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A
A
This
is
my
third
session
and
for
the
entirety
of
that
time
I
have
sat
right
next
to
or
in
between
senator
hardy
and
senator
spearman,
and
I'm
going
to
be
the
first
one
to
say
that
I
don't
believe
in
term
limits
and
we
are
going
to
lose
some
really
good
people
to
term
limits
this
year,
and
so,
given
that
this
could
be
the
last
opportunity,
today's
meeting
will
be
chaired
by
the
one
and
only
senator
joe
hardy,
so
senator
hardy.
Whenever
you
are
ready,
we
are
ready
to
be
in.
B
I'd
like
to
call
the
human
and
health
services
meeting
to
order
and
we
will
be
going
in
the
following
order-
that
is
totally
flexible,
but
we
will
be
starting
with
assemblywoman
garlow,
presenting
ab216
those
of
you
that
are
on
the
video.
B
We
welcome
your
participation
and
we
will
call
on
support
after
assemblywoman
garlow
speaks
and
then
we'll
from
the
audience
here
and
then
go
on
the
phone,
and
we
hope
that
there
are
people
who
are
here
that
will
be
able
to
back
you
up,
assemblywoman,
carlo.
So
without
further
ado,
we've
been
through
this
before.
If
you
would
like
to
go
ahead
and
present,
and
that
is
ab216.
C
Thank
you,
mr
chair
and
members
of
the
senate,
hhs
committee.
For
the
record.
My
name
is
michelle
gorla
I
represent
assembly
district
35
located
in
southwest
clark
county.
I'm
pleased
to
be
here
today
to
co-present
assembly
bill
216.,
I'm
also
joined
by
mary
liberati
and
I
hope
she's
on
the
zoom
she's,
with
administrator
for
aging
disability
division,
ab216
mandates
that
the
state
plan
for
medicaid
include
coverage
for
cognitive
assessments
and
care
planning
services
provided
to
persons
with
symptoms
of
cognitive
impairment.
This
would
include
alzheimer's
or
dementia.
C
Alzheimer's
disease
is
the
single
most
expensive
disease
in
the
united
states,
outpacing
the
cost
of
cancer
and
heart
disease,
and
an
analysis
by
the
alzheimer's
association
calculated
the
direct
cost
posed
to
caregivers
totaled
305
billion
dollars
in
2020
alone.
The
alzheimer's
association
also
estimates
that
medicare
and
medicaid
covers
67
of
the
total
costs.
C
There
are
several
early
intervention
and
detection
strategies
that
can
avoid
the
astronomical
expenses
associated
with
late
stage,
dementia
and
alzheimer's.
In
fact,
the
milken
institute
released
a
report
showing
that
early
diagnosis
in
the
mild
cognitive
impairment
stage
could
create
cost
savings
as
much
as
7.9
trillion
in
u.s
health
and
long-term
care
expenditures
by
enabling
better
planning
management
and
care.
C
Ab216
requires
estate
plan
for
medicaid
to
cover
the
non-federal
share
for
cognitive
assessment
and
care
planning
services
for
persons
with
cognitive
impairment,
symptoms
by
funding
assessments
and
care
planning.
We
can
get
ahead
of
cognitive
decline
to
ensure
those
suffering
and
their
caregivers
can
manage
the
devastation
of
cognitive
impairment
and
for
family
members.
Families
with
members
who
may
have
alzheimer's
this
bill
will
ensure
support
services
are
in
place
as
the
disease
progresses.
C
B
D
Good
afternoon,
chairman
hardy
and
members
of
the
committee,
my
name
is
mary
laverati
m-a-r-y-l-I-v-e-r-a-t-t-I,
I'm
a
volunteer
with
the
alzheimer's
association
aarp
and
the
nevada
commission
on
aging.
So
today,
I'm
representing
the
commission
on
aging,
I'm
a
retired
administrator
for
aging
and
disability
services.
So
I'm
I'm
currently
just
volunteering.
D
As
you
heard,
this
bill
is
going
to
allow
our
families
who
have
alzheimer's
to
to,
and
it
enables
the
physician
to
spend
more
time
with
them
to
actually
do
a
thorough
assessment
and
diagnosis
and
then
to
help
with
the
care
planning.
So
I
just
want
to
give
you
a
little
bit
of
background
on
dementia
is
not
just
for
seniors.
D
D
So
we
know
that
it's
more
prevalent
for
65
and
older
older,
but
here
in
nevada,
according
to
a
2015
survey
conducted
by
nevada,
department
of
health
and
human
services,
it
showed
that
16
percent,
or
one
in
six
nevadans
between
the
ages
of
45
and
64,
reported
worsening
confusion
and
memory
loss
that
we
call
subjective
cognitive
decline.
Scd.
D
So
the
importance
of
early
and
accurate
diagnosis
is
because
younger
younger
onset,
dementia
affects
work,
finances
and
family
many
times.
People
are
still
employed
when
this
happens.
An
early
inaccurate
diagnosis
is
crucial
also
to
rule
out
other
potentially
treatable
conditions
and
to
get
the
most
appropriate
treatment
early
in
the
disease
process.
D
My
own
experience
is
that
my
father
one
day
thought
there
was
an
intruder
in
his
house
called
the
police,
the
police
came.
He
didn't
believe
they
were
the
police,
wouldn't
let
him
in
the
house
and
a
neighbor
finally
came
over
and
helped
convince
him
that
they
were
the
police.
D
D
D
D
In
addition,
it
allows
individuals
to
apply
for
disability
insurance
and
supplemental
income
benefits
from
the
social
security
administration
and
of
vital
importance.
It
also
allows
individuals
to
access
clinical
trials
that
are
ongoing
across
the
country,
and
we
know
that
we'll
only
find
a
cure
with
research,
so
this
service
that
we're
asking
for
here
in
nevada
is
already
covered
by
medicare
and
by
tricare
it
was
added
to
those
programs
in
2018.,
while
nevada
doesn't
cover
it.
There
are
16
other
states
that
have
this
service.
D
We
feel
that
there's
future
cost
savings
through
the
social
security
administration,
which
has
a
for
younger
onset
alzheimer's.
It
has
that
condition
under
its
compassionate
allowances
initiative,
which
gives
that
anybody
with
the
disease
and
expedited
access
to
social
security,
disability
insurance
and
also
supplemental
security
income.
D
D
B
F
I
don't
have
a
question,
mr
chairman,
but
I
would
say
that
I've
worked
with
mary
liverati
for.
G
So
so
my
question
would
be
a
couple
of
things:
the
cognitive
impairments,
a
lot
of
people
just
talk
about
dementia,
alzheimer's,
but
there's
that
other
disease,
lewy
bodies.
That
is
really
really
rare,
and
I
don't
know
that
we've
come
up
with
anything
that
will
help
people
to
get
through
that.
G
D
For
the
record
mary
liverati,
dementia
is
like
think
of
it
like
vegetables
and
then
all
of
lewy
body,
alzheimer's
frontal
temporal,
are
all
like
the
carrots
celery
potatoes.
So
dementia
is
the
overarching
disease,
so
we
are
doing
a
lot
of
research,
but
I
have
not
heard
anything
specifically
with
that's
covet
related,
although
I
can
get
that
information
for
you
and
get
back
to
you.
I'd
be
happy
to
provide
that.
I
had
cancer
treatment.
G
C
H
Thank
you.
Actually,
I
am
from
a
beautiful,
downtown
boulder
city
and
I
can't
tell
you
what
a
delight
is
to
be
here
as
senator
hardy
hosts
the
last
meeting
this
one
he
used
to
be
my
doctor,
and
so
it's
wonderful
to
see
you
again.
