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A
With
that,
we
may
be
jumping
around
a
little
bit
today,
but
we're
going
to
go
ahead
and
try
to
get
some
business
done
quickly,
so
we're
going
to
start
with
the
work
session.
This
is
a
little
unusual
on
senate
bill
390.
This
is
a
bill
that
we
have
already
work
sessions
out
of
this
committee
with
an
amendu
pass.
It
went
over
to
finance.
There
was
a
pretty
significant
rework
of
this
bill
between
the
time
we
work.
Sessioned
at
mfinance
took
a
look
at
it
in
finance.
A
We
only
dealt
with
the
finance
issue
and
then
they
sent
it
back
over
here
so
that
we
could
look
at
the
full
amendment.
There
are
two
exhibits
posted
that
are
tables
that
are
our
walk
through
to
the
two
components
of
this
bill.
E
Good
afternoon
and
thank
you
senator
grady,
I
will
start
with
the
988
portion
of
sb
390.,
so
hopefully
for
your
reference,
you
have
a
document
that
is
entitled
crisis
response,
account,
988
and
crisis
services
and
I'll
walk
through
the
sections.
These
are
not
in
the
order
in
which
the
sections
appear
in
the
bill,
but
we
have
configured
these
high-level
overviews
in
a
way
that
I,
I
hope,
helps
to
explain
what
the
bill
is
intending
to
do
so
I'll
start.
Actually,
with
section
five,
and
in
section
five
of
the
bill,
the.
A
A
F
E
Okay,
so
section
5
establishes
the
crisis
response
fee
and
account
in
this
amendment.
It
is
the
state
board
of
health
that
adopts
the
regulations
establishing
the
amount
of
the
surcharge
for
the
988
call
center
operations,
mobile
crisis
and
crisis
stabilization
in
the
amendment.
The
surcharge
is
not
to
exceed
50
cents
per
month
per
line.
The
surcharge
is
collected
from
telecommunications
and
providers
and
then
transferred
to
the
division.
E
The
crisis
response
account
is
developed
in
the
state
general
fund
and
the
state
treasury
will
deposit
into
the
account
and
the
division
of
behavioral
health,
public
and
behavioral
health
will
administer
this
account
when
the
money
is
deposited
in
the
account
the
money
stays
in
the
fund
and
is
not
reverted
back
to
the
general
fund
at
the
end
of
the
year,
so
it
can
accumulate
those
dollars
and
that
the
money
will
be
used
for
988
operations,
technology,
mobile
crisis
and
crisis
stabilization,
as
it
was
authorized
through
the
federal
enabling
legislation.
E
The
bill
also
requires
obligations
of
the
division
of
public
and
behavioral
health,
which
essentially
requires
us
to
support
the
implementation
of
the
988
hotline,
establish
at
least
one
support
center,
and
that
would
be
the
the
call
center
encourage.
The
establishment
of
mobile
crisis
teams,
collect
required
information
on
the
hotline
and
collaborate
with
veterans,
crisis
line
in
the
national
suicide
prevention
hotline,
adopt
regulations
which
will
help
to
establish
the
qualifications
of
providers,
as
well
as
communication
and
sharing
of
information.
E
It
also
describes
what
the
support
center
is
required
to
do
as
it
is
affiliated
with
the
national
suicide
prevention
lifeline
and
then
establishes
accountability,
including
reports
concerning
the
usage
of
the
hotline
and
associated
services
which
need
to
be
reported
to
specific
entities
and
then
reports
concerning
revenue
generated
by
the
surcharge
deposits
and
expenditures.
E
A
Let's
pause
here
for
just
a
second,
so
senator
keith.
G
Thank
you,
madam
chair.
I
think
it's
probably
important
to
note
that
a
few
of
the
items
that
miss
watered
as
outlined
or
dr
woodard
has
outlined
are
different
than
what
was
presented
to
the
senate
finance
committee
earlier.
G
Well,
I
guess
last
week
at
this
point
right
last
week
I
don't
know-
and
I
think
a
couple
of
those
I
just
wanted
to
highlight
a
couple
of
those
points
because
we're
working
with
the
telecommunications
industry
who's
going
to
be,
you
know,
working
to
establish
or
stand
up
and
collect
a
lot
of
this
revenue.
G
So
I
think
it's
important
and
I'd
say
that
it
really
starts
in
section
three
on
page
four
of
the
bill
in
subsection
three,
that
provides
some
liability
protection
for
those
telecommunications
providers,
which
is
something
that
I
think
they
had
rightfully
requested.
If
you
move
on
to
page
six
of
the
mock-up
section,
five
subsection
or
at
the
bottom
of
subsection,
one,
the
the
cert,
the
amount
of
the
surcharge
is
capped
in
this
mock-up
on
the
top
of
page
six
at
50
cents.
G
I
think
that
if
we,
if
you
said
if
we
process
this
bill
tonight,
I'd
suggest
an
amendment
to
that
to
35
cents
and
knowing
that
I
believe
that
that
would
provide
revenue
sufficient
when
matched
through
the
federal,
the
available
federal
dollars
to
to
address
the
the
goals
and
objectives
of
the
account
and
then
additionally,
this.
G
This
provides
the
regulatory
oversight
for
creating
that
surcharge
to
the
state
board
of
health
rather
than
the
public
utilities.
Commission
and
the
the
everyone
will
then
have
to
go
through
the
usual
administrative
procedures,
act
to
to
walk
through
that
regulatory
process
at
the
board
of
health
and
alleged
comm.
G
Five
on
the
middle,
the
page
are
on
page
six
as
well
lines.
Eleven
and
twelve
12
indicates
that
any
funds
generated
by
this
this
new
surcharge
cannot
be
used
to
supplant
any
existing
funding
that
currently
is
used
for
those
behavioral
health
services.
