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From YouTube: 3/9/2021 - Senate Committee on Health and Human Services
Description
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
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A
Thanks
so
much
and
just
for
everybody
on
the
zoom,
if
you
are
not
I'm
a
committee
member
or
presenting
the
bills
at
this
time,
you
don't
need
to
keep
your
cameras
on
well,
you
can.
You
can
turn
it
on
when
it's
your
time
so
hello,
everyone,
I'd
like
to
go
ahead
and
call
to
order
the
tuesday
march
9th
meeting
of
the
senate
committee
on
health
and
human
services
we'll
go
ahead
and
just
do
a
verbal
roll
call.
A
I
see
that
senators
harris
kikefer
and
hardy
are
here
and
it
looks
like
we
are
still
waiting
for
senator
spearman.
Please
mark
her
present
when
she
arrives.
I
wanted
to
just
do
the
brief
introduction.
I
know
folks
are
figuring
it
out,
but
let's
just
make
sure
so.
There
are
many
ways
that
you
can
participate
with
us
here
in
the
legislative
session,
and
that
includes
sending
in
written
testimony
using
our
opinion
poll
on
our
website
registering
and
signing
up
to
testify
sending
emails
to
your
your
senator
or
the
members
of
the
committee.
A
I
encourage
you
to
do
all
that
if
you
are
having
any
challenges
figuring
out,
how
to
do
that.
If
you,
google,
the
nevada
legislature
and
get
onto
our
website,
there's
a
help
bar
and
if
you
go
on
that
help
bar
it'll
help
you
to
figure
it
out
and
if
that's
not
working
on
our
agenda
is
an
email
address
and
you
can
send
an
email
to
the
committee
manager
and
she'd
be
happy
to
help
you
out
as
well.
A
Today,
just
wanted
to
talk
about
what
we're
going
to
do.
We're
going
to
be
hearing
two
bills:
sp5
and
sb40.
Both
of
these
bills
are
presented
by
the
patient
protection
commission.
A
There
has
been
a
lot
of
interest
in
these
bills,
and
so
just
by
way
of
process,
we
do
have
the
bill
presenter
with
us
on
the
zoom,
and
then
we
also
have
folks
who
are
interested
in
presenting
an
amendment
we'll
allow
the
bill
president,
the
executive
director
of
the
patient
protection
commission
to
make
her
bill
presentation
with
the
length
of
time
that
it
takes
for
those
who
are
proposing
amendments
we'll
do
that
under
support
opposition
or
neutral.
A
So
you'll
need
to
pick
your
lane
and
then
we
will
give
you
three
minutes
to
present
the
contents
of
the
amendments.
But
we
have
you
on
the
zoom
call
here,
so
that
if
members
have
questions
that
there's
an
opportunity
for
them
to
answer
those
questions,
once
we
move
through
the
folks
who
are
on
the
zoom
call,
we
will
then
also
go
to
the
phone
lines
to
also
do
support
opposition
and
neutral.
So
I
just
want
everybody
to
anticipate
the
process
there.
A
We'll
do
all
the
support
at
once
I'll
be
opposition
at
once
and
all
the
neutral
at
once,
regardless
of
which
format
folks
are.
In
with
that.
I
think
we
are
ready
to
go
ahead
and
open
up
the
hearing
on
senate
bill.
Five,
miss
kulhagian
whenever
you're.
B
B
I
think
I
have
to
meet
myself.
Thank
you
so
much
chair,
ratty
members
of
the
committee.
My
name
is
sarah
scholhagen
for
the
record.
I
serve
as
the
executive
director
for
nevada's
patient
protection
commission.
First,
let
me
just
say
thank
you
so
much
for
giving
me
the
opportunity
to
come
before
you
to
present
these
two
measures
and
to
show
you
all
the
work
that
the
commission
put
in
to
these
requests.
B
So
I
think
that
what
I'd
like
to
do
chair,
ratty,
is
kind
of
give
a
high
level
overview
of
the
commission,
talk
about
their
work
and
and
start
by
also
talking
about
the
process
and
how
these
measures
came.
B
About
so
the
nevada
patient
protection
commission
was
created
by
senate
bill
544
last
legislative
session.
It
was
a
measure
sponsored
by
governor
sislek
and
received
unanimous
bipartisan
support.
In
its
passage,
the
commission
is
comprised
of
a
multi-faceted
team
of
healthcare
experts
advocates
and
providers
and
industries
charged
with
systematically
reviewing
issues
related
to
the
healthcare
needs
of
nevada
residents
to
the
quality,
accessibility
and
affordability
of
health
care.
In
addition,
the
the
commission
is
charged
with
making
informed
recommendations
to
the
governor
designed
to
improve
health
care
for
all
nevadans.
B
B
What
I'd
like
to
do
is
just
tell
you
a
little
bit
about
the
commission's
work,
and
so
the
commission
held
its
first
meeting
last
year
on
february
3rd
and
met
one
more
time
on
march,
2nd
before
governor
sissel
act
made
a
declaration
of
emergency
in
the
state
of
nevada
to
address,
contain
and
mitigate
the
effects
of
coba
19..
B
Several
meetings
were
postponed
as
the
commission
followed
his
directives
and
guidelines
for
hosting
public
meetings
on
may
19th.
He
requested
for
this
commission
prioritize
its
work
to
best
serve
nevada
in
this
time
of
state
and
national
emergency,
specifically
asking
for
the
assistance
with
recommendations
around
the
long-term
recovery
for
our
state.
B
B
So
the
approved
working
document
is
what
outlines
this
commission's
request,
and
so
the
bill
seeks
to
enact
legislation
to
codify
telehealth
flexibilities
granted
during
the
coven
19
public
health
emergency.
Specifically,
it
is
aimed
to
increase
patient
access
to
high
quality
care,
while
reducing
costs
and
improving
patient
and
provider
safety
through
the
inclusion
of
clear,
effective
and
sustainable
telehealth
medicine
in
our
nevada,
revised
statutes.
B
That
is
a
long
way
for
me
to
say
that
really
the
commission
had
a
lot
of
discussion
and
deliberation
and
saw
that
patients
were
kind
of
told
to
stay
home
and
during
the
pandemic,
and
they
saw
an
increase
of
access
to
health
care
was
increased
by
the
utilization
of
telehealth
services.
So
the
commission
saw
a
great
deal
of
value
in
improving
access
and
as
a
new
way
forward,
felt
that,
having
this
measure
in
front
of
you
was
a
part
of
that
long-term
recovery
for
our
state
to
improve
access
to
patient
care.
B
Further
this
piece
it
requires
that
the
state
use
and
evaluate
to
the
dashboard
to
make
access
more
equitable,
and
it
also
requires
not
only
the
commission
but
the
commission,
the
patient
protection
commission,
the
commission
on
behavioral
health,
the
five
regional
policy
boards
and
the
legislative
committee
on
health
care
to
include
this
data
dashboard
in
their
review
of
their
duties
and
I'm
actually
available
for
any
questions.
A
C
B
Thank
you
for
the
question
senator
keither,
chair
ratty
through
you
to
senator
keith
keffer.
I
I
believe
it
does
that
that
is
the
modality.
That
is,
it
just
means
standard
telephone,
but
I
would
like
to
kind
of
push
that
off
to
somebody
who
may
know
that
better
than
me
and
I've
got
dwayne
on
the
line,
and
he
may
be
able
to
answer
that
to
you.
Your
question
specifically.
D
Good
afternoon
committee
dwayne
young,
deputy
administrator
for
the
division
of
healthcare
financing
and
policy
for
the
record.
This
language
is
existing
in
standard
nrs
and
it
does
reply
to
what
we
would
consider
both
a
landline
and
cellular
device.
C
I
know
I
highlighted
the
definition
somewhere
term
includes.
C
I
can't
find
it
so
is
the
is
the
provision
of
telehealth.
The
provision
of
telehealth
will
include
services
provided
through
a
standard
telephone,
but
they
can
be
billed
differently.
Is
that
am
I
reading
that
correctly?.
D
Dwayne,
young
deputy
administrator
for
the
division,
healthcare,
financing
and
policy.
Yes,
currently
telephone
is
restricted
by
the
federal
government
because
it
is
a
non-hipaa
compliant
platform
and
that
federal
cfr
is
actually
governed
by
the
office
of
civil
rights
within
the
department
of
justice.
D
Existing
language
in
422
says
to
the
extent
applicable,
that
is
on
page
seven
section
under
section
21
line
14,
and
so
we
believe
that
that
gives
this
bill
the
authority
to
allow
telephone
if
it
were
to
be
allowed
by
the
federal
government
to
the
extent
applicable,
but
then
also
does
set
up
that
the
division,
except
for
services
provided
using
standard
telephone.
D
The
same
amount
has
the
discrepancy
to
not
pay
parity
chapter
422
requires
parity
for
in-person
services
and
telehealth,
so
this
would
allow
us
to
set
up
a
separate
modifier
for
telephone
delivered
services
and
we
could
pay
them
at
us
at
a
different
rate
than
what
we
have
paid.
Traditional
telehealth
or
in-person
visits
and
part
of
this
language.
D
Mr
hagie
and
I
both
serve
as
part
of
the
western
states
compact
for
the
governor's
office,
and
this
is
something
that
other
states
have
done
so
that
when
they
do
face
a
budget
shortfall
or
crisis,
they
don't
have
to
cut
rates
across
the
board.
But
they
can
set
up
a
discrepancy
and
payment
from
those
services
delivered
via
telephone
versus
those
by
telephone.
D
Only
particularly
when
they're
dealing
with
providers
who
are
cost
based
reimbursed
and
the
the
challenges
of
buying
telehealth
equipment
or
setting
up
shop
for
in-person
visits
are
taken
into
consideration
and
building
those
rates,
as
opposed
to
operating
in
simple
telephone
calls.
A
And
let
me
just
interrupt
here
for
miss
calhagan
for
the
remainder
of
today's
meeting.
You
can
go
direct
to
the
senator
okay
great.
Thank
you.
B
C
Thank
you
so,
with.
C
D
Telehealth
dwayne
young
deputy
administrator
for
the
record
again,
thank
you
for
the
question,
and
that
is
the
modality,
and
so
if
this
is
a
standard
telehealth
visit,
there
are
audio
visual
requirements.
If
it
is
telephone,
there
is
a
certain
audio
requirement.
There
are
apps
that
utilize,
remote
patient
monitoring
codes.
Those
are
different,
cpt
codes
that
are
billed
usually
in
conjunction
with
another
visit
nevada
does
not
currently
cover
those
codes,
and
so
usually
working
through
an
app
through
a
health.
D
App
is
not
part
of
the
reimbursed
process
in
working
with
a
physician
currently.
C
Because,
while
we're
on
the
definition-
and
I
know
that
we'll
get
it
presented
later,
there's
some
discussion
about
the
the
types
of
types
of
definitions
that
are
allowed-
I
think
it
was
the
the
definition
being
provided
by
synchronous
or
asynchronous
technology.
C
D
Again,
dwayne
young
deputy
administrator
for
the
record.
Yes,
it
is
our
belief
that
is
covered
under
422,
our
section
that
governs
nevada,
medicaid,
okay,.
A
E
Thank
you,
chair
ratty.
I
had
a
question
about
who
would
be
able
to
access
this
kind
of
all-payer
system.
Is
the
information
kind
of
aggregate
and
not
anonymized?
You
know
who
who's
got
the
ability
to
kind
of
pull
information
from
that
output,
so.