I
want
to
thank
the
entire
group
for
your
time
and
consideration.
H
As
you
listen
to
my
story,
my
husband
drew.
Was
he
celebrated
his
47th
birthday
living
his
dream?
He
had
a
dream
engineering
he
owned
and
restored
and
maintained
a
fleet
of
vintage
airplanes.
He
was
an
accomplished
worker.
He
was
an
avid
reader,
traveler
history
buff
and
he
was
living
his
dream
as
a
737
captain
for
a
major
airline
a
month
after
his
47th
birthday,
he
would
surrender
his
pilot's
license.
H
H
H
I
will
know
that
his
mother
had
alzheimer's.
She
died
when
she
was
58.
He
has
two
sisters,
one
of
them
has
already
passed
away
and
the
other
one
is
in
the
middle
moderate
stages
of
alzheimer's.
H
I
took
him
to
the
doctor
and
three
years
later
after
mris
pet
skins,
numerous
blood
tests
for
everything,
including
heavy
metals.
What
have
you?
The
dna
blood
test
showed
that
he
had
the
genetic
mutation
on
14,
chromosome
and
another
procedure
confirmed
elevated
levels
of
tau
protein
in
his
spinal
fluid,
it
was
official,
he
had
alzheimer's
disease,
they
referred
to
it
as
apaoe-4,
which
is
a
rare
form
of
alzheimer's
that
presents
itself
in
younger
people.
It
also
is
responsible
for
familial
cases,
and
he
was
only
50
years
old
at
this
time.
H
H
H
I've
got
two
molars,
I
was
experiencing
atrial
fibrillation
and
so
eventually
the
last
18
months
of
his
life
were
spent
in
a
very
nice
clean,
safe
group
home
that
specialized
in
dementia
and
they
tended
to
his
every
need,
but
they
did
not
accept
medicare
and
so
social
security,
disability
insurance
covered
about
60
and
the
rest
of
it
was
out
of
pocket,
and
I
was
with
him
as
he
drew
his
last
breath.
Only
two
weeks
after
his
58th
birthday,
my
husband
of
30
years
was
now
gone
and
I
was
a
widow
at
55.
H
So
now
what
I've
been
fortunate
enough
to
be
able
to
work
with
the
alzheimer's
association
as
a
volunteer
here
in
the
desert
southwest
chapter
for
five
years
now,
I've
been
doing
educational
presentations,
facilitating
caregiver
support
groups
and
for
the
senior
center
for
the
nevada,
state
veterans,
home
and
now
I've
been
recently
become
an
advocate
of
something
that
is
very
near
and
dear
to
my
heart,
and
I
have
to
say,
my
story
is
not
unique
in
any
way
the
caregivers.
H
B
I
Ready
good
afternoon,
chair
hardy
to
the
committee,
miss
lynch
will
provide
testimony
in
neutral.
There
was
a
fiscal
note
on
this
bill
that
was
removed
because
we
believe
that
this
is
a
savings
based
off
of
delaying
care
into
a
nursing
facility
and
providing
other
services
such
as
home,
health
and
personal
care
services,
and
so
this
lynch
will
speak
to
the
policy
and
testimony.
But
I
can
answer
any
questions
that
can
make
me.
B
J
J
F
Mr
interim
chair
and
members
of
the
committee
for
the
record,
my
name
is
barry
gold,
b-a-r-r-y-g-o-l-d
and
I
am
the
director
of
government
relations
for
aarp
nevada.
I
first
have
to
apologize
to
mary
liberati
in
advance.
I'm
like
she's,
a
dear
friend,
but
I
heard
her
say
earlier:
dementia
isn't
just
for
seniors.
You
know.
I
think
we
need
to
put
that
on
a
t-shirt.
Maybe-
and
I
know
several
people
who
would
do
very
well
wearing
that
t-shirt.
F
But
anyway
we
we've
heard
what
the
bill
does
and
we've
heard
why
it's
important
and
we've
heard
about
the
terrible
impact
this
disease
can
have
and
all
cognitive
impact
can
have
on
people
earlier
in
their
lives.
F
J
K
Thank
you
chair
hardy
and
committee
members,
misty
grimmer
with
the
ferraro
group
representing
the
alzheimer's
association.
I
certainly
have
nothing
more
powerful
to
say
than
what
miss
peterson's
story
already
conveyed.
So
I
will
just
let
you
guys
know
that
we
are
in
very,
very
strong
support
of
this
bill
and
I
hope
that
you
move
it
right
out
of
that
committee
today,
so
we
can
make
sure
it
gets
through
the
process.
Thank
you.
J
For
the
callers
that
have
just
joined
us,
we
are
on
testimony
in
support
of
ab216.
If
you
would
like
to
provide
testimony
in
support,
please
press
star
9
now
to
enter
the
queue.
B
J
B
K
K
We
just
wanted
to
go
on
record
today,
thanking
mary
liberati
and
all
the
members
of
the
commission
on
aging
for
their
leadership
and
working
and
collaborating
on
this
bill.
We
believe
that
this
bill
will
have
a
tremendous
impact
on
the
populations
that
adsc
serves,
and
I
would
also
like
to
add
that
this
film
may
reduce
unnecessary
guardianships
in
our
state
unnecessary
in
our
state,
and
we
appreciate
the
input
on
the
fiscal
note
from
our
colleagues
at
dhcsp.
J
J
Chair
at
this
time,
there
are
no
additional
callers
wishing
to
testify
in
a
neutral
position.
C
Thank
you
chair
and
thank
you.
Members
of
the
senate,
health
and
human
services
committee
really
appreciate
your
consideration
for
this
bill
and
if
I
could
take
a
moment
of
privilege,
I
would
also
like
to
ask
everyone
to
come.
Join
me
for
the
walk
to
end
alzheimer's
in
october,
it's
october
2nd
in
sparks
and
october
16th
in
las
vegas.
So
thank
you
very
much.
B
F
Thank
you,
chair
and
members
of
the
committee
for
the
record.
I'm
david
orent
liquor
representing
assembly
district
20.,
I'm
here
to
present
assembly
bill
191,
which
requires
medicaid
to
reimburse
services
provided
by
community
health
workers
and
by
doing
so
that
will
increase
the
capacity
of
our
health
care
system
for
prevention
and
early
treatment,
and
that
will
lead
to
considerable
cost
savings,
and
I
will
now
turn
it
over
to
our
my
co-presenter
j
colbert
clauselle,
who
will
tell
us
more
about
the
role
of
community
health
workers.
B
L
L
L
Chws
are
community
members
who
bridge
the
gaps
in
nevada's
health
care
system,
chws
come
from
underserved,
rural
and
urban
communities.
They
represent
the
diversity
of
our
state
in
the
medical
service
sector,
medical
chws
provide
education
and
training
for
patient
self-management
and
are
defined
in
nrs
449.0027.
L
The
nevada
division
of
public
and
behavioral
health
trialed
chw
service
in
our
state
and
found
a
nearly
two
dollar
savings
for
every
dollar
spent.
Er
visits
decreased
fourteen
percent
urgent
care
by
six
percent.
Acute
admits
by
eighteen
percent
and
repeat
hospital
visits,
reduced
twenty
percent
when
chws
were
utilized
to
manage
chronic
illnesses.
L
B
I
Deputy
administrator
dwayne
young
for
the
record
chair
hardy
and
we've
discussed
this.
