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From YouTube: 3/18/2021 - Assembly Ways and Means and Senate Finance, Subcommittees on General Government
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For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
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A
Well,
welcome
to
the
joint
assembly
and
senate
committee
subcommittee.
Excuse
me
and
our
finance
committees
I'm
going
to
go
ahead
and
call
this
meeting
to
order.
Can
the
secretary
please
take
the
role
senator
brooks.
C
C
A
Here,
thank
you.
Will
you
please
mark
senator,
brooks
absent,
excused
and
mark
assemblyman
haven
present
when
he
arrives
today
we
have
one
budget
and
well,
I
guess,
before
we
get
started
on
that,
I'm
just
gonna
do
the
regular
housekeeping
stuff.
The
public
has
access
to
this
committee
meeting
via
nellis
or
our
youtube
channel.
You
are
welcome
to
check
out
the
agenda
there
and
any
presentation
materials
as
well
as
participate
in
public
comment
at
the
end
of
the
meeting
public
comment
is
limited
to
two
minutes
per
caller.
A
However,
you
are
always
welcome
to
submit
written
comments
to
the
committee
at
any
time
and
with
that
a
couple
things
for
presenters.
Would
you
please
remember
to
state
your
name
clearly
for
the
record?
It
is
so
helpful
for
the
secretaries
to
have
that
when
they're
taking
the
minutes
and
for
members,
if
you
don't
mind,
muting
yourself
when
you're,
not
speaking,
that,
helps
with
the
background
noise
and
with
that,
let's
go
ahead
and
get
started
with
the
budget.
E
F
D
F
D
My
name
is
ryan
high.
I'm
the
chief,
the
ceo
of
the
exchange
here
today,
we'll
be
going
over
our
agency
overview,
our
strategic
priorities,
our
marketplace
landscape,
our
exchange
enrollment,
our
outline
of
special
enrollment
periods,
our.
E
A
D
Say
that
our
executive
director,
heather
kerbuelik,
she
says
she's-
sorry
she's
not
here
today,
but
she
is
doing
a
special
assignment
over
at
the
governor's
office,
but
I
think
jennifer-
and
I
will
do
well
today
presenting
the
exchange
so
without
further
ado,
we'll
jump
right
in
so
the
silver
state
health
insurance
exchange
is
a
state-based
marketplace.
D
Okay,
sorry,
our
strategic
priorities:
we,
our
strategic
strategic
priorities,
are
to
increase
the
number
of
insured
persons
in
nevada,
second,
to
facilitate
the
purchase
and
sale
of
qualified
health
and
dental
plans.
D
We,
as
I
said,
we
had
three
catastrophic
plans:
19
bronze,
25
silver
and
six
gold.
These
are
our
metal
levels.
Nevadans
and
clark
and
nine
counties
have
choices
available
from
all
53
plans
offered
from
the
five
carriers.
D
C
D
Great,
so
our
final
plan
of
selection
was
81
are
new
consumers.
Twenty
five
thousand
two
hundred
and
ending
corrects
near
297
and
the
re-enrollees
was
fifty
six
thousand
six.
Oh
six,
now
moving
to
a
state-based
exchange,
we
were
able
to
offer
special
or
extended
enrollment
periods
and
that's
the
flexibility
we
have
in
being
in
state-based
exchange
and
off
of
the
federal
platform
we're
allowed
for
these
multiple
agile,
special
enrollment
periods.
D
So
we
had
one
from
march
17th
to
may
15
2020,
which
was
an
accessible,
exceptional
circumstance,
scp
related
to
the
covet
19
pandemic.
We
also
had
one
we
extended
our
open
enrollment
period,
our
traditional
open
enrollment
period.
We
went
from
december
16th
to
january
15th,
and
this
was
an
extended
open,
enrollment
period
known
as
the
marketplace.
D
Stabilization
sct
currently
we're
in
a
february
15th
to
may
15th
missed
open
enrollment
period
scp,
and
this
is
due
to
the
continued
covet
19
pandemic,
and
we
allow
this
open
enrollment
period
for
our
consumers,
and
we
have
an
upcoming
april
2021
special
enrollment
period
related
to
the
american
rescue
plan,
act
or
artha.
F
Thank
you.
Thank
you,
ryan.
So
now
we'll
move
into
the
governor
recommended
funding
changes
again.
This
is
jennifer
corrupt
for
the
record.
The
budget
highlights
include
for
the
21
22
state
fiscal
year.
It
will
be
a
total
18,
850
3
472
budget
with
fees
and
reserves.
F
F
These
represent
costs
associated
with
extending
the
open
enrollment
and
it
increases
the
consumer
assistance,
call
center
hours
and
access.
These
two
decision
units
will
extend
open
enrollment
to
january
15th
of
each
year
and
include
full
weekend
call
center
coverage
and
capacity
at
a
fixed
cost
throughout
the
duration
of
the
contract.
F
Initial
costs
for
this
decision
unit
were
actually
approved
in
state
fiscal
year.
21
through
work
programs,
wpc,
51386
and
c51387
the
reason
that
we've
included
these
two
decision
units
is
because,
on
june
29th
of
2020,
the
board
of
the
silver
state
health
insurance
exchange
approved
regulation
ef-05,
which
provides
the
board
authority
to
establish
a
market
stabilization
special
enrollment
period
to
supplement
the
federal
open,
enrollment
period,
which
runs
november
1st
through
december
15th,
which
does
allow
additional
time
for
nevada
consumers
to
shop,
apply
and
enroll
in
coverage
on
the
exchange.