So
those
are
the
primary
differences
between
what
was
presented
to
the
senate
finance
committee
in
this
in
this
section
of
the
bill
and
what
you
see
in
the
mock-up
today.
A
Great
thank
you
and
just
we'll
note
for
the
record
that
we're
in
agreement
with
all
of
those
changes,
and
so
that
is
a
considered
considered
to
be
a
friendly
change
to
the
bill,
all
right.
So
then,
dr
woodard,
if
you
would
move
on
to
the
opioid
settlement
portion
of
the
bill
and
as
concisely
as
possible,
talk
through
the
changes
there.
E
Sure
stephanie
woodard
again
for
the
record
and
moving
on
to
sd390
fund
for
resilient
nevada,
and
that
is
the
opioid
supplement
limitation
funding
sections
seven
through
nine
point:
five
in
the
bill.
What
this
section
of
the
bill
does
in
section
8
is
establishes
the
fund
for
resilient
nevada.
E
Recoveries
related
to
the
opioid
settlement
or
litigations
are
deposited
into
the
fund,
and
those
recoveries
can
be
in
a
lump
sum
on
through
scheduled
payments
and
likely.
These
are
going
to
be
occurring
over
years,
and
we
still
don't
know
how
much
is
expected
to
be
recovered.
E
It
also
establishes
an
advisory
committee
for
a
resilient
nevada
fund,
and
this
committee
is
created
to
advise
the
department
on
the
use
of
the
recoveries
related
to
combating
the
opioid
epidemic
and
the
appointment
of
the
members
is
split
in
part
between
the
attorney
general,
the
office
of
minority
health
and
equity
and
the
department
of
health
and
human
services.
E
E
The
state
plan
will
be
developed
based
on
the
needs,
assessment
and
the
priorities
established
and
that
state
plan
will
be
approved
through
the
legislature
or
ifc
in
order
for
the
department
to
distribute
money
from
the
fund.
According
to
that
state
plan,
the
department
will
allocate
funds
to
statewide
projects
and
there's
the
possibility
that
that
could
include
the
988
fund
or
the
the
crisis
response
fund
that
I
had
just
described
in
the
earlier
sections.
E
Some
some
significant
changes
to
the
version
that
you
have
before
you
today
compared
to
previous
versions.
We
really
want
to
focus
the
funds
for
resilient
nevada
on
statewide
projects.
However,
there
may
be
need
for
us
to
work
with
regional,
county,
local
or
tribal
agencies.
E
E
We
may
also
distribute
dollars
to
community-based
organizations
based
on
the
needs
identified
in
the
needs,
assessment
and
subsequent
state
plan,
and
the
state
plan
will
need
to
be
updated.
I
believe
it's
every
four
years
now
and
that
accountability
includes
reports,
considering
all
of
the
findings
and
recommendations,
as
well
as
funding
administered
out
of
the
account.
A
So
those
are
the
other
pieces
that
I
would
highlight
as
we
based
on
some
of
the
comments
from
the
committee
members
really
tightened
up
making
sure
there
are
multiple
places
in
the
bill
that
now
look
at
disparate
impact
on
certain
communities
and
make
sure
that
we're
doing
outreach
to
lots
of
individuals
who
we
may
not
get
to
otherwise.
A
So
those
are
the
big,
significant
changes
on
that
senator
keatcover.
A
G
Thank
you,
madam
chair.
I
appreciate
the
indulgence,
so
the
I
think
the
intent
coming
out
of
the
out
of
the
finance
committee
was
to
ensure
that
the
the
account
that
was
set
up
pursuant
to
this
act
would
be
an
executive
budget
account
and
that
we
would
budget
these
funds
similar
to
the
method
that
we
use
for
the
healthy
nevada
fund,
so
that
the
department
would
come
up
with
an
expenditure
plan.
It
would
be
incorporated
into
their
budget
proposal
and
we
would
move
forward
that
way
make
adjustments,
perhaps
as
necessary.
G
If
additional
settlements
come
in
during
the
during
the
interim,
we
could
do
that,
potentially
through
the
ifc
process.
I'm
not
positive
that
the
amendment
that
I
looked
at
previously
and
thought
accomplished
that
actually
does.
But
what
I'd
like
to
do
is
perhaps
move
forward
with
the
amendment
today
and
we
could
maybe
talk
about
that
a
little
bit
further,
but
certainly
what
we
do
have
before
us,
reinserts
the
role
of
the
legislature
in
the
process
and
ensures
that
it
moves
into
an
executive
budget
account
and
not,
and
rather
than
a
non-executive
one.
Thank
you.
A
Thank
you,
senator
kekefer,
so
with
that
that
explains
all
of
the
changes
this
bill
has
been
on
a
journey.
Let
me
just
say,
but
I
think
we're
getting
it
to
a
good
place
where
it
has
a
very
strong
programmatic
side,
where
we're
making
sure
that
the
settlement
dollars
get
used
to
address
the
impact
of
the
opioid
epidemic
as
well
as
making
sure
that
there's
a
good
focus
on
disparate
communities
and,
at
the
same
time,
are
doing
the
work
that
senator
kikefer
has
identified.
A
B
Thank
you,
madam
chair.
It's
not
not
a
question.
It's
a
comment,
dr
woodard.
Thank
you
and
senoretti,
and
everybody
that's
worked
on
this
bill.
This
is
this
is
quite
encouraging,
because
this
is
a
major
step
for
us,
moving
in
the
direction
of
bringing
equity
to
the
communities
that
have
been
hurt
so
badly
in
the
pandemic.
So
thank
you.
Thank
you.
I
really
appreciate
that.
A
H
Thank
you,
madam
chair.
So
if
I
could
understand
this,
I
got
two
markets
that
are
very
impressive:
the
work
that
went
into
them
so,
if
I
could
understand
it
on
the
fund
for
resilient
nevada,
I
know
state
money
is
going
to
this
unless
it
would
be
the
needs
assessment.
