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From YouTube: 4/20/2021 - Assembly Ways and Means and Senate Finance, Subcommittees on Human Services
Description
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A
A
And
I
am
here:
if
you
will
mark
assemblyman
feyerson
president
when
he
arrives,
I
know
he'll
be
running
late.
All
other
members
are
present.
Today
we
will
be
having
budget
closings
for
the
department
of
human
health
and
human
services,
division
of
public
and
behavioral
health
if
the
building
is
on
limited
openings,
so
there's
still
a
number
of
people
joining
us
by
zoom
or
by
phone.
Please
know
that
there
will
be
public
comment
at
the
end
of
today's
meeting.
A
C
C
A
D
C
A
B
B
A
C
D
E
A
C
C
D
C
C
Thank
you.
The
second
major
decision
in
front
of
the
subcommittee
can
be
found
on
page
30
and
concerns
the
transfer
of
the
office
of
suicide
prevention,
inclusive
of
four
positions
to
this
budget
from
the
maternal
child
and
adolescent
services
budget,
the
transfer
is
hoped
to
increase
the
competitiveness
of
the
office
of
suicide
prevention
in
federal
grand
applications.
C
There's
a
technical
adjustment
to
the
recommended
action
portions
of
the
fund
to
support
the
office
of
suicide
prevention
were
by
mistake,
left
in
the
maternal
child
in
adolescent
soros
budget.
The
technical
adjustment
would
correct
this
to
ensure
that
the
office
of
suicide
prevention
is
transferred
in
its
entirety.
To
this
budget.
A
D
A
C
C
C
The
second
measure
concerns
budget
amendment
a
two
one:
five,
seven,
four,
three,
seven,
three
one:
seven
zero!
Excuse
me,
this
amendment
would
add
12.3
million
dollars
in
federal
substance,
abuse
prevention
and
treatment,
and
community
mental
health
services
block
grant
covet
19
emergency
relief
funds
in
fiscal
year
2022
and
8.7
million
in
2023.
C
A
F
G
Stephanie
woodard
for
the
record
just
to
clarify
the
question:
are
you
speaking
of
the
emergency
covid19
grant
or
the
mental
health
and
substance
abuse
block
grants.
G
No
problem,
so
the
covid,
the
er
covid
19,
grant.
We
are
continuing
to
do
a
lot
of
the
work
that
was
initiated
in
the
original
grant.
As
noted
in
previous
testimony,
the
need
for
the
services
that
were
first
funded
under
the
covid19
grant
has
actually
exceeded
what
was
anticipated
and
some
of
those
subordies
were
actually
running
out
of
grant
funds
far
sooner
than
we
had
anticipated.
G
G
G
There
are
some
positions
that
are
funded
through
this
grant,
including
those
that
are
necessary
in
order
to
be
able
to
properly
administer
the
grant.
G
A
Yes,
assemblywoman
titus.
B
Thank
you,
madam
chair.
Dr
wader.
Do
we
have
any
more
actually
positions
or
providers
that
have
been
employed
to
for
in
some
of
these
positions
for
access
and
wait
times
on
some
of
these
mental
health
issues?
Is
any
of
this
funding
going
so
towards
that.
G
Stephanie
woodard
for
the
record.
Yes,
actually.
What
we
have
seen
with
the
funding
in
both
northern
and
southern
nevada
is
that
we
have
been
able
to
provide
some
diversion
from
emergency
rooms
where
we
know
that
individuals,
on
average,
about
90
individuals
on
any
given
day,
are
waiting
for
inpatient
stays
for
psychiatric
care
by
providing
the
crisis
triage,
as
well
as
supplemental
funding
for
inpatient.
C
G
Actually
referred
to
that
level
of
care
so
and-
and
they
are
working,
these
hospitals
are
working
really
across
the
networks
in
their
region
to
make
sure
that
where
there
are
open
beds
available,
those
individuals
are
able
to
access
that
care.
Knowing
that
there
is
additional
funding
for
care
in
the
hospitals
that
have
been
funded
for
uninsured
and
underinsured
individuals.
D
B
Madam
chair
go
ahead
so
that
that's
excellent
news
are
we
seeing
we
knew
that
we
saw
certainly
an
uptick
in
mental
health
concerns
with
this
pandemic.
Are
we
beginning
to
see
that
level
off?
Are
you
still
seeing
the
the
increasing
that
we
we
had
saw
at
the
start
of
this
pandemic.
G
Thank
you,
chair
through
you
to
assembly
women,
titus
and
stephanie
woodard
for
the
record,
we're
actually
continuing
to
see
a
need
for
behavioral
health
services
throughout
the
continuum
of
care
and
really
throughout
the
state.
As
I
have
presented
to
this
committee
and
other
committees
before
typically
following
major
disasters,
we
don't
see
the
surge
in
behavioral
health
need
until
approximately
12
to
18
months
after
the
onset
of
the
event.
