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From YouTube: 5/6/2021 - Senate Committee on Health and Human Services
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A
A
And
chair
ready
here
and
please
do
mark
senators
hardy
and
spearman
present
as
they
arrive
today.
Folks,
we
have
four
bills
to
hear
the
planned
order,
for
today
is
ab287,
ab326,
ab374
and
then
ab278.
C
Good
afternoon,
chair
ratty
and
members
of
the
senate
health
and
human
services
committee
for
the
record,
I
am
danielle
monroe
moreno.
I
represent
assembly
district
1,
which
is
primarily
in
the
city
of
north
las
vegas,
and
I
am
here
today
to
present
for
your
consideration
assembly
bill
287,
a
measure
providing
for
the
licensing
and
regulating
of
free
standing,
birthing
centers
joining
me
here
today.
Virtually
is
miss
tara
reigns.
C
Who
will
be
my
co-presenter
and
if
I
have
to
jump
out
and
leave
for
another
committee
man,
she
is
more
than
capable
to
take
over
for
me
and
we
may
have
others
joining
us
from
serenity,
birth,
center
and
women's
care
from
in
las
vegas,
and
I
believe
we
have
members
from
dhhs
who
will
be
able
to
answer
any
questions
that
you
may
have
as
well.
C
While
I
do
not
disagree
with
the
decision,
it
was
definitely
warranted.
It
did
place
undue
stress
on
families
and
undue
stress
on
the
pregnant
woman
as
she
went
into
labor
and
delivery.
People
were
looking
for
options.
Families
reached
out
to
me
and
asked
about
freestanding
birthing
centers.
There
were
constituents
in
my
district
that
were
not
comfortable
with
giving
birth
at
home,
but
didn't
feel
that
there
were
any
other
options,
so
ab287
simply
defines
in
nrs
statutes.
What
a
freestanding
birthing
center
is.
C
I
did
have
a
short
three
minute
video.
I
am
going
to
forgo
that
video,
because
your
committee
did
start
a
little
bit
later
and
I
know
you
have
other
bills
after
me.
I'm
going
to
turn
the
presentation
over
to
ms
starr
reigns,
who
will
have
a
short
presentation
so
that
everyone
will
be
able
to
understand
what
the
freestanding
birthing
center
is
so
tara?
The
floor
is
yours,.
D
Good
afternoon,
this
is
tara
raines
for
the
record,
and
I
appreciate
the
opportunity
to
present
this
afternoon.
I
have
prepared
a
short
presentation
on
freestanding
birth
centers
and
why
they
would
be
incredibly
beneficial
for
nevadans.
D
D
D
We've
seen
in
recent
years,
a
rise
in
birth
centers
as
prisoners
are
found
to
give
folks
the
access
to
the
birth
of
their
choice.
Right
now,
in
the
united
states
there
are
384
freestanding
birth.
Centers
11
of
those
birth
centers
are
owned
by
black
black
birth
center
owners,
which
that
number
has
been
growing
a
new
one
actually
just
opened
this
week,
which
is
exciting.
D
We
know
that
birth
centers
caught
roughly
19
871
births
in
2018
and
roughly
a
half
of
a
percent
of
all
uf
us
births
based
on
recent
data,
took
place
in
birth
centers,
and
this
is
a
200
percent
increase
in
birth
snubbers
over
the
past
10
years.
D
Folks
who
deliver
in
birth
centers
tend
to
leave
their
births
feeling
empowered
and
excited
as
they
enter
into
the
journey
of
parenthood.
D
Currently,
as
assemblywoman
moreno
mentioned
before
earlier,
the
us
currently
is
ranked
worst
of
all
developed
countries
in
regards
to
birth
outcomes.
Mothers
here
have
a
higher
risk
of
dying
in
childbirth.
Despite
the
us
spending
more
on
on
the
childbirth
process,
we're
55th
in
maternal
mortality
two
times
higher
than
37
other
nations,
we're
33rd
in
infant
mortality
with
5.8
deaths
per
1000,
live
births
and
racial
disparities
make
that
exponentially
greater,
and
we
know
that
medicaid
nationally
pays
for
almost
half
of
births.
D
More
specifically,
around
the
black
maternal
health
crisis,
according
to
the
cdc
40
out
of
every
100
000
african-american
birthing
persons
die
during
childbirth.
That's
three
times
more
than
three
times
the
rate
of
their
white
peers
and
african
americans
are
currently
three
to
four
times
more
likely
to
suffer
a
severe
disability
after
childbirth,
and
these
are
little
births
that
that
we're
referring
to,
and
so
in
addition
to
being
as
what
appears
to
be
a
safer
option
for
women
of
color.
D
We
know
that
42.3
percent
of
u.s
births
were
medicaid
births,
and
current
estimates
suggest
that
in
nevada
that
rate
of
60
to
70
percent
of
births,
particularly
projected
in
the
current
in
the
coming
year,
will
be
covered
by
medicaid,
and
we
know
that
the
childbirth
process
has
been
dominated
by
costly
and
often
unnecessary
interventions.
D
D
Again
regarding
birth
center
values,
a
washington
dc
medicaid
study
estimated
a
cost
savings
of
roughly
eleven
hundred
dollars,
almost
twelve
hundred
dollars
per
birth
and
using
birth,
centers
and
saved
roughly
11.6
million
dollars
per
per
10
000
berts
in
the
district
of
columbia.
D
So
what
would
that
mean
in
nevada
if
we
took
that
number
and
just
looking
at
clark
county
which
had
41
000
birth
certificates
issued
last
year,
and
we
estimated
that
all
60
of
the
medicaid
births
in
clark
county
were
delivered
in
birth?
D
Additional
implications
for
medicaid
at
more
pregnant
beneficiaries,
access
birth,
centers
for
maternity
care.
There
would
be
better
birth
outcomes,
further
saving
medicaid
funds
on
the
back
end.
Some
of
that
recovery
care.
It's
a
high
value
for
folks,
even
if
they
would
do
an
open
access
model,
which
is
where
they
only
receive
their
prenatal
care
at
the
birth
center
and
they
actually
deliver
in
the
hospitals.
The
outcomes
have
been
found
to
be
better,
particularly
because
many
birth,
centers
use
and
I'll
talk
about
this
in
a
minute.
D
We
know
that
medicaid
beneficiaries
have
expressed
being
satisfied
with
birth
center
care.
But,
however,
currently
only
a
small
number
of
medicaid
beneficiaries
nationally
are
able
to
access
this
particular
model
for
their
births,
and
we
know
that
state
regulations
like
the
ones
we're
seeking
to
change
today
can
can
lead
to
that
limitation
so
again,
stressing
that
birth
centers
have
been
identified
in
the
strong
start.
D
So,
looking
at
the
strong
start,
data
which
looked
at
the
birth
center
midwifery
model
of
care
versus
national
data,
what
we
see
is
that
the
american
association
of
birth,
centers,
strong
start
data,
does
have
better
outcomes.
It
reduces
the
incidence
of
preterm
birth,
reduces
the
incidence
of
low
birth
weight.
Births
reduces
the
incidence
of
very
low
birth
weight,
birth
births,
which
are
those
those
critical
births,
reduce
cesarean
sections
as
the
primary
and
then
the
total
cesarean
meaning
for
for
subsequent
births.
D
The
repeats
was
also
reduced,
particularly
as
it
relates
to
race
and
the
black
maternal
health
crisis.
The
aapc
strong
start
data
suggests
that
for
black
african
american
birthing
persons,
the
the
outcomes,
the
disparities
were
diminished
tremendously.
I'd
like
to
particularly
draw
your
attention
to
the
reduction
of
cesarean
birds
for
black
and
african-american
birthing
persons
and
and
that
reduction,
and
also
the
reduction
and
low
birth
weight
babies
using
the
birth
center
and
midwifery
model.
D
So
again,
some
other
benefits.
It
is
a
time
and
birth
center
prenatal
care
is
time
intensive
and
it
is
relationship
based.
It
midwives
see
fewer
clients
per
day
which
allows
them
to
spend
more
time
with
the
folks
that
they
are
supporting.
D
This
model
has
been
incentivized
because
these
relationships,
because
this
access
to
resources,
because
this
support
system
does
result
in
better
outcomes.
There
is
cost
savings
to
medi
medicaid,
and
we
also
know
that
this
leads
to
an
increase
in
body
fed
babies
which,
in
addition
to
lower
rates
of
caesareans
and
perinatal
and
postpartum
interventions.
D
So
I'd
like
to
take
a
second
to
share
my
story
and
how
I
became
involved
in
this
work
so
and.
A
I'm
gonna
interrupt
you
just
for
a
second
as
a
courtesy,
so
I
need
to
step
out
and
present
a
bill
on
another
committee.
So
senator
harris
is
going
to
take
over
chairing
this
meeting
and
you
will
have
a
couple
of
very
attempted
sentence.
Attentive
senator
senators
before
senator
hardy
or
myself
were
able
to
make
it
back,
but
do
not
take
that
as
a
sign
of
lack
of
interest.
Just
the
realities
of
the
scheduling
of
the
building.
Please
go
ahead.
D
Okay,
awesome.
Thank
you
and
good
luck
in
your
your
next,
your
next
meeting.
So
my
story
is,
I
became
pregnant
and
was
nervous
about
entering
the
medical
system.
D
Having
read
what
I
knew
had
read
and
learned
a
lot
about
the
black
maternal
health
crisis
and
having
watched
high
profile
black
women
have
difficulty
with
their
pregnancies
like
serena
williams,
in
which
she
found
herself
in
a
hospital
with
doctors
who
did
not
believe
her
and
almost
died
in
childbirth
and
had
a
loss
and
in
losing
that
pregnancy
received
care
from
my
medical
provider.
That
was
so
egregious
that,
when
reported,
I
actually
received
a
refund
of
all
of
my
co-pays
from
a
major
insurance
provider
in
addition
to
an
apology
letter.
D
D
D
D
I'd
like
to
thank
monet,
nicole
photography
for
lending
me
beautiful
photos
of
her
birds
and
and
my
partner
matt,
for
allowing
me
to
quit
a
10-year
job
to
pursue
birthing
equity
and
access
and
the
incredible
communities
of
birth
workers
in
nevada
and
across
the
country
who
work
so
hard
to
empower
their
their
clients
and
to
give
them
the
strength
to
have
the
births
of
their
desire.