That
needs
to
be
done,
or
is
this
fund
completely
separate
and
distinct
from
any
state
money?
Therefore,
it
doesn't
have
a
two-thirds
requirement
to
increase
a
fee
or
tax
or
whatever.
A
Thank
you
for
the
question
senator
hardy,
so
the
fund
for
resilient
nevada
is
a
bucket
that
catches
all
of
the
settlement
dollars
into
an
executive
budget
account
so
that
they
can
be
appropriately
handled.
There
would
be
no
general
fund.
The
bill
does
contemplate
eight
percent
of
allowed
administrative
costs
so
that
the
work
can
be
implemented,
but
the
majority
of
it
gets
out
and
and
makes
a
difference.
H
A
Thank
you
for
the
question
so
in
that
fund,
that
is
the
surcharge
from
the
988
to
stand
up
the
988
hotline
and
that
35
cents
jumps
into
that
font,
35
cents
per,
and
it
is
no
longer
the
what
the
amendment
does
is.
It
puts
a
cap
up
to
35
and
then
the
regulatory
process
will
determine
what
the
actual
need
is,
but
it
can
go
no
higher
than
35
cents.
H
I
Yeah,
actually
that's
pretty
common,
where
the
legislature
sets
the
maximum
amount
of
the
fee
and
the
boards
can
prescribe
less
than
that
fee
if
they
want
that's
pretty
common
for,
like
professional
licensing.
Most
of
the
professional
licensing
boards
operate
that
way.
So.
H
A
A
I
Yeah,
I
would
also
like
to
point
out:
I
found
this
statute
nr
for
the
licensure
of
medical
facilities.
Nrs
lets
the
state
board
of
health
set
or
nrs
449.050
lets
the
state
board
of
health
to
set
application
fees
at
an
amount
determined
by
regulation
of
the
board,
so
in.
In
that
case,
the
state
board
of
health
does
determine
what
the
licensing
fees
are.
A
Appreciate
it
and
then
just
as
a
gentle
reminder,
the
reason
for
that
is
because
we
have
a
988
planning
grant
that
is
underway
at
this
time
and
through
the
process
of
that
988
planning
grant.
We
are
assessing
the
need,
which
will
therefore
determine
what
the
appropriate
budget
needs
are
to
set
that
fee
all
right,
mr
doc,.
A
H
Thank
you.
I
appreciate
it
so
the
way
I
see
this
is
I
mean
this
is
a
lot
of
work
went
into
this
I
and
I'm
impressed
one
of
the
challenges
I
have
is
you
know
where
this
is
all
going
to
fit
at
the
end
game,
how
we're
going
to
afford
this
and
how
we're
going
to
afford
that.
So
I
I
will
be
voting
no,
but
very
impressed
and
willing
to
look
at
this
in
a
changing
way
if
it
all
fits
together.
Thank
you,
madam
chair.
A
Thank
you
senator.
I
will
court
you
strongly
over
the
next
day
or
two
all
right
with
that.
I'm
looking
for
an
amended
pass
got
a
motion
from
senator
harris,
second,
from
senator
spearman,
seeing
any
any
discussion
senator
key
keeper.
A
Thank
you
for
the
clarification.
Yes
senator.
That
would
include
lowering
the
cap
to
35
cents,
all
right,
all
those
in
favor
signify
by
saying
aye
aye
any
oppose,
so
I've
got
everybody
in
favor,
except
for
senator
hardy
motion
passes
want
to
thank
the
committee
for
the
discretion.
That
was
the
oddest
work
session.
A
I
think
we
have
ever
done
but
important
in
terms
of
moving
that
bill
along
this
late
in
the
session,
all
right
with
that
we're
going
to
leave
work
session
and
we
are
going
to
open
the
hearing
on
sb
424
and
invite
senator
assemblywoman
make
sorry
for
not
424..
Let
me
try
again
348
assembly
bill
348
and
the
site
invite
assembly
carlton
to
the
diocese
to
walk
us
through
the
bill.
D
Thank
you
very
much,
madam
chair
and
committee
members
and
it's
nice
to
be
on
the
second
floor
again
and
I'll,
introduce
myself
as
assemblywoman,
maggie
carlton
representing
assembly
district
14,
former
senator
for
senate
district
21,
who
spent
a
lot
of
time
in
my
life
in
that
room
there
in
this
room
here.
So
thank
you
all
very
much
for
hearing
the
bill
today.
Let
me
get
everything
together.
We've
all
had
one
of
those
days
where
we're
running
from
place
to
place
and
I've
been
carrying
this
folder
with
me
for
most
of
the
afternoon.
D
So
thank
you
again.
I've
introduced
myself
and
just
to
let
you
know,
this
is
going
to
be
a
little
piece
of
history.
This
will
be
the
last
bill
that
I
present
in
this
building,
so
with
my
name
on
it
with
my
name
on
it,
so
the
other
ones.
I
don't
put
my
name
on
so,
but
moving
forward
so
before
you
today,
you
have
a
the
assembly
bill,
348
in
its
first
reprint.
It
went
through
a
huge
rewrite
in
the
assembly.
D
D
On
the
surprise
billing
bill
that
we
were
very
pleased-
and
I
was
very
honored
to
be
part
of
getting
passed
last
session
through
a
lot
of
those
conversations.
We
had
a
side
conversation,
an
intertwined
conversation
about
a
patient
protection
commission,
and
that
was
going
to
be
a
proposal
last
session,
but
when
we
saw
the
governor's
budget-
and
he
had
suggested
it
in
his
budget-
we
let
that
go
and-
and
we
went
with
the
governors
with
the
governor's
recommendation
and
the
patient
protection
protection
commission
was
set
up.
D
We
all
know
that
sometimes
the
first
time
around
the
block.