A
Senator
harris,
I
believe
that
there
might
be
some
confusion,
because
both
bills
have
a
data
collection
component,
but
the
claims
database
is
actually
senate
bill
40,
as
opposed
to
senate
bill
5,
and
I
completely
understand
why
you
may
be
confused
by
that
because
I
was
earlier,
but
this
bill
does
have
some
data
collection
components
so
miss
kolhagen.
Could
you
talk
about
the
data
collection
components
in
this
bill?
Sure
thank.
B
You
senator
ready
yes,
so
so
this
is
not
a
data
collection
bill
that
mirrors
what
the
senate
bill
40
does.
This
is
a
data
collection
bill.
That's
really
puts
the
burden
on
the
state
to
utilize
existing
resources,
so
the
data
collection
efforts
are
all
done
within
the
state
and
there's
no
burden
on
any
of
the
payers
or
insurers
to
submit
any
data
for
the
dashboard,
so
they
intended
for
the
state
to
utilize
existing
information
to
create
the
dashboard.
B
I
think
the
idea
behind
it
was
you
can't
improve
what
you
can't
measure,
and
so,
when
you
look
at
health
equity
and
wanting
to
make
sure
that
you
address
equitable
access
for
patients
in
our
state,
you
wanted
to
have
some
sort
of
measurement
of
that,
and
so
this
creation
of
the
data
data
dashboard
is
the
first
step
to
measure
telehealth
access
to
address
equitable
access
and
to
start
looking
at
a
vulnerable
population.
E
And
so
am
I
understanding
you
correct
that
only
whomever,
I
guess
is
the
administrator
of
this
would
have
access
to
the
data
itself
and
the
rest
would
just
kind
of
be
publicly
available
in
the
dashboard.
B
So
if
you're
familiar
with
some
of
the
amazing
data
dashboards
that
the
state
has
produced
related
to
covid19,
it's
very
similar
to
that
so
they're
going
to
create
a
data
dashboard
that
will
be
housed
on
their
site,
as
well
as
the
patient
protection
commission.
So
all
the
consumers
can
see
and
access
that
data.
B
However,
it
is
created
by
the
department
of
health
and
human
services
and
then
so
there's
no
data
release
or
request
for
it,
because
it's
it's
about
a
data,
dashboard
creation.
E
And
chair
ready,
if
I
may
just
want
additional
follow-up.
Thank
you.
So
I
is
it
going
to
be
the
department
of
health
and
human
services
that
will
put
into
place
all
of
the
protections
around
that
data
right.
So
when
you,
when
you
get
personalized
data,
you
wanna,
you
wanna,
see:
okay!
Well,
we've
got
a
five
year
limit
or
you
know
all
of
these
kind
of
protections
in
place
about
how
it's
allowed
to
be
used
and
who
can
control
it.
So
is
that
where
we're
going
to
see
that.
A
Senator
harris
I'm
going
to
jump
in
here
on
this
one,
so
this
bill
doesn't
contemplate
any
new
data
collection,
so
it
only
uses
the
data
that
the
state
already
has
so,
for
example,
medicaid
medicaid
claims
that
are
covered
by
hipaa
and
all
the
rules
for
medicaid
or
the
number
of
individuals
who
are
receiving
respite
care
or
like.
But
it's
only
the
data
that
the
state
already
owns.
A
What
it
asks
is
that,
when
we're
sharing
that
data
that
we
do
it
in
a
dashboard
that
makes
that
data
understandable
to
the
general
public
and
all
of
us,
so
it
is
less
about
new
data,
so
whatever
protections
are
currently
in
place
for
that
data
still
stands,
and
this
bill
doesn't
do
anything
about
that.
The
next
bill
again
lots
of
questions
about
that
data,
because
it's
a
new
new
data,
but
this
bill
is
really
just
about
taking
the
data
that
we
currently
have.
A
E
It
does
yes,
I
just
you
know
I
worry
a
bit
about.
You,
know:
consumer
protection
and
anytime,
you
centralize
a
bunch
of
data,
even
if
you
already
have
access
to
it.
You
know
there's
some
some
questions,
but
that
that
makes
sense.
Thank
you.
A
B
You
senator
ratty.
I
believe
that
that
is
accurate
and
later
on
in
the
bill
hearing
under
testimony.
There
is
a
amendment
from
dpbh
that
addresses
some
of
the
data
dashboard
kind
of
creation,
mostly
related
to
the
fiscal
note,
but
kyrah
morgan
is
available
to
answer
questions
and
she
could
speak
to
that
better
than
I
can.
But
you
are
correct
in
my
understanding.
A
F
Kyra
morgan
for
the
record,
I'm
the
state
biostatistician
for
the
department
of
health
and
human
services
and
that's
absolutely
correct
all
of
the
data
that
would
be
presented
in
the
data
dashboard
and
our
amendment
will
speak
more
to
this
in
public
comment.
But
all
the
data
that
we
would
present
would
be
aggregate.
There
would
not
be
anything
to
identify
a
person
on
an
individual
level.
E
No,
that's!
Okay.
I
have
faith
that
you
know
our
department
is
handling
people's
health
information
appropriately,
so
no
issues.
Thank
you.
Thank.
G
G
Allow
the
user,
you
know,
which
is
apparently
quote
different
groups
and
populations,
the
analysis
of
telehealth
by
different
groups
and
populations
and
then
use
that
for
ethnicity,
ancestry,
national
origin,
color,
sex
sexual.
Do
we
actually
have
that
for
individual
people
that
then
can
be
disaggregated
or
or
I'm
not
sure
how
you
did
that
and
then
how
you
use
it?
I
guess
I
it's
too
basic
of
a
question.
F
A
F
F
Really
applicable
to
the
amendment
that
we
submitted
from
the
which
really
just
adds
language
around
the
dashboard
being
contingent
on
what
data
is
actually
available
and
within
federal
regulation
for
us
to
collect
and
present,
and
some
of
that
is
not
going
to
be
data-
that's
available
right
now,
and
so
it's
likely
that
the
dashboard
will
be
a
subset
of.
What's.
Actually,
I
think
that
the
big
goal
from
the
patient
protection
commission,
but
we'll
be
able
to
include
at
an
aggregate
level
as
much
information
as.
G
A
B
Thank
you
so
much
for
the
question
senator
hardy,
so
the
intent
of
the
data
dashboard
is
really
to
be
the
first
step
to
measure
telehealth
access
and
to
address
equitable
access
and
look
into
vulnerable
populations.
So
it
requires
the
department
to
include
in
their
evaluation
of
telehealth
services
that
data
dashboard.
So
it's
required
to
part
one
that
the
department
of
health
and
human
services
must
create
it
and
then
two
they
must
utilize
it
in
their
decision-making
process.
In
addition
to
that,
it
also
ties
in
the
other
advisory
boards
in
the
state.
B
Patient
protection
commission
included
commission
on
behavioral
health,
the
five
regional
behavioral
health
policy
boards,
as
well
as
a
legislative
committee
on
health
care,
to
also
review
the
data
dashboard
and
include
that
in
their
review
of
their
own
policy.
So
it's
again
looking
at
the
long-term
recovery
and
really
aiming
at
addressing
health
equity.
B
A
B
Thank
you
for
the
question
senator
hardy
sarah
shalhagian
for
the
record.
I
don't
know
specifically,
but
I
think
that
and
dwayne
may
be
able
to
help
me,
but
I
believe
the
state
of
colorado
is
doing
this
and
that
they
have
built
a
equitable
dashboard.
That
kind
of
is
in
the
same
thought
process
as
what
the
commission's
intent
was.
B
But
I
found
that
out
after
the
fact-
and
so
I
believe
colorado
is
doing
it,
but
I'm
not
aware
of
any
other
state
that
is
doing
it
and
dwayne
might
be
able
to
speak
to
that
too,
because,
as
he
mentioned
earlier,
we're
a
part
of
this
telehealth
subcommittee
together.
And
I
that's
a
multi-state
collaborative.
D
Wing
young
deputy
administrator
for
medicaid
for
the
record.
Yes,
as
michelle
against
pointed
out
colorado,
has
done
this.
I
don't
think
that
that
particularly
influenced
the
decision
of
the
patient
protection
commission,
but
there
are
other
states
within
those
western
states,
compacts
such
as
california,
that
are
looking
at
this
as
well
as
far
as
having
the
data
for
telehealth
to
medicaid
policy.
D
I
think
it's
very
important
to
have
this
data
senator
harding,
your
district,
as
you
know,
has
heavily
relied
on
telehealth
and
some
of
the
more
rural
parts,
the
same
as
they
have
in
senator
harris's
district
and
some
of
the
more
urban
areas
where
we
know
they
don't
necessarily
have
the
infrastructure
and
had
a
difficult
transition
in
the
pandemic,
and
so
really
having
this
types
of
data
and
knowing
how
the
services
would
deliver
will
help
us
to
figure
out
how
to
more
equitably
address
grants
when
they
are
available.
D
As
the
department
has
given
out
telehealth
grants
in
the
past,
and
also
how
to
better
support
providers
who
have
not
made
that
transition
are
having
difficulty
making
that
transition.
A
But
I'm
going
to
give
senator
spearman
a
shot,
but
before
she
jumps
in,
I
just
want
to
clarify
something
that
you
just
said:
deputy
director
young.
So
as
an
example.
Here
we
may
not
know
the
race,
gender
ethnicity,
of
an
individual
patient,
but
we
may
be
able
to
see
utilization
patterns
within,
say
the
medicaid
telehealth
utilization.
A
H
Spearman,
thank
you,
madam
chair.
Most
of
my
questions
were
already
answered,
but
so
the
date
that
you're
collecting
they're
about,
I
think
the
last
four
categories
there
would
be
soji
sexual
orientation,
gender
identity.
You
all
have
the
ability
to
share
that
information
so
that
it's
not
just
one
particular.
H
Portion
of
health
care,
and
then
we
don't
have
the
information
for
another
and
obviously
with
with
the
information
the
personal
information
redacted.
Once
you
collect
that,
do
you
have
the
ability
to
share
that
with
other
internal
agencies
or
not.
B
Thank
you
for
the
question.
Senator
spearman.
The
intent
is
to
share
the
information.
The
intent
is
to
have
it
housed
on
the
dhh
website,
as
well
as
the
patient
protection
commission's
website
and
for
those
other
public
bodies
that
I
referenced
earlier
to
review
the
dashboard.
So
I
think
kaira
could
speak
to
maybe
more
specificity
on.
If
I'm
not
answering
your
question,
but
I
think
that
I'm
sorry,
I'm
not
sure.
H
Right
and
policy
will
be
directed
based
upon
that,
for
example,
if
you're
looking
at
one
particular
demographic
and
that's
been
hit
hardest
with
covet,
you
will
direct
resources
to
that
community
so
that
the
underlying
morbidities
would
be
addressed
when
the
other
pandemic
comes
because
we
know
it's
not
a
if
it's
a
win,
the
other
endemic
comes
and
be
and
be
able
to
do
some
things
in
terms
of
education,
not
just
education
for
prevention,
but
not
just
addressing
those
comorbidities.
So
thank
you.
It's
been
helpful.
A
C
Hey
man,
I'm
sure
a
lot
of
my
questions
were
asked
and
answered.
I
appreciate
it
on
the
data
analysis
and
the
policy
recommendations.
You're
specifically
asking
for
eight
different
boards
to
provide
policy
advice
to
you.
B
Thank
you
so
much
senator
ki
kever,
sarah
scholhagen
for
the
record.
