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From YouTube: 3/5/2021 - Senate Finance and Assembly Ways and Means, Subcommittees on Human Services
Description
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
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A
C
A
Here
all
right,
we've
been
doing
this
for
a
while.
Now
wrapping
up,
oh
we've
got
a
echo.
Does
everybody
have
an
echo
bps?
Is
there
anything
you
can
do
to
help
us
with
the
echo?
Oh
magic
you've
solved
it.
Thank
you
so
we're
wrapping
up
week.
Five
we've
been
doing
this
for
a
while.
I
think
those
of
you
who
are
following
along
on
finance
probably
already
know
that
there
are
multiple
ways
to
participate,
but
just
in
case
there's
anybody
new
here
today.
A
So
I
did
want
to
note
that
senator
cannizzaro,
an
assemblywoman
tolls
well
senator
kenneth
czarro,
is
absent
in
an
excuse
and
assemblywoman
tolls
is
presenting
a
bill
and
will
be
here
shortly.
We're
going
to
be
jumping
into
the
patient
protection
commission
bills
today,
as
well
as
some
are
not
bill's
budgets.
Excuse
me,
as
well
as
some
from
the
aging
and
disability
services,
division
and
I'll,
go
ahead
and
ask
if
that
we
start
with
sarah
culhagan.
The
executive
director
of
the
patient
protection
commission.
D
D
D
I
have
jessica
adams,
our
deputy
administrator
over
developmental
services,
as
well
as
our
community-based
care
program,
jeff
haig,
our
deputy
administrator
over
administrative
services,
ricky
robb,
the
deputy
administrator
for
children's
services,
as
well
as
our
planning,
advocacy
and
community
unit,
robin
hager,
our
administrative
services
officer,
jennifer,
fishman,
quality
assurance
manager,
harry
embry,
the
governor's
consumer
health
advocate
and
online.
We
do
have
sarah
schlhabien.
The
executive
director
of
the
patient
protection
commission
slide
one
moving
to
slide.
One
is
aging
and
disability
services
mission
statement
and
on
slide,
two
outlines
our
division
goals.
D
These
goals
were
established
as
part
of
the
department's
olmstead
integration
plan
and
really
do
focus
on
integration,
quality
of
care,
self-determination
and
dignity
for
nevadans
that
we
serve
and
support.
Moving
to
slide.
Three
is
our
organizational
chart
you'll
see
in
green.
The
proposed
changes
to
our
organization,
which
does
include
the
transition
of
the
consumer
health
assistance
program,
the
nevada
211
program
and
the
patient
protection
commission
to
aging
and
disability
services,
division.
D
D
Our
budget
is
really
mostly
caseload
driven.
We
have
26
different
programs
within
aging
and
disability
services
with
a
variety
of
structures.
Some
of
those
provide
direct
services
to
the
community.
Others
are
a
shared
model
where
the
state
agency
provides
the
service,
alongside
with
community
partners
and
then.
F
G
D
Organizations
that
are
100
provided
within
the
community,
but
funded
by
adsd
and
with
oversight
and
technical
assistance
provided
by
the
agency.
The
three
largest
programs
are
our
medicaid
home
and
community-based
waiver
programs
of
note
is
several
of
our
direct
service
programs.
Do
have
federal
mandates
related
to
waitlists
and
service
delivery,
while
others
are
authorized
in
statute
and
allow
for
services
to
be
provided,
as
funds
are
available.
D
And
slide
seven
actually
begins.
The
presentation
of
our
budget
account
is
the
patient
protection
commission
being
first,
the
transfer
of
the
patient
protection
commission
to
aging
and
disability
service
is
really
focused
on
aligning
the
ppc
with
other
patient
advocacy
services
within
the
state.
Adsd
has
several
programs
that
provide
advocacy
related
to
patients.
Healthcare
needs,
including
our
long-term
care
ombudsman
program,
our
adult
protective
services
program,
the
office
of
consumer
health
assistance,
our
community
advocates
programs,
our
homeland,
community-based
waiver
programs,
as
well
as
the
aging
and
disability
resource
centers,
located
statewide.
D
A
H
Very
much
madam
chair,
I
think
in
schmidt,
for
the
overview.
I
know
there
was
a
lot
of
conversation
about
this
last
session
and
we
know
that
whenever
we
do
something
the
first
time
that
it's
kind
of
like
okay,
let's
see
what
we
can
put
together
and
hopefully
it
works.
I
want
to
congratulate
the
commission.
H
That
we
set
up
they've
been
working
very
hard
and
in
full
disclosure.
I
put
a
bill
draft
in
a
long
time
ago,
because
I
thought
there
might
need
to
be
some
changes.
Usually
the
second
time
around.
You
want
to
see
what
works,
what
doesn't
and
make
some
adjustments.
So
I
am
talking
to
some
folks
about
some
possible
changes
to
the
patient
protection
commission
and
so
your
proposal,
to
put
it
under
adsd
the
conversations
that
we've
had
in
previous
meetings
with
the
new
data
analytics
being
under
the
director's
office.
H
I
was
just
wondering
if,
with
that
proposal,
layered
with
some
of
the
priorities
that
the
patient
protection
commission
is
working
on
as
far
as
making
sure
to
address
health
care
needs
and
get
a
real
sense
of
where
health
care
is
in
this
state.
If
there
would
be
room
for
a
conversation
about
it,
possibly
ending
up
in
the
director's
office.
H
D
The
record,
well,
I
think,
there's
always
room
for
that
conversation.
I
would
just
point
out
that
the
director's
office
provides
administrative
oversight
and
one
of
the
things
that
aging
and
disability
services
could
provide
to
the
ppc
is
that
is
the
resources
and
when
it
comes
to
staffing,
reach
I.t
support
those
types
of
things.
D
I
just
think
that
one
of
the
like,
I
said,
if
we're
absolutely
open
to
that
conversation,
I
think
that
the
director's
office
sometimes
doesn't
have
the
amount
of
resources
that
maybe
one
of
the
divisions
does
so.
H
And
I
think
it
was
generally
came
about
because
of
the
data
analytics
part
of
it
and
the
patient
protection
commission
really
digs
in
on
data
in
the
state
and
so
having
them
sort
of
mesh
there.
So
we
we
can
continue
that
conversation
and
and
madam
chair,
you
know,
I
want
to
make
sure
that
we've,
given
them
all
the
statutory
authority,
that
they
need
to
get
the
job
done,
that
they're
looking
at
and
making
sure
that
they
can,
where
no
matter
where
it
ends
up
that
they
can
still
get
their
duties
done.
H
D
In
the
schmidt
for
the
record,
I
will
defer
to
sarah
for,
if
she's
identified
or
is
aware
of
anything,
there's
nothing
that
I'm
aware
of.
I.
F
D
I
Sarah
thank
you
for
the
question
that
assemblywoman
carlton
sarah
hagian
for
the
record.
I
can
tell
you
that
I
will
always
advocate
for
more
of
resources.
For
the
commission.
You
know
last
year
I
think
was
unprecedented
for
for
all
of
us,
but
for
the
commission
particularly
and
when
we
got
up
and
operating
it's
true,
I
would
be
remiss
if
I
didn't
highlight
director,
whitley
and
his
office.
I
I
would
not
have
been
able
to
hit
the
ground
running
as
fast
as
we
did
and
get
meetings
established
without
his
office
and
his
assistance
in
in
helping
me
launch
the
commission,
but
shortly
after
the
commission
held
its
first
meeting,
I
think
we
held
two
meetings
and
then
we
went
into
a
pandemic
and
in
that
pandemic
there
was
a
hiring
freeze.
So
I
was
not
able
to
fulfill
the
policy
analyst
position
that
I
think
will
help
facilitate
the
work
of
this
commission
tremendously.
I
I
know
that
this
budget
account
does
recommend
for
that
funding
to
continue,
and
I
believe
I
will
be
able
to
fulfill
that
position
as
soon
as
july.
1..
Another
resource
that
was
made
available
to
the
commission
was
some
dollars
allocated
for
consulting
services.
That
dollar
amount
is
25
000,
which
is
not
insignificant,
but
I
could
make
a
recommendation
that
if
there
is
additional
funding
to
allow
for
a
larger
amount,
that
could
also
help
the
commission
contract
with
other
technical
assistants.
That
may
not
be
immediately
available
to
us.
I
H
And
thank
you,
madam
chair,
and
I
I
wouldn't
expect
anything
less
you've
done
a
wonderful
job,
considering
what
you
were
facing
and
the
importance
of
this
commission.
The
the
high
level
overview
that
we
want
it
to
take.
We've
always
made
this
decisions
on
health
care
in
the
state
by
anecdote,
and
we
need
to
stop
doing
that.
We
need
someone
who
has
the
data
and
that's
why
I
believe
the
patient
protection
commission
really
comes
in
and
we
might
have
misnamed
it.
It
might
need
to
be
called
something
else.
H
But
truly
we
want
to
know
where
healthcare
is
in
the
state
so
that
we
know
what
we
can
do
to
help
get
the
patients
out
of
the
middle
of
the
the
healthcare
that
you
know
and
make
sure
that
they
get
access
to
the
health
care
that
they
need.
So
I
I
will
be
reaching
out
to
members
of
the
commission
to
to
talk
with
them.
I'm
finalizing
some
of
the
points
of
that
bill
draft
I
always
want.
H
I
You,
madam
care,
may
take
a
one
one
moment
for
a
point
of
privilege,
just
to
mention
something.
Assemblywoman
carlton
mentioned
patience,
and
I
would
be
remiss
if
I
didn't
touch
upon
that
for
just
a
moment.
I
Please
go
ahead,
mrs
goldhamer,
great
thanks,
sarah
hagin
for
the
record
assemblyman
carlton.
I
really
appreciate
you
mentioning
the
patients
and
one
thing
that
I
noticed
last
year
and
it
could
be
a
function
of
just
our
current
climate,
but
there
wasn't
as
much
active
patient
participation
that
I
had
hoped
to
see
be
generated
by
the
creation
of
this
commission
myself,
and
it
takes
a
lot
of
work.
I
think
there's
just
a
marketing
aspect
to
it.
We
did
the
best
that
we
could.
I
I
encouraged
outreach
from
all
of
the
commission
members
built
a
patient
portal
on
our
website.
You
know
all
of
our
meetings
were
held
publicly
in
the
commission,
actually
held
11
public
meetings
last
year,
but
our
patient
voices
in
my
opinion,
were
were
limited.
We
didn't
have
as
much
engagement
and
so
having
more
resources
available,
even
for
advocacy
services
to
some
extent,
to
really
show
that
we're
here
we
exist
and
we
want
to
hear
from.
I
You
would
also
be,
I
think,
wonderful
for
the
commission,
and
I
would
sincerely
appreciate
that,
in
your
consideration.
A
Thank
you,
madam
chair,
and
I
think
what
I'd
like
to
do
there,
particularly
because
I
think
part
of
this
proposal,
wherever
it
ends
up
part
of
this
proposal
of
connecting
it
to
dhhs,
could
be
connecting
it
to
audiences
as
well.
So
I'm
going
to
take
it
back
to
adsd
on
that
and
see
if
miss
schmidt.
If
you
have
any
comments,
given
the
line
of
questions
and
comments
as
well,
absolutely.
D
Finishment
for
the
record-
yes,
we
do
have
you
know
we
host
here
several
independent
commissions
as
well
as
boards.
We
have
the
commission
for
services
for
persons
with
disabilities,
the
commission
on
aging
the
statewide
independent
living
council,
the
assistant
technology,
independent
living
council,
and
I
know
I'm
missing
a
couple.
Others,
the
autism
commission
board.
So
we
do
have
several
organizations
and
with
the
transition
of
office
of
consumer
health
assistance.
D
F
You,
madam
chair,
appreciate
the
opportunity
to
ask
a
question
and,
and
that
comment
regarding
the
number
of
commissions
is
a
perfect
segue
into
what
my
question
was
and
regarding
this
patient
protection
commission.
I
know
you've
presented
to
us
before
in
pre-previous
budget.
I'm
ju.
I
too
am
concerned
about
the
actual
interaction
and
accomplishments
of
all
these
multiple
commissions
and
are
they
all
living
in
different
silos,
or
is
it
an
opportunity
for
us
to
maybe
put
them
under
on
one
roof
where
they
can
all
communicate
with
each
other?
F
So
we're
not
we're
trying
to
gather
data
assembly.
Woman
carlton
mentioned
about
truly,
you
know
patience,
and-
and
is
this
a
correct
term
for
this
commission
patient
protection?
Commission,
I'm
not
so
sure
they've
have
you
protected
patients?
Have
you
identified
areas
where
patients
aren't
being
protected
because
that's
what
the
name
would
suggest
versus
health
care
needs
access
to
care,
and
so
my
question
would
be.
I
know
that
you
had
or
bdrs
and
you
presented
them
to
us.
But
could
you
remind
me
what
did
any
of
those
actually
involve
protecting
patients.
I
Sure
thank
you
for
the
question.
Assemblywoman
titus,
sarah
hagian,
for
the
record.
The
commission
did
put
in
a
request
for
two
bill
drafts
that
are
currently
pending
and
they
haven't
been
heard,
but
they're
scheduled
to
be
heard
in
senate
health
and
human
services
on
tuesday
and
both
of
the
bills,
I
think,
would
benefit
patients
tremendously.
But
the
way
they
are,
the
the
measures
are
addressed
at
increased
access
and
quality,
and
so
you've
got
one
measure.
I
That's
dealing
with
transparency
and
the
goal
of
that
measure
is
to
enhance
patients,
healthcare
experience
and
improve
outcomes
by
implementing
transparency
measures
that
help
understand
data
trends
and
the
second
one
is
aimed
at
access
for
patients
and
that
one
deals
with
telehealth
and
codifying
certain
telehealth
flexibility
that
would
be
granted
during
the
public
health
emergency
declaration
and
also
focuses
on
equitable
access
of
telehealth
services,
and
that
is
aimed
at
implementing
some
data
collection
procedures
as
well
to
show
equitable
access
and
vulnerable
populations
with
telehealth
services
and.
D
C
I
Those
both
of
those
measures
are
patient-driven
initiatives,
gathering.
F
I
Thank
you,
assemblywoman
titus
sheriff
hagian
for
the
record.
The
commission
had
the
option
to
request
up
to
three
measures
and
they
requested
two.
F
Okay,
great
was
there
anything
about
a
workforce
development
or
anything
that
you
brought
forward.
I
A
Marilyn,
are
I'm
sorry
senator
donderol
luke?
Would
you
do
you
have
another
question.