When
you
set
one
of
these
things
up,
it
doesn't
exactly
work
the
way
you
thought
it
was
going
to
be.
I
want
to
congratulate
the
executive
director
and
the
president
of
the
commission,
the
the
director
of
the
commission,
that
did
really
really
great
work
over
this
last
year.
They
had
a
number
of
meetings
and
considering
they
were
trying
to
get
things
done
in
a
pandemic,
but
I
do
know
it
did
take
a
while
to
get
it
set
up
and
running.
D
It
was
originally
proposed
to
go
to
aging
and
disabilities,
but
in
conversations
through
assembly
ways
and
means
and
senate
finance,
we
found
what
we
believe
to
be
a
better
home
in
the
office
of
the
director.
So
that's
the
the
first
thing
that
you
changed
and
that
has
been
changed
in
the
budget,
so
this
sort
of
became
a
de
facto
budget
implementation
bill.
With
some
of
these
changes
next,
you
go
through
the
change
in
the
different
memberships.
D
I'll
tell
you
that
the
concern
that
I
heard
in
most
of
those
concerns
I
heard
today
and
not
really
before
today,
but
today
is
that
folks
would
rather
see
more
people
come
on
to
the
patient
protection
commission
and
not
be
replaced.
The
proposal
in
this
bill
is
to
replace
some
folks.
It
is
to
get
this
commission
to
the
point
where
we
are
truly
talking
about
having
real
data,
talking
about
quality
of
health
care,
accessibility
of
health
care
and
the
affordability
of
health
care.
D
The
11
members
of
the
commission
at
this
time,
I
believe,
can
honestly
be
viewed
as
industry
stakeholders
in
a
number
of
ways
part
way
through
the
work
that
the
commission
was
doing.
I
started
to
hear
concerns
about
some
conflict
issues,
and
that
is
why,
in
this
bill,
you
will
see
that
we
added
the
standard
language
of
disclosure
and
conflict.
So
that
everyone
knows
who
they're
exactly
representing
so
we,
that
is
how
we
tried
to
address
that
particular
issue.
D
As
I
said
before,
I
think
the
executive
director
has
done
an
excellent
job
with
this,
and
I
believe
these
changes
in
membership
will
truly
make
a
signif
significant
difference
in
the
work
that
this
commission
will
be
able
to
do
in
the
future
to
get
good
hard
data.
As
long
as
I've
been
in
this
building.
Unfortunately,
we
have
had
to
make
a
lot
of
decision
based
on
health
care
with
anecdotal
data.
D
We
can
now
start
making
real
decisions,
and
you've
heard
me
say
that
before
so
as
you
go
through
the
the
membership
you'll
see
a
lot
of
it
being
switched
over
to
a
more
non-profit
world
than
the
for
profit
world.
Now,
just
because
you're
non-profit
doesn't
mean
you,
don't
have
a
budget
that
you
have
to
balance
and
you
don't
have
to
be
accountable
for
the
dollars
that
need
to
be
done,
but
it
does
mean
that
you
there
is
a
little
bit
of
a
different
attitude
towards
it.
D
So
we
try
to
incorporate
some
of
the
existing
positions
and
then
change
some
to
represent
a
more
broad
base
of
who
we
believe
would
actually
be
the
best
voice
for
patients
in
the
future.
So
I
would
be
happy
to
answer
any
questions.
I'm
I
cut
this
way
way
back.
I
know
you're
busy,
it's
not
a
long
bill
and
I'm
very
happy
to
answer
any
questions
on
on
the
bill
and
also
I
want
to
point
out.
I
apologize
madam
chair.
D
This
commission
will
have
sole
authority
over
the
millback
memorial
fund
program
that
the
patient
protection
commission
will
be
able
to
work
on
and
that
aims
at
sustainable
health
care
costs.
So
this
commission
will
have
sole
authority
over
that,
and
that
will
be
a
lot
of
work
for
them
to
get
done
over
this
next
biennium.
A
Thank
you,
assemblyman
carlton.
So,
first
of
all
I
wanted
to
thank
you
for
acknowledging
that
this
bill
had
the
all-payers
claims
database
in
it
and
for
working
with
the
executive
director
of
the
patient
protection
commission
early
in
the
session
to
make
sure
that
we
didn't
have
multiple
vehicles
and
conflicting
work
going
on
greatly
appreciated,
and
so
with
that
members
any
questions
senator
hardy.
H
Thank
you,
madam
chair.
I
think
the
sponsor
already
alluded
to
the
obvious
questions
that
I
have.
If
we
concentrate
on
the
non-profits
were
basically
not
getting,
you
know
half
or
more
of
the
care,
that's
provided
by
hospitals,
health,
insurers,
academic
institutions
and
the
drug
industry
or
the
pharmaceutical
industry.
So
that's
my
concern
with
the
bill.
I
think.
Realistically,
we
do
need
the
data,
we
do
need
the
input
and
I
think
it's
it's
a
one-armed
input
and
that's
my
concern
with
it.
Thank
you.
Manager.
G
Thank
you
good
to
see
you,
ms
carlton
I'll,
see
you
again
shortly,
but
my
question
is
related
to
the
health
information
exchange
language
in
in
section
three,
we
already
have
an
exchange,
or
am
I
misreading
what
section
three
one
c
does
you
know?
We've
got
the
statewide
designated
health
insurance
health
information
exchange,
which
is,
I
think,
working
to
continue
to
expand
and
build
out
their
their
network
of
providers
and
facilities
that
that
are
coordinating
the
exchange
of
health
information.
So
I'm
just
trying
to
understand
exactly
what
we're
getting
at
in
in
that.
D
I
believe
it's
just
to
allow
the
the
commission
to
have
have
some
jurisdiction
over
that
and
and
work
in
that
that
particular
area.