The
intent
is
just
to
have
them
included
in
in
their
review
process,
whether
they
make
it
a
priority
is
going
to
be
at
the
discretion
of
each
public
body.
It's
just
making
it
known
that
that
we
intend
for
the
data
dashboard
to
be
created
and
to
be
reviewed,
and
so
what
level
of
priority
those
bodies
choose
to
utilize.
The
dashboard
is
going
to
be
at
their
discretion.
C
Thank
you
for
that.
My
follow-up
question
on
the
telehealth
issue
was
related
to
behavioral
health
parity
and
whether
they're
this
this
creates
a
disparity
for
behavioral
health
services
in
terms
of
reimbursement.
B
C
So
right,
so
if
the
so
behavioral
health
services
might
be
able,
maybe
fully
adequately
provided
over
a
telephonic
means.
C
Right
and
up
to
the
physician
to
do
that,
but
then
we
are
reducing
reimbursement
for
a
service
that
may
be
fully
appropriate
for
a
telephonic
service.
Sure.
Thank
you.
We
have
our
ongoing
requirement
for
behavioral
health,
parity,
okay,.
B
Senator
key
kepper,
sarah
schulhagen
for
the
record,
so
I
think
the
intent
of
the
commission's
bill
draft
really
was
allowing
for
increased
access
through
payment
parity
on
the
insurer
side
or
all
payer
parity,
but
recognizing
that
the
use
of
a
standard
telephone
may
not
warrant
the
same
type
of
payment,
parity
or
standard
of
care,
and
so
the
commission
did
not
want
to
restrict
the
use
of
a
standard
telephone
or
telephonic,
but
but
also
recognize
that
it
may
not
be
a
they
don't
want
to
change
the
standard
of
care
in
the
sense
that
saying
that
it's
the
same
as
in
person
service
did.
C
Was
I
I
guess
just
just
to
flesh
out
a
little
bit
it
was?
Was
there
discussion
had
about
whether
that
was
an
appropriate
decision
for
mental
health
services
as
well
as
physical
healthcare.
B
A
Second
round
for
anybody
else,
senator
spearman,
you
still
have
your
virtual
hand
up,
but
I'm
not
sure
if
that's
a
leftover
from
the
last
round,
okay,
all
right!
So
then
I
will
ask-
and
this
might
be
more
for
deputy
director
young,
but
my
understanding
is
there's
movement
at
the
national
level
that
we're
in
a
little
bit
of
an
uncertain
time
right
now
in
terms
of
reimbursement
for
telephone
only
or
voice
only
versus
a
full,
true
telehealth
solution
and
we're
kind
of
waiting
to
see
how
that
landscape
works.
A
So
I
I
think
if
we
were
to
say
we
wanted
telephone
to
be
fully
within
parity
right
now.
We
would
be
also
saying
that
the
state
would
have
to
pay
100
of
that,
because
it's
not
currently
a
medicaid
reimbursement,
but
that
we're
anticipating
or
waiting
to
find
out.
If
the
federal
government
moves
on
that-
and
so
I
think
I
heard
you
say
earlier-
that
the
bill
is
written
in
such
a
way
that
if
there
is
movement
then
we
could
benefit
from
that
and
therefore
nevadans
could
benefit
from
that.
D
Certainly,
thank
you
senator
gerardi
for
the
question
again
for
the
record
dwayne
young,
deputy
administrator
for
nevada,
medicaid,
and
so
I
believe,
I'll
take
the
first
piece
of
that
that
question,
which
was
yes.
There
are
conversations
at
the
federal
level.
D
As
I
stated
earlier,
this
is
a
cfr
that
is
governed
by
the
office
of
civil
rights
under
hipaa,
which
is
then
under
the
department
of
justice
when,
during
the
pandemic
and
during
the
declaration
of
the
public
health
emergency,
the
office
of
civil
rights
made
non-hip
and
client
compliant
platforms,
which
include
telephone,
they
decided
not
to
enforce
the
prohibition
on
those
and
so
cms,
then
provided
a
directive
that
this
could
be
reimbursed
and
utilized.
D
The
state
then
covered
it
in
its
1135
waiver,
so
we
are
currently
reimbursing
for
telephone
services,
with
certain
exceptions
back
to
the
language
of
the
chapter.
We
believe
that
if
the
federal
government
were
to
take
movement
on
this,
the
language
that
was
existing
within
this
law
that
was
not
modified.
D
That
says,
to
the
extent
applicable
applies
to
us
being
able
to
get
actual
reimbursement
or
match,
and
so
we
have
interpreted
that
as
our
ability
that
if
the
federal
government
were
to
allow
this
and
we
were
to
get
matched,
then
we
would
certainly
continue
those
flexibilities.
D
We
also
see
that
this
not
changing
that
language
also
gives
us
the
discretion,
as
we
have
used
during
the
pandemic
through
our
covet
memos,
to
provide
further
guidance
about
services
that
weren't
traditionally
allowed
for
telehealth
and
services
that
are
were
traditionally
allowed
for
telehealth,
but
not
certainly
not
appropriate
for
telephone,
and
we
have
done
that
with
some
rehabilitative
mental
health
services,
as
well
as
some
health
services
on
the
medical
side
as
well,
and
provided
those
guidances
on
our
website
and
and
announcements
out
to
providers.
D
And
so
we
don't
see
this
bill
as
changing
anything
under
our
operations,
but
really
allowing
for
that
enhancement
and
allowing
for
us
to
take
advantage.
Should
the
federal
government
move
on
this
in
a
different
way
to
then
craft
some
parameters
in
permanent
policy
around
the
reimbursement
for
telephone
services,
if
reimbursed
by
the
federal
government.
A
A
Okay,
so
we're
going
to
go
ahead
and
start
with
those
who
would
like
to
testify
in
support,
and
so
is
there
anybody
on
the
line
who
would
like
to
testify
in
support
of
sb5,
and
this
is
within
the
zoom-
that's
in
the
support,
but
has
an
amendment
so
I'm
just
unclear
dhhs
american
telemedicine,
medicine,
association
and
teledoc,
if
you're
here
to
testify
in
support
of
the
bill
generally
and
then
just
to
suggest
the
amendment.
So
I
see
some
nodding.
F
A
J
Good
afternoon,
madam
chair
members
of
the
committee,
my
name
is
claudia
doug
tucker,
I'm
senior
vice
president
of
government
affairs
and
public
policy
at
teledoc
health.
I've
testified
before
this
body
before
so
I
will
forego
the
definition
of
teledac
and
what
we
do
and
jump
right
into
the
meat
of
the
matter.
Here.
We
support
this
bill.
We,
while
we
were
not
engaged
with
the
work
of
the
patient
protection
commission.
J
Quite
frankly,
I
was
unaware
of
it,
but
we
have
met
virtually
on
the
phone
with
miss
kohigian
and
really
appreciate
the
work
that
she
has
done.
We
support
the
their
mission
to
enact
legislation
that
codifies
the
telehealth
flexibilities
that
were
granted
during
covet
19
during
the
public
health
emergency
thing
number
two
done
properly.
J
Lastly,
we
encourage
language
that
will
allow
for
expanded
access
to
expert
medical
second
opinion
services,
the
best
specialists
in
the
country
without
incurring
the
cost
and
inconvenience
of
travel.
We
support
the
work
that
the
legislature
is
doing
to
help
increase
access
to
telehealth
treatment,
the
ability
to
use
a
telephone
to
expand
the
reach
of
mental
health
services
to
those
who
need
it
is
critical.
The
health
care
provider
shortage
is
real.
However,
in
rural
areas,
getting
an
in-person
appointment
with
a
mental
health
provider
is
nearly
impossible.
J
A
A
K
K
I
I
don't
interpret
that
and
to
mean
that
you
have
to
have
both
or
it's
not
telehealth
I
mean
it
can
be.
It
can
be
either
one
and
the
and
was
just
meant
to
say
that
the
definition
of
telehealth
includes
both
of
those
things.
So
I
think
that
the
the
store
and
forward
technology
is,
I
think
that
it
falls
within
that
definition.
K
The
second
thing
I
will
say
is
that
nrs
629.515
does
not
authorize
or
prohibit
anyone
from
engaging
in
any
activity
depending
on
whether
it's
telehealth
or
not
like
it
doesn't
say
that
if
it's
not
telehealth,
you
can't
do
it,
and
it
doesn't
say
that
if
it
is
telehealth
that
you
can
do
it
all
it
says
is
that
if
you're
going
to
use
telehealth
for
the
purposes
prescribed
in
subsection
one,
you
have
to
be
licensed
in
this
state
and
the
boards
are
allowed
to
to
regulate
beyond
that.
K
And
so
basically,
as
I
said,
it's
not
that
particular
statute
and
that
particular
definition
is
not
about
what
people
are
allowed
to
do
or
or
not
allowed
to
do
with.
The
one
exception
is
that
if
you
are
doing
the
things
described
in
subsection
one
through
telehealth,
you
have
to
have
a
license
and
that
that's
the
extent
of
it.
B
Thank
you
karate.
Actually,
if
you
don't
mind,
I
have
our
attorney
mr
greg
ott
on
the
line
who
helped
me
review
this
and
looked
at
the
clarification
of
their
intent
and
if
I
can
direct
to
him
for
his
analysis,.
I
L
Deputy
attorney
general
gregor,
I
would
be
brief
chair.
I
don't
have
very
much
to
add
to
what
mr
robin
said.
I
was
actually
agreeing
and
nodding
with
my
camera
off,
so
I
think
he
had
it
did
a
very
good
job.
I
came
to
the
same
position
when
I
looked
at
the
statue.
A
A
M
Thank
you
so
much
chair
and
thank
you
so
much
to
the
committee.
My
name
is
kyle
zebly
and
I'm
representing
the
american
telemedicine
association.
Thank
you
for
the
opportunity
to
testify
before
you
today.
We
applaud
the
work
done
by
legislature
for
their
efforts
to
craft
common
self,
the
common
sense,
telehealth
policy
on
behalf
of
the
ata
and
the
over
400
organizations
we
represent.
I
am
testifying
in
support
of
senate
bill
5
and
to
offer
additional
amendments
to
further
expand,
nevadan's,
easy
and
efficient
access
to
affordable
quality
health
care.
M
M
State
legislatures
should
not
discriminate
against
certain
technologies
so
long
as
the
licensed
practitioner
determines
in
his
or
her
professional
opinion
that
the
technologies
used
in
the
delivery
of
telehealth
services
are
sufficient
to
diagnose
and
or
treat
the
condition
presented
by
the
patient.
Additionally,
the
ata
recommends
supporting
teledoc's
amendment
just
mentioned.
That
would
include
language
that
would
allow
a
physician-patient
relationship
to
be
established
via
the
use
of
telehealth
technologies.
M
If
such
a
relationship
does
not
already
exist,
the
18
ata
maintains
that
so
long
as
the
patient
has
consented
to
the
use
of
telehealth,
it
is
an
accepted,
acceptable
mode
of
delivering
healthcare
services
and
the
patient
and
practitioner
have
identified
themselves
and
disclosed
the
appropriate
credentials.
A
practitioner
and
patient
should
not
be
prevented
from
establishing
a
professional
relationship
through
the
appropriate
technologies
that
meet
the
standards
of
care
for
licensees,
having
codified
permission
to
establish
physician-patient
relationships
via
telehealth
would
make
practitioners
more
comfortable
doing
so.