G
However,
the
longer
that
a
disaster
is
prolonged,
as
well
as
some
of
the
other
secondary
and
tertiary
issues,
such
as
financial
instability
and
housing,
instability
and
the
like,
can
add
to
a
breakdown
of
those
coping
strategies
over
the
course
of
time,
leading
more
and
more
individuals
needing
that
behavioral
health
support.
We've
been
very
fortunate
that
we've
had
the
crisis,
counseling
assistance
in
training
program
through
fema
and
samsa.
D
D
How
does
that
overlay
with
the
other
community-wide
crisis,
stabilization
efforts
that
we've
been
working
on
with
the
crisis
now
model,
I'm
not
familiar
with
signature,
healthcare
services
or,
if
I
am
I'm
not
remembering
that
I'm
familiar
so
in
the
north?
Who
is
that?
Where
do
they
live
just
help
me
connect
the
dots
please.
G
Sure,
stephanie
woodard
for
the
record,
threw
you
chair
to
senator
ratty.
This
would
be
desert
parkway,
a
hospital
down
in
clark,
county
and
reno
behavioral
health
up
in
reno.
Both
of
these
hospitals
were
actively
engaged
in
providing
24
7
psychiatric
triage
care.
G
So
when
we
had
discussed
with
them
really
the
need
for
the
continued
services,
as
well
as
expansion,
to
help
to
offset
the
cust
the
cost
of
uncompensated
care,
it
was
really
a
natural
fit
and
actually
I
think
it
speaks
directly
to
a
lot
of
the
work
that
we've
been
working
on
related
to
crisis
stabilization
services.
D
And
so
how
are
they
getting
for
in
the
in
the
north,
for
example?
Just
because
I'm
more
familiar
with
that
one?
What
is
the
process
for
that
person
who's
in
crisis
out
in
the
community
to
get
connected
to
reno
behavioral
health?
Are
they
going
through
the
crisis
call
service
now,
or
is
it
law
enforcement,
or
how
are
we
bypassing
the
emergency
room
in
that
particular
model?.
G
Through
you,
chair
to
senator
ratty
stephanie
woodard
for
the
record,
it's
really
all
of
the
above,
so
they
have
had
a
24
7
psychiatric
triage
telephone
line
for
quite
some
time
to
assist
individuals
in
navigating
to
their
front
door
for
psychiatric
triage
they're,
also
being
referred.
Individuals
directly
from
the
crisis,
support
services
of
nevada,
as
well
as
from
emergency
rooms.
I
do
believe
that
they
do
some
law
enforcement
drop-offs.
G
This
funding
really
was
to
help
to
expand
what
it
was
that
they
were
already
doing,
recognizing
that
it
was
the
uncompensated
care
piece
that
really
needed
to
be
addressed
so
that
anyone
in
crisis
could
be
served
in
an
alternative
setting
versus
the
emergency
room.
D
B
B
G
So
stephanie
woodard
for
the
record,
through
you,
chair
to
assemblywoman
tolls
in
northern
nevada
and
in
southern
nevada,
we're
really
seeing
that
it's
not
any
one
solution,
that's
contributing
to
some
of
the
lessened
numbers
of
individuals,
waiting
for
emergency
or
waiting
for
inpatient
beds
through
emergency
rooms.
So,
in
addition
to
the
psychiatric
triage
that
we
have
up
in
northern
nevada,
a
renowned
hospital
who
has
seen
really
the
largest
number
of
individuals
waiting
for
inpatient
has
also
simultaneous
to
this
as
started
an
alert
team
through
their
emergency
room.
G
So
it's
a
multidisciplinary
team
that
really
works
to
provide
intensive
case
management
and
assessment
to
individuals
with
behavioral
health
issues
that
are
coming
to
their
emergency
rooms.
They
have
found
that
this
has
reduced
the
number
of
individuals
that
are
waiting
for
inpatient
beds
because
they
are
getting
that
psychiatric
evaluation
up
front
and
then
the
team
is
working
with
regional
hospitals
to
be
able
to
ensure
that
if
someone
meets
that
level
of
care,
that
transfer
of
care
can
be
expedited
as
quickly
as
possible
down
in
southern
nevada.
G
The
relationship
that
the
crisis
response
team
through
las
vegas
fire
and
rescue
has
had
with
desert
parkway
has
been
long-standing,
so
oftentimes
when
the
crt
team
is
working
with
someone
who's
in
a
behavioral
health
crisis.
They
do
the
transport
to
desert
parkway
prior
to
these
grant
funds
being
available.
G
That
was
at
a
significant
cost
to
desert
parkway
because
they
were
taking
all
individuals
that
were
being
dropped
off
by
the
crt
team.
So
this
is
helping
to
supplement
some
of
that
cost.
There
are
a
lot
of
other
hospitals
down
in
southern
nevada
that
are
very
interested
in
being
able
to
provide
similar
services
recognizing
the
need
in
the
community,
as
well
as
some
of
the
pretty
significant
cost
offsets
that
there
could
be,
especially
for
those
hospitals
that
also
run
emergency
rooms.