Thank
you.
So
much
for
your
time.
E
C
It
does
I
would
just
this
is
danielle
monroe
moreno
for
the
record.
There
is
continued
conversations
going
on
between
the
sponsors
of
the
bill
and
the
department
of
health
and
human
service,
and
there's
a
proposed
amendment
with
language
that
we
will
have
to
this
committee
soon.
E
F
D
G
Thank
you,
madam
vice
chair
or
whatever
you
are
senator
the
thank
you.
Assemblyman
are
there
and
I
haven't.
I
know
that
there
are
ref.
There
are
regulations
that
are
referenced
in
the
bill,
but
I
haven't
had
a
chance
to
look
them
up.
Are
there
requirements
for
for
relationships
with
with
hospitals
in
case
there's
an
emergency
at
a
birthing
center
or
any
of
those
transfer
requirements?
I
know
that
there's
the
30
mile
distance
allowed
and
that
that's
a
long
way
when
people
are
in
distress.
So
I'm
curious
about
that.
C
Danielle
monroe
moreno
for
the
record
and
you'll
hear
from
the
opposition
the
the
30
miles
distance
and
I'd
like
to
reference
that
first,
when
making
creating
the
language
for
the
bill
we've
heard
from
our
rural
communities
that
do
not
have
hospitals
at
all
in
some
of
our
communities
and
that's
why
the
30
miles
we
know
in
some
of
our
urban
communities
the
nearest
hospital
made
10
10
to
15
miles.
F
Hi
genevieve
burkett
for
the
record
we
are,
are
required
by
the
state
of
nevada
to
attempt
to
develop
a
collaborating
transfer
relationship
with
our
closest
hospital
and
for
us,
its
university
medical
center
in
las
vegas,
and
we
have
to
send
them
a
certified
letter
requesting
that
relationship
and
we,
so
we
have
attempted
that
we.
F
That
being
said,
they
have
not
responded.
However,
that
being
said
have
to
you
know
they,
they
must
receive
our
patients
and
we
do
have
a
great
working
relationship
with
labor
and
delivery
and
nicu
and
also
we,
then
our
transfer
rate
is
about
12
of
our
clients.
F
Maybe
one
to
two
percent
of
those
clients
are
emergent.
The
rest
are
okay,
mom
has
had
prolonged
labor
and
would
like
to
transfer
mom
would
like
an
epidural
and
would
like
to
transfer.
So
that
is
a
lot
of
what
we're
you
know
what
our
transfers
look
like
and
every
single
step
of
you
know.
Every
single
prenatal
visit
admission
into
the
birth
center
requires
a
risk
assessment
that
is
outlined.
F
We
we
have.
We
follow
state
of
nevada
recommendations
for
women
who
risk
out
of
birth
center
care
because
you
must
be
a
low
risk
and
we
have
even
gone
above
and
beyond
that
and
are
in
line
with
the
commission
for
the
accreditation
of
birth
centers,
which
is
our
accrediting
body
to
make
sure
the
women
that
we're
caring
for
are
appropriate
for
our
level
of
care.
D
I'd
like
to
add
to
that
and
say
that,
as
you
can
imagine,
there
are
folks
who
are
not
as
excited
about
this
model
of
empowering
and
promoting
equity
for
birthing
persons
as
we
are,
and
so.
D
For
that
reason
it
was
added
that
it
was
stated
that
an
attempt
must
be
made
to
establish
a
relationship
with
the
hospital,
but
that
not
because
it
was
believed
that
requiring
the
relationship
would
be
prohibitive
and
may
prevent
folks
from
being
able
to
open
birth
centers
right,
because
that
would
then
put
the
birth
center
owners
and
operators
at
the
mercy
of
of
the
hospitals.
Essentially.
D
So
so
so
safety
being
key-
and
you
know
birth,
centers-
that
that
12
percent
transfer
rate
don't
think
of
it
as
like
transfer
and
the
heat
of
the
moment,
but
think
of
that
as
including
transfer
at
like
36
weeks,
because
the
blood
pressure
can't
become
regulated
or
transfer
at
32
weeks,
because
some
type
of
anomaly
has
been
discovered
in
the
pregnancy
right.
So
those
transfers
occur
before
before
labor
and
delivery
as
well.
G
Thank
you
yeah.
I
appreciate
that
and
so
on
the
on
the
data
that
you
that
that
you
quoted-
and
this
is
these-
this
is
new
to
me.
So
I
appreciate
it.
I
appreciate
the
indulgence
is
the
I
mean.
Let
me
start
over.
The
it
seems
like
the
the
moms
who
are
giving
birth
in
birthing.
Centers
are
like
super
healthy
and
had
a
lot
of
prenatal
care
and
they're
in
sort
of
the
best
of
opportunities
to
have
a
really
successful
and
healthy
birthing
process.
G
So
is
all
the
data
that
you
cited
comparing
apples
to
apples
and
you
have
the
same
success
rate
or
those
success
rates
that
you
cite
is
that
compared
to
the
broader
population
of
births
or
to
people
who
meet
the
same
criteria
of
people
who
would
be
able
to
give
birth
in
a
birthing
center.
D
Yeah,
I
think
that's
an
excellent
question
and
so
part
of
what
makes
these
birthing
people
healthy
and
ready
for
successful
birds
is
the
prenatal
care
that
they
get
and
the
bird
center.
And
so
I
remember
my
first
visit
included
a
nutrition
class
and
so
there's
conversation
about
what
I
should
be
eating
to
to
keep
my
baby
healthy
and
where
there
are
resources
to
find
these
healthy
things.
And
it's
really
spending.
D
I
guess
it
was
about
a
90
minute
nutrition
class
as
part
of
my
first
visit,
and
so
it
becomes
apples
to
apples
simply
in
that
the
model
of
care
looks
different
in
a
hospital.
So
as
much
as
so
so,
it
is
looking
at
a
general
population
of
folks
who
went
through
birth
centers.
Knowing
that
everyone
doesn't
start
at
a
birth
center.
I
don't
know
doing
working
out
and
being
healthy
and
eating
right.
D
Just
like
everyone
who
starts
out
at
a
hospital
pregnant,
doesn't
start
off
working
out
and
eating
healthy,
and
I
don't
know
doing
all
the
things.
Is
that
helpful
as
a
and.
C
This
is
danielle
before
you
go
genevieve.
I
just
want
to
add
one
thing.
My
oldest
daughter
had
her
firstborn
with
the
the
service
of
a
midwife,
which
I
thought
she
was
nuts.
It
was
during
my
first
session
and
she
was
going
to
do
a
home,
birth
and
a
pool,
and
I
really
thought
my
daughter,
I'm
like.
Where
did
I
go
wrong,
but
when
I
was
able
to
be
there
and
go
through
the
pregnancy
with
her,
she
was
my
first
born
giving
birth
to
her
firstborn.
C
I
remembered
giving
birth
to
her.
I
had
gone
into
labor.
My
car
broke
down
on
the
side
of
the
highway
between
arizona
and
california,
and
I
had
to
be
taken
by
an
ambulance
to
a
hospital
that
I
knew
no
one
in
because
the
doctor
that
I
had
had
told
me
that
I
was
going
through
false
labor.
It
was
okay
to
make
the
drive.
C
I
almost
died,
giving
birth
to
her,
because
the
the
medical
professional
that
was
in
charge
at
that
hospital
didn't
believe
the
situation
that
I
was
going
through.
My
first
birth.
I
didn't
know
what
could
go
wrong,
but
I
I
literally
almost
died
after
giving
birth
to
her.
She
knew
about
that
and
she
decided
to
do
something
different,
her
care
with
her
midwife.
She
had
more
visits
with
that
midwife
than
I
ever
had
with
my
doctors
in
any
of
my
pregnancies.
C
C
C
Birth,
I'd
ever
been
a
part
of,
and
it
was
that
way
because
they
embraced
the
entire
family
and
they
had
spent
time
to
get
to
know
her
that
oftentimes,
our
doctors
and
they're
wonderful.
I
have
a
wonderful
ob
gyn,
but
their
office
is
so
busy.
They
don't
have
that
extra
time,
but
what
the
midwife
also
made
her
do
she
said
you
know
I
I'm
great,
but
things
can
go
wrong
and
she
insisted
that
she
pre-register
at
the
hospital
and
build
that
relationship
with
the
doctor
at
the
hospital.
C
E
E
Okay,
I
don't
see
any.
Is
there
anybody
on
the
zoom
who'd
like
to
testify
and
support.
H
H
H
F
F
A-M-B-E-R-F-A-L-G-O-U-T,
I
am
the
northern
nevada
manager
for
battleborn
progress.
I'm
calling
today,
because
we
are
in
full
support
of
assembly
bill
287
this
bill,
prioritizes
women
and
their
options
for
giving
birth
in
nevada.
As
a
mother,
I
can
fully
recognize
the
importance
of
choosing
the
birthing
plan.
That
is
right
for
you
and
your
family.
There
are
much
better
outcomes
for
newborns
and
for
mothers
when
moms
are
given
a
choice
in
how
to
set
up
the
birthing
plan
that
works
best
for
them.
F
H
E
I
Good
afternoon
senators,
my
name
is
jimmy
lau
with
ferrari
public
affairs
representing
dignity,
health,
saint
rose,
dominican,
dignity
submitted
a
letter
from
our
chief
medical
officer
to
nellis,
which
outlines
some
of
our
concerns
I'll
go
through
those
just
very
briefly:
they're,
rather
technical
in
nature.
So
the
first
one
is
the
distance
required
from
the
birthing
center
to
the
hospital.
I
Our
second
concern
is
the
lack
of
a
qualified
provider
for
higher
level
interventions
that
may
be
necessary
in
a
birth,
so
someone
that
may
be
able
to
intubate
an
infant
and
that's
generally,
a
very
hard
task
to
do
so.
Someone
with
the
qualifications
and
technical
skills
to
do
that
at
the
birthing
center
and
then
the
third
concern
is
the
relationship
with
the
hospital.
H
B
Good
evening
this
is
lynn
chapman
state
vice
president
of
nevada
families
for
freedom
l-y-n-n-c-h-a-p-m-a-n.