M
Lastly,
I'm
proclaiming
the
of
course
support
for
allowing
peer-to-peer
consultations
via
telehealth
peer-to-peer
consultations
do
not
involve
diagnoses
or
treatments;
they
simply
enable
patients
to
access
the
opinions
of
licensed
experts
around
the
country,
regardless
of
those
experts.
Geographic
locations,
nevada
is
currently
one
of
only
11
states,
which
has
yet
to
adopt
a
statute
that
allows
for
peer-to-peer
consultation
through
tell
health
technologies
between
a
state
licensed
practitioner
and
an
out-of-state
medical
expert.
M
Without
that
expert
having
to
be
licensed
in
both
locations,
all
of
nevada's
neighboring
states,
with
the
exception
of
utah,
allow
for
peer-to-peer
consultations
via
telehealth,
including
this
language,
would
bring
nevada
in
line
with
the
rest
of
the
country
and
build
this
progressive,
telehealth
policy
we
have
been
talking
about
today.
Thank
you
so
much
for
your
time
and
let
us
know
how
the
ata
can
be
helpful
in
your
efforts
and
happy
to
answer
questions.
A
Yeah
so
some
similar
concepts
here,
let's
start
with
the
peer-to-peer
notion
that
it's
not
explicitly
covered
in
state
law
and
the
establishing
the
patient
relationship
pieces.
So,
mr
robbins,
you,
I
think,
you've
seen
the
amendment.
Is
there
any
concerns
about
the
language
suggestion
around
peer-to-peer
we'll
start
there.
K
No,
that
I
mean
that
would
be
something
that
that
we
could
include
it
wouldn't
be
legally
problematic.
It
would
just
basically
restrict
the
ability
of
the
professional
licensing
boards
to
regulate
these
sort
of
consultations.
A
K
That
is
up
to
the
individual
boards
that
regulate
the
the
various
health
care
professions
so
yeah.
I
I'm
not
really
sure
what
sort
of
what
sort
of
requirements
they
have,
but
it's
up
to
the
their
regulations
and
their
standards
of
practice.
A
Okay,
so
the
notion
of
those
two
amendments
is
the
legislature
dictating
that
versus
the
boards.
Regulating
that
exactly.
Okay,
great,
thank
you
for
the
clarification.
I
see
that
dr
hardy
has
a
sound
up,
so
dr
hardy.
G
Thank
you,
madam
chair.
I'm
a
little
confused.
The
peer-to-peer
affirmations
happen.
All
the
time
now
is
the
peer-to-peer
also
have
a
patient
in
the
middle
of
the
peer-to-peer
and
therefore
it
can
charge
the
peer
in
the
other
state
in
charge
or
the
peer
in
the
state
of
patient
residence
can
charge,
or
is
it
just
allowing
a
peer
to
talk
to
appear?
G
G
M
I
I
don't
believe
this
is
in
in
regards
to
reimbursement.
It
would
just
be
the
legislature
making
clear
that
it
is
an
appropriate
way
to
have
telehealth
interactions
with
another
peer
in
another
state,
senator
hardy.
That
makes
sense.
G
M
I
think
I
think
it
would
be
making
it
this
is
kyle's
ugly
for
the
record,
I
think
it'd
be
making
it
explicitly
legal.
I
don't
know
if
it
is
explicit
at
the
moment
senator
hardy,
I
don't
believe
it
is.
A
Okay,
so
I
think,
as
soon
answered
thank
you
senator
other
questions
on
the
concept
of
the
amendment,
mr
higgin,
anything
that
you
or
your
that
mr
ott
would
like
to
add
to
the
conversation.
A
All
right,
so
thank
you,
mr
zebly,
for
your
time
here
today.
Thank
you
all
right.
So
is
there
anybody
else
who's
in
the
zoom
call
who
is
here
to
testify
and
support?
We
would
be
moving
beyond
folks
who
have
an
amendment
now
and
just
looking
for
folks
who
are
on
the
zoom
call
who
are
intending
to
testify,
and
I
don't
there
is,
but
I'm
just
double
checking
all
right
bps
then,
if
you
could
go
ahead
and
open
up
the
phone
line
for
testimony
in
support
of.
A
N
N
O
C-H-A-R-L-I-E-S-H-E-P-A-R-D-
and
I
am
the
state
president
of
aarp
nevada-
we
have
certainly
seen
the
value
of
telehealth
during
the
pandemic
for
improving
access
to
medical
care
and
treatment.
When
people
are
basically
told
to
stay
home
as
much
as
possible,
telehealth
may
be
the
only
option
available
for
medical
appointments
and
services.
O
O
These
groups
should
be
able
to
have
access
to
telehealth
services
using
the
equipment
they
currently
have
and
can
afford.
The
data
dashboard
is
another
important
addition
that
will
help
us
determine
how
telehealth
is
being
used
by
who
and
best
practices.
However,
in
section
1,
subsection
1a2
age
is
a
critical
category
that
must
be
must
also
be
indicated.
As
open
quote,
another
category
determined
useful
by
the
department.
Close
quote:
they
should
also
consider
family
caregivers
involvement
as
another
useful
category.
O
During
this
time
of
covet,
19
people
have
been
told
to
stay
at
home
as
much
as
possible,
and
we
also
know
that
transportation
is
also
a
huge
barrier
for
many
older
nevadans
and
low
income.
Telehealth
can
bring
routine
and
specialty
health
services
to
their
home
when
trips
are
out
are
challenging
or
perhaps
may
even
be
dangerous.
O
Family
caregivers
need
help
if
they
are
to
continue
doing
what
they
do,
and
telemedicine
is
one
way
to
provide
this
needed
support.
Aarp
on
behalf
of
our
345
000
members
across
the
silver
state
support
sb5
that
will
improve
access
to
healthcare
by
increasing
the
availability
of
telehealth
or
nevada
families,
who
must
rely
on
standard
telephones
with
audio.
Only
thank
you,
madam
chair.
N
I
Good
afternoon,
for
the
record,
my
name
is
jazz:
margarita
tobin
tias
and
tom
oh,
be
as
in
boy,
oh
and
as
a
nancy.
Thank
you
senate
committee
on
health
and
human
services.
I
am
an
organizer
with
planned
parenthood,
boats,
nevada
and
a
community
member
planned
parenthood
votes.
Nevada
is
in
favor
of
sb5,
because
making
telehealth
accessible
through
the
standard
telephone
would
be
a
long-term
investment
in
the
health,
safety
and
well-being
of
nevadans.
I
N
N
I
I
We
think
this
bill
has
a
lot
of
really
great
pieces
to
it.
Telehealth,
as
I
think
everyone
has
come
to
realize,
especially
during
this
pandemic,
has
great
great
resources
and
and
really
supportive
of
the
the
general
concept,
we're
also
really
supportive
of
the
data
dashboard
and
think
it's
a
great
service
for
all
of
our
members.
I
N
P
Our
members
are
specifically
concerned
about
the
impact
that
audio
only
and
other
ace
and
increase
asynchronous
modalities
for
the
provision
of
medical
services
will
have
on
the
workers
compensation
system
section,
seven,
which
modifies
nrf616c,
730
and
section
9,
which
redefines
the
definition
of
telehealth
that's
contained
in
nrs629515
are
particularly
concerning
for
our
members.
Workers.
Compensation
is
not
the
same
as
general
lines
of
health
insurance
and
the
nevada
industrial
insurance
act
and
its
grand
bargain
represent
a
careful
balancing
of
the
interests
of
multiple
parties,
including
employers,
insurers,
third
party
administrators
and
the
injured
workers.
P
The
admission
of
the
initiation
of
a
claim
under
the
nevada
industrial
insurance
act
involves
reporting
of
potential
workplace
injury
to
your
employer
and
then
seeking
appropriate
medical
care.
This
involves
a
careful
assessment
by
a
medical
professional
who
would,
of
necessity,
need
to
see
injuries
and
signs
of
an
illness,
because,
over
and
above
just
finding
a
diagnosis,
they
are
charged
under
the
act
with
opining.
As
to
whether
upon
their
examination
or
what
they're
told
by
the
allegedly
injured
worker,
they
can
quote
directly
connect
the
injury
or
occupational
disease
as
being
job
incurred.
P
Specifically,
we
are
concerned
about
secondary
gain
and
fraud
issues,
identity,
verification
malingering,
which
could
be
obscured
the
lack
of
non-verbal
obligations
and
tactile
testing,
increased
income
complexity
in
the
system
and
a
lack
of
an
adequate
definition
under
nrs2629515
to
include,
for
example,
which
modalities
could
be
done
via
telehealth.
N
Q
Thanks,
madam
chair
members
of
the
committee,
my
name
is
tom
clark
t-o-m-c-l-a-r-k,
I'm
here
on
behalf
of
the
nevada
association
of
health
plans
on
senate
bill
5.,
and
we
recognize
all
the
great
work
that's
been
done
by
the
legislature
in
2013
and
2015,
and
also
the
work
of
the
ppc
over
the
last
year.
But
we
do
have
some
concerns
with
senate
bill
5.,
we
recommended
insurers
continue
to
have
the
flexibility
to
negotiate
prices
to
keep
health
coverage
affordable
for
the
consumer
services
provided
by
telehealth
must
be
comparable
to
the
services
provided
in
an
office.
Visit.
Q
It's
important
that
we
can
develop
value-based
arrangements
by
focusing
health
outcomes,
not
just
the
volume
of
services
provided
the
payment
parity
provision
is
contradictory
to
telehealth's
cost
effectiveness
if
telehealth
can
help
produce
costs
by
using
the
health
care
system
and
reduce
provider
visits
it's
contradictory
to
mandate
that
those
services
be
paid
at
the
same
rate.
Thank
you,
madam
chair.
N
Callers,
if
you'd
like
to
testify
in
opposition
and
are
just
now
joining
us,
please
press
star,
9
now
to
enter
your
place
in
the
queue
once
again.
If
you
are
just
now
joining
us
and
wish
to
testify
in
opposition
to
sb5,
please
press
star
9.
N
A
I
For
the
record,
this
is
this
is
debbie
reynolds,
deputy
administrator
with
public
and
behavioral
health.
I
believe
kyra
morgan
got
kicked
out
of
zoom
and
she's
trying
to
reconnect
now
I
do
apologize.
I
may
be
able
to
present
the
amendment
the
proposed
amendment
that
was.
A
Put
forward
by
the
department
of
health
and
human
services
allows
us.
I
And
report
on
the
data
that's
currently
available
to
us
the
bill
as
written
does
not
refer
to
the
data
that
is
only
available
to
us
at
this
time,
so
we
understood
it
to
mean
that
we
would
need
to
reach
out
and
collect
the
data,
which
is
why
there
was
currently
such
a
large
fiscal
note
on
it.
However,
the
amendment
as
as
proposed
would
allow
us
to
remove
our
fiscal
note.
A
Thank
you
and
that's
in
line
with
the
testimony
on
the
bill
that
this
was
intended
to
collect
existing
data
and
share
it.
Okay,
any
member
members
of
the
committee,
any
questions
specifically
to
the
amendment
and
senator
hardy.
Your
electronic
hand
is
still
up,
so
I'm
not
sure
if
that's
a
hold
over
from
the
last
conversation.
If
you
have
a
question.
G
Well,
let
me
ask
the
question
which
amendment,
because
I've
heard
somebody
talk
about
a
provider
talking
to
a
family
member
I've,
and
so
I'm
I'm
totally
confused,
because
where
I
come
from
we're
talking
about
telehealth
being
used
in
order
to
be
able
to
have
payment
because
we
talk
about
payment
parity,
but
the
bill.
