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From YouTube: 3/16/2021 - Assembly Ways and Means and Senate Finance, Subcommittees on Human Services
Description
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A
A
Thank
you-
and
I
am
here,
would
you
please
mark
assemblyman,
speaker,
fryerson,
absent,
excused,
I'd
like
to
welcome
everyone
to
today's
meeting?
Today
we
will
be
hearing
six
budgets
from
the
department
of
public
and
behavioral
health,
but
before
we
get
started
just
a
short
overview,
the
building
remains
closed
and
everything
will
be
conducted
virtually
for
the
members
on
the
committee.
If
you
would
keep
your
cameras
on
and
all
your
electronic
devices
silence,
it
helps
with
the
background
noise
and
for
the
community.
A
That's
watching
you
will
be
able
to
get
public
comment
at
the
end
of
today's
meeting,
so
without
further
delay.
I
will
invite
administrator
sheriff
to
the
virtual
committee
room
and
you
can
start
with
your
presentations.
A
C
Good
morning
my
name
is
lisa
sharik
administrator
for
the
division
of
public
and
behavioral
health.
Here
with
me
today
is
joe
malay,
deputy
administrator
for
clinical
services
to
my
left,
debbie
reynolds,
deputy
administrator
for
administrative
services
directly
behind
me,
and
also
here
with
me
today-
is
dr
stephanie
woodard,
our
dhhs
senior
behavioral
health
advisor
behind
me
to
the
left
and
as
well.
We
have
dr
elizabeth
neighbors
who's
joining
us
via
zoom,
who
is
our
statewide
forensic
director
slide.
C
Slide
five
and
six
provides
a
snapshot
of
the
division's
requested
funding
for
fy,
2223
and
biennium
account
summary
for
the
behavioral
behavioral
health
budgets
we
will
be
covering
today
highlighted
in
green
slide.
7
provides
an
overview
of
covid19
funding
received
in
our
behavioral
health
budget
accounts
totaling
over
38.6
million
and
slide
8
provides
an
overview
of
this
funding.
Broken
down
by
the
federal
authorization
act
specific
to
slide.
Seven.
C
I
do
credit
the
bureau
of
behavioral
health
prevention
and
wellness,
along
with
our
fiscal
hr
and
contract
unit
staff,
for
ensuring
we
were
able
to
stand
up
these
crucial
programs
within
very
tight
deadlines.
We
also
received
just
over
533
thousand
dollars.
In
cares
act,
provider
really
funds,
because
scams
and
nams
are
cms
certified
psychiatric
hospitals.
C
I
just
want
to
start
by
explaining
that
our
agency
requested
budget
included
general
fund
reductions
of
31
million
dollars
over
the
biennium.
We
are
sincerely
sincerely
grateful
that
many
of
these
reductions
were
added
back
by
the
governor.
However,
there
are
still
some
reductions
that
remain
and
will
have
an
impact.
We
try
to
limit
the
impact
of
the
reductions
to
the
direct
services
provided
by
dbph
and
to
our
staff,
who
provide
these
services.
C
It's
also
important
to
note
that
we
transfer
a
significant
amount
of
cat
category
1
vacancy
savings
each
year
to
cover
contract
positions
and
category
8
professional
services
and
category
9,
which
is
our
mental
health
technician
services.
So
it's
important
to
maintain
an
adequate
level
of
vacancy
savings,
particularly
at
snams
and
namms,
and
lakes
crossing.
As
these
categories
are
reliant
on
vacancy
savings
to
fund
direct
services
provided
by
contract
positions,
slide
9
provides
an
overview
of
behavioral
health
administration
budget
account
3168.
C
This
budget
account
supports
the
behavioral
health
budget
accounts.
We
will
be
reviewing
today
and
also
provide
support
to
the
commission
on
behavioral
health
and
funds,
the
central
billing
unit
and
the
nevada
psychology
interim
consortium,
otherwise
known
as
nvpic
nbpic,
was
created
to
offer
quality
training
to
clinical
psychology.
C
Since
its
inception,
in
august,
2015
envy
pick
has
had
17
students
of
those
nine
state
of
nevada
and
seven
were
hired
by
the
state.
Currently,
four
are
employed
by
the
state
moving
to
slide
10,
we
are
requesting
a
cost
allocation
redistribution
to
remove
general
fund
in
the
administrative
accounts
and
fund
the
full
cost
allocation
into
the
behavioral
health
accounts.
C
C
Specifically,
the
joint
money
committees
directed
us
to
review
our
cost
allocation
charges
and
consider,
including
the
division-wide
administrative
costs
proportional
to
the
services
provided
to
the
behavioral
health
budgets
by
removing
the
general
fund
in
the
administrative
accounts
and
instead
budgeting
the
general
fund
in
the
behavioral
health
accounts
in
transferring
those
transferring
through
the
cost
allocation.
It
allows
the
division-wide
administrative
costs
to
be
proportionally
budgeted
based
on
the
actual
administrative
oversight
and
support
provided
to
the
behavioral
health
budgets,
as
requested
by
the
legislature
in
the
letter
of
intent.
C
D
And
thank
you
very
much,
madam
chair.
So
I
guess
if
you
could
just
expand
a
little
bit
upon
the
statewide
allocation,
the
swag
cap,
whatever
acronym
we
want
to
use
for
that.
What
the
thought
process
behind
that
is,
I
think
you're
trying
to
get
more
transparency.
D
If
I
understand
the
proposal
correctly
and
it
will
will
address
the
services
that
you
provide
across
all
the
different
budget
accounts.
So
could
you
just
expand
on
that
a
little
bit
please
and
then
I
have
a
question
about
the
psychology
interns.
E
The
intent
is
to
ensure
that
the
administrative
support
that's
provided
to
the
behavioral
health
accounts
is
appropriately
budgeted
in
their
accounts
and
then
transferred
to
the
administrative
accounts.
To
give
you
a
little
bit
of
an
example
in
fy
20,
there
was
528
000
budgeted
in
both
the
both
administrative
accounts.
3168
and
3223
actual
collected
amount
was
286
000..
So
this
is
the
amount
that
was
budgeted
based
on
a
percentage
of
medicaid
revenue
to
the
overall
revenue
in
the
budget,
but
it
wasn't
based
on
the
actual
administrative
support
provided
to
those
budgets.
E
D
Yes,
it
does,
it
makes
it
a
bit
clearer
for
those
that
don't
understand
how
how
we
do
the
cost
allocation
program
so
and-
and
it
does
allow
us
to
track-
and
it
gives
you
hard
numbers
moving
forward
in
order
to
make
able
to
make
the
correct
ask
for
funding
in
future
biennium.
So
I
I
appreciate
you
moving
towards
that,
and
this
will
be
totally
cost
neutral.
So
it's
not
like
there's
going
to
be
a
cut
involved.
It's
just
a
matter
of
how
the
the
dollars
are
apportioned
out
on
the
psychology
internship.
D
C
Lisa
for
the
record,
so
I
think
with
having
17
students
being
able
to
go
through
the
program
and
doing
quick,
math
16
of
them
actually
staying
in
nevada.
I
do
believe
it
is
a
successful
program.
C
D
C
Lisa
sharik
for
the
record
slide.
11
provides
an
overview
of
problem.
Gambling
budget
account
3200.
in
2005.
The
nevada
state
legislator
legislature
passed
senate
bill
357
to
create
the
revolving
account
for
the
prevention
and
treatment
of
problem
gambling
and
an
advisory
committee
on
problem
gambling
to
advise
the
department
of
health
and
human
services
in
its
administration.
Of
this
account,
the
2019
legislature
did
not
approve
the
governor's
recommendation
to
change
the
primary
funding
source
for
this
budget
from
quarterly
slot
tax
revenue
to
gaming
percentage
fee
revenue
imposed
by
nrs
463.370.
C
Slide
12
this
budget
is
a
is
100
percent
funded
with
state
general
fund
e686
due
to
required
budget
reductions.
This
decision
unit
reduces
problem
gambling
services
by
176
000
each
year
of
the
biennium.
The
advisory
council
and
problem
gambling
will
determine
how
to
allocate
the
budget
once
finalized
e-902
transfers.
One
social
services,
specialist
fte
from
budget
account
3170
to
better
align
duties
of
the
position.
C
C
B
Thank
you
so
much
madam
chair,
and
thank
you
for
the
presentation
I
know
this
is.
This
was
also
something
that
we
were
discussing
quite
a
bit
during
the
special
session.
I
was
just
wondering
if
you
could
give
us
a
little
bit
more
background
on
the
program
itself,
especially
over
the
last
biennium.
How
many
people
did
the
agency
support
in
getting
treatment
and
how
did
the
pandemic
impact
the
activities
under
this
program.
C
Hi
lisa
sharik
for
the
record
in
fy
20,
there
were
436
treatment,
clients
and
so
far
in
fy
21
there's
been
177
treatment,
clients.
It
appears
that
the
average
cost
per
client
is
about
2
775
dollars
and
there
is
about
only
11
of
the
clients
are
approved
for
medicaid.
C
As
far
as
covid
the
covet
impact
during
fy
20,
all
funds
were
allocated
to
be
spent
on
track
for
were
allocated
to
be
spent
and
on
track
for
complete
spending,
but
due
to
cova
19
and
the
state
mandated
restriction,
the
subrecipients
were
not
able
to
spend
all
the
funds.
This
is
due
to
the
governor's
required
lockdowns
social
distancing
restrictions
and
then
budget
restrictions
gambling
treatment
providers
had
in
regards
to
the
decrease
in
services.
C
B
Thank
you.
No,
I
think
that
was
that
was
sufficient.
That
leads
me
to
a
second
question,
so
with
the
impact
that
the
pandemic
had
on
treatment
services,
was
there
any
shift
to
prevention
and
research
activities
over
the
last
year
or
so.
G
Good
morning,
stephanie
woodard
for
the
record
there's
consistent
oversight
over
the
spending,
that's
happening
with
all
of
the
providers
and
other
contracted
programs
such
as
prevention
and
research,
and
so
the
committee
is
actually
actively
reviewing
if
there
needs
to
be
a
reallocation
to
prevention
and
research
services
for
the
remainder
of
this
year.
G
Correct
there's
been
quite
a
bit
of
conversation.
What
we're
seeing
is
that,
because
of
covid,
we
had
fewer
admissions
into
treatment.
However,
the
admissions
for
treatment
are
beginning
to
pick
up,
and
so
we
want
to
make
sure
that
we
allocate
appropriately
and
don't
undercut
the
necessary
funding
in
order
to
be
able
to
support
the
increased
demand
for
the
remainder
of
the
year.
B
Thank
you.
I
appreciate
that.
I
understand
with
things
starting
to
open
back
up,
we
are
likely
to
see
an
increase
in
in
the
need
for
treatment.