F
So
on
july,
21st
the
board
directed
the
exchange
staff
to
create
an
mssep
which
effectively
extends
the
oep
to
january
15th
of
each
year,
as
ryan
had
indicated
earlier.
So
the
extended
consumer
assistance
call
center
functionality
and
weekend
call
center
capacity
to
maintain
oep
stacking
levels
through
the
end
of
each
mssep
allows
the
exchange
to
meet
the
needs
of
nevada
consumers,
enrollment
professionals
and
brokers,
and
ensures
the
consumer
assistance.
Call
center
is
fully
and
appropriately
staffed
to
handle
consumer
inquiries.
A
B
Thank
you
so
much
chair,
peters
and
thank
you
for
being
here
this
morning
and
a
quick
question
about
how
cobid
and
the
pandemic
has
affected
the
workload
at
the
call
centers.
Could
you
talk
a
little
bit
about
that.
D
Sure
I
can
take
that.
Okay,
yes,
no!
Yes,
right
for
the
record
ryan,
hi
chief
operations
officer.
I
can
give
you
some
quick
stats,
and
maybe
this
might
facilitate
some
more
questions
here,
but
so
our
our
py
our
plan
year,
2020
numbers
were
for
the
call
center
were
1
900,
I'm
sorry,
one
thousand
nine
hundred
and
fifty
thousand
plan
year,
2021
or
eighty
three
000
a
lot
of
those
first
year.
D
E
D
Seen
increases
especially
last
year
through
the
march
17th
coveted
special
enrollment
period
calls
were
up
about
20
this
year,
starting
in
february
of
this
year,
calls
are
up
about
25
percent
over
non-special
along
the
period
weeks.
F
D
F
Through
now
so
I
mean
it's
not
okay,
our
plan
year
20
numbers
which
is
195
000.
You
can
see
that
we're
already
at
50
so
early
into
the
plan
year
versus
the
full
scope
of
plan
year,
2020.
so
and
our
plan
years
run
on
a
calendar
year
for
for
everybody's
information.
A
Yes,
assemblywoman
gorilla
we're
having
a
little
bit
of
trouble
hearing
you
if
you
don't
mind
speaking
a
little
bit
more
loudly
and
also
secretary
for
the
record,
would
you
mark
assemblyman
haven
as
president,
please.
B
Okay,
great
and
thank
you
for
the
follow-up.
Can
you
talk
a
little
bit
more
about
the
extended
enrollment
period
of
30
days
in
the
additional
call
center
capacity
for
the
extended
open
enrollment
period
and
the
increased
enrollment.
F
I'll,
let
ryan
talk
about
our
enrollment
numbers
through
the
period,
but
our
our
technology
vendor
and
our
call
center
vendors
get
insured
and
our
contract
has
two
different
levels
of
stacking.
We
have
staffing
for
our
call
center,
which
is
through
the
open
enrollment
period,
and
we
have
staffing
for
the
call
center,
which
is
through
our
special
enrollment
period.
So
our
open,
enrollment
call
center
staffing
is
at
48
48
call
center
employees
that
are
there.
F
You
know
specifically
working
on
nevada,
taking
about
a
calls
and
handling
about
a
consumer
and
burger
inquiries
during
our
special
enrollment
period.
That
number
drops
down
to
28
because
our
call
volume
isn't
the
same.
So
when
we
decided
to
extend
the
open
enrollment
period,
we
needed
to
increase
our
capacity
in.
F
Center
to
meet
that
48
consumer
or
that
48
call
center
personnel
number
so
that
we
can
continue
to
meet
the
needs
of
our
nevada,
consumers
and
brokers
that
were
calling
in
so
we're
going
from
48
to
28
staff
members
through
the
dirt.
Through
that
extra
30
days
from
december
16th
through
january
15th.
D
Then
ryan
hines
for
the
record
so
moving
to
a
state-based
exchange.
You
know
we
have
this
flexibility.
We
could
be
more
agile
than
let's
say
the
federal
government,
so.
B
D
You
some
quick
numbers,
the
march
17th
to
may
15
2020,
except
for
all
circumstance
period
for
coded
last
year.
In
2020
we
added
about
another
5400
nevadans
were
able
to
take
advantage
of
that
special
enrollment
period,
which
was
great
from
december
16th
to
january
15th
of
this
year
about
8
700
nevadans
were
able
to
enroll
for
the
exchange
through
our
extended
open
enrollment
period
and
then
to
date
from
february
15
to
today
about
another
2
300
were
able
to
take
advantage
of
this
new
special
moment.
Here
we
have
going
on
right
now.
B
B
A
Thank
you.
Are
there
any
other
questions
from
committee
members
on
these
two
units?
I
don't
see
any
okay,
I
think
we
can
move
on
then.
Thank
you
so
much.
B
F
Okay,
so
can
everybody
see
my
screen.
F
Great
thank
you
jennifer
prep
for
the
record.
The
next
decision
unit
that
we'll
move
into
is
decision
unit
e352,
and
this
is
fbe
operations,
marketing
and
outreach.
This
request
maintains
funding
for
our
marketing
and
outreach
at
state
fiscal
year,
20
base
year
levels
to
continue
existing
marketing
and
outreach
activities
in
sfy
20.
The
exchange
was
unable
to
fully
execute
budgeted
marketing
and
outreach
funds
due
to
the
covid19
pandemic
and
shelter-in-place
emergency
directives
issued
by
governor
sister
beginning
in
march
of
2020..
F
B
F
Over
3.2
million
dollars
a
year,
and
this
requested
funding
will
be
used
towards
continuing
marketing
and
outreach
efforts
for
us,
especially
in
this
time
of
the
kobe
19
pandemic.