The
the.
A
I
could
just
interrupt
for
a
second,
so
we
talked
so
the
teledog
and
ata
amendments
were
addressed
under
support,
and
I
think
you
had
your
questions
answered
there
at
this
point
in
time.
In
the
hearing
we're
focused
on
the
amendment
from
dhhs.
That
is
really
just
about
saying:
whatever
data
is
available
and
whatever
funding
is
available,
then
they're
going
to
do
the
data
dashboard
piece.
I'd
like
to
keep
us
on
that
in
this
neutral
testimony.
A
E
It
is
thank
you,
chair
ready,
so
I
understand
that
you
know:
we've
made
it
clear
we're
going
to
be
using
data
that
we're
already
collecting
and
so
there's
no
additional
expense
there,
but
I
imagine
the
creation
of
the
dashboard
itself
is
still
going
to
cost.
Something
is
that
right.
F
A
Thank
you
and
and
again,
miss
morgan,
just
because
I
think
it's
important
that
this
is
on
the
record.
Your
colleagues
testified
that
this
amendment
would
remove.
The
fiscal
note
is
that
your
assessment,
as
well.
F
That's
correct:
I
apologize
I'm
I'm
having
connection
issues.
I'm
sorry.
The
amendment
really
just
clarifies
the
language
that
I
think
sarah
talked
about
at
the
beginning,
to
strengthen
it,
to
ensure
that
we're
not
relying
on
additional
data
collection
that
we
would
be
using
the
data
and
resources
that
are
already
available
to
create
the
dashboard
which
would
eliminate
the
fiscal
note
from
the
division
of
public
and
behavioral
health.
A
N
N
N
H
Hi
good
afternoon
this
is
helen
foley
h-e-l-e-n
s
is
in
frank
o-l-e-y,
and
today
I
am
representing
delta
dental
and
we
are
calling
in
support
of
the
dhhs
amendment,
because
we
believe
that
the
language
to
the
extent,
resources
and
data
are
available,
satisfies
our
needs
and
concerns.
H
As
we
first
looked
at
the
legislation,
I
I
must
say
that
the
delta
dental
does
support
telehealth
and
has
been
working
closely
throughout
the
united
states
on
these
issues,
but
when
we
saw
that
there
might
be
some
very
specific,
intrusive
questions
that
you
know
if
someone
comes
into
a
dentist's
office
and
they
need
a
tooth
filled
and
they're
asked
what
their
gender
identity
is
and
their
their
sexual
orientation
and
whether
they
have
mental
health
problems,
we
just
did
not
feel
that
that
was
appropriate.
H
But
now
with
this
new
amendment,
so
that
it
just
includes
data
that
is
already
available.
We
do
not
have
an
objection
to
the
legislation
and
thank
you
for
your
time.
B
Thank
you,
chair,
ratty,
sarah
hagian,
for
the
record.
I
just
would
like
to
say
my
closing
remarks
that
I
thank
you
for
your
consideration
of
this
measure
and
really
want
to
thank
everybody.
Who
is
a
part
of
the
process
in
helping
to
address
clarification
of
the
intent,
and
I
would
be
remiss
if
I
didn't
pause
and
thank
each
and
every
one
of
the
commissioners
who
put
in
the
effort
and
the
time
and
the
work
to
put
this
measure
in
front
of
you.
A
All
right
so
committee
members
working
real
hard
here
in
a
virtual
environment
to
not
have
this
turn
into
a
free-for-all,
but
I
do
know
that
we
have
a
bill
that
was
presented
by
the
sponsor
with
three
amendments.
My
my
top
concern
here
is
that
you
get
your
questions
answered.
So
if
you
could
just
be
very
clear
about
who
you're
pointing
the
question
to
and
what
topic,
I
think
that
would
be
helpful,
so
any
additional
senator
hardy,
I
believe
you
had
questions
I'll
start
with
you.
Yeah.
G
Thank
you,
madam
chair,
so
let
me
clarify
for
my
own
edification.
This
has
nothing
to
do
with
preventing
a
doctor
from
talking
to
a
doctor
some
place
elsewhere.
Nor
does
it
have
anything
to
do
with
getting
payment
for
that.
Nor
does
it
allow
or
not
allow
a
doctor
from
talking
to
another
patient's
family
or
a
family
caregiver.
Nor
does
it
allow
payment
for
that
interchange
because
it's
already
going
on
and
even
though
it's
not
explicitly
allowed
it's
what
we
do
anyway
and
this
bill
doesn't
change
that
at
all.
Nor
does
it
reimburse
for
that.
B
A
Yeah
and
just
going
to
check
in
with
mr
odd
is
that
your
understanding
of
the
bill
as
written
as
well.
A
A
A
All
right,
so
it
looks
like
we
actually
don't
have
the
presenter
of
the
amendments
anymore
for
either
one.
So
I'm
gonna
go
to
our
legal
counsel.
Mr
robbins,
what
what
can
you
talk
to
us
at
all
about
what
current
law
is
in
terms
of
the
peer-to-peer
interaction,
and
if
this
amendment
would
have
an
effect.
K
Well,
under
current
law,
as
I
said
before,
it's
kind
of
up
to
the
individual
what's
allowed
in
under
the
individual
statutes
and
regulations
governing
the
the
different
professions,
but
for
physicians
in
particular,
nrs
630.047,
subsection
one
paragraph
b
set
basically
says
that
a
physician
doesn't
have
to
have
a
license
if
they
are,
if
they're,
consulting
with
or
providing
assistance
to
a
nevada
licensed
physician
except
and
they're
legally
qualified
to
practice
in
the
state
where
they
reside
and
that
that
statute
doesn't
explicitly
mention
telehealth
but
generally,
where
telehealth
isn't
explicitly
made
different.
K
We
interpret
that
or
we
interpret
the
same
provisions
that
apply
to
the
provision
of
services
in
person
to
apply
to
the
provision
of
those
services
by
telehealth.
So
consultation
on
a
on
an
irregular
basis
for
physicians
is
explicitly
allowed
by
chapter
30.
G
H
A
A
B
Time,
okay,
thank
you,
chair
ratty
members
of
the
committee.
My
name
is
sarah
shalhagian
for
the
record.
I
serve
as
the
executive
director
of
nevada's
patient
protection
commission.
So
earlier
in
my
hearing
on
sb5,
I
gave
you
an
overview
of
the
commission,
their
meetings
activities
and
ultimately,
what
led
to
the
last
measure
that
is
applicable
to
this
measure.
So
it
was
in
the
same
hearing
and
work
session
on
the
31st
that
the
commission
discussed,
debated
and
voted
on
their
working
document,
which
is
going
to
be
putting
this
measure
in
front
of
you.
B
So
I'm
going
to
skip
to
that
and
being
mindful
of
everybody's
time
this
evening
so
senate
bill
40
is
in
front
of
you
today,
and
the
intent
of
this
measure
is
a
bill
that
seeks
to
enact
mandated
reporting
of
data
to
the
state
of
nevada,
patient
protection,
commission,
department
of
health
and
human
services,
the
attorney
general's
office,
to
allow
for
the
monitoring
monitoring
of
help
the
healthcare
industry,
including
pricing
for
healthcare
components,
all
health
care,
insurers,
all
pair
claims,
drug
costs,
hospital
prices,
health
care,
entity,
ownership
and
mergers,
consolidation
closures
and
governance
for
health
care
committee.
B
I'll
go
back
one
second,
this
is
another
measure
that
really
seeks
to
improve
access
to
care,
but
again,
with
the
same
mindset
that
you
can
improve
what
you
can't
measure.
So
this
is
the
first
step
to
address
monitoring
of
the
health
care
industry
and
looking
at
health
care
costs.
B
B
The
second
part
of
this
request
is:
it
requires
a
report
each
year,
summarizing
health
care,
quality,
nevada
for
presentation
to
the
governor
legislature
and
the
commission,
and
that
is
addressed
in
section
14
of
the
bill.
The
third
component
is
it
ensures
that
the
commission
and
the
department
of
health
and
human
services
have
the
authority
to
request
ad
hoc
reports
regarding
regarding
price,
cost,
consolidation
and
access
to
care.
You'll
find
that
in
section
one,
the
largest
portion
of
this
measure
relates
to
the
establishment
of
an
all
payer
claims
database.
B
But
before
I
go
into
that,
I
really
want
to
take
a
moment
to
highlight
senator
spearman's
work
on
paving
the
way
for
this
conversation
to
happen.
In
the
last
legislative
session,
she
had
a
measure
that
sought
to
establish
an
all-payer
claims
database
and,
as
the
commission
was
deliberating
and
debating
on
this
measure
and
transparency
measures,
I
communicated
with
her
and
told
her
that
the
commission
was
deliberating
this
and
she
was
quite
enthusiastic
to
see
the
conversation
be
picked
up.
B
So
I'd
like
to
just
pause
and
recognize
her
efforts
for
paving
the
way
for
this
measure.
B
The
data
the
database
requires
the
department
of
health
and
human
services
to
establish
an
all
payer
claims
database
of
information
relating
to
health
insurance
claims
resulting
from
medical,
dental
or
pharmacy
benefits
provided
to
the
state.
Public
and
private
insurers
that
provide
health
benefits
are
regulated
in
the
state,
must
submit
data
to
the
database
and
certain
insurers,
regulated
by
federal
law,
may
submit
data
to
the
database.
B
Section
9
is
the
primary
authorizing
legislation
and
all
other
sections
relate
to
the
establishment
of
this
database
and
finally,
this
measure
mandates
reporting
of
data
to
the
state
of
nevada,
to
the
ppc
department
of
health
and
human
services.
The
attorney
general's
office
to
further
allow
for
the
monitoring
of
the
health
care
industry,
and
there
are
provisions
in
section,
1
and
13.,
and
now
I'm
ready
to
answer
any
questions
that
you
may
have
and
I
suspect
there
may
be
a
decent.
A
Amount:
okay,
senator
harris.
Would
you
like
to
start
with
what
I
suspect
might
be
a
similar
line
of
questioning.
E
I
would
thank
you,
chair
ratty,
so
my
question
is
data
protection.
E
I
I'm
guessing
and
of
course
you
know,
hipaa
will
continue
to
be
the
the
standard
for
all
health
information,
but
who
will
have
access
to
this
database?
E
You
know
who
will
be
able
to
kind
of
ping
that
information
on
you
know,
I
guess
the
individual
level
and
what
type
of
protections
or
parameters
do
we
anticipate
being
put
around
that
access.
B
Thank
you
so
much
for
the
question
senator
harris
sarah
shalhagian
for
the
record.
I
can
tell
you
that
the
this
legislation
primarily
focus
as
it's
written
on
authorizing
the
state
to
create
the
data
dashboard
and
establishing
regulations
for
that
creation
to
include
the
data
collection
process
data
release
process.
B
But
what
I
would
like
to
do
is
defer
to
sandy
rubella,
who
is
on
the
line
who
can
answer
questions
you
have
she's,
the
chief
I.t
manager
and
and
pretty
much
the
guru
of
the
all
payer
claims
database
efforts
for
our
state.
So
if
you
don't
mind
chair
ready,
I
really
would
like
to
lean
on
her
to
help
answer
some
questions.
B
R
Hi,
so
this
is
sandy
rublet,
I'm
the
chief
I.t
manager
for
the
department
of
health
and
human
services.