I
know
several
times
in
several
sessions
and
this
has
evolved.
We
would
stand
this
up
as
a
separate
provider
type,
and
so
the
community
health
worker
would
enroll
into
medicaid,
but
they
would
be
linked
to
either
that
physician
that
aprn
or
that
physician
assistant
they
themselves
would
bill
linked
with
that
enrollment
linked
and
they
would
be
reimbursed
as
a
separate
provider
type.
I
Dwayne
young
deputy
administrator
for
the
record,
the
money
goes
to
the
enrolled
provider
and
so
the
that
that
provider
could
have
another
arrangement
with
their
supervising
provider
in
which
they
do
the
billing
collectively
for
the
group.
But
that
is
not
an
arrangement
that
nevada
medicaid
is
involved
in.
B
G
Thank
you.
So
I
have
a
question
and
my
concern
would
my
question
is
about
what,
if
anything,
are
we
doing
or
do
we
need
to
do
to
make
sure
that
the
community
health
workers
are
representative
of
the
communities?
The
diverse
communities
here
in
nevada.
I
Deputy
administrator
dwayne
young
for
the
record,
and
so
I
may
I
will
start-
and
I
may
pass
this
off
to
mr
colbert,
but
I
believe
that
there
is
language
actually
previously
within
nrs,
which
focuses
in
the
regs
that
the
community
health
workers
must
be
representative
of
the
communities
that
they
serve.
I
We
know
that
the
existing
community
health
workers
that
are
being
utilized
through
community
coalitions
through
local
hospitals,
fairly
qualified
health
centers
through
grants
are
representative
of
that
community
and
are
also
bilingual
or
multilingual
in
order
to
reflect
the
needs
of
the
community
in
which
they
serve.
G
So,
thank
you.
Thank
you.
So
I
guess
what
I'm
asking
a
little
bit
more
pointed
it's
it's
in
the
regs,
but
sometimes
the
regs
don't
translate
into
reality,
and
so
my
my
concern
would
be
if
we're
going
to,
if
this
is
going
to
be
implemented,
to
make
sure
that
that
it's,
even
with
respect
to
and
representative
of
the
communities
that
we
serve
nevada,
is
getting
more
gray
and
nevada's
getting
more
diverse.
G
But
if
we're
not
intentional
about
making
sure
we're
reaching
out
to
bipolar
communities
to
make
sure
that
the
people
who
are
in
those
communities
that
are
already
doing
the
work
that
we're
partnering
with
them
getting
them
on
board
getting
iodized.
However,
that
looks
and
and
I'm
saying
that,
because
of
of
the
things
that
have
not
happened
during
covet.
L
So
if,
if
I
may
speak
to
that
through
you
chair
hardy,
it
is
absolutely
the
concern
we
do
not
have
a
diverse
health
work.
Workforce
in
the
state
of
nevada
and
community
health
workers
are
the
easiest
door
in
so
we're
starting
programs
at
high
schools.
L
The
chw
program
itself
we're
bringing
in
new
instructors
who
represent
different
communities.
So
we
have
an
instructor
from
fernley
we're
bringing
in
an
instructor
from
a
urban
las
vegas
community,
who
will
fortunately
start
in
june
and
so
by
by
representing
everybody
in
those
instructors
and
in
the
current
work
pool
that
we
have
we're
able
to
bring
in
a
more
diverse
workforce
that
can
then
go
on
to
social
work
positions
or
pursue
higher
nursing
degrees.
So
it's
a
it's
a
door
in
to
people
who
haven't
been
or
had
access
to
these
positions
before.
G
Thank
you.
That's
that's
very
insightful.
If,
if
I
can
be
so
bold,
not
that
you
don't
know,
but
just
humor
me
a
couple
of
things
that
I
think
we
we
might
do
better
as
a
state
when
we're
talking
about
reaching
out
to
bipolar
communities
is
to
go
to
the
people
that
know
the
people
like
churches,
fraternity,
sororities,
community
organizations,
those
sorts
of
things
and
and
listening
sessions
to
find
out
what
we
need
to
do
differently.
G
But
my
fear
is
that,
if
there's
not
any
intentionality
about
making
sure
that
we're
reaching
out
and
we're
acknowledging
diversity
that
it
will
it
will,
it
will
land
the
same
way
every
other
bill
lands.
And
if
we're
not
intentional
about
developing
some
type
of
a
template
to
do
outreach
with
with
diverse
communities,
then
nothing
happens
except
good
intentions.
That
really
don't
go
anywhere
and
don't
please
don't.
Please
don't
hear
that
as
a
slam,
I'm
just
I'm
saying
you
know
generally,
if
what
whatever
we
don't
plan
on
really
doesn't
happen.
L
And
I,
through
you
chair
hardy,
I
I
absolutely
agree.
I
I
think
you've
hit
the
nail
on
the
head
and
we
are
applying
for
funding
to
hire
chws
directly
in
these
communities
from
every
source
we
can
find
out
there.
So
we
have
coveted
relief
funds
that
are
specifically
targeted,
targeted
to
hispanic
and
native
american
tribal
agencies,
we're
looking
at
updating
our
curriculum
by
bringing
in
consultants
from
the
communities
who
can
help
review
any
all
of
the
language
and
and
work
to
address
those
issues.
L
So
I
I
think
you're,
absolutely
correct
and,
like
my
my
office,
is
actually
right
above
the
healthy
communities
coalition
food
pantry.
So
I
get
to
be
like
right
there
with
the
communities
that
that
we're
serving
so
that
we
are
listening
and
we
have
that
voice.
B
Any
other
comments
I
have
a
question
when
a
physician
assistance
for
assistant,
for
instance,
is
working
with
the
physician,
there's,
usually
an
agreement
that
we
have
to
have
in
place,
and
the
board
of
medical
examiners
is
interested
in
what
that
agreement
is
and
that
we
have
a
official
designation
who
we
are
supervising.
B
What
are
the
ways
that
those
agreements
have
worked
or
working
or
how
we
can
not
recreate
the
wheel,
but
get
something
done
that
physicians
are
then
comfortable
with
the
liability
issues
they
have
and
the
board
certification
they
have,
and
how
does
that
work?
And
mr
oren
licker
assemblyman
orrin
lecker
would
probably
like
to
feel
that
thanks.
L
So
this
is
a
really
important
through
you
chair.
If
I,
if
I
may,
this
is
again
a
super
important
question.
L
Most
states
that
have
community
health
workers
have
a
much
more
broad
supervision
provision
than
we're
looking
at
proposing
here,
and
I
I
think
our
very
conservative
method
is-
is
a
great
way
to
start
this
program
and
run
it
like
they.
These
other
programs
will
use
social
workers
and
of
these
other
different
provider
types
to
be
the
supervisor,
but
in
nevada,
that's
not
what's
being
proposed
here,
we're
looking
at
a
very
a
very
structured
setup.
L
The
community
health
workers
have
a
license
that
has
been
approved
and
we're
getting
a
lot
of
momentum
and
and
people
who
are
going
for
that
license.
They're
doing
continuing
education
classes,
the
they'll
be
working
with
the
physicians
and
the
apns
and
those
physician
assistants
with
a
lot
of
support
both
for
the
employer
who
are
working
with
the
medicaid
office
and
from
the
association
and
then
from
national
partners,
as
the
chw
programs
are
expanding
in
texas
in
california
to
to
really
make
sure
that
that
we
catch
things
early.