We
oppose
the
portion
of
ab-287
that
eliminates
the
words
mother
and
father
from
birth
certificates
and
other
legal
documents.
Kimberly.
Ells
author
and
policy
advisor
for
family
watch
international
wrote
an
article
about
erasing
motherhood
in
the
article
she
pointed
out
that
our
congressional
house
just
moved
to
eurase
language
that
expresses
familial
relationships.
B
The
socialist
feminist
ideology
articulated
by
schulimus
firestone
in
the
1970s
said
quote:
it
has
become
necessary
to
free
humanity
from
the
tyranny
of
its
biology,
unquote
and
quote,
eliminate
the
sex
distinction
itself,
so
that
genital
differences
between
human
beings
would
no
longer
matter
culturally.
Unquote
else
goes
on
to
say
quote
if
there
are
not
two
specific
perceivable
sexes
that
can
be
definitively
recognized
by
law
that
it
becomes
difficult
to
define
or
defend
mothers
and
fathers,
along
with
their
parental
rights.
B
In
legal
terms,
therefore,
the
belonging
of
children
to
their
parents
is
increasingly
thrown
into
question,
and
the
family
stands
on
trembling
legal
legs,
unquote
by
putting
on
birth
certificate
person
who
gives
birth
and
the
other
person
other
person.
This
bill
insults
mothers
and
fathers
everywhere
by
eliminating
their
standing,
legal
and
otherwise,
and
it
denigrates
their
very
important
and
time-honored
roles.
Please
amend
out
this
part
of
the
bill.
Thank
you.
H
J
J
What
I
see
happening
here,
as
reflected
in
the
language
adopted
in
this
bill,
is
another
step
toward
undermining
the
family.
Another
attempt
to
minimize
the
family
unit,
which
is
the
basis
and
foundation
upon
which
a
civil
site
society
exists,
look
at
look
at
what
is
happening
in
many
parts
of
our
country,
where
fathers
are
absent
from
the
lives
of
young
adolescents.
J
You
want
to
reduce
crime,
then
strengthen
the
family
and
improve
the
education
of
our
kids.
It's
that
simple.
Personally,
the
thought
of
referring
to
my
dad
as
the
other
person
is
nauseating,
even
if
just
on
a
birth
certificate
and
to
my
mother,
who
will
be
97
years
old
later
this
month
as
the
person
giving
birth
distasteful.
J
E
H
E
C
Thank
you,
senator
harris,
assemblywoman,
danielle,
monroe
moreno
for
the
record,
just
in
response
to
some
of
the
opposition
for
dignity,
health.
I
appreciate
the
comments
and
but,
as
I
said,
I
went
home
drove
from
my
house
to
the
hospitals
near
me.
There
is
not
a
hospital
within
five
miles
of
my
urban
home,
so,
if
they'd
like
to
discuss
any
other
mileage,
five
miles
is
unreasonable.
C
As
far
as
having
someone
to
handle
a
high
level
pregnancy
issues,
pregnant
people
cannot
utilize
a
birthing
center
if
they
are
a
high
level
birth,
only
those
low-level
uncomplicated
pregnancies
and,
as
you
heard
during
the
testimony,
they
monitor
the
pregnancies
throughout
and
if
they
see
any
reason
why
a
mom
should
would
be
in
a
better
place
to
have
her
baby
in
the
hospital
they
make.
Those
transfers
early,
also
relationships.
C
C
As
far
as
the
gender
neutral
language
the
world
we
live
in
has
changed.
I
was
born
a
few
years
ago
and
I'm
adopted,
I
am,
have
been
looking
for
my
birth,
mother
and
father
for
a
number
of
years
wanted
that
to
find
out
who
they
were
for
health
reasons,
but
also
just
to
tell
them.
Thank
you
for
the
choice
that
they
made.
C
C
G
E
D
D
Yes,
I'm
so
sorry
senator
harris
for
interrupting.
This
is
tara
rains
to
the
record.
I
wanted
to
offer
a
point
of
clarification
in
the
opposition.
They
stated
that
infant
intubation
cannot
happen
at
birth
centers.
However,
midwives
are
trained
in
infant
intubation
and
ms
burkett
can
speak
more
to
that.
That
was
not
accurate
information.
I
just
thought
it
was
important
for
you
all
to
have
the
most
accurate
information
as
you're
making
this
very
very
important
decision.
E
Okay,
we'll
make
sure
that's
on
the
record,
and
with
that
I
will
now
close
the
hearing
on
ab287
open
the
hearing
on
ab326
and
welcome
our
colleague
assemblyman
roberts
to
the
table.
Welcome
assemblyman
go
ahead
and
begin
when
you're
ready
thank.
K
You,
madam
vice
vice
chair,
it's
a
pleasure
to
be
here,
I'm
for
the
record,
I'm
assemblyman
tom
roberts
from
assembly
district
13..
I
am
here
today
to
present
you
a
bill
assembly
bill
326,
which
revises
the
provisions
governing
cannabis,
with,
with
your
permission,
I'll
I'll,
go
over
like
the
back
story
for
why
this
bill
came
into
fruition,
then
I'll
go
over
the
the
technical
aspects
of
the
bill.
K
I
have
mr
john
sandy
to
explain
a
to
explain
a
portion
of
the
bill
regarding
receiverships
and
there's
a
proposed
amendment
that
each
of
you
should
have
gotten
that
we
cleaned
up
the
language
and
I'll
kind
of
talk
about.
You
know
why
that
is
what
it
is
and
then
I'll
turn
it
back
over
to
the
to
you
for
questions
so
with
that.
This
is
currently
36
states
that
have
legalized
medical
marijuana
in
15
states
that
have
regulated
adult
use,
cannabis
programs.
K
Despite
this
there's
an
illegal
market
for
marijuana,
it
is
still
thriving.
The
reason
is
simple
economics.
The
las
vegas
metropolitan
police
department
announced
last
april
that
it
had
made
the
largest
indoor
marijuana
grow
operation
bust
of
over
5
700
individual
plants.
Weighing
more
than
860
pounds
and
valued
at
nearly
9
million
dollars,
there
are
consequences
to
the
black
market,
unlicensed
cannabis
producers
and
retailers
compete
against
legal
dispensaries
with
lower
tax
collection
and
impact
stake
revenue
and
physical
year
2019
and
20
state
sales
tax
on
cannabis.
Products
in
nevada
amounted
to
to
about
53
million
dollars.
K
K
I
know
from
my
time
at
the
metropolitan
police
department
before
I
left,
I
was
over
the
investigations
section
and
we
started
to
see
a
decline
in
jury
appeal
for
marijuana
cases
on
the
criminal
side,
simply
because
it
is
now
legal
in
the
state
and
the
the
voters
passed
it
on
the
ballot
measure
and
so
there's
just
not
a
lot
of
jury
appeal
for
these
criminal
cases.
K
So
I
talked
to
law
enforcement
to
include
prosecutors
in
the
high
density,
drug
trafficking
section
in
the
da's
office,
and
they
basically
highlighted
some
of
the
things
that
I
already
knew.
Although
we
were
getting
some
criminal
prosecution,
it
wasn't
as
much
as
it
used
to
be.
It
basically
went
after
folks
with
violent
priors
and
a
lot
of
a
lot
of
the
cases
just
weren't
being
prosecuted
and
as
a
result,
law
enforcement
didn't
have
an
appetite
to
police
these.
K
So
the
black
market
continues
to
thrive.
So
one
of
the
prosecutors
actually
recommended
that
I
contact
the
contractor's
board
and
the
contractor's
board.
The
gentleman
that
is
actually
runs.
The
enforcement
division
of
that
happens
to
be
an
ex
drug
enforcement
agent
supervisor
and
he
suggested
that
they
have
civil
infractions
that
go
along
with
their
criminal
infractions.
K
One
goes
after
advertisers,
so
you
have
to
advertise
a
specific
way
and
if
somebody
you
know
doesn't
do
that,
then
they
can
actually
go
after
them
criminally
and
civilly.
Although
this
bill
only
applies
for
for
civil
civil
penalties
and
in
addition,
if
you
conduct
a
sale
in
for
the
contractors
board,
it's
actually,
if
you
conduct
contracting
business
without
a
license,
they
have
the
ability
to
fine
you
and
that
money
goes
back
into
education.
K
For
the
for
the
program,
you
know
to
to
educate
the
public
on
licensed
contractors
and
unlicensed
contractors,
and
it
also
helps
support
the
enforcement
effort.
Those
are
nrs.
K
K
Folks,
like
that,
that
are
that
are
trying
to
police
or
regulate
the
unregulated
market,
give
them
a
tool
other
than
criminal
prosecution
to
go
after
people
operating
a
business
without
a
license
and
or
advertising,
and
so
what
you
see
before
me
I'll
go
over
the
technical
aspects
of
the
of
the
bill
in
section
one,
it
basically
says
you
know
a
person
who
does
not
hold
a
license
and
who,
in
violation
the
provisions
of
this
title,
cultivates,
delivers,
transfers,
supplies,
sells
cannabis
or
manufactures,
delivers,
transfers
supplies
or
sells
cannabis
products.
K
Products
is
labeled
is
liable
to
a
civil
penalty,
if
not
more
than
fifty
thousand
dollars
to
be
brought
by
the
district
attorney
or
the
city
attorney
the
jurisdiction
in
which
the
violation
occurred.
K
K
We
we
added
language
in
the
cannabis
compliance
board.
I
worked
with
them
to
basically
allow
them
to
regulate
the
advertising,
to
say
if
you're
going
to
advertise
for
cannabis
products,
they're
going
to
set
forth
some
regulations
and
work
with
the
industry
so
that
it's
not
too
burdensome,
and
so
that
actually
gets
the
effect
is
like.
So
you
as
a
consumer
would
know
all
right.
K
This
is
a
legitimate
business
that
I'm
ordering
from
or
not,
and
so
that's
that's
the
premise
for
that
now
I
will
tell
you
in
in
section
1.5:
we
did
leave
out
the
word
advertise,
so
I
will
be
seeking
an
amendment
for
that.
I
just
caught
that
it
did
not
make
it
off
the
floor
without
the
word
advertise
on
that.
So
I
will
have
to
make
a
change
to
add
that
so
that
it
actually
helps
on
the
advertising
aspect.
