnings
balance,
and
then
it
sits
on
top
of
that
procedure
so
that
the
employees
receive
their
on-demand
pay
as
requested
and
through
the
employer
integration.
It's
automatically
resolved
on
payday,
so
there's
no
employee
account,
debiting
or
direct
to
consumer
activity.
I
H
Thank
you
that
clarifies
that
to
me.
Okay,
thank
you
for
that.
So
we
will
go
ahead
and
move
to
callers
who
are
in
support
of
sb
198.
B
B
C
Thank
you,
chairwoman,
spear
win
vice
chairman
luke
and
members
of
the
committee
for
allowing
me
to
testify.
Today.
My
name
is
sangeetha
rajanathan
and
I'm
the
general
counsel
and
chief
compliance
officer
for
ernin.
I
also
want
to
thank
the
majority
leader
canazaro
for
her
leadership
on
this
important
issue
and
taking
the
time
to
understand
the
intricacies
of
the
on-demand
pay
industry.
C
C
Our
cash
out
product
is
an
alternative
to
expensive
payday
loans,
overdraft
fees
and
the
late
philippines
that
causes
cycles
of
debt
vernon
is
asking
that
fb
198
is
strengthened
to
treat
on-demand
pay
providers
equally
and
to
include
strong
consumer
protection
provisions
like
vcap
debit
attempt
limits
and
annual
usage
reporting
requirements
to
fid,
including
transparency
around
how
earnings
are
verified.
Legislation
should
not
be
used
as
a
tax
tip
to
pick
winners
and
losers.
C
C
Using
our
direct
to
consumer
on-demand
pay,
product
vernon
is
not
a
lender,
and
our
cash
out
product
is
not
alone.
We
only
give
people
access
to
the
amount
of
money
that
they
have
already
earned.
People
support
earning
voluntarily
with
tips.
Our
business
model
provides
a
no
cost,
no
interest
no
fee
option
for
workers
to
access
their
money
when
they
need
it
and
at
a
level
that
meets
their
budget
while
sb
198
is
well
intentioned.
C
It
currently
leaves
out,
on
behalf
of
the
on-demand
pay
industry
and
its
consumers,
by
excluding
the
directed
consumer
model
from
being
treated
equally.
In
fact,
the
bill
would
consider
direct
consumer
providers
to
be
alone,
even
though
the
employer,
integrated
and
directed
consumer
providers
offer
essentially
the
same
service.
C
C
We
both
provide
workers
access
to
third-party
funds
based
on
their
workers,
recruit
earnings,
regardless
of
whether
the
service
is
employer
integrated.
The
money
in
advance
is
never
directly
from
the
employer's
payroll.
Both
b2b
and
b2c
providers
have
authorization
to
develop
the
consumer's
account
for
repayment.
The
only
differences
are
employer,
integrated
providers
sign
contracts
well
with
employers.
C
While
we
have
agreements
correctly
with
workers,
we
give
workers
the
flexibility
to
take
this
tool
with
them,
no
matter
where
they
work,
but
they're
employed
by
a
big
corporation
or
at
the
coffee
shop
down
the
street
employer
integrated
providers
verify
employee
wages
with
the
employer,
whereas
these
verify
wage
information
such
as
timesheets
and
wage
steps.
With
the
employee's
explicit
permission,
employer
integrated
providers,
charge
employers
and
customers
for
this
service
in
the
form
of
transaction
fees.
C
C
We
would
really
welcome
the
opportunity
to
speak
with
the
senate
majority
leader
committee
members
and
all
stakeholders
on
this
issue
so
that
we
can
ensure
consumers,
especially
those
employed
by
small
businesses,
are
protected
and
provided
with
options
to
access
their
earnings
in
real
time.
Thank
you
very
much
for
the
opportunity
to
speak.
B
B
D
Good
morning,
for
the
record,
my
name
is
peter
alves,
p-e-t-e-r
a-l-d-o-u-s,
I'm
a
staff
attorney
at
legal
aid
center
of
southern
nevada,
where
I
help
low-income
nevadans
protect
themselves
from
predatory
lenders.
I'd
like
to
thank
madam
vice
chair
and
members
of
the
committee
for
this
opportunity
to
comment
this
morning.
I'd
also
like
to
thank
majority
leader
conozaro
for
bringing
this
legislation,
as
it
is
important
for
the
state
to
regulate
this
new
and
potentially
helpful
service.
D
I
appreciate
the
continuing
dialogue
we've
had
regarding
this
bill.
For
the
most
part,
I
believe
this
bill
will
help
low-income
nevadans
by
giving
them
a
safer
and
less
expensive
option
to
meet
unexpected
expenses.
I
especially
appreciate
that
the
bill
makes
a
distinction
between
employer,
integrated
and
direct
to
consumer
providers,
since
the
relative
risk
to
consumers
is
much
lower
in
the
employer
integrated
model.
I
still
have
a
few
concerns
with
the
bill
that
I
hope
can
be
addressed.
D
I
want
to
be
sure
that
the
financial
institutions
division
is
able
to
effectively
regulate
providers,
and
I
echo
the
concerns
that
they've
raised
previously.
I
am
also
concerned
about
language
in
17
in
section
17,
regarding
recourse
in
cases
where
the
provider
believes
that
fraud
has
occurred.
Unfortunately,
financial
institutions
make
mistakes
and
I
want
to
ensure
that
the
burden
for
resolving
providers
mistakes
is
worn
by
the
provider
rather
than
the
users
who
are
already
in
financial
distress.
D
B
C
H
Okay,
thank
you
for
that.
So
any
closing
comments,
majority
leader.
G
Thank
you,
madam
vice
chair.
I
just
wanted
to
again
thank
the
committee
for
allowing
me
to
be
here
to
present
senate
bill
198.
G
I
think
it's
so
important
for
us
to
take
the
step
in
being
able
to
regulate
this
in
a
way
that
will
ensure
consumer
protection,
because
this
practice
is
going
on,
regardless
of
whether
we
step
in
or
not,
and
so
I
think
it
is
incumbent
for
us
to
really
take
the
initiative
in
ensuring
that
what
we
put
in
place
makes
sense,
because
employees
are
accessing
this,
they
are
utilizing
it
and
if
we
can
ensure,
there's
consumer
protections
built
in
then
that's
what
we
should
be
doing
so
again.
G
Thank
you
for
all
of
your
time.
Thank
you
for
all
of
your
your
questions,
and
it's
always
good
to
be
here
in
commerce
and
labor.
H
F
Thank
you,
madam
vice
chair.
Are
you
inviting
me
to
the
diocese?
I
am
great.
Well,
hello,
everybody.