C
I
do
and
thank
you
senator
ratty,
chair
ready.
So
can
you
explain
how
the
duties
of
that
patient
protection
commission
align
with
the
direct
consumer
services
provided
through
the
office
of
consumer
health
assistance,
as
well
as
the
programs
that
are
anticipated
to
be
placed
under
the
new
consumer,
health
advocacy
and
protection
unit.
D
F
D
Within
aging
and
disability
services,
as
we've
heard,
the
discussion
with
all
the
other
commissions
and
advocacy
groups
that
we
support
is
really
kind
of
connecting
those
voices
with
the
work
of
the
patient
protection
commission.
So
we're
not
changing
any
duties
with
any
of
the
programs.
The
office
of
consumer
health
assistance
as
well
will
continue
to
do
all
the
same
activities,
but
having
a
house
here
really
allows
us
to
cross-coordinate,
I
would
just
say
as
an
example
in
the
past
year,
so
assemblywoman
titus's
question
earlier.
D
We
we
have
started
to
host
cross
committee.
We
get
the
chairs
of
all
of
our
commissions
and
committees
together
and
and
hosted
a
training
and
kind
of
a
cross-collaboration
to
make
sure
that,
where
there's
priority
areas
that
people
want
to
focus
on
they're
working
together,
rather
than
separately
and
independent
of
each
other.
So
if
there's
a
you
know
a
policy
area
that
is
impacting
all
of
those
groups,
we
are
working
together
to
move
forward
those
policy
initiatives.
C
Thank
you
very
much,
and
I
too
would
like
to
thank
all
of
you
for
working
on
this
project
and
mr
hagan
thank
you
for
taking
the
helm
and
doing
such
a
great
job.
I
agree
with
chair
carlton
we
many
times
it
takes
us
longer
than
we
wish
to
get
things
in
place,
but
I
I
know
you're
all
working
hard,
and
so
thank
you
very
much.
Thank
you,
chair,
ready.
A
Thank
you,
I
think
assemblyman
carlton
has
a
follow-up,
and
let
me
know
for
the
record
that
assemblywoman
benita
thompson
has
arrived.
H
And
thank
you
very
much,
madam
chair,
for
recognizing
me
a
second
time
after
my
long
line
of
thoughts
and
comments
earlier,
but
I
think
there's
another
point
that
I'd
like
to
make
the
services
are
delivered
through
adsd,
but
the
actual
counsel
for
adsd
is
in
the
director's
office,
and
I
didn't
mention
this
earlier.
I'm
sorry.
H
I
had
my
notes-
and
I
skipped
right
by
that
particular
bullet
point,
but
I
see
this
commission
being
along
the
same
lines
as
the
council
being
that
higher
level
and
that's
one
of
the
thought
processes
behind
having
it
in
the
director's
office,
so
just
wanted
to
put
it
on
the
record
in
the
interest
of
full
transparency,
that's
kind
of
what
I
was
comparing
it
to.
Thank
you
very
much,
madam
chair.
D
This
budget
serves
as
our
primary
administrative
budget
and
contains
functions
related
to
the
division's
operations,
including
our
human
resources,
fiscal
services,
information
technology
and
administrative
positions
of
note.
In
this
budget,
account
is
proposed
to
have
85
full-time
positions
by
the
end
of
the
biennium,
but
this
budget
account
now
has
less
ftes
than
it
did
prior
to
the
addition
of
when
we
merged
with
development,
developmental
and
disability
services
back
in
2014..
D
I
just
want
to
make
sure
that
everybody
understands
that
that
merger
represented
a
279
growth
in
our
agency
and
we've
grown
another
35
since
then-
and
I
just
mentioned
this-
because
I
think
it's
important
for
this
body
and
the
public
to
understand
that,
while
we
always
focus
our
priorities
on
serving
events,
it
is
very
difficult
to
do
that
effectively
and
efficiently
without
the
appropriate
administrative
resources
moving
to
slide.
9
are
the
decision
units
for
budget
account
3151.
D
E680
holds
six
position
vacants
for
the
first
fiscal
year
and
then
e-911
is
a
position
transfer
of
one
management
analyst
position
to
the
data
analytics
department.
As
you
heard
in
several
budget
presentations
prior
the
creation
of
the
data
analytics
student
at
the
director's
office.
This
is
one
additional
staff
for
that
department.
Are
there
any
questions
related
to
this
budget
account.
A
D
A
D
B
You
have
a
question,
and
this
is
just
more
kind
of
about
the
logistics.
So
I
know
that
through
a
number
of
these
budgets,
we
are
holding
positions
vacant
in
one
year
and
then
bringing
them
back
online.
The
next
year
and
they've
been
held
vacant,
probably
since
this
past
summer
or
before,
depending
on
or
when
the
hiring
phrase
hit.
So
how?
How
does
that
actually
work
are?
I
guess,
like
for
the,
for
these
positions?
B
Are
there
people
that
were
hired
and
employed,
and
then
we
let
them
go
and
then
we'll
open
up
and
do
an
entire
rehiring
process
in
when
you're
allowed
to
rehire
again,
or
did
those
people
get
transferred
to
other
areas
or
did
they?
Are
you
actually
completely
exiting
people
out
of
state
service
and
then
completely
onboarding
new
people
into
state
service.
D
Initiate
for
the
record,
that's
a
great
question
as
part
of
this
process
in
order
to
not
impact
our
staff,
we
identified
vacant
positions
for
anything
that
was
being
held
so
all
proposed
positions
that
are
being
held
were
vacant
at
the
time
that
we
made
that
determination.
B
Okay,
so
you
didn't
have
to
do
layoffs.
These
were,
I
guess
we
should
say
organically
vacant
and
I
because
they
were
organically
vacant.
Do
you
imagine
that
when
you
have
the
ability
to
hire
for
them
again
that
they
will
be
filled
or
do
you
feel
like
it's
70
chance
they
get
filled?
You
still
have
issues
with
pay
where,
where
you
just
can't,
you
know
you're
not
going
to
land
an
actual.
Are
you
historically
problems
landing
people
into
these
positions
or
something
like
that
finish.
D
Schmidt
for
the
record,
so
I
would
say
the
majority
we
would
have
no
problem
filling,
especially
on
the
administrative
budget.
These
types
of
positions
that
we're
holding
in
this
particular
budget
are
not
that
difficult
to
fill.
We
would
we
anticipate
we'd,
be
able
to
fill
those
pretty
quickly
some
of
our
direct
service
programs,
where
we
do
have
challenges
they
are
hard
to
fill.
We
may
you
know
we
oftentimes
have
to
contact
staff
to
fulfill
those
duties
when
we
aren't
able
to
hire
internally.
B
A
quick
follow-up,
madam
chairman,
on
this
in
this
particular
budget.
The
information
technology
professional
that
that
was
vacant
is,
would
that
be
a
position?
That's
hard
to
hire.
Remember
we've
had
previous
conversations
about
how
it
you
know
how
hard
it
is
for
the
state
to
compete,
kind
of
in
the
I.t
world
with
the
private
sector.
Okay,.
J
All
right
good
morning,
jeff
pegg
for
the
record,
yes,
that
those
historically.
C
D
Been
a
difficult
to
recruit
position,
obviously,
there's
a
lot
of
private
sector
companies.
J
D
Makes
it
difficult
so
we
would
anticipate
maybe
a
little
bit
of
ease
given
the
job
market
today,
but
historically
they
have
been
problematic.
B
Perfect.
Thank
you,
madam
chair,
that
helps
me
to
know
that
when
I
look
at
a
lot
of
these
vacant
positions,
I'm
holding
in
my
head
the
fact
that
they
were
already
vacant
even
probably
before
the
hiring
freeze
and
that's
how
we
kind
of
got
this
mix
of
vacancies.
It's
not.
These
are
not
positions,
you've
necessarily
chosen
to
make
vacant.
You
were
just
taking
this
organic
bacon
season
and
holding
them
vacant.
So
that
helps
me
to
know
thanks.
A
Thank
you
assemblywoman,
and
you
may
be
getting
the
the
questions
that
we've
had
building
up
over
several
budgets.
So
I
apologize
for
that.
But
I'd
like
to
follow
up
on
that.
But
so
it's
wonderful
wonderful
when
we
are
able
to
make
some
of
our
budget
cuts
that
are
necessary
using
vacancies
so
that
no
one
has
to
be
laid
off.
But
I
think
sometimes
the
unintended
consequences
of
that
is
that
the
staff
that
we're
missing
isn't
necessarily
strategic
to
the
needs
of
the
agency.
A
And
so
can
I
assume
that
there
is
a
process
that
there,
if
there's
a
critical
position,
that
you
need
filled
that
you
have
can
get
a
waiver
to
a
freeze
or
a-
and
this
is
probably
a
newbie
question-
haven't
just
haven't
been
on
finance
committee
before
so.
If
it's
a
critical
position
that
you
need
filled,
how.
D
D
We
were
very,
we
tried
to
not
freeze
critical
positions,
but
sometimes
I
think
because
of
the
challenge
with
the
budget
and
the
numbers
that
we
had
to
come
up
with.
There
were
some
critical
positions
that
were
frozen
and
it
does
create
challenges.
Some
of
our
programs
don't
have
supervision
down
in
certain
areas
which
is
creating
challenges
for
us,
so
the
process
we
have
identified
if
there
are
if
something
becomes
available.
D
If
that
happens
during
this
budget
and
when
we
get
the
new
projections,
we've
identified
those
critical
positions
and
prioritize
them
and
would
you
know,
be
welcome
to
work
with
the
ability
to
bring
back
those
most
critical
ones.
A
I
think
that
this
committee
would
be
interested
in
making
sure
that
we're
being
thoughtful
about
anything,
that's
a
critical
position
for
the
functioning
of
the
agency.
We
don't
want
to
pay
for
it
later
because
they
were
maybe
penny
is
the
pennywise
and
pound
foolish.
I
believe,
is
the
phrase.
So
thank
you.
I
appreciate
it.
Okay
committee,
any
other
questions
on
this
budget.
D
And
disability
rx
program,
this
program
provides
medicare
part
d
premium
subsidies
to
eligible
in
individuals
and
slide.
11
has
the
only
decision,
unit
related
to
this
budget
account
and
that
would
be
e225
which
eliminates
the
pharmacy
subsidy
program
funding.
These
were
funds
that
were
previously
used
to
pay
actual
prescription
costs
for
medicare
recipients,
but
with
the
elimination
of
the
donut
hole,
the
need
for
this
type
of
pharmacy
coverage
has
ended.
I
think
we've
talked
about
this
in
several
presentations
where
that
donut
hole
has
it
deteriorated
and
the
cost
to
the
individual
remained
the
same.
D
The
age
of
state
agencies
no
longer
had
a
need
to
actually
subsidize
and
pay
for
prescription
drugs,
so
these
funds
are
specific
to
those
prescription
drug
contacts.
The
funding
in
the
budget
remains
available
to
pay
the
subsidy
for
the
part
d
premium.
We
currently
pay
a
premium
subsidy
of
up
to
37
dollars
a
month
to
help
people
offset
the
cost
of
their
part
d
plan.
C
Yes,
thank
you,
madam
chair.
I
was
just
wondering
how
was
the
premium
subsidy
of
37
a
month
determined
and
how?
What
to
what
extent
does
that
offset
participants,
part
d
premiums.
A
D
At
the
amount
of
money
we
had
available
and
the
number
of
research
potential
recipients
to
determine
that's
up
to
the
amount,
as
well
as
took
into
account
the
average
cost
of
part
b
premium
plans,
I'll
defer
to
ricky
rob
our
deputy
administrator
for
a
little
bit
more
detail.
Because
I
know
that
while
we
offer
up
to
37
the
average
is
not
quite
that
high.
So,
unfortunately
not
everybody
has
been
meeting
that
high
of
a
subsidy.
J
Good
morning,
ricky
rob
deputy
davis
trigger
for
the
record
so
that
the
amount
is
up
to
the
37.
Our
actual
average
is
27
in
2019,
and
so
at
this
point
in
time
that
was
based
on
the
subsidy
programs
that
were
available
through
the
medicare
part
d
program,
and
so
that
average
was
set
based
on
funding
as
well
as
usage
and
again
currently
it
is
set
at
37,
but
our
average
is
27.
J
and
with
I'm
sorry,
if
I,
if
I
may
add,
with
the
changes
within
the
donut
hole,
the
the
case
look
has
decreased
and
it
continues
to
decrease
as
the
need
and
the
part
d
plans
have
actually
increased.
Then
the
need
for
the
subsidy
has
decreased.
C
Thank
you
for
that
yeah.
If
I
can
ask
a
brief
follow-up
question
and
it's
on
the
issue
of
caseloads,
how
many
clients
do
you
anticipate
assisting
on
average
during
each
month
with
the
the
funding
in
this
budget
for
the
upcoming.
J
Biennium
ricky
ross
of
the
record,
our
current
case
load,
so
I
can
tell
you
from
december
2021
with
731
in
january.
It
was
598
for
that
month
for
additional.
If
I
could
just
have
a
moment
for
february.
J
Actually,
I
would
need
to
get
back
to
you
in
regards
to
the
february
numbers,
but
I
can
tell
you
that
has
been
the
trend.
Since
july
of
2020,
we
were
at
830
august
was
8
35
september
809,
and
then
in
october
we
went
to
771
november,
was
7
53
december
731
and
then
again
january
lifts
at
5.98.
J
So
that
is
where
we
have
seen
that
trend
between
open
enrollment
and
the
changes
in
the
medicare
part
d.
Subsidy
supports
in
those
actual
programs
have
their
that
has
increased
for
them
to
receive
a
better
coverage
within
their
part
d
and
that
no
longer
needs
the
additional
subsidy
to
provide
that,
which
is
why
we're
seeing
the
case
loads
increase.
C
Thank
you
for
that
additional
information.
Thank
you
for
the
questions
madam
chair.
A
You
bet
assemble
the
woman
benitez
thompson.
B
Thank
you
so
much,
and
so
as
I
look
at
the
the
application
for
the
senior
rx
program-
and
I
know
you've
got
a
bill
out
there
to
kind
of
change
some
of
the
eligibility
requirements,
but
knowing
that
there's
been
a
change
going
on,
so
I
guess
it
looks,
it
looks
like
we
really
are
shifting
to
making
sure
that
the
state
is
a
payer
of
last
resorts
lots
of
good
questions
in
there
about
have
you
already
applied
for
medicare
special
help
and
have
you
already
applied
for
medicaid,
but
this
is
really
a
program
where
folks
need
to
kind
of
have
a
lot
of
ducks
in
the
road
they're
rows
right.