G
So
I
I
would
say
assemblyman
told
us
that
it's
not
just
this
program,
but
I
think
it's
a
number
of
different
programs
as
well
as
the
community
really
coming
in
alongside
and
supporting
efforts
around,
ensuring
that
individuals
are
in
who
are
in
crisis,
are
receiving
the
most
appropriate
care.
H
So
much,
and
so
if
I
remember
right
when
we
were
having
this
conversation
on
the
first
hearing
back
in
on
march
16th,
this
is
the
program
we
were
talking
about
where,
because
we
have
this
this,
this
chunk
of
grant
dollars
we're
able
to
pay
the
provider
who
are
taking
these
people
their
full
rates
right.
So
if
we're
probably
gonna
see
good
numbers,
we're
probably
gonna
see
things
working
right
now,
because
we've
got
these
federal
dollars,
but
once
these
grants
expire,
just
like
the
last
grant
did
once
these
grants
expire,
we
don't
have
them
again.
H
Then
we
just
go
back
to
the
medicaid
rates,
which
we
know
the
providers
aren't
willing
to
take.
So
we
should
enjoy
this
while
we
have
it
and
hope
that
maybe
some
more
of
these
grant
dollars
come
through,
but
otherwise
we
know
that
we
go
back
to
the
same
old
song
and
dance,
which
is
our
typical
medicaid
rates.
These
providers
that
you're
mentioning
in
the
north
and
south
they're-
not
they
don't
they
don't
accept
these
patients
at
the
regular
medicaid
rate.
A
G
G
Thank
you
so
through
your
chair
to
assemblywoman
benitez
thompson
just
to
follow
up
on
that,
I
do
think
that
it's
important
two
things
to
to
call
out
here.
The
first
is
that
for
the
inpatient
rates
we
actually
are
matching
the
medicaid
rate,
because
we
did
not
want
to
artificially
inflate
what
in
an
individual
hospital
was
getting
and
we
would
really
have
no
basis
for
establishing
that
rate,
so
we
are
paying
them
the
a
fee
for
service
rate
for
those
beds.
G
But
the
second
thing
that
I
want
to
just
mention
is
that
the
opportunities
to
expand
access
to
inpatient
beds
do
exist
through
1115
demonstration
waivers.
There
is
a
demonstration
waiver
that
states
can
apply
for
and
a
handful
of
states
have
applied
for
and
have
been
funded,
which
removes
the
imd
exclusion.
G
So
in
a
state
like
nevada,
where
we
really
have
this
hybrid
system,
where
a
significant
portion
of
our
population
is
covered
by
managed
care,
but
another
portion
is
covered
by
fee
for
service
because
we
have
so
few
non-imds
in
the
state.
We
really
lack
access
to
care
for
those
individuals
who
are
fee
for
service.
H
No,
no
thank
you.
I
just.
I
think
that
when
we
we
have
these
conversations,
it's
it's
never
about
a
willingness
necessarily
to
do
it.
We've
been
working
on
different
pieces
of
this
puzzle
for
years
to
try
to
get
to
a
place
where
we
could
even
have
talk
about
diversions
from
er
and
who
can
transport
for
diversions
to
er
and
all
of
that.
H
But
I
think
that
that
I
I
think
I
heard
something
a
little
bit
different
than
what
I've
experienced
with
the
inpatient
and
the
medicaid
rates
in
those
folks
who
take
the
inpatient
medicaid
rate.
But
if
there's
a
trend
change
out
there,
then
that's.
D
I
would
recommend
the
approval
of
decision
decision
unit
e
490,
with
the
noted
technical
adjustment
in
fiscal
year,
2022
to
increase
samsokova
19,
grant
authority
to
2.1
million
to
include
a
recent
supplemental
grant
award
with
the
grant
being
eliminated
in
fiscal
year
2023
and
the
recommended
budget.
D
Amendment
eight
two
one:
five:
seven:
four:
three
one:
seven:
zero,
which
adds
12.3
million
in
federal,
sapta
and
cmhs;
corona
coronavirus
relief
funds
to
this
budget
in
fiscal
year,
2022
and
8.7
million
in
fiscal
year
2023,
and
would
extend
my
gratitude
to
the
staff
for
all
of
the
extra
coveted
relief
programs
and
work.
That's
been
done
over
the
last
year.
A
C
C
D
A
C
C
The
executive
budget
recommends
reducing
contracted
psychiatric
services
and
substituting
general
funds
with
medicaid
reimbursement
revenues
for
general
fund
reductions
of
1.2
million
over
the
2021-23
biennium.
During
the
march
16th
hearing,
the
agency
stated
that
the
recommended
reductions
would
not
result
in
any
service
reductions.
E
I
just
think
it's
really
important
to
put
on
the
record
that
it's
been
indicated
by
the
agency
that
this
particular
recommendation
should
not
have
any
direct
effects
on
the
service
levels,
because
the
there's
some
savings
that
has
been
allocated
to
some
of
this
over
the
years
so
hope
we
would
have
a
much
deeper
conversation
if
we
thought
that
this
was
going
to
impact
service
levels.