It's
critical
to
maintain
current
funding
to
continue
to
promote
awareness
of
negative
health
link
and
the
availability
of
low-cost,
comprehensive
health
insurance
coverage.
F
F
Budget
the
same
you
know,
one
other
thing
to
point
out
is
that
economic
forecasts
from
industry
analysts
do
indicate
that
the
effects
of
the
code
of
19
public
health
emergency
are
likely
to
remain
high
for
a
period
of
18
to
24
months
so,
and
the
reason
that
we
weren't
able
to
fully
execute
our
funding
in
state
fiscal
year.
2020
was
because,
between
march
13th
and
june
30th
we
had
64
different
outreach.
Events
with
the
total
estimated
audience
size
of
16
558
were
cancelled,
that
created
a
savings
of
over
55
000.
F
B
F
Also
further
impacted
our
ability
to
fully
execute
our
budget.
We
had
another
79
000
in
savings
due
to
the
cancellation
of
planned
display
media,
which
you
know
were
strategically
placed
in
businesses
such
as
laundromats
and
hair
salons
and
convenience
stores
that
resulted
in
a
loss
of
over
5.9
million
nevada
health
link
impressions
to
consumers.
And
so,
if
you
remember
last
year
in
in
march,
you
know
we
were
all
under
the
stay
at
home
order.
So
it
didn't.
F
You
know
we
had
to
cancel
those
because
there
was
nobody
in
those
locations
to
be
able
to
use
that.
So
therefore,
like
giving
the
considerations
of
you
know,
the
initial
effects
of
the
pandemic
last
year
is
imperative
for
nevada
health
plan
to
continue
with
our
ongoing
marketing
and
advertising
efforts.
It's
very
important
for
us
to
continue
to
reach
eligible
nevada
consumers
and
ensure
that
they
do
have
access
to
comprehensive
health
insurance.
F
Move
on
to
the
next
one
again
jennifer
for
the
record,
so
this
is
s3e
operations,
new
position,
we're
going
to
talk
about
decision,
unit
e
353,
and
this
request
funds
one
classified
health
resource
analyst
2
to
absorb
functions
and
responsibilities
that
were
previously
provided
by
cms.
F
So
in
the
first
year
of
operations
of
the
state-based
exchange,
the
need
for
hr
health
resource
analyst
2,
which
I'm
going
to
refer
to
as
an
hra2
from
here
on,
was
identified
to
concentrate
on
the
federally
mandated
data
analysis.
Research
and
reporting
to
cms
cms
does
require
the
submission
of
comprehensive
enrollment
data
multiple
times
throughout
the
year
and
weekly
during
the
annual
open
enrollment
period.
One
thing
I
do
want
to
note
is
that
with
us
extending
our
open
enrollment
to
january
15th,
we
are
also
required
to
report
weekly
all
the
way
through
january
15th.
F
Also,
as
we
have
done
the
last
year,
we
did
the
exceptional
circumstances,
special
enrollment
period
for
the
coved
19
pandemic,
as
well
as
the
second
exceptional
circumstances,
open.
F
I
want
to
say
on
a
week-to-week
basis,
it's
15
different
data
points
and
then
a
cumulative
report
that
is
over
100
and
I
think
it's
128
data
points
I
could
be
off
by
a
point
or
two,
but
that's
our
cms
reporting,
but
we
also
receive
multiple
requests
for
data
from
other
agencies,
including
the
legislature,
the
division
of
insurance,
other
state
and
county
government
agencies,
academia,
other
federal
government
agency,
requests
to
media
and
local
and
national
industry
organizations.
F
Further.
The
exchange
has
over
200
internal
data
reports
that
we're
working
through
and
a
health
resource
analyst
is
needed,
so
the
exchange
can
leverage
all
of
these
statistics
and
trends
and
reports
into
actionable
decisions
that
will
improve
our
operational
efficiency.
This
will
also
provide
the
exchange
with
the
capabilities
to
conduct
in-house
data
analytics
and
provide
reporting
to
all
internal.
F
Stakeholders
current
staff
are
performing
these
duties
where
they
can,
but
the
number
frequency
and
complex
nature
of
these
requests
and
the
significant
statistical
analysis
required
has
become
unmanageable.
Current
staff
does
not
have
the
capacity
to
respond
to
requests
or
submit
the
federally
mandated
reports
in
a
timely
manner.
F
So
this
really
translates
into
an
optimal
staffing
level
of
one
fte
for
every
three
to
four
insurance
carriers
and
the
security
and
reconciliation
unit
has
been
operating
at
a
resource
deficit.
Essentially,
since
its
inception,
the
exchanges
anticipating
the
entry
of
one
new
insurance
carrier
into
nevada's
marketplace
for
plan
year
20.
F
Well,
we
did
welcome
two
new
insurance
carriers
for
plan
year,
21
which
we're
in
now
and
then
an
additional
insurance
carrier
in
plan
year
2022
and
we're
already
starting
to
think
about
plan
year
2023
and
we
have
had
a
lot
of
interest,
and
so
it
could
again
be
anywhere
from
one
to
five
up
to
some
of
the
things
that
we've
heard.
So
but
again,
that's
a
long
ways
off,
and
so
we
don't
have
more
information
than
that
other
than
we
have
had
significant
interest
and
continue
expect
to
continue
our
growth.
F
F
This
is
welcome
for
consumers.