L
We
know
that
these
chws
are
qualified
to
do
the
tasks
that
they're
doing
and
that
they're
able
to
connect
to
the
tasks
that
that
they're
not
able
to
do
and
and
so
there's
kind
of
two
pieces
to
your
question.
There's
there's
the
one
side
of
of
this
following
the
the
cash
that
goes,
and
I
think
our
medicaid
office
has
has
looked
at
that,
and
I
could
let
them
speak
to
that.
L
And
then
the
side
that
I'm
more
looking
on
is
that
responsibility
and
that
accountability
piece,
because
we
want
this
program
to
be
successful.
We
need
more
outreach
workers.
We
we
need
more
touches
with
with
the
clients
or
the
the
healthcare
clients
in
the
state
of
nevada
and
that's
what
this
is
really
looking
to
expand
so
that
we
can
reduce
and
and
not
demand
so
much
of
our
health
care
systems,
because
we're
catching
things
so
early.
L
We're
teaching
things
in
a
culturally
relevant
way
in
the
appropriate
languages
and
in
directly
in
the
communities
and
the
schools
and
the
homes
in
the
churches
that
that
people
actually
live
and
where
they're
going
to
build
those
trusting
relationships.
B
L
A
great
question
chair
hardy
so
as
chw
is
not
required
to
have
a
license
to
be
called
a
chw,
but
I
believe
for
the
medicaid
reimbursement
that
that
license.
They'll
they'll
need
to
pursue
that,
and
I
can
defer
that
to
the
medicaid
office.
I
L
That
has
already
been
created
and
we
currently
are
running
the
classes.
So
a
lot
of
employers
are
using
the
program,
even
though
this
hasn't
been
tied
with
with
the
medicaid,
so
this
bill
isn't
about
creating
the
program
the
program's
already
there.
This
is
about
that
medicaid
reimbursement
for
those
staff,
members
who
are
serving
those
medicaid
clients.
B
I
I
would
need
to
dwayne
young
for
the
record
I
would
need
to
confer,
but
that
was
accomplished
in
the
2015
session,
perhaps
mr
robbins,
to
provide
this
information.
B
F
F
Yes,
a
community
health
worker
pool
means
a
person
or
agency
which
provides
for
compensation
and
through
its
employees
or
by
contract
with
community
health
workers.
The
services
of
community
health
workers
to
any
natural
person,
medical
facility
or
facility
for
the
dependent
the
term
does
not
include
an
independent
contractor
who
personally
provides
the
services
of
a
community
health
worker
or
a
facility
for
the
dependent
or
medical
facility
other
than
a
community
health
worker
pool
which
provides
the
services
of
a
community
health
worker.
F
F
Well,
that's
partially
right!
I
I
think
that
it
would
be
a
pool
could
be
paid
under
this,
but
it
also
could
be
if
a
community
health
worker
is
working
for
a
facility,
then
they
would
get
paid
through
that
facility
or
if
a
community
health
worker
is
working
for
a
physician,
a
physician
assistant
or
an
advanced
practice
registered
nurse
in
their
individual
capacity.
B
A
Thank
you
senator,
and
I
appreciate
the
line
of
questioning
and
thanks.
I
think,
we're
getting
to
clarity,
the
community
health
worker
models
that
I'm
familiar
they're
generally
working
for
agencies,
many
non-profit
agencies.
So
I
think
the
way
that
I
understand
it
is.
They
have
to
be
supervised
by
the
list
of
licensed
professionals
that
are
in
the
bill,
but
not
necessarily
sponsored
by.
If
that,
I'm
not
sure
that
that's
a
legal
term,
but
the
agency
will
be
paying
them.
A
The
agency
would
also
be
paying
the
physician
or
the
apr
whatever
the
list
of
licensed
professionals
is
that
they
can
work
under
here.
The
physician,
physicians,
assistants
or
aprns,
but
not
necessarily
a
direct
pay
relationship
between
those
two,
but
there
always
has
to
be
a
supervisory
relationship
between
those
two.
Is
that
correct,
assemblyman
or
enlightener,
or
mr
colbert
cluster.
L
D
F
About
partnering,
with
the
office
of
minority
health
and
equity.
D
To
possibly
do
a
little
bit
of
outreach
and
and
gain
some
cultural
competency
for
for
these
community
health
workers.
I
Dwayne
young
for
the
record,
yes
senator
hardy
and,
as
said
chair
radio
has
pointed
out.
We
just
require
that
and
I
use
the
term
licensure
we
use
when
it's
licensure
or
certification,
in
this
case
certification
as
a
requirement
of
enrollment
that
physician,
physician,
assistant
or
aprn
is
the
supervisor.
But
yes,
they
are
certainly
employed
through
agencies,
as
I
pointed
out
earlier,
federally
qualified
health
centers
and
a
marine
of
medicaid
providers,
and
this
would
provide
that
reimbursement
back
to
them.
But
the
arrangements
may
be
multi-varied
based
on
their
current
payment
arrangement.
B
L
It
chair
hardy,
we
do
have
a
curriculum
and
we
did
that
with
the
nevada
certification
board
kind
of
created
that
and
workshop
that
we're
looking
at
updating
that
curriculum
a
little
bit
right
now,
but
those
classes
are
ongoing
and
we
can't
open
enough
classes
they're
very
popular.
L
It's
an
eight-week
program
just
to
give
you
kind
of
a
scope
of
that
that
distance.
There
are
two
other
programs
that
do
chw
education
in
the
state.
One
is
a
college
of
southern
nevada
and
then
another
one
is
at
truckee
meadows,
community
college
and
all
three
of
us
work
together
and
apply
for
funding
jointly.
B
Thank
you
any
observations
or
questions
about
that.
So
what
I
as
I
understand
it,
then
what
we're
doing
with
this
bill
is
we're
going
to
get
a
stream
of
income
that
will
help
the
community
health
care
workers
have
motivation
to
become
one
to
work
with
in
within
the
system
and
to
be
able
to
expand
all
the
healthcare
delivery,
particularly
we're
interested
in
health
professions,
shortage
areas,
the
bypaw
communities,
the
zip
codes
that
are
recognizing
that
and
it
sounds
like
you're
committed
in
that
same
direction.
Is
that
all
true
I
see
heads
shaking.
B
Thank
you.
Thank
you.
Any
other
comments.
If
we
could
have
those
who
would
be
in
support
of
this
in
the
room
come.
B
F
Thank
you
chair
hardy
members
of
the
committee
for
the
record.
My
name
is
katie
ryan
and
I'm
the
system
director
of
government
relations
for
nevada
for
dignity,
health,
saint,
rose,
dominican.
We
provided
a
letter
of
support
to
the
committee,
we're
so
grateful
that
the
interim
health
committee
took
this
up
as
one
of
their
issues.
Last
interim
and
during
normal
circumstances
we
have
chws
and
promotores
out
in
the
community
doing
this
work
teaching
about
disease,
chronic
conditions,
etc.
F
B
F
Thank
you
chair
hardy
and
committee
members.
My
name
is
kendall
lyons
and
I
am
the
director
of
health
policy
for
children's
advocacy
alliance.
I
sit
here
not
only
as
an
advocate
for
children
and
families,
but
also
as
a
former
community
health
worker
for
one
of
the
medicaid
managed
care
organizations
in
our
state.
F
B
J
J
J
J
Sure
it
seems
that
this
caller
is
having
some
technical
difficulties.
I
will
move
on
to
the
next
one
and
then
circle
back.
If
that
is.
J
K
K
Today
I
offer
support
on
behalf
of
the
nevada
aap
in
favor
of
ab191
community
health
workers
play
a
crucial
role
in
the
dissemination
of
medically
accurate
information
to
various
communities.
