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From YouTube: 3/2/2021 - Senate Committee on Health and Human Services
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A
Welcome
everybody
I'm
going
to
call
to
order
the
senate
committee
on
health
and
human
services
for
march,
2nd
at
3
32
p.m.
If
we
could
go
ahead
and
get
a
roll
call,
oh
wait!
No,
I'm
sorry!
I'm
just
gonna
do
that
differently.
We
do
have
senator
keith,
keffers
senators,
key
keffer,
hardy
paris
and
spearman
president.
A
Please
note
that
everybody
is
president
and
accounted
for
for
the
record
just
want
to
remind
everybody
that
there
are
multiple
ways
to
participate,
even
though
the
building
is
closed
and
if
you
do
go
to
the
nevada
legislature
website
and
use
the
help
bar
at
the
top,
it
will
tell
you
about
all
of
those
different
ways.
You
can,
of
course
use
our
opinion
poll
function.
A
You
can
register
to
testify
it's
great
if
you
register
in
advance,
but
you
can
register
right
now
if
you're
interested
in
testifying
and
of
course
you
can
also
send
emails
to
the
committee.
If
you
send
in
written
comments,
we
will
try
to
make
note
of
those
comments
and
get
them
put
into
the
public
record.
A
B
Madam
chair
megan
kamalassy
for
the
record,
I'm
with
the
research
division
of
the
legislative
council
bureau.
The
first
bill
on
work
session
today
is
senate
bill
69.
This
was
heard
in
the
committee
on
february
9th
and
it
makes
a
variety
of
changes
related
to
behavioral
health.
B
Specifically,
it
requires
peer
recovery,
support
specialists
and
peer
recovery,
support
specialist
supervisors
to
be
certified.
It
requires
the
department
of
education
to
develop,
maintain
and
publish
a
list
of
evidence-based
curricula
and
programs
concerning
substance
misuse
and
substance
use
disorder.
B
Three
amendments
were
proposed
to
the
measure
and
they're
all
attached
in
the
work
session
document,
so
the
first
is
a
conceptual
amendment
that
was
proposed
by
senator
ratty
as
the
chair
of
the
washington
washoe
regional
behavioral
health
policy
board,
which
is
the
bill
sponsor,
and
the
amendment
was
proposed
in
the
most
part
during
the
bill
hearing.
However,
the
only
changes
since
the
bill
hearing
were
in
section
one
of
the
proposed
amendment,
and
so
it
requires
this
portion
of
the
amendment
requires
a
person
to
be
certified
by
the
nevada.
B
Sorry,
this
relates
to
peer
recovery,
support
specialists
or
specialist
supervisors
and
requires
them
to
be
certified
by
the
nevada,
certification
board
or
its
successor
organization
if
the
person
holds
themselves
out
as
a
peer
recovery
support
specialist
for
adults.
So
this
is
specifically
the
big
changes
that
we're
focusing
on
people
who
are
at
least
18
years
of
age
or
peer
recovery
support
specialist
supervisors,
who
supervises
the
provision
of
peer
recovery,
support
services
to
adults.
The
big
change
there
is
just
that:
we're
focusing
on
folks,
18
years
of
age
or
older,
and
the
other
piece.
B
B
So
that's
the
first
amendment.
The
second
amendment
was
submitted
by
clark
county
and
it
was
discussed
briefly
during
testimony
on
the
bill
during
the
bill
hearing
and
essentially,
this
conceptual
amendment
would
require
any
employer
of
a
pure
support,
recovery,
specialist
or
peer
recovery
support
recovery,
specialist
supervisor
who
works
with
children,
to
conduct
a
background
check
through
dhhs,
and
they
did
ask
that.
We
clarified
that
it's
not
a
background
check
through
the
division
of
public
and
behavioral
health,
or
rather
through
dhhs's
statewide.
B
And
then
the
amendment
would
also
allow
a
child
welfare
agency
to
establish
a
process
and
criteria
for
waiving
the
results
of
a
background
check
for
providing
peer
support.
Recovery,
specialist
or
supervisor
services
and
similar
requirements
are
already
exist
in
nrs,
in
statutes
related
to
background
checks
for
employees
of
small
child
care
establishments.
B
And
then
the
third
proposed
amendment
to
this
bill
was
proposed
by
clark,
county
and
washoe
county
public
defenders,
and
it
would
just
delete
section
16
of
the
bill
which
currently
provide
for
the
assault
and
battery
on
a
peer
support,
specialist
or
peer
supervisor
as
a
misdemeanor.
So
it
would
just
delete
that
section
of
the
bill.
A
Thank
you
megan.
So
just
a
couple
comments
for
the
members
of
the
committee.
First
of
all,
as
you
can
probably
tell
from
the
amendments,
the
representatives
of
the
board
and
the
presenters
of
the
bill
did
meet
with
and
discuss
all
the
requests
for
amendments
that
came
up
during
the
hearing
and
the
work
product
that
you
see
in
front
of
you
reflects
those
decisions.
A
If
you
have
clarifying
questions
on
any
of
those
amendments,
the
other
piece
that
I
wanted
to
say
at
this
time
was
to
thank
eric,
robbins
and
megan
kamlossi,
who
have
done
a
lot
of
work
on
this
particular
bill
to
meet
with
lots
of
different
stakeholders
and
then
to
specifically
to
mr
robbins
to
help
us
understand
how
we
could
do
what
they
were
requesting
within
the
confines
of
nrs.
So
thank
you
for
the
amount
of
time
that
the
two
of
you
have
put
into
this
bill
and
then
also
to
say
these
are
long
bills.
A
And
so
I
am
I'm
just
letting
everybody
know
right
here
that
whether
it
ends
up
in
finance
committee
or
goes
to
the
floor
may
be
perfectly
comfortable
to
put
this
bill
on
the
desk
and
give
people
time
to
digest
it
again,
because
there
are
lengthy
bills
with
lots
of
amendments.
And
I
want
to
make
sure
that
we're
getting
this
right.
So
with
that,
I
will
open
it
up
to
the
members
of
the
committee
to
see
if
there's
any
clarifying
questions.
C
Thank
you,
madam
chair.
By
and
large,
I
appreciate
senate
bill
69.
I
was
concerned
about
the
successor
organization
that
is
undefined
and
have
some
disquiet
about
it.
I
will
be
voting
no
on
this,
but
reserving
my
right
to
change
the
vote
on
the
floor
when
I've
seen
everything
come
together
with
the
amendments.
A
C
Thank
you,
I'm
going
to
go
for
the
opposite
direction
of
my
colleague
and
I'll
vote.
Yes
for
now,
but
reserve
my
right
one.
We
see
the
full
bill.
My
some
of
my
concerns
specifically
related
to
some
of
the
scope,
practice
and
potential
overlap
and
ensuring
that
this
we
this
was
entirely
contained,
as
as
people
doing
this
work
for
compensation,
but
for
now
I'll
I'll
support
it
and
see
what
it
looks
like.
A
C
A
Yes,
and
then
I
also
did
intend
to
put
on
the
record-
because
we
didn't
get
to
do
this
in
the
hearing,
but
this
bill
is
not
intended
in
any
way
to
affect
family
to
family
peer
programs,
so
where
a
family
member
is
supporting
another
family
member.