The
entry
of
these
new
carriers
will
further
strain
the
resources
of
the
security
and
reconciliation
unit,
and
so
this
position
is
requested
to
bolster
the
resources
of
the
unit
and
ensure
that
our
target
service
levels
can
be
achieved,
and
the
business
process
analyst,
as
well
as
the
hra
previously
discussed,
would
both
be
effective
october.
1St
of
2021.
F
So
our
next
slide
is
decision
unit
e357,
and
this
is
going
to
fund
one
classified
health
program
specialist
one
in
the
communications
unit.
Again
the
exchange
operates
as
a
state-based
exchange
under
which
affordable
care
act,
health
insurance
exchange
functions
are
performed
between
exchange
staff
and
the
eligibility
and
enrollment
platform.
F
Nevadahealthlink.Com
marketing
outreach
plan,
certification,
carrier
relations,
stakeholder
management
and
broker
and
navigator
functions
are
provided
by
the
exchange.
The
communications
officer,
oversees
the
exchange's
marketing
vendor
and
marketing
and
outreach
campaign.
The
current
vendor
is
responsible
for
strategizing
implementing
and
overseeing
all
outreach
efforts,
including
event
organization
planning
and
statewide
community
relations
outreach
for
targeted
populations.
F
This
request
moves
these
duties
from
the
marketing
vendor
to
in-house
responsibility
and
coverage
by
the
health
program
specialist.
This
will
streamline
the
exchange's
efforts
to
conduct
outreach
to
targeted,
uninsured
and
underinsured
populations,
subsequently
increasing
enrollment
into
qualified
health
plans.
The
health
program
specialist
is
requested
for
the
henderson
duty
location
and
is
effective
october.
1St
2021
and
ideally
the
exchange
is
hoping
to
recruit
a
bilingual
candidate.
F
Finally,
decision
unity:
358
is
our
last
new
position
request
and
this
request
will
fund
one
classified
program
officer,
one
in
the
consumer
assistance
unit.
The
consumer
assistance
unit
consists
of
three
full-time
employees
and
one
the
three
full-time
program
officers
and
one
quality
assurance
manager
and
is
responsible
for
coordinating
the
tier
three
consumer
assistance
activities
for
13
different
insurance
carriers.
F
F
Further,
the
exchange
is
confirmed
the
entry
of
one
new
insurance
carrier
well,
sorry
when
we
are
expecting
an
additional
insurance
carrier
into
nevada's
marketplace
and
plan
year
2022
and
anticipated
additional
carriers
in
plan
year
2023.
F
F
The
exchange
currently
awards
funds
to
eight
navigator
entities
with
26
full-time
equivalent
ipas
in
state
fiscal
year,
2020
navigator
and
ipa
entities
were
awarded
a
maximum
of
3
500
a
month
per
full-time
ipa
reimbursable
on
a
billable
hour
basis.
If
a
navigator
or
ipa
entity
had
a
reduction
in
billable
hours,
they
would
have
a
subsequent
reduction
in
reimbursements
throughout
the
year.
Billable
hours
from
ipas
would
fluctuate
depending
on
demand
and
consumer
needs.
For
instance,
there
were
much
higher
billable
hour
reimbursements
during
the
open
enrollment
period
and
lower
billable
hour
reimbursements.
During
our
special
enrollment
periods.
F
This
reimbursement
methodology
made
it
difficult
for
funded
navigator
entities
to
develop
accurate
cost
projections
and
budgets
further.
The
kobit
19
pandemic,
requiring
the
closure
of
non-essential
businesses
and
filter
and
place
orders
beginning
in
march
2020,
had
a
detrimental
impact
on
navigator.
Ipa
entities
and
billable
hours
were
significantly
reduced.
This
led
to
the
exchange
realizing
a
savings
of
over
three
hundred
thousand
dollars
in
state
fiscal
year,
20,
navigator
and
brokerage
category.
F
So
in
an
effort
to
stabilize
funding,
because
you
know
we
do
mostly
work
with
non-profit
community
based
organizations
that
are
really
reliant
on
this
funding
to
stabilize
his
funding
and
to
provide
a
more
consistent
and
stable
statewide
pool
of
ipas
and
state
fiscal
year,
21
the
exchange
realigned
the
reimbursement
methodology
to
be
consistent
with
grant
management,
best
practices
and
reimbursement
guidelines,
as
directed
by
the
office
of
grants,
procurement,
coordination
and
management.
F
F
Includes
the
development
and
implementation
of
mutually
agreed
upon
goals
and
objectives,
detailed
work
plans
and
evidence-based
evaluation
methods
used
to
gauge
the
performance
of
navigator
entity
partners.
Reimbursement
is
based
on
the
maintenance
of
full-time
ipas
and
progress
towards
the
achievement
of
program
goals.
This
provides
navigator
and
ipa
entities
the
ability
to
focus
on
broader
longer,
true
goals,
to
identify
and
assist
eligible
nevada
consumers
with
enrollment
into
qhps.
F
So
decision
unit
e367
for
fbe
operations,
this
funds,
software
licensing
costs
for
the
exchange
to
maintain
an
existing,
affordable
care
act,
compliant
casework
system
in
august
of
2019,
the
exchange
purchased
licenses
for
salesforce,
using
one
of
the
state's
master
purchase,
orders
and
developed
the
casework
system.
In-House
initial
costs
were
approved
in
state
fiscal
year,
2021
through
work
program,
c0
or
c50618,
and
this
request
continues:
funding
three
state
fiscal
year.
2023
the
transition
to
a
state-based
exchange
required
the
exchange
to
implement
a
secure
collaborative
casework
system
for
use
with
nevada's
on-exchange
insurance
carriers.