In
one
specific
study,
research
showed
that
community
health
workers
significantly
improve
the
health
outcomes
of
children
with
asthma.
Community
health
workers
have
great
potential
to
improve
kids
access
to
health
care
and
increase
family's
adherence
to
providers
recommendations.
K
The
nevada
aap
currently
has
more
than
250
members,
most
of
whom
are
board
certified
pediatricians.
Both
primary
and
specialty
care
members
also
include
pediatric
nurse
practitioners,
physician
assistants,
pediatric
residents
and
medical
students,
all
of
whom
live
and
work
in
nevada
and
have
dedicated
their
professional
lives
to
the
health
of
all
children.
Thank
you
for
this
opportunity
to
speak
in
support
of
ab191.
J
E
E
J
J
B
J
J
J
Queue
chair
howdy
at
this
time.
No
callers
are
wishing
to
provide
testimony
in
a
neutral
position
for
ab191.
K
B
Thank
you
very
much.
Are
there
any
comments
from
the
sponsor
mr
assemblyman
orenlicker?
If
you
could
come
make
any
closing
comments,
you'd,
like
sure.
F
B
Oh
we're
missing
somebody
we're
moving
forward
anyway,
and
we
will
accept
senator
harris's
vote
when
and
if
she
gets
back.
Thank
you,
those
in
favor
of
the
motion,
please
say
aye
aye,
any
opposed,
say,
nay,
motion
passes.
Thank
you.
B
B
M
Thank
you
senator
hardy
and
members
of
the
senate,
health
and
human
services
committee.
I
think
that's
where
I
am
right
now.
Please,
someone
tell
me:
okay,
all
right
right
place,
my
name
is
chandra
summers,
armstrong-
and
I
am
the
assembly
woman
for
assembly
district
six
before
you
today
to
present
assembly
bill
256,
which
would
enable
medicaid
coverage
for
non-medical
doula
support
services.
M
I'm
joined
here
today
by
our
fearless
community
advocate
quentin
savoir
of
make
it
work.
Nevada,
miss
jolina
walker
of
the
kg
sisterhood
we
have
lauren
is
that
lauren,
no
erin,
okay,
I'm
confused
and
we
have
mr
dwayne
young
from
hhs.
M
I
actually
believe
we
have
lauren
on
the
phone
lauren
kilagritis
of
thrive,
wellness
of
reno
and
the
reno
doula
project
and
there's
one
more
person
on
zoom.
I
don't
recognize
the
face.
If
you
could
please
just
wave.
M
Oh
okay,
it's
been
a
day.
All
right,
you
can
tell
I'm
nervous
all
right.
So
let
me
start
this
presentation
with
a
personal
story.
In
january
1987
I
found
out,
I
was
pregnant
with
my
first
child.
I
was
living
with
my
first
husband
in
the
small
town
of
fispec
west
germany,
and
we
were
stationed
in
an
air
force
forward
operating
location.
M
The
nearest
military
hospital
was
over
two
hours
away
in
a
port
town
of
bremerhoffen
because
of
the
distance
between
where
we
lived
in
fispec
and
the
military
army
hospital
in
bremerhoffen.
I
was
given
the
option.
I
could
either
go
to
bremerhoff
in
two
weeks
before
my
due
date
and
stay
in
the
hospital
to
have
my
baby
or
I
could
in
have
services
at
the
local
german
hospital.
M
So
I
decided
I'm
going
to
have
my
baby
in
the
local
hospital.
They've
got
to
have
some
great
folks
here,
and
so
I
signed
up.
I
didn't
know
it
at
the
time,
but
part
of
the
continuum
of
care
in
that
region
was
the
services
of
a
midwife.
Her
name
was
gisela
busa.
M
She
was
a
stout
dark-haired,
no-nonsense
woman,
who
spoke
very
little
english,
and
although
she
had
a
firm
demeanor,
froubusa
exuded
kindness
and
competence,
she
was
just
what
I
needed
as
a
first
time
mom.
I
was
5
000
miles
away
from
my
mom
having
my
first
baby
and
she
provided
everything
that
I
needed
at
that
time.
M
M
She
talked
to
me
about
how
to
position
the
baby
during
the
day
so
that
we
wouldn't
have
aspirations
and
sids,
and
I
was
able
to
attend
lamar's
classes
and
leche
lee
classes
in
her
home.
She
had
a
two
or
three
story
house
and
the
first
floor
padded
room,
and
there
were
probably
a
dozen
of
us
young
moms
that
would
go
to
her
house
on
a
weekly
basis
for
this
training.
M
She
was
my
rock
during
the
birthing
process.
Epidurals
are
not
common
in
their
healthcare
delivery
system
and
that's
where
lamaze
came
in
and
she
really
helped
me
get
through
with
breathing
concentration
touch
and
encouragement,
and
after
I
had
the
baby,
she
visited
me
every
day
in
the
hospital
in
germany.
At
that
time,
a
new
mom
stayed
in
the
hospital
for
six
days
six
days,
and
you
can
imagine
that
I
felt
fabulous,
because
this
woman,
who
thought
she
was
my
mama,
made
sure
that
I
got
the
best
care
possible.
M
Current
best
practices
tell
us
that
non-medical
doula
services
are
great
and
providing
great
at
providing
support
for
the
mom,
while
the
midwife's
job
and
the
physician
delivers
the
baby,
and
so
I
just
want
to
share
that
with
you
all
to
just
to
let
you
know
that
this
is
a
personal
issue
with
me
when
quentin
came
to
me
with
this
legislation.
M
This
is
the
first
thing
that
came
to
my
mind.
Was
this
amazing
experience
I
had,
and
I'm
just
really
excited
to
be
here
to
present
to
you
and
at
this
moment
I'd
like
to
turn
the
presentation
over
to
mr
quentin
savoir
of
make
it
work
nevada
and
he
can
explain
how
his
organization
is
engaged
in
advocating
for
this
bill.
N
Thank
you
ter
hardy.
Thank
you
assemblywoman
for
the
record.
My
name
is
quentin
savoie,
I'm
the
deputy
director
at
make
it
work
nevada,
make
it
work,
nevada,
education
fund.
We
build
power
around
economic
justice,
racial
justice
and
reproductive
justice.
Part
of
the
mission
of
our
organization
is
to
advocate
for
the
health
and
vitality
of
our
community
members
and
ab256
is
anchored
in
that
intention.
N
We
are
facing
a
national
maternal
health
crisis
in
this
country,
as
the
united
states
is
the
most
dangerous
place
in
the
developed
world
for
an
expectant
parent
to
give
birth.
Let
that
set
in
the
reality
is
even
more
dismal
for
black
women
who
die
at
disproportionately
higher
rates
than
their
counterparts.
N
43
black
women
die
every
100,
000
live
births,
and
that's
just
unacceptable
in
the
greatest
nation
on
earth.
When
I
first
learned
of
this
statistic
it
devastated
me,
it
devastated
me
because
I
know
how
I
feel
about
my
own
mom.
It
devastated
me
because
I
couldn't
help
but
think
about
all
the
future
nevadans
that
would
be
born
into
this
world
without
their
mothers.
N
I
was
overcome
with
grief
wondering
how
many
of
these
children
would
never
know
the
unconditional
love
and
comforting
warmth
of
their
mama.
It
didn't
take
long
for
us
to
find
out
that
the
national
trends
that
we're
facing
as
a
country
are
particularly
present
right
here
in
nevada.