My
name
is
senator
julia
ratty
and
I
represent
senate
district
13,
which
is
kind
of
the
middle
of
reno
and
sparks
I'm
thrilled
to
be
here
today
with
you
in
the
senate
senate
committee
on
commerce
and
labor.
My
first
visit
with
you
here
this
session.
F
I
am
very
excited
that
talks
about
the
role
of
a
very
important
part
of
our
healthcare
workforce,
and
that
is
pharmacists.
F
I'm
saying
these
words
very
seriously,
if
there's
a
silver
lining
to
the
pandemic,
and-
and
I
I
say
those
words
with
caution,
knowing
that
we've
lost,
we
have
many
families,
who've
lost
loved
ones,
and
I
do
not
want
to
in
any
way
understate
what
has
happened
there.
But
if
there's
a
silver
lining,
it
is
that
the
pandemic
has
exposed
some
weaknesses
in
our
system
of
care,
and
we've
certainly
seen
that
in
terms
of
the
disproportionate
impact
on
people
of
color
and
other
communities.
F
We've
seen
that
with
the
lack
of
public
health
infrastructure,
and
in
this
case
we
have
seen
it
in
a
practice
that
we
have
in
state
law,
which
is
something
that's
known
as
a
collaborative
agreement
that
allows
us
to
get
the
maximum
benefit
out
of
the
workforce.
F
F
I
want
to
express
my
thanks
to
the
nevada,
pharmacy
alliance
and
the
nevada
society
of
health
system
pharmacists,
who
put
together
a
quick
two-page
graphic
for
you.
It's
in
the
exhibits,
if
you
like
to
see
bullets
rather
than
a
white
paper,
and
we
are
still
45th
in
the
nation
when
it
comes
to
access
to
health
care.
We
know
that
as
the
state
of
nevada,
we
have
many
many
areas
of
our
state
that
are
health
care
shortage
areas
where
there
just
aren't
enough
practitioners.
F
We
are
48th
in
the
nation
in
terms
of
primary
care,
physicians
per
one
hundred
thousand
population.
Yet,
at
the
same
time,
ninety
percent
of
nevadans
live
within
five
miles
of
a
community.
Pharmacy
pharmacies
and
pharmacists
by
their
nature
are
neighborhood
based.
They
are
perhaps
some
of
our
most
accessible
healthcare
providers
and
we're
under
usable,
but
we
are
under
utilizing
them
again.
They
have
a
doctorate
level
education.
They
have
a
well-defined
scope
of
practice
and
collaborative
agreements
that
allow
them
to
work
with
a
physician.
So
let
me
just
try
to
give
you
an
example.
F
Let's
say
I
come
down
with
the
symptoms
for
strep
throat
and
I
have
a
primary
care
provider,
I'm
lucky
enough
to
have
a
primary
care
provider,
but
it's
going
to
take
several
days
for
me
to
get
into
that
person
and
if
I
go
to
my
pharmacy,
if
my
pharmacist
can
run
a
test,
read
that
test
and
give
you
the
prescription
for
strep
throat
and
in
this
specific
example,
lots
of
research.
We
know
what
what
what
drug
to
prescribe.
We
know
that
drug
is
not
particularly
dangerous.
F
We
know
that
if
we
get
it
to
you
more
quickly
that
you're
likely
to
have
a
much
better
outcome.
If
all
of
that
can
happen,
if
I
drive
one
mile
from
my
house
to
my
local
grocery
store
that
has
a
pharmacy
situated
in
it,
I'm
going
to
have
a
significantly
better
health
outcome
going
to
be
significantly
more
convenient
for
me,
and
my
employer
is
probably
going
to
see
me
back
at
work
more
quickly.
The
downstream
effects
are
significant.
F
What
that
pharmacist
can
do
and
how
they
can
do
it
and
under
what
strict
protocols
they
can
do
it
so
that
the
safety
of
the
patient
is
still
maintained,
that
patient
gets
access
to
health
care.
We
haven't
broken
the
provider
relationship,
but
we
are
utilizing
a
professional
who
has
the
skills
to
help
us
get
what
we
need
in
a
convenient,
cost-effective
location.
F
F
F
So
if
I
have
to
go
to
my
doctor
and
that
doctor
has
to
refer
me
to
that
pharmacist,
it
really
takes
away.
The
whole
example
again
right,
not
helpful.
If
for
something
as
simple
as
the
strep
throat
situation,
it
takes
out
another
limitation
that
says
that
the
doctor
pharmacist
relationship
has
to
be
within
100
miles
of
each
other.
F
No
logical
reason
why
that
doctor
and
not
pharmacists
need
to
be
within
100
miles
of
each
other
and
it
takes
away
what
was
written
into
the
law
at
one
point,
which
was
a
piece
that
says
that
pharmacist
has
to
tell
that
patient
that
they're
not
a
doctor,
but
that
that
patient
is
consenting
to
this
happening
through
a
pharmacist.
F
We
think
it's
unnecessary,
we're
open
to
conversation
on
that
piece.
It
just
doesn't,
it
seems
obvious
and
we're
just
it's
another.
It's
more
paperwork
that
needs
to
be
generated.
Every
time,
there's
a
visit,
and
then
it
does
clear
up
the
definitions
of
how
what
needs
to
be
in
the
agreement
between
the
doctor
and
the
pharmacist
so
that
everybody's
on
the
same
page,
they
know
what
the
pharmacist
is
allowed
to
do
and
under
what
conditions,
no
matter
what
rules
and
protocols.
So
that's,
basically
what
the
bill
does.
F
I
have
a
team
of
here
of
people
here
to
help
present
the
bill
and
answer
your
questions,
so
I'm
gonna
turn
it
over
to
beth
slamowitz
who's.
Our
senior
policy
advisor
at
the
department
of
health
and
human
services
on
pharmacy
and
she's
gonna
walk
you
specifically
through
the
components
of
the
bill.
Unless
chair
given
the
time,
you
would
rather
just
go
straight
to
questions
so
with
the
to
the
preference
of
the
committee.
Do
you
want
a
bill
walkthrough,
or
would
you
like
to
just
go
to
questions?
I.
J
Thank
you
senator
roddy,
and
thank
you
vice
chair,
neil
and
members
of
the
committee
for
the
record.
My
name
is
beth
slamwitz
and
I'm
a
senior
policy
advisor
on
pharmacy
for
the
department
of
health
and
human
services.
J
So
I
just
want
to
kind
of
give
a
brief
introduction
to
what
a
collaborative
practice
agreement
is
for
those
that
are
unfamiliar
and
then
walk
through
the
sections
of
the
bill
and
what
language
has
been
changed
with
the
bill.
A
collaborative
practice
agreement
creates
a
formal
practice
relationship
between
a
pharmacist
and
a
healthcare
practitioner
whereby
the
pharmacist
assumes
responsibility
for
specific
care
functions.