B
B
They
really
because,
with
the
questions
they're
going
to
be
asked,
they
kind
of
have
to
you
know,
make
sure
the
medicare
medicaid
applications
in
and
then
attach
their
approval
of
the
medicaid
application
and
make
sure
that
they've
got
their
medicare
special
help.
I
I
haven't
done
that
process
before
so
I
don't
know
if
that's
a
one
week
or
one
month
or
four
month
process,
but
but
am
I
understanding
that
right,
like
that's
the
way
that
we
want
to
make
sure
that
we
talk
about
this
with
the
public?
J
Yes,
thank
you
for
the
question
I
receive
rob
for
the
record,
and
really
this
is
because
of
the
changes
within
the
plan
types
as
well
as
the
donut
hole.
It
is
truly
a
subsidy
program.
It
is
not
to
pay
for
direct
prescriptions,
and
so
that
is
how
it
is
changed
based
on
the
donut
hole
closure,
and
so
it's
really
important
for
people
to
understand
that
this
is
to
increase
their
subsidy
and
to
ensure
that
they
have
appropriate
coverage
for
their
pharmacy
benefits
and.
D
J
This
particular
program
has
really
shifted
based
on
the
changes
on
the
federal
level.
B
Perfect
and
just
while
we're
on
it
I
want
to,
I
want
to
ask,
because
I
think
it's
something
that
might
be
helpful
for
us
and
the
public
as
we
think
about
these
kind
of
programs.
I've
noticed
that
in
more
and
more
applications,
a
copy
of
the
medicare
card
is
required
to
be
attached
and
for
some
populations,
that's
really
easy
to
do.
I
think
for
older
populations,
especially
those
with
dementia,
where
they're
losing
all
their
stuff
or
they've
hidden
their
wallet.
D
Finishment
for
the
record,
so
I
think
a
couple
things
right
now.
Yes,
we
do
require
that
information.
We
do
not
have
an
electronic
database
to
verify
that,
whereas
the
division
of
welfare
and
supportive
services,
for
example,
they
do
have
those
electronic
connections,
so
they
can
do
that
electronically
with
just
a
number.
D
We
don't
have
that
type
of
resource.
For
this
small
program,
one
of
the
goals
of
av35,
which
is
to
reduce,
give
us
the
availability
to
create
a
program
that
makes
sense
around
prescription.
Drug
costs
for
folks
with
disabilities
and
for
seniors
is
really
spending
the
next
biannual
doing
some
public
outreach
and
understanding
what
the
needs
are
and
being
able
to
adopt
regulations
that
builds
a
program
going
forward
that
actually
provides
the
support.
That's
needed.
B
A
One
follow-up
question
because
it
looks
like
a
budget
cut
right
in
our
numbers
because
we're
there's
a
resource
resource,
that's
going
away,
but
I
think
what
I
hear
you
saying
is
that
at
the
national
level
there
were
some
solutions
in
medicare
that
closed
doughnut
holes,
and
so
we
didn't
need
the
direct
payment
for
prescriptions
anymore.
We
do
need
the
helping
people
purchase,
part
d
so
that
they
have
coverage.
G
A
He's
a
dual
enrollee,
medicare
and
medicaid
doesn't
have
any
money
really
to
pay
for
this,
and
so
is
this
the
program
that
is
helping
him
to
have
part
d,
and
is
it
sliding
scale?
So
if
the
income
is
extremely
low,
they're
they're
not
going
to
be
hurt.
I
just
want
to
make
sure
that
we
get
on
the
record
at
the
very
end
of
the
day,
with
all
of
these
this
shifting
are
there
any
senior,
low-income
patients
that
are
people
with
disabilities
that
aren't
going
to
have
the
same
level
of
resource
that
they
have
today.
D
Management
for
the
record,
so
I
as
assembly
women,
veneers
thompson,
mentioned
this
program,
does
for
the
very
low
income.
There
are
several
federal
programs:
the
there
is
the
qualified,
medicare
beneficiary
program
and
there's
the
campaign.
Somebody
which
kind
of
covers
those
folks
at
the
next
level,
and
then
this
program
was
always
intended
to
be
those
that
were
just
above
that
so
seniors
that
were
above
the
federal
poverty
limit,
but
still
needed
help
because
prescription
costs
were
so
outrageous
when
this
program
was
developed,
that
we
were
seeing
so
many
people
not
being
able
to
access.
D
So
this
program
was
developed
to
help
those
folks,
so
that
I
hope
that
answers
your
question.
So,
yes,
those
programs
are
not
being
impacted.
Those
low
income
programs
are
not
being
impacted
by
this
reduction.
A
A
Super
helpful
reminder
of
what
the
target
population
is
for
this
specific
program
and
that
there
are
other
programs.
So
thank
you
for
that.
Any
other
questions
from
the
committee.
D
This
budget
account
has
several
programs
within
the
budget,
the
planning,
advocacy
and
community
program,
otherwise
known
as
the
pac
unit,
our
community-based
care,
otherwise
known
as
our
cdc
unit,
our
long-term
care
ombudsman
program,
as
well
as
our
adult
protective
services
program,
I'd
like
to
review
these
each
program
separately
as
far
as
decision
units
just
to
give
an
understanding
of
what
goes
on.
D
D
This
program
is
responsible
for
13
programs
and
services
that
are
listed
here.
While
there
are
no
decision
units.
I
would
like
to
provide
the
committee
with
some
information
related
to
the
work
of
this
unit.
D
D
Historically,
the
subaward
ratios
have
averaged
around
45
to
one
and
this
year
in
state
fiscal
year,
20
that
has
raised
to
83
to
one
nearly
doubling
a
lot
of
this
has
been
related
to
additional
funds
received
through
the
coronavirus
relief
funds.
This
group
has
worked
diligently
to
turn
around
federal
dollars
and
get
them
back
out
to
the
community.
They
created
an
expedited
ramp
process
so
that
grantees
could
access
those
funds
immediately
to
get
mostly
ground
food
and
nutrition
services.
D
As
part
of
the
aging
disability
services
response,
we
worked
closely
with
the
aging
network
to
initiate
a
rapid
response
effort
known
as
nevada's
covent,
aging
network
response
or
nevada.
Can
this
program
help
coordinate
the
network
and
ensure
older
adults
have
access
to
critical
services,
including
food
and
medication,
social
supports
and
telehealth
services?
D
This
effort
partnered
with
our
existing
no
wrong
door
efforts
and
our
nevada
care
connection,
as
well
as
nevada
211,
to
help
individuals
explore
services
and
supports
after
their
immediate
needs,
were
met
so
we're
very
proud
of
this
work.
While
it
wasn't
an
initial
rapid
response,
it
has
now
been
tied
to
long-term
solutions
as
well.
So
we
help
families
and
individuals
gain.
D
D
D
This
group
has
also
supported
coordination
of
vaccination
efforts
for
seniors.
They
have
been
heavily
involved
in
working
with
the
community
partners
and
giving
people
access
to
the
vaccinations,
and
so
I
just
wanted
to
take
a
moment.
I
appreciate
the
indulgence,
but
I
just
wanted
to
take
a
moment
to
acknowledge
the
work
of
this
group
they're
an
incredibly
dedicated
group
who
have
remained
flexible
during
this
year.
C
D
This
unit
is
responsible
for
the
frail
elderly
and
the
physically
disabled
waivers,
along
with
three
other
programs
that
sit
right.
On
top
of
those
we've
talked
earlier
about
the
crx
program
being
one
for
the
next
level.
These
programs
sit
on
top
of
the
waivers
for
those
folks
that
aren't
eligible
for
the
waiver.
They
may
need
these
same
services,
but
their
income's
just
a
little
too
high.
F
D
D
Are
the
decision
units
for
the
cb
for
the
pause
program,
m202
and
203
fund
the
caseload
projections
for
the
personal
assistant
services,
as
well
as
the
projected
wait
list
for
these
services
moving
to
slide?
17
are
the
decision
units
for
the
cope
and
homemaker
program,
m204
and
205
fund
the
homemaker
program
caseload,
as
well
as
their
projected
wait
list
and
m206
and
207
from
the
community
options
program
for
seniors
caseload
as
well
as
wait
list
I'll
pause
here
to
see.
D
Here
I
would
like
to
reiterate
one
of
the
activities
we
have
here
related
to
this
group.
This
program
is
the
division
of
wealth
and
supportive
services
has
an
I.t
initiative
to
streamline
enrollment
in
the
application
process.
This
budget,
we
because
we
do
the
eligibility
and
enrollment
for
the.
C
D
We
have
to
coordinate
across
three
different
agencies
and
that
budget,
or
that
it
project
will
create
efficiencies
for
this
program
and
really
electronic.
Like
now.
We
have
one
piece
of
paper
that
has
to
be
touched
three
different
times
by
three
different
agencies,
so
we're.
C
D
D
Moving
on
to
slide
19
the
long-term
care
investment
programs.
This
program
works
to
resolve
problems
for
individual
residents,
while
providing
advocacy
to
residents
of
nursing
homes,
residential
facilities
for
groups
and
homes
for
individual
residents,
residential
care
facilities.
I
apologize
moving
on
to
slide
20.
D
Is
the
caseware
projections
for
this
program?
Well,
21
is
the
decision
unit
for
the
program.
M209
is
a
caseload,
staffing
adjustments.
You
see
it
is
a
reduction
in
staff.
We
we
believe
that
covert.
19
has
had
what
we
know.
Program
19
has
had
a
huge
impact
on
this
program,
as
we
were
not
allowed
in
facilities
for
several
months,
even
though
last
session,
the
facility
types
that
we
visit
were
expanded.
D
On
moving
on
to
slide,
22
is
our
adult
protective
services
program,
adult
protective
services
prevent
and
remedy
abuse,
neglect,
self-neglect
exploitation,
isolation
and
abandonment
of
seniors
and
vulnerable
adults.
Age
18
to
59.
july
1st
of
2019,
the
expansion
to
adult
vulnerable
adults
went
into
place.
We've
had
a
successful
transition
due
to
the
planning
and
technical
assistance
we
received
from
national
experts.
D
D
A
H
D
H
A
Certain
that
there
are
questions
related
to
this
budget
account
that's
a
lot
of
different
information,
so
committee
members,
if
you
could,
when
you're,
asking
these
questions,
refer
to
the
program
or
the
decision
unit
whenever
possible.
I
think
that
that
will
be
incredibly
helpful.
I
believe
that
assemblywoman
monroe
moreno
has
some
questions
to
start.
B
You,
madam
chair,
yes,
I'd
like
to
start
with
the
community
based
care
programs,
the
the
caseload
adjustments.
I
was
looking
at
the
wait
list
for
the
personal
assistant
services,
the
homemaker
and
community
options.
Program
for
elderly
and
the
numbers
of
clients
being
served
seem
to
be
lower
than
the
legislatively
approved
for
fy
2021..
D
D
So
we
have
seen
a
reduction
in
utilization
while
people
remain
eligible
for
the
program,
they
have
not
been
utilizing
the
program
and
then,
additionally,
we
had
some
folks
that
were
on
the
wait
list
and
when
we
reached
out
to
initiate
services
they
were
not
interested
at
this
time
because
of
the
pandemic,
so
that
has
impacted
the
case
loads.
D
The
other
piece,
as
far
as
the
reductions
there's
been
adjustments
because
our
cases
did
reduce
due
to
the
pandemic.
So
that's
what
you
see
in
these
decision
units
is
some
of
those
reductions
in
addition
to
the
prosper
eligible
has
reduced
for
those
groups
as
well,
so
the
actual
cost
per
eligible
originally
was
running
around
613
last
session,
and
it
currently
is
being
budgeted
at
493
this
session.
D
So
we've
been
working
with
lcd
staff
to
address
any
adjustments
that
have
been
needed,
but
there
has
been
a
lot
of
fluctuation
in
the
numbers
for
these
programs.
These
are
the
clothing
cameras.
C
J
Caseload,
it
will
happen
starting
today
and
then.
B
For
that
and
then
could
you
just
discuss
the
intentions
of
the
waitlist
decisions
that
were
in
the
executive
budget?
Does
the
agency
intend
to
serve
all
the
projected
clients
in
the
upcoming
buying,
including
those
who
are
waiting
for
service.
D
F
My
question
is
regarding
budget
item
m209
the
long-term
care
and
the
staffing
lower
than
projection
than
you
projected
for
the
from
last
by
any
on
the
number
of
contacts
you
explained
briefly
that
the
number
the
case
load
number
was
lower
because
you
weren't
allowed
into
the
long-term
care
and
care
units
because
of
the
pandemic.
F
That
wouldn't
stop
you
from
opening
a
case
or
receiving
calls.
Could
you
clarify
why
that
case
told
maybe
was
down,
or
did
you
actually
have
the
calls
you
just
couldn't
fall
through
on
them,
because
in
my
perception,
tons
of
families
were
calling
calling
you
for
assistance
because
they
couldn't
get
in
to
see
their
loved
ones
and
other
concerns.
So
could
you
clarify
that
a
little
certainly.
D
Dana
schmidt
for
the
record,
I'll
I'll
start
and
jennifer
fishman
might
need
to
add
a
little
bit
too
to
my
comments.
But
the
normal
activities
of
the
long-term
care
ombudsman
include
regular
residential
facility
visits
and
those
oftentimes.
What
happens
is
we'll
go
in
for
a
visit
and
that
visit
once
we're
walking
through
the
facility
will
become
five
six
activities
right.
D
It's
a
week
to
build
our
tesla
based
on
activities
so
because
we
weren't
going
into
facilities
if
a
family
called
that's
one
activity,
but
because
we
didn't
go
to
the
facility
and
then
talk
to
five
other
people
about
that
situation.
It
really
reduced
our
numbers
because
our
caseloads
are
driven
by
activities,
so
those
overall
activities
have
dropped,
even
though
we
might
be
still
getting
the
calls
from
families
we're
not
actually
going
into
the
facility
and
generating
additional
activities
that
count
towards
the
caseload
projection.
F
So
j
may
follow
up
on
that,
madam
sheriff.
Okay.
So
just
to
just
to
be
clear,
then
it's
not
about
the
number
of
actual
long-term
care
patients
and
then
families
or
whatever
your
numbers
are
actually
based
on
one
one
call
and
you
have
interaction
with
five
people,
so
you
use
that
five
interactions
to
to
give
a
number
on
activities
or
case
loads
is
that
how
your
numbers,
not
actual
patients
like
one
to
one.
D
D
C
D
Dr
titus,
it
is
not
a
one-to-one
so
currently
there
are
over
16
000
long-term
care
beds
in
the
state.