To
answer
the
first
question,
which
I
believe
was
about
security
requirements,
what
we
would
do
is
contract
with
a
third-party
vendor
and
part
of
that
contracting
process
would
require
that
they
have
certain
certifications
and
there's
a
lot
of
acronyms
here
so
bear
with
me.
R
The
first
one
is
the
health
information,
trust
alliance
or
high
trust
certification,
and
that
ensures
that
they
would
comply
with
hipaa
regulations
in
addition
to
the
national
institute
of
standards
and
technology
or
the
nist
security
requirements.
So
that's
about
protecting
the
data
that
we
would
house
both
in
transit,
stored
and
in
release
of
the
data.
So
we
would
follow
those
hipaa
requirements
for
that.
R
As
far
as
releasing
the
data
for
the
most
part,
it
would
be
de-identified
and
aggregated
it
wouldn't
be.
You
know
someone
able
to
ping
the
database
for
one
particular
patient,
but-
and
I
would
defer
to
kyra
to
explain
a
little
bit
more
about
data.
R
The
data
requests
in
detail,
but
there
is
a
situation
where
we
would
release
data
in
an
identified
manner
for
research
purposes
and
those
would
be
governed
and
controlled
with
data
use
agreements
between
the
parties
to
ensure
that
there's
an
agreement
and
liability
to
ensure
the
data
is
not
released
improperly.
F
F
I
would
just
add
that
we're
already
collecting
all
of
this
information
on
our
medicaid
population,
and
so
the
security
protocols
that
we
have
in
place
to
protect
that
information
would
be
extended
to
this
population.
F
We
also
collect
highly
sensitive
data
around
our
communicable
diseases,
including
things
like
hiv,
where
we
obviously
have
to
maintain
confidentiality
to
the
highest
regard,
and-
and
so
we
do
have
a
lot
of
processes
in
place
to
protect
this
information.
This
would
really
just
be
an
extension
of
that
to
include
payers
that
aren't
already
captured
in
some
of
our
already
existing
data
collection
mechanisms.
F
E
G
G
The
social
security
number,
the
telephone
number,
the
medical
record
number,
the
health
plan
beneficiary
number,
the
license
number,
the
vehicle
identification
number,
the
serial
number,
the
internet
address
the
electronic,
the
biometric
identifier
in
a
photographic
image
I
mean
that's,
that's
a
recipe
for
disaster
when
someone
hacks
it.
I
have
major
misgivings
about
this.
Thank
you.
I
guess
it's
more
a
statement
than
a
question.
Thank
you.
B
Thank
you
senator
hardy
for
your
comments.
I
can
tell
you
that
this
specific
language
was
not
included
in
the
commission's
request
and
it
was
more
of
a
product
of
drafting
interpretation
and
indicating
that
it
was
a
necessary
component
of
this
measure
and
if
you
would
like
to
have
more
comments
about
this,
maybe
sandy
could
opine
on
her
thoughts
on
on
this.
But
I'm
not
sure
that
is
what
you're
seeking.
A
So
let
me
let
me
just
make
sure
that
we're
understanding
the
flow
of
the
bill,
and
so
we
may
need
mr
robin's
help
on
this,
but
I
think
that
this
is
the
information
that
they're
specifically
saying
can't
be
released
individually
and
must
be
aggregated
correct.
K
K
It's
just
saying
that
if
any
of
that
information
does
wind
up
in
the
all-player
claims
that
database,
then
it
then
it
has
to
be
treated
in
a
certain
manner
under
under
section
13
and
basically
the
the
people
who
can
have
access
to
that
information
are
very,
very
limited,
especially
with
respect
to
the
other
types
of
information
that
may
be
in
the
database.
A
H
Senator
spearman,
thank
you,
madam
chair,
and
I
think
when
we
had
this
session
there
was
some
concerns
about
that
as
well.
But
if
I'm
not
mistaken,
I
think
washington
state
has
something
very
similar,
and
I
know
that
they
have
increased
security.
I
mean
you
know:
nothing's
100,
but
they've
increased
the
ssl
security
on
this
type
of
information
and
for
the
most
part,
if
I'm
not
mistaken,
I
think
a
lot
of
it
is
redacted,
so
that
other
than
research
or
trying
to
establish
what
the
patterns
are.
H
I
don't
know
that
there's
identifiable
information
on
a
person.
I
could
be
wrong,
though,
but
I
think
I
think
some
of
the
protections
are
introduction
and
making
sure
that
when
it
is
disaggregated
that
there
there's
no
compartment
information
that
will
allow
someone
to
go
back
and
identify
an
individual.
A
B
I
am
aware
of,
I
believe,
19
states
that
have
established
all
pair
claims
database
and
there
is
a
national
effort
under
the
no
surprises
act,
to
entice
other
states
to
create
data
or
to
create
all
pair
claims
databases,
and
it
provides
an
opportunity
for
federal
funding
and
I
believe
it's
a
non-competitive
application
process.
R
Yes,
thank
you.
Sarah.
This
is
sandy
rublet,
I'm
the
chief
I.t
manager
for
the
department
of
health
and
human
services,
sarah's
correct.
There
are
around
19
to
23
databases
in
existence
in
varying
sizes.
R
I
think
the
first
one
established
was
in
maine
and
there
is
a
a
lot
of
interest
at
the
federal
level
so
much
so
that
there
is
a
non-competitive
grant
for
all
states
to
apply,
for
we
believe
that
the
funding
would
be
available
starting
in
october,
and
we
do
intend
to
apply
for
that
grant.
There
is
2.5
million
dollars
available
over
a
two
and
a
half
year
period
to
either
improve
your
existing
or
establish
an
apcd.
So
we
we
are
very
interested
in
that.
R
R
Some
states
have
decided
to
have
other
feeds
into
the
database
to
help
enrich
their
data,
but
at
the
very
minimum
it
is
claims
data.
So
I
wouldn't
necessarily
think
that
we
would
find
a
vehicle
identification
number
or
biometric
information,
as
described
in
that
description
in
section
5
I
believe,
but
I'm
sure
maybe
some
other
states
have
done
that.
Maybe
they
have
connections
and
needs
for
that
data.
A
The
intent
of
this
legislation
is
claims
data,
so
we're
talking
about
the
patient.
What
the
patient
condition
was,
what
got
billed
what
got
paid
for,
and
just
I
think,
a
reminder
that
the
point
of
this
bill
is
for
us
to
understand
how
much
health
care
costs
so
that
we
can
start
to
make
informed
decisions
about
how
we
we
invest
our
dollars
in
terms
of
health
care
and
how
we
manage
health
care
costs.
G
Thank
you,
madam
chair,
going
back
to
the
prior
bill
with
the
social
security
number.
I
suspect
they
can
figure
out
age.
G
So
the
comment
that
was
made
about
age
apparently
isn't
in
this
and
question
mark
and
then
have
any
of
these
19
or
23
states
have
a
data
breach
from
their
database
ever
yet.
R
Thank
you
for
the
question
senator
hardy.
This
is
sandy
ruble
with
the
department
of
health
and
human
services.
I
am
not
aware
of
any
data
breaches
in
all
payers
claims
database
they
because
of
the
nature
of
the
data
that
is
housed
in
the
databases.
R
C
C
The
way
I
read
this
right
is
that,
basically,
you
can't
have
private
insurance
or
public
insurance
for
that
matter,
without
having
your
health
care
claims
submitted
to
this
air
database
right.
Is
there
just?
Is
there
an
opt.
R
R
C
So
I
mean
I
don't
I
understand
that
you
know
we.
We
try
to
protect
it
as
as
best
we
can,
but
when
we
hold
it
and
we
hold
it
all
in
one
place,
it
becomes
a
target
right.
So
you
know,
I
think
I
share
dr
hardy's
concerns
about
me
as
a
individual
who's.
C
You
know
potentially
required
to
carry
health
insurance
and
then
have
the
data
collected
by
that
health
insurance
company
as
a
part
of
their
payment
system,
be
required
to
be
turned
over
to
the
analysis.
I
just
it
was
more
of
a
philosophical
statement
than
a
question
madam
chair,
but
I'll
leave
it
at
that.
Thank
you.
A
A
So
if
you
could
turn
your
cameras
on
and
let
us
know
if
you
here
are
here
sure
all
right,
so
I'm
going
to
call
on
sure
it's
a
bicycle.
Sorry.
S
Yeah
sure
short
list
from
pharma
for
the
record.
Madam
chair
members
of
the
committee,
thank
you
for
the
opportunity
to
speak
with
you
all
today,
pharma
is
in
support
in
general
to
an
all-peer
claims
database
bill.
We
think
this
will
help
highlight
the
cost
drivers
in
the
state
of
nevada
and
really
provide
that
important
nevada,
specific
information
on
health
care
costs
in
the
state.
We
have
submitted
two
clarifying
amendments
that
are
available
as
exhibits
on
the
website.
S
The
first
relates
to
the
definition
of
proprietary
financial
information
and
section
section
7,
recognizing
that
health
care
agreements
can
occur
between
more
parties
than
just
health
care
providers.
We
have
asked
that
proprietary
financial
information
in
an
agreement
between
a
manufacturer
of
a
prescription
drug
also
fall
under
the
definition
of
proprietary
financial
information.
S
The
second
amendment
is
to
section
20
of
the
bill
and
it
is
to
add,
if
there
is
a
report
that
is
released,
and
it
is
available
that
the
report
consider
race,
ethnicity
and
other
health
disparities.
We
think
this
is
an
important
area
for
this
state
to
consider,
especially
given
the
pandemic
and
the
inequities
that
we
have
seen
in
healthcare.
S
It
would
be
more
to
senator
rowdy's
point
on
sb5,
where,
if
you
can
determine
information
based
on
neighborhood
or
zip
code,
consider
that
in
the
report
potentially
for
further
investigation
or
otherwise
also
just
while
I'm
testifying
in
support
we've
reviewed
amendments
by
others
and
just
want
to
flag
that
pharma
has
some
concerns
with
the
amendment
offered
by
the
attorney
general's
office
in
section
1
number
two
and
I'm
happy
to
continue
to
work
with
stakeholders
to
address
those
concerns
and
hopefully
see
the
passage
of
sb40.
Thank
you.
A
Thank
you.
Is
there
anybody
else
on
the
call
who
is
testifying
in
the
support
that
is
here
to
present
an
amendment?
I
have
amendments
from
a
group
of
stakeholders
and
carfax,
and
I
don't
know
that
they're
under
support.
A
Okay,
mr
clark,
can
you
confirm,
is
yours
going
to
be
more
on
opposition
or
neutral.
Q
A
Fantastic,
so
please
proceed
and
for
the
members
for
the
members
of
the
committee.
This
is
the
conceptual
amendment
dated
march
8th
2021
and
has
the
four
sponsors
across
the
top
nevada
association
of
health
plans,
nevada
hospital
association,
nevada
state,
medical
association
and
pcma.
You
have
three
minutes
to
provide
your
support,
testimony
and
discuss
the
amendment.
Mr
clark.
Q
Thank
you,
madam
chair
and
members
of
the
committee.
My
name
is
tom
clarke,
I'm
the
athlete
nevada
association
of
health
plans,
as
the
chair
referred
we're
speaking
to
a
conceptual
amendment
that
was
worked
on
with
the
four
groups
that
are
listed
myself
and
bill.
Welch
will
each
kind
of
tag
team
some
of
this
and
we'll
get
through
it
as
quickly
as
we
can
jumping
straight
to
the
amendment
and,
first
of
all
I
do
want
to
say
that
we
firmly
believe
that
the
apcd
is
going
to
be
a
tool
for
public
policy.