I
just
have
one
last
question
and
I
was
just
wondering
if
you
know
you
you
described
in
in
dollar
amounts
the
proposed
budget
reductions.
Can
you
describe
the
and-
and
I
know
that
you
said
that
the
allocations
to
the
the
recipients
will
still
have
to
be
made
afterward,
but
can
you
give
any
estimate
of
the
effects
that
these
program
reductions
would
have
on
our
problem?
C
Lisa
sherick
for
the
record.
If
the
total
176
thousand
dollars
each
year
are
reduced,
each
year
went
directly
as
a
reduction
to
treatment
services.
C
C
This
budget
account
is
accountable
for
developing
community
infrastructure,
such
as
applying
for
eligible
grants,
grants
management,
statewide
leadership
and
strategic
planning.
This
budget
account
also
includes
integrated
mental
health
substance
abuse
and
co-occurring
disorders,
including
the
development
and
submission
of
the
biannual
joint
mental
health
substance.
Abuse
block
grant.
C
Slide
14:
this
budget
is
primarily
funded
with
federal
funds,
as
well
as
general
fund,
which
is
used
to
match
the
federal
block
grants
and
other
revenue
which
includes
transfer
revenue
and
certification
fees,
e-225
requests
to
convert
four
positions
into
ftes,
including
three
health
program,
specialist
ones
and
one
administrative
assistant.
Three,
this
request
transfers
one
psychologist
position
from
rural
clinics
budget
account
3648
to
better
align
duties
of
the
position.
C
C
H
Thank
you
so
much
so
before
I
get
into
kind
of
more
specifics
of
3170,
I
had
a
question
more
about
the
32.7
million
of
federal
dollars
that
came
through.
So
I
don't.
I
don't
see
any
of
that
money
landing
landing
in
some
of
the
specific
programs
that
that
we
have
was
all
of
that
granted
out
to
outside
agencies.
E
Just
to
clarify
24
million
of
the
32
million
that's
listed
was
just
received
in
grant
awards
last
week
and
we
will
be
submitting
work
programs
to
request
authority
to
spend
those
dollars,
so
those
additional
funds
have
not
actually
been
allocated
out
to
the
community.
Yet
as
far
as
the
existing
eight
million
dollars,
those
funds
have
been
obligated,
and
I
will
turn
it
over
to
dr
witter
to
elaborate
on
that.
G
So
aside
from
the
stephanie
woodard
for
the
record,
aside
from
the
additional
dollars
that
we
just
received
last
week
and
all
of
those
dollars
have
been
obligated
and
have
been
sub-awarded
out
to
the
communities,
we
continue
to
evaluate
what
the
needs
are,
because
the
situations
related
to
behavioral
health
treatment
and
needs
in
our
communities
continues
to
unfold.
So
we
look
forward
to
pushing
out
competitive
rfas
to
ensure
that
we
are
addressing
all
of
those
needs
with
the
new
federal
funds
that
we
just
received.
H
H
I
guess,
because
I
look
at
some
of
the
budgets
we
have
here
and
I
look
at
some
of
the
decisions
we're
gonna
have
to
make
in
position
eliminations
and
different
things
like
that,
but
he
sees
some
some
pots
of
money
that
that
typically,
you
would
think
are
starving
for
dollars,
so
the
suicide
prevention
lifeline
all
of
our
suicide
prevention
programs,
where
there's
proposal
to
move
the
office
around
in
one
of
these
in
I
think
in
this
budget,
specifically
yeah
in
in
this
budget.
H
Specifically,
we've
got
you
know
early
diversion
programs
and
and
different
things
in
here,
so
I
guess
about
8
million
what
what
pieces
of
those
8
million
landed
in
nevada,
state
kind
of
supported
programs
versus
going
out
for
competitive.
G
Bid
so
stephanie
woodard
for
the
record.
All
of
those
funds
actually
went
out
to
the
community
to
specifically
address
the
needs
related
to
behavioral
health
and
covid.
What
we
have
done
is
funded
hospitals
to
help
to
relieve
some
of
the
backlog
that
we
were
seeing
in
emergency
rooms,
especially
with
covid
and
the
medical
surge.
We
knew
that
we
needed
to
move
very
quickly
to
help
to
move
individuals
who
needed
higher
levels
of
care
out
of
emergency
rooms
and
into
inpatient
treatment.
G
We
were
also
required
to
do
some
set-aside
funding,
so
ten
percent
of
the
covid
funds,
covidir
funds
were
required
to
go
towards
healthcare
providers
and
that
was
allocated
to
unlv
to
establish
a
warm
line
for
healthcare
providers,
as
well
as
some
cme
classes
for
supporting
wellness
and
then
dcfs
actually
has
received
some
funds
to
support
the
expansion
of
children's
mobile
crisis,
specifically
to
expand
access.
24
7
statewide.
H
H
I
don't
want
to
ask
anyone
to
do
more
work,
but
if,
if
we
could
just
get
that
rundown
or
if
you
want
to
point
me
to
where
it
already
is,
if
we
already
asked
in
a
previous
ifc
meeting
or
when
we
were
approving
these
funds,
I
can
go
back
to
those
work
documents
on
that.
H
I
just
wanted
kind
of
to
make
sure
that
I
understood
where
all
of
that
went
and
then
it
sounds
like
we'll
be
hearing
from
you
about
where
the
additional
24
million
that
we
got
notice
of
will
will
go
to.
I
would
just
make
the
plea
that
some
of
the
state
programs
and
offices
that
we've
stood
up
once
again,
you
know
I.
I
think
that
the
competitive
grant
programs
are
good,
but
I
also
want
to
balance
it
with
seeing
some
of
our
own
ftes,
who
do
this
great
work?
G
And
stephanie
woodard
for
the
record.
Yes,
we
will
follow
up
with
additional
information.
I
also
want
to
reiterate
that
some
of
these
funds
went
to
standing
up
our
crisis,
counseling
assistance
and
training
program
that
was
done
through
a
number
of
contract
positions
that
the
state
ended
up,
hiring
to
be
able
to
provide
specifically
two
communities.
G
It
was
the
fastest
way
that
we
were
able
to
stand
up
that
program,
and
so,
instead
of
doing
a
competitive
bid
for
that
program,
we
did
actually
directly
fund
those
positions
and
then
allocated
across
communities,
and
we
have
been
working
very
closely
with
the
office
of
suicide
prevention
so
when
and
where
some
of
those
funds
have
been
available
to
support
suicide
prevention
activities
and
trainings,
as
well
as
further
support
for
the
crisis
line.
H
Could
you
remember
the
four
I
think?
Did
you
say
the
four
contract
positions
that
are
going
to
three
full-time
health
programs?
Specialists
are
those
those
positions
that
you
mentioned.
G
C
G
Those
are
positions
that
have
been
supporting
other
grants,
including
our
block
grants
and,
as
you
know,
block
grant
allocations
come
in
annually.
We
have
had
some
difficulty
filling
those
contract
positions
and
maintaining
the
expertise
that
we
develop
in
those
positions
as
they
leave
for
other
positions.
So
we're
hoping
that
being
able
to
convert
those
positions
to
fte
will
help
us
actually
recruit
and
retain
qualified
individuals
and
really
help
them
move
forward
in
the
progress
of
developing
that
expertise
and
maintaining
them
in
our
positions.
H
No,
no,
I
don't
think
so.
I
just
wanted
to
make
sure
that
I
was
thinking
of
the
right
positions.
We
talk
about
so
many
positions
and
so
many
budgets.
So
I
think
I
might
have
been
thinking
of
a
different
set
of
positions,
but
I've
asked
the
staff
to
help
clarify
to
make
sure
I'm
thinking
of
all
of
the
different
funding
sources
for
the
different
positions.
We're
talking
about.
I
Thank
you,
madam
chair.
I
have
a
question
regarding
the
the
transferring
of
the
psychologist
from
the
rural
clinics
and
moving
that
position
over
we've
heard
that
you
have
difficulty
finding
positions.
You've
testified
on
the
concerns
about
mental
health,
especially
with
this
covid
pandemic,
and
on
the
difficulty
of
finding
providers
in
rural
areas,
and
I'm
just
concerned
that
we're
moving
that
position
out
as
opposed
to
just
creating
a
new
position
and
keeping
the
rural
psychologist
in
that
same
position.
Can
you
give
me
the
what
the
thoughts
were
behind
that
particular
decision
unit.
C
Lisa
sherick
for
the
record,
so
that
position
has
been
working
with
rural
clinics
but
more
in
regards
to
the
statewide
disaster
behavioral
health
plan.
That
is
really
needed.
C
F
God,
sorry,
jim
lay
for
the
record
just
to
clarify
that
psychologist
has
been
hard
to
fill
in
the
rules.
Currently,
it's
with
the
position
that
is
in
an
urban
area
and
and
helping
with
that
with
the
program.
F
However,
there
it
does
have
a
slight
impact
on
our
services
and
rural
health
and
that
the
psychological
testing
of
individuals
in
rural
clinics
will
be
delayed
a
little
bit
longer.
Currently,
we
already
have
about
a
two-month
waiting
list
for
those
psyc
testing,
so
we
expect
that
to
increase
about
three
to
four
months.
C
And
lisa
sherick
for
the
record.
My
thought
came
back
to
me
just
based
on
the
economic
situation
that
we've
been
facing
this
past
year.
It
didn't
seem
to
be
in
the
best
interest
to
request
an
additional
position
that
would
be
general
funded.
I
Okay,
I
do
have
some
concerns
in
the
last,
but
on
the
next
budget
we
have,
I
have
even
greater
concerns
and
then
to
see
this
one
also
when
we
know
it's
hard
to
fill
and
what
I
heard,
I
think
I
heard
you
say
is
the
position
now
currently
being
filled
by
somebody
in
an
urban
area.
That's
been
doing
some
assistance.
You
already
have
a
two
months
waiting
list.
This
is
going
to
solve
a
problem.
I
I
just
don't
see
that
that
that
will
help.
But
again
I'm
just
putting
my
concerns
on
the
record.
I
The
next
question
I
have
is
you
mentioned
our
majority
floor.
Leader
mentioned
the
several
millions
of
dollars.
We've
gotten
that
we
don't
see
in
this
budget
we're
worried
about
some
of
the
process
happening
here.
We
mentioned
suicide
prevention,
I'm
wondering
if
there's
any
push
to
do
the
988
calls.
I
don't
see
anything
in
any
of
this
budget.
I
know
it's
a
national
priority.
There's
been
some
discussion
this
year.
Are
we
working
on
that.
C
G
Stephanie
woodard
for
the
record,
so
crisis
support
services
of
nevada
is
our
national
suicide
prevention
hotline
here
in
the
state.
It
is
those
hotlines
that
have
been
prioritized
to
stand
up
the
988
systems
we
have
through
our
crisis,
counseling
and
assistance
and
training
program,
provided
them
five
additional
staff.