A
Okay,
great.
So
let's
go
ahead
and
move
on
to
sp
70.,
miss
kamalasi.
B
Thank
you,
madam
chair
megan,
kamalasi
for
the
record
senate
bill.
70
was
heard
in
this
committee
on
february
9th
as
well.
This
bill
also
makes
various
changes
related
to
mental
health.
It
defines
the
term
mental
health
crisis
hold
and
emergency
admission
and
prescribes
separate
processes
for
the
detention
of
a
person
on
a
mental
health
crisis
hold
in
an
emergency
admission
admission.
It
revises
provisions
related
to
assisted
outpatient
treatment
and
prescribes
separate
processes
for
requiring
a
person
to
receive
involuntary
aot.
B
B
The
bill
also
revises
provisions
related
to
parental
or
guardian
notification
and
release
of
an
unemancipated
person
who
is
under
18
years
of
age
and
placed
on
a
mental
health
crisis
hold.
And
finally,
the
bill
revises
the
definition
of
chemical
restraint
as
it
relates
to
controlling
an
acute
or
episodic
behavior
that
places
the
person
or
others
at
risk
of
harm.
In
certain
circumstances,
the
attached
amendment
was
submitted
by
jessica
blood,
the
regional
behavioral
health
coordinator
for
the
northern
regional
behavioral
health
policy
board.
B
A
C
Thank
you,
madam
chair.
I
have
to
go
on
the
record
of
appreciation
for
jessica
flood
and
taking
time
to
spend
some
time
with
me
on
this.
I
have
some
concerns
still
on
any
other
person
and
protecting
civil
rights.
I
will
be
voting
no
with
the
right
to
change
my
mind
on
the
floor,
looking
forward
to
further
discussions,
but
I
do
not
want
to
hold
this
up.
Thank
you.
C
Same
same
dance,
different
song-
yes
I'll,
be
voting
yes
on
this
one
with
the
right
to
change
to
a
no
on
the
floor.
If
I
get
uncomfortable
when
the
final
language
comes
out,
but
I
certainly
appreciate
what
we're
trying
to
do.
A
Thank
you
and
again
acknowledging
that
this
was
another
long
bill
with
another
long
amendment,
so
I
too
am
looking
forward
to
seeing
it
all
in
one
space
when
it
comes
out
of
drafting
with
the
amendments
incorporated
any
other
questions
or
comments
for
this
particular
bill.
A
It
is,
was
that
an
amend
you
passed,
senator
schneiderlin,
you
passed,
I
mean,
do
pass
right.
F
E
A
A
men
do
pass
from
senator
spearman
seconded
by
senator
harris.
A
C
A
A
Okay,
I
will
note
on
both
of
those
that
I
will
go
ahead
and
take
the
floor.
Assignments,
despair.
Anybody
else
walking
through
these
bells
moving
forward.
Okay,
let's
go
ahead;
miss
kumasi
and
move
on
to
sv93.
B
Thank
you,
madam
chair
making
homeless
for
the
record
senate
bill.
93
was
heard
in
this
committee
on
february
16th.
It
makes
two
changes
related
to
medicaid.
First,
the
bill
requires
the
director
of
the
department
of
health
and
human
services
to
include
in
estate
plan
for
medicaid
authorization
from
medicaid
recipient
to
to
directly
receive
reimbursements
for
certain
covered
personal
care
services.
A
Thank
you,
miss
kamasi,
I'll
note
that
senator
hardy
is
with
us
today
representing
this
bill,
and
so,
if
there
are
any
clarifying
questions
before
the
vote,
senator
hardy
would
be
available
to
answer
them.
We
also
have
representatives
from
medicaid
on
the
call
with
us.
Is
there
anybody
who
has
any
clarifying
questions
or
comments
they'd
like
to
make
on
sb
93
before
we
move
to
the
vote?
A
Got
I
think,
senator
key
keffer
had
his
hand
up
before,
so
I'm
going
to
take
a
do
pass
from
senator
key
keffer
and
senator
hardy.
Would
you
be
a
second
all
right,
so
I've
got
a
do
pass
from
senator
keith
keffer
seconded
by
senator
hardy.
Any
discussion.
C
G
A
Chair
ready,
yes
right,
senator
hardy,
would
you
take
the
floor
statement
on
that?
One.
C
A
Great.
Thank
you
all
right.
We're
going
to
move
on
to
the
work
session
on
sb
123.,
miss
kamlasi.
Thank.
B
You
adam
chair,
megan
komasi,
for
the
record
senate
bill.
123
was
heard
in
this
committee
on
february
18th.
It
revises
the
qualification
qualifications
for
appointment
to
the
nevada,
silver
haired
legislative
forum
by
reducing
the
state
residency
requirements
from
five
years
to
one
year
or
six
months.
If
the
nominee
is
a
member
of
the
military,
it
also
reduces
the
senatorial
district
residency
requirement
from
three
years
to
30
days.
B
In
addition,
sb
123
revises
the
state
residency
requirement
for
an
ex-officio
member
of
the
nevada
silver-haired
congress
to
vote
on
matters
considered
by
the
congress
from
five
years
to
one
year
for
six
months.
If
the
person
is
a
member
of
the
military
and
during
the
bill
hearing
senator
spearman,
the
bill
sponsor
proposed
the
attached
conceptual
amendment
and
the
amendment
would
revise
the
bill
so
that
the
residency
requirement
for
in-state
residency
would
be
six
months
for
all
nominees.
B
A
A
C,
none
secretary.
Would
you
please
call
the
vote.
D
A
C
A
A
All
right,
thank
you.
Everybody
all
right
takes
a
village
to
get
a
bill
out
of
this
committee.
So
with
that
secretary,
would
you
please
follow
the
vote.
C
C
C
A
And
chair
ready,
yes
and
senator
spearman,
can
I
assume
that
you
would
like
the
floor
statement
on
this
one,
fantastic,
all
right
team?
I
think
we
made
it
through
our
first
first
work
session.
We've
moved
four
bills
along.
They
all
have
a
person
assigned
to
do
the
floor
speech
so
hopefully
we're
in
good
shape.
So
with
that,
I
am
going
to
turn
the
committee
over
for
the
time
being
to
oh,
I'm
getting
a
message
message:
senator
spearman
that
ledgeops
is
getting
ready
to
hear
your
bill.
Did
you
want
to
go
over
to
that
committee.
A
E
A
Ready
you
senator
harris,
so
I
am
very
pleased
to
be
bringing
forward
senate
bill
156
on
behalf
of
the
senate
health
and
human
services
committee.
I
asked
the
committee
to
sponsor
this
bill
rather
than
me
as
an
individual,
because
this
bill
does
build
off
of
significant
work.
That's
been
done
in
the
state,
taking
a
look
at
how
do
we
moder
modernize
our
response
in
the
state
of
nevada
to
a
person
who
is
experiencing
a
behavioral
health
crisis?
A
H
It's
been
a
bad
day:
you've
been
in
a
bad
car
accident
or
experiencing
chest
pain.
Fortunately,
there
is
an
emergency
medical
system
built
to
respond
immediately
to
your
crisis.
Now
rewind,
it's
been
a
bad
day,
but
this
time
it's
due
to
a
mental
health
crisis
like
thoughts
of
suicide.