We
conducted
field
research
and
a
series
of
focus
groups
in
order
to
best
understand
the
health
needs
of
our
community
members.
N
Our
black
women's
agenda
survey,
a
survey
of
more
than
one
thousand
black
women
in
nevada,
discovered
that
more
than
a
fifth
of
respondents
reported
maternal
health
as
their
most
preeminent
and
pressing
issue.
We
also
found
that
one-fifth
of
respondents
reported
feeling
like
they
had
no
control
over
their
body
or
the
decisions
associated
with
their
body.
N
In
the
series
of
focus
groups,
we
hosted,
we
were
able
to
dig
a
little
deeper.
It
was
in
these
conversations
that
we
learned
the
troubling
realities
that
postpartum
has
on
new
parents:
the
women
in
birth
parents.
We
spoke
to
talked
about
feeling,
stressed
fatigued
and
experienced
hardships
with
chest
or
breastfeeding,
amongst
other
hardships
that
a
non-medical
doula
would
be
aptly
capable
of
supporting
a
parent
through.
N
Finally,
these
conversations
culminated
with
our
community
members,
revealing
that
doulas
would
be
the
most
helpful
resource
during
pregnancy,
alongside
parenting
classes
and
additional
resources
to
help
them
with
postpartum
depression.
Our
research
and
conversations
resulted
in
the
pursuit
of
this
legislation.
N
There
is
immeasurable
value
in
having
support
guidance
and
an
ally
when
navigating
all
the
logistics,
uncertainty
and
newness
of
childbirth.
Furthermore,
research
has
found
that
mothers
and
expectant
parents
that
have
access
to
doulas
have
improved
birth
outcomes
and
improved
overall
health.
Ab256
is
community
driven
policy
at
its
core.
It's
about
the
type
of
future.
We
want.
Our
nevada
and
children
to
have,
hopefully
it's
one
where
we
see
value
in
their
lives
before
they
even
arrive.
N
Hopefully
it's
one
where
we
ensure
that
their
mother
or
birth
parent
has
access
to
any
and
all
the
resources
that
not
only
can
ensure
a
safe
and
healthy
birth,
but
also
ensure
a
postpartum
period
that
is
met
with
support
and
ease
instead
of
trauma
and
stress.
We
can
do
something
about
this
and
we
should
thank
you
for
your
time
and
attention
and
I'm
now
going
to
turn
our
presentation
over
to
one
of
our
community
partners,
jolena
simpson,
with
the
kijiji
sisterhood.
Thank
you.
O
O
O
We
build
relationships
that
connect
to
the
heart
and
the
desire
of
birthing
families
as
they
work
to
bring
a
healthy
baby
into
the
world.
Duel
is
our
coach,
confidant
teacher
and
hype
man.
We
stand
beside
and
hold
space
for
our
strong
birthing
people
through
education,
conversation
and
support.
We
provide
vital
connections
to
understanding
and
navigating
the
birth
process.
O
O
Research
shows
that
doula
care
can
help
mitigate
some
of
the
negative
social
determinants
of
health,
such
as
poverty
and
systemic
racism,
which
can
negatively
impact
birthing
outcomes.
Dueling
doula
care
provides
clients
with
a
sense
of
agency,
feelings
of
personal
security,
respect
and
autonomy,
doulas,
provide
knowledge,
transference
and
connectedness
in
communities
of
color
rural
environments
and
low-income
communities.
This
translates
to
better
birth
and
postpartum
outcomes.
O
We
provide
a
continuity
of
care
that
brings
community
with
us
when
we
step
into
the
hospital
with
our
clients,
we
also
provide
support
and
resources
to
our
clients.
When
they
go
home,
we
have
eyes
on
hands
on
and
hearts
on
our
clients.
We
stand
in
the
gap
to
provide
resources
to
protect
a
birthing
person
and
their
new
baby,
because
we
take
time
to
build
relationships
with
clients.
We
are
often
the
first
call
when
they
have
questions
or
concerns.
O
We
reaffirm
them
as
parents
and
connect
them
with
medical
providers
and
community
resources
such
as
lactation,
professionals,
affinity,
support
groups
and
mental
health
providers.
Doula
work
is
work.
I
have
been
a
professional,
a
birth
professional
in
las
vegas
for
18
years,
and
I've
seen
families
choose
unsupported
birth
and
postpartum
because
they
were
unable
to
finance
it.
I
have
personally
sat
in
the
living
room
with
postpartum
families,
with
mothers
who
are
exhibiting
suicidal
ideation,
and
I
stayed
with
that
mother
until
their
till
their
partner
could
get
home
and
provide
support.
O
We
connected
them
with
emotional
support,
educational
support
and
medical
support
and,
with
their
permission,
provided
reports
to
their
care
provider,
so
that
they
could
be
brought
into
the
loop
to
support
that
family
doulas
spend
hours
in
direct
one-to-one
care
with
each
client,
doulas
and
communities
will
often
reduce
their
fees
or
go
unpaid
to
support
families
at
their
own
financial
expense.
O
Paying
community
doulas
is
one
way
to
support
health
and
economic
well-being
within
our
communities,
simply
because
a
birthing
person
is
unable
to
pay
for
their.
The
expanding
rates
of
private
doula
care
does
not
mean
that
they
are
any
less
deserving
of
this
protection
and
support
by
allowing
equitable
medicaid
reimbursement,
we
will
be
able
to
serve
our
communities
in
a
way
that
is
financially
viable
for
both
the
birthing
families,
the
community
and
the
doulas.
Thank
you.
M
Thank
you
chair
at
this
time.
I'd
like
to
go
to
the
phone.
We
have
lauren,
I'm
going
to
say
her
last
name
properly,
so
I'm
just
going
to
stick
with
lauren
until
I
can
get
it
upright
lauren
provided.
If,
if,
if
the
folks
in
the
broadcast
can
help,
there
is
a
powerpoint
that
we
provided
on
that
lauren
provided
to
us.
B
J
K
B
The
the
chair
is
going
to
make
a
decision,
we're
convinced
without
a
powerpoint.
K
Thank
you
so
much
for
inviting
me
here
today.
Hi
everyone.
My
name
is
lauren
calagridis
and
I'm
calling
to
voice
my
strong
support
of
baby
256.,
I'm
a
psychotherapist
focusing
on
perinatal
mental
health
in
northern
nevada,
as
well
as
the
doula
with
reno
doula
project
and
bright
heart
birth.
I'm
also
the
program
manager
of
thrive
wellness
of
reno's.
It
takes
a
village
program
which
is
the
only
intensive,
outpatient
mental
health
treatment
program
in
nevada
that
specializes
in
the
treatment
of
perinatal
mood
and
anxiety
disorders,
which
impact
upwards
of
20
percent
of
birthing
people.
K
Many
other
partners
and
those
numbers
are
disproportionately
high
during
the
pandemic
as
well.
In
my
role
at
thrive,
I
see
connections
every
day
between
high
rates
of
perinatal
mood
and
anxiety
disorders
and
corresponding
birth
trauma,
lack
of
social
support,
cesarean
births
and
other
factors
that
duels
can
directly
reduce
and
positively
impact.
K
Doulas
are
also
key
referral
sources
that
get
parents
to
us
who
are
struggling
and
link
them
to
the
kind
of
psychiatric
and
medical
support,
as
well
as
community
resource
supports
that
they
need
and
deserve.
They
leverage
the
trust
and
deep,
knowing
they
have
of
their
clients
in
order
to
connect
them
to
the
care
that
is
needed
when
things
are
most
dire.