However,
that
doesn't
equate
to
16
000.
C
J
F
D
The
finishment
for
the
record,
we
are
returning
now
to
visits,
so
we
are
hopeful
that
the
data,
when
our
the
payload
projections,
as
robin
had
mentioned,
are
going
to
be
done
in
the
next
couple
weeks.
We're
hopeful
that
those
increased
activities
since
we've
started
we've
begun
about
two
three
weeks
ago
or
a
month
ago,
I'm
not
sure
to
return
to
facility
visit,
we're
hoping
that
that
number
will
increase.
D
Of
the
calls
that
we
used
to
get
because
a
lot
of
times
it
was
generated
by
us
just
touching
base
with
people,
so
we
are
concerned
with
the
loss
of
staff
and
our
ability
to
maintain
just
our
minimum
number
of
visits,
let
alone
any
additional
complaints
we
are
receiving.
So
we
are
hopeful
yeah.
The
projections
will
come
in
higher
as
over
the
next.
F
D
F
A
Thank
you.
I
did
want
to
follow
up
on
this
line
of
questioning
a
little
bit
and
then
I'll,
I
know,
there's
some
more
questions,
but
particularly
on
the
long-term
care
ombudsman
program.
We
there's
just
obviously
a
lot
of
concern
around
long-term
care
facilities.
Given
what
happened
in
the
pandemic,
I'm
acknowledging
that
I'm
old
enough
to
receive
the
aarp
magazine
and
they've
done
a
three-part
series
on
some
of
the
concerns
we
have
with
our
long-term
care
facilities
and
and
assisted
living
facilities.
A
Just
generally,
we
gave
you,
I
believe
in
the
last
session
we
significantly
increased
the
staffing
around
this
program.
I
mean,
and
I
think
it's
pretty
darn
close-
that
the
number
of
positions
that
we
gave
you
to
address
the
needs
are
about
what
we're
taking
away
now,
and
so
I
think,
I'm
basically
just
reiterating
the
question
that
assemblywoman
titus
asked
and
I
think
you've
expressed
your
concerns,
but
if
you
could.
J
A
D
Deanna
schmidt,
for
the
record,
as
I
mentioned
before,
yes,
we
are.
We
are
concerned
with
our
ability
to
just
do
our
minimum
number
of
visits
with
the
staffing
reduction,
so
we-
and
we
have
seen
I
think,
covet
19-
has
taught
us
a
lot
about
long-term
care
facilities
and
some
of
the
issues
and
concerns
as
well.
D
Using
the
right
data
because
oftentimes
as
we
said,
five
activities
equals
the
case,
but
that
doesn't
mean
that
we
shouldn't
be
there
for
every
individual
that
needs
us
to
be
there.
So
I
do
think
there's
some
work
that
we
can
do
planning
going
forward
in
the
next
biennium
to
make
sure
that
our
members
and
our
data
support
the
needs
and
staffing
needs
in
this
program.
A
All
right
all
right,
I
think
assemblyman
roberts
has
a
question.
C
Thank
you,
madam
chair.
Thank
you
guys
for
the
presentation.
I
like
the
mask
too
and
actually
read
your
lips
too.
C
That
you
were
recommended
to
hold
vacant
and
then
you
would
restore
those
in
2023.
My
question
is:
how
long
have
they
been.
H
C
You
know
is
this
something
that
they've
they've
been
vacant
since
2019,
and
so
we're
gonna
we're
gonna,
restore
these
after
four
years
and
and
and
how
is
it
impacting
your
your
ability
to
to
render
services?
Is
it
impacting
you
do
you
think
the
peso
the
need
to
keep
them
on
the
books,
rather
than
just
eliminate
them.
D
So,
yes,
there's
been
a
direct
impact
to
the
services
provided,
not
only
in
going
into
the
next
biennium,
but
over
the
last
year,
these
positions.
Without
these
positions,
we
have
seen
an
impact
in
our
ability
to
provide
timely
services,
but
they
have
been
vacant
since
the
higher.
G
C
D
C
A
You
but
assemblywoman
anita
thompson.
B
Thank
you
so
much.
I
just
want
to
echo
real
quick,
the
conversation
about
the
potential
loss
to
these
long-term
care
audience.
Ombudsman,
I
feel
like
make.
We
gave
the
department
10
last
session
and
just
be
really
nice
to
see
that
stick.
B
I
imagine
that,
as
we
start
looking
back
at
the
data
coming
out
of
skilled
nursing
facilities,
the
mds
and
all
the
quality
measures,
I
I
just
imagine,
there's
going
to
be
kind
of
nose,
diving
and
a
lot
of
those
measures
across
the
board
and
when
the
facilities
were
shut
down
to
families
and
outside
providers.
B
The
only
set
of
eyes
and
ears
were
the
staff
in
there,
and
I
know
that
long-term
ombudsmen
had
trouble
even
trying
to
get
into
or
communicate
with
staff,
and
whenever
we
have
congregate
things,
whether
it's
children
or
adults,
or
you
know,
I
need
those
closed-door
congregate
care
settings
that
the
government
just
has
to
have
eyes
and
ears
in
there
or
things
go
wrong
in
a
way
that
we
just
get
our
pants
suit
off.
Quite
frankly,
so
I
just
can't
underscore
the
importance
of
that.
B
The
second
thing
I
would
say
is
so
as
we
look
at
the
I'm
looking
at
the
home
community
based
waiver
programs,
and
I
know
that
there
was
specific
carers
dollars
and
fundings
allocated
to
skilled
nursing
facilities,
but
I
don't
believe
any
care
dollars
really
ended
up
like
in
our
in
our
waiver
program
in
our
home
community-based
waiver
programs,
and
my
first
question
is:
am
I
correct
in
that
recollection?
B
D
D
There
were
no
well,
there
was
no
direct
additional
funding
on
the
waiver
unit.
I
would
say
that
we
did
have
the
increased
federal,
medicaid
assistance
percentage
so
that
increased
fmap
offset
some
of
the
costs
for
those
waiver
services,
but
those
again
those
are
in
the
medicaid
budget.
For
these
two
programs,
the
dollars
are
in
the
medicaid
budget,
not
in
our
division.
B
I
appreciate
that,
if
I
could
I'll
go
on
to
a
kind
of
a
follow-up
question,
madam
chair,
if
that's
okay,
please
do
so.
As
I
look
at
the
covet
dashboard
and
I
look
at
the
data
we
can
see
data
by
facilities
and
when
it
seems
to
me
that
it
looks
like
our
residents
of
smaller
congregate
care
settings
in
group,
our
residential
group
homes
for
the
elderly
and
medically
fragile
that
they
seem
to
fare
surprisingly
better
than
those
who
are
elderly
and
medically
fragile
in
a
skilled
nursing
facility.
B
It
you
can't
really
parse
out
the
data
to
see
you
know,
I
think
the
the
group
homes
are
lumped
in
with
the
assisted
living,
so
you
can
kind
of
take
a
look
here
and
there,
but
do
do
we
know
that,
do
we
know
as
we
look
forward
and
we
think
about
our
congregate
care
settings
for
seniors
what
type
of
settings
did
better
than
other
settings
management.
D
For
the
record,
so
while
we
haven't
dug
into
that
type
of
data,
at
this
point
I
think
it's
you
make
a
really
good
point
that
we
need
to
be
looking
at
how
folks
fared
and
what
the
issues
were
and
reaching
back
out
to
those
providers
to
get
input.
I
know
that
in
a
smaller
setting
it's
much
easier
to
isolate
the
whole
group
of
small.
You
know
a
smaller
group
than
it
is
with
the
nursing
facilities.
I
think
one
of
the
issues
with
the
nursing
facilities
is
oftentimes.
D
The
staff
work
in
more
than
one
facility,
whereas
in
group
homes
and
smaller
settings
it's
you
know,
the
staff
remain
the
same
and
consistent,
but
I
don't
have
a
direct
answer
other
than
anecdotal,
but
I
do
think
it's
a
worthy
discussion
that
we
could
live
with
our
data
analytics
groups
to
kind
of
provide
some
more
information.
Now
that
we
have
a
year's
worth
of
data.
B
I'd
I'd
appreciate
that,
because
I
think
that
before
the
pandemic,
we
saw
two
things
happening.
We
saw
the
skilled
nursing
facility
switching
to
their
book
of
business
to
medicare
and
rehab
beds,
because
those
pay
more
so
few
nursing
facilities
taking
long-term
medicaid
patients,
but
also
just
people
not
wanting.
You
know
this
idea
of
I'm
going
to
go
into
a
nursing
home.
Just
that
doesn't
happen
really
anymore.
No
one
plans
to
say:
I'm
gonna,
you
know
check
myself
into
a
nursing
home
and
spend
10
years
there
five
years
there.
B
So
I
I
just
as
we
talk
about
how
we're
planning
for
these
community-based
services
supporting
people
in
the
home
and
then
your
staffing
to
make
sure
that
we
can
actually
fill
those
weightless
spots
and
expand.
Those
weightless
spots,
I
think,
is,
I
think,
it's
exponential
now,
because
I
think
in
the
next
couple
of
years
people
are
just
going
to
want
to
stay
home
and
so
to
keep
them
safe.
B
We're
going
to
need
all
of
these
programs
well
staffed
in
order
to
support
that
and
if
it
produces
better
health
data-
and
we
just
know,
people
are
going
to
be
safer
from
big
infections
and
not
just
not
just
cobid,
but
you
know
merson
all
those
other
great
things
that
they
get
in
big
congregants
their
care
settings.
Then
we
should
just
know
that
we
should
plan
to
support
that
trend
as
well.
D
C
D
So,
yes,
we
will
definitely
work
with
data
analytics
and
dig
into
some
of
those
numbers
and
see
what
we
can
provide
to
you,
because
absolutely
I
mean
as
aging
and
disability
services.
You
know
we
advocate
for
community-based
care
in
all
settings,
but
we
can't
speak
highly
enough
or
advocate
more
for
the
fact
that
people
should
have
the
ability
to
remain
in
their
community
and
in
a
setting
of
their
choice,
to
the
extent
that
that's-
and
we
know
that
it's
also
cost
effective
right.
B
That's
so
kind
of
you
to
remind
me:
I
did
on
adult
protective
services
and
looking
at
the
number
of
vacancies
you
have,
there
does
seem
to
be
quite
a
bit
of
vacancies
in
this
program
and
it's
it's
new,
and
so
I
think
we
should
probably
try
to
fund
it
right,
get
it
right
and
and
kind
of
look
back
and
say:
okay
in
the
past
couple
years,
how
things
been
going
do
those?
Can
you
tell
me
more
about
those
vacancies?
Are
those
vacancies
happening
more
in
one
area
than
another?
Are
they
I
guess?
D
For
the
record,
so
yes,
we
have
had
the
number
one
cause
of
vacancies
in
the
adult
protective
services
unit
is
the
difficulty
of
recruiting.
We
have
had
a
very
difficult
time
recruiting
staff
our
established
caseload
ratio
is
normally
one
to
forty.
Our
current
average
caseload
is
running
at
1-93,
so
those
staff
are
working
overtime.
They
are
overwhelmed
their
ability
to
get
out
and
respond.
Timely
is
being
impacted
by
that
the
vacancy
rate
for
social
workers
and
adult
rights
specialists
currently
is
running
at
about
51
percent.
D
D
So,
as
you
can
imagine,
when
you
look
at
the
activities
that
this
group
has
and
the
functions
of
this
group,
it
is
very
difficult
for
them
to
continue
at
that
kind
of
caseload
ratio.
We
are
concerned
with
burnout,
but
our
number
one
reason
is
really
we're
having
a
difficult
time
to
recruit
those
positions,
we
see
a
lot
of
turnover
folks
can
get
hired
in
our
adult
protective
services
unit
as
a
social
worker
and
then
move
on
to
other
agencies
for
an
increase
in
pay.
D
B
Thank
you
so
much.
I
appreciate
that.
I
think
we
just
need
to
remember
that.
The
reason
why
we
have
an
adult
protective
services
isn't
because
necessarily-
and
you
know
myself
included
in
this-
wasn't
like
we
said-
oh
here's,
this
program-
we
need
to
stand
up.
It
was
an
audit
by
was
it
the
department
of
justice
and
our
victims
of
crime
stuff.
B
It
came
from
higher
up
saying
you
are
not
doing
right
and
not
providing
these
services
as
a
state,
and
so
we,
we
kind
of
stood
this
program
up
to
make
sure
that
we
we
could
be
better
compliance
in
that
way,
and
so
we
we
ought
to
think
twice
about
making
sure
that
we're
doing
it
right,
because
otherwise
we
you
know
once
again,
we
we
might
just
be
forced
to
down
the
road
if
we
aren't
proactive
about
it.
Thank
you
for
letting
letting
us
know.
A
Thank
you,
senator
keator.
A
C
Sure
appreciate
it.
I
wanted
to
follow
up
quickly
on
the
first
questions
asked
by
assemblyman
monroe
moreno
regarding
case
load.
I
think
michelle
said
that
you're
budgeted
at
493
but
actuals
were
at
619
and
you
were
going
to
reproject
with
with
the
anticipated
caseload
growth.
Did
I
hear
that
right
and
if
so,
are
you
going
to
just
go
back
to
the
613?
Are
you
going
to
use
a
different
number.
D
Finish
for
the
record,
so
that
was
related
to
the
cope
and
homemaker
program
where
the
actual
cost
for
clients
has
been
reduced.
Again.
We
think
part
of
that
is
utilization
because
folks
have
you
know,
asked
for
less
less
time
in
their
home,
so
we
will
re-look
at
during
the
projections
what
the
average
cost
is
to
date
and
use
that
it's
always,
I
think
the
methodology,
and
maybe
robin
could
speak
to
the
methodologies
we
usually
use
the
average
actual
cost,
rather
than
a
projected
class.
C
J
C
C
Thank
you
for
that
look
forward
to
when
we
get
those
recalculations
to
learn
more
about
how
you
came
up
with
a
number
on
the
on
the
m208.
It
also
seems
like
there
was
a
a
reduction
in
staffing
proposed
when
we're
trying
to
add
people
to
the
roles,
and
we
might
actually
need
to
increase.
Can
you
talk
a
little
bit
about
what's
going
on
with
the.
C
D
D
J
C
J
Medicaid
has
funded
wait
list
for
us
and
unfortunately
I
missed
that,
and
so
I
didn't
include
the
stacking
that
would
be
needed
to
fund
that
wait
list.
So
all
those
things
will
come
into
play.