We
also
have
a
lifeline
expansion
grant
that
has
supported
them
in
in
expanding
their
services,
to
be
able
to
answer
more
in-state
calls,
and
actually
we
have
not
only
met
but
exceeded
what
the
expectations
were
in
a
relatively
short
period
of
time.
G
For
us
to
be
able
to
answer
a
sufficient
number
of
in-state
calls
with
some
of
the
additional
covid
er
samsa
funds.
We
are
also
going
to
be
funding
an
additional
six
positions
so
that
we
can
really
begin
to
staff
up
the
988
line
with
the
new
infusion
of
federal
funds.
So
the
mental
health
and
substance
abuse
block
grant
dollars
that
we
just
received
last
week.
There
is
a
priority
on
those
funds
to
make
sure
that
we
are
using
them
to
build
out
our
crisis
system
of
care
which
includes
988.
G
So
we
will
be
working
with
samsa
to
actively
determine
what
level
of
funding
we
can
devote
to
not
only
988
but
also
mobile
crisis
and
crisis.
Stabilization
centers.
Those
have
been
major
priorities
for
us.
So
when
we
have
been
able
to
get
funding
in,
we
have
been
able
to
identify
which
funding
is
most
appropriate
to
be
able
to
continue
to
build
the
infrastructure
necessary
to
stand
up.
988
and
the
entire
crisis
continue.
I
Great
thank
you
for
that.
Thank
you,
madam
chair,
for
the
question,
just
a
comment
that,
when
you
get
that
plan
put
together
when
you
have
those
monies
on
what
the
the
pathway
will
be
to
to
make
that
988,
viable
and
and
advertising
that
and
make
sure
folks
understand
how
they
can
access
that,
I
think
we
would
all
like
to
have
some
follow
up
on
that,
and
thank
you,
madam
chair,
for
the
questions.
E
Thank
you
so
much
madam
chair,
and
thank
you
to
the
staff
for
presenting
this,
and
I
have
a
couple
questions
and
hopefully
they
haven't
been
intertwined
in
other
answers
already,
but
I
want
I
want.
I
want
to
be
clear.
So
can
you
explain
why
the
substance,
abuse,
treatment
and
treatment
agency
is
recommending
that
we're
transferring
those
contract
positions
over
to
permanent
state.
G
Positions,
stephanie
woodard
for
the
record
again.
Yes,
these
are
positions
that
support
long-standing
grant
activities
and
we
have
had
a
difficult
time
maintaining
contractors
in
these
positions
for
the
longevity
of
the
grants
that
they
oversee.
G
So
what
we
have
found
is
that
we've
had
a
difficult
time,
filling
the
contract
positions
and
then,
when
we
do
fill
them,
there
is
an
enormous
amount
of
learning
that
needs
to
happen
in
order
for
them
to
develop
the
depth
of
knowledge
needed
in
order
for
them
to
perform
these
functions,
and
so
we've
had
a
difficult
time.
Also,
then
retaining
contract
positions
when
we
know
that
they
would
opt
for
an
fte
with
benefits
in
all
the
the
other
real
benefits
that
come
with
state
employment.
G
So
we
see
that
converting
these
positions
to
fte
will
allow
us
to
recruit
and
retain
highly
qualified
individuals
for
these
positions
and
hopefully
allow
them
to
stay
within
the
programs
long
enough
that
they
can
really
develop
the
expertise
and
provide
what
is
needed
to
the
program.
E
Thank
you
very
much
because
you
answered
the
second
part
of
that
question
that
I
was
going
to
ask
about.
You
know
giving
me
the
advantages
of
that.
So
then,
with
that,
would
you
please
provide
an
update
of
the
work
of
the
suicide
prevention
office
and
including
its
activities
during
the
corona
bios,
because
I
know
that
that's
been
an
issue
and
I've
been
working
on
some
of
that
and
have
some
bills
that
I've
brought
forward.
So
if
you
could
give
us
an
update
on
that,
it
would
be
very
much
appreciated
here.
G
So
stephanie
woodard
for
the
record
we've
been
working
very
closely
with
the
office
of
suicide
prevention
on
a
number
of
different
initiatives.
G
So
early
on
in
the
pandemic,
we
established
a
behavioral
health
task
force
which
actively
involved
the
office
of
suicide
prevention
and
developed
a
behavioral
health
recovery
plan
for
covid
we've
been
using
that
plan
to
really
guide
much
of
our
activities.
They
have
provided
suicide
prevention,
training
and
consultation
to
our
resilience,
ambassadors
that
are.
E
J
G
News
is
that,
as
I
mentioned,
the
additional
block
grant
funds
that
we
just
received
last
week
are
allowing
us
to
do
a
bit
more
of
an
expansion
of
what
is
allowed
under
those
dollars.
So
we
will
be
working
with
samsa
to
determine
what
additional
activities
we
can
fund
with
those
dollars
that
previously
would
have
been
prohibited
in
additional
sorry,
were
you
going
to
say
something?
G
Okay.
In
addition,
our
state
opioid
response
grant
funding.
We
have
been
supporting
the
office
of
suicide
prevention
and
the
zero
suicide
initiative.
G
We
are
happy
to
say
that
we've
got
16
hospitals
that
have
signed
on
to
the
zero
suicide
initiative
and
the
staff
that
is
leading
the
charge
has
actively
recruited
additional
hospitals
and
healthcare
systems
to
also
implement
zero
suicide,
and
we
are
funding
a
biostatistician
who
will
then
be
able
to
assist
us
in
gathering
all
of
suicide-related
data
so
that
we
can
continue
to
formulate
what
our
plan
is
to
address
suicide
prevention
and
postpension
in
nevada.
E
Thank
you.
No,
I
just
I.
I
got
ahead
of
myself
as
I
was
listening,
so
who
are
those
3,
500
individuals
that
you
have
trained?
Do
they
ever
reach
down
into
the
schools.
G
Stephanie
woodard
for
the
record
yes
office
of
suicide
prevention
has
a
long-standing
collaborative
relationship
with
the
department
of
education
and
school
districts.
We
have
been
providing
support
to
clark
county
school
district
and
washoe
county.
They
provide
additional
ongoing
consultation
and
training
for
a
number
of
other
groups,
including
first
responders
parents,
teachers
faith-based
organizations.
E
Well,
that's
perfect
information.
Thank
you
very
much
and
if
you
don't
mind,
I'd
like
to
reach
out
to
you
offline
to
discuss
something
that
I'm
working
on,
so
thank
you
very
much
and
thank
you
for
what
you
do.
A
Thank
you
senator
for
the
questions
and
in
that
dialogue
I
have
a
question
as
we've
been
living
through
this
pandemic,
could
you
tell
us
how
are
the
the
service
providers
of
substance,
abuse
prevention
and
the
treatment
agencies
adjusting
the
challenges
that
have
occurred
during
this
pandemic?.
G
Stephanie
woodard
for
the
record,
I
would
say
that
the
vast
majority
of
providers
were
able
to
pivot
to
using
telehealth
almost
exclusively
very
early
on
in
the
pandemic.
We
offered
additional
funding
and
flexible
funding
if
they
were
already
receiving
funding
to
help
them
to
meet
the
needs
for
telehealth
and
their
patients.
G
We
have
seen
a
lot
of
demand
for
treatment
services
via
telehealth,
so
most
of
them
have
been
able
to
continue
not
only
their
lines
of
existing
service
but
including
telehealth
for
increased
access
to
care.
We
also
know
that
behavioral
health
providers
really
struggled
with
maintaining
staffing
at
adequate
levels
at
various
times
during
the
pandemic
and
especially
for
our
residential
treatment
providers.
G
Some
of
them
had
to
really
do
additional
work
to
make
sure
that
the
patients
that
were
entering
their
facilities
were
coveted
free
and
we
did
have
outbreaks
in
some
of
our
residential
treatment
facilities
that
were
handled
very
quickly
so
that
it
could
be
contained.
G
So
we
have
seen
some
variable
impact.
At
times
they
haven't
been
able
to
admit
as
many
people
as
they
would
have
previously,
but
working
within
the
entire
network
and
most
individuals
who
demonstrated
a
need
for
care,
especially
those
higher
levels
of
care.
We
were
able
to
admit
timely.
A
C
Lisa
sherick
for
the
record
before
we
move
into
our
clinical
services
budgets
for
rural
stems
and
nams
I'd
like
to
acknowledge
the
hard
work
our
clinical
services
team
has
done
during
the
past
year.
Navigating
covid,
while
ensuring
our
hospitals
and
outpatient
services
throughout
nevada
have
continued
to
provide
the
necessary
services
to
the
community,
while
ensuring
protocols
to
reduce
covet
impact
were
implemented.
C
You
will
note
projected
demand
for
dbph
clinical
services
at
the
end
of
fy23
begins
to
increase
after
an
initial
decrease
during
the
early
months
of
the
pandemic.
However,
the
overall
average
projection
demonstrates
a
decline.
Staffing
coverage
remains
challenging
due
to
the
pandemic,
and
there
are
multiple
position
vacancies,
but
recruitment
efforts
continue.
C
It
should
be
noted
that
our
caseload
projections
will
be
updated
again
by
the
office
of
analytics
at
the
end
of
march,
and
we
will
provide
updated
projections
to
your
fiscal
staff.
Clinical
services
provides
services
statewide
in
our
inpatient
hospitals
and
outpatient
clinics
to
those
with
serious
mental
illness.
C
Since
the
beginning
of
the
pandemic,
our
caseloads
have
decreased
or
remain
stable,
while
studies
from
entities
such
as
centers
for
disease
control
and
prevention
in
some
substance,
abuse
and
mental
health
services,
administration
show
increased
levels
of
anxiety
and
depression
during
and
following
a
crisis
even
such
as
the
pandemic.
Our
services
have
not
reflected
those
increases.
C
Data,
analysis
of
caseloads
and
medication,
utilization
of
35
000
claims
show
no
increase
in
those
seeking
mental
health
services
provided
by
our
hospitals
and
outpatient
clinics,
call
lines
and
early
intervention
services
such
as
mobile
outreach
teams,
children's
mobile
crisis
team
care
teams
and
rural
extended
access
to
community
health,
otherwise
known
as
reach
are
first-line
resources
that
provide
rapid
intervention
that
reduces
anxiety,
we've
noted.
Sometimes
it
could
just
be
another
person
that
understands
and
an
offer
of
help.
The
intervention
of
these
services
assists
individuals
so
that
long-term
services
may
not
be
needed.
C
The
office
of
analytics
determines
projections
from
actual
caseload
numbers,
as
you
can
see,
for
nams
medication
clinic
caseload
has
been
decreasing
since
september
2019.
However,
however,
caseload
projections
at
the
end
of
fy
23
are
showing
a
slight
increase.