The
same
emergency
medical
system
that
responds
to
chest
pain
also
responds
to
this
type
of
crisis
and
is
less
than
ideal
to
handle
it.
Yet
it
is
this
system
that
responds
to
thousands
of
people
in
a
mental
health
crisis.
H
H
One
a
crisis
call
center
staffed
by
specialists
that
coordinate
all
levels
of
crisis
care.
They
evaluate
the
current
crisis
and
can
support
and
stabilize
the
90
of
the
cases
they
get.
Those
that
need
more
get
more
with
these
hubs,
dispatching
appropriate
resources
and
then
supporting
those
resources
and
finding
the
best
solutions.
H
Component,
2,
24,
7
mobile
crisis
teams
that
work
in
the
streets
meeting,
people
where
they
are
and
for
the
majority,
resolving
their
crisis.
Right
then
dispatched
by
the
call
center
hub.
They
lessen
the
burden
on
local
police
and
reduce
the
stigma
that
some
feel
when
a
uniformed
officer
knocks
on
their
door
component
3
crisis
stabilization
locations,
which
constitute
the
retreat
model,
can
offer
short-term
care
for
people
who
need
support
and
observation,
regardless
of
their
level
of
crisis.
H
These
programs
operate
24
7
and
are
the
right
door
to
everyone
in
a
mental
health
crisis,
including
those
that
may
require
involuntary
treatment.
These
high-tech
high-touch
facilities
divert
away
from
the
emergency
departments
and
jails
while
providing
immediate
specialized
treatment.
Police
no
longer
need
to
decide
between
ed's
or
jail.
The
no
wrong
door
approach
reduces
the
time
needed
to
handle
these
cases
from
hours
to
minutes
and
allows
police
to
go
back
to
supporting
public
safety,
a
role
they're
uniquely
trained
to
do.
Let's
review
the
impact
of
the
crisis
now
model
in
maricopa,
county
arizona.
A
Thank
you
morgan,
so
I
am
super
excited
to
be
bringing
forward
a
group
of
bills
that
will
help
the
state
of
nevada
take
some
steps
forward
to
rebuilding
our
crisis
response
system
to
address
the
needs
of
a
person
who
is
in
the
middle
of
a
behavioral
health
crisis.
As
the
video
alluded
to
right
now,
somebody
calls
9-1-1
and
that
operator,
on
the
other,
the
end
of
the
phone
is
going
to
ask
police
fire
or
medical
and
for
many
families
or
individuals
who
are
experiencing
a
behavioral
health
crisis.
A
They
don't
really
fit
in
to
one
of
those
categories
and
so
starting
with
some
good
work
that
was
done
in
maricopa
county,
but
then
now
other
states
across
the
nation
colorado
oregon.
Many
other
states
have
started
to
adopt
and
build
out
a
specific
system
that
is
designed
to
address
behavioral
health.
I
want
to
be
clear
that
I
think
that
this
is
has
significant
overlap
between
sort
of
the
criminal
justice
reform
and
social
justice
reform
work
that
we've
been
trying
to
tackle
as
a
state,
as
well
as
the
appropriate
behavioral
health
response.
A
When
we
are
rolling
law
enforcement
to
every
behavioral
health
crisis
or
many
behavioral
health
crises,
even
though
that
person
really
needs
a
behavioral
health,
professional
or
perhaps
a
peer
or
somebody
who
is
specifically
trained
to
deal
with
behavioral
health,
we've
been
doing
all
kinds
of
interventions,
all
kinds
of
resources
where
we're
trying
to
train
police
to
do
something
that
really
they
were
never
designed
to
do,
and
so,
rather
to
con
than
continuing
down
that
path.
We
still
seek
to
partner
with
law
enforcement.
A
A
So
all
credit
again
to
dr
woodard
and
her
team
have
been
working
on
this
initiative,
but
the
model
that
was
built
in
phoenix
arizona
was
then
picked
up
by
samsa
at
the
national
level
and
is
now
being
distributed
as
a
national
best
practice.
That
model
has
four
critical
components.
The
first
is
this
high-tech
crisis
call
center
I'll
be
bringing
forward
another
bill
sponsored
by
this
committee
as
soon
as
it
comes
out
of
drafting
that
will
specifically
talk
about
the
work.
That's
happening
around
988
and
centralizing
behavioral
health
crisis
into
a
separate
system.
A
The
next
piece
is
a
again,
I'm
sorry,
those
crisis
call
centers
have
these
specialists,
they
do
air
traffic
control,
which
is
critically
important,
so
there
they
know
where
there
might
be
a
mobile
crisis
team
where
there
might
be
a
bed
that's
available
where
they
can
get
somebody
into
an
outpatient
treatment
program,
if
necessary.
So
we
immediately
lean
into
the
case
management
that
is
necessary
to
support
that
person,
both
in
their
immediate
crisis,
but
with
any
follow-up
care.
A
This
model
is
highly
dependent
on
having
those
peers
as
part
of
the
response,
so
somebody
with
lived
experience
along
with
the
behavioral
health
professional,
and
so
these
folks
can
be
dispatched
by
that
high
tech,
air
traffic
control
system.
If
you
will
they
go
out
and
meet
people
in
the
hospital
emergency
room
on
a
street
corner
in
the
family's
home
wherever
is
necessary
to
help
stabilize
that
crisis.
A
The
washoe
policy
board
last
session
brought
forward
a
bill
to
do
licensing
for
crisis,
stabilization,
centers
and
an
effort
to
help
build
out
this
model,
and
what
we've
learned
since
the
last
session
is
that
the
language
that
we
put
together
was
too
narrow.
It
limited
crisis,
stabilization
centers
to
only
psychiatric
hospitals
and
that
probably
wasn't
an
appropriate
approach.
So
this
bill
seeks
to
expand
the
number
of
agencies
that
can
be
considered
and
can
seek
an
endorsement
to
have
to
become
a
crisis.
A
So
these
essential
principles
get
woven
through
the
entire
entire
system
of
care
and
in
phoenix
it
took
them
13
years
to
build
out
this
new
system.
We
hope
to
accelerate
that,
but
there
has
already
been
a
solid
two
years
of
groundwork.
That's
been
laid
by
the
leadership
coming
out
of
department
of
health
and
human
services
working
with
the
regional
behavioral
health
boards.
A
I
think
that
the
the
best
outcomes
are
going
to
be
for
patients
that
they're
getting
a
better
immediate,
more
positive,
behavioral
health
crisis
response,
but
there
also
are
some
long-term
savings
that
could
potentially
benefit
both
local
governments
and
the
state,
local
governments
and
the
ability
to
redirect
the
significant
amount
of
resources
that
law
enforcement
agencies
are
spending
right
now
towards
behavioral
health
crisis,
back
towards
public
safety
and
for
the
state
not
having
folks
sitting
in
hospital
rooms,
which
is
not
good
for
the
patient
in
hospital
emergency
rooms,
which
is
not
good
for
the
patient.
A
G
Good
afternoon
my
name
is
dwayne
young
and
I'm
deputy
administrator
for
the
division
of
healthcare
financing
and
policy.
Thank
you
to
senator
rowdy
for
the
opportunity
to
allow
medicaid
to
speak.