F
So
these
decision
units
to
the
three
hundred
and
ten
dollars
in
spaces
well
you're,
twenty
two
and
the
ten
thousand
nine
hundred
and
seventy
nine
dollars
in
state
fiscal
year.
23
are
the
contracted
increases
that
we
will
have
to
pay
each
year.
So
the
base
amount
was
49
000
and
I
can't
remember
the
exact
number,
but
some
change
so
moving
into
state
fiscal
year.
22
it's
going
to
be
like
56,
000
and
then
state
fiscal
year
23
it's
going
to
go
up
incrementally
from
there.
So
that's
why
these
numbers
are
a
little
different.
F
These
are
in
categories
26
and
4..
E710
requests
the
replacement
of
computer
hardware
equipment
for
the
eats
recemented
replacement
schedule,
and
these
replacement
equipment
replacements
are
scheduled
to
occur
in
state
fiscal
year.
23.
e711
request
funds
and
replacement
of
the
video
teleconferencing
equipment
per
the
each
recommended
replacement
schedule.
That's
scheduled
to
occur
in
state
fiscal
year,
22
and
e366
requests.
This
request
funds
a
new
copy
release
for
a
second
unit
located
in
the
carson
city
office
for
2700
in
both
state
fiscal
year,
22
and
23.
F
So
finally,
we'll
talk
about
our
reserve
projections
based
on
current
projections.
The
exchange
expects
to
maintain
180
day
or
about
180
day
reserve
in
state
fiscal
year
21
through
24.,
and
one
thing
that
I
did
want
to
point
out.
While
this
is
generally
a
higher
reserve
level
than
is
recommended
because
the
silver
state
health
insurance
exchange
is
still
subject
to
so
much
uncertainty
in
the
marketplace.
And
you
know,
we've
moved
out
of
this
era
of
you
know
the
questionable
you.
B
F
Aca,
if
it's
you
know
going
to
be
consistent
or
if
it's
going
to
stay,
I
think
we
feel
pretty
confident
that
you
know
it's
going
to
stay
and
that
we're
going
to
continue
on.
However,
you
know
we
are
in
the
american
rescue
plan
act
as
a
very
good
example
of
that
we
are
sometimes
subject
to
federal
legislation
and
mandates
that
we
need
to
implement
quickly
and
that
do
come
at
a
cost
for
us,
and
so
that's
why
we
are
requesting
the
higher
reserve
levels
so
and.
A
F
Did
want
to
point
out
that
when
this
budget
was
originally
written
thinking
back,
you
know
we
were
looking
at.
You
know
we
were
putting
in
our
projected
revenues
and
our
projected
reserve
balances
in
august
of
2020,
so
we
budgeted
them
extremely
conservatively,
and
so
this
budget
is
really
based
on
a
worst-case
scenario
for
the
exchange
we
weren't
sure
if
our
enrollment
was
going
to
decrease
significantly
as
it
has,
you
know
more
of
our
consumers
would
move
on
to
medicaid
or
if
they
would
be
staying
on
the
exchange.
F
But
you
know
now
that
we're
five
or
six
months
later
and
we're
seeing
our
plan
year,
2021
revenues,
we're
feeling
much
more
confident
in
the
stable
income
levels
or
revenue
levels
of
the
exchange
and
that's
everything
I
have
so
we're
happy
and
welcome
to
take
any
questions.
F
A
Thank
you
for
the
presentation
and
we
do
have
a
couple
of
questions
related
to
some
of
those
areas.
I'm
gonna
go
to
assembly
woman
miller.
First
thank.
B
You
chair
my
questions.
I
want
to
go
back
a
little
in
your
presentation.
You
mentioned
that
and
you
listed
multiple
entities
that
have
been
requesting
data
and
statistical
analysis
from
the
exchange,
and
I
was
just
wondering
if
there
are
any
factors
that
you
think
are
contributing
to
an
increase
in
those
requests.
F
You
know
in
response
to
the
kevin
19
pandemic,
especially
when
it
comes
in
terms
of
you
know,
the
number
of
additional
people
who
have
been
able
to
obtain
health
insurance
coverage
on
the
exchange,
and
then
I
think,
ryan
can
probably
talk
a
little
bit
more
about
some
of
the,
and
this
has
kind
of
been
one
of
those
areas
where,
like
the
first
part
of
last
year,
was
kind
of
the
data
request,
kind
of
fell
under
me,
and
then
they
got
moved
to
ryan,
and
so,
if
you
know
we're
kind
of
going
back
and
forth,
it's
because
we
are
a
small
organization
and
we've
had
to
be
agile
and
nimble
and
we've
all
kind
of
picked
up
where
we
could
so
at
the
first
part
of
last
year.
B
F
Health
insurance
coverage
that
was,
you
know,
offered
through
the
cove
19
pandemic.
A
lot
of
requests
from
our
insurance
carriers.
That
was
one
of
the
biggest
things
is
that
we
were
now
able
to
offer
member
level
enrollment
information
to
our
individual
qhp
plans
and
our
stand-alone
health
plans
central
health
plans.
So
we
we
were
able
to
provide
our
carriers
last
year
with
some
pretty
detailed
reporting
that
they
weren't
ever
able
to
get
from
cms.
F
So
I
mean
broken
down
like
you
know,
by
the
number
of
consumers
that
they
had
broken
down
to
their
zip
code
level
and
now
at
the
county
level,
so
and
whether
those
consumers
were
new
consumers
or
new
enroll,
automatically
enrollees
or
if
they
were.
What's
the
word
active
re-enrollee,
so
they
actually
came
onto
the
exchange
platform
and
made
changes
to
their
accounts.