K
Beyond
the
central
goal
of
preventing
human
suffering
related
to
perinatal
mental
health
struggles,
it
is
also
reasonable
to
assess
that
duels
pose
additional
cost
savings
potential
in
terms
of
preventing
and
lessening
the
need
for
additional
psychiatric
and
mental
health
treatment,
postpartum,
which
many
insurers
are
paying
for
at
great
length.
In
this
way,
dual
coverage
is
a
powerful
intervention
that
meets
the
department
of
health
and
human
services,
triple
aim
of
improving
health
outcomes,
quality
of
care
and
cost
savings.
K
I
truly
believe
that
the
expansion
of
medicaid
coverage
in
the
state
of
nevada
would
benefit
all
parties
involved
from
health
care
providers,
looking
to
improve
birth
outcomes,
to
overextended
nurses,
on
labor
and
delivery
floors
to
insurers,
looking
for
cost
saving
opportunities
to
doulas
that
are
hustling
and
hustling
out
of
pocket
to
make
sure
that
people
in
their
community
access
the
support
that
they
deserve
and,
of
course,
the
most
most
of
all
the
birthing
people
themselves
who
deserve
to
have
experiences
that
are
supported,
safe
and
dignified.
Thank
you.
So
much.
M
B
Thank
you.
We
have
a
exhibit
powerpoint
exhibit
attached
as
well
as
we
have
this
wonderful
summary
of
the
methods
of
state
savings,
and
we
see
the
fiscal
note.
That
is
a
negative
fiscal
note.
In
other
words,
this
is
going
to
save
money
and
I
may
be
taking
somebody
else's
thunder,
but
I
don't
mind
if
they
don't
say
anything.
A
Thank
you,
chair
hardy.
I
appreciate
the
opportunity
so,
unlike
the
the
first
two
bills
that
we
heard
this
session,
it
looks
like
doula
services
are
not
an
eligible
service
for
medicaid
automatically
and
that
it
requires
that
we
apply
for
a
waiver,
and
so
just
wanted
to
have.
Whoever
is
best
situated,
who,
I
suspect,
will
be
the
fabulous
dwayne
young
to
walk
us
through
the
process
for
applying
for
the
waiver
and
what
the?
What
the
conditions
of
that
waiver
are.
I
Dwayne,
young,
deputy
administrator
for
the
division
of
healthcare,
financing
and
policy
for
the
record,
the
language
in
the
bill
is
written
as
a
state
plan
or
waiver.
The
good
news
is,
we
do
not
have
to
apply
for
a
waiver
for
these
services.
We
can
actually
add
this
through
the
state
plan
process,
and
so
it
does
not
have
that
additional
financial
impact
and
is
much
easier
to
do.
A
Fantastic,
so
the
intention
then,
would
be
to
put
this
in
the
next
spa
state
plan.
Amendment.
I
Again,
dwayne
young
for
the
record.
Yes,
I
believe
the
effective
date
is
for
the
first
of
the
year,
and
so
in
the
interim
we
would
work
with
stakeholders.
There
is
a
provision
within
the
bill
that
says
we
determine
the
enrollment
based
off
of
our
work
with
stakeholders,
there's
several
different
national
recommendations
and
certifications
that
we
would
apply
that
to.
We
would
build
the
state
plan,
as
well
as
the
corresponding
policy,
and
have
that
ready
to
roll
out
at
the
top
of
the
year.
B
C
Good
evening,
chair
members
of
the
committee
for
the
record,
my
name
is
christine
saunders
and
I'm
the
policy
director
with
progressive
leadership,
atlanta
nevada,
here
in
support
of
assembly
bill.
256
nevada
has
made
a
commitment
to
addressing
maternal
mortality
in
the
state,
but
there
are
still
women
who
have
been
left
behind.
According
to
the
national
academy
for
state
health
policy,
black
and
indigenous
women
are
three
to
four
times
more
likely
to
die
from
pregnancy-related
causes
than
white
women.
C
Culturally
competent
doulas
are
able
to
provide
support
and
care
to
improve
birth
outcomes
for
women
of
color
data
shows
that
doula
assisted
mothers
were
four
times
less
likely
to
have
a
low
birth
weight,
baby
2
times
less
likely
to
experience
a
birth
complication
involving
themselves
or
their
baby,
less
likely
to
require
a
cesarean
section
and
significantly
more
likely
to
initiate
breastfeeding
medicaid
coverage
of
doula
care
will
ensure
that
all
future
nevadans,
regardless
of
their
family's
economic
status,
are
born
with
the
best
possible
health
outcomes
and
support
from
the
state.
We
urge
your
support.
Thank
you.
F
P
P
According
to
america's
health
rankings,
nevada
ranks
46
of
the
50
states
when
it
comes
to
women
in
health,
children's
health,
mostly
due
to
the
state's
low
position
of
population
ratios.
We
also
recognize
that
women
who
are
medicaid
beneficiaries
are
at
the
highest
risk
of
poor
birth
outcomes
in
the
united
states,
and
women
of
color
are
especially
vulnerable
and
face
many
barriers
when
accessing
doulas.
P
J
J
J
K
K
B
J
K
Hi
good
afternoon,
for
the
record,
my
name
is
christine
hernandez,
c-r-I-s-t-I-n-a
h-e-r-n-a-n-d-e-z
and
I
had
something
really
profound
written.
But
jolina
simpson
did
a
wonderful
job
making
the
case
for
doulas,
and
I
just
urge
you
all
to
support
this
bill
and
thank
you
so
much
to
assemblywoman
summers,
armstrong
and
to
make
it
work
for
pioneering
this.
J
K
Hello,
mr
chairman,
in
the
committee
for
the
record,
my
name
is
emily
barney
I
spelled
e-m-I-l-y
b-a-r-n-e-y.
K
I'm
again
a
voice
of
many
and
everyone
has
done
an
incredible
job
of
advocating
for
doulas
and
the
community,
and
so
I
will
just
say
that
I'm
in
strong
support
of
ab256,
especially
for
that
of
families
of
color,
who
have
not
had
access
to
dealers
for
far
too
long
and
need
to
have
more
resources
in
order
to
improve
their
birth
outcomes
and
decrease
the
likelihood
of
negative
birth
outcomes
in
the
maternal
mortality
crisis
that
is
currently
happening
in
our
country.
So
I
strongly
strongly
strongly
support
this
bill.
Thank
you.
So
much.
J
K
Hello,
my
name
is
sarah
joelton
for
the
record.
That's
e
s-a-r-a-h-g-e-o,
w
a
l
t
o
n.
I
am
representing
bright
heart:
birth
services
biggest
little
baby,
the
tricky
middle
birth
network
and
the
reno
jeweler
project
in
northern
nevada.
I'm
currently
sitting
director
at
reno
jeweler
project,
which
was
started
in
2012
as
a
way
to
help
parents
access
doula
support
historically
having
a
doula
was
one
of
a
thing
that
only
people
of
privilege
were
allowed
to
access.
K
The
real
deal
project
mission
is
to
close
the
gap
in
access
by
reducing
the
cost
of
a
doula
through
an
income-based
lighting
scale,
ensuring
that
families
of
all
income
levels
are
able
to
hire
a
doula.
This
is
an
incredibly
important
and
personal
goal
of
mine.
There
is
no
doubt
that
doulas
provide
a
necessary
service.