H
Thank
you,
madam
chair,
and
if
I
could
go
back
to
adult
protective
services,
when
we
move
this
over
from
elder
protective
to
adult
protective,
we
did
it
with
a
lot
of
the
victims
of
crime
act
grant
dollars,
and
I
know
a
lot
of
those
have
changed.
So
I
guess
my
question
to
the
agency
is,
with
the
funding
switch
that
we're
looking
that's
being
proposed.
H
What
other
alternatives
did
you
look
for,
and
is
there
something
about
the
victims
of
crime,
grant
funds
not
being
available
that
we
should
be
aware
of.
D
We
we
continue
to
apply
for
those
each
year
and
but
those
funds
have
been
limited
and
not
available
at
the
level
that
we
originally
anticipated
or
hoped
for.
I
would
mention
to
the
committee.
I
think
it's
important
to
understand
at
the
federal
level
right
now
there
is
legislation
we
recently
were
awarded
federal,
direct
dollars
for
adult
protective
services.
D
For
the
first
time
ever
in
the
recent
bill,
we've
received
a
little
over
seven
hundred
thousand
dollars
that
that
first
amount
of
funding-
we're
going
to
be
receiving
here
soon
is
really
restricted
on
the
time
frame,
but
the,
but
the
hopeful
part
of
that
is
it's
the
first
time
that
the
the
federal
government
has
identified
funding
directly
for
adult
protective
services.
D
Unfortunately,
we
don't
know
that
yet,
and
we
can't
bank
on
that,
but
we
are
very
hopeful
and
there
is
a
lot
of
advocacy
going
into
that
from
all
the
state,
adult
protective
service
programs,
where
we
are
really
pushing
to
get
that
funding
available,
because
it's
something
that
hasn't
been
available
to
states.
So
if
that
were
to
come,
that
would
also
help
offset
any
costs
related
to
this
program.
H
A
A
I
think
we,
we
think
about
social
workers
and
case
workers
and
all
those
frontline
folks
but
fun
to
hear
about
the
mighty
grant
warrior
team
behind
the
scenes
that
was
making
sure
that
all
that
extra
money
got
out
there
and
got
deployed,
and
so
please
express
our
gratitude
to
that
unit
and
the
nevada
can
project
has
been
extraordinary
and
I'm
glad
to
hear
that
it's
going
to
shift
from
being
a
immediate
response
to
a
long-term
program,
so
lots
of
kudos
there
in
that
budget.
A
There's
an
administrative
assistant,
three
position
that
it
looks
like
the
recommendation.
It
looks
like
it's
identified,
been
identified
as
no
longer
needed,
but
it
hasn't
been
eliminated.
It's
just
been
held
vacant,
so
we
just
need
a
little
clarification
on
that.
Is
that
that's
something
that
can
go
away
altogether
or
is
that
something
you're
planning
on
filling
when
resources
are
available.
D
You
just
fit
for
that
record
so
that
transition
was
previously
funded
through
federal
dollars.
It
was
a
grant
funded
position,
so
the
grant
funding
we've
shifted
that
particular
grant
to
the
community.
It
used
to
be
the
state
that
operated
that
grant.
It
was
the
some
of
the
medicare
assistance
programs
with
our
shift
to
the
community
providing
those
services.
That
position
was
no
longer
needed
because
we
were
no
longer
operating
the
program.
D
A
Thank
you.
That's
a
helpful
verification!
Okay!
Well,
I
think
we
made
it
through
that
particular
budget.
Congratulations
to
everyone
on
great
questions
and
great
answers.
We'll
go
ahead
and
move
on
to
3208.,
hey.
D
So,
starting
on
slide,
26
is
budget
account,
3208
the
nevada,
early
intervention
services
program.
This
program
provides
specialized,
supports
and
services
to
children,
birth
to
age
3,
who
have
developmental
delays
with
disabilities
and
their
families
in
order
to
meet
the
individualized
developmental
and
learning
needs.
D
D
D
And
then
moving
to
slide.
29
are
the
budget
reductions
for
the
nis
budget,
with
e680
holding
vacant
29
positions
for
the
fiscal
year,
22
and
e698
and
699
reducing
the
monthly
per
child
per
month,
payment
to
community
providers
from
565
to
500..
D
Additionally,
I
just
it's
a
note
that
the
federal
flexibilities
during
the
copen
19
pandemic
have
also
allowed
the
telehealth
services
to
be
provided
for
many
of
the
services
within
the
ei
program,
which
has
reduced
the
cost
associated
with
transportation,
for
both
the
providers
and
the
state.
A
I
believe
senator
dan
darrell
luke
has
a
question.
C
Thank
you,
madam
chair,
of
course,
every
budget.
You
know
we,
I
think,
wins,
because
we
all
think
every
area
is
so
important.
But
what
I
would
like
you
to
do
is
please
explain
the
both
the
need
and
the
benefits
of
replacing
caseworker
positions
with
supervisors
and
administrative
support
staff.
D
D
So
there's
a
team
of
people
that
have
to
do
that,
no
matter
what
the
case
load
is
well,
we
historically
didn't
have
that
identified,
so
our
case
load
kept
growing
and
we
weren't
getting
the
right
appropriate
staff.
So
our
ratios
were
out
of
alignment,
so
we
really
took
the
time
this
this
budget
bill
to
identify
those
administrative
activities,
pull
them
out
of
caseload
and
then
identify
the
caseload
ratios
that
were
appropriate.
D
What
we
were
seeing
is
we
were
having
one
of
two
things:
either
too
many
staff
and
not
enough
supervisors
or
too
many
supervisors
and
not
enough
staff.
So
the
ratios
of
staffing
ratios
for
supervision,
we're
getting
out
of
alignment.
So
that's
why
you
see
the
adjustment
here
is
really
to
kind
of
clean
it
up
and
make
sure
that
we
have
the
appropriate
staffing
ratios
to
be
effective.
J
Morning,
thank
you
rob
for
the
record,
so
we
basically
looked
at
all
ratios
and
we
looked
at
compliance
as
well
as
as
quality
insurance,
and
so
previously
things
have
been.
This
case
would
have
been
budgeted
out
of
1-25
and
over
that
1-19
we
really
do
start
to
see
our
quality
go
down
and
our
compliance
become
an
issue.
So.
J
D
J
Our
caseload
staff
and
we've
been
able
to
look
at
the
data
and
I'll
give
a
shout
out
to
the
2019
session.
Our
management
analyst
team
that
you
approve
have
been
able
to
really
dig
into
the
data
and
see
what
works,
what
doesn't
work
and
and
how
does
that
affect
our
quality
and
our
compliance,
and
that
119
has
really
shown
to
be
the
most
appropriate
caseload
ratio
versus
what
we've
been
utilized
in
the
past.
C
Thank
you
and
then,
if
you
could
discuss
whether
there's
a
potential
for
the
cost
per
eligible
for
the
state
caseload
to
increase
for
the
upcoming
biennium.
As
you
know,
service
utilization
and
how
services
are
delivered
begin
to
return
to
pre-pandemic
norms.
D
Management
for
the
record,
so
I
think,
as
we've
talked
about
in
many
of
our
caseloads.
Yes,
there
is
a
potential
for
that.
We
try
to
take
that
into
account,
but
we
know
utilization
has
been
down.
We
know
the
use
of
telehealth
has
reduced
our
costs,
while
telehealth
has
been
wonderful
alternative.
Sometimes
it's
not
always
the
best
alternative.
D
So
I
think
that
there
is
a
potential
for
increases
in
costs
for
our
agency
as
we
return
to
direct
services
in
the
home,
many
families
have
been
hesitant
to
have
us
in
their
homes
right
now,
but
as
vaccinations
expand
across
the
state,
and
I
think
ricky
could
probably
highlight
a
little
bit
about
what
we're
doing
to
re-enter.
As
far
as
a
re-entry
program,
we
kind
of
have
a
plan
that
will
impact
our
costs
for
eligible
ricky.
J
D
J
The
record
we
are
a
natural
environment
model
which
is
one
of
our
federal
requirements,
that
it
must
be
in
the
child's
natural
environment
and
typically
that
is
their
home
and
so
with.
Obviously,
during
the
pandemic,
we
were
not
able
to
do
that,
and
the
federal
flexibility
gave
us
the
ability
to
implement
telehealth,
so
we're
currently
looking
at
a
phased-in
approach
of
our
re-entry
right
now.
J
What
we've
done
we're
in
phase
one
and
phase
two
based
on
the
need
of
the
program
and
the
access
to
where
we
are
doing
more
of
the
clinical
environment
based
on
the
needs
of
the
child,
so
those
higher
need
individuals
will
be
able
to
come
into
the
clinic,
be
seen
either
by
the
physician,
the
developmental
specialist
or
the
therapist
in
which
they
need
and
we'll
be
able
to
provide
that
within
the
clinics.
J
And
then
once
we,
the
state
reopens
more,
then
we
will
be
looking
into
the
next
phase,
which
is
phase
three,
which
would
be
those
natural
environments
back
into
the
home
once
it
is
appropriate
for
the
children,
as
well
as
the
staff.
C
Thank
you
so
much
so
what
impacts
does
the
agency
anticipate
then
on
the
government
or
the
community
provider
capacity
as
the
recommended
rate
reduction.
J
Thank
you
for
the
question.
Ricky
rob
for
the
record
at
this
point
in
time
that
they
have
been
at
a
565
and
the
information
that
we
have
had
in
the
past.
Sorry
565
is
per
child
per
month
and
that
is
for
an
active
ifsp.
D
J
Really
important
for
us
to
know
that
we
are
currently
working
directly
with
the
trade
association,
as
well
as
all
early
intervention
service
community
providers
to
obtain
that
information
to
what
the
actual
impact
would
be.
We
can
say
there
has
been
an
increase
since
that
2012,
executive
audit
and
and
with
aca
they've,
had
the
ability
to
build
private,
both
private
as
well
as
medicaid,
and
to
increase
those
revenues
for
them.
J
I
can
say
anecdotally:
they
have
stated
that
it
will
impact
them,
but
based
on
data
and
numbers,
we
do
show
that
they
have
received
an
incre,
an
increase
over
the
years
and
it'll
basically
be
a
business
model
decision
for
them
on
what
they'll
be
able
to
continue
on.
Based
on
that
potential
erection
or
the.
J
Reduction
and
I'm
sorry
can
I
just
also
add
for
my
for
the
last
question
I
want
to
just
assure
that
all
of
you
know
that
there
is
still
a
moratorium
in
place
that
was
put
in
place
by
the
early
intervention
physicians
and
which
has
not
allowed
for
that
face-to-face
visit
and
that
natural
in-home
environment
visits.
I
just
want
to
make
sure
that
that's
on
the
record
that
that
is
still
active
that
was
put
in
place
on
march
15
of
2020..
So
my
apologies
for
doing
that
in
the
middle
of
this
question.
J
C
C
Thank
you,
madam
chair.
Thank
you
miss
rob.
I
appreciate
the
the
note
that
they
can
build
private
insurance
as
a
as
a
component
of
of
the
reimbursement,
if
the,
if
the
families
agree
to
that,
but
you
you
can
do
that
as
well
from
the
state
side
correct
and
if
so,
how
successful
is
the
state
of
being
able
to
get
permission
to
build
private
insurance.
J
Thank
you
for
the
question.
Ricky
rob
for
the
record.
Yes,
we
as
a
state
agency
are
able
to
bill
and
we
do-
and
I
can
tell
you
the
management
analyst
team
again
has
been
very
supportive
in
providing
us
data
and
support
in
actually
increasing
those
revenues
based
on
our
medicaid
tcm
billing
and
our
private
insurance,
and
so
with
that
that
actual
revenue
actually
offsets
the
supports
to
the
overall
system.
C
C
J
For
the
record,
robin
hager,
we
do
have
multiple.
I
think.
C
J
D
D
C
Thank
you,
the
so,
with
the
with
the
rate
reduction
to
the
to
the
community
providers.
You.
F
J
Thank
you
for
the
record
great
question,
so
there's
multiple
things
that
we
will
take
into
account
in
regards
to
that.
We've
also
been
talking
about
the
flexibilities
in
between
whether
category
12
is
our
private,
which
is
our
community
providers
and
then.
G
J
14
is
our
state
providers
for
the
direct
service
piece
of
it,
so
there's
multiple
things
that
go
into
account
with
that
that
particular
question,
but
what
it
will
be
is
when
we're
also
looking
at
being
able
to
have
the
flexibility
between
those
accounts,
but
also
knowing
that
we
fluctuate
when
it
comes
to
referrals.
So
between
parent
choice,
as
well
as
what
we
call
rotation.
J
Look
at
it
on
a
weekly
to
daily
basis,
and
we
also
put
out
to
the
community
providers
weekly
to
let
them
know
what's
available,
how
much
space
can
the
community
providers
take
within
our
authority,
our
budget
authority
and
then
what
would
what
we
would
look
at
on
the
state
side?
So
we
would.
We
would
monitor
that
very
closely,
just
as
we've
been
doing
and
continue
with
that
again,
that's
another
one
of
those
management,
analyst
teams
that
has
been
a
true
benefit
to
us
during
this
past
year.
C
I'm
sure
just
more
of
a
statement
on
this
one,
but
you
know
I
worry
that
if
we
reduce
this
rate
at
this
level,
it's
going
to
reduce
community
capacity
and
push
more
people
into
the
state
side,
and
you
know
the
compounding
effect
of
that
is
that
we've
used
this
program
to
help
bolster
up
community
support
so
that
these
programs
are
available
to
people
not
just
on
this
program
but
other
programs,
and
if
they
need
supports,
they
can
go,
find
them
in
the
community.
And
I'm
I'm
significantly.
C
I'm
very
concerned
that
this
is
going
to
have
a
significant
impact
on
people's
ability
to
access
care
in
our
community,
and
I
think,
finally,
you
know
one
of
the
things
that
the
that
the
providers
have
looked
at
is
whether
this
budget
would
be
an
acceptable
place
to
spend
tana
funds.
It's
focusing
on
some
medical
needs
of
or
or
care
needs
of
children,
and
we
see
we'll
see
in
the
next
budget
account
that
you're
able
to
use
it
for
atap
funding
is
there?
J
Ricky
wrap
for
their
record.
We
have
evaluated
that
with
the
division
of
welfare
and
supportive
services
and
because
early
intervention
is
an
actual
medical
service
delivery
where
an
education
model,
but
the
actual
services
that
are
provided
are
medical.
They
are
excluded
from
utilizing
the
mechanic
dollars.
We've
also
received
feedback
from
the
federal,
as
well
as
our
deputy
attorney
general,
where
atap
is.