K
But
with
that
I'll
tell
you
why
we
added
the
receivership
language
is
working
with
the
cherryjager.
On
the
other
side,
we
had
some
folks
that
needed
some
cleanup
language
for
receivership
for
these
businesses.
K
So
we
amended
the
bill
on
the
floor.
We
actually
didn't
get
everything
we
needed
into
it,
which
is
why
we
have
a
proposed
amendment
today
and
mr
sandy,
who
is
an
attorney,
and
I
am
not
we'll
go
over
the
the
aspects
of
that
bill
and
help
me
answer
any
questions
to
it
and
with
that
I'll
turn
over
to
mr
sandy.
L
Thank
you
for
that.
Madame
vice
vice
chair.
I
like
that
go
with
it
for
the
record
john
sandy.
The
fourth
with
argentum
partners
here
today
on
behalf
of
united
ams
united
ams,
is
actually
the
first
court
appointed
receiver
to
operate
in
the
cannabis
industry.
L
There
might
have
been
one
before
us,
I
believe
in
washington,
but
we
were
pretty
pretty
close
and
the
reason
why
receiverships
are
important
or
why
we
feel
that
this
is
an
important
area
of
the
law
to
address
in
our
statutes
is
typically
in
most
industries
when
a
business
falls
on
hard
times
or
creditors
feel
that
a
business
is
not
being
run
as
it
should.
We
have
bankruptcy
that
is
there
to
protect
both
the
the
business
and
and
the
creditors
in
our
instance.
L
In
this
case,
the
business
did
file
for
for
bankruptcy
protection
and
it
was
rejected
because
under
federal
law,
cannabis
is
an
illegal
substance
scheduled
schedule
one
and
that
the
bankruptcy
law
fell
or
the
bankruptcy
court
felt
that
the
federal
protections
for
those
businesses
did
not
apply
to
those
types
of
businesses,
and
so
the
case
got
pushed
to
the
state
court
which
which
granted
a
receivership.
L
But
we
realized
that
there
weren't
laws
that
really
addressed
that
and
so
in
working
with
the
ag's
office
and
working
with
the
ccb,
we
put
together
some
language
that
gives
the
ccb
the
authority
to
quali
or
establish
qualifications
for
receiverships
the
minimum
qualifications
that
you
would
expect
a
receiver
to
have.
L
That
would
step
in
to
try
and
fix
the
situation
as
a
bankruptcy
might
bankruptcy
trustee
might
do
the
amendment
really
is
to
give
flexibility
to
the
ccb
and
you
notice
in
the
original
bill,
or
the
original
amendment
excuse
me,
my
mask:
is
it
says
that
they
shall
put
those
shall
adopt
regulations
that
establish
those
sections
that
are
put
in
the
the
bill?
This
says
that
they
may
do
that
and
gives
them
some
discretion,
which
is
what
they
felt
would
be
the
best.
So
we
are
comfortable
with
that.
E
All
right
are
there
any
questions
from
committee
members,
senator
kikofer.
G
Thank
you,
senator
the
so
in
section
in
the
civil
penalty,
section
I'm
assuming
in
section
1.5.
So
under
what
process
does
an
individual
get
found
to
be
liable
for
the
violation
right?
So
if
police
aren't
really
enforcing
it
or
sort
of
who
makes
the
determination
that
there
was
a
violation?
And
is
there
any
sort
of
appeal
right
for
that
person?.
K
Thank
you
for
the
question
for
the
record
assemblyman
tom
roberts
through
you,
madam
chair,
to
senator
kiker.
So
the
premise
was
to
give
the
local
courts
of
jurisdiction
so
an
instance.
Let's
say
your
city
of
henderson:
it
could
be
police
officers
or
their
code
enforcement.
That
actually
would
issue
a
civil
citation
to
folks
that
are
engaged
in
in
the
in
the
actions
that
are
highlighted
in
the
section
and
then
it
would
go
through
the
normal
civil
process.
G
I
appreciate
that,
thank
you
and
then
in
the
in
the
section
1.7
as
it
relates
to
receivership.
This
is
my
own
lack
of
knowledge
on
this
subject.
Are
there
time
limits
for
how
long
an
establishment
could
be
in
receivership
and
then
is
there
anything
as
a
follow-up
to
that?
Are
there?
Is
there
anything
that
prohibits
a
receiver
from
then
sort
of
taking
over
full
ownership
right?
L
Thank
you
for
the
question
for
the
record
john
sandy
iv
with
argentine
partners,
madame
vice
chair
through
you
to
senator
keith
keffer,
so
receivership
is
really
an
equitable
remedy
at
the
court,
the
court
resides
over
the
receivership
estate
and
everything
has
to
be
approved
through
the
receivership.
L
So
at
this
point
in
our
case,
for
example,
the
the
receiver
has
come
in
inventoried
all
the
assets
kind
of
established
relationships
with
cultivators
and
and
everything
and
gotten
the
the
company
to
a
position
where
it
could
be
transferred
and
sold
to
allow
for
the
creditors,
which
were
employees
that
were
owed
back
pay,
some
of
the
investors
and
others
to
get
some
of
their
money,
recouped.
L
That
is
in
the
process
of
being
approved
by
the
court.
So
if
the
court
wanted
to
put
time
limits
and
establish
limitations,
the
court
would
have
the
discretion
under
their
equitable
powers.
To
do
that,
I'm
not
aware
of
anything
in
the
law
that
would
require
a
certain
period
of
time.
It's
really.
It
would
depend
upon
the
complexity
of
the
business,
how
difficult
of
a
case
it
would
be
to
get
it
reestablished
or
or
whatever
would
be
in
the
best
interest
of
the
of
the
creditors
in
the
receivership
estate.
L
G
I
think
so,
thank
you,
mr
sandy.
So
then,
at
the
end
of
or
at
the
court's
discretion
it
moves
out
of
receivership
and
into
an
ownership.
A
new
ownership
structure.
Right
and
is,
is
it
a
process
is?
Is
there
opportunities
for
the
for
the
receiver
to
convert
into
full
owner,
or
does
it
is
that
something
that
a
court
approves
or
is
a
receivership,
truly
a
temporary
sort
of
management
contract,
which
is
what
I've
always
thought
of
it?
As.
L
For
the
record-
yes,
john
sandy,
the
fourth
madam
chair,
through
you
or
vice
chair
through
you,
two
senator
key
keffer.
It
would
I'm
not
I'm
not
really
aware
that
a
receiver
ship
would
become
the
full-time
owner.
The
receiver
is,
is
a
award
of
the
the
court.
It
acts
on
behalf
of
the
court,
and
so
I
couldn't
imagine
a
situation
where
that
would
make
sense
that
the
receiver's
gonna
be
the
full-time
owner.
Typically,
it's
a
it's
a
it's.
L
It
acts
as
similar
to
a
trustee
in
bankruptcy
where
its
job
is
to
act
on
behalf
of
the
court
to
re-establish
the
business
and
protect
the
assets
of
the
business
so
that
it
they
could
be,
or
in
a
organized
fashion,
transferred
or
liquidated.
However,
the
receiver
felt
would
be
best
to
protect
the
people.
G
L
Madam
vice
chair
for
the
record
john
say
the
fourth
threw
you
to
senator
hardy
that
in
most
cases,
that
is
how
it
work
and
so
for
our
example
in
in
the
language
here,
it's
there
we're
going
to
create
a
new
agent
card,
for
that
would
be
a
receiver
ship
designation.
In
our
example,
the
receiver
had
to
obtain
its
own
regis
registered
agent
card
so
that
it
was
and
have
the
background
checks
that
the
ccb
required
of
him
to
be
able
to
step
in
and
operate
that
business.
L
But
yes,
that
was
his
charge
from
the
court
was
get
this
business
re-established
and
try
and
protect
the
assets
is
to
the
extent
possible,
and
I'm
I'm
happy
to
report
that
in
our
instance
I
believe
it
worked
well
for
everybody
and
and
that
a
lot
of
the
value
of
the
estate
was
able
to
be
saved
and
a
lot
of
the
creditors
were
able
to
get
some
of
their
money
back.
L
Yeah,
so
excuse
me
for
the
record
john
cedar,
the
fourth
madam
vice
chair
to
youth
through
you,
you
can
go
directly.
Thank
you
senator
hardy.
So
again,
the
the
court
is
really
in
a
lot
of
respects,
running
the
show
on
that,
so
the
receiver
doesn't
actually
get
to
keep
profits.
The
receiver
is
taking
those
profits
and
putting
them
back
into
the
business
to
try
and
generate
it.
I
it
does.
The
receiver
is
able
to
charge
a
fee.
L
It's
a
fee
based
hourly,
I
believe
in
most
instances
and
those
fees
again
are
reviewed
by
the
court
for
reasonableness
and
the
creditors.
All
the
creditors
have
an
opportunity
to
file
protests
for
that
if
they
felt
that
they
were
unreasonable
for
any
reason,
and
then
the
judge
would
be
the
person
that
would
ultimately
have
to
sign
off
on
whether
those
were
reasonable
fees
or
not,
but
as
far
as
the
profits
go,
the
receiver
doesn't
get
to
keep
any
of
those.
Thank
you
and
all.
L
John
sandy
for
the
record
in
this
state-
yes,
marijuana
is
still
a
pretty
cash
heavy
business.
L
E
So
I
have
a
question
about
the
the
civil
penalty
of
not
more
than
fifty
thousand
dollars.
What
what
I
don't
see
in
the
bill
is
any
discussion
about
how
that
fine
should
be
assessed.
So
is
it
based
on
quantity
or
number
of
violations,
or
what
factors
do
you
imagine
should
be
taking
into
consideration
and
determining
whether
to
find
you
zero
or
up
to
up
to
fifty
thousand.
K
Thank
you,
man,
I'm
sure,
similar
than
tom
roberts
for
the
record.
K
So
we
modeled
this
after
the
language
that
is
in
the
contractors
board
and
what
I
am
told
what
they
do
is
they
they
base
it
on
the
number
of
violations,
the
size
of
the
company
and
so
on
and
so
forth,
and
and
that
those
are
all
factors
that
are
taken
into
account
by
the
hearing
master
or
the
you
know,
or
the
hearing
officer
or
judge
whichever
venue
you
are
in
and
in
that
statute,
as
well,
it's
silent
and
basically
leaves
discretion
to
the
to
those
folks
presiding
over
those
hearings.