Also
with
me
is
dr
stephanie
wooder
senior
advisor
of
behavioral
health
for
dhhs
to
answer
questions.
G
As
the
senator
pointed
out,
the
goal
of
this
bill
is
to
modify
the
precisions
of
assist
assembly
bill
66
from
the
last
session.
The
removal
of
the
16
bed
requirement
would
assist
in
allowing
current
psychiatric
facilities
to
overcome
the
burden
of
creating
a
hospital
within
a
hospital.
Expanding
this
to
acute
hospitals
will
allow
them
to
be
endorsed
and
reimbursed
to
provide
a
higher
standard
of
care
to
individuals
already
presenting
within
their
emergency
rooms.
These
cases
can
then
be
triaged
to
the
most
appropriate
levels
of
care.
G
The
division
has
met
with
multiple
facilities
and
hospitals
willing
to
participate
in
models
such
as
crisis
now
and
empath.
Should
these
restrictions
be
removed,
allowing
for
greater
flexibility
and
a
reimbursement
mechanism
for
medicaid
that
is
higher
than
the
observation
codes
and
would
allow
these
facilities
to
provide
a
higher
standard
of
care
as
well
as
recruit
and
retain
more
professionals
and
behavioral
health
to
work
and
staff?
These
areas.
F
Sure
so
the
national
association
of
state
mental
health
program
directors
issued
a
number
of
policy
briefs
several
years
ago,
looking
at
the
need
to
move
what
they
said
beyond
beds.
So
currently,
if
you
look
at
the
model,
the
majority
of
individuals
who
are
in
a
behavioral
health
crisis,
more
often
than
not,
will
end
up
in
an
emergency
room
where
they
may
or
may
not
end
up
with
specialty
psychiatric
care
and
often
times
are
waiting
hours,
if
not
days,
for
an
appropriate
placement.
F
All
the
while
they
may
not
really
receive
a
comprehensive
evaluation
that
can
help
to
determine
what
level
of
care
they
need
and
then
match
them
with
the
appropriate
services.
The
living
room
model
is
a
completely
different
paradigm,
we're
talking
about
a
large
room
that
has
the
ability
for
people
to
really
be
actively
engaged.
It's
one
of
the
reasons
that
the
infusion
of
peers
is
so
vitally
important.
F
We're
really
working
with
individuals
where
they're
at
related
to
their
crisis,
actively
engaging
them
in
problem
solving
and
de-escalation.
One
of
the
reasons
that
we
see
the
need
for
hospitals
to
be
able
to
do
this
is
because
we
also
recognize
the
need
for
safety,
should
an
individual
need,
additional
supports
or
or
access
to
a
bed.
But
these
living
room
models
are
really
considered
warm
and
welcoming.
You
don't
have
staff
behind
large
plexiglass
windows.
A
Great,
thank
you,
and
I
think
an
important
concept
here
is
this
is
a
sub
acute
model
and
is
meant
traditionally
to
be
24
hours
or
less,
and
so,
if
a
person
can't
be
stabilized
in
that
period
of
time,
then
the
next
step
would
be
to
put
them
into
an
appropriate
level
of
care.
That
would
be
an
inpatient
facility.
A
If
they
can
be
stabilized,
then
it
is
making
sure
that
they
are
discharged
with
a
good
case
management
plan
that
gets
them
into
outpatient
care
medication
if
they
need
it
whatever
their
their
particular
plan
is
so
with
that.
I
think
we'll
go
ahead
and
close
the
formal
part
of
the
bill,
presentation
and
open
it
up
for
questions
senator
kikefer.
Do
you
have
a
question.
C
Yes,
I
do
madam
chair.
Thank
you
very
much.
So
is
the
our,
so
this
would
be
sort
of
a
mr
young.
You
said
it's
from
hospital
within
a
hospital,
so
these
you
anticipate
that
some
of
these
would
be
built
out
within
some
of
our
existing
acute
care
facilities.
G
G
It
really
was
an
advocate
just
for
current
hospitals
and
psychiatric
facilities
to
do
this
because
it's
very
expensive
to
run
a
separate,
60
dead
facility,
striking
that
language
as
it
is
in
the
bill
and
then
also
for
the
allowance
of
acute
hospitals,
would
allow
them
would
have
a
separate
area
within
the
hospital,
but
they
wouldn't
have
the
restraints
on
the
bed
count,
and
so
they'd
be
more
flexible
for
staffing.
But,
yes,
it
would
be
an
area
within
the
hospital,
both
the
empath
model
and
crisis.
G
Now
look
at
a
separate
area,
as
dr
woodard's
point
out.
That's
a
bit
more
comfortable,
more
conducive
to
an
environment
of
recovery
that
would
be
within
the
facility,
but
certainly
someone
would
be
moved
out
of
the
emergency
room
into
this
area,
triaged
appropriately,
as
as
senator
ratty
stated
within
the
first
24
hours
and
then
moved
to
the
appropriate
level
of
care
or
given
a
plan
of
safe
discharge
to
return
home.
F
I
can
address
that
stephanie
woodard
for
the
record,
so
it's
very
possible,
and
we
would
expect
that
a
number
of
individuals
that
would
be
presenting
for
care
in
a
crisis,
stabilization
unit
or
center
would
already
be
initiated
on
a
legal
hold.
What
they
have
found
in
places
where
they
have
done.
F
Stephanie
woodard
for
the
record.
This
is
one
of
the
reasons
that
we
really
wanted.
Our
crisis,
stabilization
units
or
centers
to
be
in
existing
hospitals.
They
have
to
meet
a
number
of
different
safety
and
security
measures,
including
having
things
like
anti-ligature
in
the
ability
to
do
seclusion
and
restraint
should
those
be
necessary,
but
in
hospitals
or
crisis
stabilization
centers
that
have
really
used
this
model.
F
What
they
find
is
that
the
need
for
seclusion
and
restraint
really
is
very,
very
little,
and
I
think
a
lot
of
it
has
to
do
with
not
only
the
philosophy
behind
the
care
that's
being
provided,
but
the
way
that
the
staff
are
trained
to
be
able
to
engage
with
individuals
that
are
in
the
crisis.
Stabilization
centers.
A
I
would
just
like
to
build
on
that
answer
just
a
little
bit
to
say
what
we
learned
in
phoenix
was
the
the
really
important
piece
about
making
these
successful
was
the
the
ability
to
say
yes
to
everyone
and
so,
whether
it's
a
legal
2000,
whether
it's
a
substance,
use
withdrawal
issue,
whether
it's
a
you
know,
you
name
it
the
range
in
spectrum,
if,
if
law
enforcement
or
a
mobile
crisis
team,
has
brought
these
folks
to
the
door.
A
A
Maybe
this
is
wasn't
the
right
place,
but
they
need
to
be
able
to
say
yes
what
other
communities
have
learned
is
if
they
can't
say
yes
to
everyone,
then
pretty
soon
folks
stop
sending
folks
there,
and
when
we
start
making
that
decision,
then
we
lose
the
efficacy
of
the
program,
and
so
they
really
do
have
quite
a
bit
of
capabilities
built
in
and
therefore
a
higher
reimbursement
rate.