Outpatient
services
has
stayed,
has
stayed
relatively
stable
throughout
2020.
C
All
other
case
load
has
relatively
been
stable
or
decreased
for
scams.
Medication
clinic
caseload
has
stayed
relatively
stable,
outpatient
services
has
been
decreasing
since
february
2020,
all
other
caseload
has
relatively
been
stable
or
decreased
for
rule
medication
clinic
caseload
has
decreased
since
the
start
of
the
pandemic.
However,
caseload
projections
are
showing
slight
increase
to
pre-pandemic
levels.
C
C
C
C
C
C
E-682
aligns
revenue
from
general
fund
to
other
sources
for
the
purchase
of
replacement
equipment.
Dbph
has
confirmed
with
the
division
of
health
care,
finance
and
policy
that
these
expenses
are
eligible
when
providing
support
for
positions
and
operating
and
operating
costs
slide.
21
e686
reduces
psychiatric
services.
C
This
is
our
cat,
eight
or
contract
professional
mental
health
services,
category,
which
has
had
an
average
savings
of
over
486
000
over
the
last
three
fiscal
years.
Service
levels
are
not
anticipated
to
be
reduced
and
will
be
retained.
Since
this
is
across
all
rural
services,
there
is
not
a
clinic
specific
impact.
J
Thank
you
chair,
I'm
of
course,
always
concerned
about
the
vacancies.
So
how
would
those
vacancies
impact
services
in
real
nevada.
F
For
the
record,
joe
malay,
sustaining
the
rural
clinics,
it
was
important
to
us
as
it
is
to
the
communities
we
serve.
The
clients
we
serve
and
even
the
employees
that
work
and
live
in
those
communities
as
well.
Telehealth
services
really
allowed
us
to
have
that
flexibility
and
coverage
and
staffing
where
vacancies
were.
F
So
we
have
looked
at
the
flexibility
of
staffing
for
those
vacancies
for
and
as
I
mentioned
earlier,
one
of
them
was
a
psychologist,
of
course,
but
we
have
our
mental
health
counselors
in
our
clinics,
also
that
we
have
our
clinic
managers
that
can
cover
as
needed
as
well
and
though,
with
telehealth
services,
though
we
don't
have
the
entire
treatment
team
right
there
on
site.
We
always
have
someone
in
every
clinic
that
greets
them
can
assist
them
and
assess
them
as
needed.
J
Thank
you
for
the
answer.
I
I
think
that
probably
one
of
the
happy
outcomes
of
the
pandemic,
if
you
will
has
been
the
acceleration
of
the
adoption
of
telehealth-
and
I
think
we're
all
very
excited
about
that.
J
I
think,
though
we
also
recognize
that
telehealth
is
not
indicated
for
every
interaction,
and
so
I'm
I'm
just
wanting
to
dig
in
a
little
bit
more
about
particularly
in
rural
nevada,
because
I
do
think
that
everybody
wants
to
just
believe
that
telehealth
is
going
to
be
the
solution
for
all
of
the
needs,
but
we
know
that
there
are
folks
who
need
a
different
modality
than
telehealth.
Sometimes.
So,
how
are
we
managing
to
that
as
we're
moving
through
the
pandemic?.
F
F
That
is
a
team
of
providers
that,
when
no
matter
where
a
client
would
like
to
access
services,
we
get
a
response
to
them
and
interventions
to
them
quickly.
The
other
point
that
we
do,
as
we
have
been
working
with
the
rural
hospital
partners
in
providing
those
interventions
in
the
emergency
rooms
so
that
they
get
quick
access.
We
consult
with
the
er
physicians
and
nurses
as
well.
F
We
also
have
our
mobile
crisis
teams
as
well,
for
both
adults
and
youth.
So
when
a
call
comes
in
from
either
a
parent
or
a
youth,
we
have
our
team
that
goes
out
to
those
clients
in
order
to
provide
intervention
services,
we
have
the
rural
clinics
have
been
using
telehealth
for
a
long
time.
The
world
health,
hospital
partnerships
and
other
partners
throughout
the
counties
have
really
expanded
and
worked
with
us
to
improve
telehealth
services,
and
so
we
continue
to
do
that
also
have
clinic
sites
so
that
we
can
provide
those
services.
C
J
Then
I
guess
the
other
piece
that
I'm
concerned
about
is
sort
of
the
tale
of
this
pandemic.
I
think
we
know
that
there's
a
lot
of
people
who
have
experienced,
I
would
just
go
so
far
as
to
say
trauma
if
you
lost
a
loved
one
and
you
weren't
able
to
be
there
in
the
hospital
with
them
or
a
year
of
isolation,
domestic
violence
that
didn't
get
addressed
like
just
I.
J
I
think
we
are
all
pretty
clear
on
the
understanding
that
there
have
been
more
challenges
to
behavioral
health
during
the
pandemic
and
that
that
the
impacts
of
that
may
last
much
longer
than
the
pandemic
itself.
And
so
I'm
curious
about
how
you're
thinking
about
your
strat,
what
strategies
the
agency
will
use
to
meet.
What
I
think
we
are
all
anticipating
will
be
an
increased
demand
for
services
as
we're
moving
out
of
the
pandemic
and
for
the
rest
of
the
biennium.
F
Yes,
thank
you
for
the
question
jimmy
for
the
record.
Yes,
we
have.
We
have
staffing
currently
that
can
meet
the
pre-pandemic
level,
and
so
we're
thankful
for
that.
Our
vacancies
have
been
especially
in
the
rural
counties,
have
been
there
for
quite
a
while.
Our
employees
in
all
the
communities,
know
their
communities
well,
they
work
and
live
in
those
communities,
and
so
they
can
kind
of
be
a
pulse
to
us
as
well
in
those
communities
to
let
us
know.
F
What's
what's
occurring,
I
our
early
intervention
services
working
with
multiple
other
divisions,
the
division,
child
and
family
services
and
others
have
really
helped
in
assisting
around
this
post,
maybe
pandemic
or
as
we
see
it,
kind
of
I
guess,
leveling
off,
and
so
we've
really
been
working
on
how
we
can
improve
those
interventions
and
provide
services
to
those
clients
and
really
it's
getting
to
those
that
in
need
those
call
lines.
F
J
G
Stephanie
woodard
for
the
record,
through
our
crisis,
counseling
assistance
and
training
program
with
our
resilience,
ambassadors
and
resilience
ambassador
supervisors.
We
have
been
working
alongside
and
offering
webinars
and
additional
support
for.
Anyone
who
needs
it,
including
state
employees.
We've
had
a
very
close
relationship
with
the
division
of
emergency
management
and
have
provided
them
on-site
and
off-site
additional
support.
J
A
You
thank
you
so
much
for
asking
that
question.
I
was
going
to
ask
that
so
I'm
like
mines,
assemblywoman
titus,.
I
Thank
you,
madam
chair,
for
the
question
and
thank
you
senator
raddy,
for
pointing
out.
So
some
of
the
concerns
that
I
too
have
regarding
telehealth
is.
It
is
helpful,
but
there's
still
times
that
you
need
literally
to
have
an
in-person
meeting
and
so
back
to
my
same
line
of
questioning
that
I
asked
a
moment
ago
in
a
previous
budget,
there
was
a
mention
that
there
was
a
perhaps
several
week
weight
lifts.
I
Could
you
clarify
you
mentioned
that
there
was
a
wait
list
for
testing
mental
health
testing,
but
what's
the
wait
time
for
actual
a
counseling
or
a
referral,
so
once
you
say,
there's
somebody
in
the
each
office
in
these
rural
clinics
so
that
somebody
can
come
in
and
be
assessed,
or
at
least
say
hello
on
daily.
What's
the
wait
list
for
even
a
telehealth
appointment,
let
alone
the
wait
list
for
a
referral
for
some
actual
intervention?
Can
you
give
me
any
of
those
details?
Please.
J
F
The
record
for
most
of
our
wait
list,
depending
on
what
it
is,
can
be
anywhere
from
immediate
access
through
our
intervention
models
up
to
three
days
is
usually
for
our
reach
or
our
mobile
crisis
teams.
F
And
then,
however,
should
you
call
a
clinic,
and
you
need
to
talk
to
somebody-
there
is
immediate
someone
there
for
you.
It
won't
always
be
your
psychiatrist
or
your
licensed
clinical
social
worker,
but
we
always
have
someone
there.
That's
part
of
the
reach
team,
no
matter
where
you
call
you
can
speak
to
one
of
those
providers
that
is
monday
through
friday,
eight
to
five
o'clock
those
services
as
well.
F
So
we
have
someone
specifically
for
that
reach
team
for
that,
as
far
as
getting
into
the
clinic
into
your
medical
clinic,
those
those
wait
times
are
a
little
bit
longer,
they're
up
to
a
week
to
10
days
to
get
into
those
services
all
right.
So.
I
You
there's
always
immediate
access
with
some
sort
of
immediate
access
for
some
referral
immediately,
but
then
the
actual
follow-up,
because
that's
the
key,
you
know
you
can
have
that
you
have
the
most.
We
have
this
early
intervention.
You
have
some
of
this
other
stuff
right
away,
but
from
there
other
than
an
emergency
room
within
a
week
to
10
days,
they'll
be
actually
having
either
a
psychologist.
A
psychiatrist
or
a
social
worker
or
a
mental
health
person,
be
able
to
see
them
within
a
week
to
10
days,
correct.
I
Right
all
right
so
a
week
to
10
days,
no
matter
so
that's
good,
and
thank
you
for
that.
That's
better
than
expected
and
if
I
might
follow
up
with
another
question,
madam
chair
on
slide
20,
you
had
the
breakdown
of
how
the
rural
clinics-
and
these
are
rural,
mental
health
clinics
to
be
different
than
the
rural
public
health
clinics,
where
the
public
health
nurse
is.
But
on
these
rural
clinics
you
had
a
breakdown
of
72
percent
general
funds,
one
percent
federal
funds
and
22
percent
other
22
other.
I
Is
that
from
grants
or
what
is
that
20
source
of
funding.
E
Thank
you
for
the
question.
Debbie
reynolds
for
the
record.
The
other
funds
in
the
account
represent.
E
I
E
Reynolds
for
the
record
we
do,
we
did
actually
actually
receive
some
crf
treasury
funds
to
also
reimburse
the
the
mobile
crisis
services.
I
C
Lisa
sherick
for
the
record.
Oh
sorry,
it
just.
C
I
Thank
you.
Thank
you,
madam
chair,
for
the
questions.
H
Thanks
so
much,
I
just
had
one
last
question
and
sorry
we're
still
back
on
the
in
three
one,
seven
one
so
on
the
reduced
psychiatry
positions
and
the
the
the
kind
of
shifting
some
of
those
to
mental
health.
I
was
wondering
how
those
costs
look.