E
K
Correct
for
the
record
assembly,
tom
roberts
yeah,
you
would
be
correct,
it
would
be
the
it
would
be
a
code
enforcement
and
or
a
business
licensing
entity.
Whoever
whoever
manages
those
businesses
in
those
districts
in
concert
with
either
the
city
attorney
or
the
district
attorney.
E
E
E
H
H
J
Thank
you
senator
harris
the
members
of
the
committee
for
the
record,
mike
cathart
c-a-t-h
c-a-r-t,
representing
the
city
of
henderson.
The
city
is
in
support
of
ab326
and
want
to
thank
assemblyman
roberts
for
spending
time
with
us
discussing
how
this
tool
could
be
utilized
having
another
option
and
trying
to
stop
the
illegal
sale
of
cannabis
is
welcome
and
we
hope
this
tool
helps
to
lower
the
level
of
black
market
products
competing
with
the
well-regulated
legal
cannabis
industry.
H
J
Thank
you
so
much.
My
name
is
chad.
Christensen
last
name
is
c-h-r-I-s-t-e-n
s-e-n.
Madam
vice
chair
members
of
the
committee.
It's
an
honor
to
be
able
to
share
my
perspective
on
this.
I
am
one
of
the
two
owners
of
piso's
dispensary
in
in
clark,
county
and,
and
I
really
appreciate
assemblyman
roberts
and
the
others
who
have
been
working
on
this
legislation,
because
it's
important
for
a
number
of
reasons.
I
wanted
to
focus
on
on
two
and
I
I
want
to
make
sure
I'm
not
repetitive
to
what
has
already
been
addressed.
J
I
think
this
perspective
is
is
important.
The
state
of
california,
which
has
a
lot
of
parallels
to
it's.
What
we're
seeing
in
in
nevada,
has
had
up
to
70
percent.
That's
seven.
J
Zero
percent
of
the
market
of
cannabis
consumed
is
illegal
and
we
don't
know-
I
don't
know
personally
the
exact
number,
but
but
I
have
been
told
that
it
is
again
a
lot
of
parallels
and
that
the
number
would
be
very
similar
if
we
considered
the
fact
that
the
cannabis
market
is,
or
at
least
came
close
to
being
the
second
largest
taxpayer
in
the
state
of
nevada.
That
that
raises
the
two
points
that
I
wanted
to
or
brings
into
brings
a
concern
on
two
points
that
I
wanted
to
address.
J
Number
one
is
public
health
and
number:
two
is
revenue
to
the
state
on
the
public
health
perspective,
black
market
or
illegal
cannabis
is
not
tested
and
and
that
the
body
that
I'm
addressing
now
the
legislature
made
sure
that
the
state
of
nevada
has
the
most
robust
testing
system
to
protect
patients
and
consumers.
J
Visitors
to
our
state
anything
happens
if
someone
assumes
that
they're
buying
a
legal
product
and
it's
not
and
it
is
detrimental
to
their
health,
then
that
becomes
a
significant
bad
press
nationally,
because
we
are
the
state
of
nevada
or
the
the
city
of
las
vegas.
Protecting
the
the
the
health
of
of
our
community
is
is
top
priority
number
two.
I'm
making
sure
that
that
revenue
goes
to
the
state
to
schools,
to
the
programs.
You
all
are
working
so
hard
to
to
fund.
J
H
F
L-A-Y-K-E-M-A-R-T-I-N
good
afternoon
foreign
harris
and
members
of
the
health
and
human
services
committee,
I'm
the
executive
director
of
the
nevada,
dispensary
association.
We
want
to
thank
assemblyman
roberts
for
seeking
to
provide
additional
tools
to
combat
the
illicit
market,
particularly
organized
crimes.
We're
grateful
that
assemblyman
roberts
has
been
flexible
in
working
with
the
industry
to
ensure
that
requiring
identification
on
advertising
would
not
be
overly
them
to
the
industry,
while
also
providing
a
helpful
way
to
to
help
consumers
distinguish
ads
for
licensed
versus
unlicensed
businesses.
F
Additionally,
we
support
the
amendment
language
to
establish
a
process
for
receivership
in
the
cannabis
industry
as
federal
bankruptcy.
Protection
is
not
an
option
for
cannabis.
Businesses,
the
statutory
language
and
ccp
regulations
will
help
provide
needed
guidance
for
insolvent
businesses
and
receiverships
within
the
cannabis
industry.
Thank
you.
H
E
E
H
H
E
H
H
K
Thank
you,
man,
I'm
sure.
I
appreciate
your
time
today
and
hearing
the
bill
yeah.
I
I
it
was
a
very
big
work
in
progress
as
as
it
came
out
of
drafting,
and
there
was
a
number
of
changes
and,
as
you
can
see,
we
still
have
some
and
obviously
we're
going
to
make
some
changes.
If
there's
some
things
that
make
you
feel
uncomfortable
and
that
we
need
to
tighten
up,
I'm
certainly
agreeable
to
to
any
of
those
that
the
committee
might
have
before
you
would
pass
this.
K
E
E
M
Thank
you
vice
vice
chair.
I
believe
and
thank
you
members
of
this
esteemed
health
and
human
services
committee.
This
is
my
first
time
presenting
a
bill
before
senate
health
and
human
services,
and
it's
quite
a
pleasure
for
the
record.
My
name
is
assemblywoman
jill
tolls.
I
represent
assembly
district
25
and
I'd
just
like
to
start
off
by
saying
that
dave.
This
is
for
you,
so
I'm
here
to
present
assembly
bill
374
and
I'd
like
to
start
with
a
little
bit
of
background
to
orient
us
back
to
this
topic.
M
So,
with
your
permission,
vice
chair,
chair,
I'd,
like
to
begin
in
november
of
last
year,
the
national
drug
helpline
placed
nevada
as
one
of
28
states
on
red
alert
for
increased
risk
of
death
from
overdoses
from
opioids
and
other
drugs.
The
coven
19
pandemic
has
amplified
the
existing
opioid
crisis.
M
M
This
bill
is
based
on
the
direct
input
of
the
attorney
general,
the
attorney
general's
office,
the
department
of
health
and
human
services,
naco
proof
and
representatives
of
the
mental
health
and
recovery
prevention
and
treatment.
Community,
I'd
like
to
briefly
run
through
some
highlights
of
the
bills,
starting
with
sections
five
through
seven,
which
establishes
the
nevada,
statewide
substance,
use
response,
working
group
and
outlines
the
membership
service
requirements
and
other
functions
of
the
working
group.
M
Section.
6
subsection
2
outlines
the
membership
of
the
group,
including
the
attorney
general
or
appointee,
the
director
of
department
of
health
and
human
services
or
appointee
representatives
of
local
governments
from
washoe
clark
and
rural
county
representation,
law
enforcement,
health
care,
recovery,
treatment
and
prevention,
communities
and
legislators,
and
I'd
like
to
stop
for
a
moment
and
add
that
it
is
my
intention
to
add
an
amendment
to
this
bill.
That
would
also
include
representation
from
a
hospital
considering
that
they
are
often
on
the
front
line,
particularly
in
the
emergency
rooms,
as
well
as
k-12
representation.
M
I'm
reporting
to
the
governor
attorney
general
advisory
commission
on
the
administration
of
justice
and
the
director
of
lcb,
section
10.5
requires
that
the
department
of
health
and
human
services
submit
a
report
concerning
the
use
of
money
received
by
the
state
from
settlements,
civil
actions,
gifts,
grants
or
donations
and
all
other
money
spent
by
the
state
and
each
political
subdivision
for
purposes
relating
to
substance.
Misuse
and
substance.
Use
disorders
to
the
working
group
annually.
M
And
with
that
I
would
like
to
turn
to
dr
stephanie
woodard
from
the
department
of
health
and
human
services
to
provide
a
statement
and
and
also
elaborate
a
little
further
on
the
reasoning
for
the
duties
included
in
this
task
force
and
then
turn
it.
Over
to
second
assistant,
deputy
attorney
general
christine
brady
from
the
attorney
general's
office.
N
N
As
many
of
you
already
know,
the
issues
around
substance
use,
misuse
and
addiction
are
complex
and
often
involve
an
interplay
between
individual
risk
factors
and
environmental,
social
and
economic
conditions,
just
as
there
is
no
one
single
driver
that
contributes
to
the
rising
rates
of
substance,
misuse,
addiction
and
overdose.
There
is
also
no
one
single
solution.
N
Such
efforts
led
to
the
creation
of
the
previous
attorney
general's
substance,
abuse
working
group
and
the
since
sunsetted
governor's,
opioid
accountability,
task
force
meetings
where
stakeholders
engaged
in
data-driven
discussions,
supported
needed
policy
and
program,
development
and
implementation,
reduced
duplication
of
efforts
and
brought
accountability
and
transparency
to
the
process.
N
It
was
through
this
very
intentional
work
across
systems
that
has
led
to
coordinated
strategies
to
address
the
crises
at
hand,
and
yet,
as
nevada
now
faces,
new
challenges
related
to
substance,
use,
addiction
and
overdose.
We
have
also
seen
that
is
not.
It
is
not
sufficient
to
establish
groups
to
singularly
focus
on
one
issue
or
substance
at
a
time.
We
truly
do
need
a
comprehensive
and
collaborative
approach.
N
The
proposed
statewide
substance
use
response
working
group
in
eb.
374
will
bring
stakeholders
together
to
develop
comprehensive,
evidence-based
strategies
and
recommendations
for
prevention,
early
intervention,
treatment,
recovery,
harm
reduction,
data
sharing,
criminal
justice
interventions
and
public
policy.
N
This
group
will
also
assess
and
evaluate
existing
pathways
to
treatment
and
recovery
work
to
understand
how
nevadans
are
able
to
access
treatment
and
recovery
support
services
from
various
points
within
the
sequential
intercept
model.
That
means
that
for
individuals
that
interface
with
law
enforcement
or
the
criminal
justice
system,
with
a
specific
emphasis
on
deflection
and
diversion
from
the
criminal
justice
system,
it
will
also
work
to
improve
and
expand,
evidence-based
or
evidence-informed
practices,
procedures
and
strategies
for
the
treatment
and
support
for
individuals
who
are
in
recovery,
as
well
as
specific
recommendations
for
special
populations.