I
understand
it
fairly
well,
but
I
have
a
really
hard
time
and
senator
kirkhoffer.
You
just
played
stump
stumped
the
assembly
woman
on
that
on.
D
I
G
D
D
But
we
have
to
understand
that
this
current
committee
has
a
true
industry
flavor
to
it,
and
if
we're
going
to
have
real
honest
objective
conversations,
I
believe
the
industry
needs
to
step
back
and
let
other
folks
come
forward
and
have
those
real
conversations.
This
doesn't
say
that
the
industry
can't
participate.
D
They
just
will
not
be
voting
members
and
I
believe,
when
we
get
into
these
real
discussions
about
health
care
cost
in
the
future.
We
need
to
make
sure
that
we
have
folks
on
this
commission
that
don't
have
that
inherent
conflict
of
providing
data
and
having
conversations
about
what
costs
are
when
their
job
is
to
be
part
of
this
commission
but
they're
being
paid
by
an
industry.
So
I'm
trying
to
be
as
polite
about
this
as
possible,
because
I
understand
everyone
has
a
job
to
do.
I
represent
a
group
of
people.
D
A
J
J
You
hear
me
we
sure,
can
okay
great.
Thank
you
so
much
to
ready
members
of
the
committee.
My
name
is
sarah
higgian
for
the
record.
I
serve
as
the
executive
director
for
nevada's
patient
protection
commission.
Thank
you
so
much
to
chair
ready
to
give
me
a
moment
to
talk
about
the
peterson
milbank
program
for
sustainable
health
care
costs.
It
was
announced
back
in
march.
J
With
nevada's
participation
in
this
program,
we
are
receiving
technical
assistance
from
baylet
health,
who
is
helping
nevada
set
and
implement
healthcare
cost
growth
targets.
These
targets
are
really
a
first
step
towards
making
health
care
more
affordable
and
transparent.
J
What
this
program
is
really
aimed
to
do
and
the
project
or
goals
are,
is
to
focus
on
the
underlying
causes
of
the
rising
health
care
costs
and
really
to
develop
the
capacity
to
track
and
benchmark
healthcare
spending
across
payers
at
the
state
level
and
to
analyze
spending
data
in
an
effort
to
pinpoint
cost
drivers
and
inform
interventions.
J
I
can
continue
to
go
on
and
talk
about
this,
but
I'm
happy
to
take
any
questions
about
the
program.
It's
really
exciting
time
for
nevada
to
have
this
multi-state
collaborative
effort.
It's
a
two-year
program
that
really
just
helps
our
state
kind
of
launch
into
establishing
a
benchmark
and
looking
at
healthcare
spending
in
a
data-driven
way.
G
I
appreciate
that
and
I
I
do
now
recall
that,
as
you
said,
congratulations
for
for
leading
that
effort.
I
I
certainly
appreciate
it
and
is:
is
there
a
requirement
that
we
designate
a
lead
agency
to
as
a
part
of
that
participation?
Sometimes
sometimes
that
happens
and
tell
your
dog
I
said
hi.
J
Sorry,
chair,
ratty,
senator
ki
keffer
in
this
time
of
zoom
I
am
adapting
and
my
little
one
is
quite
rambunctious.
So
if
you
don't
mind,
would
you
please
repeat
that
question.
G
Yeah,
thank
you
I
appreciate
it
is.
Is
there
a
requirement
that
we
just
have
to
designate
a
lead
agency
as
a
part
of
the
or
the
sort
of
the
sole
authority
over
over
participation
in
that,
and,
if
not
that's,
okay,.
J
Thank
you
for
the
question
senator
for
through
you,
chair,
ratty,
back
to
senator
kikefor.
No,
there
is
no
program
requirement
to
designate
any
sole
agency.
Rather,
there
is
a
requirement
that
the
governor
designate
a
state
lead
to
manage
the
participation
of
this
program,
and
so
that
is
the
requirement.
A
B
Thank
you
so
much
carlton.
This
is
exciting
because
I
know
washington
state
has
done
this.
They
started
in
2014
and
that
was
the
bill
was
introduced
by
senator
randy
becker
and
I
believe,
if
I'm
not
mistaken,
it
passed
on
bipartisan
lines,
because
this
is
important
information
and
it
will.
It
will
put
more
power
in
the
hands
of
the
consumer,
because
they'll
be
able
to
see
exactly
what's
going
on.
So
thank
you.
H
Senator
spearman
did
not
say
the
va
hospital
was
going
to
be
involved
with
this,
and
I'm
just
wondering
if
we're
going
to
involve
the
va
hospital
sunrise,
obviously
is
a
profit,
but
the
va
hospital.
Isn't
you
know,
I
do
have
misgivings
about
the
one
armed
approach,
but
are
we
going
to
involve
the
va
system.
A
D
The
va
is
under
federal
jurisdiction
and
I
would
never
want
to
speak
for
the
feds.
I'm
not
sure
there
would
be
nothing
that
would
prohibit
them
from
participating
as
far
as
public
members
and
being
involved
in
the
meetings
and
making
sure
that
their
input
was
there,
but
as
far
as
how
they
are
actually
classified.
I
Yeah
eric
robbins
for
the
record
yeah.
If,
if
it's
a
yeah
non-profit
hospital
like
the
a
federal
hospital,
would
qualify
if
they
were
chosen
and
they
meet
the
other
criteria
and
they
wanted
to
participate.
D
And-
and
thank
you,
madam
chair,
that's
nice,
that's
that's
great
knowledge
to
know
and
and
as
this
bill
moves
forward,
letting
the
governor
know
so
that,
as
he
chooses
representation,
he
could
reach
out
to
someone
at
the
va
and
let
them
know
that
there
might
possibly
be
an
opportunity
for
them
to
participate,
because
this
still
will
all
be.