J
It
fits
in
many
different
costs
and
we'll
see
that
when
we
present
that
budget
as
well,
but
really
the
main
piece
of
that
is
that
it's
behavioral.
It
sits
in
many
different
buckets
and
it
only
builds
medical
based
on
nevada's
determination
for
ada
services
as
a
requirement.
J
It
it
fits
in
many
buckets.
Actually,
it
sits
in
the
educational
behavioral
as
well
as
as
as
medical,
but
it's
not
siloed
as
a
medical
service.
C
F
Thank
you,
madam
chair.
I
want
to
continue
on
the
same
line
of
questions
that
senator
kikeford
just
did
and
clarification
is
needed.
F
I
think
you
you
talk
about
a
business
model
and
a
business
model
reduction
and
how
you
function
as
a
business
and
and
at
the
same
time,
you're
talking
that
it's
potentially
a
medical
model,
and
how
are
we
morphing
those
two
definitions
when
it
comes
to
access
to
care
for
first,
for
this
particular
group
of
nevadans
and-
and
I'm
have
some
concerns
that
it's
it's
not
very
clear
because
I'm
hearing
you
say
that
you're
decreasing
the
reimbursement
for
providers,
and
I
I
need
some
clarification
on
that.
Are
you
you
have
your
own
group.
F
So
the
question
is,
you
know
you're
talking
about
these
case
workers
and
that
you
also
mentioned
there.
It's
mandatory,
no
wait
list,
so
everybody
that
calls
and
needs
assistance
or
requests
from
a
family
for
their
child
is
then
referred
to
a
caseworker
immediately.
There's
no
wait
list
on
that,
and
then
I
have
a
follow-up
question.
If
I
might
I'm
sure
so,
could
you
answer
that
and
clarify
to
me
what
that
means
that
there's
a
no
wait
list.
D
Certainly
schmidt
for
the
record,
so
I
think
a
couple
of
things
with
that
question
is
so
we're
mandated
to
provide
timely
services.
So
there
are
time
frames
established
under
the
idea,
part
c
regulations
for
each
service
and
each
step
of
the
way.
So
when
a
family
comes
in
and
gets
their
assessment,
there's
a
timeline,
there's
a
timeline
to
get
the
first
delivery.
D
So,
each
step
of
the
way
there
are
guidelines,
the
regulations
that
we
must
adhere
to
the
intake
process.
I
think
it's
part
of
the
confusion
is
so
that,
yes,
there
are
state
case
workers.
This
is
a
shared
model,
so
we
provide
the
service
and
the
community
providers
provide
the
same
service.
So
families
are
referred
into
the
state
single
point
of
entry
where
their
evaluation
is
done
for
eligibility
and
then
they
are
offered
their
choice,
so
they
choose
who
they
want
to
go
to.
They
can
be
referred
to
if
they
have
a
choice.
D
F
D
F
Answer,
thank
you
for
the
clarification,
so
that
actually
is
this
part?
If
I
might
follow
up
on
that,
madam
chair,
because
that
brings
me
to
this.
So
what's
the
actual
time
frame,
the
person
a
family
calls-
and
you
say
they
get
an
assessment
after
that
assessment,
then
it's
determined
what
their
potential
needs
are
and
then
they
are
referred
out.
F
But
my
concern
is
that
we
truly
have
a
limited
number
of
early
behavior
interventionalists
b.
We
have
access
to
community
providers
very
limited
throughout
the
state.
What
I'm
not
hearing
is
how
long
does
it
take
to
get
into
one
of
these
providers?
What
what's
the
average
wait
list
that
could
two
weeks
two
months?
How
long
does
it
really
take
to
get
this?
These
children
actual
some
intervention,
not
just
an
assessment,
I'm
talking
about
care,
ricky.
J
Rob
for
the
record
and
actually
there's
there
was
a
little
bit
confusion
there.
So
when
the
family
calls
they
go
into
the
single
point
of
entry,
they're
expo-
and
it's
not
deemed
at
that
point
about
the
assessment
that
is
when
they
make
the
decision
to
where
they
would
like
to
go
and
then
once
that
is
referred
to,
and
we
have
we
have
two
days
to
or
I'm
sorry
three
days
to
get
that
referral
to
that
community
provider
within
that
timeline,
then.
C
J
It
just
really
depends
on
hiring
and
things
like
that,
so
losing
any
capacity.
There
would
be
a
detriment
to
the
entire
system.
It
is
very
important
for
us
to
maintain
that
capacity
so
and
they
do
a
great
job.
So
please
know
it's
not
we're
not
talking
about
a
business
decision
there,
because
they
are
part
of
this
system
and
we
could
not
do
it
without
them.
F
Right
and
I'm,
and
if
I
might
fall
that
line
I'm
very
concerned
about
that
capacity,
but
you
still
haven't
answered
you
said
well,
they
have
up
to
45
days
so
when
somebody
calls
and
they
get
in
that
rotation.
So
now
I'm
hearing
they
haven't
even
been
really
getting
in
that
rotation
to
be
assessed,
and
if
they
don't
know
enough
to
ask
for
a
community
provider,
they
don't
know,
they
just
say
get
me
the
earliest
possible
intervention,
or
at
least
an
assessment.
What's
the
average
time
for
that
to
happen,.
J
D
F
Thank
you
because
I'm
hearing
that
it
could
take
as
much
as
if
it's
45
days
to
get
them
in
and
then
now
another
30
days
before,
anything's
actually
done
I'm
hearing.
It
could
be
up
to
two
months
before
there's
any
really
literally
laying
on
of
the
hands
or
actually
offering
a
solution
for
this
family
or
up
to
60
months
days,
and
I'm
just
curious
if
we
could
actually
see
how
long
it
really
takes
to
get
not
just
a
phone
call,
not
just
do
a
test,
but
have
a
family
have
some
feeling
like
somebody's.
F
H
Thank
you,
madam
chair,
very
much,
and
I
just
wanted
to
say
that
you
know
for
a
lot
of
sessions.
We
had
a
lot
of
parents
in
this
building
talking
about
eis
and
a
lot
of
work
has
been
done
to
be
able
to
address
the
needs
of
these
children
and
making
sure
that
the
medically
fragile
children
are
fenced
off
and
taken
care
of
the
debate
was:
does
it
stay
state
service?
Do
we
go
private?
We
now
have
a
mixture
we're
trying
to
do
the
best
of
both
worlds.
H
I've
always
been
kind
of
struck
with
the
difference
in
the
cost.
I
believe
when
the
state
provides
the
services.
I
think
what
we've
got
in
our
notes.
Right
now
is
approximately
290
dollars
a
month
per
child,
but
when
we
go
into
the
private
provider,
that
number
increases-
and
I
think
there
might
have
been
a
couple
of
miscalculations-
so
I
I
believe
it's
close
to
five
hundred
and
fifty
dollars
per
month
for
the
private
providers
and
the
parents
have
a
choice.
H
So
there
were
times
when
we
had
parents
showing
up
saying
it
was
four
to
five
months
before
their
children
got
services.
I
believe
we're
on
the
right
track,
we're
trying
to
address
all
these
children's
needs,
but
I
still
do
have
concerns.
I
understand
the
provider's
concern
in
a
rate
decrease,
but
when
I
compare
the
amount
that
we're
paying
those
providers
versus
the
amount
that
the
state
is
doing
it
for,
I
think
that's
a
important
conversation
to
have
so
that
we
we're
really
comparing
apples
to
apples
here
and,
what's
being
done.
So.
H
D
For
the
record,
I
think
what
we
would
offer
to
do
is
work
with
your
staff
to
verify
those
numbers
that
you're
looking
at
and
making
sure
that
we
have
the
most
accurate
information.
H
D
Finished
for
the
record,
so
we
have
done
those
populations
and
with
this
rate
reduction
we
will
still
continue
to
meet
that
maintenance
of
effort.
D
The
autism
treatment
assistance
program
assists
parents
and
caregivers
with
the
cost
of
providing
autism
specific
treatments
to
their
children,
who
have
been
diagnosed
with
autism
spectrum
disorder.
There
are
several
plan
types
within
this
program.
We
have
a
comprehensive
plan,
an
insurance
assistance
plan,
social
skills,
targeted
plans
that
support
individuals
and
family
needs,
as
well
as
transitional
services.
So
I
think
it's
important
that
we
understand
that
it's
not
just
one
service
in
this
public
account.
There
are
multiple
options
that
families
can
access
services
and
supports
from
us
moving
on
to
slide
31.
D
This
shows
the
caseload
projections
for
the
autism
treatment,
assistance
program
and
slide.
32
is
the
decision
units
for
that
program
with
m201,
providing
funding
for
the
case
load
increases
in
the
next
biennium
and
m203
funding
the
elimination
of
the
wait
list.
The
current
wait
list
is
projected
at
148
children,
and
so
this
decision
unit
would
provide
services
to
all
of
those
children
as
well
as
include
includes
four
ds
physicians,
to
provide
those
services.
D
And
with
that,
I
would
be
happy
to
take
any
questions
regarding
this
budget
account.
C
Question,
thank
you
very
much.
This
is
of
utmost
concern,
so
how
has
the
pandemic
affected
the
program's
ability
to
provide
services
and
has
it
impacted
whether
families
are
seeking
services
and
if
so,
can
you?
What
is
the
program
observed.
D
J
Thank
you
for
the
question.
Ricky
rob
for
the
record.
So
while
our
case
load
maintains
steady
and
the
service
delivery,
as
as
mischief
has
referred,
has
reduced
during
the
pandemic.
So
from
march
until
may
of
2020,
we
were
not
insurances
as
well
as
medicaid
have
restrictions
on
telehealth
or
ada,
and
because
that's
a
face-to-face
therapeutic
service
for
them,
and
so
this
has
the
moratorium
on
services
as
well
as
a
lot
of
our
registered
behavioral
technicians,
our
rbts
in
the
field
and
then
one
of
the
once
the
restrictions
were
moved.
J
We've
slowly
seen,
service
delivery
come
back.
My
apologies,
although
telehealth
has
approved
again,
it's
not
clinically
appropriate
for
all
children
on
the
spectrum,
and
so
it's
very
important
that
we
are
resuming
those
face-to-face.
So
we.
J
Been
resuming
face-to-face
services
with
the
individuals
for
aba,
but
we're
also
working
on
the
loss
of
those
registered
behavioral
technicians
as
well.
So
we
are
seeing
some
of
that
capacity
to
decrease
during
the
pandemic,
and
so
we
are
continually
working
with
the
providers,
all
aba
providers
to
get
back
into
the
homes
with
the
families
working
they're
going
to
the
parks.
They're
going
to
those
individuals
supports
programs
to
allow
those
individuals
to
receive
the
services
again.
That'll
just
be
a
slow,
phased-in
approach,
as
we
move
forward.
C
So
I
understand,
even
in
las
vegas,
with
the
ackerman
autism
center,
that
there
are
more
than
even
these
numbers
indicate
of
children
waiting
for
services.
So
what
are
the
primary
factors
contributing
to
the
number
of
children
waiting
and
does
the
agency
anticipate
the
atap
service
providers
in
the
upcoming
biennium
to
support
projected
caseload
growth
and
eliminate
that
wait
list?
C
Because
I
I
worry
about
those
children
having
to
wait
because
we
all
know
one
of
the
success
stories
with
many
children
with
autism
is
the
early
intervention
and
immediate
therapies.
And
what
have
you
working
with
these
kids.
J
Thank
you
for
the
question
and
I'm
going
to
answer
that
in
two
parts,
one
being
the
wait
list
for
the
autism
treatment
assistance
program
is
based
on
staffing
for
us
right
now.
That
is
because
we've
obviously
had
the
freezes
since
2020,
and
so
we
have
service
delivery
dollars,
but
we
don't
have
the
staffing
to
actually
provide
that
service.
J
So
I
can
say
that
in
regards
to
atax,
wait
let's
when
it
comes
to
the
ackerman
center,
that
is
a
diagnosing
wait
list,
and
that
has
several
factors,
so
that
is
autism
for
aba
and
then
also
with
the
passage
in
2019.
J
G
J
J
Specific
for
autism,
so
when
we
look
at
the
ackermann
center,
there
are
multiple
factors
that
go
into
their
wait
list
and
again
that's
for.
C
Diagnosis,
thank
you
very
much
and
I
guess
one
last
question
will
be:
how
will
the
governor's
recommendations
to
ad
staff
reduce
both
the
number
of
those
children
waiting
and
the
wait
time
to
begin
receiving
those
atap
services.
J
Let's
be
able
to
add
staff
would
be
significant
for
the
program.
Oh
sorry,
ricky
rob
for
the
record.
My
apologies,
the
ability
to
add
staff
will
allow
us
to
utilize
the
service
delivery
dollars
that
are
budgeted
and
that
will
that
will
be
significant.
We
have
a
140
ratio
for
one
case
manager
to
40
children
and
so
to
be
able
to
have
that
staffing
would
make
a
significant
impact
to
the
program.
A
You
bet,
I
believe,
assemblyman
carlton
has
a
question.
H
Thank
you,
madam
chair
I,
and
had
to
find
my
mouse
buried
amongst
all
the
stuff
that
I
have
in
front
of
me.
So
my
question
relates
to
the
tanf
discussion
that
we
just
previously
had
it's
no
secret.
I've
been
very
protective
of
of
tanf
dollars
in
the
time
that
I've
been
here,
it's
a
very
limited
source
of
dollars
and
it's
really
meant
to
support
families
in
their
time
of
need
with
basic
needs.
It's
about
family
survival.
H
So
I
think
I'd
like
to
have
a
further
discussion
about
using
tanf
dollars
here
and
if
they're
used
here,
are
they
going
to
be
taken
out
of
pre-k?
Are
they
going
to
be
taken
out
of
child
welfare?
Are
they
going
to
be
taken
out
of
the
the
work
and
supportive
systems
that
we
have?
Are
they
going
to
be
taken
out
of
child
care?
It's
a
limited
pot
of
money
and
it's
not
a
very
big
pot.
It
hasn't
changed
since
1999
we've
been
getting
the
same
amount,
so
I
just
have
concerns
about
using
tanf
dollars
here.
D
Finishing
it
for
the
record,
so
obviously,
when
we
were
building
our
business
this
year,
we
you
know
we
were
looking
for
any
opportunity
to
find
funding
to
offset
the
general
fund
need,
and
we
worked
with
our
partners
over
division
of
welfare
and
supportive
services
to
identify
tan
of
the
ten
of
funds
that
we've
identified
to
use
our
reserve
funds.