J
They
also
say
that
states
should
evaluate
practice,
setting
and
drug
therapy
restrictions
to
determine
whether
pharmacists
and
providers
face
disincentives
and
unnecessarily
discourage
collaborative
practice
agreements.
Healthcare
workforce
is
critical
component
of
for
a
healthy
nevada.
The
intent
of
sdt29
is
to
remove
current
collaborative
practice
authority
barriers
that
exist
and
increase
the
flexibility
by
defining
elements
that
are
more
appropriately
determined
by
the
parties
at
the
practice
level
who
voluntarily
enter
into
a
collaborative
practice
agreement.
J
In
section
1,
nrs
639
nrs6390124
is
amended
to
remove
the
requirement
that
the
development
of
written
guidelines
and
protocols
in
collaboration
with
the
practitioner
are
intended
for
a
patient
in
a
licensed
medical
facility
or
in
a
setting
that
is
affiliated
with
a
medical
facility
where
a
patient
is
receiving
care.
A
pharmacist
practice
setting
or
a
patient's
relationship
with
a
medical
facility
should
not
be
a
barrier
to
the
pharmacist
and
practitioner's
ability
to
enter
into
an
agreement.
J
Section
2,
subsection
4
maintains
the
current
language
that
outlines
the
requirements
of
a
pharmacist
who
engages
in
the
agreement.
These
requirements
include
documentation
of
the
treatment
of
care,
documentation
of
any
decision
or
action
concerning
the
management
of
drug
therapy,
the
maintenance
of
records
concerning
the
care
or
treatment
for
at
least
seven
years.
J
Lastly,
the
requirement
that
a
practitioner
may
not
enter
into
collaborative
practice
agreement
with
a
pharmacist
for
the
management
of
a
controlled
substance
is
removed.
It
is
recommended
that
all
prescription
drugs,
including
control
substances,
may
be
included
within
a
pharmacist
pro
collaborative
practice
authority.
J
A
description
of
the
means
by
which
the
practitioner
will
monitor
clinical
outcomes
and
intercede
when
necessary.
Authorization
for
the
practitioner
to
override
the
agreement
and
authorization
for
either
party
to
terminate
the
agreement.
The
effective
date
of
the
agreement
and
the
date
by
which
a
review
must
be
conducted
for
the
renewal
of
the
agreement.
J
This
includes,
but
is
not
limited
to
description
of
diseases,
drugs
or
drug
classes
to
be
covered.
The
types
of
decisions
a
pharmacist
can
make
regarding
the
diseases,
drugs
or
drug
classes.
The
training
the
pharmacist
is
required
to
complete
the
procedures.
The
pharmacist
is
required
to
follow,
to
make
any
changes
to
drug
therapy
or
any
other
therapeutic
decisions,
including
would
be
the
criteria
to
make
those
decisions
and
procedures
for
documenting
or
reporting
to
the
practitioner
and
procedures
for
the
practitioner
to
provide
feedback
to
the
pharmacist.
J
F
Thank
you,
dr
slamowicz,
so
before
we
open
it
up
for
questions
vice
chair
with
your
discretion,
I
would
like
to
let
you
know
who's
here
and
available
to
answer
questions.
So,
of
course
we
have
myself.
We
have
dr
beth
slamowicz,
who
works
for
department
of
health
and
human
services
as
the
pharmacy
advisor,
but
we
also
have
dr
adam
porath,
who
is
a
pharmacist
who
works
with
renowned
medical
and
is
practicing
in
the
field
so
for
the
more
practical
practicing
in
the
field
questions
he
may
be
your
best
bet.
F
H
You
for
that
senator
picker.
E
Amen,
chair
and
and
thank
you
senator
ratty.
This
is
well
outside
my
wheelhouse,
so
I
just
have
a
couple
of
basic
questions
that
come
from
a
legal
perspective
number
one.
I
want
to
make
sure
I
understand
who
we're
talking
about
here
that
we're
talking
about
the
ability
with
a
particular
pharmacist,
not
a
pharmacy
like
cvs
or
you
know,
I
don't
know
I
go
to
vaughn's.
You
know
we're
not
talking
about
the
pharmacy,
but
a
an
agreement
between
a
pharmacist,
a
particular
pharmacist
and
a
particular
physician.
Is
that
correct.
J
Certainly
so
again
for
the
record
beth
slamlet
senior
policy
advisor
on
pharmacy
for
dhhs,
so
the
way
that
a
collaborative
practice
agreement
works
is
the
physician
and
the
practicing
pharmacist
or
pharmacists
can
be
part
of
that
collective
agreement.
So,
when
you're
mentioning
a
retail
type
of
setting
collaborative
practice,
agreements
can
take
place
in
that
setting
where
there
are
a
number
of
pharmacists
that
are
named
and
a
physician
that
is
working
collaboratively
with
them
so
or
with
the
pharmacy
itself.
J
F
Ms
long
beth,
thank
you
for
the
question
senator
pickard,
so
currently
the
existing.
H
C
E
All
right,
I'm
just
thinking
in
terms
of
you,
know
the
practical
nature.
You
know
when
we're
talking
about
things
like
any
long-term.
E
Drug
therapy,
where
particularly
if
there
are
reactions
that
need
to
be
watched
for
and
pharmacies
are
busy
operations,
you
know
every
time
I
go
to
vons
or
cvs
they're
scrambling
to
get
everybody
helped,
and
so,
since
we're
now
adding
diagnosis
and
and
treatment.
E
As
a
lawyer,
I
I
I
balk
at
that,
not
because
it's
not
cumbersome.
It's
certainly
that,
but
I
I
would
suggest
we
might
want
to
talk
to
the
legal
eagles
on
this,
because
informed
consent
or
lack
of
informed
consent
could
open
the
pharmacy
then
to
some
legal
liability.
I
don't
know
the
extent
of
that.
This
is
not
my
area
of
expertise,
but
I
just
wanted
to
toss
that
out
there
and
that's
all
I
had
madam
chair.
It
looks
like
dr
slamowicz
still
wants
to
respond
to
that.
So.
A
F
And
before
she
jumps
in,
I
did
neglect
to
introduce
michael
hillaby,
who
is
also
here
representing
the
board
of
pharmacy.
I
apologize
michael.
Please
go
ahead.
Beth.
J
Thank
you,
so
I
just
wanted
to
jump
in
really
quick
and
make
sure
that
it's
clear
that
we're
not
eliminating
informed
consent.
That
can
still
happen
just
within
the
agreement,
and
you
know
dictated
between
the
practitioners
as
to
what
both
the
provider
of
care
is
comfortable
with,
as
well
as
what
the
pharmacist
is
comfortable
with
and
what
is
done
in
terms
of
legalities
and
then
also
want
to
be
clear
that
these
are
voluntary.