F
B
F
B
I
would
like
to
echo
what
assemblywoman
gorlow
said
and
just
about
the
amount
of
information
that
we
saw
being
pumped
out
and
the
flexibilities
in
changing
deadlines
and
dates
and
stuff
like
that
to
accommodate
what
was
happening
in
people's
lives
as
people
were,
losing
their
jobs
and
and
needing
assistance.
Obviously
we
really
really
appreciate
that.
You
know
really
appreciate
that.
B
I
have
one
more
brief
question
and
I
don't
know
if
you
can
answer
it,
because
I
know
what
the
technical
answer
is
that
it
all
depends
on
the
menu
of
services
and
the
selections
in
your
age
and
your
health
and
all
this
kind
of
stuff,
but
on
average,
how
much
does
it
cost
them
about
in
if
they
just
to
get
into
the
plan?
Do
you
have
some
kind
of
average
numbers
that
that
it
cost
each
month.
F
Yeah
and
I'm
like
I'm
a
numbers
person,
so
I'm
kind
of
going
through,
but
I
think
our
our
average
premium
in
plan
year
2020
was
774
dollars,
but
then
the
out-of-pocket
average
that
they
paid
was
185..
It's
close
to
200.
D
F
F
D
D
A
Thank
you
assemblywoman
for
the
question,
and
I
I
would
also
like
to
echo.
I
was
a
user
of
the
exchange
for
a
period
of
time
and
you
guys
have
made
quite
the
strides
on
accessibility
and
openness
and
the
call
center
is
making
a
huge
difference.
Those
more
open
times
can
be
just
the
lifesaver
for
some
folks
who
are
struggling
to
get
insurance
so
kudos
and
congratulations
on
those
efforts.
Thank
you.
So
much
for
doing
that.
I
have
another
question
from
senator
dennis.
Please.
C
Thank
you.
So
my
question
has
to
do
with
the
you
know.
Historically,
you've
used
a
vendor
to
do
your
marketing
and
so
now
you're
out
doing
and
you're
going
to
redrew
the
contract
with
your
vendor,
but
instead
of
having
the
vendor
do
the
high
level
strategic
planning
and
outreach
you're
you're,
proposing
to
have
a
position
now
within
the
agency
to
within
within
the
organization
to
do
that.
So
what
what
factors
did
you
consider
when
you
were
determining
that
need
for
the
outreach
and
everything
and
that
representation
in
southern
nevada.
F
Thank
you
for
your
question.
Jennifer
for
the
record.
We
considered
many
factors.
Primarily,
the
clocks
was
a
big
factor
previously,
and
our
contract
is
just
changing.
F
The
board
of
examiners
has
approved
our
new
contract,
which
rfp
beginning
on
april
1st,
so
we'll
now
be
contracted
with
the
abbey
agency,
but
our
previous
contractor,
we
were
paying
roughly
16
000
a
month
for
these
services
and
so
being
able
to
bring
the
service
in-house
came
at
a
significant
cost
savings
to
the
agency,
and
it
allowed
us
to
move
more
of
those
dollars
that
were
in
our
marketing
budget
into
actual
advertising
and
direct
media.
F
That
could
broaden
the
exposure
of
the
exchange,
but
then
we
also
really
wanted
to
have
somebody
full-time
on
staff.
That
would,
you
know,
be
able
to
provide
more
of
a
dedicated
mindset
towards
these
types
of
activities
and
really
be
working
within
the
community
and
working
with
our
stakeholders.
One-On-One
and
just
be,
you
know
primarily
focused
on
those
activities.
Those
those
were
the
big
things
that
we
thought
about.
C
F
It
is
where
the
majority
of
our
need
is
most
of
as
with
most
things
in
nevada,
but
most
of
our
enrollees
and
our
consumer
base
is
in
the
clark
county
area.
Most
of
the
stakeholders,
especially
with
the
navigator
program,
are
based
in
the
henderson
area.
We
work
very,
very
hard
to
make
sure
that
you
know
we're
we're
partnering
and
working
with
community-based
organizations
on
a
statewide
basis,
but
I
think
of
the
eight
entities
that
we
have.
Five
of
them
are
in
the
las
vegas
area.
B
F
Right,
sorry,
for
crap,
for
the
record,
I
apologize
I
get
a
little
enthusiastic,
but
our
our
intent
is
to
continue
to
expand
and
grow
our
our
outreach
and
our
marketing
efforts.
So
we
feel
that
having
this
health
program
specialist
in
the
henderson
office
will
facilitate
that
expanded
outreach
and
growth.
You
know
we
still
have
about
100
000
people
in
nevada
that
are
qualified
for
coverage
on
the
exchange
and
would
qualify
for
subsidies,
and
so
our
goal
is
to
continue
reaching
those
people
and
continue
to
close
the
gap
on
that
number.
So.
A
Thank
you.
I
have
a
couple
more
questions
from
vice
chair,
howard,
key.
B
Thank
you,
madam
chair,
and
I
just
want
to
go
specifically
to
decision
unit
e358
and
the
program
officer.
I
know
in
your
presentation.
You
mentioned
that
going
from
11
to
13
carriers.
Has
you
guys
stretched
very
thin,
but
can
you
walk
me
through
what
kind
of
complaints
are
escalated
to
you
for
resolution?
D
Sure
for
the
record
ryan
hi,
the
ceo
of
the
exchange,
so
the
types
of
tickets
that
come
to
our
quality
assurance
unit-
these
are,
above
so
recalls.
We
have
a
contracted
call
center
with
a
get
insured.