N
The
efficacy
and
expand
implementations
of
programs
to
educate
youth
and
families,
about
substance
use
and
to
reduce
harms
associated
with
drug
use.
It
will
improve
coordination
between
local
state
and
federal
law
enforcement
agencies
and
public
health
entities
to
enhance
the
communication
of
timely
and
relevant
information
and
data.
N
There
are
a
number
of
reports
that
this
group
will
generate
as
well
as
recommendations,
and
it
will
also
work
to
study
and
evaluate
and
provide
recommendations
towards
the
opioid
settlement
litigation
funding
that
the
state
will
be
receiving
through
the
attorney
general's
office
and
its
litigation
efforts.
On
the
state's
behalf.
C
The
attorney
general's
office
is
proud
to
support
this
bill
and
we
are
thankful
to
assemblywoman
tolls
for
this
bipartisan
bill,
because
drug
abuse
and
addiction
knows
no
boundaries
or
party
who
hasn't
been
personally
impacted
by
problematic
substance,
use
or
addiction.
Almost
everyone
has
themselves
been
impacted
or
a
family
member
or
a
friend.
C
Use
response
group
with
helping
to
provide
meeting
space
with
helping
to
provide
the
public
meeting,
make
sure
that
they
comply
with
open
meeting
laws
and
so
forth,
and
so
we
will
give
endeavor
to
give
support.
In
that
way,
this
working
group
is
consisting,
as
you
can
see,
of
a
diverse
and
dynamic
group
of
professionals
and
citizens
who
will
work
hard
to
combat
the
statewide
problem.
E
A
Thank
you.
I
just
want
to
take
a
moment,
while
miss
brady
is
here
to
thank
her
for
the
significant
efforts
that
she
has
put
a
lot
of
time
and
energy
into
this
bill
and
another
bill
that
I'm
working
with
on.
So
thank
you,
for
she
has
been
just
really
engaged
appreciate,
appreciate
you
all
right,
so
is
that
we're
still
in
the
presentation?
Okay,
great
assemblywoman
tools.
M
Thank
you
chair,
and
it's
good
to
see
you.
That
actually
concludes
our
presentation
portion.
I
will
state
that
we
have
courtney
hunter
from
shatterproof,
which
is
a
national
non-profit,
dedicated
to
addiction
recovery,
and
then
we
are
also
joined
by
our
miss
las
vegas,
kelsey
matthews,
who
is
here
to
also
provide
support
and
testimony,
but
I
I
will
defer
to
the
chair
and
this
committee,
if
you'd
like
to
hear
from
them
first
and
then
open
up
for
questions
or
if
you'd
like
to
go
straight
to
questions
now.
A
Thank
you
assemblywoman,
since
I
missed
the
first
part,
would
you
mind
repeating
it
just
kidding?
I
think
that
we'll
go
to
the
committee
for
questions.
Anybody
have
pretty
straightforward.
We
covered.
I
just
want
to
make
sure
that
we
covered
the
amendment.
M
A
All
right,
then,
with
that
we'll
close
the
hearing,
we'll
close
the
presentation
and
open
public
testimony
on
ab374.
Is
there
anybody
in
the
room
who
would
like
to
testify
in
support
of
ab374.
O
Good
afternoon,
madam
chair,
madam
vice
vice
chair
members
of
the
senate,
health
and
human
services
committee,
I
actually
have
two
pieces
of
testimony.
If
you
will,
my
colleague,
helen
foley
was
here
had
to
leave,
but
if
I
may
present
her
testimony
great
so
on
behalf
of
helen
foley
of
foley
public
affairs,
she
wished
to
present
testimony
for
first
med
health
and
wellness
center,
a
federally
qualified
health
center
in
clark
county
speaking
for
helen,
I
am
the
chairman
of
the
board
of
first
met
health
and
wellness
center
and
fqhc
in
southern
nevada.
O
In
addition
to
traditional
medical
care,
we
provide
mental
health
and
substance
addiction
services
to
approximately
1200
patients
monthly.
While
we
are
very
proud
of
the
services
we
provide,
there
are
many
roadblocks
to
quality
care.
A
strong
working
group
can
help
alleviate
some
of
these
problems
in
order
to
streamline
the
process
and
provide
greater
access
with
better
outcomes,
especially
to
the
low
income
and
underserved
populations.
O
Some
of
these
opportunities
include
providing
reimbursement
for
supportive
services,
like
case
management
for
patients
with
substance
use
disorders,
allowing
group
therapy
and
peer
support
for
medication,
assisted
treatment
or
mat
programs,
removing
the
barrier
for
dispensing
subop
suboxone
for
mhrt
certified
providers
and
the
program
should
also
pay
for
the
initial
phase
of
suboxone
induction
to
prevent
barriers
to
initiating
care.
Many
children
and
families
come
as
a
referral
from
the
schools
department
of
family
services,
department
of
juvenile
justice
services,
because
we
connect
our
patients
to
external
resources
and
have
a
robust
group
of
providers.
O
We
are
able
to
give
a
perspective
of
the
lower
income
patient
that
are
generally
affected
by
substance
use.
We
would
like
a
seat
at
the
table
or
on
an
advisory
committee,
as
this
working
group
moves
forward
on
this
critical
issue.
We
thank
assemblywoman
tools
for
her
sponsorship
of
this
legislation
and
now,
if
I
may
speaking
as
myself,
please
go
ahead
good
afternoon.
Sarah
adler,
with
silver
state
government
relations,
speaking
on
behalf
of
vitality
and
unlimited
and
new
frontier
to
community
certified
community
based
health,
centers
and
residential
addiction,
treatment
centers
in
rural
nevada.
O
So
as
dr
woodard
did
a
great
job
detailing
addressing
substance,
use
disorders
requires
active
work
in
prevention,
in
residential
treatment
and
in
community-based
care
to
support
recovery.
So
I
won't
repeat
the
great
point
she
made
about
that.
The
substance
use
disorder
working
group
uses
throughout
its
language,
recognition
of
state
and
local.
O
We
would
like
to
bring
to
that
just
cast
a
light
on
rural
frontier
and
tribal
and
diverse
communities
and
populations
as
specific
communities
that
we
are
confident
will
be
addressed
by
the
disorder
working
group,
but
we
just
wanted
to
say
it
and
then
our
final
point
is
a
need
very
strong
need
to
look
at
workforce
development.
O
In
many
ways
the
legislature
has
addressed
the
need
for
developing
the
behavioral
health
workforce,
but
we
want
to
bring
to
your
attention
specific
need
related
to
licensed
alcohol
and
drug
counselors
and
licensed
clinical
alcohol
and
drug
counselors.
The
good
news
in
nevada
is
that
stigma
is
falling
away
from
mental
illness.
We
have
developed
many
in
the
licensed
professions
that
work
with
mental
illness,
but
we
are
falling
behind
in
our
licensed
alcohol
and
drug
workforce.
O
I
Needless
to
say,
hospitals
see
all
too
often
the
unfortunate
results
of
substance
addiction
and
have
to
treat
this
every
day.
This
bill
is
an
incredibly
impressive
approach
to
solving
it's
helping
to
address
this
problem,
which
is
incredibly
getting
worse
all
the
time.
Unfortunately,
but
when
you
put
together
that
group
particular
group
of
people
which
people
is
very
well
chosen
and
by
by
the
way,
we're
thankful
that
a
hospital
is
going
to
be
added.
I
But
then,
when
you
see
the
way
it
is
melded
into
the
way
the
state
works,
how
it's
going
to
meet,
how
it's
going
to
be
supported
and,
and
especially
how
it's
when
I
was
reading
the
bill,
I
thought
to
myself
what's
going
to
happen,
is
this
going
to
be
other
place
where
everything
just
goes
and
we
talk,
everybody
talks
and
dies,
and
no
that's
not
the
case.
I
So
we
strongly
support
this
bill.
We,
we
really
believe
it's
an
outstanding
bill
and
we
stand
ready
to
help
in
any
way
the
hospitals
possibly
can
to
make
this
a
success.
I
am
also
one
of
those
folks
who
related
by
marriage
took
pil,
was
given
opioids
after
operation
and
15
years
later,
as
an
addict.
He
died
of
an
overdose,
so
it
doesn't
escape
anybody.
I
Good
afternoon,
chair
ratty
members
of
the
committee,
my
name
is
jimmy
lau
with
ferrari
public
affairs
representing
dignity,
health
saint
rose,
dominican.
First,
we
would
like
to
thank
the
assemblywoman
for
bringing
forward
this
important
bill
and
second
thank
her
for
adding
our
unique
voice
to
the
table.
So
hospitals
are
in
a
unique
position
in
this
nexus,
largely
because
hospitals
encounter
people
that
may
not
have
access
to
other
health
care
options.
I
An
example
of
this
is
a
person
who
may
not
have
a
primary
care
provider
ending
up
in
an
emergency
room
and
hospitals
at
that
point,
have
the
ability
to
intervene
and
take
steps
necessary
and
get
that
person
into
care.
Dignity
participates
in
that
through
various
programs,
including
their
empowered
program,
which
for
focuses
on
pregnant
women.
I
A
P
Thank
you
so
much
for
for
allowing
us
to
to
speak
today.
My
name
is
courtney,
hunter
c-o-u-r-t-n-e-y
h-u-n-t-e-r
and
I
am
representing
shatter
proof,
which
is
a
national
non-profit,
dedicated
to
reversing
the
addiction
crisis,
and
I
wanted
to
support
and
thank
assemblywoman
tolls
for
putting
this
forward.
Thank
you
to
senator
ratty
for
also
moving
this
forward.
P
This
is
going
to
have
a
tremendous
impact
on
substance,
use
and
addiction
in
the
state
and
at
shatterproof
we're
we're
very
focused
on
evidence-based
solutions
to
ending
this
crisis
and
with
that
having
a
stakeholder
working
group
that
is
actually
looking
at
the
data
and
assessing
the
evidence
and
making
informed
solutions.
Based
on
that
evidence
is
a
critical
step
forward
and
will
will
ultimately
save
lives.
I've
no
doubt
also
at
shatterproof.