But
it's
been
indicated
that
it
will
not.
I
just
thought
it
would.
E
A
C
There
are
a
number
of
other
closing
items
which
is
subsequently
fined
on
page
19..
Other
closing
item
number
seven
is
a
technical
adjustment
to
the
base
budget.
It
consists
of
revenue
offsets
higher
than
initially
projected
non-general
fund
revenues
result
in
general
fund
reductions
of
240
584
dollars
in
fiscal
year,
2022
and
lower
than
initially
expected.
Non-General
fund
revenues
in
general
fund
increases
of
fifty
nine
thousand
dollars,
fifty
nine
thousand
and
three
dollars
in
fiscal
year.
2023.
C
A
Motion
is
second
by
simple
woman.
Carlton
any
discussion
on
emotion,
all
in
favor
say
aye
aye
any
opposed
motion
carries
moving
now.
C
C
C
C
E
Thank
you,
madam
chair,
and
in
going
over
this
and
trying
to
evaluate
where
we
are
we.
We
know
there
have
been
issues
with
the
cblas
and
it's
a
number
of
them
are
not
operating
any
longer
for
for
multiple
reasons,
not
for
any
particular
one
in
looking
at
the
reduction
in
the
first
year
of
389
thousand
and
399.
E
C
Chair
for
you
to
71
carlton
the
reduced,
the
the
amount
would
be
reduced
in
fiscal
year,
2022
to
693
139
000
for
cbla
homes.
E
C
E
E
E
So
it's
a
two-year
biennium.
They
have
the
money
the
first
year.
They
can
draw
the
money
down
the
second
year
if
they
would
need
to,
and
if
we
did
not
approve
the
addition
of
the
389
000
and
399,
they
could
submit
a
work
program
if
the
funds
were
needed.
If
these
cbla
homes
come
back
to
ifc,
to
be
able
to
pull
those
dollars
down,
we
wouldn't
necessarily
need
to
put
it
in
a
restricted
fund.
It
would
just
be
available,
as
any
other
work
program
would
be
if
caseload
increased.
Is
that
correct.
E
C
E
Thank
you,
and
I
appreciate
that,
and
you
know
we
all
want
to
support
these
funds,
and
I
have
no
idea
where
anybody
else
on
this
committee
is
on
this
one,
but
I'm
just
looking
at
some
of
the
others.
Knowing
that
you
know,
there's
a
lot
of
gives
and
takes
in
a
lot
of
these
budgets
and
we're
gonna
probably
run
into
a
couple
that
are
gonna,
be
three
four
five
hundred
thousand
dollars
more
than
what
we
originally
thought.
So
I'm
just
trying
to
think
ahead
and
think.
E
Where
can
we
possibly
set
a
few
dollars
aside
as
we
move
through
all
these,
so
that
when
we
get
to
the
very
end
we
can
get
there?
I
just
wanted
to
make
sure
that
we
had
a
thorough
conversation
about
it
and
everyone
understood
exactly
where
we
were
going
with
that.
So,
madam
chair,
thank
thank
you
for
the
latitude
to
have
a
full
discussion.
D
Thank
you-
and
I
do
think
this
is
this
one's
unusual-
how
it's
been
budgeted,
we've
seen
a
lot
of
like
holding
something
vacant
in
the
first
year
and
then
going
to
the
second
year
and
having
it
increased,
but
this
one's
a
little
bit
different.
So
I
know
that
the
cblas
have
been
through
quite
a
journey,
and
so
I
would
like
to
hear
from
staff
why
the
lower
number
in
the
first
year
and
then
why
the
do
you
have
confidence
that
those
services
would
be
available
in
the
second
year.
D
D
Sheriff
I'm
sorry
well,
whoever
has
the
best
information
on
the
community-based
living
arrangements
from
the
agency.
Yes,
sorry.
F
Good
morning,
lisa
sheriff
for
the
record.
Yes,
we
are
confident
that
we
will
be
able
to
maintain
the
services
through
fy22.
D
F
Elisa
sherick
for
the
record,
so
we
can
always
use
more
cblas.
I
I
think
that's
a
fact
that
we
can
realize
throughout
the
state,
while
we
are
able
to
maintain
the
current
individuals
in
services
right
now,
there
is
always
the
potential
that
there
will
be
additional
people
looking
for
services
in
the
coming
years.
A
Thank
you
so
much
for
that
answer,
but
I'm
going
to
ask
you
to
go
into
a
little
bit
more
depth.
There
were
a
lot
of
shoulders
would
be.
Hopefully
it's
going
to
happen
kind
of
thing.
We're
looking
at
one
point:
well
a
million
dollars
in
that
second
year.
I
Good
morning,
joe
malay
for
for
the
record,
chair
and
committee,
so
when
our
cblas
in
northern
nevada
have
seen
a
decrease
in
our
caseload,
I
I
did
want
to
point
out
that
you
do
need
to
be
in
the
services
with
nams
in
order
to
get
into
cbla
homes,
and
we
have
seen
a
decrease
in
our
caseloads
there
at
northern
nevada
facilities
with
that
said,
though,
we
fortunately
will
not
displace
anyone.