Q
That's
going
to
benefit
nevada,
long
term,
we
support
sample
40
and
we
simply
want
to
make
it
robust
and
accurate
and
as
quantitative
as
we
possibly
can.
Mr
welch
will
discuss
section
8
with
the
definitions
going
to
section
9
in
subsection
1.
This
goes
to
senator
hardy's
question
about
data.
Yes,
there
are
certain
things
listed
in
section
five
of
the
bill,
but
we
firmly
believe
after
conversations
among
ourselves
and
with
other
stakeholders
that
these
will
be
determined
in
regulation.
Q
The
other
part
that
we
would
like
to
add
in
that
section
nine
is
a
part
as
a
some
language
that
says
that
that
the
apc
will
be
built
and
maintained
by
a
third
party
vendor
in
discussions
that
may
be
already
considered.
So
it
may
not
have
to
happen
in
the
legislation,
but
we
would
definitely
want
to
make
sure
that
a
third-party
vendor
is
acquired
to
do
so.
Q
Mr
welch
will
talk
about
section
three
I'll
jump
to
section
10
under
health
carrier
in
the
definition
there's
two
a
couple
of
things
that
we'd
like
to
have
not
have
to
report
to
the
abcd:
those
carriers
that
provide
medicare,
supplemental
insurance,
dental
vision
and
disease,
specific
insurance
and
that's
a
pretty
consistent
theme
throughout
the
other
19
states
that
have
adopted
these
and
then
also
health
carriers
with
less
than
a
thousand
lives
being
covered.
They
would
not
be
required
to
report
on
the
apcd
as
well.
Q
Mr
walter
tucked
sean
section,
11,
jumping
to
section
13..
This
really
gets
to.
When
is
all
of
this
going
to
start
right.
The
timeline
for
the
promulgation
of
the
regulation
getting
all
of
the
stakeholders
together
and
things
we're
not
really
sure
how
long
that's
going
to
take,
but
what
we
would
like
the
timeline
to
be
for
the
collection
and
the
release
of
data
six
months
after
the
finalization
of
the
regulations
that
create
the
cd.
That's
when
the
clock
starts.
Q
That's
when
we're
all
going
to
be
participating
in
this
process
just
quickly,
jumping
down
to
section
14.
As
far
as
the
annual
report
is
considered,
we
contemplate
two
committees
that
mr
welch
will
discuss.
We
hope
that
those
two
committees
will
be
able
to
review
that
report
for
it
or
before
it's
published
and
then
section
17.
Q
A
lot
of
there's
there's
three
different
places
where
money
comes
into
play
right:
the
fee
that
you're
going
to
charge
for
people
to
access
the
data,
the
we
actually
it's
not
in
the
legislation,
but
we
proceed
through
regulation,
putting
together
a
penalty
phase
for
those
insurers
that
are
required
to
participate,
but
do
not.
Q
We
really
want
this
data
to
be
as
accurate
and
as
quantitative
as
possible,
and
then
the
third
part
of
that
is
that
any
of
the
moneys
that
are
collected
from
fees
and
the
work
penalties
would
go
directly
into
furthering
the
apcd
and
not
the
general
fund.
So
mr
welch,
if
you're
available
I'll
turn
it
over
to
you,.
A
T
Thank
you,
madam
sharing
committee
members
bill
walsh
with
the
nevada
hospital
association.
I
won't
report,
I
won't
repeat
talk
mr
clark's
comments,
but
we
are
here
in
support
of
the
bill,
and
the
committee
coalition
does
support
the
intent
of
this
legislation.
Think
it
will
be
beneficial
to
the
state
of
nevada,
section
8
and
we
designated
section
8,
but
we
really
mean
in
the
definition
categories.
There
are
terms
used
throughout
the
bill
that
we
feel
it
would
be
beneficial
to
define
so
that
there's
clarity
on
what
information
is
being
collected.
T
Who
is
making
decisions
for
research
and
what
is
a
government
entity
so,
for
example,
under
cost
of
health
care,
depending
upon
who
you
talk
to
you'll,
get
a
different
interpretation
of
cost,
and
so
we're
proposing
some
definition
in
there?
Isn't
that
cost
of
the
provider
to
provide
the
service
cost
of
the
payer
to
facilitate
the
insurance
and
pay
for
services
cost
of
the
consumer,
for
what
their
insurance
cost
is
and
what
may
be
their
out-of-pocket
costs
or
services
that
they
receive?
T
With
regards
to
research,
we
think
it's
very
important
that
there's
a
consistency,
standard
and
guidance
on
what
will
be
recognized
as
valid
research,
and
it
does
refer
to
an
institutional
institutional
review
board.
There
is
a
federal
definition
for
that,
and
we
would
suggest
some
language
being
there
defining
who
and
what
the
institutional
resource
reward
review
board
would
be
governmental.
P
T
Find
a
standard
definition
in
the
nrs
or
in
the
indices
as
to
what
is
a
governmental
entity,
and
we
think
that
there
should
be
some
parameters
to
lay
that
out,
because
there's
a
lot
of
conversation
or
a
lot
of
language
in
the
bill
that
refers
to
releasing
information
to
governmental
agencies
under
section
9,
subsection.
Three.
T
We
do
believe-
and
this
is
not-
and
I
wanna
be
candid-
this
does
not
happen
in
every
state
that
has
an
apcd,
but
in
our
experience
with
the
many
hospital
systems
that
we
have
in
the
states
where
they
are
working
with
apcds
what
they
have
where
they
have
found
it
to
be
most
successful
in
accomplishing
its
goals,
they
have
developed
a
stakeholders
advisory
committee
to
work
with
the
the
state
oversight
regulatory
body.
T
This
would
help
ensure
proactive
engagement
and
and
buy
in
by
all
concerned
parties,
and
then
there's
a
data
governance
committee.
The
data
governance
committee
would
be
made
by
individuals
within
the
organizations
whose
data
is
being
reported
and
who
is
reporting
that
data,
so
that
we
make
sure
that
there's
consistency
in
the
platform
and
in
the
manner
in
which
that
data
is
being
submitted
so
that
there
is
the
ability
to
bring
it
together
and
do
the
analytic
work
that
is
intended
and
and
be
able
to
be
aggregated
for
the
release
and
reports.
T
In
section
11.
We
do
recognize.
There's
been
a
lot
of
talk
about
hipaa
and
the
requirement
for
patient
privacy,
and
we
do
understand
that
in
the
bill
it
talks
about
the
stadium
sees
it
that
they
will
comply
with
that.
But,
as
has
been
demonstrated
in
the
testimony
today,
this
data
can
be
released
to
researchers
in
its
de-aggregated
form
for
their
research
project
and-
and
I
I
did
hear
one
of
the
testifiers-
that
they
would
put
this
in
their
a
participating
agreement
or
their
the
agreements
with
the
researchers.
T
We
know
that
that
would
apply
to
the
various
state
agencies
and,
as
it
has
been
described
today,
but
we
think
that
there
should
be
language
in
there
that
all
researchers
who
access
this
data,
any
reports
that
they
produce
also
must
be
released
in
an
aggregated
form,
so
that
there
is
no
potential
risk
of
compromising
patient
privacy
and
that
there
would
also
not
be
any
risk
of
releasing
any
proprietary
financial
information
from
those
data
who's
been
reported,
section
12.
T
We
also
believe
that
understanding
that
the
law
can
only
regulate
a
small
percentage
of
those
who
are
insured
in
the
state
of
nevada,
and
while
the
law
does
provide
for
voluntary
participation
by
self-funded
plans,
state
plans
etc,
they
are
not
governed
in,
are
not
mandated
to
participate.
So
we
think
in
any
report
that's
released.
There
should
be
some
clarification
of
what
percent
of
the
total
population
that
this
report
really
represents,
so
that
we
understand
that
it's,
for
example,
my.
T
What
we
believe
is
that
about
19
to
22
percent
of
the
insured
lives
in
the
state
of
nevada
are
through
commercially
licensed
insurance
companies
in
the
state
of
nevada,
where
who
would
be
required
to
submit
this
information,
and
so
you
can
see
that
the
the
larger
portion
of
insured
lives
would
not
be
included
in
this
in
the
state
of
collection,
at
least
unless
they
are
voluntarily
doing
so.
A
A
N
N
N
N
N
N
All
right
sure,
we'll
circle
back
to
this
caller,
we'll
move
on
to
the
next
one.
A
N
I
Good
afternoon
share
ratty
members
of
the
committee
for
the
record.
My
name
is
katie
ryan,
k-a-t-I-e
r-y-a-n
and
I'm
system,
director
of
nevada
government
relations
for
dignity.
Health,
saint
rose
dominican.
We
are
here
today
as
an
us
two
in
support
of
the
conceptual
amendment
provided
to
the
committee
by
the
nevada
hospital
association.
At
all.
We
wanted
to
go
on
the
record,
also
an
appreciation
of
sarah
chilhagian
from
the
ppc
senator
ratty
and
other
stakeholders
for
continuing
conversations
around
best
practices
in
other
states
and
making
sure
we
can
make
this
bill
the
best
it
can
be.
N
I
Our
coalition
has
consistently
supported
transparency
in
healthcare,
quality
and
pricing,
including
transparent,
the
prescription,
transparency
bills
from
2017,
2019
and
surprise
bills
from
last
session,
and
we
definitely
support
the
transparency
provisions
in
this
bill.
We
also
support
the
intent
of
this
bill
to
create
the
building
blocks,
rc
needs
for
future
quality
and
price
management
and
healthcare.
I
N
N
N
N
N
I
Thank
you
for
the
record.
My
name
is
babette
bond
chairman
turbo
marathi
and
vice
chair
spearman
and
members
of
senate
health
committee.
I
hope
you
can
hear
me,
okay
for
by
way
of
disclosure,
I'm
a
member
of
the
nevada,
patient
protection
commission,
but
I'm
here
today
on
behalf
of
the
culinary
health
fund
that
I'm
the
director
of
public
policy
for
the
fund.
I
The
culinary
health
fund
supports
the
patient
protection
commission
and
in
its
current
version
the
bill
that's
been
created
for
fb40.
We
like
the
current
version.
The
culinary
help
fund
covers
125
000
lives
with
comprehensive
health
benefits
we
contract
with
our
own
network
and
we
care
for
our
members,
which
are
60
members
of
non-white,
racist
and
ethnicity.
We
operate
two
pharmacies
that
allow
patients
to
fill
prescriptions
without
a
copay
and
we
operate
a
health
center
that
saw
forty
thousand
patients
the
year
before
covet.
I
I
I
Erisa
plans,
as
you
said,
are
optional.
They
can
participate
by
choice
and
for
that
to
happen
the
product
has
to
be
transparent,
and
so
as
a
process.
We
support
the
program
being
housed
within
the
public
health
arena,
and
we've
heard
testimony
today
that
we
want
to
urge
the
committee
to
pass
the
bill
that
was
created
not
the
bill,
as
amended
by
the
stakeholder
amendments
that
we've
heard
about.
Particularly.
We
strongly
oppose
legislation
that
would
de-identify
the
elements
needed
in
a
database,
such
as
the
provider
and
the
facility
and
the
price
paid
for
services
or
care.
I
We
need
that
information
for
the
database
to
work.
We
also
think
that
the
database
should
span
times
the
amendment
that
we
heard
about
today
sounds
like
it
wouldn't,
and
so
we
think
trend
is
important.