J
You
know,
I
I
don't
think
you're
gonna
see
every
walgreens
and
every
cvs
and
every
bonds
you
know
jump
into
the
arena.
It
obviously
is
going
to
be
based
on
you
know,
capacity
and
willingness
and
opportunity,
and
whether
or
not
it
makes
sense
for
that
community.
But
I
do
know,
especially
in
our
rural
settings.
It
is
a
huge
opportunity
for
them
to
work
with
physicians.
That,
perhaps
are
you
know
100
miles
or
more
or
what
not
away
many
states.
The
way
that
they've
put
these
in
place
with
community
pharmacies
are
not.
J
You
know,
complicated
drug
therapy
types
of
management.
It's
usually
involves
a
point
of
care
testing,
something
that
pharmacists
are
already
allowed
to
do
within
this
state.
J
The
problem,
or
the
roadblock,
is
that
pharmacists
currently
under
nrs
are
allowed
to
are
allowed
to
take
specimens,
but
they're
not
allowed
to
read
or
respond
to
a
test
unless
it's
under
a
collaborative
practice
agreement
and
because
that
doesn't
currently
occur
in
a
retail
setting.
Simple
point
of
care
testing
such
as
senator
rowdy
mentioned
with
a
strep
test,
or
even
something
like
a
rapid
flu
test.
You
know
and
then
to
be
able
to
treat
that
person
immediately
is
not
something
that
can
currently
occur
under
current
statute.
So.
E
No-
and
I
appreciate
that
that
does
clarify
to
me
and
and
just
so
you're
aware,
the
informed
consent
I
was
talking
about
was
between
the
pharmacist
and
the
patient.
It's
that
it's
that
interface,
that
you
know
the
patient
always
needs
to
know
that
the
pharmacist
is
not
a
doctor
and
is
not
necessarily
trained
to
do
all
that
a
doctor
would
do,
and
if
we
were
to
curtail
that
informed
consent.
E
F
F
I
also
did
just
want
to
follow
up
to
to
just
make
clear
we're
spending
a
lot
of
time
and
energy
talking
about
the
retail
environment
and-
and
I
think
that
that's
important-
because
for
the
rapid
flu
that
gets
you
that
flu
antiviral
that
you
need
within
48
hours,
it's
ideal
right,
but
these
also
could
be
used
in
an
hiv
clinic
where
there's
a
specific
pharmacist
who
is
trained
specifically
to
deal
with
that
or
a
cancer
location,
and
in
that
scope
of
or
in
that
collaborative
agreement.
F
There's
going
to
be
a
significantly
different
list
of
things
that
that
pharmacist
can
do
in
that
agreement
with
that
doctor
and
that
specialty
versus
what
you
might
see
a
walgreens
sign
up
for,
which
would
be
perhaps
strep
and
flu.
So,
that's
why
it's
so
important
that
the
details
end
up
in
the
collaborative
agreement
and
not
in
nrs,
where
we're
trying
to
micromanage
that
relationship
between
a
pharmacist
and
a
doctor
and
a
patient
where
we
can
make
a
patient's
life
significantly
easier
in
a
multitude
of
settings
by
by
trying
to
get
it
all
in
nrs.
H
Okay,
thank
you
for
that.
Chair
spearman
is
back.
I
will
turn
the
gavel
over
to
her.
The
next
person
is
senator
hardy.
D
I've
got
a
little
thing
that
says
somebody
muted
me,
so
apparently
they
didn't
well,
I'm
okay.
I
gave
senator
ratty
a
list
at
first
blush
of
my
questions
yesterday.
D
So
obviously,
what
we're
talking
about
is
a
pharmacist
allowed
to
practice
the
art
and
science
of
medicine
independently,
albeit
covered
by
a
collaborative
agreement
with
a
physician,
and
the
physician
is
nowhere
near
and
I'll
use
the
example
of
the
strep
test.
You
know.
One
of
the
reasons
we
treat
strep
throat
is
to
prevent
rheumatic
fever,
and
so
this
pharmacist,
as
far
as
I
know,
doesn't
have
a
stethoscope
isn't
trained
in
murmurs
and
so
documenting.
D
What
a
person
has
before
and
after
they're
treated
becomes
an
issue,
it's
easy
to
say:
well,
they
can
do
a
simple
test
and
do
a
simple
treatment
and
and
that's
good
when
it
works,
except
when
it
goes
south,
so
the
ability
to
order
lab
tests
do
studies
interpret
the
studies.
Follow
up
with
appointments.
Do
an
examination.
D
D
How
many
pharmacists
can
one
doctor
have
a
collaborative
agreement
with?
Is
there
one
doctor
in
clark
county,
for
instance,
that
can
say
I'm
going
to
take
all
of
the
pharmacists
in
cvs
or
all
of
the
pharmacists.
F
May
I
interrupt
you
there
and
take
just
those
two
questions
and
then
we'll
come
back
for
more
yep
great.
So,
mr
poro,
do
you
want
to
try
to
take
the
either
of
those.
F
I
So
I
can
speak
to
how
things
operate
currently,
which
is
obviously
problematic,
because
in
the
in
the
current
state,
each
individual
pharmacist
and
each
individual
physician
have
to
be
listed
out
in
in
the
agreement,
and
so
I
think
that
you
know
that
that's
really
been
the
the
barrier
in
the
community
pharmacy.
Setting
is
that
you
know
we
do
have
to
have
that
individually.
Listed
out
from
a
liability
perspective.
Senator
hardy
is
is
absolutely
correct.
I
I
mean
everything
is
being
done
ultimately
under
the
authority
of
the
practitioner,
and
so,
while
you
know
all
pharmacists
involved
in
collaborative
practice,
work
are
encouraged
to
have
individual
liability
coverage
in
most
cases
with
collaborate
practice
agreements.
The
position
is
the
deeper
pocket
and
that's
where
that's
gonna
lie.
F
A
Excuse
me
senator
reddy,
mr
president,
will
you
please
introduce
yourself
every
time
you
speak,
so
our
secretaries
know
who's
talking.
D
Yes,
I
I
did
not
hear
the
answer
to
my
question
as
to
a
limit,
or
how
many
I
mean
we,
we
talk
doctors,
physician
assistants
and
we
limit
how
many
physician
assistants-
and
these
are
basically
people
who
are
not
a
physician
assistant
but
are
going
to
be
in
that
role.
F
Thank
you
senator
hardy
for
the
question
you're
right.
We
missed
that
answer.
So
the
there
is
no
limit
in
nrs,
because
the
limits
could
be
very
different
depending
on
what
is
in
that
collaborative
practice
agreement.