In
fy
22
we've
been
working
really
hard
communicating
with
those
providers.
I
A
Questions
it
does
senator
reddy.
D
D
F
Lisa
sherick
for
the
record.
I
don't
have
the
specific
answer
of
where
that
person
would
go.
However,
we
would
work
with
the
community
to
see
what
options
would
be
available.
I
believe
in
the
behavioral
health
budget
presentation
on
the
16th.
D
F
E
Thank
you
so,
and
thank
you
for
the
follow-up,
madam
chair,
so
in
the
conversation
that
we
just
had
about
possibly
seven
to
nine
folks,
not
having
placement
is
that
placement
is
that
lack
of
placement
due
to
no
beds
available,
or
is
it
due
to
funding,
because
it's
my
understanding,
you
can
pull
the
second
year
down
into
the
first
year.
So
funding
should
not
be
the
issue.
The
issue
is
actually
that
there
are
no
beds
available.
Is
that
correct,
or
did
I
misunderstand.
B
E
Could
do
that
so
that
may
be
where
I'm
misunderstanding
it
and
then
was
part
of
the
conversation
earlier
with
staff.
So,
madam
chair,
if
that's
one
of
the
options
we
would
need
to
use,
but
the
question
actually
was
and-
and
thank
you
for
clarifying
that,
but
the
question
actually
was:
is
there
if
there
were
funds
available,
is
there
a
placement
available?
I
We
do
have
some
limited
sorry,
I'm
hearing
feedback.
My
apologies,
we
do
have
some
limited
bed
availability.
We
do
not
have
funding.
E
J
J
J
However,
if
the
subcommittee
chose
or
had
a
desire
to
make,
that
recommendation
to
the
full
committee
and
the
full
committees
approved
to
include
this
budget
account
in
that
section
of
the
back
language
that
would
allow
this
budget
to
have
the
authority
then
to
transfer
funds
between
fiscal
years.
As
you
described
with
the
approval
of
the
interim
finance
committee
and
upon
recommendation
of
the
governor.
E
And-
and
thank
you,
madam
chair,
and
thank
you,
mr
leiser,
for
for
making
it
very
clear
it's
hard
to
remember
which
ones
are
allowed
and
which
ones
aren't.
But
I
firmly
believe
that
any
time
you're
dealing
with
people
and
caseloads-
and
you
never
know
where
you're
going
to
be
and
because
of
the
way
we
do
our
budgeting
over
a
two-year
period.
E
We
want
to
make
sure
that
someone
isn't
left
out
in
the
cold
in
june,
just
because
it's
not
the
first
of
july
that
there
are
dollars
waiting
there
and
we
can't
do
anything
for
them
simply
because
the
calendar
isn't
working
for
them.
So
I
would
suggest
to
the
committee
that
in
this
particular
case,
because
this
is
real
people
who
are
being
impacted-
it's
not
just
a
paper
money
change
that
we
have
a
discussion
about
allowing
the
dollars
from
the
second
year
to
be
drawn
down
into
the
first
year.
E
E
A
K
Thank
you,
madam
chair.
So
mr
leiser
is
it
generally
when
we
authorize
those
transfers
in
the
appropriations
act,
it's
budget
account
specific
right,
so
you'd
be
looking
at
potentially
adding
it
for
3162
as
an
entire
account
or
specifically
for
this
expenditure.
Category.
J
For
the
record,
brodie
lizard
fiscal
analysis
division,
madam
chair,
through
you
to
senator
keith
keffer
the.
I
believe
that
the
section
of
the
bill
that
I'm
looking
at
is
budget
account
specific,
and
so
yes,
this
would,
if
consideration
was
given.
This
would
add
the
budget
account
to
that
section.
K
Thank
you,
mr
elijah.
I
appreciate
that.
I
just
madam
chair,
I'm
a
little
nervous
about
providing
that
authority
for
the
entire
budget
account
knowing
how
big
it
is
right,
we're
running
a
hospital,
we're
running
clba's,
we're
running
jobs
in
daytrade
or
maybe
not
jdt,
but
there's
a
lot
in
this
budget,
so
I
mean
basically
we'd
be
if
we
were
to
do
it.
I
would
worry
that
we're
creating
basically
a.
D
A
Thank
you
that
can
be
an
offline
conversation
with
you
and
fiscal
staff
to
get
the
answers
to
those
questions.
So
any
other
discussion
on
this
item
before
I
call
for
the
motion
and.
E
Madame
sheriff
I
mean
I,
I
think
senator
kitkapper
brought
up
a
very
good
point.
I
was
strictly
focused
on
this
particular
issue,
because
this
is
you
know,
dealing
with
these
folks
and
being
able
to
have
the
resources
to
address
them
and
not
have
the
calendar
work
again.
Them,
I
think,
is
very,
very,
very
positive.