But
what
other
communities
have
found
is
that
still
spending
a
whole
lot
less
money
than
those
sitting
in
an
emergency
room.
C
Oh,
if
I'm
a
chair
I
know
I
gave
up
but
jumping
back
in
sorry,
so
we're
talking
about
like
at
the
mallory
center
in
carson
city
right,
but
allowing
sort
of
such
a
thing
to
be
built
within
the
walls
of
a
larger
hospital.
G
And
senator,
if
I
may,
I
would
add,
to
senator
keith
kepper's
question.
The
mallory
center
is
one
of
the
reasons
that
we
asked
the
senator
and
the
committee
to
bring
for
this
types
of
legislation
because
they
didn't
fit
in
the
existing
language,
and
this
would
allow
them
to
receive
that
reimbursement.
G
If
they're
too
big-
currently
I'm
sorry
cinderella,
they're
too
large,
currently
too
many
beds,
currently,
no
because
they're
considered
an
acute
their
license
is
attached
to
an
acute
hospital,
not
a
freestanding
psychiatric,
so
they
didn't
qualify.
So
the
removal
of
that
language
will
allow
them
to
to
qualify
to
perform
these
services,
even
though
they're
performing
these
services,
just
not
without
a
proper
reimbursement.
E
C
A
So
I'll
start,
but
then
I
think
I'm
going
to
ask
either
dr
woodard
or
mr
young
to
finish
so
the
I
believe
by
westcare
you're,
referring
to
what
is
created
in
nrs
as
the
crisis
triage
center
and
right
now.
This
does
not
eliminate
in
any
way
the
crisis
triage
centers.
A
The
crisis,
triage
centers,
have
evolved
a
little
bit
differently.
I
think
than
anybody
had
anticipated
and
they've
perhaps
evolved
a
little
bit
differently
in
clark
county
than
they
have
in
marshall
county.
E
E
Is
that
something
that
you
know,
would
these
these
stabilization
centers
be
set
up
to
offer
some
type
of
services
for
people
who
are
homeless
and
also
experiencing
a
mental
health.
A
So
it's
it's
a
great
question,
senator
and
one
that
I
think
often
gets
a
little
bit
conflated
in
in
this
particular
model.
So
it's
very
important
that
we're
very
clear
here,
so
the
experience
of
other
communities
has
been
that
absolutely
individuals
who
are
experiencing
homelessness
also
experience
behavioral
health
crisis,
and
it
has
absolutely
been
that
if
you
have
a
more
appropriate
behavioral
health
response,
then
you
have
a
higher
likelihood
of
helping
that
individual
to
move
out
of
homelessness
and
into
a
more
stable
situation.
A
There
will
be
a
significant
effort
and
because
of
the
high
tech
high
touch
air
traffic
control
system
and
ability
to
connect
them
back
to
their
case
manager
that
they're
already
working
with
services
that
they're
already
connected
with,
because
we'll
have
that
case
management
embedded
into
the
system.
If
you
will,
but
we
can't
guarantee
that
everybody
who
gets
their
crisis
stabilized
will
be
ready
and
willing
to
then
go
into
housing,
but
it
does
dramatically
increase
the
odds
that
that
might
happen.
E
I
just
wanted
to
ensure
that
they
wouldn't
be
turned
away
at
the
at
the
door.
You
know
because
they
are
homeless.
So
thank
you
for
that.
I,
I
guess
my
next
question
is
to,
and
maybe
this
will
come
in
the
steps,
one
and
and
two
to
this
process,
but
is
there
any
way
to
ensure
that
if
an
officer
for
some
reason
reason
responds
that
they
will
be
taking
people
to
the
crisis,
stabilization
center
versus
jail?
E
You
know,
someone
may
be
a
bit
combative
and
is
now
assaulted,
an
officer
and
so
they're.
You
know
going
straight
to
jail,
I
mean.
Is
there
some
way
to
ensure
that,
when
picked
up
by
an
officer
that
they
actually
end
up
at
one
of
these
centers.
A
It's
a
great
question:
it
doesn't
necessarily
relate
directly
to
this
bill,
and
so
there
will
be
another
bill
where
we
can
dig
into
that
deeper,
and
that
is
the
nine
nine
eight
eight
system
so
that
that's
coming.
That's
a
teaser
for
you.
What
I
will
say
is
that,
what's
incredibly
important
for
the
whole
crisis,
stabilization
system
is
that
there
is
a
strong
partnership
with
law
enforcement
and
a
big
part
of
that
is
working
with,
not
necessarily
actually
with
the
law
enforcement.
A
And
so
there
will
be
situations
where
somebody
who's
experienced
a
behavioral
health
crisis
who
is
putting
themselves
or
others
in
such
a
level
of
danger
that
a
public
safety
response
is
appropriate
and
there
will
be
other
situations
where
a
person
is
experiencing
a
behavioral
health
crisis
where
law
enforcement
will
never
be
dispatched
because
there
isn't
a
public
safety
issue.
And
so
I
can't
say
that
there's
a
one-size-fits-all
or
a
guarantee,
but
where
the
model
really
works
is
when
you
dispatch
the
right
response
or
what
is
happening
on
the
ground.
E
Okay,
seeing
none
chair
ready
if
it's
okay
with
you,
we'll
open
it
up
for
testimony
and
support.
I
I
I
I
D
D
I
C
C-H-R-I-S-T-O-P-H-E-R-S-O-E,
I
am
with
strategy
360
representing
the
eight
valley
health
system,
acute
care
hospitals.
While
we
appreciate
the
work
done
on
ab66
from
the
2019
session,
it
did
limit
the
kinds
of
hospitals
that
could
provide
crisis.
Stabilization
services
and
sb
156
rectifies
that
unintended
consequence.
We
support
sb
156.
Thank.
C
E
That,
unfortunately,
senator
hardy,
I
think
it's
it's
fairly
difficult
to
have
a
back
and
forth
with
the
callers
on
the
phone,
but
I
believe
it
was
christopher
rose
from
strategies
360,
and
we
can
reach
out
to
him
to
follow
up
with
you
on
that.
If
that's
okay,
thank
you.
I
I
D
T-A-R-Y-N-H-I-A-T-T
with
the
american
foundation
for
suicide
prevention,
nevada
chapter-
we
just
want
to
thank
the
madam
chair
for
this
amazing
bill.
I
oversee
our
utah
and
nevada
chapters
and
to
see
crisis
services,
be
improved
and
implement
the
zero
suicide
strategy
of
improving
access
to
care
and,
specifically,
suicide,
safe
care.
We
know
that
this
bill
will
save
lives,
so
we
again
are
in
strong
support
and
just
appreciate
the
good
work
being
done
in
the
state
of
nevada
and
by
all
of
you.
So
thank
you
so
much
for
your.
D
I
I
I
D
D
Sb
156
is
a
mechanism
to
incentivize
local
hospitals
to
provide
crisis
stabilization
services
and
it's
a
great
way
for
the
state
to
partner
partner
with
local
hospitals
to
provide
these
services,
thereby
potentially
greatly
expanding
access
to
these
critical
services
throughout
nevada.
Thank
you,
madam
chairman,
and
members
of
the
committee
for
allowing
me
to
speak
today.
I
hope
everyone
is
doing.