H
I'm
assuming,
although
I
don't
want
to
be
wrong,
I'm
not
sure
at
all
that
that
would
mean
contracts
for
telehealth
providers,
or
I
think
I
saw
on
the
back
end
of
the
budgets
that
you're
reducing
out
charges
to
their
like
private
insurance
and
for
those
who
might
have
it
who
walk
in
the
clinic
and
further
associated
costs.
I
was
just
wondering
where
that
cost
shift
happens.
If
we're
doing
a
reduction
of
ftes,
then
the
cost,
for,
I
guess,
an
enhancement
in
those
telehealth
contracts
or.
H
I'm
I'm
referencing
six.
Eight.
I
think
it's
six,
eight
one
on
the
I'm
in
still
in
real
mental
health.
So
I
was
looking
at
so
one
mental
health
counselor
position
in
ely,
the
psychiatric
caseworker
and
fernley
one
mental
health,
counselor
fallon,
one
mental
health,
counselor
naca,
one
and
then
carson
city
so
and
then
one
in
hawthorne.
H
F
Journal
for
the
record,
some
of
those
the
clinic
managers
are
also
a
mental
health
professionals,
so
those
that
are
counselors
are
there
on
the
sites.
So
there's
direct
sites
there,
the
others
yes,
will
be
via
telehealth.
F
F
A
C
C
Slide
23
provides
an
overview
of
requested
language
in
the
appropriations
act.
We
are
requesting
continued
ability
to
transfer
general
fund
appropriation
between
sam's
budget
account,
3161
nams
budget
account
3162
and
lakes.
Crossing
budget
account
3645,
with
the
approval
of
the
of
the
interim
finance
committee
upon
recommendation
of
the
governor.
C
Slide
24
provides
an
overview
of
northern
nevada,
adult
mental
health
services
budget
account.
3162
nams
provides
behavioral
health
services
for
both
inpatient
hospital
and
outpatient
treatment.
Settings
services
provided
by
outpatient
include
the
mobile
outreach
safety
team
or
most
medication
clinic
residential
mental
health
court
counseling
care
coordination
and
assessment
services,
along
with
justice
involved,
diversion
or
jid,
which
include
assisted
outpatient
treatment
and
the
community
diversion
team.
C
C
C
Slide:
26
e-901.
We
are
requesting
to
transfer
one
senior
physician
from
nams
to
the
division
of
healthcare
financing
and
policy
to
enhance
medicaid
reimbursement
related
to
pharmacy
services.
This
is
a
companion
decision
unit
previously
discussed
during
the
division
of
health
care,
finance
and
policy
budget
presentation.
C
C
C
A
Thank
you
so
much
for
that.
It
had
to
happen
once
today
and
assemblywoman
carlton
will
go
to
you
to
get
the
questions
started.
Thank
you.
D
D
But
I
think
the
bigger
discussion
is
that
the
total
amount
of
vacancies
that
we
have
and
how
we
decided
on
these
22
and
to
be
realistic,
even
if,
when
the
vacancy
threshold
is
lifted
for
the
following
fiscal
year,
do
we
think
we'll
be
able
to
fill
these
vacancies?
What
is
the
underlying
issue
when
we've
got
62
current
vacant
positions
very
much.
F
Jumbley
for
the
record-
yes,
nems
says:
caseload
has
drastically
reduced,
particularly
over
the
last
couple
of
years
and
continues
through
the
pandemic
as
well,
and
also
our
vacancy
rate
has
maintained
itself
at
about
26
when
the
largest
vacancy,
though,
is
that
in
psych
nurse
twos
in
particular,
which
that
vacancy
rate
is
closer
to
30
percent.
The
22
positions
that
were
vacant
and
will
be
held
during
this
biennium
are
were
chosen
because
of
the
caseload
reduction,
so
particularly
in
the
outpatient
setting
and
the
inpatient
inpatient.
F
F
Some
of
those
physicians
and
inpatient
were
reduced.
Those
in
outpatient
as
well
were
reduced,
so
if
we
could
maintain
adequate
coverage
for
those
clients
that
we
have
seen
up
to
the
pre
pandemic
levels,
so
in
outpatient
services,
we
looked
at
those
positions
that
were
caseload
dependent
and,
where
case
loads
were
diminishing.
Those
are
the
vacancies
that
we
held.
C
I
think
it's
a
valid
question
about
being
able
to
in
the
second
year,
if
we'd
be
able
to
I'll
use
my
words
easily
fill
22
22.55
positions
or
at
least
easier
quickly-
and
my
answer
is,
I
don't
know
I
do
know
when
it
comes
to
especially
the
clinical
positions.
That's
always
been
a
challenge
in
northern
nevada,
especially
during
covid
when
it
when
it
came
to
nursing
positions,
we
were
at
a
point.
C
We
were
just
not
competitive
in
any
capacity
with
the
private
hospitals
due
to
their
abilities
to
pay
or
offer
sign-on
bonuses,
or
things
like
that
to
make
sure
that
they
had
adequate
staffing
for
covid.
So
I
do
think
the
the
clinical
positions
are
always
a
challenge,
and
that's
where
you
know.
We
need
to
continue
to
work
at
that
within
nevada.
To
make
sure
we
have
the
necessary
infrastructure.
D
If
I
could
just
briefly
follow
up
so
with
the
conversations
of
where
we
think
we
we
know
their
mental
health
needs
in
the
state
right
now,
and
we
know
there
are
folks
that
are
not
reaching
out
for
that
assistance
because
of
the
pandemic
and
how
maybe
they're
waiting
to
get
a
vaccine,
maybe
they're,
waiting
to
see
if
they
go
back
to
work,
they're
they're,
trying
to
maybe
handle
it
on
their
own,
but
we're
going
to
go
back
to
pre-pandemic
levels
at
some
time
and
I
think
anecdotally
we're
all
talking
about
the
desperate
need
for
mental
health,
as
people
try
to
readjust
back
to
what
not
might
not
be
the
regular
normal,
but
maybe
a
little
more
normal.
D
C
Lisa
sherick
for
the
record,
you
know
we're
hopeful
that
we
will
be
in
a
position
to
provide
the
necessary
services.
You
know,
as
as
I
indicated
a
little
bit
earlier
on
in
the
presentation
you
know.
We
have
really
looked
at
this
very
closely
to
determine
how
this
might
impact
our
state,
outpatient
services
and
hospitals,
and
you
know
yes,
while
there
has
been
an
increase
in
depression,
symptoms
and
anxiety,
there
doesn't
seem
to
be
a
direct
correlation
that
it
would
connect
back
to
actually
qualifying
and
receiving
an
open
case
through
nams
and
snams.
C
That's
not
to
say
if,
if
folks
don't
show
up
at
any
one
of
our
clinics
that
we
would
not
make
sure
that
we
connect
them
to
the
appropriate
resources,
and
I
do
believe
that
the
behavioral
health
services
that
has
been
stood
up
during
covet
and
the
crisis
counseling
and
the
resilience
project
and
things
like
that.
Real
and
the
the
mobile
outreach
teams
that
miss
malay
had
mentioned,
really
are
addressing
a
lot
of
those
things
in
in
in
the
meantime.
C
But
but
I
think
it
is
still
a
little
bit
unclear
to
us
on
how
this
is
going
to
truly
look
in
a
year
from
now,
but
regardless
of
the
research
that
we've
done
in
the
analysis,
even
looking
at
claims
data
to
get
some
type
of
picture
to
see.
If
that
would
correlate
back
to
our
caseloads,
nothing
seems
to
indicate
at
least
from
the
state
services
perspective
and
increase
at
this
time,
but
I'm
not
saying
that
there
may
not
be,
but
unfortunately
there's
there's
nothing.
C
I
don't
have
a
crystal
ball
to
to
show
me
what
it's
going
to
look
like,
but
based
on
the
data
that
we
use.
There
is
nothing
concrete.
D
We
all
wish
we
had
a
crystal
ball
right
now,
because
things
are
especially
about
six
months
ago,
eight
months
ago,
we
really
wish
we
would
have
had
a
crystal
ball
so
that
we
could
plan.
So
I
just
want
to
make
sure
that
we're
we're
prepared
and
that
we're
thinking
about
it.
So
with
that,
madam
chair,
I
do
have
a
couple
questions
on
community
based
but
I'll
I'll
yield
and
let
other
members
ask
questions
and
then
come
back
to
be
the
cleanup
hitter.
If
you
need
me
to
be.
Thank
you
very
much,
madam
chair.
A
H
Thank
you
so
much,
madam
chairwoman,
I
appreciate
that
so
my
question
is:
I'm
just
trying
to
get
a
picture
for
my
own
brain
of
kind
of
how
things
everything
was
working
across
the
system.
So
at
the
front
end
of
the
budgets
we
heard
about
federal
grant
money
to
hospitals
to
help
with
their
psychiatric
cases.
H
Those
you
know
help
opening
up
those
clogs
in
the
er,
and
so
I
guess
I'm
wondering
and
then
how
that
how
those
folks
navigated
through
the
system
if,
on
the
back
end,
we
seem
to
have
fewer
folks
landing
up
in
in,
like
our
our
nams
beds
or
in
civil
commitment
beds
and
such
so.
H
I
guess
I
was
kind
of
wondering
from
the
front
to
the
back
end
then,
and
we're
since
we're
in
the
nam's
budgets.
I
should
probably
stay
specific
to
northern
nevada,
so
I
guess,
then,
those
psychiat,
the
psychiatric
help
that
we
were
paying
for
in
the
ers
up
north
was
that
then
more
like
diversion
or
was
it
clearing
holds?
Was
it
helping
assessing
on
holds?
Was
it
transport
to
other
types
of
behavioral
health
facilities.
C
Hi
lisa
sharik
for
the
record.
I
do
know
that
one
of
the
community
hospitals
or
programs
in
the
north
have
actually
stood
up
this
wonderful
program
where
they're
they're
working
with
the
emergency
rooms,
and
it
seems
to
be
that's
where
a
lot
of
the
decline
has
correlated
to,
and
I
believe
that
might
be
a
grant,
though
so
I'm
not
sure
if
that's
going
to
end,
and
we
could
provide
some
further
details
on
that
specific
program.
But
it
definitely
has
shown
wonderful
results
for
the
folks
that
are
in
the
emergency
rooms.
C
G
G
Woodard
for
the
record-
yes,
so
renown's
program
is
doing
what
we
would
intend
for
other
programs
to
do,
which
is
to
really
truly
evaluate
individuals
to
determine,
if
they're
appropriate
for
inpatient
beds,
so
that
we
don't
have
individuals
that
are
languishing
in
emergency
rooms
that
actually
don't
meet
that
level
of
care.
G
And
what
they
have
found
is
that
for
individuals
who
are
transported
to
the
hospital
they
are
able
to
rapidly
assess
what
those
needs
are
and
then
facilitate
transfer
to
a
psychiatric
inpatient
beds
in
the
community
when
necessary,
and
those
beds
include
nams
that
include
the
other
hospitals
in
northern
nevada
that
provide
inpatient
psychiatric
care.