E
I
understand
where
he's
coming
from,
I'm
not
going
to
open
that
barn
door
on
my
way
out
of
this
building,
so
that
would
that
would
be
a
mess
for
the
folks
behind
us
to
have
to
try
to
close
that
door
again.
D
E
Madam
sheriff,
I
may
it's
much
easier
for
staff
if
we
do
the
work
here
in
the
subcommittee
budget
closings
and
that
way,
when
it's
reported
to
full
committee,
there's
less
work
to
be
done
at
the
full
committee
level.
We
will
just
receive
the
report
from
the
subcommittee.
We
would
agree
and
move
forward.
Otherwise,
if
we
leave
it
for
that
second
step,
it
makes
that
second
step
a
little
bit
longer.
So
if
we
can
address
it
today
and
everyone's
comfortable
with
it,
that
just
makes
things
smoother
when
we
hit
crunch
time.
D
J
For
the
record,
brodylizer
fiscal
analysis
division
as
the
language
currently
exists.
Yes,
it
does
require
ifc
approval,
and
so,
as
I
understand
this
senator
ready-
and
if
this
helps
with
with
the
potential
motion,
the
the
recommendation
would
be
to
recommend
the
reductions
in
general
fund
appropriations
of
the
three
hundred
and
eighty
nine
thousand
three
hundred
ninety
nine
dollars
for
the
community
based
living
arrangement
program
in
fiscal
year.
J
Twenty
twenty
two
and
that
the
subcommittee
recommends
the
inclusion
of
back
language
that
allows
for
transfers
between
fiscal
years
in
the
northern
nevada,
adult
mental
health
services
budget,
specifically
for
the
purposes
of
community-based
living
arrangement.
Services
upon
approval
from
the
interim
finance
committee
and
upon
the
recommendation
of
the
governor.
D
A
Second,
it's
been
moved
by
senator
ratty
and
second
by
assemblywoman
carlton
the
motion
as
detailed
by
fiscal
staff.
Any
discussion
on
the
motion
see
none
all
in
favor
of
the
motion
say
aye
any
opposed
motion
passes.
Moving
on.
C
Christendom
fiscal
analysis,
division
for
the
record.
The
second
major
decision
concerns
caseload
projection
based
staffing
reductions
in
the
closing
package
from
page
23
on
caseload
projection
are
usually
updated
in
march
during
legislative
session
to
allow
for
the
inclusion
of
recent
data
january
21
and
february
21
caseloads
for
as
accurate
as
possible
case
law
projections.
C
During
the
march
16th
hearing,
however,
the
agency
indicated
the
need
for
thorough
revision
of
its
caseload
analysis.
Beyond
the
usual
data
update
caseload
data
for
some
outpatient
programs
had,
according
to
the
agency
not
been
reported
correctly
in
the
past
concerning
improve
approved
staff,
patient
ratios,
with
the
effect
that
some
programs
were
effectively
overstaffed
and
others
understaffed.
C
C
C
Right
next
to
this
column
is
a
column
entitled
revised
agency
recommendation,
which
includes
the
adjust
case
of
driven
position.
Eliminations
based
on
the
march
29
caseload
analysis
revisions,
whereas
the
executive
budget
recommended
eliminating
4.02
full-time
equivalent
positions.
The
technical
adjustment
based
on
the
revised
caseload
analysis
before
the
committee
would
eliminate
5.02
positions.
H
A
quick
observation,
I
think
we
from
my
notes
had
some
conversations
about
it
during
the
subcommittee
hearings,
but
I
think
the
numbers
have
on
the
medication
clinic
have
changed
just
a
little
bit
since
that
march.
16Th
hearing
and
drop
flour.
So
just
noting
for
the
record
the
difference
in
the
downward
trend
for
our
northern
nevada
medication
clinics.
H
But
then
in
the
south
we
see
the
the
exact
opposite
happening,
kind
of
a
steeper
upward
trend,
and
I
don't
know
if,
if
data
can
tell
us
any
reason,
why
more
about
that
or
I'm
sure
it's
a
number
of
different
reasons.
But
just
noting
it
for
the
record
is
something
for
us
to
keep
our
eye
on.
H
Madam
chairwoman,
if
it's
okay,
I
just
wanted
to
note
it
for
the
record
as
kind
of
more
something
to
just
to
mindfulness,
to
to
watch
as
we
watch
these
trends.
I
don't
know
if
it's
a
one-off,
I
don't
know
if
there
are
server
provider
issues
or
other
things
happening
respective
to
the
community.
The
population
tends
to
be
the
population,
so
I
don't.
I
don't
know
that
it's
maybe
there.
I
think
on
this,
though
I
did
want
to
just
make
one
other
comment
I
had,
and
it
was
with
the
staffing.
H
So
of
course
really
I'm
glad
that
there's
been
a
look
at
the
staffing
and
the
positions
that
are
needed.
I
think
the
one
thing
that
I
wanted
to
put
on
the
record
and
hear
from
the
division
was
just
a
little
bit
more
on
if
we
are
we're
doing
a
reduction
in
some
of
these
positions
like
the
psychologist
one
or
the
psychiatric
caseworker
too,
with
projected
average
caseload
in
2023
being
about
66
people
and
the
staffing
ratio
now
being
1-35.