D
I
I
D
This
is
joan
hall
j-o-a-n-h-a-l-l,
representing
nevada
rural
hospital
partners.
Nrhp
is
very
supportive
of
licensed
hospitals
being
allowed
an
endorsement
as
a
crisis
stabilization
center,
we
have
seen
other
states
successfully
using
this
type
of
service
to
increase
access
to
the
most
beneficial
behavioral
health
care
in
an
appropriate
setting.
D
The
majority
of
critical
access
hospitals
in
nevada
are
not
accredited,
but
rather
licensed
and
certified
by
the
division
of
public
and
behavioral
health
bureau
of
health
care
quality
and
compliance,
hoping
that
there
is
an
opportunity
to
allow
these
hospitals
to
also
receive
this
endorsement
if
they
meet
the
other
requirements.
This
bill
we'd
like
to
be
able
to
talk
about
that
little
amendment.
Thank
you.
I
I
I
I
I
J
Just
like
to
thank
you
all
for
your
time
today
and
for
even
just
giving
this
opportunity
for
this
bill
to
be
heard
as
someone
who
has
lost
a
brother
to
suicide,
I
would
love
love,
love
to
have
so
many
more
resources
for
him
to
have
been
able
to
reach
out,
and
I
think
that
if
this
had
been
available,
maybe
he
could
have
been
alive
today.
J
It's
very
very
sad
to
to
think
about,
but
right
before
his
crisis
that
ended
up
taking
his
life,
then
he
did
have
a
run-in
with
police
and
he
wasn't
sure
you
know
he
was
kind
of
having
a
psychotic
break
and
wasn't
sure
you
know
how
to
handle
it
and
then
about
a
month
later,
then
he
ended
up
passing
from
suicide,
and
this
is
someone
that
never
a
day
in
their
life
had
a
ticket
or
had
any
types
of
run
in
with
the
police
or
law
enforcement.
J
I
I
E
Okay,
it's
my
understanding.
There
may
be
some
people
who
are
on
video
who
would
like
to
testify
in
the
neutral
position
and
I'd
invite
them
to
turn
their
cameras
on
or
raise
their
hands
if
they'd
like
to
do
so.
At
this.
E
A
Madam
chair,
if
I
could
just
make
a
closing
comment
on,
oh,
please
do.
Thank
you
just
by
way
of
closing,
I
did
want
to
note
the
comments
made
from
joan
hall
regarding
the
accreditation
at
the
rural
and
frontier
hospitals
and
pledges.
That
is
definitely
something
that
we
will
look
into,
because
we
definitely
want
to
make
sure
that
this
model
is
available
in
as
many
nevada
communities
as
possible.
A
E
A
F
Thank
you.
Thank
you.
Vice
vice
chair
harris
now
you're
doing
a
fabulous
job
and
you
could
have
stayed
there
but
anyway,
so
now
I
will
open
the
mini
hearing
on
senate
bill.
One
five,
four.
A
Thank
you,
madam
chair.
This
is
senator
julia
ratty
for
the
record.
I
represent
senate
district
13
and
am
pleased
to
bring
you
sb
154.
A
This
is
a
bill
that
came
out
of
the
interim
committee
on
health
care,
also
focused
on
behavioral
health
challenges.
Building
off
of
the
last
bill
that
we
heard
it's
wonderful
if
we're
going
to
get
to
a
place
where
90
of
people
who
are
experiencing
a
crisis
can
be
stabilized
over
the
phone.
Another
eight
or
nine
percent
could
be
stabilized
by
a
mobile
crisis
team
and
another
percentage
could
be
stabilized
in
a
crisis
stabilization
center.
A
But
the
truth
of
the
matter
is
that
there
are
going
to
be
still
people
in
our
community
who,
once
they
have
been
stabilized,
need,
are
going
to
need
a
bed
they're
going
to
need
a
bed
to
pursue
their
substance.
Use
recovery,
they're
going
to
need
to
be
a
bed
because
they
have
a
serious
mental
illness
or
they
have
a
or
a
child
who,
with
a
serious
emotional
disturbance,
and
one
of
the
barriers
that
exists
in
our
community
could
be
addressed.
A
If
we
were
to
apply
to
medicaid
for
a
waiver-
and
I
know
it's
always
fun-
to
talk
about
medicaid
waivers
they're-
the
most
exciting
topic
that
comes
before
the
the
committee
on
health
and
human
services-
but
they
can
be
very
powerful.
We
saw
that
with
the
1915
eye
waiver
that
we
applied
for
last
session.
A
That
gave
us
the
ability
to
work
with
cms
to
do
some
things
around
tenancy
support
and
supportive
housing,
and
this
is
very
similar
to
that
that
it
is
the
first
step
in
a
process
that
would
allow
us
to
work
with
our
federal
partners
to
see
if
we
could
build
a
better
model
to
be
able
to
make
sure
that
we
have
the
behavioral
health
resources
that
we
need
in
our
community.
So
I'm
going
to
share
screen
again.
A
A
Great
all
right,
so,
let's
just
start
by
talking
about
what
an
imd
is
so
an
ind
is
and
is
known
in
federal
parlance
as
a
institution
for
mental
disease
that
is
defined
as
a
facility
that
has
16
or
more
psychiatric
beds
or
50
percent.
More
or
more
of
their
emissions
are
for
a
behavioral
health
disorder.
A
If
you
are
an
imd,
then
you
are
excluded
from
being
eligible
for
medicaid
reimbursement.
So
that
means
that
if
we
wanted
to
invest
in
more
beds
in
these
kinds
of
settings,
it
would
be
a
100
general
fund.
It
would
mean
that
we
would
have
to
do
that
all
with
state
dollars
and
in
reality
that
doesn't
happen,
and
then
there
is
not
a
business
model
that
works
in
our
community
that
allows
us
to
get
to
the
number
of
beds
that
we
need.
A
A
What
we've
learned
is
that
we
kind
of
get
caught
in
a
vicious
cycle
where,
if
the
legislature
has
an
authorized,
medicaid
or
directed
medicaid
to
apply
for
a
waiver,
then
they
don't
have
the
budget
authority
needed
to
move
forward
with
that
waiver
and
they
can't
really
figure
out
how
much
programs
are
going
to
cost
without
going
through
a
very
extensive
process,
with
the
senators
senators
centers
for
medicaid
cms,
let
me
just
say
cms,
and
so
then
we
just
cut.
We
just
get
caught
in
a
cycle
and
we
don't
make
progress.
A
So
what
we
have
learned
is
that
if
we
start
with
the
budget
bill
this
bill
that
directs
them
to
apply
for
the
waiver,
then
that
allows
for
some
analysis
that
allows
us
to
figure
out
if
it
really
makes
sense
to
move
forward.
A
Usually
some
startup
costs
and
there's
usually
some
an
upfront
investment
that
needs
to
happen
to
get
these
services
underway
once
these
services
are
underway,
we
save
money
on
the
back
end
by
again
diverting
folks
out
of
emergency
rooms
and
higher
expense
services
and
facilities.
So
that's
the
nature
of
a
medicaid
waiver.
That's
just
generally
how
they
work,
and
so
the
idea
here
would
be
step
one.
We
passed
this
bill
step.