We've
also
provided
funding
to
reno
behavioral
health
for
that
alternative
front
door.
G
So,
instead
of
individuals
going
to
the
emergency
room,
they
have
a
place
to
go
in
the
community
for
a
rapid
triage
so
that
they're
being
evaluated
as
well
from
there.
They
can
either
refer
to
their
own
outpatient
programs
if
they
are
appropriate
or
to
other
community
outpatient
programs.
They're
using
our
platform
called
open
beds,
which
allows
for
a
real-time
inventory
of
inpatient
and
outpatient
access
to
care.
So
those
referrals
can
be
facilitated
electronically
and
then
from
there.
H
G
Money,
emergency
response
grant
dollars
that
we
received,
so
I
think
that
grant.
H
To
them,
I
appreciate
that,
because
I
that
really,
that
really
is
significant,
if
we're
saying
just
through
having
a
organized
system
of
care
on
this
part
which
we've
we've
really
been
lacking,
or
we've
been
trying
and
working
hard
too.
But
it's
hard
to
fund
it's
hard
to
stand
up.
You've
got
lots
of
different
institutions
and
things
in
place.
H
If
that
really
seems
to
be
something
to
help
move
people
in
a
in
a
better
way
to
an
appropriate
bed,
then
then
it
would
then
that's
great,
that's
great
if
it's
really
because
of
people
landing
in
a
more
appropriate
spot
faster.
I
know
you
mentioned
the
payer
source,
so
I
think,
did
you
say
that
a
piece
of
this
grant
would
pay
for
the
the
bed
if
the
person
did
not
have
a
pair
source.
G
Stephanie
woodard
for
the
record.
Yes,
that's
correct!
In
addition
to
that,
we
know
that
in
our
urban
areas,
so
we
have
a
similar
program.
That's
happening
down
in
southern
nevada,
for
individuals
who
are
on
fee-for-service
medicaid
as
the
access
to
inpatient
psychiatric
beds
is
very
low
because
they
because
of
the
imd
exclusion,
and
so
what
these
dollars
do
is
allow
additional
beds
to
be
open
to
those
individuals
so
that
they
can
be
reimbursed
for
those
services.
I
Thank
you,
madam
chair,
and
thank
you
vice
chair
benitez
thompson
for
asking
that
that
line
of
question
because
mine's
on
that
same
issue,
I
I
need
on
the
record.
I've
sat
on
this
committee
now
for
four
four
sessions,
and
always
always
it's
been
an
issue
with
wait
times
in
the
emergency
rooms.
G
So
stephanie
woodard
for
the
record.
I
think
it's
a
great
question
and
we
don't
quite
have
an
answer
for
it.
Yet
one
of
the
goals
for
using
that
open
bed
system
is
so
that
we
truly
have
transparency
into
the
system
at
any
one
time
to
see
who
is
waiting
in
an
emergency
room
or
even
in
a
crisis
stabilization
center
that
meets
criteria
for
an
inpatient
bed
so
that
we
can
calculate
wait
times
and
we
can
see
which
hospitals
are
transferring
in
which
hospitals
are
receiving.
G
We
do
not
have
that
data
as
of
yet
we
really
need
full
participation
from
all
of
the
hospitals.
In
order
for
this
to
happen,
currently,
participation
in
the
open
bed
system
is
voluntary
and
what
we
have
heard
from
other
states
where
they
have
started
with
the
voluntary
pathway.
G
They
have
very
differential
participation
across
the
system
between
emergency
rooms
and
psychiatric
hospitals,
as
well
as
outpatient
providers.
So
many
of
those
states
have
had
to
go
to
mandatory
enrollment
in
use
of
the
system
in
order
for
us
to
get
really
the
full
clear
picture
of
what's
actually
happening
within
the
system.
I
Oh,
you,
don't
you
cannot
give
me
a
figure
right
now
on
what
the
average
wait.
Time
is
in
emergency
rooms
for
mental
health
admission.
No,
not
at
this
time.
Well
how?
Why
is
that?
I
know
you're
you're,
changing
programs.
I
know
the
open
bed
but
prior
sessions,
you
were
able
to
answer
those
questions.
It
became
a
big
issue
because
we
had
an
average
weight,
but
now
all
that
information
is
gone,
I
can
answer
for
a
husband.
F
Generally,
for
the
record,
I
I'm
I
can
answer
specifically
for
deeney
townsend
hospital
on
the
namm's
campus,
and
so
the
average
wait
time
when
once
a
a
packet
for
admission
is
completed,
is
four
to
five
days,
so
that
hasn't
changed.
But
I
think
when
we
look
at
the
overall
numbers
is
what
you're
asking
for
other
hospitals
and
how
long
they're,
actually
in
the
er
before
the
admission
documentation
is
complete,
is
the
numbers
that
we
don't
have
at
this
time
all
right.
I
So
four
to
five
days
makes
sense,
literally
spent
thousands
of
hours
in
emergency
room
and
thing
we
dreaded
when
a
mental
health
person
came
in
that
we
had
to
keep
in
our
er,
which
were
we
were
not
set
up,
but
still
are
not
set
up
for
a
mental
health
person,
potential
suicide
person
and
then
waiting
four
or
five
days
literally.
I
I've
had
patients
wait
days
in
my
emergency
room
for
that
admission,
so
so
very
interested
in
and
if
any
of
this
have
been
effective,
lowering
these
emissions
and
as
soon
as
you
get
that
information
once
you're
able
to
track
it.
That
would
be
great
and
one
other
question
on
a
different
transfer
chair,
please
my
question
regarding
your
physician,
the
transferring
of
the
physician
that
you're
moving
for
purposes
of
the
medication
a
clinic.
I
C
This
position
does
provide
oversight
and
management
of
the
drug
transparency
program
and
reporting
oversight
and
participation
of
the
medicaid
drug
use,
review
board
and
silver
state
scripps
board
other
things
such
as
review
and
oversight
or
management
of
the
state,
pbm
and
pharmacy
contracts,
management
of
the
state
medicaid
drug
rebate
program
among
many
many
other
things.
So
this
position
really
aligns
to
what
it's
doing
to
support
medicaid
as
well
as
dhhs
as
a
whole
related
to
pharmacy
services,
etc.
I
C
Lisa
share
it
for
the
record,
so
it
is
a
senior
physician
and
you
know
I
would
have
to
go
back
and
and
verify
why
it
was
not
a
pharmacist
position.
I
would
anticipate
because
at
the
time
we
did
not
have
perhaps
that
position
as
well
as
a
competitiveness
of
any
high-level
clinical
positions,
are
always
challenging
with
the
state
positions
right.
D
And
thank
you,
madam
chair,
so
I'd
like
to
talk
about
the
cblas,
the
community-based
living
arrangement
services
in
reading.
Through
this,
it
appears
as
though
there's
been
a
decline
in
in
homes
that
are
available,
and
that's
why
the
resulting
cuts
reductions
in
this
budget
really
shouldn't
affect
any
actual
service.
D
F
Chile,
for
the
record,
we've
seen
a
decline
in
our
cbl
homes
over
the
past
couple
of
years.
So
partly
we
believe
it's
due
to
the
regulations.
Some
providers
just
retire,
and
so
that
turnover
occurs
as
well,
so
either
by
choice
or
by
not
being
able
to
meet
the
new
requirements,
and
so
that's
part
of
the
reduction.
When
we
look
at
actually
placements
within
those
cvla
homes,
we
do
look
more
at
what
each
client's
needs
are.
F
D
So
I
I'm
just
concerned
that
I
want
to
make
sure
it's
available
different
levels
of
care
for
folks,
depending
upon
where
they
are.
We
want
to
make
sure
they're
in
the
right
spot,
so
I
think
we
really
want
to
know
if,
if
there's
a
way
for
us
to
address
this
in
the
future,
if
there
are
any
issues
that
we
need
to
do,
but
if
it's
basically
just
a
change
in
the
culture
of
cblas,
then
that's
just
to
be
expected.
D
H
Yeah
I
had
a
quick
question
once
again.
This
is
just
for
my
better
understanding
for
the
state
of
record
and
all
that
kind
of
good
stuff.
I
guess
I
think
I
heard
you
say
that
so
we
know
that
hcqc
is
closing
down
more
of
these
cblas
really
good,
because
we
want
good
providers
out
there,
but
then
I
think
I
heard
you
say:
you're
utilizing
other
group
homes
versus
cblas
and
I
wasn't
sure
how
I
should
interpret
that
or
what
that
meant.
C
Lisa
sherick
for
the
record,
so
I
just
wanted
to
clarify
our
intent
was
not
to
say:
hcqc
is
closing
down
these
providers.
It
appears
more
so
that,
because
they're
not
able
to
be
compliant,
it's
more
their
choice
to
to
not
be.
H
F
Assembly
for
the
record,
in
order
to
provide
adequate
fare,
pain,
I'm
sorry
adequate
care
to
clients
and
their
housing
needs.
We
do
have
some
other
arrangements
that
we
can
make
as
opposed
to
just
cblas.
We
do
have
group
homes,
we
have
basic
group
homes,
we
have
the
special
needs
group
homes
and
we
have
intensive
special
needs
group
homes
so
that
people
will
get
the
housing
that
they
need
to
be
successful
in
their
recovery
plan,
but
it
it
doesn't
limit
options
for
just
cblas.
H
That,
oh
sorry,
I'm
sorry
it's
okay!
I
was
guessing.
I
know
we're
right.
We're
get
we're
running
short
on
time,
and
I
appreciate
that.
So
I
think
let's
do
is
follow
up
with
the
conversation
with
you
folks.
I
just
want
to
make
sure
that
I
mean
the
only
I
want
to
make
sure
I'm
understanding
the
qualitative
difference
between
the
the
typologies,
the
type
of
the
homes
that
we're
setting
up
or
that
are
set
up
and
the
licensing
regulations
behind
them.
H
I
just
want
to
make
sure
that
we're
not
shifting
an
issue
which
I
know
that
we
would
never
consciously
do,
but
I
think
I
I
don't
have
a
good
understanding
of
what
those
other
group
homes
are
the
populations
they
serve,
and
so
I
can
take
that
conversation
offline.
I
appreciate
your
response.
C
J
A
J
It
just
may
be
more
profitable
to
turn
into
a
market
rate
rental,
as
opposed
to
staying
in
the
cbla
business.
I
wonder
how
many
of
them
are
losing
truly
because
of
the
economics
of
it,
and
so
I'm
one
I
I
think,
is
wonderful
that
we're
shifting
the
current
population
into
appropriately
licensed
group
homes
and
that's
a
really
good
outcome
and
with
along
with
the
majority
leader
from
the
assembly,
believe
that
you
know
there's
some
really
positive
things
that
needed
to
happen
there.