They
handle
tier
one
and
tier
two
types
of
calls.
Tier
one
might
be
a
password
reset.
Let's
say
tier
two
may
be
something
that
might
be
escalated
to
a
supervisor
at
the
call
center.
So
the
tier
three
calls
that
the
call
center
will
pass
to
us
will.
D
That
requires
more
detailed
research
or
maybe
some
action
taken
by
the
exchange.
These
might
be
things
like,
maybe
back
dating
and
enrollment
coverage,
maybe
if,
for
whatever
reason,
there's
an
issue
between
our.
D
D
So
those
are
the
types
of
calls
that
we
get
and
why,
as
we
add
carriers,
you
can
probably
guess
that
we'll
get
more
calls
and
more
reasons
to
research
and
answer
these
types
of
questions.
F
B
F
Okay,
for
now
what
I'm
hearing
yes
for
now
now,
there's
so
many
curveballs.
You
know
that
have
been
thrown
and
so
there's
been.
You
know
a
lot
of
things
that
you
know
may
have
happened
over
the
last
year
that
has
increased.
F
You
know
or
put
a
strain
on
our
capacity
that
you
know
when
you
look
at
this,
you
know
strategically
from
a
10-year
perspective.
You
know:
will
these
things
still
be
in
place?
So
looking.
B
F
If
things
were
normal
and
if
this
was
just
the
exact
or
the
expected
growth
over
the
next
couple
of
years-
and
we
didn't
have
this
public
health
pandemic
in
crisis,
I
think
that
we
would
be
feeling
like
the
four
additional
staff
members
would
have
as
well
staffed.
I
think
the
additional
responsibilities
that
we've
absorbed
as
a
result
of
the
pandemic
have,
as
with
all
of
our
state
agencies
and
partners.
You
know,
we've
all
been
working
a
lot
extra.
D
And
it's
for
the
record
ryan
hi.
It's
been
a
very
interesting
year
and
that's
why
we
were
pausing
and
jennifer.
You
know
for
not
seeing
each
other.
You
know
we
had
this
special
enrollment
period
last
spring
in
march
and
then
we
had
to
extend
our
or
we
were
able
to
extend
our
open
enrollment
period
into
january
and
then,
with
this
new
scp,
this
new
special
one
period.
We
have
right
now
with
the
coveted
pandemic
that
we're
currently
in
right.
D
Now
we
didn't
anticipate
any
of
these
and
then
the
american
rescue
plan
act.
This
orfa
act,
that's
coming
up.
None
of
this
was
planned
for
so
that
we're
trying
to
answer
your
question.
We
think
that'll
be
enough
resources
and
stuff,
but
with
the
exchange
it
seems
like
there's
a
new
thing
coming
every
quarter
almost.
A
Thank
you
for
the
questions
I
kind
of
wanted
to
talk
a
little
bit
about
what
you're
expecting
or,
if
you've,
had
the
opportunity
to
assess
from
the
american
recovery
act
the
impacts
that
may
have
on
the
exchange.
A
I
have
this
vague
memory
of
hearing
a
report
that
the
federal
subsidy
may
go
up
for
those
exchange
networks
and
for
the
people
who
who
qualify
for
those,
and
so
can
you
just
talk
a
little
bit
about
what
those
what
those
that
will
do
to
your
office
and
and
where
you
see
there
there
may
be
some
need
for
for
additional
flexibility
again.
F
Yeah
so
some
of
the
most
exciting
things
that
are,
I
apologize,
jennifer
correct
for
the
record,
but
some
of
the
most
exciting
things
we're
looking
forward
to
with
the
implementation
of
arpa
or
the
american
rescue
plan
act
is
the
people
who
are
at
or
below
400
of
the
federal
poverty
level
are
now
going
to
qualify
for
increased
subsidies.
F
So
that's
going
to
allow
them
to
buy
more
generous
plans
or
it
will
allow
additional
consumers
onto
the
exchange
because
plans
are
going
to
be
more
affordable,
but
then
yeah
with
these
increased
subsidies,
but
then
like
what
is
very
exciting.
Is
that
we're
going
to
be
increasing
subsidies
for
that
population
of
over
400?
So
we're
moving
now
to
a
place
where
everybody
is
going
to
qualify
for
subsidies?
F
It
would
be
more
rare
that
a
person
didn't
qualify
for
subsidies
to
purchase
health
insurance
on
the
exchange
than
not,
which
is
very
exciting,
because
when
we
had
run
some
analysis
previously,
last
year
we
had
a
large
population
of
exchange
in
the
middle
east
that
actually
did
fall
into
that
of
a
400.
D
F
Maximum
out
of
pocket
that
in
exchange
through-
and
I
might
be
getting
this
a
little
bit
wrong,
but
you
know,
or
the
income
trap
is
going
to
move
from
9.83
down
to
8.5.
So
that's
the
amount
of
household
income
that
a
family
could
apply
towards
their
premiums
each
month.
So
again,
that's
another
factor.
That's
going
to
make
insurance
coverage
much
more
affordable
for
nevadans,
and
then
you
know
looking
at
some
information
that
came
out
from
hhs
earlier
this
week
there
in
nevada,
specifically
the
uninsured
population.
F
That's
now
going
to
be
newly
eligible
for
for
subsidies
is
going
to
be
about
41,
000
people
in
nevada
and
then
the
uninsured
population.
That's
now
eligible
for
a
zero
dollar
benchmark
marketplace
plan.
Our
marketplace
coverage
is
going
to
be
6100
people,
so
that's
6,
100
people
that
will
be
able
to
purchase
insurance
on
the
exchange
and
have
zero
dollars
out
of
pocket
right,
yep.