Two,
the
waiver
application
is
put
together
by
the
dhcfp,
our
state
department
of
medicaid.
A
They
go
through
that
extensive
process.
Many
other
states
have
done
this.
Actually
those
numbers
are
a
little
bit
outdated.
We've
got
more
than
it's
in
the
30s
now
of
states
that
have
done
it
for
substance,
use,
disorder,
treatment
and
we're
closing
in
on
10
states
that
have
pending
approval
or
the
serious
mental
illness
and
serious
emotionally
disturbed.
A
A
Part
of
the
reason
that
there's
not
enough
access
to
care
for
behavioral
health
is
there
isn't
a
good
business
model
where
entities
can
make
it
pencil
to
be
able
to
provide
these
services,
and
this
waiver
to
medicaid
would
allow
us
to
apply,
for
you
know
that
that
waiver
to
do
it
a
little
bit
differently
to
prove
that
we
can
make
it
budget
neutral
and
to
be
able
to
seek
reimbursement
for
these
facilities
known
as
imds.
So
again,
I'm
going
to
turn
it
over
to
dwayne
young
who
can
correct
anything.
A
G
Good
afternoon,
vice
chair,
spearman
and
committee
again
so
grateful
to
senator
raddy
for
allowing
the
division
of
healthcare,
healthcare,
financing
and
policy
to
participate
as
a
co-presenter.
In
this
hearing
and
share
with
you
some
facts
again,
my
name
is
dwayne
young,
deputy
administrator
for
that
division.
For
the
record,
the
senator
has
done
an
excellent
job
in
pointing
out
what
the
imd
exclusion
does.
I
just
want
to
give
you
some
information
that
in
nevada
only
two
facilities
in
the
north
and
one
in
the
south
qualify
as
not
meeting
the
imd
rule.
G
These
are
all
acute
hospitals
with
impatient
psychiatric
units
fee
for
service
medicaid,
which
includes
seriously
and
persistently
mentally
ill
individuals
within
the
medically
aged
line
and
disabled
populations
are
dependent
upon
these
facilities
and
the
two
state
hospitals.
It
goes
without
saying
that
this
has
created
over
the
years
a
consistent
bottleneck
with
people
waiting
in
emergency
rooms
and
facilities
for
treatment,
managed
care
organizations
can,
through
a
final
rule,
pay
up
to
15
days
per
month
for
crisis
care
for
an
individual
in
an
inpatient
setting
in
lieu
of
more
expensive
care.
G
G
These
are
levels
that
are
currently
missing
within
nevada's
health
scope
for
medicaid
recipients,
allowing
the
division
to
be
a
flexibility
to
apply
for
the
1115
demonstration
waiver
allows
the
state
the
flexibility
to
to
provide
services
proving
their
budget
neutrality
over
the
five-year
life
of
the
waiver.
This
can
be
done
by
adhering
to
cms,
robust
measurements
and
standards
of
neutrality.
Nevada's
unique
position
with
the
support
grant
allows
us
to
leverage
the
expertise
and
guidance
that
we've
received
in
technical
assistance
and
planning.
A
A
Certainly,
there
are
a
lot
of
fiscal
questions
in
terms
of
how
we
get
started
with
a
waiver,
and
I
would
suspect
that
this
bill
will
get
pulled
into
the
finance
committee,
where
we
can
dig
deeper
into
how
this
would
affect
the
medicaid
budget
specifically,
but
from
as
a
policy
standpoint,
I
think
it's
fantastic
policy.
A
F
Thank
you,
ma'am
sure,
committee
members.
Any
questions.
C
A
B
So
there
are
two
separate
waivers:
the
waiver
search
for
substance
use
disorder
services
is
up
to
31
states
and
the
waiver.
The
division
of
health
care
financing
and
policy
is
authorized
to
apply
for
which
relates
to
individuals
with
serious
mental
illness
or
severe
emotional
disturbance
or
disorder
is
up
to
seven.
C
G
For
the
record,
and
so
cms
has
advised
states
to
apply
for
the
substance,
use
disorder,
waiver
first
and
then
use
that
as
a
template
to
apply
for
the
waiver
regarding
smi
and
sed,
and
so
that's
why
those
numbers
are
higher
on
the
substance,
use
disorders.
F
E
Thank
you
vice
chair
spearman,
just
one
minor
suggestion
and
I'm
gonna
be
a
little
picky.
But
if
you
know
me,
that's
probably
not
too
much
of
a
surprise
section.
One
paragraph
section,
one
subsection
four
paragraph
b
describes
defines
a
child
with
a
serious
emotional
disturbance
and
exempts
mental
disorders
designated
as
a
code
v
disorder
in
the
dsm.
E
A
As
the
sponsor
I'll
say,
I
have
nothing
to
say
about
that,
because
I
barely
understood
what
you
just
said,
but
I'll
ask
mr
robbins.
If
to
look
into
it
and
make
sure
that
we
have
the
clarity
that
you're.
F
A
C
Absolutely
I
apologize
I'm
I
I'm
listening
in
and
drafting
right
now
at
the
at
this
same
time.
So
I
I
missed
the
question.
What
was
the
question.
E
So,
mr
robbins,
on
and
I'll
just
refer
to
the
line
line
36
it
refers
to
something
other
than
a
mental
disorder
designated
as
a
code
v
disorder,
and
the
dsm
makes
it
clear
that
code
v
disorders
are
not
mental
disorders
and
I
so
that
may
be
just
a
little
duplicative
and
again
it's
just
a
picky
point
and
probably
doesn't
have
too
much
impact,
but
there
may
be
a
a
slightly
cleaner
way
to
get
at
that.
C
Okay,
we're
we're
happy
to
look
into
any
revisions
that
might
be
necessary.
F
I
don't
see
any
other
hands
up.
Anyone
else
have
a
question.
F
No
matter,
I
just
have
one
question:
I
guess
this
might
even
apply
to
the
previous
bill.
Will
there
be
any
funding
to
make
sure
that
law
enforcement
is
trained
in
recognizing
the
mental
illness?
If
they're
called
to
a
crisis,
someone
was
having
a
psychotic
break.
Will
there
be
anything
done
so
that
the
person
that
the
family,
that
called
doesn't
wind
up
planning
a
funeral
for
the
person
who
was
ill
in
four
days.
A
So
what
I
will
say
is
that
this
particular
bill
is
not
about
the
crisis
intervention,
so
this
particular
bill
is
we're
well
past
that
intervention,
and
this
is
a
person
who
is
now
been
evaluated
and
they
are
being
offered
and,
in
some
cases
mandated
to
be
in
a
substance,
use
disorder,
treatment
facility
or
a
psychiatric
treatment
facility
where
it's
an
inpatient
bed.
So
for
this
particular
bill,
we're
several
steps
past
that
call
to
a
law
enforcement
officer
and
crisis
stabilization.
A
I
believe
that
you
may
have
been
out
of
the
virtual
room
and
presenting
your
bill
in
legislative
operations
when
we
were
talking
about
the
last
bill,
sb156,
which
is
really
all
about
rebuilding
the
crisis
stabilization
system,
and
what
I
will
will
say
is
that,
while
there
is
not
explicitly
money
for
training
for
law
enforcement
in
that
bill,
what
that
bill
seeks
to
do
is
in
most
cases
not
have
law
enforcement
respond
at
all,
and
so,
where
you
reduce
the
interaction
between
law
enforcement
and
a
person
who's
experiencing
a
behavioral
health
crisis
by
having,
instead
of
law
enforcement,
rolling
rolling,
a
behavioral
health,
professional
and
a
peer
with
lived
experience.