H
I
think
that
means
that
there
will
just
be
one
or
two
people
in
any
of
these
positions
and
so
wanted
to
know
if,
if
that
was
going
to
be
sufficient
just
for
for
coverage
for
people
taking
time
off,
if
you're,
the
the
only
psychologist,
that's
there
do
you.
You
know
how.
How
does
that
work
for
meeting
patient
needs
when
you
just
have
a
staff
of
one
or
two,
or
is
there
more
flexibility
that
we
should?
We
should
know
about
and
have
on
the
record
to
help
us
keep
in
mind
covering
patient
needs.
I
Good
morning,
joe
malay
for
the
record,
thank
you
for
that
question.
And
yes,
the
both
physicians
actually
have
some
flexibility.
When
we
looked
at
a
particular
psychiatric
caseworker,
those
are
unlicensed
positions,
but
they
do
have
flexibility
to
move
without
programs.
I
When
we
looked
at
the
reductions
for
the
caseload,
particularly
in
fy
23,
we
did
round
down
so
that
we
could
have
a
little
bit
more
coverage
of
psychiatric
caseworkers
for
any
kind
of
unexpected
absences
to
meet
that
caseload,
so
that
that
did
help
us.
The
psychologist
is
very
flexible,
as
well
mostly
seen
in
counseling
services,
and
we
did
see
a
slight
decrease
in
that.
A
C
Christian
tower
fiscal
analysis,
division
for
the
record
on
page
25
subpoena
will
find
other
items.
Other
closing
item
number
eight
has
a
technical
adjustment
to
an
agency,
specific
inflation
factor.
Other
closing
item
number:
nine
is
a
technical
adjustment
to
the
base
budget
based
on
updated
revenue.
Projections
for
non-general
fund
revenue
resources
in
this
budget
for
the
2123
biennium
fiscal
staff
recommends
revenue
offsets
resulting
in
general
fund
reductions
of
433
982
in
fiscal
year
2022
and
400
035
435
000
2
in
fiscal
year.
2023.
K
Thank
you
ma'am
sure.
I
apologize
mr
tower
what
the
transfer
of
the
senior
physician
to
de
hickfap
I'm
sure
it
was
presented,
and
I'm
sure
I
just
forgot.
What
is
that
position?
Why
is
it
moving
over
to
medicaid.
C
D
I'd
make
a
motion
to
recommend
other
closing
items,
one
through
seven.
The
closed
is
recommended
by
the
governor.
Other
closing
item
eight
be
closed
with
no
to
technical
adjustments.
Other
closing
item
nine,
because
as
a
technical
adjustment
and
request
authority
for
staff
to
make
other
technical
adjustments
as
necessary.
A
C
C
C
The
subcommittee
will
find
again
a
table
summarizing
the
results
of
the
revised
caseload
analysis.
As
concerns
position,
eliminations,
the
executive
budget
recommends
the
elimination
of
five
positions
to
account
for
projected
decrease
in
caseloads
in
the
justice
involved.
Diversion
program
resulting
in
general
fund
reductions
of
nine
hundred
three
thousand
seven
hundred
fifty
six
dollars
over
the
upcoming
biennium.
C
The
revised
caseload
analysis,
as
of
march
29th,
found
that
large
and
by
the
justice
involved
diversion
program
is
actually
not
decreasing
but
increasing
caseloads.
However,
there
were
also
individual
programs
that
were
due
to
staff
patient
ratio.
Arrows
overstaffed,
resulting
in
total,
is
the
need
for
2.0
full-time,
equivalent
position.
Eliminations
the
difference
between
the
executive
budget
and
the
adjustments
based
on
march
29
revisions
is
thus
that,
whereas
the
executive
budget
recommended
the
elimination
of
five
positions,
the
adjustment
recommends
elimination
of
two
positions
in
dollars.
This
different
at
up
to
566
377
over
the
biennium.
A
B
C
C
C
Does
the
subcommittee
wish
to
recommend
approving
the
addition
of
four
positions
and
580
6990
in
general
fund
appropriation
dollars
to
the
medication
clinic
program
in
fiscal
year
2023
and
then,
given
the
uncertainty
concerning
case
law
projection
in
fiscal
year,
23
the
if
the
chair
wishes
to
do
so.
The
subcommittee
could
consider
if
the
subcommittee
wishes
to
approve
the
addition
of
580
690
dollars
to
fund
four
new
positions,
but
if
it
prefers
to
wait
until
additional
caseload
experience
demonstrates
whether
all
or
just
one
or
two
of
the
positions
are
warranted.
J
Thank
you,
madam
chair,
for
the
record
brodylizer
fiscal
analysis.
Division
just
like
to
acknowledge
the
work
that
mr
tower
has
been
been
doing
and
thank
him
and
the
agency
staff,
as
well
as
the
governor's
finance
office,
to
work
through
a
number
of
these
caseload
items
that
you've
heard
about
today.