P
A
number
of
our
core
programs
include
looking
at
treatment,
quality
and
assessing
treatment,
quality,
advancing
behavioral
health
and
integrating
behavioral
health
into
the
primary
care
settings,
which
is
something
that's
been
talked
a
lot
about
so
far
in
the
in
the
testimony
that's
been
given
around
provider
shortage
and
making
sure
that
we're
we're
saving
lives
through
education,
empowering
communities
and
eradicating
stigma
at
shatterproof.
P
We
also
worked
with
johns
hopkins
university
to
to
put
out
some
guiding
principles
around
how
states
are
spending
opioid
settlement
dollars,
and
I
just
want
to
highlight
a
couple
of
those
because
I'm
very
proud
of
this
bill
in
nevada,
because
I
think
it's
the
best
one
that
I've
seen
in
all
of
the
bills
across
the
country
that
are
looking
at
addressing
this
issue,
particularly
with
regard
to
the
opioid
settlement
dollars
and
and
being
prepared
to
have
that
process
in
place
upon
receiving
the
that
allocation.
P
And
one
of
the
principles
is
spending
money
to
save
lives.
So
that
is
having
a
dedicated
fund
and
making
sure
that
we're
not
supplanting
dollars.
Another
one
is
focusing
on
on
racial
equity,
and
I
think
we're
really
doing
that
through
this,
this
stakeholder
advisory
group
that's
pulling
together
all
different
sorts
of
community
stakeholders
to
have
a
seat
at
the
table
and
have
a
voice.
P
Those
have
who
have
been
you
know,
underrepresented
in
the
past
and
can
also
represent
harm
reduction,
because
if
we
are
not
alive,
we
cannot
recover
and
then
the
final
one
that
I'll
just
highlight
is
is
transparency,
and
I
think,
having
the
reporting
mechanism
within
this
group
is
a
tremendous
asset
and
will
really
go
toward
providing
that
transparent
record
for
the
state
and
also
for
the
country.
P
So
again
just
want
to
be
want
to
testify
in
support
of
this
bill,
and
thank
you
all
for
really
leading
the
way
in
terms
of
you
know,
having
comprehensive
solutions
and
and
saving
lives,
and
thank
you.
I
we
also
have
our
ambassador
kelsey
matthews,
and
I
think
she
would
like
to
testify.
Q
Q
It
is
my
personal
life
experiences
that
have
inspired
me
to
join
the
fight
against
the
addiction
crisis
and
pursue
both
social
work
and
law
degrees,
so
that
I'm
able
to
go
on
to
make
a
better
impact
in
the
life
of
others.
Addiction
is
a
family
disease.
The
entire
family
unit
suffers
and
I
can
attest
to
that
firsthand.
I
was
parentified
over
my
mother
and
her
struggle
with
an
addiction
as
a
child,
and
I
functioned
as
one
of
her
primary
caretakers
alongside
my
grandparents,
this
continued
until
her
death.
Q
When
I
was
17
years
old,
I
have
seen
things
that
no
child
should
see.
I
have
witnessed
my
mother
overdose
repeatedly
saved
her
life.
Numerous
times
found
myself
at
the
hands
of
drug
dealers
and
countless
other
unimaginable
things,
including
being
born
addicted
to
cocaine,
which
ended
with
finding
her
dead
in
2016..
Q
Q
Looking
back,
I
can
see
that
there
were
gaps
within
the
system
exist
today
in
times
that
my
mother
did
look
for
help.
There
was
a
severe
lack
of
resources
available
to
her
whether
it
was
receiving
inadequate
treatment
from
medical
and
mental
health
professionals
being
stigmatized
and
denied
care
due
to
insurance
and
financial
reasons
or
trend
facilities
or
other
providers
being
understaffed
underprepared.
Q
This
is
the
sad
reality
right
here
in
our
own
communities.
The
creation
of
this
statewide
task
force
being
proposed
is
a
necessary
act
in
the
fight
against
this
crisis.
In
order
to
be
successful,
it
is
going
to
take
a
team
effort.
We
need
a
diverse
team
of
people
from
all
different
backgrounds
who
that's
real,
lived
experiences
with
substance
use
disorders.
Q
Q
A
H
H
F
Hello
and
thank
you,
committee,
chairwoman,
ratty
and
committee
members,
my
name
is
dr
brenda
pearson
b-r-e-n-d-a
p-e-a-r-s-o-n,
and
I
am
here
representing
the
clark
county
education,
association,
ccea
support
assembly,
bill
374,
as
amended,
and
thanks
assemblywoman
tolls
for
bringing
this
bill
forward
at
the
beginning
of
the
pandemic.
We
realized
the
stay-at-home
orders
were
going
to
open
up
the
potential
for
increased
substance
abuse.
F
However,
as
we
try
to
address
substance,
use
and
overdose
from
all
fronts,
with
our
mental
and
behavioral
professionals
wrap
around
services
and
programs
that
provide
opioid
antagonists
on
campus,
we
must
look
at
how
we
can
work
together
as
a
community
to
put
together
to
put
people
together
and
students
in
recovery
through
the
addition
of
a
representative
of
k-12.
This
work
group
will
be
able
to
address
substance
abuse
in
our
education
system.
Additionally,
we
now
have
the
opportunity
to
discuss
and
implement
best
practices
that
would
lead
to
proactive
supports
to
address
this
issue.
F
Clark,
county's
mission,
high
school,
the
first
comprehensive
secondary
school
designed
for
students
in
recovery
from
substance,
abuse,
youth
and
or
dependency,
has
brought
hope
and
support
to
students
in
need.
We
hope
that
by
adding
k-12
to
this
work
group,
we
will
be
able
to
look
at
the
successes
of
mission
high
school
and
devise
health
and
human
service
public
outreach
across
the
rest
of
the
state
that
replicate
the
program
at
the
end
of
the
day
as
educators,
we
must
do
everything
in
our
power
to
put
our
students.
H
F
H
A
A
H
H
H
H
A
A
H
M
Thank
you
chair
members
of
this
committee.
This
is
very
meaningful
legislation
for
myself
and
so
many
others,
and
I
appreciate
you
hearing
this
bill.
I
appreciate
the
support
of
the
of
the
chair
and
co-sponsoring
and
I
will
be
offering
an
amendment
as
I
noted
before,
and
since
I
will
be
offering
an
amendment.
I
also
would
like
to
just
open
up
the
invitation
that
if
anyone
else
would
like
to
join
on
as
a
co-sponsor,
I'm
always
happy
for
the
additional
support
as
well.
A
Thank
you
I'll
just
take
a
minute
and
thank
assemblywoman
tools,
as
has
happened
in
the
past.
We
both
came
into
the
session
with
intentions
to
work
on
very
similar
issues
and
pretty
quickly
got
in
a
room
and
decided
to
work
together.
So
I
appreciate
very
much
your
work
on
this
bill
and
your
support
of
my
work
on
some
other
bills
always
good
to
have
such
a
good
partner.
So
thank
you
for
that.
A
With
that
we'll
go
ahead
and
close
the
hearing
on
ab374
and
thank
you
for
your
time
and
then
we
will
open
the
hearing
on
our
last
bill
for
the
afternoon
ab278
and
invite
assemblywoman
duran
up
to
the
table
to
testify
assemblywoman.
If
you
want
to
sanitize,
there's
some
wipes
and
some
hand
sanitizer
there
and
we
can
start
whenever
you
are.
A
A
R
So
I
want
to
thank
you
for
your
time
today
and
for
allowing
me
to
present
av
assembly
bill
278,
which
requires
a
physician
to
complete
a
data
request
when
renewing
his
or
her
license
or
registration.
R
Today,
we'll
provide
background
information
from
and
bhavat
bond
director
of
public
policy
at
the
culinary
health
fund
and
mya
homes.
Health
care,
research
manager
for
the
culinary
health
fund
unite
here
will
provide
additional
background
and
the
details
of
the
bill
nationally.
Private
equity
firms
are
making
a
splash
in
health
care.
According
to
the
journal
of
the
american
medical
association,
acquisition
of
physician
practices
by
private
equity
firms
have
more
than
doubled
from
2013
to
2016..
R
However,
the
extent
that
the
firms
have
infiltrated
the
industry
has
been
difficult
to
quantify
due
to
non-disclosure
agreements
and
other
business
practices.
Private
equity
firms
have
been
at
the
center
of
the
surprise.
Billing
controversy
that
has
taken
the
industry
by
storm
congress
is
looking
at
the
billing
practices
of
physician
groups
that
are
owned
by
private
equity
firms,
which
may
behind
may
be
behind
the
bulk
balancing
billing
a
practice
which
leads
to
unexpected
excessive
medical
bills
for
patients
to
say
all
those
bees
all
together
tongue.
R
R
When
local
hospitals
merge
into
massive
health
systems,
it
can
significantly
affect
the
practices
of
private
physicians.
According
to
the
loan
institute
from
2012
to
2016,
the
number
of
hospital
acquired
physician
practices
increased
from
thirty
five
thousand
seven
hundred
to
more
than
eighty
thousand
by
twenty
eighteen.
Forty
four
percent
of
physicians
were
employed
by
hospitals
or
health
systems
nearly
doubled
in
the
rate
in
twenty
twelve
nevada,
like
other
states,
is
limited
in
understanding
how
these
changes
in
the
marketplace,
impact
patients,
public
and
private
payers
and
physicians.
A
S
All
right
go
for
it,
wonderful,
so
for
the
record
maya
holmes,
I'm
the
healthcare
research
manager
for
the
culinary
health
fund.
We
want
to
thank
assemblywoman
duran
for
bringing
this
needed
bill
forward.
We
would
also
like
to
thank
purati
vice
chair
spearman
and
the
committee
members
for
their
federation
of
important
legislation.
S
S
Nevada
ranks
48th
in
the
country
for
clinical
care,
44th
for
act,
pesky
care
and
42nd
due
to
adults,
avoiding
care
because
of
cost
nevada
ranks
47th
in
the
nation
for
quality
of
care.
Yet
little
is
known
about
specific
market
forces
that
may
impact
the
physician
shortage,
access,
affordability
and
quality,
including
basic
information
such
as
who
owns
or
has
bought
a
physician.
Practicate
ownership
of
physician
practices
has
changed
dramatically
over
the
last
decade.
The
american
medical
association
announced
in
2019
that
more
physicians
were
employed
than
independent
for
the
first
time.