So
again,
going
back
to
the
flu
example,
you
may
have
one
physician
for
lots
of
pharmacists
in
a
retail
setting
where
we're
comfortable
with
the
ability
to
take
a
rapid
flu
test
and
tend
to
then
to
do
a
prescription,
for
we
may
not
have
that
same
comfort.
Level.
F
Clearly,
would
not
have
that
same
comfort
level
if
we're
talking
about
a
controlled
substance
in
a
cancer
pain
management
clinic
where
there's
going
to
be
a
much
likely
likelier
relationship,
tighter
relationship
between
a
physician
and
a
pharmacist,
who's
working
in
that
kind
of
a
collaborative
agreement,
so
those
limits
get
defined
in
the
practice
agreement
based
on
the
agreement
between
the
physician,
the
physician
doesn't
have
to
sign
that
agreement.
Pharmacist
doesn't
have
to
sign
that
agreement.
This
is
all
voluntary,
so
those
two
professionals
with
their
professional
background,
make
that
decision
within
that
agreement.
D
So
if
I
may,
then
what
is
the
motivation
for
the
physician
to
take
on
liability
which
the
physician
has
no
control
of
what
happens
day
to
day
in
a
collaborative
agreement?
I
guess
adam
would
be
the
one
who
say
you
know
is
the
pharmacist
hired
by
the
doctor.
Is
there
a
sharing
of
the
fee?
Is
there
an
employment
agreement?
F
Let
me
just
start
senator
ready
for
the
record
and
then
I'll
turn
it
over
to
mr
poro.
So
again
I
want
to
emphasize
the
collaborative
practice.
Agreements
are
already
in
place
with
no
limits,
so
there's
enough,
we,
the
market,
is
tested
and
there's
enough
motivation
that
these
already
exist,
and
this
is
just
removing
some
barriers.
So
I
just
want
to
make
sure
that
that
point
is
clear.
Mr
pratt,
for
dr
perez
excuse
me.
I
Thank
you
for
the
record.
I
As
far
as
any
monetary
relationship
between
the
the
practitioner
and
the
pharmacist
typically
does
not
exist.
The
motivation
from
the
practitioner
perspective
is
several
fold.
I
think
number
one.
They
are
increasing
access
to
care
for
their
patients,
and
so
the
pharmacist
can
see
them
in
between
the
visits
that
they
have.
I
If
they
have
a
you
know
in
my
practice
I
deal
with
a
lot
of
cardiovascular
disease,
diabetes,
blood
pressure,
etc,
and
so
when
we
have
patients
that
are
struggling
with
those
disease
states,
the
practitioners
aren't
necessarily
able
to
see
them
as
often
as
a
pharmacist
might
be
able
to
touch
base
with
them
check
their
blood
pressure
and
adjust
their
medications.
I
So
it's
a
it's
an
access
thing.
I
think
the
evidence
supports,
especially
with
chronic
disease
states,
that
co-management
between
a
pharmacist
and
a
physician
improves
outcomes
across
the
board,
proven
in
blood
pressure,
diabetes,
etc,
and
so
that's
the
motivation
for
practitioners
to
get
into
these
relationships
is
because
they
think
it's
going
to
improve
care.
H
Thank
you
senator
spearman,
so
I
just
had
one
question
and
it's
dealing
with
the
retail
pharmacy
piece
of
this.
H
So
I
understand
where
we're
going
and
why
we're
going
this
way,
but
the
clinical
service
that
would
then
be
offered
by
a
pharmacist
with
a
doctorate
I
mean
what
is
going
to
be
the
compensation
structure
for
those
pharmacists,
because,
typically
that
clinical
service
is
rolled
into
their
salary,
they
are
not
allowed
to
use
the
mpi,
which
is
their
provider
identifier
number
or
establish
themselves
outside
of
the
retail
pharmacy
space,
and
this
is
additional
work
so
in
in
the
reality
you
know
a
pharmacist
can
deal
with
so
many
characters
that
come
through
drug
addicts,
people
who
have
other
issues
and
so
and
they
become
this
front
line
person,
but
they
are
not
compensated
for
that
activity,
which
this
is
an
expansion
of.
F
Thank
you
for
the
question.
Senator
neil
I'm
going
to
start
with
dr
porath
to
talk
about
the
financial
model
that
he
works
in,
which
is
a
little
different
than
retail,
and
then
ask
miss
mcminiman.
If
she
can
talk
about
the
retail
environment.
I
For
for
the
record,
adam
porath,
again,
church
spearman,
do
you,
I
guess
to
vice
chair
neil,
to
answer
your
question
currently
most
collaborative
practice
agreements.
The
financial
arrangement
is
that
the
facility
that
the
pharmacist
is
working
with
will
collect
the
evaluation
and
management
charges
and
then
the
the
pharmacist
is,
as
you
said,
an
employee
of
that
facility,
and
so
there's
no
really
financial
incentive
for
the
pharmacist
to
get
involved
in
this
work.
I
When
we
talk
about
the
transition
to
how
this
would
work
in
a
retail
setting,
there
has
to
be
a
transition
of
the
expectations
of
a
community
pharmacist
to
move
away
from
producing
a
certain
number
of
prescriptions
an
hour
to
this
other
value-based
activity,
and
so
there
does
need
to
be
otherwise.
What
incentive
would
there
be
for
walgreens
to
have
their
pharmacist
involved
in
this
work?
If,
if
they're,
not
filling
prescriptions
and
they're
doing
this
other
clinical
activity,
then
they're
not
making
money?
I
And
so
in
this
scenario,
the
scenario
that
we're
talking
about
with
a
community
pharmacy
setting
there
is
these
point
of
care
tests,
are
a
revenue
generating
activity
and
so
without
direct
remuneration
for
the
clinical
services
that
a
pharmacist
is
providing
and
which
there
there
is
no
mechanism
in
this
bill
for
that
to
exist.
That
would
be
something
that
would
have
to
be
negotiated
with
payers.
I
H
Well,
I
I'm
glad
you
brought
up
and
and
I'd
love
to
talk
offline
if
that's
an
opportunity,
because
at
the
end
of
the
day,
pharmacists
earned
their
degree
in
their
credentials
and
they
didn't
go
to
medical
school
on
purpose
and
if
they're
going
to
engage
in
this
practice,
you
know
with
more
work
and
the
quotas
that
exist
within
retail
right,
because
there
are
true
quotas
that
have
to
be
met
and
there
are
criteria
and
actual
you
know
it's
like
the
the
work,
their
their
evaluations,
which
they
are
then
judged
on
for
failing
to
perform
within
this
retail
environment.