K
Birthing
people
who
have
doulas
attend
their
birth
have
lower
rates
of
unnecessary
interventions
during
labor
and
higher
rates
of
birthing
satisfaction,
in
addition
to
the
renal
jeweler
project,
I'm
also
a
birth
and
postpartum
doula,
a
certified
child
birth
educator,
the
owner
of
a
local
family
resource
center
and
the
owner
of
bright
harper
services.
Breithart
works
tirelessly
to
make
the
role
of
doula
a
legitimate
within
the
field.
K
J
K
J
P
For
the
record.
We
are
pleased
to
support
bill
av256.
Our
focus
and
commitment
is
to
help
people
in
the
community
overcome
health
disparities
and
improve
birth
outcomes.
As
part
of
this
effort,
we
just
launched
a
do
a
pilot
in
clark
county
this
month
to
provide
peer
support
to
pregnant
women
during
pregnancy,
delivery
and
postpartum.
P
We
are
working
in
collaboration
with
ob
gyn
providers
to
assemble
this
birth
team.
Our
aim
is
to
surround
the
expectant
mother
with
support
to
meet
not
only
her
physical
needs,
but
also
her
emotional
and
psychosocial
needs.
As
we
began
having
these
conversations
in
the
community
with
doula
organizations,
the
cost
of
training
and
certification
was
identified
as
a
barrier
to
address
this
barrier
and
support
diversity
in
the
workforce.
We
are
providing
scholarships
to
become
trained,
certified
doulas.
J
B
F
K
M
F
M
Have
it
okay?
The
last
slide
that
I
wanted
to
share
with
you
all
was
a
picture
of
frabusa
and
I
there
are
two
pictures.
One
of
them
is
of
me
as
a
young
25
year
old,
first
time,
mom
and
a
picture
of
fabulous,
and
I
in
2013,
when
I
went
back
to
germany
to
visit
with
her
to
give
her
an
update
on
the
two
beautiful
boys
that
she
helped
me
to
birth
and
to
check
to
see
how
she
was
doing
birth
professionals,
whether
they
are
doulas
or
midwives,
really
really
impact
the
lives
of
birthing
moms.
M
B
Thank
you
appreciate
you.
Bringing
this
forward
to
us
is.
Are
there
feelings
on
on
the
committee
take
that
as
a
motion
meant
and
do
pass,
senator
reddy
and
second
by
senator
spearman
any
discussion,
all
those
in
favor
say
aye,
any
opposed,
say,
nay,
it's
unanimous
with
all
those
here
and
we
will
close
the
hearing
on
and
the
work
session
on,
ab256
and
open
the
hearing
on
ab192
assemblywoman
going.
B
Q
Thank
you,
leslie
cohen,
assembly,
district,
29
and
and
actually
assembly
bill
192
is,
is
our
bill.
It
came
out
of
the
interim
committee
from
the
2019-2020
interim
from
the
interim
committee
on
healthcare
and,
as
you
may
recall,
two
of
our
priorities
on
that
committee
were
public
health
and
maternal
and
child
health,
and
this
bill
addresses
both.
Q
That
report
to
the
cdc.
We
also
have
the
second
highest
rate
in
congenital
syphilis,
which
is
when
a
mother
with
syphilis
passes.
The
infection
onto
her
baby
during
pregnancy
and
trends
have
not
been
moving
in
the
right
direction
for
us.
Unfortunately,
according
to
the
cdc
nevada
saw
a
289
percent
increase
in
congenital
syphilis
between
2015
and
2018,
and
congenital
syphilis
can
significantly
affect
the
baby's
health.
It
can
cause
miscarriage.
Q
Stillbirth,
prematurity,
low
birth
weight
or
even
death
up
to
40
percent
of
babies
born
to
women
with
untreated
syphilis
may
be
stillborn
or
die
from
the
infection,
as
a
newborn.
Congenital
syphilis
can
also
result
in
deformed
bones,
enlarged
liver
and
spleen,
brain
and
nerve
problems
and
a
host
of
other
health
issues.
Q
So,
but
the
good
news
is
that
both
syphilis
and
congenital
syphilis
are
preventable.
Syphilis
can
be
treated
and
cured
with
antibiotics
and
congenital
syphilis
can
be
treated,
though.
Babies,
who
have
it
need
to
be
treated
as
soon
as
possible
to
reduce
their
risk
of
serious
conditions
and
the
key
to
treatment
and
prevention
are
ensuring
that
moms
are
tested
for
syphilis
and
receive
prenatal
care
as
necessary,
and
so
what
the
bill
does
is
it
aims
to
align
nevada's
std
testing
requirements
with
cdc
recommendations.
Q
I
can
go
through
the
bill
or
I
know
nope,
because
you
guys
are
good
readers.
I
remember
that
so.
With
that
I
can
take
questions.
We
should
have
on
assume
some
hhs
representatives,
so
right.
Okay,
so
I
see
miss
kessler's
there,
so
yeah.
I
think
we're
ready
to
take
questions
unless
ms
kessler
would
like
to
make
any
statements.
A
It's
not
even
a
question,
it's
a
comment.
I
it
has
been
good
to
to
hear
this
work
and
follow
this
work
from
the
interim
committee
on
health,
and
I
am
grateful
that
you
have
shepherded
it
forward
to
this
point
in
the
session.
A
I
think
that
the
data
was
compelling
and
obviously
the
population
that
we're
serving
there
was
a
lot
of
a
lot
of
focus
on
maternal
and
child
health,
and
so
just
just
my
gratitude
to
the
chair
of
the
interim
health
committee
for
continuing
to
focus
on
this
and
bring
it
forward.
I
think
we
decided
this
was
one
we
didn't
want
to
give
up
on,
and
here
we
are.
B
Thank
you.
Is
there
anyone
else
in
support
of
your
bill?
That
would
like
to
say
something
positive
about
ab9
192
briefly,.
Q
I
am
not
aware
senator,
but
if
I
could
briefly
leslie
cohen
assembly,
district,
29
and
and
thank
chair
roddy,
we
we
did
a
lot
of
great
work
over
the
interim
and
thank
you
as
well
for
that
work
and
I
think
the
bills
reflect
the
hard
work
that
we
did
during
the
interim
and
the
fact
that
they've
been
passing
and
and
doing
good
things.
F
Know
look.
This
is
an
important
bill.
I
just
want
to
make
brief
supportive
comments.
I'm
representing
both
the
southern
nevada
and
washoe
county
health
district,
but
you
heard
a
lot
of
the
stats
from
assemblyman
cohen,
about
nevada's
problem
with
syphilis,
and
really
our
sti
rates
are
are
all
very
high
across
the
board.
You.
F
J
J
Q
Thank
you,
leslie
cohen
assembly
district
29.
Thank
you
for
hearing
the
bill,
and
I
also
just
would
be
remiss
if
I
didn't
thank
mr
robbins
and
miss
camalossi
for
all
their
hard
work
on
the
bill
during
the
interim
and
during
session,
and
also
the
you
know,
our
our
hhs
partners
with
the
state
who
you
know,
brought
us
the
bill
and
made
us
aware
of
this
issue
and
also
worked
very
hard
on
it.
Thank
you.
B
Thank
you
any
comments
from
the
committee
member.
I
would
open
the
work
close
the
hearing
and
open
the
work
session
on
ab192
move
to
approved
by
senator
harris
and
second
by
senator
spearman.
Although
any
discussion,
all
those
in
favor,
please
say
aye,
all
those
opposed,
please
say
no
motion
passes
with
all
those
present.
Thank
you
very
much
close
that
work
session,
and
is
there
any
public
comment
here
in
the
room
or
on
the
phone
lines.