A
So
while
it
does
not
specifically
to
your
question,
address
training
for
law
enforcement,
I
think
there's
another
bill.
That's
coming
again,
I'm
just
going
to
keep
doing
a
teaser
because
there's
a
an
important
part
of
the
crisis
stabilization
center,
which
is
the
crisis
call
line
and
how
we
dispatch
and
who
we
dispatch
where
that
will
come
forward
in
another
bill.
So
I
guess
I'm
asking
for
a
little
bit
of
a
parking
lot
for
that
question.
The
direct
answer
is
no.
There's.
No
funding
in
this
bill
or
any
of
the
other
bills.
A
We
heard
today
specifically
directed
at
training
for
law
enforcement,
but
overall,
multiple
bills,
working
on
dramatic
improvements
to
the
crisis
response
and
in
most
cases,
trying
not
to
rule
law
enforcement
but
making
sure
when
we
do
rule
law
enforcement
that
it's
a
better.
F
Outcome
and
the
angels
all
saying
hallelujah.
Thank
you.
Are
there
any
additional
questions
from
committee
members.
I
I
J
Z-E-D-N-I-C-E-K,
I
am
the
ceo
at
desert,
parkway
behavioral
health
care
hospital
in
las
vegas
and
the
interim
ceo
at
reno
behavioral
hospital
in
reno
nevada.
So
I
wanted
to
just
thank
everyone
for
listening
to
this
bill.
I've
been
awaiting
something
like
this
for
the
last
10
years
of
being
in
a
leadership
role
here
in
nevada,
and
so
I'm
I'm
in
support
of
currently
as
a
what
we
would
be
called
an
imd
person
I
or
an
imd
facility.
J
J
There
is
a
gap
in
service
because
we
are
not
able
to
treat
patients
and
be
compensated
for
medicaid,
often
acquiring
quite
a
bit
of
charity
when
we
have
patients
with
medicaid
we're
also
30
percent
less
costly
than
the
short-term,
acute
hospitals,
so
the
imds
in
the
long
run
there
there
would
be
a
cost
cost
savings.
J
I
think
this
would
also-
and
I
should
say
think
I
know
this
will
also
help
bypass
the
ers
so
that
there
is
a
direct
relationship
that
we
have
with
the
most
team
in
the
north,
see
our
team
mobile
crisis,
metro,
police
officers,
remsa
all
the
all
the
agencies
that
are
responding
to
these
crises
in
both
communities.
J
Our
full
intention
would
be
to
partner
and
be
able
to
bypass
that
er
and
come
directly
to
us.
I
think
this
also
allows
a
more
progressive
way
of
thinking,
as
explained
by
dwayne
and
dr
woodard,
in
regards
to
being
a
little
bit
more
progressive
with
having
this
additional
funding
available
to
us.
So
I
think
that
I'm
in
support-
and
I
really
I
thank
you
as
well-
for
bringing
this
forward.
I
J
D
I
I
D
Good
afternoon
chair
vice
chair
and
committee,
my
name
is
leah
case
l-e-a-c-a-s-e
here
today
on
behalf
of
the
nevada
psychiatric
association,
and
I
want
to
echo
what
the
ceo
from
desert
parkway
said
and
what
miami
nevada
said
that
this
bill
will
have
a
real
impact
on
people's
lives.
D
We
are
in
in
full
support
and
really
have
to
say
thank
you
to
senator
ratty
for
bringing
this
bill
forward
and
to
the
whole
dhhs
team,
dr
woodard
administrator
young
cody
finney,
who
worked
with
us
and
others
over
the
interim
to
bring
this
pulse
of
fruition,
and
we
are
very
excited
to
see
it
at
a
hearing
and
look
forward
to
working
with
you
more
thank.
I
C
C
F
So
we
will
go
to
opposition
now
and
three
minutes
per
caller.
I
F
Okay,
thank
you
and
I'd
just
like
to
ask
those
questions.
Just
in
case
someone
didn't
hear
the
first
time
or
is
having
mechanical
difficulty.
So
with
that,
madam
chair,
would
you
like
to
have
additional
words.
A
Just
a
quick
closing,
mostly
of
gratitude.
First
of
all,
I'd
like
to
address
some
gratitude
to
the
nevada
psychiatric
association.
They
have
advocated
for
this
bill
at
the
washoe
regional
policy
board
at
the
interim
committee
for
healthcare.
A
They
were
the
ones
who
put
together
the
lovely
graphic
that
I
used
today,
and
so
I
just
want
to
thank
them
for
continuing
to
be
wonderful
advocates
for
this
concept
and
supporting
the
spill,
and
then
I'd
like
to
thank
again
the
department
of
health
and
human
services
and
specifically
dwayne
young
and
stephanie,
dr
woodard,
for
their
work
on
making
sure
that
this
bill
was
viable
and
something
that
we
could
move
forward
so
again.
A
Team
effort
on
this
one,
and
I'm
just
appreciative
to
all
of
the
folks
who
are
much
smarter
than
I
am
who've,
been
figuring
out
where
the
gaps
are
in
service
and
trying
to
come
up
with
good
ideas
to
address
them.
With
that,
I
appreciate
the
committee
allowing
me
the
time
to
present
this
bill
again,
senator
julia
ready
from
senate
district
13..
Thank
you.
A
Thank
you.
So
I
did
just
want
to
note
that
both
of
the
bills
that
we
heard
today
were
referred
to
this
committee
on
monday
and
we
scheduled
them
for
a
hearing
on
tuesday,
which
is
a
very
quick
turnaround
and
while
clearly
some
folks
were
able
to
catch
it
and
were
able
to
participate
today.
A
But
if
there's
anybody
out
there
who
are
just
learning
about
this
bill
and
these
bills
and
have
some
input
that
they
would
like
to
give,
we
will
hold
off
a
bit
to
do
the
work
sessions
just
to
make
sure
that,
given
the
short
turnaround
from
referral
from
floor
to
committee,
to
scheduling
of
the
bills
that
folks
have
an
opportunity.
So
just
know
that
please
reach
out
to
me
if
you
have
additional
input.
A
Our
next
midi
hearing
for
those
of
you
who
may
need
to
run
off
to
something
else,
is
going
we're
going
to
be
dark
on
march
4th
we'll
be
back
again
on
march
9th
tuesday
of
next
week,
and
we
will
be
hearing.
I
believe
we
are
scheduled
to
hear
two
bills
at
that
point,
sb5
and
sb40.
So
we
hope
you'll
join
us
next
tuesday.
A
A
little
bit
more
notice
on
those
and
with
that
I'm
going
to
go
ahead
and
ask
that
any
written
testimony
that
was
submitted
in
support
or
or
opposition
or
neutral
for
anything
that
we
heard
today,
please
be
included
in
the
record
and
I'm
gonna
go
go
ahead
and
ask
bps
to
open
it
up
for
public
comment.