H
F
Thank
you
senator
neil
liz
mcminiman
did
you
have
an
answer
actually.
H
Thank
you,
senator
ratty
and
madam
chair
liz
mcminiman
retail
association
in
nevada,
and
I
just
wanted
to
add
to
senator
neil's,
add
a
little
something
to
what
adam
forth
said
in
other
states.
This
this
practice
has
been
ongoing.
The
change
of
commun,
the
the
makeup
in
a
community
pharmacy
is
changing
and
what
we're
going
to
see
going
forward
in
utilizing
that
pharmacist
in
the
highest
best
good
of
their
education
level.
So
I
think
what
I
will
do
senator
neil
for
you
is.
H
I
will
talk
to
some
of
our
nationals
and
find
out
how
this
works
in
other
states,
because
I
know
that
this
has
been
implemented
in
many
other
states.
H
We've
had
some
roadblocks
in
the
in
nevada
in
the
past
to
expand
the
community
pharmacy
to
be
the
to
be
able
to
provide
these
type
of
services
through
things
like
utilizing
our
techs
in
the
pharmacy
and
and
getting
that
pharmacist
out
there
to
do
the
practice
that
they've
been
educated
to
do
as
opposed
to
being
back
behind
the
pharmacy
and
reaching
those
quotas
that
you
talked
about.
Senator
neil
I
get
it
and
I
will
work
with
you
offline,
we'll,
get
the
answers
to
that
question
and
find
out
how
that
works.
H
As
far
as
the
compensation
for
the
pharmacist
who's
working
in
those
in
those
type
of
settings.
F
Yeah
and-
and
I
will
we'll
just
say
that
I
don't
think
we
can
get
to
the
compensation
structure
until
we
have
eliminated
the
barriers
in
nrs
to
allow
for
the
model
to
work.
So
there
are
so
many
barriers
in
nrs.
F
Now
you
couldn't
build
a
financial
model
that
would
make
sense
for
any
of
the
parties,
and
so
until
we
remove
some
of
the
barriers
in
nrs
to
collaborative
practice
which
again
already
exists
in
paper,
and
there
are
some
collaborative
practice
agreements
that
are
underway
in
our
state,
but
to
truly
be
able
to
use
this
group
of
professionals
to
the
top
of
their
education
in
a
way
that
I
think
that
they
would
find
more
fulfilling
in
their
day
job,
whether
that
still
ends
up
being
a
salary
position
or
something
else.
F
A
Thank
you,
senator
reddy,
and
with
that
I
don't
see
any
other
hands
up
with
that.
Let's
go
to
the
phones
for
comment
and
we
will
have
15
minutes.
B
C
Good
afternoon,
chair
and
members
of
the
committee
nick
vanderpool,
nick
v-a-n-d-e-r-p-o-e-l
with
capital
partners
today
representing
representing
the
reno
sparks
chamber
of
commerce
here
today
to
support
senate
bill
229
senate
bill
229,
as
outlined,
expands
access
to
health
care
to
nevadans,
especially
in
rural
nevada.
We
know
there
is
a
doctor
shortage
in
nevada,
so
this
this
bill.
C
So
with
this
bill
it
will
fill
a
much
needed
gap
in
services.
During
this
pandemic,
pharmacists
played
even
more
of
an
essential
role,
and
this
bill
allows
them
to
continue
serving
nevada
nevadans,
an
even
more
needed
role
in
the.
In
conclusion,
we
appreciate
senator
ratty
for
bringing
forth
sb
229
and
urge
your
support.
Thank
you,
chair
and
committee
members.
B
C
Good
morning
my
name
is
vasuda
gupta
v-a-s-u-d-h-a
last
name
g-u-p-t-a.
I
am
an
associate
professor
at
roseman
university
college
of
pharmacy
and
a
board-certified
clinical
pharmacist
at
a
federally
qualified
health
center
in
henderson.
I
am
representing
nevada
pharmacy
alliance
and
we
fully
support
senate
bill
229..
C
As
part
of
my
clinical
responsibilities,
I
provide
direct
patient
care
to
a
medically
complex
underserved
population.
I
optimize
the
use
of
medications
for
chronic
diseases
to
ensure
efficacy,
while
limiting
adverse
effects
and
misuse
in
collaboration
with
primary
care
providers.
The
providers
that
I
work
with
will
attest
that
I
am
a
valuable
part
of
the
healthcare
team
helping
to
improve
care
through
medication
management.
This
is
especially
true
for
disease
states
that
are
mostly
managed
through
complex
groups
of
medications
and
requires
significant
education,
such
as
diabetes.
C
No
other
healthcare
providers
receive
four
years
of
a
doctorate
education.
That's
primarily
focused
on
the
management
of
diseases,
utilizing
medications,
I'm
knowledgeable
about
the
30
different
types
of
insulin
that
are
available
on
the
market
and
oftentimes
more
so
than
the
primary
care
providers,
I'm
aware
of
which
ones
of
those
are
most
likely
to
be
covered
by
the
patient's
insurance.
C
However,
most
community
health,
centers
and
primary
care
offices
do
not
have
a
clinical
pharmacist
to
provide
these
services.
Most
pharmacists
are
located
in
community
pharmacies,
as
we've
discussed,
and
the
current
restrictions
in
implementing
the
cpa
in
a
pharmacy
limit
the
provision
of
care
and
make
it
impossible
for
pharmacists
to
provide
these
services.
C
Sb
229
allows
for
appropriate
loosening
of
those
restrictions
so
that
unnecessary
requirements
don't
hinder
pharmacists
from
using
their
medication
expertise
to
expand
access
to
healthcare
for
nevadans.
I
want
to
emphasize
that
pharmacists
are
still
acting
within
their
scope
of
practice
and
still
in
collaboration
with
practitioners
and
those
drills
are
clearly
delineated
within
the
cpa.
C
B
C
Hi
crystal
riccio
k-r-y-s-t-a-l
last
name
r-I-c-c-I-o
for
the
record,
I'm
a
22-year
resident
of
nevada,
an
associate
professor
of
pharmacy
practice
with
roseman
university
and
one
of
the
few
primary
care
pharmacists
in
nevada.
Today,
I'm
speaking
personally
in
support
of
senate
bill
229,
increasing
access
to
care
for
nevadans
in
rural
frontier
and
even
urban
communities.
C
Many
of
these
residents
live
in
a
desert
both
literally
and
figuratively.
Within
a
medical
desert.
Nevada
has
a
disparate
shortage
in
primary
care.
Physicians,
and
this
bill
is
a
step
in
the
right
direction
to
increase
access
to
medical
care,
medical
providers
and
cms
have
long
promoted
the
concept
of
team-based
care
for
years
with
pharmacists
as
an
essential
part
of
an
effective
care
team
physicians
are
provided
extensive
education
and
training
in
physical
assessment
and
diagnosis,
while
pharmacists
review
receive
years
of
education
and
training
in
providing
medication
therapy
management.