These
members
will
still
all
be
chosen
by
the
governor,
and
I
think
that
would
be
an
excellent
conversation
point
to
have
with
the
governor
as
we
move
forward.
A
A
C
C
Begin
hi,
my
name
is
stacey
passo
executive
director
for
the
health
services
coalition
representing
25
employer
and
union
sponsored
health
plans
in
southern
nevada,
we're
in
support
of
ab348.
Today,
when
the
governor
formed
the
ppc,
it
was
with
the
intention
of
protecting
the
patient,
with
price
focus
being
one
of
those
topics.
In
order
for
the
commission
to
be
effective,
we
need
to
ensure
patient
voices
are
front
and
center
of
the
ppc.
C
Not
just
have
the
industry
perspective
when
healthcare
policy
recommendations
are
being
shaped,
the
ppc's
main
mission
should
be
to
examine
healthcare
access,
quality
and
affordability
in
the
state
and
make
policy
recommendations
to
continue
to
improve
the
overall
healthcare
system
in
nevada
for
the
patient.
The
coalition
coalition's
hopeful.
The
opportunity
provided
by
this
commission
is
realized
ensuring
a
voice
for
the
patient.
Thank
you.
C
K
We
are
in
support
of
this
bill.
We
believe
this
is
a
good
policy.
We
believe
that
this
will
provide
information
on
behalf
of
the
people
that
actually
utilize
health
services.
We.
C
K
That
this
will
be
that
this
will
provide
more
of
a
perspective
from
the
health
people
who
utilize
the
health
services,
as
opposed
to
those
that
are,
you
know,
run
the
hospital
industry
or
run
the
medical
industry,
and,
most
of
all,
we
believe
that
the
positions
we
would
advocate
on
the
most
important
part
of
this
system.
This
will
provide
information
for
those
most
important
parts
of
the
system,
the
patients
it's
a
good
way
for
them
to
be
represented,
as
opposed
to
just
those
in
the
industry.
L
L
The
ppc's
primary
goal
is
examining
and
proposing
solutions
to
address
access,
quality
and
affordability
in
our
health
care
system.
There
is
no
question,
nevadans
need
and
deserve
access
to
high
quality,
affordable
health
care.
Unfortunately,
ensuring
the
ppc
is
getting
direct
is
getting
directly
patient
perspectives
and
experiences
has
really
been
a
challenge.
We
would
like
the
ppc
to
be
a
voice
for
patients,
which
can
then
be
the
backbone
in
developing
effective
policy
solutions.
L
We
support
ab348
and
assemblywoman
carlton's
efforts
to
ensure
a
diversity
of
critical
patient
voices
and
stakeholders
in
our
health
care
system
are
represented
on
the
commission.
The
inclusion
of
more
members
with
a
history
of
advocating
on
behalf
of
insured
and
uninsured
patients
and
working
in
the
non-profit
sector
is
simply
essential.
The
new
voices
will
bring
specific
and
much
needed,
patient-centered
expertise
crucial
to
the
commission's
work.
We
believe
the
intent
of
ab348
is
to
maintain
a
commission
size
that
does
not
become
unwieldy,
but
really
expands.
L
The
breadth
of
expertise
to
ensure
a
greater
focus
on
in
a
broader
range
of
patient
experiences
are
really
balanced.
With
the
industry,
perspectives
and
interests.
We
also
support
assemblywoman
carlton's
efforts
to
address
any
conflicts
of
interests,
adopt
needed,
bylaws
and
place
the
ppc
within
the
department
of
health
and
human
services.
L
A
C
A
I
appreciate
it
all
right:
we
will
go
to
neutral.
Is
there
anybody
in
the
room
would
like
to
test
find.
A
M
Thank
you,
madam
chair
members
of
the
committee.
My
name
is
jim
wadhams
w-a-d-h-a-m-s,
with
black
and
whatems
appearing
on
behalf
of
the
nevada
hospital
association.
Although
we
appear
in
neutral,
I
want
to
state
very
clearly.
We
have
no
opposition
to
expanding
the
additional
membership
on
the
patient
protection
commission.
We
think
that
additional
perspective
is
is
very
helpful.
M
M
Nevada
has
over
35
short-term
acute
care,
hospitals
in
nevada,
spread
over
northern
nevada,
southern
nevada
and
rural
nevada.
There
are
county
hospitals,
district
hospitals,
non-profit
hospitals
and
for-profit
hospitals,
and,
as
as
we
just
learned,
there
may
be
an
opportunity
for
a
federal
hospital
as
well.
M
That
is
a
wide
diversity
in
the
scope
currently
under
the
mix
of
our
short-term
hospitals.
92
percent
of
the
patient
days
are
accessed
in
private
hospitals
and
in
order
to
fully
evaluate
costs,
we
think
that
that
information
on
the
cost
drivers
of
the
delivery
of
that
service
is
is
critical.
The
voice,
the
voice
of
that
care
and
the
cost
of
that
care
should
be
available
to
a
more
broadly
expanded
commission,
so
that
the
perspective
of
the
delivery
of
that
care
can
be
blended
into
the
consideration
of
of
the
cost
and
the
use
of
that
care.
M
We
know,
too,
that
the
governor
created
the
commission
with
the
help
of
the
legislature
in
2019,
and
he
took
care
to
identify
the
the
positions
that
that
should
be
part
of
the
balance
of
that
body
and
then
specifically
had
the
authority
to
identify
those
individuals
and
during
the
covet
emergency.
We
noted
the
governor
focused
his
covet
task
force
on
maintaining
hospital
capacity
and
issued
a
declaration
to
the
patient
protection
commission
to
particularly
learn
the
lessons
that
would
be
experienced
during
the
covent
crisis,
when
hospitals
were
asked
to
expand
capacity
dramatically
to
accommodate
patient
admissions.