So.
A
Those
numbers
are
incredible
that
was
really
life-changing,
that
accessibility
becomes
a
reality.
I
was
also
just
hoping
to
to
have
you
kind
of
kind
of
go
into
the
trends
you've
seen
in
the
carriers
who
are
interested
in
participating
in
the
exchange.
I
I
have
this
memory
that
you
guys
have
had
a
dip
and
have
really
recovered
from
that
with
13
carriers
now,
but
also
what
k?
A
What
are
those
carrier
services
that
they're
offering
or
the
not
services,
but
the
coverage
that
they're
offering
and
how
and
I'm
specifically
thinking
like
how
many
are
health
care
and
how
many
are
dental
and
how
many
do
you
have
any
vision?
So
if
you
could
just
describe
those
things,
that
would
be
great.
F
So
I
think
ryan-
and
I
all
both
take
parts
of
this
question
so
jennifer
for
the
record,
our
current
carriers
for
plan
year
21.
We
have
five
health
insurance,
five
qualified
health
plans,
that
is
hpn,
anthem,
silver
summit,
friday,
health
plans
and
select
health,
and
then
we
have
seven
dental
carriers.
I
think
I
might
be
able
to
throttle
them
all
from
memory,
but
it's
also
delta
rocky.
F
D
And
for
the
record
ryan
hi,
we
were
able
this
year
to
also
offer
cinema
vision
care
through
vsp
for
consumers.
We
had
a
link
on
our
website
for
consumers
that
wanted
to
take
advantage
of
just
standalone
vision,
insurance
as
well,
and
I
think
the
interest
work
we're
getting
for
next
plan
year.
You.
D
We're
still
the
process
now
of
getting
letters
of
interest
for
for
next
plan
year,
but
we're
seeing
interest
from
both
national
and
local
carriers.
A
Liberty,
thank
you
for
that
and
again.
I
think
that
this
is
an
area
where
we
are
safe
because
of
the
accessibility,
and
that
is
making
a
huge
difference
to
the
marketability
of
these
kinds
of
exchange
networks
and.
B
A
We
are
a
state
that
really
like
thrives
on
small
business.
That
means
a
ton
you
know
being
able
to
have
your.
Have
your
employees
get
coverage
and
not
have
that
that
cost
an
overhead
for
a
company
with
three
members.
You
know
three
employees
is
that's
huge,
so
thank
you
so
much
for
all
of
your
work.
Are
there
any
other
questions
from
the
committee.
A
A
All
right,
and
with
that
we'll
move
on
to
the
last
bit
of
our
agenda,
which
is
public
comment.
We
could
just
check
the
public
comment
line,
see
if
anyone
is
on
and
interested
in
in
calling
in
and.
B
B
E
I
have
had
the
pleasure
of
being
aware
and
involved
with
nevada
health
link,
also
known
as
the
silver
state
health
insurance
exchange,
since
actually
before
its
inception,
when
it
was
just
language
and
a
bdr
released
to
a
bill,
and
actually
I
had
an
amendment
that
was
included
in
the
final
bill
language.
I
have
attended
the
pre-focus
groups
for
the
health
exchange,
as
well
as
the
the
birth
of
the
health
exchange
and
the
very
first
board
meetings.
E
I've
been
attending
board
meetings
off
and
on
since
it's
beginning,
and
I've
really
watched
the
ups
and
downs
of
healthlink
over
the
years.
What
I
want
to
say
it
is
really.
I
think
the
phrase
is
cooking
with
gas
right
now.
It
is
doing
so
well,
you
heard
the
numbers
you've
heard
who's
getting
in
getting
insured
who's,
getting
supplements
and
it's
providing
what
aarp
and
I
have
talked
about
many
times-
access
to
quality,
affordable
health
care,
and
it
provides
that
that
portal
for
people
to
get
that
that
otherwise
would
not.
So
that
is
just
fabulous.
E
E
Yes,
navigators
are
part
of
the
affordable
care
act,
but
I'll
tell
you
they're
really
important
that
the
funding
be
there
to
have
an
adequate
supply
of
them
in
the
community,
because
the
brokers,
the
broker
group,
will
always
be
there,
because
I
guess
the
best
way
to
put
it
is
they
make
a
little
bit
of
money
off
of
selling
the
insurance?
The
navigators
and
in-person
assisters
are
all
those
community
agencies
all
those
do-gooders
out
in
the
community
that
are
really
helping
people
to
connect
with
insurance,
and
it's
so
important
that
they
be
there.
E
So
this
money
that
they're
able
to
do
to
help
provide
that
to
provide
that
one-on-one.
In-Person
assistance,
which
is
exactly
what
they're
called
in
the
navigator
groups,
is
such
a
crucial
part
of
the
system.
So
we
aarp
strongly
encourage
you
to
support
that
funding
on
that
decision
unit,
and
the
last
thing
I
want
to
say
is:
I
really
want
to
commend
heather
carbolic,
the
executive
director
of
nevada
healthlink.
She
has
really
taken
it
to
great
places
and
doing
great
things.
E
She
is
so
consumer
focused,
but
understands
the
need
to
balance
both
the
consumer
focus
with
the
industry
focus
and
always
dealing
with
the
federal
government
can
be
an
issue,
let's
just
say
so.
I
think
if
you
look
up
the
definition
of
what
the
executive
director
of
nevada
health
link
should
be,
you
will
see
a
picture
of
heather.
She
is
just
fabulous
so
aarp
on
behalf
of
our
345
000
members
across
the
state
strongly
support
this
budget.