For
so,
we
want
to
make
sure,
that's
included
and
we
want
to
make
sure
the
committees
that
are
assigned
are
are
advisory
only
and
they
are
not
in
charge
of
deciding
what
data
will
be
submitted
in
the
end.
So
we
appreciate
the
opportunity
to
testify.
I
N
H
Hello,
my
name
is
chris
boxy,
that's
c
c-h-r-I-s
b-as
in
boy
o-s-s-e,
representing
renowned
health,
for
the
record,
I'm
testifying
in
support
of
sb
40,
with
the
conceptual
amendments
offered
by
the
industry.
First,
I
want
to
thank
chair
ratty
for
taking
the
time
to
meet
with
stakeholders,
to
better
understand
the
recommendations
being
made
and
really
want
to
appreciate
the
work
of
the
patient
protection
commission,
the
work
that
they
went
through
to
prioritize
the
information
implementation
of
an
apcd
in
nevada
with
a
number
of
key
issues
in
front
of
them.
H
They
recognize
the
important
impact
that
an
apcd
could
have
in
nevada,
and
it's
in
that
spirit,
honoring.
The
intent
of
the
ppc
that
the
industry
stakeholder
group
came
together
to
provide
feedback
on
sb40
to
ensure
best
practices
and
lessons
learned
from
other
states
were
incorporated
on
the
front
end
of
our
implementation.
H
I
won't
repeat
what
the
other
recommendations
that
were
provided
and
you
have
in
writing,
but
we
believe
these
recommendations
that
the
industry
has
proposed
will
ensure
successful
implementation,
operation
and
meaningful
use
of
the
apcd
as
early
as
it
can
be
recognized.
I
want
to
thank
you
for
your
time
today.
A
N
I
This
is
dan
musgrove,
with
strategy
360
d-a-n-m-u-s-g-r-o-v-e
here
today
on
behalf
of
the
valley
health
system
of
hospitals.
I
certainly
don't
want
to
be
repetitive.
Madame
madam
chair,
thank
you
for
the
opportunity
to
testify
and
support.
I
would
just
want
to
go
on
record
as
supporting
the
conceptual
amendment
put
together
by
the
stakeholders
led
by
bill
welch
and
tom
clark.
I
certainly.
I
N
H
N
N
L
Thank
you,
madam
chair
mark
kruger
for
the
record
attorney
general's
office
chief
deputy
attorney
general.
I
won't
need
to
take
three
minutes.
We
submitted
a
amendment.
The
reason
for
the
amendment
is
because
there
seems
to
be
unintended
consequences
with
capturing
confidential
investigations
by
the
attorney
general's
office
and
with
that
I'll,
take
any
questions.
A
Okay,
I
think
that
we
had
a
question
hold
on
mr
kruger.
You
were
briefer
than
I
was
expecting
you
to
be
so.
Give
me
a
minute.
A
L
Madam
chairman,
for
the
record,
the
second
piece-
that's
in
section
of.
A
L
L
We
conduct
a
confidential
investigations
and
a
lot
of
times
we
work
with
the
ftc
or
the
doj,
or
we're
working
underneath
the
court
order,
or
with
other
states
and
the
the
unintended
consequence
of
not
exempting
out
the
confidentiality
of
those
investigations
would
basically
put
us
at
odds
with
our
federal
or
state
partners
or
a
court
in
our
ability
to
continue
our
investigations,
which
we
already
have
under
authority
under
598a,
by
exempting
us
out
from
the
reporting
of
information
that
we
receive
during
those
investigations
that
will
protect
that
information.
L
L
The
the
bills
on
management
kruger
for
the
record,
the
bill's
language,
won't
prohibit
us
from
doing
the
activities,
but
will
make
it
impossible
for
us
to
do
the
activities
with
our
federal
or
state
partners
so
in.
In
effect,
it
would
act
as
a
barrier
from
us
being
able
to
conduct
our
thorough
investigations
into
anti-trust,
which
would,
ironically,
thwart
the
exact
reasons
for
the
the
bill
in
the
intent
to
take
a
peek
at
health
care
costs
and
and
make
sure
that
you
know
the
health
care
costs
are.
L
You
know,
have
a
good
competition
in
the
marketplace.
Go
ahead.
No!
You
go
ahead.
In
addition,
I
wanted
to
point
out,
though,
at
the
same
time
we
might
be
able
to
benefit
in
our
investigations
by
receiving
certain
information
from
the
ppc
that's
collected
through
this
bill
and
that
information
to
the
extent
that
we
could
receive
that
and
conduct
an
investigation
under
our
authority
may
also
give
us
as
a
whole,
help
in
making
sure
that
the
markets
are.
You
know,
there's
competition
and
they
could
be.
A
Robust
okay,
and
is
it
the
claims
data
specifically
that
we
anticipate
being
in
the
database
that
you're
concerned
about.
L
Madam
chairman
or
kruger
for
the
record,
it's
not
specifically
the
claims
data.
What
it
is
is
going
back
to
section
one.
It's
the
data
regarding
the
cost
of
health
care,
and
particularly
consolidation
among
entities
that
provide
for
health
care.
A
All
right
cnn,
thank
you,
mr
kruger,
for
spending
your
afternoon
slash
early
evening
with
us.
Okay,
now
we
are
going
to
go
to
the
phone
lines
and
open
neutral
testimony.
N
N
N
N
P
Central
to
ensuring
that
this
non-personal
information
is
properly
appended
to
a
particular
vehicle
is
the
unique
17-digit
vehicle
identification
number
otherwise
known
as
the
venn.
The
vent
alone
is
a
unique
oem
generated
vehicle
identifier
that
possesses
no
relationship
whatsoever
to
an
individual.
P
Given
our
background
comments
this
evening,
carfax
submits
to
the
committee
that
the
vehicle
identification,
number
or
vin
should
be
stricken
from
the
current
definition
of
direct
patient
identifier
in
senate
bill
40.,
second
and
equally
as
important,
given
the
construct
of
the
current
definitions
of
direct
and
indirect
patient
identifiers,
we
also
would
recommend
that
license.
Plate
number
be
appropriately
reclassified
as
an
indirect
identifier,
given
its
public
visibility
and
inabil
inability
to
identify
an
individual
carfax
appreciates
this
rare
opportunity
to
make
comments
to
the
health
and
human
services
committee.
N
A
B
Thank
you,
tara,
ratty,
sarah
hagian,
for
the
record,
I,
my
closing
remarks
are
similar
to
the
last
measure
and
I
just
would
be
remiss
if
I
didn't
acknowledge
all
the
hard
work
that
went
into
this
measure
by
the
patient
protection
commission
and
all
the
stakeholders
who
have
come
together
to
try
to
improve
upon
the
bill
language.
And
so
I
stand
ready
for
any
questions
and
thank
you
for
this
opportunity.
C
I
appreciate
it.
I
apologize
for
not
asking
it
earlier
in
the
year
and
if
I
somehow
missed
an
answer
to
this
previously,
I
will
apologize
in
section
one's
done
section
two.
C
The
commission
is
empowered
to
basically
mandate
analysis
of
health
care
information
from
local
governments.
Have
you
gotten
any
feedback
from
from
help
from
those
local
governments
on
that
language?.
B
C
Yeah,
I
appreciate
just
those
one
thing
to
get
a
report
like
request,
an
existing
report
or
something
like
that,
but
requiring
another
government
to
do
an
analysis
of
information
is
something
new.
So
I
appreciate
it.
Thank.
B
You
senator
kekefer
sarah
hagian
for
the
record,
if
I
can
in
section
one
it
does
say
that
the
commission
may
request,
and
so
just
for
clarity.
I'd
like
to
point
out
that
I
believe
that
would
happen
in
the
form
of
a
public
meeting
or
a
public
request
by
the
commission,
and
there
would
be
a
process
for
that
to
happen,
and
so
then
the
local
governments
would
be
properly
notified
of
what
the
commission
is
intending
to
request.
So
I
don't
believe
it's
an
automatic
mandate
on
the
local
government.
C
Yeah
I
appreciate
that
that
it
could
certainly
be
done
during
a
public
meeting.
I
think
if
the
commission
itself
decides
to
make
a
request,
though
a
second
sentence
is
that
a
governmental
entity
from
which
such
a
report
shall
provide
the
report,
so
that's
just
stronger
than
we
usually
do
thanks
appreciate
it.
Thank
you.
A
Okay.
So
again,
I
would
like
to
express
my
gratitude
to
the
patient
protection
commission,
who
put
in
some
long
hours
many
meetings
to
bring
us
these
two
concepts.
Actually,
I'm
sorry,
I
should
close
the
hearing
on
sb
40
and
then
just
want
to
make
some
general
comments
so
again
want
to
express
my
gratitude
to
the
patient
protection
commission
for
the
long
long,
hard
work
that
they
did
on
bringing
these
two
concepts
forward.
A
One
focused
on
making
sure
that
some
of
the
really
would
have
been
impressive
gains
in
terms
of
use
and
access
of
telehealth
during
the
state
of
emergency
could
continue
on
after
the
emergency
is
completed
and
the
second
making
sure
that
we
are,
I
think,
taking
a
significant
step
forward
towards
the
transparency
of
health
care
so
that
we
can.
Hopefully,
I
think
the
end
goal
be
managing
costs,
and
so,
hopefully,
with
all
of
the
very
very,
very
many
details
that
we
discussed
today
that
those
two
concepts
are
shining
through.
A
I
want
to
thank
again
senator
spearman
for
getting
the
ball
rolling
on
the
apcb
last
session,
and
I'm
appreciating
that
the
work
has
expanded
across
the
country.
She
was
probably
bleeding
edge,
maybe
now
we're
leading
edge,
or
maybe
in
the
middle
on
that
that
concept,
but
I'm
happy
to
see
this
work
continuing
forward,
and
then
I
want
to
express
my
gratitude
to
all
of
the
stakeholders
and
ms
schulhagen,
who
have
spent
quite
a
bit
of
time
getting
us
here.
A
You
may
be
surprised
to
know,
I
think
we've
cut
the
content
of
the
amendments
by
half
from
where
we
started,
there's
still
quite
a
bit,
probably
still
some
work
to
be
done,
but
there
that's
that's
our
gift
to
you
that
maybe
we
put
them
down
in
half,
but
there's
been
a
lot
of
good
work
done
by
a
lot
of
people.
I
think
more
conversations
to
have.
The
last
thing
I
would
like
to
do
is
just
give
mr
higgins
just
the
briefest
of
moments
to
talk
about
an
exciting
announcement
today.
A
I
believe
the
announcement
was
made
today
about
a
project
that
the
state
of
nevada
has
been
included
into
as
just
a
little
teaser
and
to
encourage
folks
to
go,
find
out
more.
B
B
I
anticipate
a
further
deliberation
at
the
commission's
upcoming
meeting
on
monday
march
15th,
starting
at
9
a.m.
So,
if
I
can
make
a
plug
in
here
to
have
anyone
follow
along
the
commission's
work
and
discussion
as
we
start
rolling
up
our
sleeves
and
getting
to
work
in
addressing
health
care
costs
in
our
states
by
implementing
measures,
benchmark
measures
for
healthcare.
N
A
All
right
sounds
like
we've
warned
people
out
go
team
hhs
all
right.
I
appreciate
everybody's
participation
in
these
bills.
They're
they're
complex,
but
important
with
that
we
will
go
ahead
and
call
this
meeting
adjourned.
Everybody
have
a
great
evening,
we'll
see
you.