J
But
I
also
know
that
there's
pent
up
demand
that
we
are
not
getting
placed
somewhere.
That
is
affecting
kind
of
our
homeless.
Continuum
of
care
as
well,
and
so
I'm
concerned
about
seeing
that
we're
not
creating
whether
it's
more
of
these
or
more
spots,
someplace
else-
and
I
know
that
the
housing
branch
in
northern
nevada
makes
it
all
very
difficult
to
make
pencil.
So
I
don't
know
that.
J
There's
a
question
there,
except
for
I
know
we
had
talked
about
restructuring
our
rates
so
that
rent
was
pulled
out
separately
and
then
because
I
think
what
happens
in
many
cases
is
when
they
have
to
start
paying
more
for
the
rent.
They
get
less
care
in
a
cbla
model,
and
so
just
how
are
we?
Managing
the
extraordinary
housing
prices
in
northern
nevada
in
a
model
that
require
requires
typical
residential
housing.
C
Okay,
lisa
sherick
for
the
record.
I
I
just
wanted
to
quickly
more
make
a
comment,
so
the
division
we
do
have
a
meeting
scheduled
at
the
end
of
this
month
to
discuss
with
washoe
county
that
exact
concern
that
you
brought
up
about
the
number
of
individuals
facing
homelessness.
That
may
also
have
serious
mental
illness
and
seeing
how
we
can
you
know,
as
a
collaborative
group
figure
out
some
successes
to
to
meet
those
issues
related
to
the
cost
of
housing.
F
Generally
for
the
record,
so
our
costs
were
determined
when
we
had
a
third
party
auditor
come
in
and
look
at
the
cost
of
housing.
So
we
did
have
some
set
rates
within
our
cbla
homes
and
other
rates
as
well.
But
we
do
look
at
those
annually
as
well
to
make
market
adjustments
as
we
can
and
as
the
budget
allows.
J
C
Lisa
sherick
for
the
record.
I
don't
recall
that
term
being
used,
but
it
was
the
is
it
health,
it's
the
county,
health
and
human
services
that
reached
out
and
there's
another
entity.
I
might
have
missed
that
it
just
literally
we
organized
that
meeting
the
other
day.
A
And
I
just
have
one
last
question
before
we
close
out
this
budget
when
we
talk
about
our
the
homeless
and
severely
mentally
ill,
when
you
look
at
decision
unit
m201
and
the
positions
that
are
going
to
be
eliminated
due
to
the
caseload
when
it
comes
to
the
medication
clinics,
can
you
tell
us
how
the
agency
would
respond
to
an
increase
in
demand
beyond
the
projection
projections
in
the
caseload,
considering
the
recommended
proposed
eliminations
for
the
medical
medication
clinics.
F
Yeah,
don't
malay
for
the
record.
Sorry,
I
was
making
sure
I
would
give
you
an
accurate
response.
The
medication
clinic
in
particular
has
had
a
large
decrease
in
our
caseloads,
and
so
when
we
looked
at
those
positions
in
particular
that
were
needed
for
medication
clinic
those
were
the
reasons
they
were
vacant
and
those
were
the
reasons
that
they
were
for
reduction.
We
believe
we
can
meet
that
caseload
and
we
believe
we
can
meet
it
at
the
pre
pandemic
level.
Currently,
our
medication
clinic
caseload
is
at
54
of
normal.
E
Debbie
reynolds
for
the
record,
ms
eric
mentioned
at
the
at
the
beginning
of
the
presentation
that
the
office
of
analytics
will
be
updating
our
caseload
projections
at
the
end
of
the
month.
A
C
31.61
lisa
sherick
for
the
record
slide.
28,
provides
an
overview
of
southern
nevada,
adult
mental
health
services
budget
account
3161
snams
provides
behavioral
health
services
for
both
inpatient
civil
and
forensic
hospital
and
outpatient
treatment.
Settings
outpatient
services
include
the
mobile
outreach
safety
team
or
most
medication
clinic
program
for
assertive
community
treatment
or
packed
residential
mental
health
court
counseling
care
coordination
and
assessment
services,
along
with
justice
involved,
diversion
or
jid,
which
includes
assisted
outpatient
treatment,
misdemeanor
diversion
youth
in
transition
and
supportive
outpatient
treatment.
C
These
services
are
provided
both
inpatient
and
outpatient,
dependent
on
whether
the
court
determines
the
client
may
be
a
danger
to
self
and
or
others
or
may
not
benefit
from
outpatient
treatment
to
competency.
The
facility
also
treats
clients
determined
not
guilty
by
reason
of
insanity
and
unrestorable
clients
who
are
too
dangerous
to
commit
to
a
civil
psychiatric
hospital.
C
Slide
29
budget
3161
is
primarily
funded
with
state
general
fund,
a
small
portion
of
federal
funds,
which
is
the
shelter
plus
care
grant,
and
we
also
bill
medicaid
and
medicare
and
private
insurance
slide.
30
and
31
outline
our
three
major
decision
units
related
to
justice
involved.
Diversion
projected
case
load
decreases.
C
This
includes
m201,
it
eliminates
one
clinical
social
worker
m203
eliminates
one
mental
health,
counselor
and
m204
eliminates
three
psychiatric
caseworkers
over
the
past
week
after
thoroughly.
Looking
at
our
caseload
data,
I
have
unfortunately
determined
that
the
data
we've
been
using
going
back
to
2019
did
not
reflect
three
of
the
sub
programs.
Under
this
overarching
program,
our
caseload
data
was
only
capturing
assisted,
outpatient
treatment
and
not
including
youth
in
transition,
misdemeanor
diversion
or
supportive
outpatient
treatment.
C
C
There
are
three
in
the
misdemeanor
diversion
62
in
assisted
outpatient
treatment,
97
in
support
of
outpatient
treatment
and
seven
in
youth
in
transition
with
that
being
said,
it
appears
based
on
caseload
ratios
required
for
these
programs.
Eliminating
these
positions
would
not
align
with
program
intent.
As
stated
earlier
in
the
presentation
we
should
be
receiving
our
updated
caseload
projections
later
this
month
and
anticipate
projections
may
show
a
different
need
and
we
will
need
to
work
with
lcb
fiscal
to
address
any
revisions
to
the
budget.
C
Slide
31
e226
requests
funds
to
upgrade
and
maintain
security
cameras
throughout
the
snam's
campus
for
the
safety
of
client
staff
and
the
public
e-550
requests
funding
for
a
new
unit
dose
packager,
which
convul
converts
bulk
medication
into
unit
dose
dispensing
packaging
at
a
significant
reduction
in
medication,
cost
slide
32
e680
due
to
required
budget
reductions.
We
are
requesting
to
eliminate
snam
satellite
office
space
and
associated
operating
costs
at
3811,
west
charleston.
C
E
Started.
Thank
you
very
much,
madam
chair,
and
thank
you
for
that
information.
So
can
you
confirm
or
provide
me
with
those
acuity
levels
of
patience
and
associated
staffing
needs
at
the
ross
and
neil
hospital?
C
At
lisa
sherick
for
the
record,
so
I'm
I
am
not
entirely
clear
on
what
you're
asking,
but
I
will
say,
and
then,
if
there's
follow-up
when
it
comes
to
the
acuity
levels
of
our
hospital,
so
each
of
these
decision
units
are
our
outpatient
services
for
our
hospitals.
Acuity
is
really
based
on
each
individual
patient.
C
So
there's
not
like
a
basic
acuity
level
for
for
everyone
that
everyone's
like
a
one,
two
or
three
not
saying
it's.
Even
we
do
one
two
or
three,
but
it's
really
very
individualized,
based
on
their
symptoms,
their
presenting
status
when
they
come
into
the
hospital
as
they
progress
through
that
process.
E
Okay,
so
then,
how
did
the
agency
determine
that
holding
the
civil
inpatient
staff
positions
at
the
russ
and
neil
hospital
vacant
rather
than
the
positions
in
a
different
unit
or
program,
was
the
most
ideal
solution
to
meet
that
budgetary
issue?.
C
Lisa
sherick
for
the
record.
I
do
apologize.
I
I
misspoke
there
actually
were
two
psychiatric
nurse
positions
that
are
inpatient,
that
we
are
reducing
and
I'm
going
to
turn
it
over
to
miss
malay
for
additional
information.
F
Thank
you
for
the
question
jimily
for
the
record.
So
during
the
pandemic,
our
numbers
in
our
ers
had
decreased.
Initially,
although
we
do
see
them
starting
to
incline
again
in
the
ers,
we
do
have
our
mobile
crisis
units
out
there
continuing
to
work
with
the
emergency
room,
physicians
to
get
clients
into
the
right
treatment
venue
as
needed,
but
the
acute
is
all
the
same.
As
long
as
a
client
meets
the
criteria
for
a
mental
health
crisis,
they
are
admitted
to
our
hospital
or
involuntary
civil
commit.
So
that's
not
where
the
acuity
actually
lies.
F
They
just
have
to
meet
certain
criteria
for
us
and
so
the
elimination.
However,
specifically
of
those
two
psych
nurses,
we
have
a
30
vacancy
rate
in
our
psych
nurses
too,
in
the
south,
as
well
as
the
north.
Those
positions
are
a
little
bit
difficult
to
fill,
and
so,
for
those
reasons
we
those
were
put
up
for
reduction
with.
F
That
said,
though,
even
though
we
have
that
vacancy
now
that
the
pandemic
and
schools
are
starting
to
come
back
in
one
of
our
strong
recruitment
efforts
is
through
our
universities
and
our
nursing
and
our
medical
psychology.
All
those
disciplines
coming
back
into
our
hospitals
even
on
any
level
is
the
way
we
can
recruit
and
start
to
fill
those
vacancies
and
help
with
our
needs
and
our
hospitals.
H
So
my
questions
are
going
to
be
specific
to
the
justice
involved,
diversion
program,
the
gid
program,
and
thank
you
so
much
for
mentioning
on
the
record
that
you
folks
are
going
to
be
re-looking
at
your
data
and
rethinking
the
request
of
the
elimination
of
five
permanent
state
positions
in
this
budget.
I
appreciate
that
that
so
much
and
I'll
really
just
look
forward
to
those
ongoing
conversations.
H
We
know
that
that,
while
it
looks
like
we
only
serve
a
handful
of
not
a
handful,
relatively
speaking,
a
handful
of
clients
here
80
looks
like
82
between
the
period
of
2017
and
2020,
but
we
know
that
there's
going
to
be
some
data
cleanup
there
that
that
these
are
folks
who
bounce
between
mental
health
and
our
justice
programs.
These
are
our
million-dollar
murrays
right.
These
are
folks
who
cost
the
system
a
lot
of
money
if
we
are
not
otherwise
helping
to
case
manage
them.