D
So
this
is
a
portion
of
the
tanf
reserves
that
will
be
utilized
to
offset
these
costs
and
again,
we've
been
working
with
them,
as
well
as
their
federal
partners
to
get
clarification
around
the
uses.
One
of
the
uses
of
panic
is
to
keep
families
intact
and
one
of
the
it's
important
for
people
to
understand,
especially
their
independent
autism
treatment
assistance
services,
do
help
families
keep
their
children
in
their
home.
Oftentimes
families
are
overwhelmed
with
the
behaviors
of
their
children,
and
this
service
provides
training
to
the
parents.
D
They
can
help
them
with
the
skills
that
they
need
to
support
their
kids,
and
so
it
really
does
fall
in
line
under
that
need.
So
there
are
four
different
purposes,
and
one
of
them
is
really
how
to
maintain
the
intact
family,
and
we
believe
that
these
services,
some
of
our
services,
as
I
mentioned,
we
have
different
plan
types.
Our
families,
family
training
that
we
provide
and
skill
sets
for
the
family
members
where
we're
not
only
working
with
the
behaviors
of
the
child,
but
we
are
helping
the
family
learn
how
to.
D
Those
behaviors
when
there's
not
a
staff
available
to
support
them,
so
I
think
that's
kind
of
the
reason
that
we
identified
tenant
as
an
appropriate
use
concerns
with
long-term,
obviously,
there's
always
concerns
of
using
tenants
long
term.
But
we
know
that
this
year
was
a
unique
year
when
it
came
to
dollars
available
to
provide
services,
and
we
wanted
to
make
sure
that
we
were
able
to
ensure
autism
treatment,
assisted
services
continued
and
that
we
didn't
have
to
capture
half
the
case
load
and
create
a
waitlist
larger
than
what
we
had
before.
H
Thank
you,
madam
chair,
and
I
appreciate
that
and
and
I've
watched
the
the
treatment
of
autism
evolve
over
the
last
decade
or
so
there
was
a
time
when
we
didn't
even
talk
about
it
and
there
were
no.
There
were
no
dollars
for
these
children,
so
where
we're
going
is
is
good.
I
just
I
just
have
concerns
about
accessing
a
limited
pot
of
money
that
can
be
used
for
so
many
different
things,
but
I
also
understand
making
sure
that
these
children
have
treatment
is
is
at
the
top
of
the
list.
H
So
thank
you
for
the
explanation.
I
I
guess
I'm
gonna
need
to
go
back
and
dig
back
further
into
the
tanf
budget
a
little
bit
and
would
love
it
if
we
could
convince
our
federal
government
to
change
that
amount,
but
I
don't
think
that's
a
easy
fix
in
the
near
future.
So
thank
you
very
much.
A
Thank
you.
Can
we
just
spend
a
little
bit
of
time
on
the
cost
per
fallable
eligible
child?
I
think
that
there
have
been
some
things
that
have
impacted
that
cost
recently
and
then
there's
the
pandemic,
and
I
just
want
to
make
sure
that
we're
as
we're
moving
forward
into
this
next
biennium
thinking
about
the
cost
for
eligible
child
correctly.
D
Finished
which
of
the
records?
So
I
think,
there's
a
couple
things
that
have
gone
into
it:
not
only
the
pandemic,
but
the
history
of
the
program.
So
we
are
the
payer
of
last
resort.
So
we
over
the
course
since
the
implementation
of
this
program
and
with
the
implementation
of
the
affordable
care
act
which
provided
additional
services
and
aba.
When
I
can't
know
what
year
was
that
aba
services
were
added
to
insurance
coverage
for
some
insurance
plans.
D
D
Always
do
a
great
job
with
that
and
we
weren't
always
successful
at
getting
the
revenues
that
we
needed
to
offset
those
costs.
We
no
longer
do
that
over
the
course
of
the
last
biennium.
We've
worked
really
closely
with
our
community
providers
to
help
them
build
the
capacity
to
build
directly
on
their
own,
and
they
are
being
very.
They
have
been
very
successful
at
that
now,
so
we
are
no
longer
incurring
those
costs
so
that
brought
down
our
costs
and
then
yes,
utilization
during
the
pandemic.
D
As
miss
rob
has
mentioned
many
families,
while
they're
still
eligible
for
services,
aren't
choosing
to
have
they're,
not
utilizing
the
services
at
the
level
they
were.
We
also
know
that
there
was
a
time
frame,
we
weren't
providing
any
services,
so
that
also
has
impacted
the
cost
for
eligible.
A
D
So
finish
bit
for
the
record,
I
think
there's
a
couple
things
that
go
into
the
projections
we
as
robin
had
alluded
to.
In
many
of
our
cases,
we
used
actuals
for
fy
20.
in
historically
this.
This
budget
account
used
to
use
the
maximum
plan
type.
So
for
each
of
those
plan
types,
we
had
a
maximum
benefit
amount
and
we
had
been
budgeting
at
that
maximum
level,
which
ended
up
kind
of
over
projecting
the
costs
needed
for
this
program.
D
A
Great
thank
you.
Assemble
the
woman
in
roman
reign.
B
Thank
you,
madam
chair,
and
my
questions
on
the
budget
rejections
in
86
80
in
holding
eight
developmental
specialist
positions
vacant.
How
will
that
impact
the.
I
J
Ricky
brad
for
the
record
it
does
impact
the
program
again,
as
I
mentioned
earlier,
is
that
we
have
service
delivery
dollars,
but
we
don't
have
the
staff
to
actually
provide
the
services
and
the
case
management
and
work
directly
with
the
child,
as
well
as
the
family.
I'm
sorry
with
the
fam,
the
child,
as
well
as
the
provider,
to
ensure
that
that
family
and
child
is
receiving
appropriate
services,
and
the
other
piece
for
us,
too,
is
provider
capacity.
As
we
know
that
has
been
a
significant
issue.
C
J
Providers
and
supporting
them
through
the
process,
but
there
still
is
that
provider
capacity
issue,
especially
after
the
pandemic
by
losing
rbts
and
their
ability
to
provide
a
service,
has
has
impacted
the
child.
The
family,
as
well
as
the
providers.
A
C
A
D
I'm
sorry
if
I
so
I
did
provide
one
additional
slide,
because
I'm
on
the
budget
of
office
of
consumer
health
assistance,
I
just
wanted
to
ensure
that
we
address
any
questions
related
to
this
transfer.
D
As
I
observed
in
some
of
the
previous
other
presentations,
many
of
the
members
had
said
they
would
defer
their
questions
to
aging
disabilities.
So
I
just
provided
this
slide
here
as
an
opportunity
to
make
sure
that
any
of
your
questions
were
addressed
in
relation
to
the
office
of
consumer
health
assistance
and
no
matter
2-1-1
transitioning
to
aging
and
disability
services.
A
Thank
you,
ms
schmidt.
I
do
think
that
we
have
had
some
questions
around
that.
So
it's
the
it's.
The
patient
protection
commission
211
office
of
community
health
assistants,
are
the
group
of
programs.
I
guess
is
the
right
way
to
describe
it
that
are
recommended
for
transition
to
create
kind
of
a
division
of
helping
people
navigate.
The
health
care
system
is
that
and
or
the
health
and
human
services
system
is
that
correct?
Is
there
anything
you
want
to
elaborate
on
there
initiative.
D
For
the
record,
that's
exactly
bringing
these
under
one
roof
really
allows
us
to
kind
of
build
on
our
current,
no
wrong
door
efforts
and
build
on
the
collaboration
that
we
have
had
across
the
department.
D
I
know
I
mentioned
our
nevada
cam
project
earlier,
and
I
just
want
people
to
understand
that
when
we
as
we
transition
that
into
our
nevada
care
connection,
we
did
coordinate
with
public
and
behavioral
health,
and
so
individuals
can
come
through
that
wrong
door
and
actually
get
a
referral
over
to
public
and
behavioral
health
as
well.
So
the
efforts
that
we
have
as
a
no
longer
are
not
isolated
to
our
programs.
They
are
intended
to
be
department-wide
and
so
we're
working
continuing
to
work
across
the
department
on
those
types
of
activities,
the
transition.
D
We
have
carrie
embraces
with
us
today,
as
the
governor's
consumer
health
advocate.
She
previously
was
employed
here
at
adsd
as
our
chief
of
the
elder
protected
services.
Now,
adult
protective
services
unit
and
with
her
transition,
we've
identified
so
many
areas
of
crossover
and
ways
that
we
could
support
one
another
between
our
agency
and
the
office
of
consumer
health
assistance.
We
have
cases
where,
having
access
to
our
subject
matter,
experts
and
our
programs
staff
have
really
helped
the
consumer
advocates,
be
able
to
get
people
connected
sooner
and
quicker.
D
The
other
area
is
that
the
director's
office
really
is
an
administrative
office
and
the
office
of
consumer
health
assistance
is
a
direct
service
provider.
You
know
they
provide
a
direct,
hands-on
service
and
they
really
don't
have
the
resources
and
supports
in
that
small
office,
and
so
by
bringing
them
here,
we
really
have
the
ability
to
support
that
team
and
that
amazing,
small
and
mighty
team
with
what
they
do
with
access
to
national
level
information,
technical
assistance,
training
opportunities.
D
A
I
don't
hear
any
all
right.
I
think
we
have
finished
the
budgets
that
we
were
intended
to
get
through
today,
so
go
ahead
and
move
on.
Thank
you
to
the
staff
for
your
time
and
dedication
and
spending
your
time
with
us
today
and
thank
you
again
to
our
team
with
all
the
wonderful
support
that
you
give
us
we're
going
to
go
ahead
and
move
on
to
public
comment
now
eps.
If
you
can
help
us
open
the
public
comment
line,
we'll
limit
folks
to
two.
A
C
C
E
Yes,
my
name
is:
barry
gold,
b-a-r-r-y
last
name
g-o-l-d,
I'm
the
director
of
government
relations
for
aarp
nevada,
and
I
took
a
lot
of
notes.
So
I'm
going
to
start
talking
fast
I'd
like
to
refer
my
comments
to
budget
account
3266.
E
You
guys
asked
some
fabulous
questions
and
I
wanted
to
let
you
know
that
adsd,
when
they're,
proposing
or
thinking
or
making
these
changes,
they
bring
them
to
the
commission
on
aging
first
and
the
commission
on
aging.
I
have
the
pleasure
of
serving
on
that
and
there's
a
couple
of
other
people.
Many
of
you
know
mary
laverati
and
jeff
klein
and
trust
me.
E
We
ask
very
probing
questions
when
they
talk
about
changes
that
they're
going
to
make
to
see
exactly
what
the
impact
is
going
to
be
on
the
community
and
those
families
that
are
going
to
be
affected
by
that.
So
thank
you
for
also
asking
some
of
those
questions.
I'd
like
to
focus
on
the
waivers
for
a
bit.
E
I
know
that
you
all
know
what
those
hcbs
waivers
are:
the
frail
elderly
and
the
disability
waiver-
and
we
heard
last
week
in
the
medicaid
budget
about
increasing
the
funding
for
slots,
the
number
of
people
that
can
get
that
and
that's
really
important,
because
it's
it's
good
to
know
that
we're
thinking
about
not
just
funding
the
increase
in
caseload,
but
also
the
waiting
list
and
getting
rid
of
those
waiting
lists,
because
it's
important
to
know
that
anyone
who
is
on
the
waiting
list
who's
eligible
for
these
waiver
slots
is
nursing
home
level
of
care.
E
E
The
commission
on
aging
has
a
standing
agenda
item
to
know
about
those
waiting
lists
and
where
we
stand
and
the
report
that
I
asked
for
said
that
approximately
200
people
who
dropped
off
the
waiting
list
either
died
or
went
into
nursing
homes
and
that's
just
a
terrible
thing
for
so
many
reasons.
So
if
we
could
fund
those
waiting
lists,
we
can
really
make
a
difference
in
what's
going
on.
I
want
to
talk
about
the
long-term
care
ombudsman
a
little
bit.
I'm
glad
that
you
mentioned
that
aerp
had
a
really
strong
concern
about.
E
What's
going
on
in
nursing
homes
and
the
ombudsman
program,
aarp
sent
two
letters
to
the
governor
and
to
the
director
of
health
and
human
services
director
whitley
about
early
in
the
pandemic,
about
testing
ppe
staffings
virtual
visitation,
and
that
was
really
important
and
some
things
happened.
I
know
that
a
million
pieces
of
ppe
got
delivered
by
the
national
guard
to
nursing
homes
and
long-term
care
facilities.
We
sent
a
letter
later
about
the
ombudsman
being
able
to
re-enter
the
facility
safely
and
to
start
doing
plans.
E
Some
states
had
started
doing
planning
for
that
and
we
really
wanted
nevada
to
be
one
of
those
who
did
that.
I'd
really
like
to
thank
majority
leader,
benitez
thompson,
who
talked
about
having
eyes
and
ears
in
the
facility.
I
think
that
quote
came
straight
from
our
letter
as
well
saying
that
it's
so
important
that
they
begin
to
in
there
and
not
long
after
that.
I
was
glad
to
see
a
public
announcement
saying
that
the
ombudsman
would
be
entering
the
facilities
and
seeing
what
was
going
on
in
there.
E
What
I
will
tell
you
was
nevada
has
done
much
better
than
other
states
in
terms
of
what's
going
on,
I'm
in
some
states,
more
than
40
percent
of
the
total
number
of
state
deaths
for
code
19
have
been
in
nursing
homes,
we're
doing
much
better,
it's
more
somewhere
around
20
21,
depending
on
which
week
you've
looked
at.
So
that's
a
good
thing
to
just
kind
of
mention,
and
I
just
wanted
to
kind
of
talk
about
that
a
little
bit
and
I
think
we're
in
the
right
direction.
E
Looking
for
where
we
can
be
moving
forward,
I
think
it's
important
for
those
waiting
lists.
I
know
that
majority
floor
leader,
benitez
thompson
talked
about
having
the
adequate
staffing
to
fill
them,
not
just
funding
the
slots,
and
that's
really
so
important
and
those
staffing
positions
come
from
the
adsd
budget,
so
it's
important
that
they're
hand
and
glove
and
they
fit
together,
and
the
last
thing
I
want
to
mention
is
majority
floor
leader
benitez
thompson
in
terms
of
hcbs
services.
You
really
get
it.
E
You
really
understand
how
these
services
provide
services
on
the
people
really
need
and
keep
them
living
independently,
and
the
only
thing
I
might
add
to
that
is
at
some
point
in
time
in
the
future.
After
your
legislative
career,
you
might
want
to
consider
being
a
volunteer
and
advocating
with
aarp
on
these
hcbs
slots.