M
M
So
we
have
no
concern
about
the
expansion
of
that
commission,
but
would
request
that
the
committee
consider
reinstating
at
least
one
more
hospital
to
provide
some
of
the
diversity
of
that
perspective
and
the
cost
drivers
that
go
with
that.
Thank
you,
madam
chair.
Members
of
the
committee
would
be
happy
to
participate
any
further
on
other
discussions.
Thank.
N
Good
evening,
madam
chair
members
of
the
committee,
my
name
is
george
ross
ross
speaking
on
behalf
of
hca
healthcare.
We
will
echo
the
words
of
mr
adams,
but
I
would
like
to
add
a
few
a
few
comments.
We
are
neutral
because
we
completely
agree
with
the
objectives
that
the
sponsor
of
this
bill
stated:
quality
access,
affordability-
and
I
think
the
key
there
in
this
is
that,
as
mr
waters
pointed
out,
92
of
the
patient
beds
are
in
the
private
sector.
N
Similarly,
all
the
investments,
virtually
all
the
investments
and
other
than
what
umc
is
able
to
do
is
have
are
in
the
private
sector
in
terms
of
new
quality,
both
in
terms
of
how
you
practice
it,
how
you
apply
it
and
how
you
bring
in
new
new
features
and
new
treatments.
This
all
comes
through
the
private
sector,
so
it's
imperative
that,
if
we're
talking
about
access
we're
talking
about
quality
that
we
must
take
into
account
their
needs,
you
just
can't
take
them
totally
for
granted
and
finally,
affordability.
N
N
So
we
would
strongly
urge
you
to
add
back
a
hospital
site,
a
member
in
addition
to
what's
in
the
bill
and
make
it
just
plain
a
hospital
member
and
not
specifically
say
non-profit,
because
the
private
sector
provides
so
much
of
the
health
care
in
this
state.
Their
perspective
is
needed
and
their
knowledge
is
needed
so
that
I
thank
you
again
for
your
attention
and
for
the
opportunity-
and
I
do
thank
all
of
you
for
the
work
you
do
this
session
and
others
on
healthcare,
quality
and
access.
Thank
you.
Thank.
I
Madam
chair
good
evening,
rocky
fensath
with
carrera
nevada
here
representing
pharma,
we
support
pharma,
supports
governor
sislak's
efforts
at
creating
the
patient
protection
commission.
We
also
applaud
the
hard
work
of
the
executive
director
over
the
last
two
years,
leading
into
this
legislative
session.
Respectfully
we
would,
as
my
esteemed
colleagues
have
mentioned,
we
would
request
insertion
of
the
pharmaceutical
representative
back
in
the
patient
protection
commission.
A
C
C
K
My
name
is
jaren
hildebrand
and
I'm
the
executive
director
of
the
nevada
state
medical
association.
I
quickly,
I
know
you've
had
a
long
night.
So
I'll
keep
my
comments
brief.
I
would
just
like
to
echo
the
comments
of
my
colleagues
before
me.
Again.
We
would
like
to
see
our
seats
remain
and
we
don't
disagree
with
the
initiatives
that
chair,
chair,
carlton
is
putting
before
us.
K
I
want
to
discuss
access
to
care
quality
healthcare,
our
over
2000
physician
members
and
their
unique
patient
mix
that
these
folks
see
on
a
daily
basis.
I
I
feel
that
we
also
would
bring
a
value
to
the
patient
protection
commission
in
addition
to
an
fqhc
position
and
bring
other
perspectives
throughout
the
state
in
a
broad
spectrum
of
healthcare
policy.
Again
we'd
like
to
thank
the
committee
and
chair
carlton.
But
again
we
would
like
to
see
our
added
to
the
patient
projection.
Thank
you.
C
A
C
Thank
you
so
much.
I
will
blame
my
service
dog
start
okay,
so
I
I
do
him
here
representing
the
disability
as
a
nevada,
disability,
peer
action
coalition
and
we
ditto
to
support
folks
who
called
in-
and
we
just
want
to
give
a
big
huge
shout
out
to
assemblywoman
carlton,
the
forever
beautiful,
powerful
graceful,
brilliant
assemblywoman
carlton.
We
thank
you
and
the
rest
of
the
resilient
committee.
Thank
you
and
have
a
great
evening.
A
Well,
that
seems
fitting
we're
going
to
go
ahead
and
close
the
public
testimony,
and
I
guess,
if
you're
presenting
the
last
bill
of
your
24-year
history
of
presenting
bills,
it
seems
only
fitting
that
we
would
end
with
a
caller
who
is
going
to
call
you
brilliant
and
beautiful,
and
I
can't
even
figure
out
how
many
other
wonderful
adjectives
there
were
there.
So
with
that
assemblywoman
carlton,
any
closing
comments
and.
D
And
thank
you
very
much,
madam
chair.
I
think
it's
time
to
leave
on
that
high
note
before
I
mess
it
up
in
the
next
six
or
seven
days,
because
I'm
planning
on
six
or
seven
days.
So
thank
you
very
much
for
having
a
hearing
on
the
bill.
Today.
I
found
the
neutral
testimony
quite
unique.
D
I
did
not
get
this
neutral
testimony
in
the
assembly.
There
was
one
person
with
the
health
plans
that
did
testify
in
neutral.
I
heard
I
did
hear
from
pharma
today
in
the
hallway.
There
was
a
hallway
conversation
on
this.
D
Mr
ross
did
share
his
concerns
by
text
very
late
this
morning
with
me
and
mr
wadhams,
and
I
go
way
back
so
we
know
how
that
works
right
so
could
have
predicted
where
they
were
going
to
be.
But
I
believe
where
you
see
the
bill
right
now
is
a
very
good
position.
I'm
not
sure
if
there
was
an
actual
proposed
amendment,
but
I
did
amend
the
bill
in
the
assembly.