H
H
Okay
and
then
the
same,
I'm
gonna
ask
staff
to
follow
up
with
the
same
conversation
that
we
had
on
the
northern
nevada
mental
health
budgets
regarding
the
federal
grant
money
into
the
hospitals
for
the
psychiatric
admissions
so
same
thing
about
which
hospitals
got
those
monies
how
those
dollars
were
used.
I
I'm
assuming
that
what
was
said
for.
H
Why
should
I
shouldn't
assume
that
I
guess
let
me
know
if
it
seemed
to
work
in
the
same
way
that
we
heard
you
testify
at
working
about
working
at
up
north
or
if
we
saw
different
outcomes
for
some
reason,
or
if
the
we
saw
differences
in
the
way
the
money
was
used
in
the
way
that
it
it
affected
the
outcomes,
and
we
don't
have
to
do
it
on
the
record
I'll.
Just
look
forward
to
all
of
us.
Reading
that.
D
Thank
you,
madam
chair,
and
it
was
just
a
follow-up
on
the
vacant
positions
and
from
the
earlier
presentation
we
had
62
vacancies
in
one
of
the
budgets
due
to
difficulty
in
recruiting
people
for
pay.
Is
that
the
experience
that
we're
having
with
these
positions
here?
I
know
you
talked
a
little
bit
about
recruitment,
but
were
we
having
problems
filling
those
positions.
F
D
So
as
as
these
persist,
is
there
any
thought
of
restructuring
the
pay
grade
or
moving
some
of
these
to
contract
positions
so
that
you
could
actually
lure
people
from
some
of
the
other
work
pool
to
fill
these
positions,
because
I
mean,
I
know
our
case
loads
are
down
now
and
they're
starting
to
creep
back
up.
I
would
anticipate
they're
going
to
go
back
up,
and
I
mean
this
is
these:
are
services
that
are
entirely
needed.
Any
thoughts
restructuring
the
workforce.
C
C
With
that,
though,
comes
more
money,
obviously
that
we
would
be
requesting
since
it's
general
fund,
but
we
do.
We
do
hire
many
individuals
on
contract
currently
when
we
can't
feel
them
in
the
positions.
But
but
we
do
lose
a
lot
of
people
that
initially
apply
and
then,
when
they
find
out
what
the
pay
is.
Even
if
we
are
able
to
consider
a
step
10,
they
still
often
turn
us
down
because
we're
just
not
competitive
to
the
private
sector
when
it
comes
to
that
hourly
wage.
F
C
Lisa
sherrick
for
the
record.
Typically,
no,
that
does
not
seem
to
be
an
issue.
A
Thank
you
for
the
question
and
just
a
follow-up
to
that.
We've
heard
in
a
number
of
budget
hearings.
The
contractors
positions
often
cost
us
more
than
an
fte.
Is
that
correct.
C
D
So
but
you
but
you
lose
or
you
you
save
some
realization
in
in
pers
and
other
health
benefits.
I
I
mean
I
I
know
my
wife
was
a
contract
employee
for
the
federal
government
and
they
they
saved
quite
a
bit
of
money
there
from
from
civil
service.
I
would
assume
that's
the
same
here
and
it
was
the
same
at
metro.
C
C
Lisa
sherick
for
the
record
that
that
maybe
that
may
be
accurate,
I
would
have
to
confirm
and
get
back
to
you
on
that.
I
do
know
if
I
can,
if
I
can
recall
correctly
and
I'll,
make
sure
that
we
provide
this
formally.
Also,
if
this
is
a
request,
is
when
we
look
at
even,
for
instance,
a
psychiatric,
our
psychiatrist
position
with
the
state.
C
C
So
I
think
if
we
did
the,
I
would
have
to
do
the
calculation
on
the
retirement
along
with
that
as
to
what
the
difference
would
be,
but
I
believe
there
still
is
a
lower
amount
and
then,
when
it
often
what
I
hear-
and
maybe
this
is
more
antidotal,
but
I
have
seen
this
as
well
as
I
have
worked
at
scams
myself.
I've
worked
at
namms
before
is
that
there
are
doctors
that
they
do
work
at
various
places,
so
they
only
they
don't
just
want.
You
know
want
to
work
for
the
state.
D
Right,
thank
you
for
the
indulgence,
the
extra
question
man,
I'm
sure,
thank
you.
H
Yeah,
I
just
want
to
make
sure
that
we're
adding
to
the
record,
because
we
also
did,
at
the
end
of
the
last
biennia,
have
an
audit
that
came
through
that
talked
specifically
about
our
contracted
positions
within
these
budgets
and
across
these
budgets
and
even
managing
those
those
contracts
and
managing
that
time
can
be
quite
difficult.
H
So
I
I
would
just
reference
any
members
who
want
to
go
back
to
read
that
and
the
division
did
a
lot
of
work
and
has
done
a
lot
of
work
once
that
audit
came
out
to
address
some
of
that.
But
but
I
I
would
hate
to
leave
it
on
the
record
that
we
don't
have
empirical
evidence
about
some
of
the
downfalls
when
we
rely
heavily
on
contracting
out
these
positions
and
these
clinical
positions.
C
A
Thank
you
both
for
getting
that
on
the
record
and
clarifying
that
information,
especially
for
new
members
on
the
committee
that
may
not
have
known
that.
I
appreciate
it
members
any
other
questions
on
this
final
budget.
A
All
right,
I'm
seeing
that
I'd
like
to
thank
you
for
joining
us
here
with
the
presentation
and
being
extremely
courteous
with
us
for
all
those
in-depth
conversations
and
questions
and
we'll
look
forward
to
the
additional
information
that
was
requested
from
committee
members
and
your
work
with
our
staff.
As
you
look
at
those
eliminating
positions.
A
So
thank
you
have
a
wonderful
remainder
of
your
day,
and
that
brings
us
to
the
last
agenda
item
and
that
will
be
public
comment
and
I
will
ask
our
bps
staff
to
see
if
we
have
anyone
in
our
waiting
room
for
a
public
comment.
B
K
S-T-E-P-H-A-N-I-E-G-O-O-D-M-A-N,
I'm
the
executive
director
of
the
dr
robert
hunter
international
problem
gambling
center
here
in
las
vegas.
Thank
you
for
this
time.
Over
the
past
year,
we've
stayed
physically
open
the
entire
duration
of
the
pandemic,
while
adhering
to
all
cdc
health
and
social
distancing
guidelines
for
many
of
our
clients,
we
were
their
only
outlet
and
a
space
where
they
could
receive
help,
and
they
are
also
very
grateful.
So
we're
just
grateful.
We
were
able
to
get
that
funding
during
the
special
session
and
we
have
put
it
to
great
use.
K
This
pandemic
is
unprecedented,
as
we
all
know,
and
we
don't
have
much
data,
but
we
do
anticipate
an
increased
attendance
as
the
world
gets
back
to
normal.
The
isolation
and
significant
life
change
brought
on
by
the
pandemic
has
had
a
detrimental
effect
on
all
of
us
and
surely
on
our
problem.
Gamblers
specific
to
that
point,
I
have
to
give
accolades
to
our
state
problem
gambling
program
specialists.
K
We
were
on
a
performance
review
call
and
in
real
time
we
all
pivoted
and
created
an
adjunct.
Relapse
prevention,
support
program,
our
former
clients
who
are
in
recovery
and
leading
successful
lives
have
felt
the
impact
of
the
pandemic
too.
They
have
not
relapsed,
but
they
have
thought
about
gambling
significantly
more
than
in
normal
times.
We
have
materials
created
by
our
founder,
dr
hunter,
and
we
use
those
to
implement
this
program
and
our
first
meeting
on
march
12th
was
so
well
attended.
We
may
need
to
open
in
a
second
session.
K
K
Finally,
I
believe
there's
a
dire
need
for
awareness
in
our
state
in
general,
rather
than
identifying
this
as
a
biological
condition
of
the
brain
individuals
think
something
is
personally
wrong
with
them
or
their
loved
one.
They
don't
understand
that
this
is
a
debilitating
and
real
addiction
that
lives
in
the
very
same
part
of
the
brain
as
alcohol
and
drug
addiction.
Only
through
awareness
and
the
continued
research
that
supports
that
awareness
will
we
get
to
a
point
where
this
addiction
is
not
viewed
upon
with
shame
and
coupled
with
a
terrible
stigma.
K
We
have
the
tools
to
help
individuals
and
give
them
a
path
to
a
productive
and
happy
life.
We
need
people
to
know
we
are
here
and
that
we
can
help.
This
is
nevada,
and
I
am
a
native
to
our
state.
Home
truly
does
mean
nevada
for
me,
and
I
firmly
believe
that
if
we
are
going
to
be
the
thought
leaders
in
gaming,
we
need
to
be
the
thought
leaders
in
problem
gambling
as
well.
Thank
you
for
your
time
and
have
a
great
day.
A
B
L
L
L
The
additional
impact
of
covid19
pandemic
in
nevada
has
led
to
increased
levels
of
stress,
anxiety
and
fear
due
to
financial
insecurity,
job
loss,
illness
and
loss
of
loved
ones.
These
are
the
exact
same
risk
factors
that
can
lead
to
gambling
addiction
with
nevada
already
having
one
of
the
highest
rates
in
the
u.s
and
problem
gambling
having
one
of
the
highest
suicide
rates
of
all
addictions.
L
People
who
may
only
have
been
at
moderate
risk
for
a
gambling
problem
may
now
be
using
gambling
as
a
coping
mechanism
and
may
experience
increasing
levels
of
harm
that
can
lead
to
significant
consequences.
Providing
public
awareness
of
this
risk
and
access
to
affordable
treatment
and
support
resources
is
vital
to
our
citizens.
L
Both
organizations
are
like-minded
in
our
mission
to
provide
effective
problem,
gambling
prevention,
education,
treatment
and
research
programs
throughout
nevada,
and
our
vision
is
to
improve
the
public
health
of
nevadans
through
a
sustainable
and
comprehensive
system
of
programs
and
services
that
reduce
the
impact
of
problem
gambling
most
humbly.
I
am
blessed
to
be
able
to
say
I
have
a
person
who
has
lived
experience
with
this
issue
having
just
this
january
celebrated
30
years
of
continuous
abstinence
and
recovery
from
my
own
gambling
disorder
problem
gambling
is
treatable
and
the
evidence
shows
that
treatment
works.
L
A
A
Thank
you
so
much
seeing
that
we
have
no
other
callers
for
public
comment
that
will
bring
us
to
the
end.
The
conclusion
of
this
meeting
and
I'd
like
to
thank
our
presenters,
our
committee
broadcast
staff,
the
members
of
this
committee
and
the
public
who
are
able
to
join
us
here
virtually
here
today
and
with
that.
This
meeting
is
adjourned,
and
I
wish
you
all
a
very
productive.