J
So,
madam
chair,
the
subcommittee
may
wish
to
approve
the
decision
point
as
presented
in
your
closing
document
on
page
33,
not
approve
the
decision.
Point
that's
presented
in
your
closing
document
or,
alternatively,
the
subcommittee
could
defer
the
decision
point
to
the
full
committees.
When
staff
presents
the
subcommittee's
recommendation
for
the
division
of
public
and
behavioral.
E
So,
mr
lizer,
it's
so
if
I'm
understanding
you
correctly,
some
work
was
done
on
caseload
adjustments
and
we
got
numbers
that
we
thought
would
substantiate
this,
but
there's
a
a
bit
of
a
disagreement
on
actual
caseload
right
now.
Am
I
understanding
you
correctly
or
if
you
could
just
kind
of
restate
it?
I
I
missed
a
couple
pieces
there.
I
think
I
just
want
to
make
sure
that
I
have
a
full
understanding
of
which,
what's
actually
being
requested
of
us
by
the
gfo.
J
My
understanding
is
based
on
the
limited
information
I
have
is
that
the
governor's
finance
office
believes
that
this
is
may
represent
a
new
approach
with
this
caseload
decision
in
terms
of
the
staffing
ratios
as
compared
to
a
technical
correction
or
a
correction
to
an
error
in
the
existing
approach
and
as
such.
J
K
K
J
J
J
A
H
One
is
where
we
actually
have
the
reference
to
the
ratio,
I
think
of
1
to
35,
and
so
I,
if
we're,
if
we're
gonna,
if
we've
got,
I
guess
issues
with
the
ratio,
then
we're
probably
gonna
have
it
in
in
at
least
our
northern
nevada
budgets
as
well.
H
I
would
imagine,
although
the
one
there
led
to
the
elimination
of
six
and
this
one's
leading
to
the
addition
of
four
and
then
once
again
going
back
to
that
reference
of
we
see
a
decline
in
one
place
of
a
patient
utilization
of
the
clinic
and
then
increase
in
another
place
of
the
patient
utilization
of
the
clinic.
But
I
don't
know
if
we
need
to
take
into
consideration
it
wouldn't
not.
H
A
Well,
members,
in
light
of
the
additional
information
we
received
this
morning
and
the
discussion
that
we
have
just
had
on
this
budget
closing
item,
I
would
move
for
a
motion
to
defer
this
to
the
full
committee
so
that
our
fiscal
staff
has
an
opportunity
to
have
a
discussion
with
gfo
and
as
a
full
committee.
We
can
make
the
decision
at
that
time.
D
A
E
A
Thank
you.
Any
other
comments
see
none.
All
in
favor
of
the
motion
say
aye
any
opposed
motion
carries
moving
on.
C
The
subcommittee
we
find
major
decision
number
three
on
page
34
of
the
closing
package
concerns
office,
space,
elimination
for
general
fund
reductions.
The
executive
budget
recommends
office
space
eliminations
for
general
fund
reductions
of
76
871
dollars
in
fiscal
year,
2022
and
78
987
dollars
in
fiscal
year
2023.
C
C
D
A
C
C
C
I
will
pause
following
my
presentation
of
each
budget
to
allow
for
questions
when
I
have
presented
the
last
budget
in
this
group,
and
questions
have
been
addressed.
The
chair
may
wish
to
ask
for
a
single
motion
for
closing
consideration
on
all
of
the
budgets
for
which
fiscal
staff
is
responsible
for
developing
recommendations.
C
C
There
are
five
other
closing
items
on
page
40
with
one
technical
adjustment
of
other
closing
item
number
five
concerning
agency,
specific
inflation.
C
Fiscal
staff
recommends
that
the
following
budgets
be
closed,
as
recommended
by
the
governor
and
request
authority
for
staff
to
make
technical
adjustments
as
necessary
for
budget
101
3255
the
alcohol
tax
program
and
for
budget
101
3645
the
facility
or
fundamental
offender.
With
closing
item
number
five
closed
with
a
noted
technical
adjustment.
A
A
And
members
that
brings
us
to
the
last
item
on
our
agenda
and
that
is
public
comment.
We
actually
have
a
few
guests
for
us
in
the
audience.
So,
if
you'd
like
to
make
public
comment,
you
can
come
up
to
the
witness
den
if
there's
anyone
joining
us
by
zoom
or
telephone,
if
the
vps
can
let
the
public
know
that
we
are
available
for
public
comment.
A
Thank
you
so
much,
and
although
we
do
have
guests
in
our
audience
today,
it's
so
nice
to
see
a
live
person
here.
Thank
you
for
joining
us.
It
appears
we
do
not
have
anyone
for
public
comment
by
phone
by
zoom
or
in
person.
I'd
like
to
thank
our
broadcast
staff
for
all
the
work
that
you
do.
Our
amazing
staff
here
in
the
committee
room
with
us
and
for
committee
members.
Thank
you
and
this
meeting
is
adjourned.