Thank
you
very
much
for
the
time.
C
C
They
provided
physical
therapy
and
in-home
services
and
because
I'm
disabled
myself
and
cannot
drive
that
was
imperative
for
the
care
and
development
of
my
daughter
that
suffered
many
fractures
in
her
first
six
months
of
life,
we
had
issues
with
speeding
as
well
that
they
helped
with,
and
at
that
time
the
funding
was
already
scarce.
With
this
particular
agency
and
being
a
disabled
consumer
myself,
I
know
how
imperative
funding
is.
C
I've
also
done
human
resources
for
agencies
that
rely
on
funding
like
this
to
hire
their
employees
and
any
type
of
budget
cut
when
something
is
already
horribly.
Underfunded
is
detrimental,
and
this
time
it's
affecting
not
only
the
disabled
consumers,
but
children
that
are
already
born
with
a
disadvantage
in
life
and
have
capabilities.
C
I
know
myself
because
I
was
a
disabled
child
of
thriving
and
living
as
a
productive
adult
in
society,
but
they
need
the
support
from
their
community
and
I
am
begging
you
guys.
Please
consider
how
important
this
is
for
children
with
special
needs
and
the
resources
and
the
parents
that
are
at
a
loss
to
help
their
children.
They
don't
know
and
I'm
disabled
myself,
so
even
with
the
disability.
D
C
A
C
C
C
I
think
we
have
several
meetings
scheduled
with
with
with
a
bunch
of
members
on
next
tuesday,
which
is
alzheimer's
awareness
day
at
the
legislature,
and
we
look
forward
to
continuing
to
work
with
you
all
on
these
programs.
Thank
you.
C
C
Management
group
and
we
provide
early
intervention
services
to
children
birth
to
three
years
of
age.
Statewide,
I'm
also
the
president
of
early
intervention,
community
providers
association,
which
is
the
trade
organization
that
represents
the
majority
of
early
intervention
community
providers.
We
felt
it
important
to
express
our
sincere
concern
about
the
12
rate
reduction
in
the
governor's
executive
budget
from
565
per
child
per
month
to
500
per
child
per
month.
C
We'd
also
like
to
call
your
attention
to
the
possible
continuation
of
the
fixed
50-50
rule
that
has
a
state
providing
50
percent
of
the
services
to
children
and
families
in
need.
Community
partners
see
the
other
50
of
the
children,
but
on
approximately
25
percent
of
the
total
early
intervention
budget
and
for
an
executive
audit,
it
cost
community
partners,
30
percent,
less
to
provide
early
intervention
services
than
it
costs
nevada,
early
intervention
services,
which
is
the
state
ci
program
to
provide
the
same
services.
C
Some
of
the
history
that
got
us
here
in
2005,
through
2011
restrictions
and
legal
actions,
were
taken
against
the
state
due
to
high
wait
lists
for
services
and
non-compliance
with
individuals
with
disabilities.
Education
act,
the
public-private
partnership
service
delivery
model
was
created
as
a
solution
and
resulted
in
elimination
of
the
waitlist
in
compliance
with
ida.
C
For
the
first
time,
a
rate
decrease
of
500
dollars
per
child
per
month
would
result
in
a
de
facto
service
delivery
model
change,
state
community
partners,
possibly
going
out
of
business
and
potentially
open
the
state
up
to
legal
action,
with
the
return
of
wait
list
and
non-compliance
with
federal
mandate,
some
solutions.
In
conclusion,
tennis
funds
could
be
used
to
eliminate
the
cut
over
the
biennium
as
the
economy
continues
to
recover.
And
if
flexibility
in
the
50
50
split
was
increased
to
60,
40
or
70
30.,
we
could
ensure
parent
choice.
C
A
C
C
C
C
Good
morning,
chair
ready
and
sub-committee
members,
I'm
representing
snap,
this
native
nevada
association
of
providers,
we're
wanting
to
express
our
support
for
the
adfd
budget
items
being
considered
today.
Nat
members
partner
with
the
state
to
provide
adults
with
intellectual
disabilities
services
to
meet
their
housing,
transportation,
medical,
social
and
employment
related
needs.
C
C
I
C
C
C
I
C-O-N-N-I-E-M-C-M-U-L-L-E-N,
thank
you
for
allowing
me
to
partake
in
this
testimony.
Thank
you,
madam
chair,
and
thank
you
committee
members,
great
testimony.
A
lot
of
you
have
so
much
skill
and
knowledge
from
previous
sessions
and
really
have
done
your
due
diligence
in
serving
the
people
of
our
state.
I'm
just
calling
to
lend
my
support
to
the
adsd
budget,
I'm
particularly
interested
in
three
two:
six,
six,
that
budget
item
home
and
community
base
waivers
and
including
the
homemaker
and
the
co
budget.
I
I
understand
why
there
is
a
limited
amount
of
slots
when
the
need
is
so
high,
and
I
caution,
though,
coming
up
and
going
forward
with
the
pandemic.
Stabilizing
seniors
and
people
with
disabilities
will
be
wanting
to
engage
in
life
again.
Personal
care
in
all
levels,
including
children,
will
be
needed
and
the
caseload
will
restore
itself
and
that
wait
list
will
grow.
So
my
concern
is
with
the
policy
decisions
that
were
made
in
ab3.
I
I
understand
why
they
were
made,
and
I
understand
the
efforts
you
took
to
stabilize
the
state
and
thank
you
very
much,
but
the
rates
are
have
been
a
constant
problem.
They
are
just
too
low,
and
now
the
reduction
in
services
is
a
huge
frustration
for
people
and
for
the
industry
itself
so
rather
than
cut.
I
really
think
that
we
should
maybe
revisit
some
of
these
services.
Maybe
we
can
make
them
more
efficient
and
to
better
serve
the
people
rather
than
just
doing
away
with
them.
I
Nobody
wants
to
go
to
a
nursing,
home
and
they're
the
capacity
for
the
state
of
50
57
58,
there's
not
that
many
places
for
people
and
beds
anyway
in
a
nursing,
home
and
people
would
rather
die
in
many
cases
no
offense
to
the
nursing
home,
but
they'd
rather
die
in
their
homes,
sometimes
than
to
go
there.
So
your
ideas
about
the
small
group
homes
is
great.
I
My
mother,
when
she
was
not
acute
anymore,
was
asked
to
leave
a
skilled
nursing
facility
in
california
and
did
go
to
a
small
group,
a
home
where
she
eventually
died
on
hospice,
and
I
just
want
you
to
know
that
the
one-on-one
was
great.
I
It
was
more
affordable
and
she
got
better
care
and
the
family
was
allowed
to
be
in
there
on
an
easier
basis.
So,
thank
you
very
much
for
all
you
do
for
the
state
and
thank
you
for
allowing
me
to
testify
on
behalf
of
the
personal
care
association
of
nevada.
Thank
you.
C
G
G
She
was
she's
two
and
a
half
which
is
she's
currently
in
the
nevada
early
intervention
program,
and
I
wanted
to
show
my
support
for
a
non-budget
cut
of
three
two
zero
six.
I
believe
it
is
or
three
two
zero
eight,
particularly
I'm
focusing
on
the
intact
program,
as
my
daughter
has
to
have
ada,
which
is
calculated
at
an
average
rate
of
120
per
hour.
The
account
comes
to
being
187
thousand
five
hundred
dollars
for
a
non-insured
person.
G
She
was
returned
to
her
neis
through
a
pediatrician
who
harvey
refers
anybody
to
neis
but
she's,
unable
to
speak
she's
unable
to
adequately
communicate
the
needs
that
she
has
to
have,
such
as
when
she
goes
that
she
hands
me
a
sippy
cup.
If
she
wants
something
to
drink,
she
can't
say
cup,
she
can't
say
mom.
She
can't
say
dad.
G
These
neis
programs
and
abas
are
crucial
to
the
development
of
the
future
of
nevada,
where
we
yes,
as
a
certain
time
frame
with
the
covet
situation,
we
are
declined.
We
have
had
no
in-home
services
which,
as
an
in-home
service,
I
understand
that
the
cost
will
increase
versus
a
virtual
thing,
but
the
virtual,
via
zoom
would
not
does
not
benefit
her
as
well,
because
she
can't
focus
enough
on
a
monitor
versus
direct
interaction.
G
Now
the
aba
we've
been
approved
for
30
hours
a
week,
30
hours
a
week,
is
cupping
intensive
for
anybody
to
do
anything
even
for
a
lot
of
people
with
employment
who
are
actually
in
the
normal
normal
mind
capacity.
G
G
Now
people
don't
tend
to
use
the
resources
like
they
should
because
they're
they're
likely
and
they're
they're
not
informed
they're,
not
people
with
a
heavy
case
load
the
the
agent,
the
representatives,
the
specialists
tend
to
basically
push
on
to
the
people
who
actually
seek
his
resources
and
determine
that.
But
I
believe
that
with
the
current
funding
or
the
12
loss
in
these
funding
will
help
appreciate
that
communication
basis
to
the
community
in
which
we've
seen
an
increase
in
autistic
children
from
over
the
years
now.
G
Currently,
if
I
read
my
numbers
correctly,
it's
one
out
of
54
kids
in
the
state
of
nevada
have
autism
that's
a
high
rate
for
a
population
that
has
that
about
four
million
people.
That's
a
big
rate.
I
mean
you
think
of
thinking
about
it.
That's
like
one
at
least
one
million
people,
kids
now
to
give
my
child
a
future
who's
very
gifted
in
music.
G
G
It's
not
just
my
daughter,
it's
not
just
the
disabled
woman
that
a
woman
with
a
disability
that
you
just
heard
these
are
challenges
that
face
day-to-day
children
and
the
future
of
nevada
to
catch
up
the
future.
We
have
focusing
on
the
present
the
president
states
that,
with
the
loss
of
reduction,
we
hurt
our
community.
G
We
hurt
the
long-term
process,
because
then
we
have
to
recuperate
those
funds
to
be
able
to
assist
them
in
the
future.
Why
not?
Why
not
assist
it
now
versus
later?
I
appreciate
the
time
you
allowed
me
to
talk
and
thank
you
for
everybody
once
again,
thank
you
for
for
everybody,
for
at
least
listening
to
the
testimonies
and
hearing
that
validity
of
the
concern
of
your
community
and
the
resource
providers.
Thank
you
very
much.
C
C
Committee,
members
and
chair
this
is
deacon
tom
roberts
president
and
ceo
of
catholic
charities
of
southern
nevada.
Thank
you
for
allowing
me
to
visit
with
you
this
morning
for
a
few
minutes.
First,
let
me
thank
the
committee
for
the
support
for
nevada
seniors
for
for
so
many
years,
especially
something
when
carlton.
G
C
C
C
2188
of
those
are
funded
through
the
adsd
funding
model,
partially,
thank
god
through
the
donations.
C
G
C
C
C
When
our
son,
britain
was
six
months
old,
he
endured
a
tragic
accident
in
which
he
accidentally
suffocated
under
a
pillow
due
to
the
cropping
of
pillows
around
our
bed
during
an
impromptu
nap
time
in
which
we
didn't
want
to
move
him
to
his
crib.
But
we
also
didn't
want
him
to
roll
off
the
bed
prior
to
this
time
he
was
developing
completely
normally
and
was
a
very
healthy
child
as
a
result
of
losing
oxygen
to
his
brain.
While
my
husband
was
in
the
shower,
our
lives
have
completely
changed
at
the
time.
C
I
was
in
shock
thinking
that
britain
would
come
home
from
the
hospital
totally
fine.
I
learned
during
the
months
that
we
would
spend
in
our
local
hospital
and
even
at
a
children's
hospital
out
of
state
that
this
was
not
the
case.
I
had
no
preparation
and
no
experience
with
what
our
new
normal
would
look
like
advanced
pediatrics.
Earlier
intervention
services
have
been
a
godsend.
Britain
receives
many
types
of
therapy
to
help
us
learn
how
to
take
care
of
him.
C
The
very
best
we
can
and
improve
his
quality
of
life
therapy
is
almost
a
daily
occurrence,
giving
us
the
guidance
that
we
need
to
help
him
long
term.
Britain
was
diagnosed
with
quadriplegic,
cerebral
palsy,
meaning
all
four
of
his
lens
and
his
head
control
are
affected.
He
also
has
a
cortical
vision
impairment,
which
makes
it
difficult
for
him
to
focus
visually.
C
With
the
help
of
these
incredible
humans,
we
are
able
to
learn
how
to
help
ourselves
do
everyday
activities
with
our
son,
such
as
spoon,
feeding,
brushing
teeth,
learning
how
to
track
objects
with
his
eyes
making
sounds
playing
with
developmentally
appropriate
toys
movement
in
his
joints
and,
ultimately
enjoying
his
life.
As
we
work
show
their
goals,
we
pray
will
come
as
we
continue
to
put
forth
the
effort.
C
Again,
I
make
note
of
the
simple
things
which
are
unsafe
to
be
learning
all
on
our
own,
like
eating
and
brushing
teeth,
which
could
be
a
choking
hazard
or
exercising
his
arms
and
legs,
which
we
have
learned
from
experience,
can
be
broken
easily
as
a
result
of
brittle
less
dense
bones
due
to
lack
of
independent
movement.
I
don't
know
where
we
would
be
without
advanced
pediatrics.
C
We
never
expected
our
lives
to
take
this
turn.
They
have
been
here
for
us
every
step
of
the
way
since
britain's
accident,
and
I
know
they
are
there
for
many
families,
all
across
northern
nevada,
helping
them
get
on
their
feet,
figuratively
and
literally,
and
giving
them
the
confidence
to
move
forward
every
day
on
their
individual.
C
Britain
cannot
do
the
things
we
once
thought
he
would
do,
but
is
with
the
help
of
earlier
intervention
services
that
we
are
hopeful.
He
will
eventually
learn
these
extraordinary
skills
that
the
rest
of
us
often
take
for
granted
like
seeing
eating,
playing
and
walking.
Thank
you
for
taking
the
time
to
listen.
I
hope
you
will
give
these
services
the
chance
they
deserve.
A
C
A
Okay,
well
again,
my
gratitude
to
everybody
on
this
committee
and
the
team
at
disability
services
for
your
time
today.
I
did
just
want
to
take
a
moment.
I
know
we
had
a
significant
milestone
with
five
thousand
deaths
from.
C
A
Over
earlier
this
week,
and
I
appreciate
gary
gold
reminding
us
that
there
was
some
really
good
work
done
in
the
state
of
nevada
to
make
sure
that
the
mortality
rate
in
our
care
facilities
was
lower
than
the
national
average
and
well.