Dr
titus
brought
up
a
concern.
It
was
a
valid
concern.
D
A
Thank
you,
ms
carlton.
So
with
that
we'll
go
ahead
and
close
our
sorry
any
clarifying
questions.
Anyone
needs
answered
all
right.
So
with
that
we're
going
to
go
ahead
and
close.
Excuse
me
close
the
hearing.
A
We
have
reached
that
point
in
session,
where
it
is
important
that
we
move
things
along
relatively
quickly,
and
so
it's
my
intention
to
go
ahead
and
work
session.
The
bell
today,
I
will
start
with
my
comments.
I've
been
relatively
intimately
involved
with
the
patient
protection
commission
since
it
was
first
created.
A
The
the
patient
protection
commission
bill
originated
in
the
senate
last
session,
and
I
worked
closely
with
then
allison
combs
in
that
position
to
try
to
figure
out
what
might
work,
and
I
think
the
model
was
to
throw
some
stakeholders
who
have
are
not
always
on
the
same
page,
in
a
room
for
a
while
and
see
if
we
could
come
up
with
a
way
where
we
could
come
up
with
some
solutions
where
everybody
had
some
significant
buy-in
and
then
both
of
the
bills
that
came
out.
A
I
think
that
a
lot
of
people
put
a
lot
of
really
hard
work
in
to
try
to
make
it
work
and
I'm
not
casting
any
aspersions.
I
think
that
there's
been
good
and
sincere
efforts.
I
want
to
thank
miss
shalhagan
for
the
significant
time
and
energy
and
work
that
she's
put
in.
I
think
she's
done
an
excellent
job
as
the
executive
director
trying
to,
as
we
will
always
say,
herd
cats,
but
I
am
okay
with
trying
something
a
little
new
to
get
more
of
the
patient
advocate
voice
involved.
I
may
have
a
bias.
A
I
come
from
the
nonprofit
sector,
but
what
I
will
say
is
I've
always
felt
you
know,
thinking
of
in
my
neck
of
the
woods,
renowned
hospital,
I'm
I'm
not
sure
or
when
st
mary's
was
a
non-profit.
A
I
think
that
a
non-profit
in
a
for-profit
hospital
have
far
more
in
common
than
you
know,
a
small.
I
think
a
small
business
and
a
small
non-profit
have
more
in
common
and
a
large
business
and
a
large
nonprofit
have
more
in
common
and
those
nonprofit
hospitals
are
dealing
with
all
the
same
cost
management
and
insurance,
and
the
only
thing
that
they're
not
dealing
with
is
trying
to
pay
attention
to
for
the
profits
for
their
shareholders.
A
That's
my
personal
opinion,
but
again
I'm
ready
to
support
this
and
try
something
new
and
I
feel,
like
I've,
been
relatively
engaged
in
this
process
and
have
tried
to
be
a
good,
a
good,
neutral
player
to
continue
to
move
things
along,
but
I
hope
that
whether
you
have
a
seat
on
the
board
or
not
that
everybody
stays
engaged
and
we
continue
to
try
to
figure
out
how
to
work
together
as
people
who
care
about
advancing
health
care,
and
maybe
that's
my
tired
at
the
end
of
the
session
speech.
G
Thank
you,
madam
chair.
You
know.
I
certainly
appreciate
the
assemblywoman's
sort
of
policy
take
on
the
changes
that
she
wants
to
make.
I
would
never
ask
for
an
amendment
and
then
vote
against
the
bill,
but
if
so,
if,
if
in
the
future,
she
decides
that
she
does
want
to
make
an
amendment,
I'd
I'd
be
happy
to
entertain
that
we
could.
G
We
could
have
that
discussion,
but
for
the
time
being,
I
think
that
you
know
taking
out
the
voice
of
some
of
the
most
significant
payers
of
within
the
healthcare
system.
I
think,
is
a
problem
as
well
as
some
of
the
significant
cost
drivers
as
well,
so
just
more
of
a
more
of
a
philosophical,
different
difference
on
on
the
voices,
but
so
for
now
it'll
be
a
no,
but
I
don't
think
she
wants
to
have
that
conversation.
So
all
right
thanks.
H
H
A
Thank
you
any
other
comments.
All
right,
cnn,
I'm
looking
for
a
motion
of
do
pass,
got
a
motion
from
senator
spearman
seconded
by
senator
harris.
Any
discussion
see
none
all
those
in
favor
signify
by
saying
I
I
any
oppose
so
I've
got
spearman
harris
ready
in
favor
kika
for
hardy
opposed
motion
passes.
Thank
you,
everyone
all
right.
We
are
going
to
go
ahead
and
do
the
go
jump
back
to
the
work
session
for
senate
bill
424.
F
F
F
The
office
must
perform
certain
duties
to
improve
public
health
in
nevada,
including
analyzing,
existing
infrastructure
for
public
health
needs
and
identifying
and
making
recommendations
regarding
unmet
needs
for
public
health
services,
federal
and
private
funding
opportunities
and
ways
to
improve
coordination
between
public
health
providers.
Three
amendments
were
proposed
to
this
bill.
A
Okay,
so
had
a
little
bit
of
movement
on
this
one.
Thank
you
to
senator
spearman
for
bringing
forward
the
amendment
to
make
sure
that
this
effort
to
address
the
public
health
pandemic
also
has
the
lens
of
the
pandemic.
A
Second,
from
senator
harris
any
discussion,
seeing
none
all
those
in
favor
signify
by
saying
aye
aye
any
opposed
motion
passes
unanimously.
All
right,
I
think
I
forgot
to
do
floor
statements
so
on
3,
48
I'll,
take
the
floor
statement
390.
I
will
also
take
the
floor
statement
and
senator
spearman.
Would
you
like
to
take
424
all
right
with
that?
We
have
concluded
our
business
for
the
day
on
monday.