C
I've
worked
collaboratively
within
physician
groups
for
over
a
decade
to
provide
optimized
care
for
our
patients
as
a
significant
part
of
our
care
team
providing
extensive
education
and
chronic
disease
management.
Within
the
scope
of
my
practice,
I
am
board
certified
as
an
ambulatory
care
pharmacist
and
after
thousands
of
years
of
practice,
I'm
also
certified
diabetes
care
and
education
specialist.
C
Despite
years
of
practice,
developing
rapport
and
trust
with
my
patients
and
physicians
alike,
barriers
in
our
past
and
present
legislation
assuaged
my
pursuit
of
a
formal
collaborative
practice.
Agreement
in
the
state
of
nevada,
unfortunately,
practice
with
it
without
a
cpa,
creates
its
own
barriers
requiring
physicians
to
be
on-site
during
all
of
my
patient
encounters
and
requiring
me
to
interrupt
a
physician's
own
practice
day
to
get
approval
for
any
medication
changes.
I'm
recommending
specifically,
this
has
caused
me
to
cancel
patient
appointments
due
to
physician
illness,
physician
off-site
meetings
or
other
last-minute
physician
schedule
changes.
C
B
C
So
I
previously
worked
under
a
collaborative
practice
agreement,
but
we
did
let
it
lapse
due
to
many
difficulties
we
encountered,
including
delays
and
reapproval
of
the
agreement.
If
we
wanted
to
adjust
any
language
or
any
of
our
pharmacist
provided
services,
I
do
have
the
full
support
of
all
the
physicians
with
whom
I
work
and
they
did
all
sign
the
previous
collaborative
practice.
Agreement.
C
Patients
with
kidney
problems
see
a
nephrologist
patients
who
have
cancer,
see
an
oncologist,
so
it
does
make
sense
that
we,
as
medication
experts,
manage
a
patient's
medication
therapy
after
a
provider
has
made
a
diagnosis.
Our
training
is
also
similar
to
physicians,
but
it's
focused
on
medications.
We
complete
a
significant
number
of
clinical
training
hours
in
school
and
many
of
us,
especially
those
of
us
who
work
in
specialty
areas
and
hospitals
and
outpatient
clinics,
complete
residencies
and
hold
board
certifications.
Just
like
physicians
do
most.
C
Physicians,
who
trained
with
clinical
pharmacists,
will
also
speak
to
how
they
used
pharmacists,
to
make
patient
care
decisions,
and
they
still
consult
pharmacists
when
they
encounter
difficult
patient
cases
and
recognize
us
as
critical
members
of
an
interdisciplinary
health
care
team.
One
issue
we
encountered
after
the
dissolution
of
my
collaborative
practice
agreement
is
an
increased
burden
on
providers.
C
They
had
relied
on
me
to
make
appropriate
dosing
adjustments
for
our
protocols,
adjust
supportive
care
for
peer-reviewed
and
evidence-based
guidelines,
interchange
drug
products
for
our
internal
formulary,
and
also
to
follow
up
on
tests
and
labs
that
were
needed
for
specific
medications.
So
now
they
must
be
repeatedly
interrupted
throughout
their
day
to
implement
these
changes
that
they
feel
are
well
within
the
scope
of
practice
of
a
trusted
pharmacist
or
they
wouldn't
have
signed
the
original
agreement.
My
days
actually
usually
end
with
a
number
of
providers
in
my
office.
C
C
I
do
hesitate
to
address
this
piece
because
I
absolutely
recognize
the
importance
of
it,
but
my
physicians
did
actually
question
my
need
to
request
an
informed
consent
from
our
patients.
This
required
our
providers
to
know
which
patient
required
closer
attention
from
them,
because
they
couldn't
rely
on
those
pharmacist
interventions
to
happen
independently.
C
They
also
stated
that
our
nurse
practitioners
are
not
required
to
obtain
an
additional
informed
consent
before
those
nurse
practitioners
see
a
physician's
patients.
Nor
are
patients
required
to
sign
an
informed
consent
to
have
pharmacists,
call
a
physician
on
a
patient's
behalf
in
the
retail
setting.
C
So
in
summary,
I
feel
that
removing
barriers
to
collaborative
practice
agreements
allows
for
more
comprehensive
healthcare
teams
and
actually
greater
communication
between
providers
and
pharmacists.
It
can
reduce
delays
and
care
by
having
a
pharmacist
immediately
resolve
issues
with
the
medication,
and
it
can
augment
the
patient-provider
relationship
by
having
more
trained
eyes,
evaluate
a
patient's
therapy
resulting
in
better
controlled
healthcare
costs.
This
has
actually
been
shown
in
a
number
of
studies.
A
Submit
the
rest
of
your
comments
in
writing,
written
comments
and
writing
to
our
committee.
I'd
appreciate
it.
Thank.
B
B
C
Morning,
care
and
members
of
the
committee
for
the
record
paul
moratkin
m-o-r-a-d-k-h-a-n
with
the
vegas
chamber,
the
chamber,
is
in
support
of
sb
229
and
appreciates
the
bill's
sponsor
for
bringing
the
bill
forward
today.
I
will
be
brief,
as
you've
heard
this
bill
will
be
another
tool
in
expanding
healthcare
access
and
conveniency
for
nevadans,
as
we
continue
to
work
to
address
the
doctor
source
throughout
our
state.
C
B
D
Hello,
my
name
is
ken
conkey
k-e-n-k-u-n-k-e,
and
I
am
here
today
representing
the
nevada
pharmacy
alliance.
We
are
excited
to
expand
our
ability
to
be
able
to
take
care
of
patients,
and
I
am
here
to
show
you
show
you
our
support
for
senate
bill
229.
Since
the
pharmacy
collaborative
practice
bill
passed.
It
has
been
difficult
for
pharmacists
to
be
able
to
put
it
into
action
in
may
of
2020
2020.
We
sent
out
a
survey
to
14
pharmacists
who
are
working
inside
clinics.
D
D
Currently,
48
states
have
collaborative
practice
laws.
Some
of
those
laws
are
very
restrictive,
like
ours,
but
others
are
allowing
pharmacists
to
truly
use
the
skills
that
they
learn
in
school
to
treat
patients
at
the
best
of
their
ability.
You
may
be
wondering
how
providers
and
pharmacists
enter
into
these
agreements
in
2016
a
resource
called
advancing.
Team-Based
care
through
collaborative
practice,
agreements
was
created.
D
It
is
endorsed
by
many
organizations,
including
the
cdc
american
association
of
nurse
practitioners
and
the
american
medical
association.