S
Yet
this
is
often
national
data
based
on
periodic
surveys.
We
do
not
have
a
comprehensive
picture
of
our
state
that
demonstrates
trends
in
nevada
healthcare
market.
Some
reports
indicate
hospitals
now
employ
physicians,
who
have
been
in
private
practice
because
of
increasing
overhead
reimbursement
issues
and
the
administrative
responsibilities
of
ownership.
However,
independent
doctors
have
lower
burnout
rates.
According
to
one
study,
the
employment
status
doctors
may
also
affect
patient
access.
Another
study
found
employed
physicians,
typically
fewer
patients
than
a
day
on
average
than
private
practice.
Doctor
physician
employment
status
can
also
affect
portability.
S
Hospital
acquisitions
of
physicians,
increased
physician
prices,
an
average
of
14
30
33.5
for
cardiologists
and
12
to
20
percent
for
orthopedic
one
study.
Numerous
studies
have
shown
that
private
equity
ownership
of
physician
practices
also
leads
to
higher
price
physician.
Ownership
can
also
affect
referral
pattern.
A
stanford
study
showed
physicians,
increased
referrals
to
the
hospitals
employed
them
and
that
patients
were
more
likely
to
be
treated
in
a
high
cost.
S
Low
quality
hospital
when
they're
admitting
physicians
practice
owned
by
hospital
ab278
will
allow
policy
makers,
providers,
patients
and
payers
to
understand
critical
trends
in
nevada's
healthcare
market
and
their
impact
on
physician
volume
density
and
practice.
Ab278
adds
existing
licensing,
renewal
and
ads.
Sorry
ab278
adds
to
existing
licensing,
renewal
and
biennial
registration
requirement,
an
internet
link
to
a
form
developed
by
the
department
of
health
services
for
or
physicians
to
indicate
whether
the
physician
is
employed
or
independent
and
employed
where
the
physician
practices
and
which
entity
owns
that
practice.
S
The
board
of
medical
examiners
and
the
state
board
of
osteopathic
medicine
are
to
include
a
link
to
these
data
requests
and
applications
for
license
renewal
and
biennial
restriction.
Applicants
are
required
to
own,
but
they
are
not
subject
to
disciplinary
action
or
licensure
or
registration
refuel
refusal
for
failure
to
do
so.
Any
reporting
on
this
data
would
be
aggregated,
detect,
provider,
privacy
request
and
not
reveal
the
identity
of
the
physician.
S
The
intent
of
the
legislation
is
to
add
brief,
a
brief
data
request
to
already
required
licensing
registry
registration
reporting
step.
The
information
we
believe
will
be
known
to
the
physician.
We
do
not
think
will
add
to
administrative
burden
and
the
information
is
already
in
the
public
domain.
It's
just
not
available
in
an
aggregated,
accessible
and
meaningful
and
useful
for
policy
makers.
Providers,
patients
and
payers
and
ab278
will
provide
that.
I
would
now
like
to
turn
the
presentation
over.
T
Thank
you
am
I
I'm
muted
you're
good.
It
takes
me
a
minute.
Thank
you,
madam
chair,
and
thank
you
for
the
help
committee
and
for
the
for
the
record.
My
name
is
bobette
bond
and
I'm
the
policy
director
for
the
culinary
health
fund
and
in
addition
to
the
statistics
you
just
heard
from
assemblywoman
duran
in
my
homes,
the
journal
of
the
american
medical
association
just
last
month
came
up
with
some
data
about
what's
been
happening
with
the
cova
crisis.
T
Here's
one
more
thing,
that's
been
happening,
there's
been
more
private
equity
deals
going
on
because
of
the
crisis
they
think
and
in
2020
there
were
over
150.
Private
equity
deals
closed
just
in
the
second
half
of
the
year
and
we're
concerned
and
we're
concerned
about.
We
think
there's
a
lot
of
factors
that
go
into
quality
of
health
care
and
access
to
health
care,
and
we
know
that
nevada
is
struggling
with
this
issue
of
access
to
care
and
physician
density
and
we've
been
dramatically
impacted.
T
We
can
see
in
our
contracts
by
some
of
the
private
equity
acquisitions,
but,
as
mayas
just
said,
we
see
that
in
our
contracts,
but
we
don't
really
have
a
way
to
go.
Look
at
that
data
and
our
history
with
the
legislative
process.
The
last
you
know,
15
years
or
so
has
been
a
lot
of
health
care
transparency.
T
We
worked
a
lot
on
hospital
reporting
years
ago
and
quality
reporting
and
never
been
reporting,
and
then
in
2017
2019.
We
worked
a
lot
on
prescription
drug
reporting
and
last
session.
We
spent
a
lot
of
time
on
surprise
bills
and
some
there'd
be
some
reporting
coming
out
of
that,
but
we're
we're
still
one
of
the
states
that
has
the
least
amount
of
reporting
about.
T
What's
going
on
with
the
market
and
what's
going
on
with
pricing
and
health
care
is
just
becoming
this
never-ending.
You
know
kind
of
unfortunate
chase
to
try
to
provide
access
to
quality
while
trying
to
manage
you
know
limited
dollars,
and
I
don't
think
anyone
knows
that
better
than
the
members
of
this
committee.
T
Sometimes
I
feel
like
I'm
speaking
to
a
choir
here,
but
one
of
our
solutions
is
to
be
able
to
track
what's
going
on
and
to
see
the
impact
of
consolidation
on
pricing
in
a
way
that
we
can
monitor.
So
this
this
bill
would
provide
a
baseline
without
providing
a
lot
of
administrative
overhead
and
without
adding
a
lot
of
cost
to
the
system
by
having
the
doctors
when
they're
getting
their
license
or
renewing
their
license.
Just
provide
basic
information
about
who
they
work.
For
it's
you
know,
is
it
a
hospital?
T
Is
it
a
large
physician
group
as
those
become
larger,
or
are
you
in
a
solo
practice,
and
you
know,
what's
the
name
of
your
practice
who
owns
it,
and
you
know
how
many
are
there?
How
many
practices
are
there,
so
it
would
impact
both
the
nevada
state
board
of
medical
examiners
and
the
nevada
state
board
of
osteopathic
medicine.
T
We
realize,
if
someone's
first
being
licensed,
they
may
not
even
know
how
many
people
work
in
their
office,
so
they
may
not
even
know
how
many
doctors
are
in
their
practice
and
then
they'll
just
have
to
leave
that
space
blank
originally.
I
know
some
of
you
know
this,
and
I
know
that
senator
hardy
has
been
really
involved
in
this.
As
have
you
chairwoman
to
we
originally
intended
to
add
this
information
to
the
state
board
application
itself,
and
then
we
could
just
have
added
it
in.
T
You
know
two
fields,
but
when
we
talked
about
it
in
our
last
hearing
in
the
assembly
side,
the
medical
board
proposed
an
amendment
to
kind
of
match,
what's
already
going
on
with
sp
379
and
sp
379,
which
I'm
sure
you
can
come
on
comment
on
better
than
me
would
allow.
The
information
from
that
survey
is
going
to
be
provided
in
a
link
that
the
board
has
on
their
application
process,
and
then
the
physicians
fill
that
link
out
and
it's
a
survey,
that's
gonna.
Apparently,
and
you
should
you
should
actually
amplify
what
I'm
saying
or
correct.
T
It
is
intended
to
provide
some
really
critical
information
in
the
state
about
what's
going
on
with
our
doctor
density
and
and
in
a
way
that
doctors
will
we'll
be
able
to
see
patterns
better
there
too,
this
is
more
demographic
data.
It's
not
a
survey
that
we
wanted
to
have
be
you
know?
Yes,
no,
I
don't
know
or
refuse
to
answer
we
want.
We
just
want
this
democratic.
This
demographic
field
filled
as
maya
said,
there's
no
penalties.
If
they
don't
do
it,
but
we're
hoping
people
will
start
to
fill
it
out.
T
Importantly,
I
think
dhhs
will
have
a
role
in
this
in
making
both
of
these
bills
merge
together,
and
my
understanding
from
talking
to
dhhs
is
that's,
that's
something
they
can
do
and
that's
in
response
to
concerns
by
senator
hardy,
about
not
wanting
to
have
two
different
surveys
coming
out
of
the
board
work,
and
I
agree
so
this
was
a
way
to
do
that.
So
that's
basically
what
we're
trying
to
do.
It's
a
pretty
simple
bill
and
I'm
happy
to
answer
questions.
A
All
right
any
final
comments.
Before
we
go
to
questions
assembly,
woman,
okay,
all
right
questions
from
the
board:
there
are
a
couple
references
to
sb
379.
We
did
not
hear
that
bill
in
this
committee
because
it
went
through
commerce
correctly
correct.
A
However,
it
came
out
of
the
interim
committee
on
health
care
and
both
senator
hardy,
and
I
were
significantly
involved
in
that
effort
and
I
will
say
that
we
have
checked
in
with
our
legal
counsel
to
make
sure
that
there
was
no
conflict
between
the
two
bills.
That
would
need
to
be
remedied
and
we
have
checked
in
with
dhhs
who,
I
believe
is
on
the
line.
A
We
should
probably
just
confirm
with
dhhs
that
they
believe
that
they
can
simultaneously
implement
the
intent
of
both
bills
in
an
efficient
way.
So
is
there
anybody
from
department
of
health
and
human
services
on
miss
chapel
who
I've
known
for
probably
20
years,
miss
chapel?
Would
you
like
to
comment.
T
Good
evening,
good
evening,
chair
ready
yeah
it's
getting
late
and
it's
been
a
long
week
already
so
anyway,
yes,
smargo
chapel
for.
G
A
G
A
A
A
H
A
A
A
R
A
A
A
All
right,
sorry
about
that,
so
on
tuesday
may
11th
we
will
be
hearing
sb,
424,
sb,
438
and
ab343.
So
that
is
our
plan.
I
also
plan
to
have
a
pretty
significant
work
session
on
that
day.
So
members,
if
you
could,
let
me
know
if
you're
not
going
to
be
at
the
front
end
of
the
committee
meeting,
we'll
try
to
get
it
out
of
the
way
on
the
front
end,
but
we'll
of
course,
work
around
folk
schedules.
If
we
need
to
with
that,
I
will
open
up
for
public
comment.