I
would
encourage
you
to
look
into
this
document
earlier.
You
heard
some
scary
numbers
of
access
to
care
for
patients
in
our
state,
and
you
heard
examples
of
how
this
bill
would
open
up
access.
We
have
2470
licensed
pharmacists
that
are
ready
to
step
up
and
help
our
patients.
I
am
asking
you
to
please
show
your
support
for
senate
bill
229.
Thank
you.
A
Thank
you
broadcast.
We
have
one
more
speaker
and
then
our
time
will
be
up
and
we
will
move
to
opposition.
B
C
Yes,
my
name
is
kaelin
bowman,
k-a-y
l-y-n-n-d-o-w-m-a-n,
and
I'm
here
representing
myself
at
the
licensed
pharmacist
practicing
in
nevada
for
14
years.
I
have
practice
in
multiple
settings,
including
community
and
hospital
pharmacies
and
neighborhood
medical
clinics.
Currently
I
am
the
clinical
pharmacist
at
roseman
medical
group
working
collaboratively
with
the
providers
as
part
of
a
team-based
care
model.
This
collaboration
was
a
result
of
six
months
of
meeting
clinical
service
contract
negotiation
and
approval
to
work
outside
of
a
licensed
pharmacy
from
the
nevada
state
board
of
pharmacy.
C
I
currently
do
not
have
a
collaborative
practice
agreement
in
place.
However,
I
plan
to
pursue
this
in
the
near
future,
and
that
is
why
this
legislation
is
very
important
to
me
progressing
to
a
collaborative
practice
agreement
is
the
next
step
based
on
the
trust
built
within
the
clinic
setting
between
myself
and
other
providers.
C
The
cpa
agreement
process
requiring
approval
by
state
or
legislative
boards
is
a
concern
to
me,
since
it
may
result
in
increased
approval
time
and
burden
of
added
paperwork
allowing
the
pharma
and
providers
to
complete
the
cpa
agreement
will
allow
for
timely
implementation
of
expanded
care
for
patient
access
and
improved
patient
health
and
wellness.
As
a
member
of
the
healthcare
team,
I
have
increased
patient
awareness
of
medication,
adherence
further
support,
behavior
changes
and
self-management
of
chronic
disease
and
illness.
C
Having
a
cpa
will
maximize
my
role
as
a
pharmacist
and
utilize
my
skills
to
my
fullest
ability
and
training.
There
is
more
to
being
a
pharmacist
beyond
the
dispensing
of
medication.
I
have
been
an
immunizing
pharmacist
since
2005..
That
was
when
I
was
still
a
pharmacy
student
intern.
I
provide
drug
information.
I
initiate
non-oxygen
therapy.
C
So
how
will
the
cpa
legislation
make
a
difference?
I
will
be
able
to
collaborate
more
efficiently
and
effectively
with
the
team
care
members,
improve
health
care
outcomes
of
our
patients
and
thus
build
healthier
communities
in
nevada,
and
that
is
why
I'm
asking
you
to
show
your
support
for
senate
bill
229..
Thank
you
for
your
time.
A
Thank
you
broadcast
we'll
now
go
to
15
minutes
of
opposition.
A
Thank
you
neutral.
B
C
Good
morning,
chair
committee
members
for
the
record,
this
is
joe
malay
last
name:
m-a-l-a-y
deputy
at
the
division
of
public
and
behavioral
health
pbh
is
neutral
on
sb,
229
and
believe
this
bill
creates
flexibility
in
these
collaborative
drug
therapy
management
agreements.
Pharmacists
become
part
of
the
treatment
team.
By
working
directly
with
patients
to
manage
disease,
it
can
help
reduce
costs
in
medication
management.
C
A
Okay,
thank
you.
Let
me
just
say
by
way
of
explanation,
some
may
wonder
why
we're
doing
a
rather
abbreviated
form,
we
have
to
walk
a
fine
line.
We
only
have
120
days
to
get
things
done,
and
there
are
so
many
people
that
when
they
look
at
the
calendar-
and
they
see
the
floor
will
be
convening
at
11
o'clock.
Many
of
them
base
the
rest
of
their
schedule
around
that,
and
so
we
want
to
be
knowledge.
We
want.
A
We
want
to
acknowledge
their
time
and
effort,
but
we
also
want
to
make
sure
that
we
acknowledge
the
time
and
effort
of
the
presenter
and
the
questions.
So
it's
a
very
fine
line,
and
I
hope
that
I
have
walked
that
line
judiciously
today,
senator
reddy,
you
have
any
closing
remarks.
F
I
will
be
brief
in
my
closing
remarks.
Thank
you
so
again,
senator
raddy,
representing
senate
district
13..
First,
thank
you
to
yourself
and
the
committee
for
the
opportunity
to
present
this
bill.
It
has
been
a
personal
mission
of
mine
since
I've
met
the
privilege
to
be
elected
to
the
seat,
to
increase
access
to
health
care.
F
Honestly,
we
don't
have
many
tools
that
we
can
use,
and
so,
when
we
do
have
a
tool,
we
should
use
that
we
have
2470
pharmacists,
who
are
ready
to
step
up
and
into
their
roles,
roles
that
they
are
already
educated
for
roles
that
they
are
already
approved
for
their
scope
of
practice
in
collaboration
with
physicians
across
our
state,
and
there
are
already
collaborative
practice
agreement
laws
in
place.
We
just
have
a
few
barriers.
We
need
to
remove
to
actually
make
these
effective.
F
A
Thank
you
senator
raddy.
I
will
now
close
the
hearing
on
senate
bill
229,
we'll
open
it
up
for
public
comment.
Public
comment.
A
Okay,
thank
you
so
much.
Thank
you,
committee
members
and
vice
chair
for
taking
over
when
I
had
to
go
to
another
bill
and,
as
I
said
a
few
minutes
ago,
we're
trying
to
walk
a
fine
line
between
respecting
the
time
of
those
who
have
arranged
their
schedules,
their
work
schedules
and
lunch
schedules
around
us
convening
at
11
and
also
want
to
recognize
the
time
and
effort
that
was
put
in
by
the
presenter
and
acknowledge
the
questions
from
our
committee
members.
A
We
have
120
days
every
other
year,
and
so
whatever
we
don't
get
done
this
year,
it
will
be
a
year
and
a
half
before
we
can
come
back
and
address
it,
and
so
that's
why
I
try
to
make
sure
that
we
are
we're
recognizing
the
time
we're
serving
the
time
and
making
sure
we're
making
the
very
best
of
it.
So
with
that,
thank
you
so
much
and
we
will
adjourn
and
we
will
be
back
here
on
friday.
Thank
you
committee.
We're.